[Congressional Record Volume 155, Number 187 (Saturday, December 12, 2009)]
[Senate]
[Pages S13113-S13124]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




             OMNIBUS APPROPRIATIONS AND HEALTH CARE REFORM

  Mr. THUNE. Mr. President, I want to address the issue of health care 
reform, of course, which is the main reason Congress is here this 
weekend and was here last weekend, and in all likelihood will be here 
next weekend. But I also think it is important we put these things into 
an overall context and take a look at the bill we are voting on right 
now.
  We are going to have a vote on final passage tomorrow. We had a 
cloture vote this morning on a spending bill, and the spending bill--
which represents six, I think, appropriations bills that did not get 
done earlier this year--represents a package of spending that overall 
increases by 12 percent over last year.
  That is an interesting number, given the fact that the Consumer Price 
Index--which is the sort of, if you will, conduit to which a lot of 
these decisions that are made around here is tied; in other words, the 
CPI is what we view to be inflation; and sometimes we say we mark up 
bills at inflation or inflation plus this or inflation plus that--where 
the CPI was, ending on October 1 of this year, about two-tenths of 1 
percent but in the negative column.
  So you have a CPI that is actually negative, an inflation index that 
is actually negative for most Americans. This, again, is representative 
of the totality of our economy and what things cost, and that is a lot 
of times how appropriations bills are measured.
  So you have a CPI, Consumer Price Index, that is running in the 
negative, and yet you have appropriations bills--this one representing, 
again, as I said earlier, six appropriations bills, individual 
appropriations bills that did not get done earlier--packaged into one 
big spending bill that is a 12-percent increase over the previous year.
  How can we go to the American people and justify year-over-year 
spending increases that are 12 percent, when they are having to balance 
their budgets and tighten their belts and live in an economy where some 
people are losing their jobs? But certainly everybody is trying, 
struggling to survive out there. That is true for small businesses. 
That is true for families. That is true for pretty much everybody, it 
seems, except the Congress.
  Here in Washington, DC, we seem not to be listening to what is 
happening in America. We are marking up spending bills at 12 percent 
over last year's level, at a time when the CPI is actually running in 
the negative--when you have negative cost-of-living increase. Yet we 
are marking up appropriations bills that represent a 12-percent 
increase over last year's spending level?
  Put that on top of a stimulus bill that passed earlier this year 
that, with interest, is a $1 trillion spending bill. So you have a $1 
trillion spending bill with interest passed earlier this year, much of 
which went to the very same

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Federal agencies that are going to benefit from this 12-percent 
increase over last year in annual appropriations. So you have a $1 
trillion stimulus bill, you look at appropriations bills--again, this 
being representative of most of the bills this year--that year-over-
year increase at 12 percent, at a time when most Americans are having 
to tighten their belts.
  We hear that. We also hear that TARP is now going to be used as a 
slush fund, so to speak, to pay for all kinds of other government 
spending. In other words, they have decided--at least, I think the 
administration has--to use the TARP fund as sort of a ``pay for'' for 
lots of things they want to do.
  Most of us know that the TARP fund was created specifically to 
stabilize our financial markets, to prevent what we thought at the time 
was going to be an imminent financial collapse. That purpose has been 
served. I have a bill that would end TARP at the end of this year on 
December 31. If it is not allowed to expire at the end of this year, 
when it is set to expire--if it is not allowed to expire, if it is 
extended and it goes well into next year--it can be used, as I said, 
for all these other things that politicians have designs on doing.
  So my legislation would end it at December 31 of this year, as was 
intended, and make sure any funds that are paid back in from loans that 
have been made or assets that have been acquired actually go back to 
the Treasury to pay down the Federal debt. Because that is what, in 
fact, TARP was intended to do. Once the job was accomplished, it was 
not to become a ``grab bag'' and ``found money'' for Congress to use 
for all these other things.
  You have the TARP fund now morphing and evolving into this sort of 
political slush fund to be used for all these other spending 
priorities. You have the stimulus, this $1 trillion stimulus bill, out 
there. You have this appropriations bill with a 12-percent year-over-
year increase over last year's level. On top of all that, we pile on a 
$2.5 trillion expansion of the Federal Government in Washington to pay 
for a new entitlement program with the health care reform bill that has 
been, is being debated in the Senate in the last week and in the week 
to come.
  So at some point you have to say--and I think the American people 
look at us and say--enough already. I think that is what they are 
saying. I think the reason we are seeing these public opinion polls 
that are turning a thumbs-down on this massive expansion of the Federal 
Government here in Washington to fund health care is because the 
American public is becoming increasingly uncomfortable with the idea 
that the Federal Government continues to run the credit card up.
  The stimulus money was all borrowed money. The TARP money is borrowed 
money. The appropriations bills, for the most part, this year are--or 
for a large part, at least--borrowed money. Mr. President, 43 cents out 
of every dollar the Congress spent in the last year--the fiscal year 
ending September 30--was borrowed money.
  We continue to borrow and borrow and pass on the debt to future 
generations. We cannot continue to do that and expect to have a future 
that enjoys the same level of prosperity and the same level of economic 
growth and vitality we have experienced in the past. You cannot 
continue to pile up these massive amounts of debt. The Federal debt is 
going to double in 5 years, it is going to triple in 10, if we continue 
on the current path. Right now, I do not see anything that is going to 
put any brakes on this.
  The capacity and the appetite and the willingness and the inclination 
of Washington, DC, and politicians here to continue to spend and spend 
seems to be unlimited. At some point, we have to put the brakes on. We 
have people who have a foot on the pedal. The Democratic majority in 
the House of Representatives, the Democratic majority here in the 
Senate, the White House, all have their feet on the accelerator. 
Somebody has to put on the brake. That is what we are trying to do.
  That is why I think it is important we end TARP before it gets 
misused and spent for all these other things and why it is important we 
rein in these appropriations bills. We are doing everything we can to 
stop this appropriations bill from being passed at a 12-percent 
increase over last year's level. And we are doing everything we can, I 
would say, to stop this massive expansion--$2.5 trillion expansion--of 
the Federal Government to fund the new health care entitlement, at a 
time when we have all these other debt problems and deficits, as far as 
the eye can see.
  So I wanted to, in shifting gears, paint that as sort of the context 
against which this whole health care debate is occurring. But I want to 
shift, if I could, to some of the more recent developments with regard 
to the debate over health care.
  I think there are a couple things that, to me, are game changers in 
terms of the debate. One of those, of course, is the study that came 
out yesterday from the CMS, or the Centers for Medicare & Medicaid 
Services, the Actuary who points out the health care reform bill that 
is currently before the Senate will not drive health care costs down 
but will, in fact, increase health care costs by $234 billion, and that 
today, about one-sixth of every dollar we spend is on health care; that 
10 years from now, in 2019, that will be almost 21 percent--that is 
what the CMS Actuary said--that the total amount we spend on health 
care in this country--which today is about 17 percent--10 years from 
now will be almost 21 percent. So the amount spent on health care as a 
percentage of our gross domestic product goes dramatically up, not 
down. And $234 billion is what the CMS Actuary said health care costs 
would go up by in the next 10 years.
  Of course, we had previously the CBO essentially saying the same 
thing. The Congressional Budget Office--for those who live outside of 
Washington, DC--is sort of the nonpartisan estimator, if you will, of 
what a lot of these Federal programs are going to cost.
  The Congressional Budget Office said that under the bill put forward 
by the Senate majority here, the Democratic leadership in the Senate, 
you would actually increase health care spending by $160 billion over 
the next 10 years, again bending the health care cost curve up, not 
down. So now you have the experts--the Congressional Budget Office, the 
Centers for Medicare & Medicaid Services Actuary--all saying health 
care costs are going to go up, not down, and significantly up.
  You have the small business organizations out there saying--the 
National Federation of Independent Business, the Chamber of Commerce, 
the National Association of Wholesalers and Distributors, and I might 
add there is another group that has been formed called the Small 
Business Coalition for Affordable Healthcare, which represents 50 
different business organizations--this health care reform bill will 
increase the cost of doing business in this country and will drive up 
health care costs. So they have come out in opposition to it, as have 
all the other business organizations I mentioned, for the same reason. 
They realize health care reform ought to be about getting their costs 
down and improving their ability to create jobs. By the way, three-
quarters of the jobs created in our economy are created by small 
business.
  So what are we going to do to small businesses? Pile on a bunch of 
new taxes to pay for this expansion, this $2.5 trillion expansion of 
the Federal Government in the form of this new health care entitlement. 
All for what? So they can see their health care costs continue to go 
up. You pile on the new taxes, you cut Medicare to all the providers 
out there. And I want to draw them into this too because not only have 
the small businesses said this is going to drive health care costs up--
and they have come out opposed to it--not only has the Congressional 
Budget Office said that, not only the Centers for Medicare & Medicaid 
Services Actuary said that, you have academics saying that, but now you 
also have the providers saying that.
  Hospitals and physicians groups are coming out and saying this latest 
proposal by the Democratic majority to expand Medicare will put 
hospitals out of business. Because hospitals get underreimbursed by 
Medicare, and so do physicians. So what do they do? They shift costs 
over to the private payers, which is everybody else in this country, 
and everybody else sees their premiums go up. It shrinks the number of 
private payers, expands the number of government payers, and for these

[[Page S13115]]

hospitals in places such as South Dakota--I see my colleague from 
Wyoming on the floor--that are very dependent on Medicare, they are 
going to see less and less reimbursement coming into their facilities, 
which does not cover their costs, and very soon you will have a lot of 
hospitals, particularly in rural areas, going out of business. That has 
been stated. The chairman of the Senate Budget Committee, Senator 
Conrad from North Dakota, came out and said that basically this latest 
proposal would bankrupt a lot of hospitals in his State. I think that 
is true for a lot of States and particularly in rural States such as 
mine and the Senator from Wyoming.

  We have small businesses saying: We can't sustain these increases. We 
think this is a really bad deal. We have the experts, the analysts, the 
Congressional Budget Office, and the Center for Medicare and Medicaid 
Services saying this increases costs for health care in this country. 
And now we have the American people weighing in and saying: We think 
this is a bad deal. We think it is going to increase our health care 
costs. The CNN poll that came out 2 days ago said 61 percent of 
Americans oppose the health care reform bill that is pending right now 
in the Senate. Other polls show similar results. So we have a very 
sizable majority of the American people who have now weighed in saying 
this is a bad deal because it cuts Medicare, it raises taxes, and at 
the end of the day, it raises premiums.
  So who is for this? Who thinks this is a good thing? Well, apparently 
a number of Democrats here in the Senate, but that is an increasingly 
shrinking universe of people.
  The American people have said it is a bad deal. The experts say it is 
a bad deal. Small businesses say it is a bad deal. Providers say it is 
a bad deal. What is left?
  Well, I am hoping there are a couple of courageous Democrats who are 
going to step forward, agree with the American people, and say: We are 
listening to the American people. We are listening to the experts. We 
are listening to small businesses that create two-thirds or three-
quarters of the jobs in our economy. And we agree we are going to stop 
this train wreck from happening, sit down, start over, do this right, 
work with Republicans, and write a bill that actually does constrain 
costs, that drives the cost curve down and provides access for more 
Americans. I hope there are a few Democrats out there who will do that 
because I think on our side we have all concluded, based on what we 
hear from the American people, what we hear from the experts, what we 
hear from the business community, what we hear from the provider 
community, the hospitals and the physicians, that this is a really bad 
deal. At the end of the day, after all of this new spending, after all 
the new taxes, after all the Medicare cuts, what are we left with?
  What everybody says they want out of health care reform is lower 
costs. Our colleagues on the other side come down here repeatedly and 
say we have to do something about the cost of health care. People in 
this country are struggling with health care costs, absolutely. We 
could not agree more. What they will do with this bill if it passes is 
make matters worse, not better, by increasing costs for most Americans.
  I wish to show my colleagues exactly what I mean. If you are a family 
of four--and this is, again, according to the Congressional Budget 
Office, which looked at this and analyzed these bills and said: If you 
are in the small group market or large group market, you are going to 
see year-over-year increases in health care costs, which is somewhere 
between 5 and 6 percent, which is what we are seeing today--and by the 
way, that is twice the rate of inflation historically--but a 5- to 6-
percent increase in health care premiums. If you are in the individual 
marketplace, you are going to see your premiums go up anywhere from 10 
to 13 percent beyond that. So if you are in the individual market, it 
gets much worse. But if you are in the small group or large group 
market, here is what it says: If you are in a family of four today and 
you are receiving your insurance through your employer and they are 
getting their insurance through a large group market, you are paying 
about $13,000 a year. In 2016, 7 years from now, you are going to be 
paying over $20,000 a year for health insurance coverage.
  So your health insurance coverage is going to go up under this bill, 
not down, according to the Congressional Budget Office. It is going to 
go up at a rate that is double the rate of inflation. Again, this is 
for people who get their insurance in the large and small group 
markets. The yellow line represents the large group market, the red 
line represents the small group markets, but the result is the same. It 
is an upward trajectory. It is a spike up in the cost of health 
insurance for people who get their coverage for health insurance in one 
of those two markets. Again, as I said before, if you are in the 
individual marketplace, you could spike this thing like this because 
their costs are going to be 10 to 13 percent above and beyond what you 
are seeing here in the large group market. That is according to the 
Congressional Budget Office.
  So 90 percent of Americans, according to the Congressional Budget 
Office, are going to see their health insurance premiums stay the same, 
and by ``stay the same,'' I mean go up by twice the rate of inflation--
in other words, locking in the status quo--or worse yet, if you are in 
the individual marketplace, it will be going up 10 to 13 percent.
  So all of this talk about lowering the cost of health care and not 
settling for the status quo may sound good, it is great rhetoric, but 
it is absolutely factually inaccurate.
  So our colleagues who come down here day after day talking about how 
this health care reform bill is going to drive down the cost of health 
care are not listening. They are not listening to the American people. 
They are not listening to the experts. They are not listening to the 
small business community. They are not listening to the provider 
community.
  I have to say that even the academic community has weighed in on this 
particular issue as well.
  I wish to read for my colleagues something that was said recently by 
the dean of the Harvard Medical School:

       Speeches and news reports could lead you to believe the 
     proposed congressional legislation would tackle the problems 
     of cost, access, and quality, but that's not true. The 
     overall effort will fail to qualify as reform. I find near 
     unanimity of opinion that whatever its shape, the final 
     legislation that will emerge from Congress will markedly 
     accelerate national health care spending rather than restrain 
     it. This will make an eventual solution even more difficult.

  That from the dean of the Harvard Medical School.
  So I hope that before this debate concludes--the push is to get it 
done by the end of the year. I am not sure why. It seems to me, at 
least, that this is not something we want to hurry. We are talking 
about reordering or restructuring one-sixth of the American economy. As 
I said, today it represents 17 percent of our GDP. We spend about $2.5 
trillion a year on health care. We ought to get this right. There is an 
intent on the other side to jam this through sometime next week. Well, 
I hope we can put the brakes on this. I hope there are a couple of 
courageous Democrats--at least one but two would be better, maybe even 
more--who will step forward and say: We are going to listen to the 
American people. We are going to listen to the providers out there, the 
hospitals and physicians. We are going to listen to the experts. We are 
going to listen to the small business community that creates the jobs. 
And we are not going to blindly follow the leader and take this country 
over the cliff when it comes to health care delivery and when it comes 
to our economy.
  There is one final point I will make about that because I thought 
this was a remarkable finding by the CMS in their study. They 
essentially said that the savings that are proposed in Medicare--the 
new Federal spending that relies on Medicare cuts which are unlikely to 
be sustainable on a permanent basis--we all, over here, agree with 
that. The appetite for the Congress, the willingness for the Congress 
to cut reimbursements to hospitals and to nursing homes and to home 
health agencies and to hospices, I find very suspect.
  So at the end of the day, if you cannot sustain those--and let's say, 
for example, for a minute that you can. Let's say these Medicare cuts 
take effect. If they take effect, and if the Democrats have their way 
and they expand Medicare, we are going to put more and

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more people onto a sinking ship because we have a program that is going 
to be bankrupt in 2017, we are told by the actuaries. We are going to 
cut $1 trillion out of it over the next 10 years when it is fully 
implemented, and we are going to put more people onto it. So if those 
cuts occur, we are going to have more and more hospitals going out of 
business because they flat aren't going to be able to make ends meet. 
That is the other thing, by the way, the CMS Actuary found in their 
study.

  But they said they don't believe we can sustain these Medicare cuts 
on a permanent basis. Meaning what? Meaning that the cost of this 
program, $2.5 trillion over 10 years, is going to fall on the backs of 
future generations because it will be borrowed. It will be added to the 
debt, which is growing at $1 trillion a year, as I said earlier.
  We are going to have a vote, if you can believe that, here in the 
very near future to actually raise the debt ceiling by $2 trillion over 
and above what it is today, which is $12 trillion. This debt situation 
is probably the most serious crisis and challenge facing this country 
going forward. It just seems as though there is an endless, limitless 
appetite for spending and borrowing around here, and at some point the 
chicken is going to come home to roost and the bills will have to be 
paid. You can't continue to sustain this level of borrowing.
  These Medicare cuts are unsus-tainable, which is what the CMS Actuary 
says. That means a lot of the cost of this new program is going to be 
financed partly by tax increases, which, as I said, are harmful to 
small businesses, but secondly by more and more borrowing and more and 
more debt. More and more future generations, younger Americans, will be 
faced with a massive inheritance of Federal debt because we weren't 
willing to make the hard choices to be able to live within our means.
  So I hope when it is all said and done, there will be some people who 
will step forward, have the courage not to blindly follow the leader 
but to say with the American people, with the experts, with the small 
business community, with the provider community, with even some of the 
academic community, that this does nothing to constrain or lower health 
care costs. The emperor has no clothes. If they do that, we can sit 
down together.
  We are not here for a minute to suggest we shouldn't have health care 
reform. All we are here to suggest is that it ought to be done the 
right way, it ought to be done on a bipartisan basis, and it ought to 
be done in a way that actually bends the cost curve down rather than 
raises it and that does not cost us $2.5 trillion of cuts to Medicare, 
which is going to impact a lot of seniors, increase taxes, which is 
going to crush small businesses, or debt, which is going to punish 
future generations.
  That is what this debate is about. It is a consequential debate for 
America's future. The stakes are very high. I hope the American people 
will be engaged in it, and I hope we will be able to find some 
bipartisan support for defeating this really bad idea and moving to 
something that actually will make a difference, that will restrain 
costs, and that will provide health insurance reform that is meaningful 
reform and that doesn't bankrupt us, doesn't bankrupt hospitals, 
doesn't bankrupt future generations, doesn't cost us jobs by putting 
new taxes on small businesses, and actually bends the cost curve down.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Wyoming.
  Mr. ENZI. Mr. President, I thank the Senator from South Dakota for 
his enthusiasm and passion and ability to explain things. The passion 
we have seen throughout the day from the Republicans who have spoken is 
a reflection of the passion we are hearing in our telephone calls and 
in our e-mails and in our letters. Our volume is much higher than the 
61 percent the CNN poll says. Of course, we wouldn't expect the CNN 
poll to necessarily reflect our constituents. That enthusiasm across 
America, that passion, that concern should be reflected in this 
Chamber.
  I get a lot of mail and even phone calls from other States, and they 
say: How come my Senator isn't listening to me? How come he is not 
listening to all of my friends? Thank you for what you are doing on 
health care.
  What we are doing on health care, of course, is asking that it be 
done step by step so that we can get the confidence of the American 
people, not do something grandiose that can't be well thought out 
because it is so big.
  I spent time as the ranking member of the Health, Education, Labor, 
and Pensions Committee in an extensive markup on a bill that we had no 
input in writing. The other side says we had input into the amendments, 
and we did do some amendments and some were accepted. There were even 
some that were fairly significant that were accepted.
  Of course, what was disappointing was that after the August recess--
they didn't print it before the August recess because they didn't want 
people to know what was actually in it at that time. But following the 
August recess, when they finally printed it, we found out that 
provisions we had put in by agreement had been ripped out. Never have I 
had that happen in my 12 years in the U.S. Senate.
  Then I was part of the Gang of 6--the Group of 6, my mother would 
prefer to call it because she told me never to join a gang. But over a 
period of at least 60 days, we spent a lot of time and effort from 
morning until night trying to get a health care bill that would work 
for America.
  One of the things we discovered is that it is very extensive. Nobody 
can comprehend how big health care is in America. We talked about it 
being 16 percent of the whole economy. Well, does that register with 
you? We talk about the trillions that are involved. I don't understand 
trillions. We spend billions around here, but trillions is a whole 
other level. I don't even think the kids who work on billions 
understand trillions. When we say 1 trillion, a lot of people say: 
Well, that is just 1. Well, it is a thousand billion, and a billion is 
a thousand million. So it is a lot of money.
  But when we were doing this in this Gang of 6, what we did was kind 
of divide the issues up into 13 different parts--you might call them 
steps.
  We started working through those. Sometimes we would have to leave 
one because we had basic questions we needed to ask about those 
sections so we would have a big enough understanding to be able to 
draft legislation for it. Basic questions. Basic questions. We only 
made it through slightly more than half the 13 areas before we were 
faced with a phony deadline. They said September 15 is the drop-dead 
date for this group to finish work. If you don't have it done by then, 
we will put something together anyway.
  If you are still getting basic questions answered, don't you think 
you ought to work on it a little longer and have a few more people in? 
One of the groups we had in were the Governors. We were going to have a 
vast expansion of Medicaid--not quite as vast as is in here, and what 
is in this new bill that we have not yet seen, even though we are quite 
a ways into this, but a vast expansion of Medicaid. Medicaid works 
through the States and the States have to pick up part of the costs--
actually, they pick up a lot of the costs. As we have expanded Medicaid 
and expanded the rolls on Medicaid, we have put a greater burden not 
only on the Federal Government, though it is on the Federal Government, 
too, but also on the State governments. The State governments don't get 
to vote on it at all.
  The Senator from Tennessee, Mr. Alexander, who used to be a college 
president and was also a Secretary of Education, pointed out a number 
of times that when Governors are faced with this budget crunch on 
Medicaid, what do they do? Virtually the only place they can cut is 
universities and colleges. That is why there has been this dramatic 
increase in college tuition--because of what Medicaid has done to the 
States.
  Now we are talking about another drastic increase in the number of 
people in Medicaid. We thought it would be a good idea if we got the 
Governors on the phone--we hoped the Governors task force on Medicaid 
would meet with us, and I think they might have, but we were trying to 
rush it into a short period of time, so we did conference calls. They 
wanted to know how it was going to affect their States. We knew how 
many billions it was going to cost as a whole for those States, but we 
didn't have a breakdown individually. CBO and the Joint Tax

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Commission don't do breakdowns by States. But we had some people on 
staff--Democratic staff--who thought they could break that down, and 
they did. They presented us with these numbers, and I called my 
Governor and said: I know this is going to be a problem, and I will see 
what I can do about it, but it is a lot of money. Of course, if I am 
talking about how much it was for Wyoming, it would not sound nearly as 
much as for New York, but it is the same kind of percentages, we just 
have less population.
  Another surprising thing that happened to us was it looked like 
Nevada and New York would be hit real hard. The next day we got numbers 
and--we had the same CBO and Joint Tax score. That didn't change a bit. 
There was one set of numbers. But the evaluation, the next day, looked 
a lot better for Nevada and New York. It didn't bring it down enough, 
so there was a special provision that has been put in the bill--it was 
not done in the Gang of 6--that made it much nicer for Nevada and New 
York. We said: Wait a minute, why are you doing that for Nevada and New 
York? Some of the influential people around here from Nevada and New 
York said this economy is in a real downturn, and we are being hit 
harder than anybody else. I said: Well, that is a nice gesture, but 
this part of the bill isn't going into effect for 4 years. How do we 
know that in 4 years Nevada and New York are the ones that are going to 
be hard hit? We ought to have provisions for whoever is hard hit.
  Those are the kinds of things we were trying to take care of in 
committee with inadequate numbers. As we worked through--well, the 
President wanted to do a speech to the Nation, a joint session speech. 
They do those over on the House side, and the House and Senate show up 
for it. It was on health care. Following that health care speech, the 
next morning we went to the Gang of 6 meeting. I kept notes on what the 
President said. I had about 12 areas we had tried to draft legislation 
on that he had pretty specific suggestions on. I had to say: This is 
something we didn't do. We didn't do this yet. We talked about that for 
a whole day. Immigration was one of the big ones. Medical malpractice 
was another. That has been a huge concern to the medical community.
  I have several things I need to say on this health care bill. I know 
we are talking in the 30 hours following the appropriations bill. I 
have things to say about the appropriations bill too. I usually don't 
talk for very long down here, but I have some of that pent-up passion 
from all the calls and things I have gotten. So I will talk about both 
spending and health care.
  I will start with the spending because we just voted for a bill that 
costs $446.8 billion, and Senators didn't have any opportunity to 
debate the critical issues within that bill. Of the six bills, three--
Financial Services, Labor-HHS, and State and Foreign Ops--were 
airdropped into conference with no opportunity for debate on this 
floor. So we had no opportunity for consideration. The Transportation 
bill, the HUD bill, received a 23-percent increase over last year. The 
State and Foreign Ops bill received a 33-percent increase over last 
year. Collectively, the six appropriations bills account for a 12-
percent increase in Federal spending over last year.
  Our national deficit for the past fiscal year stands at $1.4 
trillion. I don't see that going down at all. Our current unemployment 
level is at 10 percent, despite the administration's insistence earlier 
in the year that Congress pass a $1 trillion-plus stimulus package. The 
Senate is currently in the middle of a debate on a health care reform 
bill that has a 10-year implementation cost of $2.5 trillion. Sometime 
in the next month, we will be forced to raise the Nation's debt ceiling 
for the second time this year to a level that exceeds the current 
ceiling of $12.1 trillion.
  The bill makes a number of significant policy changes with respect to 
the fairness doctrine. This omnibus does not include the fiscal year 
2008 ban on Federal funds being used to enforce or implement the so-
called fairness doctrine. The bill makes changes to several 
longstanding policy provisions contained in the Financial Services bill 
and specifically the District of Columbia section dealing with 
abortion, medical marijuana, needle exchanges, domestic partners, and 
the DC Opportunity Scholarships.
  The bill also contains 5,224 earmarks that total $3.8 billion.
  Well, let me go into the definition of an earmark. According to the 
champion of it for many years, Senator McCain, it is not an earmark if 
you take a specific project to the committee of jurisdiction, where 
they can debate it and decide whether it is a valid project and how it 
might fit in with other formulas and things they are already working 
on. If the committee that actually works that issue approves it, it is 
not an earmark. But, of course, it has to be put in, in the 
authorization process, not dropped in by airmail when the conference 
committee is meeting at the end of the bill. It is considered an 
earmark when it is just sent to conference, nobody got to debate it and 
vote on it, and it was shoved into the bill. There are ways special 
projects can be done and approved by several votes. Normally, it would 
be the committee of authorization and then the Appropriations Committee 
and then the floor of the Senate; and that same process would have 
already been done on the House side because they start all funding 
bills. So that is probably six or seven votes on an item before it can 
actually get passed, if it goes through the regular procedure.
  Of course, it is easier to have somebody to champion it and quietly 
slip it in without any votes, except a final vote. The final vote is 
what we are doing right now. It is on the whole package. You cannot 
pick out a section or an earmark and have a vote on that. Besides that, 
with 5,224 earmarks, that would take a long time. But it totals $3.8 
billion. That is still a lot of money. It has been denigrated since we 
went into the trillion-dollar category, but $3.8 billion is still a lot 
of money.
  How is this playing out around the country? I found a blog I hadn't 
seen before. It kind of speaks to what we are doing in appropriations 
right now. This is uglytruthstudios.com. It begins:

       Don't tell me where your priorities are. Show me where you 
     spend your money and I will tell you what they are.

  That is James W. Frick, who is not the author of this. The author 
then goes on to say:

       I was mad when I decided to start this blog and podcast. I 
     was mad about the current state of our congressional 
     spending. I know, I know, a lot of folks are upset about the 
     government and what they spend. My anger starts with the 
     simple fact that they cannot complete the spending process. 
     They haven't been able to complete the process, not even one 
     time, since 1999.

  You can see that this is directed against both sides of the aisle.

       Folks, you are right to be mad about the out of control 
     spending of the Federal Government, but we all must start 
     with a hard look at how the money is being spent before we 
     can take an honest look at what it's being spent on.
       Take for instance the topic of Healthcare. You will be hard 
     pressed to find a single soul in this country that doesn't 
     think the system needs to be re-evaluated.
       For the last eight plus months we have heard on the morning 
     news, the Sunday talk shows, from congressional leaders, the 
     President of the United States, and even concerned citizens 
     about the impending healthcare crisis.
       Primetime television has been interrupted for Presidential 
     addresses. The President addressed a joint session of 
     Congress, he held town meetings, he held focus group 
     meetings, he met with members of industry.
       Congress itself has begged and pleaded for people to not 
     get too excited about their plans, to work with them on 
     putting reform in place. This was a crisis. A crisis that 
     needed to be addressed immediately, the citizens of the 
     United States of America needed to get behind the effort they 
     were putting forth.
       The media was dominated with the urgency to get something 
     done. Television showed outraged Americans at town hall 
     meetings. Congress exchanged ideas and both sides pointed the 
     finger at the other side trying to show that their side was 
     most in tune with what our country needed. They were on top 
     of this situation.
       Well they have ``sort of'' been tending to the business of 
     our nation's healthcare. The ugly truth though is this: in 
     their rush to be in the media on the Healthcare crisis, 
     Congress has not yet completed the Labor, HHS and Education 
     Appropriation for the 2010 Federal Fiscal year. The House 
     completed their version of the bill on July 27. The Senate 
     has not yet passed a version of the bill.
       The Senate in all their talk about getting Healthcare done 
     has yet to even take the bill up on the floor for a vote.

  Well, that part isn't true anymore. It has been finally taken up. It 
was supposed to be October 1, but we are tardy in that.


[[Page S13118]]


       Now, mind you, tomorrow night you will probably have your 
     football game, family dinner or general quiet evening 
     interrupted by the Senate working through the weekend.

  That is where we are now.

       A vote of monumental importance during prime time 
     television, but not on the job that they should have been 
     doing; no, no, this is a vote on what they want to do.
       For simple reference sake this is the equivalent of taking 
     out a trillion plus dollar loan, making commitments 
     associated to the loan, and never spending a second asking 
     yourself the following questions: Is this in the budget? Can 
     we afford it? Hell have we even thought about what we are 
     willing to spend on it? Have we decided yet what we are 
     spending on healthcare this year?
       Healthcare was not a big enough problem this year for the 
     United States Senate to complete the normal course of 
     business by appropriating the spending for Fiscal Year 2010. 
     However, it apparently is a big enough to deal to forward 
     spend a conservative average of over $85 billion a year. It 
     is not a big enough deal to spend the $160 Plus Billion this 
     year that includes Labor and Education as well.
       The House of Representatives despite passing their 
     appropriation in July has not accounted for the spending in 
     their passage of a conservatively estimated $1.2 trillion 
     Healthcare Plan. I am sure they would argue that they have, 
     their actual spending doesn't start for a few years. I would 
     argue that you had better start thinking about doubling 
     spending in 5 years now.
       That is a slap in the face to hard working Americans. In my 
     book we all have roles to play. If you got elected to 
     Congress or in this specific case, the Senate, you were 
     placed in a position of public trusteeship. You were elected 
     to spend the people's money and make sure we are a solvent 
     nation. I bet that they just got so caught up in solving the 
     problem that they forgot to handle the process of budgeting 
     and spending. But wait, they continue to spend, and they make 
     forward commitments with our money that never come in on 
     budget.
       You will find that I am not a big call to action guy. I am 
     actually kicking myself for not stopping my normal job and 
     getting started railing on this problem before now. I have 
     watched in great horror over the last 10 years as both 
     parties have ignored the process of spending, and funded our 
     government with our tax dollars through one size fits all 
     process. A one size fits all process that generally is traded 
     on our hard earned tax dollars, votes exchanged for passage.
       It is time for the nonsense to stop. Keep watching them. I 
     have heard and firmly believe that you can track someone's 
     intentions by how they plan and spend their money. No matter 
     what the claimed intentions may be, people normally put their 
     money where their mouth is. Congress is putting our money 
     where their mouth is. If Healthcare isn't important enough to 
     finish the appropriations process on, then don't take the 
     time to spend more money on it.
       Remember--It's all about the money stupid.

  Mr. President, we are finally getting to the spending. We have been 
spending all year, but we are finally getting to some of these pieces. 
It still leaves the defense piece undone. We are continuing last year's 
appropriations up to the current time.
  I have some things I have gleaned from different places. I 
particularly thank the Wall Street Journal for their articles and 
editorials that inform America. I think if I were picking one source of 
information, that is the one I would pick. I read the Washington Post, 
the Washington Times, the Wall Street Journal, and I get clips from 
every newspaper in Wyoming. I get a couple of those newspapers 
complete. I read a lot of news, but from a national perspective and one 
that is actually paying attention to what we are doing here, my 
favorite is the Wall Street Journal.
  Earlier in the week, I quoted from a cost article I had found in the 
Wall Street Journal. I was chastised for using them as a source and 
then was countered by a Senator using Wikipedia. You can go into 
Wikipedia and do your own editing. I am not sure if that is a good 
source. I would prefer to rely on the Wall Street Journal.
  There is not any article or opinion that cannot be quibbled with, and 
that is just like the amendments we have here. What I prefer to think 
is when an amendment or an article or a speech is given, we ought to be 
looking for the idea, the grain of truth, the juice of it that should 
be used, and we are not doing that right now. We are just doing 
amendments there and amendments here. We are defeating the amendments 
here. And it kind of bothers me that we have all these amendments from 
this side because, first of all, our amendments were voted down, all 
except two, when we went through the Health, Education, Labor, and 
Pensions Committee process to get the bill out of committee and when we 
went to the Finance Committee, the same thing happened. I think we had 
two amendments that were taken as well over a whole week of amendments. 
The two bills were taken to a closed door back here and were massaged 
into a new bill. Some pieces of those two bills can be found there, but 
not all of it and not in the same form. We had no input to that at all. 
No input at all. Now it is on the Senate floor, and we have the chance 
to do amendments.
  I contend the Democrats are filibustering their own bill because 
every time we put up an amendment, they put up an amendment. If you 
wrote the bill, that bill ought to be good enough that you do not have 
to keep countering your own bill. We did not get to write the bill so 
we ought to be able to make at least some points about what ought to be 
changed by using our amendments.
  Last week--one of the most fascinating things around here that I have 
seen--there was a Democratic amendment and then a Democratic side-by-
side to it. Normally we get to present the side-by-sides. They are 
arguing within themselves. It is on a very important issue.
  Getting back to the spending, I will mention that since taking 
office, Mr. Obama pushed through a $787 billion stimulus bill. Hardly 
any of that money has actually gone out. I would guess about 25 percent 
of it is all because there is health IT in there. It is $47 billion, 
and that is not going to go out for 4 years. I don't know how you put 
something in a stimulus bill where you are trying to get something done 
immediately and not release the money for 4 years. Granted, there is 
some work that needs to be done in that 4 years in order to make that 
money worth anything at all. It just fascinates me.
  We had a $787 billion stimulus bill that was not anticipated to go 
into effect right away; $33 billion expansion of SCHIP; a $410 billion 
Omnibus appropriations spending bill; and an $80 billion car company 
bailout. The President also pushed an $821 billion cap-and-trade bill 
through the House and is now urging Congress to pass a nearly $1 
trillion health care bill.
  The administration says it is now instructing agencies to either 
freeze spending or propose 5-percent cuts in their budget for next 
year. This will not add up to much unless agencies use the budget they 
had before the stimulus inflated their spending on their baseline in 
calculating their cuts. That is why we are talking about this bill 
right now, the minibus or omnibus that is pretty ominous, with all the 
spending in it, with every one of those bills having a huge increase 
over a year ago. That will get built into the baseline so next year 
there can be another huge increase. They compound dramatically.
  If the Education Department uses its current stimulus-inflated budget 
of $141 billion instead of the $60 billion budget it had before the 
President moved into the White House, freezing its budget will do 
nothing to fix the fiscal mess that has been created. As I mentioned, 
there is this little thing of second-degreeing their own amendment.
  The Democrats are having a little problem deciding on their message. 
On the one hand, the President said just this week that we have to 
``spend our way out of this recession. On the other they keep telling 
us the deficit is too large and isn't 'sustainable.' In this tug of 
political spin, watch what they spend, not what they say. And that 
means watching this weekend's expected Senate vote,'' which we have 
had, ``on the 1,088-page $445 billion''--ominous--`` `omnibus' package 
of spending bills to fund the government for fiscal 2010. The House 
passed a similar elephant earlier this week''--I don't know why they 
are referring to it that way; it is similar to a donkey--``allowing 
spending federal agency budgets to increase spending by some $48 
billion, or about 12 percent from 2009. That increase--when inflation 
is negligible--is in addition to the $311 billion in stimulus already 
authorized or out the door for these programs. Adding this new stash 
means that federal agencies will have received nearly a 70 percent 
increase in the last 2 years.''
  Has anybody gotten that kind of increase? ``Oh, and that's not all. 
The President and Congress also want to spend as much as $200 billion 
more

[[Page S13119]]

from the Troubled Asset Relief Program''--which is another stimulus, 
but it was done as a series of loans, so we are supposed to get the 
money back from that. What they are talking about doing is taking the 
money from that program and using it for some other programs. Anything 
that comes back is supposed to go to reduce the deficit. Lord knows 
that is big enough.
  As I mentioned, there are 5,324 earmarks in this bill. That brings 
the total for the year to about 10,000 or about 23 for every 
congressional district. That is after a promise that the President 
would not sign any bill that had earmarks, but he has already done that 
once. Hopefully, he will not do it twice.
  We have been talking about jobs this week. I even got invited to the 
White House to talk to the President about jobs. Of course, the message 
the Senator from Washington, Mrs. Murray, and I delivered to the 
President is, we ought to get the Workforce Investment Act done. That 
is a job training program that would train 900,000 people a year to 
higher skill levels to meet some of the skill levels we are missing in 
this country that we are having to export.
  What has been the status on this bill? We have been working on this 
for 4 years--4 years. This country did not need jobs before. Now we 
need jobs, so maybe we are going to get something done on that.
  She, I, and Senator Kennedy passed this bill through the Senate twice 
unanimously, but the House has never taken it up. I don't know how we 
are going to get jobs done if something that is that bipartisan--it 
passed the Senate both times with everybody voting for it. We cannot 
get more bipartisan than everybody voting for it. We are talking about 
bipartisan bills. That is really important.
  Talking about jobs, one of the things I mentioned at the White House 
was that 2 days before this meeting, the EPA had put out the notice of 
the new regulation where they are going to take care of greenhouse gas 
emissions, CO2 and seven other chemicals.
  According to Kimberly A. Strassel:

       In the high stakes game of chicken the Obama White House 
     has been playing with Congress over who will regulate the 
     Earth's climate.

  Right now the Copenhagen meeting is going on--

       The president's team just motored into a ditch. So much for 
     threats.
       The threat the White House has been leveling at Congress is 
     the Environmental Protection Agency's ``endangerment 
     finding,'' which EPA Administrator Lisa Jackson finally 
     issued this week. The finding lays the groundwork for the 
     EPA to regulate greenhouse gas emissions across the entire 
     economy, on the grounds that global warming is hazardous 
     to human health.
       From the start, the Obama team has wielded the EPA action 
     as a club, warning Congress that if it did not come up with 
     cap-and-trade legislation the EPA would act on its own--and 
     in a far more blunt fashion than Congress preferred. As one 
     anonymous administration official menaced again this week: 
     ``If [Congress doesn't] pass this legislation,'' the EPA is 
     going to have to ``regulate in a command-and-control way, 
     which will probably generate even more uncertainty.''
       The thing about threats, though, is that at some point you 
     have to act on them. The EPA has been sitting on its finding 
     for months, much to the agitation of the environmental groups 
     that have been upping the pressure for action.
       President Obama, having failed to get climate legislation, 
     didn't want to show up to the Copenhagen climate talks with 
     big, fat nothing. So the EPA pulled the pin. In doing so, it 
     exploded its own threat.
       Far from alarm, the feeling sweeping through many quarters 
     of the Democratic Congress is relief. Voters know cap-and-
     trade is Washington code for painful new energy taxes. With a 
     recession on, the subject has become poisonous in 
     congressional districts. Blue Dogs and swing-state senators 
     watched in alarm as local Democrats in the recent Virginia 
     and New Jersey elections were pounded on the issue, and lost 
     their seats.
       But now? Hurrah! It's the administration's problem! No one 
     can say Washington isn't doing something; the EPA has it 
     under control. The agency's move gives Congress a further 
     excuse not to act.
       ``The Obama administration now owns this political hot 
     potato,'' says one industry source. ``If I'm [Nebraska 
     Senator] Ben Nelson or [North Dakota Senator] Kent Conrad, 
     why would I ever want to take it back?''
       All the more so, in Congress's view, because the EPA 
     ``command and control'' threat may yet prove hollow. Now that 
     the endangerment finding has become reality, the litigation 
     is also about to become real. Green groups pioneered the art 
     of environmental lawsuits. It turns out the business 
     community took careful notes.
       Industry groups are gearing up for a legal onslaught; and 
     don't underestimate their prospects. The leaked emails from 
     the Climatic Research Unit in England alone are a gold mine 
     for those who want to challenge the science underlying the 
     theory of manmade global warming.
       But the EPA's legal vulnerabilities go beyond that. The 
     agency derives its authority to regulate pollutants from the 
     Clean Air Act. To use that law to regulate greenhouse gases, 
     the EPA has to prove those gases are harmful to human health.

  That is the endangerment finding. One is CO2, and I am 
breathing that out right know.

       Put another way, it must provide ``science'' showing that a 
     slightly warmer earth will cause Americans injury or death. 
     Given that most climate scientists admit that a warmer earth 
     could provide ``net benefits'' to the West, this is a tall 
     order.
       Then there are the rules stemming from the finding. Not 
     wanting to take on the political nightmare of regulating 
     every American lawn mower, the EPA has produced a ``tailoring 
     rule'' that it says allows it to focus solely on large 
     greenhouse gas emitters. Yet the Clean Air Act--authored by 
     Congress--clearly directs EPA to also regulate small 
     emitters.
       This is where the green groups come in. The Tailoring rule 
     ``invites suits,'' says Sen. John Barrasso--

  Who is the other Senator from Wyoming--

     who has merged as a top Senate watchdog of EPA actions. Talk 
     of business litigation aside, Mr. Barrasso sees ``most of the 
     lawsuits coming from the environmental groups'' who want to 
     force the EPA to regulate everything.
       [The President] may emerge from Copenhagen with some sort 
     of ``deal.'' But his real problem is getting Congress to act, 
     and his EPA move may have just made that job harder.

  I thank Kimberly Strassel for those words.
  Staying on the topic of jobs:

       House Democrats keep stepping on President Obama's applause 
     lines about innovation and job creation. On Tuesday, Mr. 
     Obama announced that ``we're proposing a complete 
     elimination of capital gains taxes on small business 
     investment'' for 1 year. Responding with rare dispatch, 
     the House voted yesterday--

  Actually, that would be the day before yesterday now. Some of these 
things I wrote and hoped I would give before now.

     --the House voted yesterday to change the capital gains rate 
     for venture capitalists who invest in technology start-ups. 
     But rather than eliminating the tax, the House more than 
     doubled it, moving the tax rate to 35 percent from 15 percent 
     by reclassifying such gains as ordinary income.
       Private equity fund managers and managers of real-estate 
     and oil-and-gas partnerships would also get socked with a 133 
     percent tax-rate increase. Now, there's a way to encourage 
     economic growth and new jobs. Knowing how popular tax 
     increases are with unemployment at 10 percent, the House 
     majority rushed the bill to the floor without a hearing or 
     even a committee vote. Then they buried it in a package 
     advertised as an extension of tax cuts for research and 
     development.

  And that is how it will come over here.
  And, of course, there are some other problems in the United States 
with jobs. There are projections that show unemployment in construction 
will rise by about 1.3 million and that will be outweighed by the 
continued drop in manufacturing and mining jobs. Goods-producing 
employment as a whole is expected to show virtually no growth in total 
jobs, according to the report. By 2018, that sector will account for 
12.9 percent of the jobs, down from 14.2 percent of the jobs. You know, 
in order to grow the economy, you either have to produce something or 
you have to sell something. So separately, the number of workers filing 
new jobless claims rose 17,000 to 474,000 last week, the Labor 
Department said, which is an unwelcome change after 5 weeks of 
declines.
  Of course, accounting is one of my favorite things. I am the 
accountant in the Senate, and we have been doing some accounting on 
jobs that are saved. Clear back at the very beginning of the 
administration, when Secretary Geithner was appearing before the 
Finance Committee and the President was saying he will create or save 3 
million jobs, I asked what is the definition of saving a job? After he 
explained a little bit on that, I said: Well, I think probably anybody 
who is employed, still employed would meet that criteria, so why don't 
you save or create 180 million jobs? But now we have had some 
measurements done on jobs that were saved, and this one particularly

[[Page S13120]]

stuck with me. There is a report on the stimulus for a shoe store in 
Kentucky, and since I used to be in the shoe business as well, that 
kind of stuck out. This is from the Washington Examiner--a ticker on 
stimulus jobs created--and what they said is a shoe store owner claimed 
to create nine jobs on an $889 contract, when in fact he supplied nine 
pairs of shoes to the Army Corps of Engineers. A lot of accounting 
problems around here, and talking about saving jobs without a good 
definition is only one of them.
  Let's see. The government has taken over the banking industry, the 
car industry, trying to take over the health care industry, trying to 
take over the energy industry, none of which Washington knows much 
about, but one that hasn't had much said about it yet is student loans, 
and I am not sure exactly when that is coming to this body, but I did 
want to mention that the Department of Education right now is 
pressuring schools to move to a government-run student loan program in 
lieu of utilizing private lenders, who are more efficient and have 
traditionally offered better customer service. That is why people stay 
with them, is the better customer service, if the price is the same. 
However, it is also important to note that the proposed student loan 
takeover, which is H.R. 3221, would cause private lenders to cut an 
estimated 35,000 jobs across the country. That is according to a survey 
by the Federal Family Education Loan Program Industry Groups. With the 
unemployment rate lingering around 10 percent, it is nothing short of 
amazing that presumably vulnerable politicians continue to advocate big 
government programs that will result in private-sector job loss.
  We will be saying more about that as it comes up. I am not sure when 
it is going to come up, but I did hear the Secretary of Education--and 
again, this is good government accounting--said it would provide 
another $80 billion for them to work with. Under the best of government 
accounting, it would be $40 billion, I believe. And even that is only 
because of the way it is accounted for.
  Another problem we have now is with taxes, with the estate tax, and 
that is one that won't die because the Democrats are afraid to let the 
tax rate hit zero. For years, we have had people saying that the estate 
tax is not fair; that in this country you get taxed when you earn 
money, you get taxed when you buy something, you get taxed when you use 
something, you get taxed when you sell something, but the tax people 
are upset about is the tax you get after you are dead. We had a bill 
that already passed. The hated death tax is scheduled to expire, with 
the rate falling from 45 percent to zero for 2010. Then it will be 
restructured in 2011 at a rate of 55 percent.
  This bizarre policy goes back to 2001, when the Democrats wouldn't 
let President Bush permanently kill the death tax. So the Republicans 
bet if the tax were eliminated for 1 year, it would never come back. 
Well, the moment of truth has arrived and the House Democrats recently 
voted to cancel that repeal and hold the rate permanently at 45 percent 
with a $3\1/2\ million exemption. So now the majority leader wants to 
do the same, and would suspend the health care debate and turn to that 
estate tax, but he would need 60 votes to do that, and I think that is 
because all the Republicans and many of the Democrats are saying no to 
that. Blanche Lincoln and Jon Kyl, Arkansas and Arizona, have placed 
some proposals out there.
  The correct way to tax a gain in the value of assets bequeathed to an 
heir with capital gains of 15 percent is when the assets are sold. 
There ought to be some actual action that derives some revenue for it; 
otherwise, people out our way are having to sell off ranches 
prematurely in order to have the money to pay off death taxes when the 
founder of the family passes away. A recent problem we have had with 
that is that the land values are going up. I suppose they have 
stagnated at the moment, but it is hard to tell. These ranchers were 
putting money in, trying to do estate planning so they could pay this 
with not having to sell off part of the farm, and were doing a pretty 
good job of that. Of course, they made some adjustments when we made 
adjustments and started giving them a decline. And there is going to be 
a lot more said on that yet.
  We have this massive spending bill, this huge increase in spending, 
and I want to share with you some of the words of Douglas Holtz-Eakin, 
the former Director of the Congressional Budget Office, which we talk 
about here regularly and point out as being a nonpartisan office. He 
spoke recently at the Senate Committee on the Budget, or relatively 
recently--November 10. This is kind of what he said:

       President Barack Obama took office promising to lead from 
     the center and solve big problems. He has exerted enormous 
     political energy attempting to reform the Nation's health-
     care system. But the biggest economic problem facing the 
     Nation is not health care. It's the deficit. Recently, the 
     White House signaled that it will get serious about reducing 
     the deficit next year--after it locks into place the massive 
     new health-care entitlements. This is a recipe for disaster, 
     as it will create a new appetite for increased spending and 
     yet another powerful interest group to oppose deficit-
     reduction measures.
       Our fiscal situation has deteriorated rapidly in just the 
     past few years. The Federal Government ran a 2009 deficit of 
     $1.4 trillion--the highest since World War II--as spending 
     reached nearly 25 percent of GDP and total revenues fell 
     below 15 percent of GDP. Shortfalls like these have not been 
     seen in more than 50 years.
       Going forward, there is no relief in sight, as spending far 
     outpaces revenues and the Federal budget is projected to be 
     in enormous deficit every year. Our national debt is 
     projected to stand at $17.1 trillion 10 years from now, or 
     over $50,000 per American. And per American means every 
     man, woman and child.

  Continuing to quote:

       By 2019, according to the Congressional Budget Office's 
     analysis of the President's budget, the budget deficit will 
     still be roughly $1 trillion, even though the economic 
     situation will have improved and revenues will be above 
     historical norms.
       The planned deficits will have destructive consequences for 
     both fairness and economic growth. They will force upon our 
     children and grandchildren the bill for our overconsumption. 
     Federal deficits will crowd out domestic investment and 
     physical capital, human capital, and technologies that 
     increase potential GDP and the standard of living. Financing 
     deficits could crowd out exports and harm our international 
     competitiveness, as we can already see happening with the 
     large borrowing we are doing from competitors like China.

  Yes, the President went to China recently; Secretary Geithner has 
been to China. They weren't over there trying to visit the Great Wall. 
They were over there trying to explain to China how we would be able to 
pay off our bonds. And last week, it was said that Standard & Poor's 
and Moody's were taking a look at the United Kingdom and the United 
States to see if there shouldn't be a downgrade in their rating. And so 
Mr. Holtz-Eakin says:

       At what point, financial analysts ask, do rating agencies 
     downgrade the United States? When do lenders price additional 
     risk to Federal borrowing, leading to a damaging spike in 
     interest rates? How quickly will international investors flee 
     the dollar for a new reserve currency? And how will the 
     resulting higher interest rates, diminished dollar, higher 
     inflation, and economic distress manifest itself? Given the 
     President's recent reception in China--friendly but 
     fruitless--these answers may come sooner than any of us would 
     like.
       Mr. Obama and his advisers say they understand these 
     concerns, but the administration's policy changes are the 
     equivalent of steering the economy toward an iceberg. Perhaps 
     the most vivid example of sending the wrong message to 
     international capital markets are the health-care reform 
     bills--one that passed the House earlier this month and 
     another under consideration in the Senate. Whatever their 
     good intentions, they have too many flaws to be defensible.
       First and foremost, neither bends the health-cost curve 
     downward. The CBO found the House bill fails to reduce the 
     pace of health-care spending growth. An audit of the bill by 
     Richard Foster, the chief actuary for the Centers for 
     Medicare and Medicaid Services--

  And that is the CMS, which is a division of Health and Human 
Services. So this is the chief actuary issuing this report.

     --found that the pace of national health-care spending will 
     increase by 2.1 percent over 10 years, or by about $750 
     billion. Senate Majority Leader Harry Reid's bill grows just 
     as fast as the House version.

  Yesterday, or the day before yesterday, we got a new actuarial report 
that addressed the Reid bill as opposed to the House bill, and we 
talked about that fairly extensively. I haven't seen any articles about 
it yet. But one summary comment on it is that, according to this 
Actuary of CMS--which is a part of the administration--the cost of 
health care under the Reid bill will increase by seven-tenths of 1 
percent.

[[Page S13121]]

That doesn't sound like much, but it is seven-tenths of 1 percent 
more--more--than if we did nothing. That is not bending the cost curve 
down.
  Mr. Holtz-Eakin goes on to say:

       Second, each bill sets up a new entitlement program that 
     grows at 8 percent annually as far the eye can see--faster 
     than the economy will grow, faster than tax revenues will 
     grow, and just as fast as the already-broken Medicare and 
     Medicaid programs. They also create a second new entitlement 
     program, a federally run, long-term-care insurance plan.
       Finally, the bills are fiscally dishonest, using every 
     budget gimmick and trick in the book: Leave out inconvenient 
     spending, back-load spending to disguise the true scale, 
     front-load tax revenues, let inflation push up tax revenues, 
     promise spending cuts to doctors and hospitals that have no 
     record of materializing, and so on.
       If there really are savings to be found in Medicare, those 
     savings should be directed toward deficit reduction and 
     preserving Medicare, not to financing huge new entitlement 
     programs. Getting long-term budgets under control is hard 
     enough today. The job will be nearly impossible with a slew 
     of new entitlements in place.
       In short, any combination of what is moving through 
     Congress is economically dangerous and invites the rapid 
     acceleration of a debt crisis.
       It is a dramatic statement to finance markets that the 
     federal government does not understand that it must get its 
     fiscal house in order. . . .
       The time to worry about the deficit is not next year, but 
     now. There is no time to waste.

  Again, Mr. Holtz-Eakin is the former Director of the Congressional 
Budget Office and a fellow at the Manhattan Institute. This is adapted 
from testimony he gave to the Senate Committee on the Budget on 
November 10.
  Since that time I have been talking about how we have maxed out our 
credit cards, but this is something known across the Nation.
  I have to share something. I mentioned I get things from all the 
papers in Wyoming. This comes from the Lovell Chronicle. That is a 
place that is probably about 120 miles from Yellowstone Park. That is 
always how I describe our State, in terms of Yellowstone Park, because 
a lot of people know where that is.
  Her name is Diane Badget and she writes a column regularly.

       My dad used to play this silly game with us. We'd hear 
     ``THUMP, THUMP'' coming from the kitchen. One of us would 
     ask, ``Dad, what are you doing?'' He'd reply, ``Beating my 
     head against the wall.'' At that point another of us would 
     dutifully respond, ``Why?'' Then we'd wait a second for the 
     expected reply: ``Cause it feels so good when I quit!''
       Has the bickering in Washington sickened you to the point 
     where you almost don't care what they do as long as they shut 
     up? Be careful! That's what some are hoping for. They are 
     disdainful of our feeble attempts to get them to listen to 
     us. They hope that if we beat our heads against the wall long 
     enough we'll realize how much better we'd feel if we'd just 
     quit.

  She goes on to talk a little about Copenhagen.

       The plans for building safe, clean nuclear power plants to 
     provide electricity evaporated when the promise of a secure 
     place to store spent nuclear fuel suddenly ended. Yet this 
     same administration has decried coal fired plants as 
     ``ecological disasters'' and large-scale wind and solar 
     energy as too expensive to build yet. Nothing has been done 
     to utilize the vast reserves of resources in Alaska.
       Okay, if we can't use coal plants, can't afford wind or 
     sun, Alaska doesn't exist, and nuclear options just got 
     flushed, what should we do? Oh, I know! Let's gather up half 
     of the over-zealous geniuses who supported Obama's decision 
     and put them on giant hamster wheels hooked to generators! 
     Then we'll take the other half and utilize their hot air to 
     turn turbines! It makes as much sense as anything in the Cap 
     and Trade bill.
       My grandkids can't pray in school, but other kids are 
     provided with prayer mats. No wonder so many terrorists are 
     found right here in the very country they have sworn to 
     destroy. How many more radicals are walking among us, 
     undetected?

  She talks about:

       The decision to try the 9/11 conspirators in our court 
     system is a travesty. These murderers have already pleaded 
     guilty in a military tribunal. They are not entitled by our 
     Constitution to a trial. U.S. citizens are entitled to a 
     trial before a jury of their peers.

  But she does move on to healthcare as well.

       Are you confused yet? Apparently Congress is. The health 
     care plan that the Senate voted to send to the floor for 
     debate is a perfect example. One side says that it will be 
     deficit neutral, will ensure competition, will not affect 
     Medicare and won't result in more taxes. The other side says 
     it will cost too much, eliminate competition, slash Medicare 
     and tax us out of our underwear.
       Barbara Boxer (D. Ca) touted Medicare as a great example of 
     how seniors are able to chose a ``public option''. Excuse me? 
     When we turn 65 we are required to sign up for Medicare. How 
     is that optional? I think at this point both sides of the 
     aisle are trying to sell us snake oil, and somewhere in the 
     middle is the truth.
       Are you worried yet? Are your children and grandchildren 
     going to enjoy the same freedoms and opportunities that we 
     enjoyed? The future of my grandchildren should have been 
     better than the life I had, and my life has been pretty 
     doggone good. Instead, future generations are going to be 
     paying, financially and personally, for the mistakes made 
     right now by a president who presumes too much power and a 
     system of checks and balances that no longer works.

  We have been talking about having a bipartisan bill here. Maybe that 
would end the contradiction and furor that we are talking about here. I 
think a lot of people must have missed the speech Olympia Snowe made 
about durable social reform always being bipartisan. I want to share 
some comments on that. I know her speech wasn't noticed by the press 
corps.

       With Majority Leader Harry Reid's announcement this week of 
     a double-secret bargain that Democrats hope will squeeze 
     ObamaCare through the Senate after nine whole days of debate 
     so far in the world's greatest deliberative body--the Maine 
     Republican's words seem more pertinent than ever.
       Mrs. Snowe began by noting that this year's health debate 
     is ``one of the most complex and intricate undertakings the 
     Congress has ever confronted,'' and that she, too, has 
     devoted much of her three-decade political career to 
     promoting cheaper, better quality insurance. ``But it must be 
     done in an effective, common-sense and bipartisan way,'' she 
     cautioned.
       Far from ``systematically working through the concerns, the 
     issues and the alternatives,'' Mrs. Snowe added, Democrats 
     have instead favored ``artificially generated haste'' and 
     settled on a strategy ``to ram it, to jam it'' through 
     Congress. The Senator detailed her good-faith participation 
     in the ``group of six'' on the Senate Finance Committee, 
     which met some 31 times over the spring and summer and 
     reflected ``the kind of extensive, meticulous process that an 
     issue of this magnitude requires.''
       The negotiators tried to build a consensus, blending the 
     best ideas from both parties. Or at least they did before the 
     group of six, and Mrs. Snowe in particular, became a liberal 
     political target for supposed obstructionism. Chairman Max 
     Baucus then pushed their unfinished work to the Senate floor, 
     where Mr. Reid is now rushing to pass a bill in a race 
     against its rising unpopularity and President Obama's falling 
     approval ratings.
       Mr. Reid made his case with his usual intellectual nuance 
     this week: ``Instead of joining us on the right side of 
     history, all the Republicans can come up with is, `Slow down, 
     stop everything, let's start over.' If you think you've heard 
     these same excuses before, you're right. When this country 
     belatedly recognized the wrongs of slavery, there were those 
     who dug in their heels and said, 'Slow down, it's too early, 
     things aren't bad enough.' ''
       Then, after equating opposition to Medicare cuts and tax 
     increases with support for human bondage that it took a 
     bloody civil war to end, Mr. Reid went on to draw analogies 
     to women's suffrage, Social Security, civil rights and 
     Medicare.
       Mr. Reid would have done better listening to Mrs. Snowe 
     about the ``history'' of major social legislation, which she 
     also discussed in her November speech. Her main and telling 
     point was that durable social reform in America has always 
     been bipartisan, and not merely with one or two opposition 
     party votes.
       While Social Security passed when Democrats controlled both 
     Congress and the White House, she said, 64 percent of Senate 
     Republicans and 79 percent of the House GOP supported it. 
     Civil rights passed with 82 percent of Republicans in the 
     Senate and 80 percent in the House, while 41 percent and 51 
     percent, respectively, voted for Medicare. Mrs. Snowe could 
     have added the 1996 welfare reform that President Clinton 
     signed with the support of nearly all Republicans in 
     Congress, 98 Democratic Representatives and 25 Democratic 
     Senators.
       ``Policies that will affect more than 300 million people 
     simply should not be decided by partisan, one-vote-margin 
     strategies,'' Senator Snowe explained, and Congress should 
     not be ``railroading solutions along partisan lines.''

  On the debate that we have had, one of the points of contention, of 
course, has been Medicare. They talked on that side of the aisle about 
how good Medicare is. We talked on this side of the aisle about how 
Medicare is being harmed. I think what we are really giving people the 
impression of it is when we pass the bill, all of it will be free. That 
will not happen. But there was some contention that private insurance 
was less fair to people, Medicare was always fair. So I dug up some 
information on it. Investors Business Daily has done a little bit of 
research in that area. They found that:

       Throughout the health care debate insurance companies have 
     been cast as greedy villains that gleefully deny medical 
     claims. But

[[Page S13122]]

     when it comes to rejecting claims, they can't hold a candle 
     to government.

  They found the most claims are the ones denied by Medicare, not the 
private sector.
  What has happened in the last couple of days, Medicare has been so 
popular that the leader has said he is going to include, now, a piece 
that will bring the age group to 55. We have been talking about how, 
under the present circumstances, with the money that is being stolen 
from Medicare, that it is going to go broke. The majority leader--and 
evidently it is just the majority leader because when we asked to see a 
copy of it yesterday in a little colloquy we had with the Senator from 
Illinois, Senator Durbin, he said he had not seen it. So I think--I 
know they had been briefed on it probably in a general way the night 
before. But it was explained to us that if anybody knew what was 
actually in that, that then the CBO score that comes out of that, how 
much it will cost, would have to be shared with everybody.
  I thought we were in the new era of transparency. That doesn't sound 
very transparent to me. Even Democrats didn't get to see it because, if 
they did, then all of us could see how much it is going to cost as soon 
as the Congressional Budget Office has declared that.
  That bothers me. I think it kind of bothers America. What we are 
worried about is it is going to come to the floor all of a sudden and 
we are going to have to make decisions on it. Evidently it is being 
talked about a little bit on the other end of the building, because I 
saw that Speaker Pelosi stopped short of endorsing the full Senate 
compromise, saying she needed to see ``something in writing.'' But she 
said, ``There is certainly a great deal of appeal'' in expanding 
Medicare. But the Washington Post did a little editorial. This would 
have been on December 10. They called it ``Medicare Sausage? The 
emerging buy-in proposal could have costly unintended consequences.''
  Incidentally our side has only seen this based on what the media has 
heard, and I don't know what kind of briefings the media has had on 
what this particular proposal has.
  The Washington Post says: ``The emerging buy-in proposal could have 
costly unintended consequences,'' and begins by saying:

       The only thing more unsettling than watching legislative 
     sausage being made is watching it being made on the fly. The 
     11th-hour compromise on health care reform and the public 
     option supposedly includes an expansion of Medicare to let 
     people ages 55 to 64 buy into the program. This is an idea 
     dating to at least the Clinton administration, and Senate 
     Finance Committee Chairman Max Baucus originally proposed 
     allowing the buy-in as a temporary measure before the new 
     insurance exchanges get underway. However, the last minute 
     introduction of this idea within the broader context of 
     health reform raises numerous questions--not the least of 
     which is whether this proposal is a far more dramatic step 
     toward a single-payer system than the lawmakers on either 
     side realize.
       The details of how the buy-in would work are still sketchy 
     and still being fleshed out, but the basic notion is 
     uninsured individuals 55 to 64 who would be eligible to 
     participate in the newly created insurance exchanges could 
     choose instead the emergency coverage through Medicare. In 
     theory, this would not add to Medicare costs because the 
     coverage would have to be paid for--either out of pocket or 
     with the subsidies that would be provided to those at lower 
     income levels to purchase insurance on the exchanges. The 
     notion is that, because Medicare pays lower rates to health-
     care providers than do private insurers, the coverage would 
     tend to cost less than a private plan. The complication is 
     understanding what effect the buy-in option would have on the 
     new insurance exchanges and, more important, on the larger 
     health-care system.
       Currently, Medicare benefits are less generous in 
     significant ways than the plans to be offered on the 
     exchanges. For instance, there is no cap on out-of-pocket 
     expenses.

  Wasn't one of the promises that we were going to be sure that 
catastrophic was covered for everybody? One of the things I discovered 
early on in this process is that catastrophic is not covered in 
Medicare, not in the regular plan. You have to get the Medicare 
Advantage to get catastrophic or the more expensive Medigap policy. Of 
course, we are talking about taking a whole bunch of money out of the 
Medicare Advantage, which the companies say will either reduce benefits 
or eliminate it altogether.
  I think this book was delivered to every office. I got one in my 
office. It is called ``Voodoo Anyone?'' It is ``How to understand 
economics without really trying.'' I do hope every Senator finds their 
copy of this book and takes a look at it because it talks about prices, 
how prices are set, what affects prices, what happens when you fix 
prices. Then it talks about health care and energy and education and 
crime and social and agriculture and labor and monopolies, and 
financial markets and government action.
  I have never found a book that put it quite as succinctly or quite as 
understandably as this book does. We need to be paying some attention 
to the fixing prices part of it, for sure. He gives a nice example on 
this.

       You're in a college town, and you realize that there is no 
     good place to buy a decent bicycle. So you get some money 
     together (loans, the parents, investors, whatever) and you 
     open up Deals on Wheels. But business at first is slow. So 
     you figure you'll bring in customers for a sale. You look 
     at your books and you make some tough decisions. You paid 
     $100 for a bike from the manufacturer, and you sell it for 
     $110. But without customers, you realize you need to do 
     something.
       So you decide to sell the bicycles for $80 as a way to draw 
     customers to Deals on Wheels. You know that you can't 
     continue to sell your bikes at a loss, so you say it's a one-
     day sale only. And sure enough, the word gets out, and you've 
     got more customers than you can handle. They can't fit in the 
     store and spill out on the street.
       Little did you know that a lawmaker passed by, saw the 
     crowd and realized something good was going on. The 
     politician goes back to Washington, D.C., and convinces his 
     colleagues that an $80 bicycle is a great thing. ``Bicycles 
     have so many benefits,'' intones the lawmaker. ``They can 
     help you get healthy. And the more people who ride bikes, the 
     less pollution there is. And, of course, more people riding 
     bicycles will help the United States become less dependent on 
     foreign oil.
       To thunderous applause, the politician sits down and 
     watches his bill that will cap the price of bicycles at $80 
     pass in a near unanimous vote. (The politician and all his 
     colleagues have calculated a lot of votes will come their way 
     in the next election as a result of this bill).
       But for you, the bicycle dealer, the one-day sale has 
     become a permanent condition. You can't find bicycles for 
     less than $90, so you're going to be selling all bicycles at 
     a loss.
       Do you stay in business? You instead sell off the rest of 
     your inventory and explore other employment opportunities.

  I read that to lead up to what he has on Medicare. He says:

       Remember the bicycle example? A price control on bicycles 
     below the cost of production signaled to consumers to buy 
     cheap bikes. But it also told producers that they couldn't 
     make any money. When you have high demand and low supply, you 
     get a shortage. And that's where the Medicare program stands 
     today--waiting lists, fewer doctors who see Medicare patients 
     and shorter hospital stays are all evidence of a shortage in 
     the medical care for senior citizens.

  There are several more pages on Medicare I won't cover. I encourage 
my colleagues to read it. It is a very small book, a very short book, 
but it makes a lot of excellent points.
  Of course, the day before yesterday we got this report from the 
Actuary of CMS, which is part of Health and Human Services, which is a 
part of the administration. He said that Medicare would not be 
sustainable under the Reid bill.
  Is there a way to fix Medicare? I think so. We have promoted over 
here several times that instead of taking these cuts to Medicare and 
expanding them into brandnew entitlements--an entitlement is something 
that goes on forever without congressional approval--we ought to lop 
off the Medicare piece and make sure we get it right.
  Yes, there are things that have been noted that would save money. But 
that money that is saved ought to go right back into Medicare so that 
those seniors who are so nervous across the country would understand we 
weren't cutting their programs.
  They say: No, we are not cutting the program. We haven't cut a single 
guaranteed benefit.
  We also haven't fooled a single senior out there. The only ones we 
have fooled have been the AARP. Of course, the AARP is going to make 
more money off of Medigap than they ever made off Medicare Advantage. 
They have to look at where the bread is buttered here.
  Senator Dodd said that he would like to know exactly which pages had 
cuts to Medicare on it. I have a sheet here that shows the exact page 
numbers in the bill and the CBO report.
  I ask unanimous consent that the following be printed in the Record 
in this regard.

[[Page S13123]]

  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                     Medicare Cuts in the Reid Bill


                       hospitals serving seniors

       $200 billion in cuts, page 663, through Medicare quality 
     reporting programs; $1.5 billion in cuts, p. 687, Medicare 
     payment adjustments for hospital-acquired conditions; $7.1 
     billion in cuts, p. 775, hospital readmissions reduction 
     program; $20.6 billion, p. 842, Disproportionate Share 
     Hospital (DSH) payment cuts; $105.5 billion, p. 974, Medicare 
     market basket updates.


                             nursing homes

       $15 billion, p. 977, Medicare market basket updates.


                                hospices

       Nearly $8 billion, p. 987, Medicare market basket updates.


                              home health

       More than $40 billion, p. 983, Medicare market basket 
     updates.


                           medicare advantage

        $118 billion, p. 869, Medicare Advantage payment 
     adjustments; $1.9 billion, p. 908, application of coding 
     intensity adjustment.

  Mr. ENZI. Of course, the Democrats do recognize that there is a 
problem with Medicare going broke; otherwise, they wouldn't have to put 
a special commission in there. There is a special MedPAC commission. 
There already is a MedPAC, so there is going to be a MedPAC on steroids 
in there. That means it will have to report to us and we will have to 
take action on it or else they will be able to take action anyway. If 
we are not breaking the system, what do we need that for?
  Actually, if we use the money that comes from Medicare only for 
Medicare, the commission would have a much easier job.
  For one thing, we would be able to do the doc fix. The other side 
keeps referring to how the deficit will be reduced by this bill--$157 
billion in the first 10 years and another number for the second 10 
years. But that is only if you believe we will not fix any of these 
things that are major problems, such as the doctors.
  We are not paying the doctors enough. Right now, 25 percent of the 
doctors won't take a new Medicare patient. The number varies between 45 
percent and 50 percent who won't take a new Medicaid patient because we 
pay too little. We did the price fixing such as I described in that 
book. If you do price fixing, you can't afford to pay the doctors 
enough. The doctors know that. They are not going to work for nothing 
or less than nothing. Consequently, if you can't see a doctor, you 
don't have any kind of insurance. That is a basic guarantee of 
insurance, that you will get to see some medical person and they will 
do some kind of treatment if you need it. We are also hoping the doctor 
gets to make the decision on the treatment you have.
  There is also a little medical commission in the bill, preventative 
commission, a task force that put out a report on mammograms and upset 
the whole country, with some justification. As those things are adopted 
for everybody, it takes away the right for the doctor to say: My 
patient is a little bit different. We are all a little bit different. 
Some of these commissions and task forces need to be looked at. Is 
America listening?
  Last week, there was a vote in Kentucky. There were two people 
running for the legislature there. It was a highly Democratic district. 
The Republican talked about health care. That was his whole pitch. He 
did a warning on health care. He won in a heavily Democratic district.
  This is being reported repeatedly across the country. I have some 
things where I could go into some of the poll numbers that are out 
there now. I know individuals are looking at those poll numbers and 
realizing the American people have figured it out. They really have. 
Congress hasn't figured it out, but the American people have figured it 
out.
  I have to talk about one specific part of the bill. Senator Harkin 
and I worked together on this bipartisan amendment. It wasn't one we 
invented; it is one we found from Safeway. Safeway has some programs 
they put into effect for their employees on a voluntary basis that cut 
the cost of health care for Safeways while increasing the benefits for 
the employees. That is not happening anywhere in America. You have seen 
the charts on how fast health care is expanding. Safeway was able to 
get about an 8-percent reduction the first year and has been able to 
hold it level since then.
  Senator Harkin and I asked: How did you do that? One of the ways was 
to give people incentives to do the right thing. Again, it was on a 
voluntary basis. We got the flexibility for these incentives put into 
the HELP Committee markup. It was approved. It was put in. It was 
bipartisan. It should have been approved and put in. It was also a good 
idea. There was this clinic that we call Safeway that had been the lab 
for it, that had tried it and it worked. It was to raise the limit 
people could have for doing these incentives from 20 percent to 30 
percent and even up to 50 percent, if it worked. Without my approval, 
that was jerked out of the bill before it was actually printed.
  I hope people take a look at the November 29 issue of Roll Call, 
where there is an editorial by Morton Kondracke, who explains how this 
all works and what a difference it could make and how terrible it is 
that it got pulled out.
  It is interesting that some of the groups that were against it were 
ones such as the American Cancer Society, the American Heart 
Association, and the American Diabetes Association. They did it on the 
basis that it discriminates against people who want to stay fat and 
won't quit smoking. Incidentally, a smoker costs $1,200 a year to 
somebody else because it isn't included in their insurance that way.
  Ways of improving the system--I will talk about that at another time. 
I can see everybody is fascinated by all of this. We will talk about 
lawsuits and health savings accounts.
  The other side would like to eliminate health savings accounts. 
Actually, what they want to do is tell you what insurance you have to 
have. They want the government to tell you what the minimum acceptable 
insurance is. That is not bad enough. If you don't buy at least the 
minimum acceptable insurance, then you get fined. Under the House bill, 
you can go to jail. That is only if you don't pay your taxes as a 
result of the fine. That is done through the IRS. It is a huge 
expansion of the IRS at the same time.
  Health savings accounts have been working in this country. In fact, 
they work for our employees in the Senate. The health savings account 
is where you buy a high-deductible policy and you have the right to put 
money tax free into a savings account that can only be used for health, 
with the theory that if you do have something happen to you, you can 
draw out of your health savings account to pay this deductible.
  If you are young and healthy, it is a tremendous thing. One of the 
young ladies in my office said: Let's see, the amount I have to pay for 
regular insurance and the amount I have to pay for a health savings 
account are considerably different. If I took that difference and put 
that into a health savings account, it would still belong to me. It 
would roll over from year to year, and I would have that available tax 
free whenever I need it. She did that. Within 3 years, she had the 
entire deductible covered in there. She was smart enough to continue to 
put money in there, tax free money that will take care of her health 
care expenditures. Do you think she will be upset if we eliminate 
health savings accounts? Yes, I think so.
  There is another thing Senate employees use; that is, flexible 
spending accounts. Even if you pick the ones without the high 
deductible, you have the right to figure out how much your medical 
expenses are going to be the next year and put those into a special 
account, a flexible savings account. Over the next year, you can use 
that money from the flexible savings account, which comes out of your 
paycheck, tax free for the medical needs you have.
  People who know they are going to have medical needs find this to be 
useful. They find that they can tell--you have to do it by Monday--how 
much you think you are going to spend the next year. The downside of it 
is, if you don't spend it all, the extra goes back to the Federal 
Government. Even though it came out of your paycheck, it goes back to 
the Federal Government.
  A lot of people would say this would be a good deal if we could roll 
that over. There are a lot of eyeglasses and dentists appointments that 
are done in December for people to be able to use

[[Page S13124]]

that flexible spending account. If it rolled over, they could continue 
to use it for what was really necessary.
  That is being limited in the bill. That will be a detriment to people 
who have some catastrophic things happening to them. Cancer would be 
one of those things. If they know how much they are going to have to 
spend on MRIs and CAT scans and other kinds of tests over the coming 
year, in December they put that amount of money in there, and then they 
can have this little bit of a tax advantage for taking care of their 
health care costs.
  That is much like big business provides in the much better plans than 
we have in the Senate.
  To conclude, I would like to have a document printed in the Record by 
unanimous consent, which is titled: ``A Specific Plan of Action: 
Lowering Health Care Costs.''
  I am inserting this on behalf of Senator McCain because people keep 
claiming that when he ran for President, he said things differently 
than what is being said now, and with this as part of the Record, maybe 
we can get them to quit saying that. Because he did talk about waste, 
fraud, and abuse in Medicare and the need to contain it and physician 
payments and coordinated care and preventable medical errors. So I ask 
unanimous consent that document be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

         A Specific Plan of Action: Lowering Health Care Costs

       John McCain Proposes a Number of Initiatives That Can Lower 
     Health Care Costs. If we act today, we can lower health care 
     costs for families through common-sense initiatives. Within a 
     decade, health spending will comprise twenty percent of our 
     economy. This is taking an increasing toll on America's 
     families and small businesses. Even Senators Clinton and 
     Obama recognize the pressure skyrocketing health costs place 
     on small business when they exempt small businesses from 
     their employer mandate plans.
       Cheaper Drugs: Lowering Drug Prices. John McCain will look 
     to bring greater competition to our drug markets through safe 
     re-importation of drugs and faster introduction of generic 
     drugs.
       Chronic Disease: Providing Quality, Cheaper Care for 
     Chronic Disease. Chronic conditions account for three-
     quarters of the Nation's annual health care bill. By 
     emphasizing prevention, early intervention, healthy habits, 
     new treatment models, new public health infrastructure and 
     the use of information technology, we can reduce health care 
     costs. We should dedicate more federal research to caring and 
     curing chronic disease.
       Coordinated Care: Promoting Coordinated Care. Coordinated 
     care--with providers collaborating to produce the best health 
     care--offers better outcomes at lower cost. We should pay a 
     single bill for high-quality disease care which will make 
     every single provider accountable and responsive to the 
     patients' needs.
       Greater Access and Convenience: Expanding Access to Health 
     Care. Families place a high value on quickly getting simple 
     care. Government should promote greater access through walk-
     in clinics in retail outlets.
       Information Technology: Greater Use of Information 
     Technology To Reduce Costs. We should promote the rapid 
     deployment of 21st century information sytems and technology 
     that allows doctors to practice across state lines.
       Medicaid and Medicare: Reforming the Payment System To Cut 
     Costs. We must reform the payment systems in Medicaid and 
     Medicare to compensate providers for diagnosis, prevention 
     and care coordination. Medicaid and Medicare should not pay 
     for preventable medical errors or mismanagement. Medicare 
     should lead the way in health care reforms that improve 
     quality and lower costs. We need to change the way providers 
     are paid to move away from fragmented care and focus their 
     attention on prevention and coordinated care, especially for 
     those with chronic conditions. This is the most important 
     step in effectively caring for an aging population. We must 
     work in a bipartisan manner to reform the physical payment 
     system, focus efforts on eliminating fraud and move Medicare 
     into a new generation of coordinated, quality care.
       Smoking. Promoting the Availability of Smoking Cessation 
     Programs. Most smokers would love to quit but find it hard to 
     do so. Working with business and insurance companies to 
     promote availability, we can improve lives and reduce chronic 
     disease through smoking cessation programs.
       State Flexibility: Encouraging States To Lower Costs. 
     States should have the flexibility to experiment with 
     alternative forms of access, coordinated payments per episode 
     covered under Medicaid, use of private insurance in Medicaid, 
     alternative insurance policies and different licensing 
     schemes for providers.
       Tort Reform: Passing Medical Liability Reform. We must pass 
     medical liability reform that eliminates lawsuits directed at 
     doctors who follow clinical guidelines and adhere to safety 
     protocols. Every patient should have access to legal remedies 
     in cases of bad medical practice but that should not be an 
     invitation to endless, frivolous lawsuits.
       Transparency: Bringing Transparency to Health Care Costs. 
     We must make public more information on treatment options and 
     doctor records, and require transparency regarding medical 
     outcomes, quality of care, costs and prices. We must also 
     facilitate the development of national standards for 
     measuring and recording treatments and outcomes.


                Confronting the long-term care challenge

       John McCain Will Develop a Strategy for Meeting the 
     Challenge of a Population Needing Greater Long-Term Care. 
     There have been a variety of state-based experiments such as 
     Cash and Counseling or the Program of All-Inclusive Care for 
     the Elderly (PACE) that are pioneering approaches for 
     delivering care to people in a home setting. Seniors are 
     given a monthly stipend which they can use to: hire workers 
     and purchase care-related services and goods. They can get 
     help managing their care by designating representatives, such 
     as relatives or friends, to help make decisions. It also 
     offers counseling and bookkeeping services to assist 
     consumers in handling their programmatic responsibilities.


     setting the record straight: covering those with pre-existing 
                               conditions

       Myth: Some claim that under John McCain's plan, those with 
     pre-existing conditions would be denied insurance.
       Fact: John McCain supported the Health Insurance 
     Portability and Accountability Act in 1996 that took the 
     important step of providing some protection against exclusion 
     of pre-existing conditions.
       Fact: Nothing in John McCain's plan changes the fact that 
     if you are employed and insured you will build protection 
     against the cost of any pre-existing condition.
       Fact: As President, John McCain would work with governors 
     to find the solutions necessary to ensure those with pre-
     existing conditions are able to easily access care.

  Mr. ENZI. I hope, on future appropriations--I hope when the President 
gets this bill, if it makes it through the process--and it appears as 
though it should easily do that--he will veto the bill and send it back 
because the 5,224 earmarks, amounting to $3.8 billion--instead of 
talking about 5 percent of what the Cabinet members expend, it might be 
more valuable to talk about $3.8 billion.
  There are other things that need to be done. We do need to start 
being fiscally responsible. Of course, one of the questions is: Why 
haven't we been, in the past, fiscally responsible? That answer to that 
is, we did not have our credit cards maxed out before. We were able to 
print the money and nobody noticed. But now when we print the money, 
people do notice. So we have both the end of the year appropriations--
the end of the year, incidentally, was the last day of September, and 
we are doing them now--and we have this health care crisis to solve. 
There is not anybody who does not want to come up with a solution to 
it. But we want to do it step by step and get the confidence of the 
American people.
  The American people do not have confidence in what we are doing. I 
have several documents that would show what percentage of the people do 
not agree we are doing the right thing. That ought to get the attention 
in virtually every State because it is not just as a national whole, it 
is in every State. People have figured out what we are trying to do, 
and they do not think we are doing it right. We better get it right or 
people will be even more upset.
  I yield floor.

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