[Congressional Record Volume 155, Number 191 (Wednesday, December 16, 2009)]
[Senate]
[Pages S13295-S13314]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




             DEPARTMENT OF DEFENSE APPROPRIATIONS ACT, 2010

  Mr. REID. Madam President, I ask the Chair to lay before the Senate a 
message from the House with respect to H.R. 3326, the Department of 
Defense Appropriations Act.
  The PRESIDING OFFICER. The Chair lays before the Senate the message 
from the House.

                               H.R. 3326

       Resolved, That the House agree to the amendment of the 
     Senate to the bill (H.R. 3326) entitled ``An Act making 
     appropriations for the Department of Defense for the fiscal 
     year ending September 30, 2010, and for other purposes'', 
     with a House amendment to Senate Amendment.


                             Cloture Motion

  Mr. REID. Madam President, I move to concur in the House amendment, 
and I send a cloture motion to the desk.
  The PRESIDING OFFICER. The clerk will report the motion.
  The legislative clerk read as follows:

                             Cloture Motion

       We, the undersigned Senators, in accordance with the 
     provisions of rule XXII of the Standing Rules of the Senate, 
     hereby move to bring to a close debate on the motion to 
     concur in the House amendment to the Senate amendment to H.R. 
     3326, the Department of Defense Appropriations Act for Fiscal 
     Year 2010.
         Daniel K. Inouye, Harry Reid, Max Baucus, Patrick J. 
           Leahy, Sheldon Whitehouse, Carl Levin, Patty Murray, 
           Mark Begich, Maria Cantwell, Mark L. Pryor, Jack Reed, 
           Edward E. Kaufman, Al Franken, Tom Harkin, Jim Webb, 
           Paul G. Kirk, Jr., Michael F. Bennet.


                           Amendment No. 3248

  Mr. REID. Madam President, I move to concur in the House amendment 
with an amendment, which is at the desk.
  The PRESIDING OFFICER. The clerk will report.
  The legislative clerk read as follows:

       The Senator from Nevada (Mr. Reid) moves to concur in the 
     House amendment to the Senate amendment with an amendment 
     numbered 3248.

  Mr. REID. Madam President, I ask unanimous consent that reading of 
the amendment be dispensed with.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The amendment is as follows:

       At the end of the House amendment, insert the following:
       The provisions of this Act shall become effective 5 days 
     after enactment.

  Mr. REID. Madam President, I ask for the yeas and nays.
  The PRESIDING OFFICER. Is there a sufficient second?
  There is a sufficient second.
  The yeas and nays were ordered.


                Amendment No. 3252 to Amendment No. 3248

  Mr. REID. Madam President, I have an amendment at the desk.
  The PRESIDING OFFICER. The clerk will report.

       The Senator from Nevada (Mr. Reid) proposes an amendment 
     numbered 3252 to amendment No. 3248.

  Mr. REID. I ask unanimous consent that reading of the amendment be 
dispensed with.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The amendment is as follows:

       Strike ``5 days'' and insert ``1 day''.


                   Motion to Refer/Amendment No. 3249

  Mr. REID. Madam President, I have a motion to refer, with 
instructions, at the desk.
  The PRESIDING OFFICER. The clerk will report.
  The assistant legislative clerk read as follows:


[[Page S13296]]


       The Senator from Nevada (Mr. Reid) moves to refer H.R. 3326 
     to the Committee on Appropriations with instructions to 
     report back with the following amendment No. 3249:

       At the end, insert the following:
       The Appropriations Committee is requested to study the 
     impact of any delay in implementing the provisions of the Act 
     on service members' families.

  Mr. REID. Madam President, I ask for the yeas and nays.
  The PRESIDING OFFICER. Is there a sufficient second?
  There is a sufficient second.
  The yeas and nays were ordered.


                           Amendment No. 3250

  Mr. REID. Madam President, I have an amendment to my instructions at 
the desk.
  The PRESIDING OFFICER. The clerk will report.
  The assistant legislative clerk read as follows:

       The Senator from Nevada (Mr. Reid) proposes an amendment 
     numbered 3250 to the instructions of amendment No. 3249.

  Mr. REID. Madam President, I ask unanimous consent that reading of 
the amendment be dispensed with.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The amendment is as follows:

       At the end, add the following:
       ``and the health care provided to those service members.''

  Mr. REID. Madam President, I ask for the yeas and nays on the 
amendment.
  The PRESIDING OFFICER. Is there a sufficient second?
  There is a sufficient second.
  The yeas and nays were ordered.


                Amendment No. 3251 to Amendment No. 3250

  Mr. REID. Madam President, I have a second-degree amendment at the 
desk.
  The PRESIDING OFFICER. The clerk will report.
  The assistant legislative clerk read as follows:

       The Senator from Nevada (Mr. Reid) proposes an amendment 
     numbered 3251 to amendment 3250.

  Mr. REID. Madam President, I ask unanimous consent that reading of 
the amendment be dispensed with.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The amendment is as follows:

       At the end, add the following:
       ``and the children of service members.''

  Mr. REID. Madam President, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. DURBIN. Madam President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  Mr. ENSIGN. I object.
  The PRESIDING OFFICER. Objection is heard. The clerk will continue 
calling the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. REID. Madam President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Is there objection?
  Without objection, it is so ordered.
  Mr. REID. It is my understanding that the Senator from Texas wishes 
to speak for up to 5 minutes. I ask unanimous consent that she be 
recognized, and following that Senator Durbin be recognized.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The Senator from Texas is recognized.
  Mrs. HUTCHISON. Madam President, I thank the majority leader for 
allowing me to speak because I am very concerned about a precedent that 
has been set on the floor in this last vote.
  When the Senator from Vermont withdrew his amendment and started 
talking, my motion to commit was the measure pending on the floor. I 
did not have notice--which is the normal procedure here--to be able to 
talk on my motion. We had no idea there would be a motion to table my 
motion before I had a chance to close.
  Here is my point. The measure that was tabled, the Hutchison-Thune 
motion, would have assured the American people that there would not be 
4 years of tax collection before any kind of program would be put 
forward under the health care reform package. I thought it was very 
important that Senator Thune and I be able to close on that. That is a 
concept we have always had in the Senate--that a program starts when it 
starts. That means if taxes are included, the taxes will start when the 
program starts. That is not the case in the underlying bill. The 
underlying health care reform bill has 4 years of taxes. There will be 
taxes on insurance companies that will surely raise the premium of 
every insurance policy in America. There are taxes on prescription drug 
companies, so that prescription drug prices will surely go up. There 
are taxes on medical device companies, so the prices on health care 
equipment will also go up. How much are we talking about? We are 
talking about $100 billion in taxes that will start in 3 weeks--in 
January of 2010. Again, we are looking at taxes that will start in 3 
weeks, next month, which will accumulate up to $73 billion before a 
program is implemented that will give anyone a choice of an affordable 
health care option.
  That is the motion that was tabled 10 minutes ago. I want to make 
sure everyone knows I never had a chance to close on the motion. 
Senator Thune didn't have a chance to close, because it was a motion 
made that could not be objected to. That is not the way things have 
operated here in the past, and I think it is time we bring back the 
traditions of the Senate, where we have time that we agree to, 
everybody has their say, and then we go forward.
  I am very concerned about that process. I hope it is not setting 
precedent because I think we can resurrect health care reform if we 
have a bipartisan health care effort. If we have an effort that will 
bring down the costs, that will increase the risk pools so that an 
employer will be able to afford to offer employees health care 
coverage, bring down the costs of health care with medical malpractice 
reform that would save $54 billion in the system, we can do things 
without a government takeover of health care. But the bill that is 
before us has $\1/2\ trillion in Medicare cuts--Medicare cuts, $\1/2\ 
trillion--and $\1/2\ trillion in new taxes--taxes on businesses that 
offer not enough coverage, businesses that offer too much coverage, a 
40-percent excise tax on policies that give what is called Cadillac 
coverage, the high benefit plans. So if you have a good insurance 
policy, you have a 40-percent tax on top of the premium you pay. And if 
you have too little coverage, you also get taxed. You are whipsawed in 
this bill.

  I think the small business people of this country know what this bill 
is about because that is the comment we are getting. They are the 
people calling into our offices. They are the people I see on the 
airplanes as I go back and forth to try to make sure we are covering 
the bases on this bill and trying to let the American people know what 
is in it.
  I am concerned about the precedent that was set, but more than that, 
I am concerned that the American people must know that if this bill 
passes as it is on the floor today, the taxes will take effect in 3 
weeks, that insurance premiums will surely go up, prescription drugs 
will surely go up, prices on medical equipment will surely go up, and 
there will not be an affordable insurance plan for people to choose to 
take for 4 years. It is like buying a house and having the mortgage 
company hand you the keys and say: Come back in 4 years, and we will 
let you unlock the door.
  I don't think that is transparency, and it is certainly not health 
care reform. I hope there is still a chance that we can bring this body 
to a bipartisan effort that will allow lower premiums, more health care 
options for the people of this country but, most important, that will 
keep the quality of health care, the choices we have in health care 
that Americans have come to expect and not start going on the road to a 
single-payer system because in the end, that is what the bill before us 
will lead to. It will be a single-payer system. It will take choices 
out. It will take quality out.
  It will add taxes and burdens on our small businesses at a time when 
they need to be able to hire people to get our economy going and to get 
that jobless rate down. We need them to employ people. We need to 
encourage our employers to employ people. They cannot do it if we put 
more taxes and burdens on them, which is what the bill before us does.
  I thank the majority leader for allowing me to speak since I did not 
have a chance to speak before my motion was tabled. I hope the American 
people

[[Page S13297]]

are listening because we have a chance to do this right. The bill on 
the floor today is not that bill.
  I yield the floor.
  The PRESIDING OFFICER (Mr. Burris). The Senator from Illinois is 
recognized.
  Mr. DURBIN. Mr. President, I thank the Senator from Texas. I am glad 
she had an opportunity to speak. We disagree on this issue, but I am 
glad she had her opportunity to speak.
  I hear from different people. Obviously, we must ride on different 
planes because the people I speak with are anxious to see some change 
in this health care system and know that 14,000 Americans lose their 
health insurance every single day. They know that most people cannot 
afford health insurance because of the increase in costs.
  I say to the Senator from Texas, she is my friend and we have worked 
on many issues in the past, but we disagree on this issue.
  I am coming before the Senate with a holiday proposal. Recently there 
was a book that was published about World War I. It was about trench 
warfare that went on and on with horrendous casualties and lives being 
lost. Then there came a moment, a Christmas moment, when they decided 
to call a truce because of Christmas and play a soccer game. The Allied 
and Axis troops came out and, for a brief moment, stopped the war, 
played the soccer game, and went back to the trenches and the next day 
started shooting again.
  I am looking for a holiday truce here for our troops because what we 
have before us right now is the Department of Defense appropriations 
bill. Although Senator Hutchison and I clearly disagree and many 
Members on both sides clearly disagree when it comes to health care, 
there is no disagreement when it comes to our troops. Every one of us 
supports our troops. Every one of us wants to make sure they have what 
they need, the resources they need to perform their mission 
successfully and come home safely.
  This bill that is before us, this Department of Defense 
appropriations conference report, is an attempt for us to do something 
to help these troops in time of war. I would hope I could appeal to my 
colleagues on the other side of the aisle that for one brief, shining 
moment in the spirit of the holiday we set aside our political 
differences for the sake of our men and women in uniform.
  The point I am getting to is that if we go through the ordinary, 
tortured procedure and wait, it is going to take us days to complete 
this bill for our troops. I hope we can show good faith on both sides 
of the aisle and overcome that. I hope we could enter into a consent 
agreement among Republicans and Democrats because I know as I stand 
here that the Republicans feel as the Democrats do--that we should 
provide funding for our overseas operations of our men and women in 
uniform.
  In this bill, $101 billion is included for operations and maintenance 
for ongoing military operations in Iraq and Afghanistan and to support 
the preparations to continue the withdrawal from Iraq.
  In this bill, there is $23.36 billion for equipment. We want to make 
sure our men and women in uniform have the equipment they need to make 
certain they are safe and have what they need to come home safely.
  There is also a pay raise in this bill, a 3.4-percent pay raise. Does 
anyone dispute the need that our military has to be recognized for what 
they have given our country and be given a pay raise?
  When it comes to readiness and training, there is $154 billion for 
the defense operation and maintenance account to increase readiness.
  In the field of military health care, there is $29 billion for the 
Defense Health Program to provide quality care for servicemembers and 
their families. It includes, incidentally, $120 million for traumatic 
brain injury and psychological health research.
  These are issues we have all come together on. We are not arguing 
about these issues, and I do not think we should at this moment.
  There is $472 million for family advocacy programs and full funding 
for Family Support and Yellow Ribbon to provide support to military 
families, including quality childcare, job training for spouses, and 
expanded counseling and outreach.
  There is one other section of the bill--and I will yield for a 
question from my friend from Alaska when I complete this point--there 
is one other section that relates to the unemployment crisis facing 
this country. It is a modest extension of the unemployment benefits. 
The last time it was on the floor, I believe it passed 97 to 0. I do 
not believe there is any controversy to the fact that we want to extend 
unemployment insurance benefits through February 28 of next year. It is 
difficult to envision a situation where we would actually leave here to 
go home to our families for the holidays and not take care of the 
unemployed.
  There is also a provision for their health insurance under COBRA and 
for food stamps on which we know so many unemployed families rely. It 
seems to me if there is one thing in the midst of this political 
turmoil we can agree on, it is let's stand behind our troops, let's 
make sure people who are unemployed have a happy holiday season. Why do 
we want a tortured process to reach a ``yes'' on this conference 
report? I appeal to my colleagues on the other side of the aisle to 
make this a bipartisan effort. Let's do this part. We can return to the 
health care bill and the debate. But let's get this done and do it 
without all the necessary motions and time that may be spent.
  I yield for a question from the Senator from Alaska.
  The PRESIDING OFFICER. The Senator from Alaska is recognized.
  Mr. BEGICH. Mr. President, I appreciate the Senator from Illinois 
bringing up what I consider a very most important piece of legislation 
to Alaska. Eleven percent of our population are veterans. We have 
thousands of military individuals in our State.
  I am new to the process. One of the questions I have for the 
Senator--and I hope he can enlighten me and also enlighten the whole 
public watching--this is probably one of the most important departments 
at this time. We are in two wars. Can the Senator give me an 
explanation? In the past--Senator Durbin started to do it--the Defense 
bill seemed to be one of those bills where we all came together. It is 
a bipartisan approach. I know as members of the Armed Services 
Committee, it seems every time we deal with these issues we are 
unified.
  Help me to understand why this is something that seems to be 
controversial and yet should be so simple for us to do.
  Mr. DURBIN. I say in response to the Senator from Alaska, I think it 
is the moment. If we were in a different political environment, I think 
the Republican Senators and Democratic Senators would agree that this 
should go through and go through quickly. But we have been caught up 
for weeks now in debate and controversy, and this bill has been tossed 
into that environment. That is the explanation because I do not think 
there is a single provision I read here that Republican Senators do not 
support, as the Democratic Senators support. That is why I made my 
suggestion.
  Mr. BEGICH. Mr. President, if I may ask one more question. That last 
statement the Senator from Illinois made, I know as a member of the 
Armed Services Committee, I have not heard complaints about this bill 
from anyone from the other side. I am asking, from a leadership 
position, have we heard any complaints on this legislation? Is it just 
that, it is the moment in time?
  Mr. DURBIN. I say in response to the Senator from Alaska, it does 
include some provisions relative to the unemployed. There were other 
things that could have been included by the House, but we reached out 
to the Republican side and asked: Are any of these problematic? By and 
large, they said here are the things you should not include, and we did 
not. We did our best to ensure we brought a noncontroversial bill for 
consideration.
  Mr. BEGICH. I thank the Senator.
  Ms. STABENOW. Will the Senator yield for a question?
  Mr. DURBIN. I am happy to yield to the Senator from Michigan.
  Ms. STABENOW. Mr. President, from the Senator's explanation and from 
what we have been working on, I want the Senator to clarify two things.
  First of all, we could do this conference report today if there were 
a willingness and, secondly, we have a pay raise for our troops that is 
coming right before Christmas, the holidays,

[[Page S13298]]

help for families, help for those who have lost their jobs and are 
trying to figure out how they keep their health care going, and help 
for people who are trying to put food on the table for the holidays; is 
that correct? I ask the Senator to expand. As I understand it, we could 
actually get this done today and give people some peace of mind going 
into the holidays.
  Mr. DURBIN. I say to the Senator from Michigan, yes, we could enter 
into a consent agreement now and pass this conference report without 
controversy, and I bet you it would get a unanimous vote.
  As the Senator from Michigan described this, everybody here wants to 
make sure we take care of our troops. We received a unanimous vote, if 
memory serves me, the last time we extended unemployment benefits. I 
think most Members want to stand up and help those who are unemployed 
through this difficult time of unemployment in our country.
  If there ever were a bill to bring us together in those two areas--
helping our troops and helping the unemployed--this is the bill.
  Ms. STABENOW. Mr. President, I wish to ask another question of the 
Senator from Illinois. If, in fact, the Senator from Illinois is 
finding the same thing I am right now--certainly, we have the highest 
unemployment rate in Michigan--and we are hearing it from all over the 
country; we are hearing from people that their unemployment benefits 
are about to expire. They are trying to figure out how they are going 
to make it through the next few months.
  There are particular concerns that if we do not extend it by the end 
of the year that, in fact, many will have to go out and resign up with 
a new bureaucracy to continue benefits.
  I wonder if the Senator has heard the same kinds of concerns and 
sense of urgency people have about being able to keep a roof over their 
head, keep food on the table, and keep their health care going--the 
same sense of urgency that I know we are feeling from people in 
Michigan?
  Mr. DURBIN. I say in response to the Senator from Michigan, through 
the Chair, that I am happy to read the latest unemployment statistics 
showing the number of people declared unemployed each month is going 
down. We will not feel good about it until it is turned around and we 
are creating jobs again, which I hope is soon.
  In the meantime, we have about six unemployed people for every job 
that is available. These people are in a market that is terrible, and 
they are trying their best. Some have gone back to school. Some are 
getting training courses. Some are trying to keep things together with 
their family and not lose their home because of unemployment.
  I am sure the Senator from Michigan has met with the unemployed in 
Michigan, as I have in Illinois. Some are, little by little, exhausting 
the savings they have. Even with COBRA, many people find the COBRA 
provision, which gives people a chance to buy insurance at discounts, 
is still too expensive. They are without a job. They are running the 
risk of losing their home. They are without health insurance for their 
children and are desperately looking for a job. We certainly do not 
want to put them in a situation where there is a question mark as to 
whether after December 31 the unemployment check will be there next 
month. I think it is that peace of mind we owe these folks caught up in 
the bad circumstances of our economy.
  Ms. STABENOW. If I may conclude, to clarify, we can get this done 
today. We can create that peace of mind for families going into the 
holidays, going into Christmas, into the end of the year. We could 
actually do that today in the next few hours?
  Mr. DURBIN. That is correct, I say to the Senator from Michigan, we 
can. Earlier we were embroiled in the reading of an amendment that 
would have literally consumed the entire day and forced us into another 
day's time and run the risk of not providing money for the troops when 
the continuing resolution, the funding resolution, ran out.
  The Senator from Vermont withdrew his amendment, and now we have 
moved to this bill. But there is nothing stopping us. A consent 
agreement can be entered into by both sides of the aisle that can move 
this through quickly and say to our troops: We are with you.
  I yield to the Senator from Rhode Island.
  Mr. WHITEHOUSE. Mr. President, will the Senator from Illinois yield 
for a question?
  Mr. DURBIN. I will be happy to yield.
  Mr. WHITEHOUSE. I am interested in the parliamentary situation that 
took place earlier whereby one of our Members was actually obliged to 
withdraw an amendment that was going to be voted on by all of us 
because of an insistence on the part of the other side that 800 pages 
be read by our poor clerk before that vote should take place.
  I have also heard the other side say that we want to get going, we 
want to move toward votes. I would be interested in the reflections of 
the distinguished majority whip on the extent to which a procedural 
objection to force the clerk to read 800 pages of an amendment, and 
deny one of our colleagues his vote, fairly represents a desire to move 
forward and get through our votes.

  Mr. DURBIN. I would say in response to the Senator from Rhode Island, 
we have heard repeatedly that people want amendment, debate, and a 
vote. What happened on the floor today, when Senator Coburn of Oklahoma 
refused to give consent to suspending the reading of the amendment, is 
that the clerk--clerks, I should say--were forced to start reading. As 
good as they are at reading, the fact is, it was going to take up to 10 
hours to read this amendment. During that 10-hour period of time, 
nothing could happen--no debate, no amendments--nothing other than 
listening to the clerks' melodious voices. Fortunately for us, the 
Senator from Vermont stepped up and said: I withdraw the amendment. But 
if there was a true interest in debate and amendments on health care, 
it is inconsistent to say we are going to take a day out of the whole 
affair and read an amendment.
  I can tell you, as I said to the Senator from Oklahoma, I can't 
believe there is a person in America who sat glued to the C-SPAN 
television listening to this amendment so they would understand it. It 
is a very complicated amendment page by page but, in general, 
understandable. The Senator from Vermont was seeking a single-payer 
health care system. It was not likely to pass, but it is something he 
believes in fervently and he wanted to offer it. So I would say the 
strategy on the floor today belies any request that we have more debate 
and more amendments.
  Before the Senator from Rhode Island continues, I think this has been 
cleared on both sides, but I ask unanimous consent that the time until 
6:15 p.m. be equally divided between the two sides, with Senators 
permitted to speak for up to 15 minutes each.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. WHITEHOUSE. If the Senator from Illinois would yield for another 
question.
  I was elected just about 3 years ago, and I came in with the new 
majority, so I did not have a chance to serve in this body when there 
was a Republican President and a Republican majority. I wonder if the 
Senator, who was here at that time, would reflect on how the other side 
viewed Defense appropriations for our troops during the Iraq war when 
they were in the majority. Were they desirous of delay and obstruction 
and debate and procedural maneuver on Defense appropriations at that 
time or is this a new strategy of theirs?
  Mr. DURBIN. I would say to my colleague from Rhode Island that 
exactly the opposite was true. They wanted to move quickly to pass any 
appropriations bill to make certain there was no question in the minds 
of our men and women in uniform that we were standing with them, and we 
did. I don't believe even those of us who voted against the invasion of 
Iraq tried to stop the proceedings from funding the troops, regardless 
of what our votes might be.
  So I think it would be consistent now for our colleagues on the other 
side of the aisle to join us, in a bipartisan fashion, to say whatever 
differences on other issues, such as health care, let's let the troops 
know this holiday season we stand behind them--Republicans and 
Democrats--and let's do it in an efficient and effective way.
  Since this unanimous consent request has been granted, I am going to

[[Page S13299]]

yield the floor and any of my colleagues who wish to speak, it will be 
equally divided time for the next 2 hours.
  At this time, I yield the floor. Mr. President, if no one seeks time, 
I suggest the absence of a quorum and I ask unanimous consent that 
during the time of the quorum the time be equally divided between both 
sides.
  The PRESIDING OFFICER. Without objection, it is so ordered. The clerk 
will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. LeMIEUX. Mr. President, I ask unanimous consent the order for the 
quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered. The 
Senator from Florida is recognized.
  Mr. LeMIEUX. Mr. President, while we have been here discussing health 
care, the clock has been ticking on our national debt. Just in the 
first 2 months of this fiscal year, we have accumulated $296 billion in 
debt. We took in revenues of $268 billion, and we spent $565 billion. 
We spent double what we took in just in the first 2 months of the 
fiscal year.
  I know you are new to this Chamber, Mr. President, as am I. I have 
only been here 90 days, but I have been here long enough to know this 
system is broken. It doesn't work. Neither this body nor the body 
across the Capitol has an ability to make ends meet. We continue to 
spend money we do not have. We spend the money of our children and our 
grandchildren. Right now we have a $12 trillion debt. It took us 167 
years in this country just to amass a $1 trillion debt in 1982. Now we 
are at $12 trillion. Every family in this country is now responsible 
for $100,000 of debt.
  Where are we getting this money? We are borrowing it from countries 
such as China, and it is hurting our standing in the world. Central 
banks that hold American currency are shedding those dollars because 
they no longer believe our country is a good investment. I worry about 
our children and our grandchildren. I have three sons, as you know, 
Max, Taylor and Chase--they are 6, 4 and 2--and we have a baby on the 
way in March. I am very worried that my children will not be able to 
experience the American dream like you and I have; to be able to be in 
the Senate, to be able to achieve all of our goals, whether in public 
service or in private. I do not believe America is going to be the same 
place for them, that it is going to hold the same opportunities because 
I believe this debt is going to strangle us.
  If this body and the body across the Capitol don't figure out we need 
to start making ends meet and stop spending the dollars of future 
generations, this country will not be the leader of the world. It will 
not have the promise we have all enjoyed.
  I rise today to speak about S.J. Res. 22, which I filed yesterday. It 
is a constitutional amendment that requires the Congress to balance its 
budget and also gives to the President of the United States a line-item 
veto so he, like most of the Governors in this country, can strike out 
inappropriate budget items, these earmarks that you hear about.
  Senator McCain spoke this weekend about $2.5 million to the 
University of Nebraska to study operations and medical procedures in 
space. We cannot afford that program under any circumstance, and we 
certainly can't afford programs like that when we are $12 trillion in 
debt. These dollar numbers are so big they are hard to comprehend.
  What does $1 trillion mean? What does $1 billion mean? In Washington 
we throw these amounts around, and we do not even comprehend them. I 
know for the American people at home it is hard to get their minds 
around how much money this is. I have said this on the Senate floor 
before, and I am going to keep saying it so people understand that 
every dollar we spend is a choice.
  One million dollars laid edge to edge on the ground would cover two 
football fields. One billion dollars laid edge to edge on the ground 
would cover the city of Key West, FL, 3.7 square miles. And $1 trillion 
would cover the State of Rhode Island--twice. If you stacked them on 
the ground going up into the sky, it would be 600 miles of one-dollar 
bills.
  Every dollar is a choice, and these numbers are out of control. Just 
this past Saturday we voted on a spending bill, a spending bill that 
had a 12-percent increase and $40 billion more than last year. I want 
to give the American people the sense of what you could do with this 
kind of money, what good you could do or, better yet, you could give it 
back to the American people and they could decide what good they could 
do with those dollars for their families.
  With $100 billion, we could give every Floridian a $5,000 tax cut.
  With $200 billion we could pay the salary of every teacher for a 
year. With $300 billion we could pay first-year tuition at a university 
of their choice for every kid who is in K-12. With $400 billion, we 
could build high-speed rail for 10,000 miles. We could connect Key West 
to Anchorage and back.
  Every dollar is a choice. We are spending money out of control. 
Similar to those who have come before me, I will sound the alarm 
because we still haven't done anything about this problem. There are 
good measures out there. Senator Gregg from New Hampshire has a 
measure, along with Senator Conrad, to put together a commission. I 
support that. Senator Sessions has a measure to bring caps back. Up 
until about 2002, we actually were making headway against the budget. 
Then those caps expired and spending went out of control.
  I support all those efforts. I support any effort to bring spending 
under control. This body doesn't have any leadership on spending. Look 
at what we spend. We don't look at the revenues coming in the door.
  I served as chief of staff to a Governor in Florida. When the budget 
started to go bad in 2007, I was on the phone monthly with the person 
who determined our receipts. I knew in Florida we could only spend as 
much money as we had. This institution does not work that way. No one 
even checks to see what kind of money we are bringing in. We just 
spend.
  I wish to talk to the American people about articles in the Wall 
Street Journal of today. This is not a Democratic problem or a 
Republican problem. This is a problem of this institution. The article 
is titled ``The Audacity of Debt.'' I wish to read one paragraph. I ask 
unanimous consent that the full article be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

             [From the Wall Street Journal, Dec. 16, 2009]

                          The Audacity of Debt


            Comparing today's deficits to those in the 1980s

        At least someone in America isn't feeling a credit 
     squeeze: Uncle Sam. This week Congress will vote to raise the 
     national debt ceiling by nearly $2 trillion, to a total of 
     $14 trillion. In this economy, everyone de-leverages except 
     government.
       It's a sign of how deep the fiscal pathologies run in this 
     Congress that $2 trillion will buy the federal government 
     only one year before it has to seek another debt hike--
     conveniently timed to come after the midterm elections. Since 
     Democrats began running Congress again in 2007, the federal 
     debt limit has climbed by 39 percent. The new hike will lift 
     the borrowing cap by another 15 percent.
       There is surely bipartisan blame for this government debt 
     boom. George W. Bush approved gigantic spending increases for 
     Medicare and bailouts. He also sponsored the first 
     ineffective``stimulus'' in February 2008--consisting of $168 
     billion in tax rebates and spending that depleted federal 
     revenues in return for no economic lift.
       Democrats ridiculed Mr. Bush as ``the most fiscally 
     irresponsible President in history,'' but then they saw him 
     and raised. They took an $800 billion deficit and made it 
     $1.4 trillion in 2009 and perhaps that high again in 2010. In 
     10 months they have approved more than $1 trillion in 
     spending that has saved union public jobs but has done little 
     to assist private job creation. Still to come is the 
     multitrillion-dollar health bill and another $100 billion to 
     $200 billion ``jobs'' bill.
       We've never obsessed over the budget deficit, because the 
     true cost of government is the amount it spends, not the 
     amount it borrows. Milton Friedman used to say that the 
     nation would be far better off with a budget half the current 
     size but with larger deficits. Mr. Obama and his allies in 
     Congress have done the opposite: They have increased the 
     budget by 50 percent and financed the spending with IOUs.
       Our concern is that the Administration and Congress view 
     this debt as a way to force a permanently higher tax base for 
     decades to come. The liberal grand strategy is to use their 
     accidentally large majorities this year to pass new 
     entitlements that start small but will explode in future 
     years. U.S. creditors will then demand higher taxes--taking

[[Page S13300]]

     income taxes back to their pre-Reagan rates and adding a 
     value-added tax too. This would expand federal spending as a 
     share of GDP to as much as 30 percent from the pre-crisis 20 
     percent.
       Remember the 1980s and 1990s when liberals said they 
     worried about the debt? We now know they were faking it. When 
     the Gipper chopped income and business tax rates by roughly 
     25 percent and then authorized a military build-up, Democrats 
     and their favorite economists predicted doom for a decade. 
     The late Paul Samuelson, the revered dean of the neo-
     Keynesians, expressed the prevailing view in those days when 
     he called the Reagan deficits ``an all-consuming evil.''
       But wait: Those ``evil'' Reagan deficits averaged less than 
     $200 billion a year, or about one-quarter as large in real 
     terms as today's deficit. The national debt held by the 
     public reached its peak in the Reagan years at 40.9 percent, 
     and hit 49.2 percent in 1995--This year debt will hit 61 
     percent of GDP, heading to 68 percent soon even by the White 
     House's optimistic estimates.
       Our view is that there is good and bad public borrowing. In 
     the 1980s federal deficits financed a military buildup that 
     ended the Cold War (leading to an annual peace dividend in 
     the 1990s of 3 percent of GDP), as well as tax cuts that 
     ended the stagflation of the 1970s and began 25 years of 
     prosperity. Those were high return investments.
       Today's debt has financed . . . what exactly? The TARP 
     money did undergird the financial system for a time and is 
     now being repaid. But most of the rest has been spent on a 
     political wish list of public programs ranging from 
     unemployment insurance to wind turbines to tax credits for 
     golf carts. Borrowing for such low return purposes makes 
     America poorer in the long run.
       By the way, today's spending and debt totals don't account 
     for the higher debt-servicing costs that are sure to come. 
     The President's own budget office forecasts that annual 
     interest payments by 2019 will be $774 billion, which will be 
     more than the federal government will spend that year on 
     national defense, education, transportation--in fact, all 
     nondefense discretionary programs.
       Democrats want to pass the debt limit increase as a 
     stowaway on the defense funding bill, hoping that few will 
     notice while pledging to reduce spending at some future date. 
     Republicans ought to force a long and careful debate that 
     educates the public. Ultimately, the U.S. government has to 
     pay its bills and the debt limit bill will have to pass. But 
     debt limit votes are one of the few times historically when 
     taxpayer advocates have leverage on Capitol Hill. Republicans 
     and Democrats who care should use it to discuss genuine ways 
     to put Washington on a renewed and tighter spending regime.
       ``Washington is shifting the burden of bad choices today 
     onto the backs of our children and grandchildren,'' Senator 
     Barack Obama said during the 2006 debt-ceiling debate. 
     ``America has a debt problem and a failure of leadership. 
     Americans deserve better.'' That was $2 trillion ago, when 
     someone else was President.
  Mr. LeMIEUX. Reading from the Wall Street Journal:

       Democrats ridiculed Mr. Bush as ``the most fiscally 
     irresponsible President in history,'' but then they saw him 
     and raised. They took an $800 billion deficit and made it 
     $1.4 trillion in 2009 and perhaps that high again in 2010. In 
     10 months they have approved more than $1 trillion in 
     spending that has saved union public jobs but has done little 
     to assist private job creation. Still to come is this 
     multitrillion-dollar health care bill and another $100 
     billion to $200 billion ``jobs'' bill.

  We can't afford the programs we have, let alone the programs we want. 
I filed this joint resolution to have a balanced budget. I filed the 
joint resolution to give the President the line-item veto like 
Governors do. I know I am tilting at windmills. I know there are very 
few people in this Chamber or the Chamber down the hall who have the 
courage to do this. They are part of the process. They go along and get 
along. But I am fresh enough to still remember how things work in the 
real world. We have to change things. Our children are not going to 
have this great country. I am so afraid that one of my kids is going to 
come to me when they are 18 or 22 and say: Dad, I am going to go to 
another country to make my living. I am going to go to Ireland or Chile 
or India because I have a better opportunity there to succeed. I can't 
pay 60 percent in taxes. I can't assume what will then be a $23 or $30 
billion debt.
  We are not even talking about all the entitlements we haven't paid 
for. We are not talking about all the money we have raided out of 
Medicare and Social Security in order to pay for current expenses. Some 
people say those obligations are more than $60 trillion, numbers we 
can't even comprehend.
  I filed this resolution. I will send a letter to every Governor 
asking them to adopt it in advance of the Congress taking it up. A 
constitutional amendment requires two-thirds of both Chambers and 
three-quarters of the States. They can act first. They can send letters 
and resolutions from their legislators to this legislative body and 
say: Get your act under control.
  It affects them too. This new health care bill is going to send an 
unfunded mandate to the States and increase Medicaid from 100 percent 
of poverty to 133 percent. They will have to pay that bill. It is going 
to cost Florida in 10 years almost $1 billion. Right now, in Florida, 
the No. 1 expenditure in our budget is Medicaid. Because we balance our 
budget, that means we take money away from teachers and education. That 
means we take money away from law enforcement. It is out of control.
  I am here to say the siren is sounding. The ship is going to hit the 
iceberg. We can't make just incremental change because then we will 
just hit the side of the iceberg. We have to make substantial change. 
The people in this body have to have the courage to do it. We can't 
just go along and get along as we have before. We cannot be tone deaf. 
The American people are onto us. They understand we are spending money 
we don't have. I will not stand by and let this great country fall into 
decline without at least arguing and pushing as strenuously as I can 
for a solution. I am willing to work with men and women of good will on 
both sides of the aisle to solve the problem. I am new here. I might 
not have all the answers. I probably don't. But I will surely work 
hard. I know this is one solution. If every State can have a balanced 
budget amendment and 43 States can have a line-item veto, why can't 
this body?
  I have filed this resolution. I look forward to talking about it 
more. I hope this body will take it seriously. I see my friend from 
Massachusetts is here. He also is new to this body, although he spent 
many years working here. We have to do things differently. We throw 
around billions and trillions like it is just nickles and dimes in our 
pockets. It is not. Every dollar is a choice. It is a choice to make. 
If we don't make the right choice, it will be a choice our children and 
grandchildren will suffer under.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Massachusetts.
  Mr. KIRK. Mr. President, ``The need for comprehensive national health 
insurance and concomitant changes in the organization and delivery of 
health care in the United States is the single most important issue of 
health policy today.'' Those are not my words. Those are the words of 
Senator Edward M. Kennedy. The ``today'' of which he spoke was December 
16, 1969, exactly 40 years ago today. It was his first major speech on 
health care reform, and I was privileged to be a young member of his 
staff. He delivered that speech to a group of physicians at Boston 
University Medical Center.
  Senator Kennedy went on to say:

       If we are to reach our goal of bringing adequate health 
     care to all our citizens, we must have full cooperation 
     between Congress, the administration, and the health 
     professionals. We already possess the knowledge and the 
     technology to achieve our goal. All we need is the will. The 
     challenge is enormous, but I am confident that we are all 
     equal to the task.

  The world has progressed in many ways since he spoke those words four 
decades ago, but our health care system has not. In 1969, the United 
States spent $18 billion on health care. Today we spend over $2 
trillion a year. Senator Kennedy pointed out, in 1969, that the Nation 
faced a shortage of primary care doctors. The reimbursement rates for 
physicians treating Medicare and Medicaid patients were too low. There 
was a need to support greater innovation in delivering care, and 
neighborhood health centers were underfunded. He said we needed to 
develop an effective means of providing quality, affordable care to all 
Americans, regardless of their standing in life.
  Does all this sound familiar? Yes. But that was then and this is now.
  In recent weeks, Senators on both sides of the aisle have come to 
this floor to debate the merits of the Patient Protection and 
Affordable Care Act. We have had our differences of opinion, to be 
sure. But on one issue there is no dispute. When it comes to our health 
care system, there is no such thing as a status quo. We will move 
forward or we will continue to fall behind.
  Here is what we will face, if we do not pass this reform. Premiums 
will skyrocket and could consume as much as 45 percent of a median 
family's income by 2016. Bankruptcies will increase due to families not 
being able to

[[Page S13301]]

afford their medical costs. More Americans will be uninsured. Small and 
large businesses will suffer financially due to health cost increases. 
Health care could constitute as much as 28 percent of our Nation's GDP 
by 2030. Fifteen percent of the Federal budget could be dedicated to 
Medicare and Medicaid by 2040.
  Ted Kennedy had a keen sense of history. He knew Germany adopted the 
idea of national health insurance in the 1880s, that Britain, France, 
and a number of other European nations embraced the concept after the 
First World War, that Canada has had a publicly funded system since the 
1950s. He would ask, as he did in 1969 and again in 2009: If all these 
nations understood long ago that their economic health was ultimately 
tied to the health of their people, why does the United States stand 
alone as the only major industrial nation in the world that fails to 
guarantee health care for all its citizens?
  It is not that we have never sought this goal in the past. 
Presidents, Republicans and Democrats, over many decades, have proposed 
national health insurance in America. Presidents Theodore Roosevelt, 
Franklin Roosevelt, Harry Truman, John F. Kennedy, Richard Nixon, and 
Bill Clinton all made health reform a part of their agenda. Now we 
stand on the threshold of history. Never has this country been so close 
to bringing affordable, quality health care to millions of America's 
families. Today, under President Obama's leadership, the goal is within 
our reach. Failure is not an option. All interested parties have been 
brought to the table. Physicians, hospitals, insurance companies, small 
businesses, pharmaceutical companies, and many others have had an 
opportunity to present their suggestions and offer their input. Dozens 
of hearings were held on all topics related to this issue.
  The House of Representatives has acted. The Senate HELP Committee, 
through the diligence of Senators Kennedy, Dodd, and Harkin and the 
Finance Committee, under the leadership of Senator Baucus, held lengthy 
executive sessions that discussed all areas of reform and delivered and 
developed their respective bills. Due to the hard work and tireless 
patience of the majority leader, we have one merged bill before us, a 
single piece of legislation which will improve the lives of millions of 
Americans in the following ways. It expands coverage to an additional 
31 million Americans, bringing health insurance to almost 94 percent of 
our citizens. It saves money by rewarding the quality and value of 
care, not the quantity and volume of care. It controls the cost of 
skyrocketing premiums and limits out-of-pocket expenses. It reduces the 
Federal deficit by an estimated $130 billion in the first 10 years and 
an estimated $650 billion in the second 10 years. It stimulates 
competition in the health insurance marketplace through establishment 
of exchanges. It strengthens Medicare by reducing unnecessary spending, 
lowering prescription costs, and closing the so-called doughnut hole. 
It attacks fraudulent and wasteful spending and helps to correct abuses 
in the system. It rewards wellness and prevention by expanding access 
to advice on how to live a healthy lifestyle by practicing good 
nutrition, increasing physical activity, and quitting smoking.
  It eliminates unfair discrimination against patients by preventing 
insurance firms from denying certain coverage to women or to 
individuals with preexisting conditions.
  It promotes flexibility and innovation in new health care 
technologies. It introduces a self-funded, voluntary choice for long-
term services and support for the elderly and disabled. Most of all, it 
saves lives by providing affordable, quality care for individuals, 
families, and small businesses.
  In my State of Massachusetts, because of our successful reform, the 
rate of the uninsured has been reduced to 2.7 percent of the 
population, and the lives of thousands of citizens of our Commonwealth 
have been immeasurably improved.
  Carol's case is one example. Carol did not realize the importance of 
having quality, affordable health insurance until she was confronted 
with the gravity of her own health problems. She is a 24-year-old woman 
suffering from seizures and desperately in need of help.
  She remembers having occasional seizures as a child. They occurred 
mostly when she was overtired. As Carol grew older, the seizures became 
more frequent. One day, she had an episode when driving her car. 
Fortunately, her passenger was able to assist her. But that frightening 
incident convinced Carol to seek professional help.
  She learned about the assistance of Health Care For All, the 
Massachusetts organization dedicated to making quality, affordable 
health care accessible to everyone. She applied and was declared 
eligible for Commonwealth Care. She immediately went to see a 
specialist and was given the health care she needed.
  Carol expressed her gratitude in these words:

       I definitely feel blessed to be a Massachusetts resident. I 
     can't thank Health Care For All and MassHealth enough for all 
     the support given to me. The Helpline counselors literally 
     held my hands and brought me to live a healthy life, where 
     there is no fear or embarrassment, but there is knowledge and 
     a total control of my seizures. So, thank you so much all of 
     you who make this happen in people's lives.

  We should all think about Carol and the millions of working families 
across the country when we vote for this legislation. It is our 
responsibility to enact laws that make a positive difference in 
people's lives, and that is what this bill is all about.
  Senator Ted Kennedy envisioned a better America where, as he said:

       [E]very American--north, south, east, west, young, old--
     will have decent, quality health care as a fundamental right 
     and not a privilege.

  This is a historic moment in our national life. We have the chance to 
finally complete the work that a respected Republican President called 
for over a century ago. Quality health care for all has always been 
needed in America but never more than now. The finish line is clearly 
in sight. The momentum and the energy are with us, and it is our 
obligation to seize this historic moment.
  Every Member of this body is aware of the valiant fight Senator 
Kennedy waged for his own health during the last 15 months of his life. 
Many of you saw him, after receiving radiation and chemotherapy in the 
morning in Boston, walk into this Chamber that he loved to cast a 
deciding vote in the afternoon on the issue he proudly called the cause 
of his life.
  While being treated at Massachusetts General Hospital, Senator 
Kennedy met a woman named Karen List. Her daughter Emily was one of 
many patients receiving a similar regimen of exhausting cancer 
treatments. They came from different walks of life, and cancer had 
touched them all.
  In September 2008, after Emily's long summer of treatments, Karen 
wrote about Senator Kennedy and other patients he had met during his 
treatment. She wrote:

       Now, it is almost fall, and little Caroline is starting 
     kindergarten. Senator Kennedy, who came from a hospital bed 
     to speak at the convention, is planning his return to the 
     Senate in January. Alex, an Apache helicopter pilot, is back 
     at Fort Campbell and expects to be deployed to Afghanistan in 
     the New Year. And Emily hopes to be well enough by spring to 
     return to her life in London. The dream, as Senator Kennedy 
     promised, does live on.

  Mr. President, I ask unanimous consent that the article by Karen List 
in the Daily Hampshire Gazette be printed in the Record.
       There being no objection, the material was ordered to be 
     printed in the Record, as follows:

           [From the Daily Hampshire Gazette, Sept. 8, 2008]

           A Champion of Health Comforts his Fellow Patients

                            (by Karen List)

       As Sen. Ted Kennedy's distinctive voice passed the torch at 
     the Democratic National Convention and promised us that the 
     dream lives on, all I could think of was that same 
     distinctive voice several weeks ago calling out: ``Where's 
     Emily?''
       Ted was at the other end of the hall in the Proton Therapy 
     Center, Dept. of Radiation Oncology, at Massachusetts General 
     Hospital, where both the senator and my daughter Emily were 
     being treated for cancer.
       The proton beam is cutting-edge treatment for certain types 
     of tumors, and the MGH center is one of only five in the 
     country and a handful in the world.
       We were lucky to be there, though it was getting 
     increasingly hard to feel lucky as seven weeks of daily 
     treatment took their toll on Emily and the other patients at 
     the center.
       They ranged in age from toddlers to the elderly. Little 
     Caroline was 5. Senator Kennedy was 77. In between them were 
     Emily, 23,

[[Page S13302]]

     and Alex, 26, two of just a few young adults in proton beam 
     treatment.
       Radiation burn was the worst side effect for many patients, 
     and it was now preventing Emily from eating or talking. She 
     was at a low point, and she needed a lift.
       We had seen Teddy come and go for several days, slipping in 
     through a side entrance and out the same way, always 
     accompanied by his wife, Vicki. When our eyes happened to 
     meet, we exchanged a thumb's up and were treated to that 
     Kennedy smile--as distinctive as the voice.
       The day before Ted's treatment was to end, Emily's nurse 
     stopped by the room where she was being treated and pulled 
     the curtain aside. Several minutes later we heard him call 
     from the other end of the hallway: ``Where's Emily?'' And 
     then he was there, talking to her, encouraging her--and just 
     as quickly, he was gone.
       Emily was so excited that she was hopping up and down in 
     the bed from a reclining position, if such a thing is 
     possible. But because she couldn't talk, she hadn't been able 
     to say a word to one of the few politicians she really 
     admires.
       The next day, our nurse delivered the card we'd written to 
     the senator, explaining how thrilled Emily had been to meet 
     him and how distressed she was that she couldn't tell him so 
     herself. On the card was a photo of Emily at her favorite 
     English pub, smiling her own distinctive smile. She had been 
     home for a short break from her work interning in the London 
     Theater when she'd been diagnosed with cancer. Now she was 
     battling to get her work and her life back.
       Teddy had just finished his treatment. This time, as he 
     came down the hall for the last time, Emily was ready. On the 
     slate that she'd been using to communicate, she'd written in 
     purple marker: ``We love you, Ted.'' The senator laughed, 
     walked to her bedside and whispered to her for a few minutes 
     in solidarity, while Vicki talked to Emily's dad and me. We 
     exchanged heartfelt good wishes for each other as they left 
     the center to return home.
       Emily had another week of treatment left. During that time, 
     her nurse told us how concerned Sen. Kennedy had been about 
     the other patients, especially the children and young 
     people--and their parents. He had been through this same 
     experience with his own son decades earlier when only one 
     type of chemotherapy was available, unlike the cocktail of 
     diverse chemo drugs that patients like Emily receive today.
       This lifelong champion of health care for all Americans, 
     especially children, had experienced once again--this time as 
     the patient himself--what first-rate cancer care could mean. 
     And he intends to continue fighting for its accessibility to 
     everyone as the senior Democrat on the Health, Education, 
     Labor, and Pensions Committee.
       On Emily's last day at the center, there was a special gift 
     waiting for her. Ted had left her a copy of his book, ``My 
     Senator and Me: A Dog's-Eye View of Washington, D.C.,'' 
     written by him and his dog Splash. It was inscribed: ``To 
     Emily--Splash and I hope you enjoy.''
       And she did. Ted had provided just the encouragement she 
     needed. He'd also left a stack of books for other young 
     patients and the book on tape for those whose vision had been 
     compromised by their treatments.
       Now it's almost fall, and little Caroline is starting 
     kindergarten. Senator Kennedy, who came from a hospital bed 
     to speak at the convention, is planning his return to the 
     Senate in January. Alex, an Apache helicopter pilot, is back 
     at Ft. Campbell and expects to be deployed to Afghanistan in 
     the New Year. And Emily hopes to be well enough by spring to 
     return to her life in London.
       The dream, as Senator Kennedy promised, does live on.

  Mr. KIRK. Karen's was a statement of hope--hope and promise for each 
of these patients in the face of daunting odds. Their age did not 
matter; their economic status did not matter; each received the highest 
quality of health care available. And so it should be for all our 
people.
  Senator Kennedy understood that we are all connected to one another. 
He often referred to President Lincoln's words about our common 
humanity and the good that can come to us all when touched ``by the 
better angels of our nature.'' And he knew that on no issue are our 
futures more connected than on health care.
  Ted Kennedy's voice still echoes in this Chamber. His spirit of hope 
and strength, of determination and perseverance is still felt here. He 
said:

       For all my years in public life, I have believed that 
     America must sail toward the shores of liberty and justice 
     for all. There is no end to that journey, only the next great 
     voyage. We know the future will outlast all of us, but I 
     believe that all of us will live on in the future we make.

  Let each of us in this Senate be moved by the better angels of our 
nature and make that future a better one for our generation and for 
generations to come. As Ted Kennedy said 40 years ago: ``All we need is 
the will.'' This is our time, Mr. President. Let us pass this 
legislation now.
  Mr. President, I ask unanimous consent that the speech delivered by 
Senator Edward M. Kennedy on December 16, 1969, be printed in the 
Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

  Address by Senator Edward M. Kennedy, Lowell Lecture Series, Boston 
     University Medical Center--Lowell Institute, December 16, 1969

       I am delighted to be in Boston today under the auspices of 
     the Boston University Medical Center and the Lowell Institute 
     to address this distinguished audience of medical educators, 
     private physicians, and lay men concerned with the quality of 
     health care in America.
       I am particularly pleased to be here because it gives me 
     the opportunity to commend the many worthy accomplishments of 
     the Boston University Medical Center and its School of 
     Medicine. You have succeeded in breaking down walls that for 
     decades have turned medicine inward toward the age-old 
     trinity of patient care, research and teaching. You have 
     expanded your horizon to embrace the equally important area 
     beyond your walls--the community in which we live.
       For more than 90 years, your Home Medical Service has taken 
     students into the community and provided model health care 
     and innovative medical services in the home. Your expanding 
     programs of new hospital affiliation have brought modern 
     urban medicine to outlying communities. You have helped to 
     lead the way in efforts throughout the world to unify cancer 
     care with cancer research, so that today's advances in the 
     laboratory become tomorrow's accepted treatment. Your School 
     of Graduate Dentistry, dedicated in September, will provide 
     high quality dental care as part of the Medical Center's 
     total health program for the community.
       In the course of the past decade, your pioneering program 
     in community psychiatry and mental health in the South End 
     and Roxbury--launched long before the Great Society and the 
     Office of Economic Opportunity came into being and made such 
     programs fashionable--have become a model for the nation. You 
     helped develop what is now the rallying cry for health 
     planning in America--that new health programs must be 
     designed with the people and by the people, not just for the 
     people. As Dr. Handler has so eloquently stated, your far-
     reaching role in community involvement is like a man standing 
     by a river watching people drown:
       ``Medicine traditionally wades in,'' he said, ``and tries 
     to save them one at a time. After doing this repeatedly, you 
     can't help but ask what is happening upstream. It seemed 
     sensible to go back and find out why all the people were 
     falling in, and try to do something about it.''
       I commend you for your leadership in looking upstream, and 
     for the remarkable efforts you are making in preventive 
     community medicine and all the other major areas of this 
     great center's activity.
       Six weeks ago in Springfield, I had the occasion to discuss 
     what I regard as the single overriding economic issue of the 
     day--the war against inflation. As I have frequently stated, 
     the war against inflation is a war that can and must be won 
     without the cost of heavy unemployment. It is a war that can 
     and must be won without cutting back on our important 
     domestic priorities.
       Nowhere is the impact of inflation more obvious than in the 
     rising cost of medical care. Never has the gift of good 
     health been more precious:
       In the last three years, the cost of health has risen by 22 
     per cent, or nearly double the rise in general consumer 
     prices.
       Hospital daily service charges have soared by the 
     astronomical rate of 55 per cent, or nearly five times the 
     rise in consumer prices. The average cost of a hospital day 
     is now $68. It will rise to $74 next year, and to $98 by 
     1973.
       Physicians' fees have risen by 21 per cent. Doctors line up 
     at lawyers' offices to form corporations and raid the Federal 
     Treasury for hundreds of thousands of dollars a year in 
     deferred taxes.
       All of this inflation has occurred during the early years 
     of Medicare and the troubled Medicaid program. The most 
     rewarding experience of Medicare has been its success in 
     solving the serious problem of health costs for our poor and 
     our aged citizens. In spite of inflation, Medicare has been 
     immensely popular. It is liked and accepted by the people.
       The most painful experience of Medicare and Medicaid has 
     been their unfulfilled promise. We sought to spread the 
     benefits of medical science and technology to millions of 
     Americans, without considering the anachronistic and obsolete 
     structure of the system by which the health services would be 
     delivered. Unwisely, as many experts have recognized, we 
     assumed that all that stood between our poor and aged 
     citizens and high quality medical care was a money ticket 
     into the mainstream of modern American medicine.
       We know now that we were wrong. The money ticket was 
     important, but it was not enough to solve the problem. In the 
     years since Medicare and Medicaid were enacted, we have 
     learned that medical insurance and payment programs could not 
     be translated instantaneously into more doctors, more nurses, 
     more health facilities, or better organization of the 
     delivery system.
       In wedding new purchasing power to the already existing 
     demand for health services, we did nothing to solve an 
     already intolerable situation. The cost of health care began

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     to soar. In some cases, the quality of care declined, and an 
     enormous strain was placed on the capacity of our existing 
     health services and facilities. When an already overworked 
     physician goes from seeing one hundred patients a day to 
     seeing two hundred patients a day, the quality of his care is 
     inevitably affected. His only escape is to consign more of 
     his patients to hospital treatment, thereby increasing the 
     strain on hospital facilities and hospital costs.
       Today in the United States, health care is big business. 
     Indeed, it is the fastest growing failing business in the 
     nation--a $60 billion industry that fails to meet the 
     urgent demands of our people. Today, more than ever 
     before, we are spending more on health care and enjoying 
     it less. By 1975, we may be spending $100 billion a year 
     on health and be worse off than we are now in terms of the 
     quality and responsiveness of our health care system.
       Perhaps the most serious fault in the present situation is 
     the failure of the Federal Government to play a greater role 
     in improving the quality of the nation's health care. Health 
     is big business in America, and the Federal Government has 
     become a major partner in this business. The total outlays 
     for medical and health-related activities in the Federal 
     budget estimated for 1970 are $18 billion, or nearly one-
     third of the total health expenditures in the nation. The 
     outlays for 1970 are divided among 14 principal departments 
     and agencies. By far the largest amount--$13 billion--is 
     expended by the Department of Health, Education and Welfare, 
     but significant amounts are also expended by the Department 
     of Defense--$2 billion--and the Veterans Administration--$1.7 
     billion.
       In 1960, the total outlays for health in the Federal budget 
     were only $3 billion. Thus, in the decade of the Sixties 
     alone, we have had a six-fold increase in total Federal 
     outlays for health. Indeed, almost 10 per cent of the total 
     Federal budget now goes for health. The major share of the 
     rise in recent years has been for Medicare and Medicaid. Yet, 
     in spite of the dramatic increases in the health budget and 
     the large amounts we are now spending, there is almost no one 
     who believes that either the Federal Government or the 
     private citizen is getting full value for his health dollar.
       Of course, a significant proportion of the increase in 
     health expenditures is being consumed by rising costs and our 
     growing population. Between 1950 and 1969, personal health 
     care expenditures increased by $42 billion. Of this increase, 
     50 per cent was attributable to rising coats, and another 19 
     per cent was attributable to population growth, so that only 
     31 per cent of the increase represents real growth in health 
     supplies and services over the past two decades.
       Although the conventional wisdom is content to blame our 
     current medical inflation on Medicare and Medicaid and the 
     excess demand created by these programs for health care, 
     there is another, more controversial aspect to the rising 
     prices. At Professor Rashi Fein and other experts in the 
     field of the economics of medicine have made clear, the basic 
     models used by economists are not appropriate when applied to 
     health. The medical market. is characterized by the absence 
     of competition, diverse products, and consumer ignorance. 
     Comparisons of quality and performance are extremely 
     difficult, if not impossible.
       In other words, the medical marketplace is an area where 
     the laws of supply and demand do not operate cleanly, and 
     where physicians have a relatively large amount of discretion 
     in setting their fees. Thus, at the time Medicaid and 
     Medicare were instituted, fees rose for a variety of reasons, 
     many of which were unrelated to the creation of excess 
     demand:
       Some physicians raised their fees in anticipation of a 
     Federal fee freeze.
       Some raised their fees in the face of rising hospital 
     costs, in order simply to preserve their slice of the growing 
     health pie.
       Some raised their fees simply because they had the 
     discretion to do so, and decided to take advantage of the 
     instability and price consciousness generated by the new 
     Federal programs.
       As In the case of physicians' fees, the economic model of 
     supply and demand does not tell the whole story of rising 
     hospital costs. In part, hospitals took the opportunity to 
     provide substantial--and wholly justified--wage and salary 
     increases to their notoriously underpaid employees. In part, 
     costs rose because the new Federal financing methods 
     contained few incentives for improving efficiency, but simply 
     encouraged hospitals to pass the higher costs on to 
     Washington.
       The high cost of medical care is but one aspect of the 
     overall health crisis, In America today, it is clear that we 
     are facing a critical shortage of health manpower. Indeed, at 
     bottom, our crisis in medicine is essentially a crisis in 
     manpower. The need is urgent for more physicians, more 
     dentists, more nurses, and more allied health professional 
     and technical workers. We must develop new types of health 
     professionals and pare-professionals. We must make far more 
     efficient utilization of our existing health manpower. Only 
     if we succeed in these efforts will we be able to free our 
     physicians and highly trained medical experts to perform the 
     sort of intricate operations and sensitive counselling 
     discussed by Dean Redlich in the inaugural lecture in this 
     series.
       The need is especially clear in the case of the shortage of 
     doctors. Our low physician-population ratio means that 
     unsatisfactory medical care is a way of life for large 
     numbers of our people in many parts of our nation. In 1967, 
     in the United States as a whole, there were 260,000 private 
     physicians providing patient care for our 200 million people. 
     This is a ratio of 130 physicians for every 100,000 citizens, 
     or one doctor for every 700 people.
       At first glance, the ratio appears to be fairly close to 
     the satisfactory ratio generally recommended by many health 
     experts, but the figures are misleading. The family doctor--
     the general practitioner--is fast disappearing, and is on the 
     verge of becoming an extinct species. At the present time 
     only one out of four of the nation's physicians is engaged in 
     the general practice of medicine. Three out of four are 
     specialists, most of whom accept patients only on a referral 
     basis. The true doctor-population ratio, therefore, is more 
     like one general practitioner per three thousand population, 
     a ratio that is clearly unacceptable for adequate health care 
     for our people. For far too many of our citizens, the only 
     ``doctor'' they know is the cold and impersonal emergency 
     ward of the municipal hospital.
       To make matters worse, the geographic distribution of our 
     doctors is highly uneven. Two-thirds of our physicians serve 
     the more affluent half of our population. In some states, of 
     course, the physician-population ratio is higher than the 
     national average of 130 doctors per 100,000 population. In 
     Washington, D.C., the ratio is 318; in New York it is 199; in 
     Massachusetts, 181.
       In sixteen states, however, the physician-population ratio 
     is far below the national average. In Alaska and Mississippi, 
     the ratio is an abysmal 69, or about one-half the national 
     average. In Alabama, it is 75. Even in Texas, it is only 106. 
     Clearly, therefore, extremely large groups of our population 
     are receiving seriously inadequate medical care because of 
     the shortage of physicians.
       One of our most urgent needs to meet this crisis is a 
     stronger Federal program to expand existing medical schools 
     and establish new schools. We must substantially increase the 
     output of doctors from our medical schools. At the present 
     time, about 8,000 students are graduated from our medical 
     schools each year. The Association of American Medical 
     Colleges estimates that the number of students entering 
     medical schools will increase by 25 per cent to 50 per cent 
     by 1975, as a result of the construction of new medical 
     schools already begun, and the expansion of existing schools 
     already planned. Yet, if the physician-patient ratio is to be 
     improved substantially, our goal should be to admit double 
     the number of current students by 1975, with special emphasis 
     on medical schools in regions where the physicians-population 
     ratio is too low.
       There is another reason why we must increase the enrollment 
     in our medical schools, aside from the need to provide better 
     health care for our people. Today in America, the medical 
     profession is that one profession that flies in the face of 
     the American credo that every man shall have the opportunity 
     to join the profession of his choice. Today in America, if a 
     poor black or white young American aspires to be a lawyer, he 
     will have the opportunity to enroll in a law school somewhere 
     in the nation that will give him the chance to fulfill his 
     dream. It is the shame of American medicine that no such 
     opportunity exists for the youngster who aspires to enter 
     what is perhaps the most exalted and selfless of all our 
     professions, the healing arts.
       Ironically, at the very time we are denying this 
     opportunity to our own citizens, we are importing thousands 
     of foreign-trained doctors each year to meet our manpower 
     crisis. Twenty per cent of the newly licensed physicians each 
     year in the United States are foreign-trained. Forty thousand 
     foreign medical graduates are now practicing medicine in the 
     United States, or about 15 per cent of the total number of 
     doctors providing patient care. Thirty per cent of all our 
     interns and residents are foreign-trained.
       These figures are appalling. I believe that at this crucial 
     period in world history, it is deeply immoral for us to be 
     luring physicians from the rest of the world to meet our own 
     doctor shortage, when their services are even more critically 
     needed in their own lands.
       The landscape we see is bleak, but it is not without hope. 
     If we are to be equal to the challenge, however, we must be 
     prepared to take major new steps. As Hippocrates himself put 
     it two thousand years ago, where the illness is extreme, 
     extreme treatments may be necessary. I would like, therefore, 
     to share with you my views as to the directions we should 
     begin to take now, if we are to meet the challenge.
       First, and perhaps most important, we need a new approach 
     to the politics of health. Our single greatest deficiency in 
     the area of health is our failure to develop a national 
     constituency, committed to a progressive and enlightened 
     health policy. As a prestigious Committee of the National 
     Academy of Sciences has recently and eloquently stated with 
     respect to the problem of the confrontation between 
     technology and society, the issue is far more serious than 
     the simple question of braking the momentum of the status 
     quo. Today, all too often, whether the area be that of 
     medicine, or education, or pollution, the vested interests 
     are strongly ranged against innovation, and there is no 
     champion capable of marshaling the diffuse advocates for 
     progress and reform. When a better teaching organization 
     threatens the bureaucratic status quo in education, we know 
     there will be organized opposition from

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     school officials, but there is seldom organized advocacy by 
     parents and children. When a new and more efficient 
     development is offered that threatens the status quo in 
     health--whether in the organization, financing, or delivery 
     of health care--we know there will be opposition from 
     organized medicine, but there is seldom organized advocacy by 
     health consumers.
       In these situations, a thorough consideration of the 
     relative merits of alternative proposals is rendered 
     difficult, if not impossible, by the presence of powerful 
     spokesmen for the old, and the absence of effective spokesmen 
     for the new. If we are to succeed in making basic changes in 
     our health care system, we can do so only by creating the 
     sort of progressive national health constituency that can 
     make itself heard in the halls of Congress and the councils 
     of organized medicine.
       To be sure, there is cause for hope. The present generation 
     of medical students is outstanding. They are already 
     beginning to develop the commitments to public causes, the 
     enlightment and social conscience so desperately needed in 
     the health profession, And, in spite of the heavy 
     responsibility that organized medicine must bear for the 
     inadequacy of our health manpower and other resources, a 
     few leaders have recently made progressive statements 
     suggesting a new recognition and awareness of the problem.
       Second, the Federal Government must play a far more active 
     and coherent role in the formulation and implementation of 
     health policy. We must develop a comprehensive and carefully 
     coordinated national health policy, with an administrative 
     structure capable of setting health goals and priorities for 
     the nation, In the spring of 1968, I introduced legislation 
     urging the creation of a National Health Council to be 
     established in the Executive Office of the President with 
     responsibility for setting health policies and making 
     recommendations for the attainment of health goals, including 
     the evaluation, coordination, and consolidation of all 
     Federal health programs and activities. The National Health 
     Council would be modeled along the lines of the Council of 
     Economic Advisors, which has consistently played a 
     superlative role in planning and coordinating the nation's 
     economic policy.
       Third, we must move away from our excessive emphasis on 
     high-cost acute-care hospital facilities. We must make more 
     imaginative use of innovative types of low-cost facilities, 
     such as neighborhood health centers and other out-patient 
     facilities, storefront clinics, and group health facilities. 
     In spite of the active opposition of a substantial segment of 
     the medical profession, group practice and hospital-based 
     practice are probably the most efficient and economical means 
     of delivering health care today. In many areas, the ideal 
     arrangement consists of a teaching hospital in a medical 
     center, with affiliations to community hospitals in the 
     surrounding area. In turn, each of the community hospitals 
     serves as the center of a series of satellite group practice 
     clinics that can reach out directly into the entire 
     community.
       Fourth, while we are building the nation's overall health 
     policy, we must give special attention to the health of our 
     urban and rural poor. For too many of the poor, the family 
     physician has disappeared, to be replaced by the endless 
     lines and impersonal waiting rooms of huge municipal and 
     county hospitals. Yet, there are few physicians today who 
     were not trained on the wards and charity patients in our 
     teaching hospitals. Too often, as Professor Alonzo Yerby has 
     eloquently stated, our poor have had to barter their bodies 
     and their dignity in return for medical treatment.
       In America today, millions of our citizens are sick, and 
     they are sick only because they are poor. We know that 
     illness is twice as frequent among the poor. We know that the 
     poor suffer three times as much heart disease, seven times as 
     many eye defects, five times as much mental retardation and 
     nervous disorders. Although our goal must be one health care 
     system open to all our citizens, we have an obligation now to 
     increase the range and efficiency of the health services and 
     facilities available to the poor, with special emphasis on 
     breaking down the barriers that have for so long divided our 
     society into a two-class system of care--one for the rich and 
     one for the poor, separate and unequal.
       Specifically, I urge the Administration to create a 
     National Health Corps, as an alternative to the draft for 
     doctors, and stronger than the ``Project U.S.A.'' program 
     recently recommended by the AMA. Today, doctors are exempt 
     from the draft if they serve two years in the National 
     Institutes of Health or other branches of the Public Health 
     Service. The same exemption should exist for doctors 
     volunteering for medical service in urban or rural poverty 
     areas, Only in this way will we be able to meet the critical 
     need for health manpower in depressed areas. And, once young 
     physicians are exposed to the problems of health care for the 
     poor, a significant proportion of them will be encouraged to 
     remain and dedicate their careers to this service.
       In addition, we should make a substantial new effort to 
     expand the neighborhood health center program. At the present 
     time, less than a dozen medical societies in the nation have 
     become actively involved in neighborhood health centers. Yet, 
     in recent weeks, prominent leaders of the AMA itself have 
     called for a greater role for neighborhood health centers as 
     a means of extending health care to the poor. A few 
     imaginative pilot projects reaching in this direction have 
     recently been funded by the Office of Economic Opportunity, 
     including a program to reorganize the out-patient department 
     at Boston City Hospital as a nucleus for community health 
     care, but our overall effort has been inadequate. Tragically, 
     at a time when even organized medicine is moving forward, we 
     have been unwilling to allocate the resources so urgently 
     needed for this program.
       Fifth, within the critical area of health manpower, we must 
     give special attention to training new types of health 
     professionals. In far too many cases, highly trained 
     physicians spend the overwhelming majority of their working 
     day in tasks that do not require their specialized medical 
     skills. One of the most promising methods of easing the 
     shortage of doctors is to train new types of health workers 
     to perform these non-specialized tasks, thereby freeing our 
     physicians for other, more urgent needs. We must develop a 
     broad new range of allied health professionals, such as 
     paramedical aides, pediatric assistants, community service 
     health officers, and family health workers.
       At a number of our universities, imaginative new programs 
     are under way to train medical corpsmen from Vietnam as 
     physicians' assistants. In the State of Washington, hospital 
     corpsmen are trained for three months in the medical school, 
     and then sent into the field for nine months' further 
     training in the offices of private physicians. A similar 
     program now exists at Duke University. These programs are 
     unique in their emphasis on combined training in the 
     classroom and in the field. They are programs that must be 
     greatly expanded if we are to meet the urgent demand for more 
     and better trained health manpower.
       Sixth, we must restore the severe budget cuts that have 
     been proposed in Federal health programs by the present 
     Administration. Later this week, the full Senate will vote on 
     Federal health appropriations for the current fiscal year, 
     1970. None of us in Congress can be proud that almost half 
     way through the present fiscal year, we are only now about to 
     vote the funds that may be used. Our error is compounded by 
     the knowledge that at this time of medical crisis, Federal 
     assistance to health programs may be drastically curtailed, 
     especially in the areas of research and manpower training.
       Today, when every medical school and every other health 
     school is being urged to expand its manpower programs, the 
     Administration is requesting far less funds than Congress 
     authorized as recently as 1968 for these vital programs.
       The impact of the proposed cuts will be felt in medical 
     schools, hospitals, research centers, and communities 
     throughout the nation. It will be measured in terms of cancer 
     research cut short, lives lost because coronary care units 
     are un-funded, special hardship for the poor, and the loss of 
     dedicated young students from careers in medicine and medical 
     research.
       Seventh, I come to what I believe is the most significant 
     health principle that we as a nation must pursue in the 
     decade of the Seventies. We must begin to move now to 
     establish a comprehensive national health insurance program, 
     capable of bringing the same amount and high quality of 
     health care to every man, woman, and child in the United 
     States.
       National health insurance is an idea whose time has been 
     long in coming. More than a millennium ago, Aristotle defined 
     the importance of health in a democratic society, when he 
     said:
       ``If we believe that men have any personal rights at all as 
     human beings, then they have an absolute moral right to such 
     a measure of good health as society and society alone is able 
     to give them.''
       Today, the United States is the only major industrial 
     nation in the world that does not have a national health 
     service or a program of national health insurance. The first 
     comprehensive compulsory national health insurance was 
     enacted in Prussia in 1854. Throughout the Twentieth century, 
     proposals have been periodically raised for an American 
     program, but never, until recently, with great chance of 
     success.
       National health insurance was a major proposal of Theodore 
     Roosevelt during his campaign for the Presidency in 1912. 
     Shortly before the First World War, a similar proposal 
     managed to gain the support of the American Medical 
     Association, whose orientation then was far different than it 
     is today, During the debate on social security in the 
     Thirties, the issue was again raised, but without success.
       Today, the prospect is better. In large part it is better 
     because of the popularity of Medicare and the fact that many 
     other great national health programs have been successfully 
     launched. The need for national health insurance has become 
     more compelling, and its absence is more conspicuous. In 
     part, the prospect is good because the popular demand for 
     change in our existing health system is consolidating urgent 
     and widespread new support for a national health insurance 
     program as a way out of the present crisis.
       For more than a year, I have been privileged to serve as a 
     member of the Committee for National Health Insurance, 
     founded by Walter Reuther, whose goal has been to mobilize 
     broad public support for a national health insurance program 
     in the United States. Two months ago in New York City, the 
     Reuther Committee sponsored a major conference, attended by 
     officers and representatives of more than 65 national 
     organizations, to consider a tentative blueprint for

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     a national health insurance program. At the time of the 
     conference, I commended Mr. Reuther for the extraordinary 
     progress his Committee has made. I look forward to the future 
     development of the program. Already, it offers. one of the 
     most attractive legislative proposals that is likely to be 
     presented for our consideration next year in Congress.
       We must recognize, therefore, that a great deal of solid 
     groundwork has already been laid toward establishing a 
     national health insurance program. It is for this reason that 
     I believe it is time to transfer the debate from the halls of 
     the universities and the offices of professors to the public 
     arena--to the hearing rooms of Congress and to the offices of 
     your elected representatives.
       Early next year, at the beginning of the second session of 
     the 91st Congress, I intend to introduce legislation 
     proposing the sort of comprehensive national health insurance 
     legislation that I believe is most appropriate at the current 
     stage of our thinking. The mandate of the Medicaid Task Force 
     in the Department of Health, Education and Welfare has been 
     expanded to investigate this area, and I urge the 
     Administration to prepare and submit its own proposals.
       Senator Ralph Yarborough of Texas has told me that, as 
     Chairman of the Senate Subcommittee on Health, he will 
     schedule comprehensive hearings next year on national health 
     insurance. Our immediate goal should be the enactment of 
     legislation laying the cornerstone for a comprehensive 
     health insurance program before the adjournment of the 
     91st Congress. This is an issue we can and must take to 
     the people. We can achieve our goal only through the 
     mobilization of millions of decent Americans, concerned 
     with the high cost and inadequate organization and 
     delivery of health care in the nation.
       Last week on the floor of the Senate, we witnessed the 
     culmination of what has been one of the most powerful 
     nationwide legislative reform movements since I joined the 
     Senate--the taxpayers' revolution. It now appears likely that 
     by the end of this month, there will be laid on the 
     President's desk the best and most comprehensive tax reform 
     bill in the history of the Federal income tax, a bill that 
     goes far toward producing a more equitable tax system.
       We need the same sort of national effort for health--we 
     need a national health revolution, a revolution by the 
     consumers of health care that will stimulate action by 
     Congress and produce a more equitable health system.
       Because of the substantial groundwork already laid, I 
     believe that we can agree on three principles we should 
     pursue in preparing an effective program for national health 
     insurance:
       First, and most important, our guiding principle should be 
     that the amount and quality of medical care an individual 
     receives is not a function of his income. There should be no 
     difference between health care for the suburbs and health 
     care for the ghetto, between health care for the rich and 
     health care for the poor.
       Second, the program should be as broad and as comprehensive 
     as possible, with the maximum free choice available to each 
     health consumer in selecting the care he receives.
       Third, the costs of the program should be borne on a 
     progressive basis related to the income level of those who 
     participate in the program.
       I believe there is no need now to lock ourselves into a 
     specific method of financing the insurance program. There are 
     distinct advantages and disadvantages to each of the obvious 
     alternative financing methods that have been proposed--
     financing out of general revenues of the Treasury, out of tax 
     credits, out of the Social Security Trust Fund, or out of 
     another independent trust fund that could be created 
     specifically for the purpose.
       At the present time, I lean toward a method of financing 
     that would be based on general Treasury revenues, with 
     sufficient guarantees to avoid the vagaries of the 
     appropriations process that have plagued the Congress so much 
     in recent years.
       I recognize the obvious merit of the tax credit and social 
     security approaches. In particular, Social Security financing 
     offers the important advantage that it is a mechanism that 
     Americans know and trust. In the thirty-five years of its 
     existence, Social Security has grown into a program that has 
     the abiding respect and affection of hundreds of millions of 
     Americans. In 1966, it demonstrated its capacity to broaden 
     its horizon by its successful implementation of the Medicare 
     program. To many, therefore, Social Security is the obvious 
     vehicle to embrace a program for national health insurance, 
     and soothe the doubts and suspicions that will inevitably 
     besiege the program when it is launched.
       At the same time, however, we must recognize the obvious 
     disadvantages of Social Security financing. Under the Social 
     Security system, the payroll tax is heavily regressive. The 
     poor pay far too high a proportion of their income to Social 
     Security than our middle or upper income citizens. Today, at 
     a time when Congress is about to grant major new tax relief 
     to all income groups, I believe it would be especially 
     inappropriate to finance a national health insurance program 
     through the conventional but regressive procedures of Social 
     Security, rather than through the progressive procedures of 
     the Federal income tax laws.
       I wish to make clear, however, that I am not now rejecting 
     an approach that would finance national health insurance by a 
     modified approach through the Social Security System. By the 
     use of payroll tax exemptions and appropriate contributions 
     from the Federal. Government, it may be possible to construct 
     a program that will build in the sort of progression that all 
     Americans can accept. The important point here is that we 
     must discuss these possibilities in a national forum, and 
     weigh the alternatives in the critical light of open hearings 
     and national debate.
       We must be candid about the costs of national health 
     insurance. In light of our present budgetary restrictions, 
     the price tags applied to the various health insurance 
     programs are too high. They range from about $10 billion for 
     ``Medicredit,'' the AMA proposal, to about $40 billion for 
     the Reuther proposal, It is therefore unrealistic to suppose 
     that a total comprehensive program can be implemented all at 
     once.
       We can all agree, however, that it is time to begin. In 
     light of the fiscal reality, the most satisfactory approach 
     is to set a goal for full implementation of the program at 
     the earliest opportunity. I believe that the goal should be 
     1975. The legislation we enact should reflect our firm 
     commitment to this target date. Halfway through the decade of 
     the Seventies, we should have a comprehensive national health 
     insurance, program in full operation for all Americans.
       I have already stated my view that legislation establishing 
     the program should be enacted next year. In January, 1971, we 
     should begin to phase-in a program that will reach out to all 
     Americans by the end of 1975, To meet that timetable, we 
     should establish coverage in the first year--1971--for all 
     infants, pre-school children, and adolescents in elementary 
     and secondary schools. In each of the following four years, 
     we should expand the coverage by approximately ten-year age 
     groups, so that by the end of 1975, all persons up to age 85 
     will be covered by the program, and the existing Medicare 
     program can be phased in completely with the new 
     comprehensive insurance.
       The idea of phasing in children first should receive wide 
     support, both from the population as a whole and from the 
     medical profession as well. As a nation today, the United 
     States is the wealthiest and most highly developed medical 
     society in the world, but we rank 14th among the major 
     industrial nations in the rate of infant mortality, and 12th 
     in the percentage of mothers who die in childbirth. In spite 
     of our wealth and technology, we have tolerated disease and 
     ill-health in generations of our children. We have failed to 
     eliminate the excessive toll of their sickness, retardation, 
     disability and death.
       Equally important, we are already close to the level of 
     manpower needed to implement a national health insurance 
     program for our youth. American medicine is equal to the 
     challenge. We have a solid tradition of excellence in 
     pediatric training, with a strong and growing supply of 
     experienced pediatricians, pediatric nurses, and allied 
     manpower.
       Moreover, by beginning our new program with youth and child 
     care, it will be easier for the medical profession to 
     implement the changes in the delivery system that must 
     accompany any effective national health insurance program. 
     And, the changes that we make in the delivery system for 
     pediatric care will give us valuable experience and insights 
     into the comparable but far more difficult changes that will 
     be necessary in the delivery of care to adults as the 
     insurance program is phased in over subsequent years.
       Finally, by phasing in the insurance program over a period 
     of years, I believe we can avoid a serious objection that 
     will otherwise be raised--that national health insurance will 
     simply exacerbate our current inflation in medical costs by 
     producing even greater demand for medical care without 
     providing essential changes in the organization and delivery 
     system.
       We know from recent experience that changes in the 
     organization and delivery of health care in the United States 
     will come only by an excruciating national effort. Throughout 
     our society today, there is perhaps no institution more 
     resistant to change than the organized medical profession. 
     Indeed, because the crisis is so serious in the organization 
     and delivery of health care, there are many who argue that we 
     must make improvements here first, before we can safely 
     embark on national health insurance.
       I believe the opposite is true. The fact that the time has 
     come for national health insurance makes it all the more 
     urgent to pour new resources into remaking our present 
     system. The organization and delivery of health care is so 
     obviously inadequate to meet our current health crisis that 
     only the catalyst of national health insurance will be able 
     to produce the sort of basic revolution that is needed if we 
     are to escape the twin evils of a national health disaster or 
     the Federalization of health care in the Seventies. To those 
     who say that national health insurance won't work unless we 
     first have an enormous increase in health manpower and health 
     facilities and a revolution in the delivery of health care, I 
     reply that until we begin moving toward national health 
     insurance, neither Congress nor the medical profession will 
     ever take the basic steps that are essential to reorganize 
     the system. Without national health insurance to galvanize us 
     into action, I fear that we will simply continue to patch the 
     present system beyond any reasonable hope of survival.
       The need for comprehensive national health insurance and 
     concomitant changes in the organization and delivery of 
     health

[[Page S13306]]

     care in the United States is the single most Important issue 
     of health policy today. If we are to reach our goal of 
     bringing adequate health care to all our citizens, we must 
     have full and generous cooperation between Congress, the 
     Administration, and the health profession. We already possess 
     the knowledge and the technology to achieve our goal. All we 
     need is the will. The challenge is enormous, but I am 
     confident that we are equal to the task.

  Mr. KIRK. Mr. President, I yield the floor.
  Mr. President, I suggest the absence of a quorum and ask unanimous 
consent that the time in the quorum call be divided equally between the 
majority and minority.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The clerk will call the roll.
  The bill clerk proceeded to call the roll.
  Mr. JOHNSON. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. JOHNSON. Mr. President, I rise to express my support for the 
Patient Protection and Affordable Care Act and to encourage my 
colleagues to support this effort to address our health care system's 
immediate and long-term challenges in a fiscally responsible manner.
  For decades, attempts have been made to reform the way our health 
care system works, but only incremental changes have been made. The 
result is a broken system where costs are rising out of control and 
millions of Americans are priced out of the health insurance market.
  In the last 8 years, health care premiums have grown four times 
faster than wages. If health care costs continue to rise at the current 
rates, without reform, it is projected that the average South Dakota 
family will be paying nearly $17,000 in yearly premiums by 2016. That 
is a 74-percent increase over the current premium costs that so many 
already struggle to afford.
  Throughout the ongoing health reform discussion, I have heard from 
far too many South Dakotans who currently face barriers in accessing 
quality health care. This can be due to exorbitant out-of-pocket costs, 
having no insurance coverage, being denied coverage by insurance 
companies, or limited or no health care providers in their area. The 
Patient Protection and Affordable Care Act addresses these barriers in 
part by extending access to affordable and meaningful health insurance 
to all Americans.
  This legislation stands up on behalf of the American people and puts 
an end to insurance industry abuses that have denied coverage to hard-
working Americans when they need it most. Insurance companies will no 
longer be able to deny coverage for preexisting conditions and will not 
be able to drop coverage just because a patient gets sick. Reform will 
ensure that families always have guaranteed choices of quality, 
affordable health insurance whether they lose their job, switch jobs, 
move, or get sick.

  The bill allows Americans to shop for the best health care plan to 
meet their needs and provides tax credits to help those who need 
assistance. It strengthens our health care workforce, improves the 
quality of care, and reduces waste, fraud, and abuse in the health care 
system.
  Every American is adversely affected in some fashion by the 
shortcomings of our existing system, and far too many have a false 
sense of security. The system costs us lives, and it costs us money. If 
we fail to act, health care costs will consume a greater and greater 
share of our Nation's economy and have tremendous potential to cripple 
our Nation's future.
  The Patient Protection and Affordable Care Act puts our Nation on a 
more sustainable financial path. The nonpartisan Congressional Budget 
Office projects that this health reform bill will reduce the Federal 
deficit by $130 billion in the next 10 years and as much as $650 
billion in the decade after that. CBO also projects that this bill will 
result in health care coverage for more than 94 percent of legal 
residents in our Nation. Our citizens deserve this basic security, 
while improving current Medicare benefits.
  This bill is the product of months of research, committee 
deliberation, and bipartisan negotiation. I have listened to some of my 
colleagues' claims that they support health reform yet object to this 
approach. These protests echo those made nearly 50 years ago when a new 
program called Medicare was proposed to provide meaningful health 
benefits to seniors. The increasing cost of health care is 
unsustainable and the do-nothing approach hurts all Americans by 
robbing us of this historic opportunity to stop talking about the 
problems and finally find a solution.
  This bill is not perfect, but a ``yes'' vote will allow the 
conference committee a chance to improve it. The United States is the 
only Nation among industrialized democracies to not have some form of 
national health care. Yet the Senate Republican Party is attempting to 
deny us the right to vote this historic legislation up or down. They 
want to kill it even before it has the chance to go to conference.
  I urge my colleagues to support the Patient Protection and Affordable 
Care Act.
  Mr. President, I ask unanimous consent that the time be charged 
equally.
  The PRESIDING OFFICER. Is there objection?
  Without objection, it is so ordered.
  The Senator from Ohio is recognized.
  Mr. VOINOVICH. Thank you, Mr. President. I have been coming to the 
floor to remind my colleagues and the American people about the fiscal 
realities our Nation faces and to explain how this health reform 
legislation would make our fiscal situation worse and our economy 
suffer even more. I have been here before to highlight how this health 
care bill is chock-full of budget gimmicks to hide its true 
unmanageable costs.
  As I have said before on the floor of the Senate, as a former mayor 
and a former Governor, many people have come to me over the years and 
said: Mayor, you have to do this; Governor, you have to do this. The 
plea they had was genuine, and the need they expressed was genuine, but 
the fact is we couldn't afford what they were asking us to do, and I 
had to say no. Unfortunately, this legislation, in my opinion, will 
increase the cost of health care, drive up our national debt, and 
contribute to unbalanced budgets as far as the eye can see in the 
United States.
  As a former Governor and chairman of the National Governors 
Association, the past chairman of the National League of Cities, one 
gimmick I am particularly concerned about is the one that puts 14 
million additional individuals into the Medicaid Program and then asks 
the States to pick up a portion of the tab. I am very familiar with 
what unfunded mandates can do to State and local governments, and I 
wish to highlight some of the potential consequences of the Medicaid 
expansion for my colleagues.
  At a $374 billion cost to Federal taxpayers, the health care bill 
before us would expand Medicaid coverage to all people under 133 
percent of the Federal poverty level. Because Medicaid costs are shared 
by the Federal and State governments, the States will be on the hook 
for $25 billion of this expansion during the first 10 years.
  To put the $25 billion into perspective, let me spend a minute 
explaining the current fiscal situation of most States in this country. 
Most States such as my State--and I am sure the same is true in the 
Presiding Officer's State--are struggling to make ends meet. I have 
never seen anything like it in my entire life.
  According to the National Governors Association, the States are in 
the deepest and longest economic downturn since the Great Depression. 
In the first two quarters of 2009, State revenues were down 11.7 and 
16.6 percent, respectively. At the same time, Medicaid spending is 
growing, which already makes up, on average, approximately 22 percent 
of States' budgets, and enrollment in the program is skyrocketing at 
the levels it is today because more and more people are becoming 
eligible for Medicaid under the current Federal law.
  In Ohio, for example, where the unemployment rate is hovering around 
10.5 percent, 154,000 Ohioans enrolled in the Medicaid Program in the 
last year alone, an 8-percent increase over last year. This is hard to 
believe, but Medicaid now provides health coverage to nearly 2 million 
Ohioans, almost one out of five residents. Unbelievable.
  Recognizing this increased demand, States have had some help from the 
Federal Government. Earlier this year,

[[Page S13307]]

Congress provided $87 billion in Federal aid to States in the so-called 
stimulus bill to help States deal with Medicaid costs. Yet this money 
was not intended to last forever. As it stands right now, in December 
2010, States will face--that is next December--States will face a steep 
budget cliff when the temporary Medicaid payments coming from the 
stimulus package expire. In facing these realities, Governors across 
the country are already wondering how they will cover the cost of their 
existing programs.
  I recently met with Ray Scheppach, who is the executive director of 
the National Governors Association. He said: Senator, Governor, Mayor, 
we are going to need some help when the money runs out or we will not 
be able to handle the Medicaid challenges we have.
  Not surprisingly, my State's current Governor, Ted Strickland, a 
Democrat, has told me if Medicaid is expanded, he hopes the Federal 
Government will assume most, if not all, the costs. In fact, he told 
the Columbus Dispatch that he has warned officials in Washington that 
``with our financial challenges right now, we are not in a position to 
accept additional Medicaid responsibilities.''
  I suspect that almost every Governor in the country would make that 
same statement to us in the Senate. By the way, this is both Republican 
and Democratic Governors.
  I ask: How can we in good conscience move forward with this bill and 
the new mandate it places on States? How can we force the States to 
make the difficult choices that we are unwilling or unable to make in 
Washington? Pass it on to them, we will pay for it a while, and then 
you guys pick up the cost.
  I served the people of Ohio as Governor for 8 years, and I was forced 
to cut my budget in the beginning four times. I will never forget it. 
There were about 5,000 people outside my office screaming because we 
had made it more difficult or increased the cost of tuition for our 
colleges. I had to make countless difficult decisions across the board 
to be fiscally responsible. I understand the demands of soaring health 
care costs, and as I called that program then, it devoured--Medicaid 
devoured up to 30 percent of our State budget, and I referred to it as 
the Medicaid Pac-Man. I think some people remember Pac-Man. That was 
the Pac-Man just eating up money like crazy. It took away money from 
primary and secondary education, higher education, roads, bridges, 
county and local government projects, and safety service programs that 
we wanted to provide for the citizens of Ohio. We had to do it. It was 
a mandate. It just sucked up that money, and that meant we didn't have 
money for higher education, secondary and primary education, and some 
of the other responsibilities of the State.

  With this experience, I became particularly concerned with the cost 
of Federal mandates, and I worked tirelessly with State and local 
governments to help pass the Unfunded Mandates Reform Act. In fact, the 
first time I ever set foot on the floor of the Senate is the day the 
unfunded mandates bill passed the Senate. It was a wonderful day for 
Ohio and for this country. I was in the Rose Garden representing State 
and local governments when President Clinton signed the legislation 
into law in 1995.
  After that experience, you can imagine how it pains me to be standing 
here today debating legislation that provides for the largest single 
expansion of the Medicaid Program in our country's history and a 
brandnew fiscal liability for States at a time when the States can 
least afford it. I have serious concerns if this bill becomes law and 
States are required to take on more just as the extra stimulus funds 
disappear--which they are going to have to do or we will have to come 
up with the money--Congress will be forced to spend billions more to 
keep the Medicaid safety net from failing completely in the not too 
distant future.
  So what I am basically saying is that when the stimulus money ends in 
December of next year, the Governors are going to be down here with a 
bathtub asking us to fill it because if we don't do it, they are going 
to have to knock off thousands of people, millions in the country, 
because they don't have the money to provide for the program.
  Now, providing extra dollars to States--and I predict it is going to 
happen. It will become an annual ritual for Congress, just as the 
doctors fix has become an annual ritual for doctors. Every year they 
come in. We are not going to cut the annual reimbursement. Next year it 
is 23 percent, I think. We are not going to fill the hole, and the 
Governors are going to be asking for the same kind of help. It is not 
only a mandate for them, it is going to become a mandate for us at a 
time when we are least able to handle anything like that.
  So as a former Governor and a former mayor, a former county 
commissioner, I urge my colleagues to consider the impact this bill 
will have on their respective States. Think about it. Talk to your 
Governors. See what it is going to do to your States. I hope each of my 
colleagues will give careful thought to the potentially devastating 
effects it could have on each of their State budgets and to consult, as 
I said, with their Governors and to talk about the fact that if this 
happens, what is going to happen in terms of the Pac-Man eating up more 
money in their State and their inability to take care of primary and 
secondary education, higher education, and all of the other 
responsibilities State governments have.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Hawaii is recognized.
  Mr. INOUYE. Mr. President, I rise today to address the Department of 
Defense appropriations bill for fiscal year 2010.
  As my colleagues know, this afternoon the Senate received this 
measure from the House which represents a compromise between the bill 
passed by the House last July and what we passed this past October.
  Since passage of the Senate measure, Vice Chairman Cochran and I and 
our staffs have spent countless hours in discussion with our colleagues 
in the House to thrash out the differences between our two bills. The 
product the Senate will consider represents the work of our 
discussions. While this is a House measure, I can assure my colleagues 
it is a very fair and balanced product.

  The Defense appropriations portion of this measure totals $636.3 
billion in discretionary spending, including more than $128 billion for 
the cost of our ongoing efforts in Iraq and Afghanistan.
  In total, the Defense bill is $3.8 billion below the request of the 
President and within the subcommittee's allocation.
  This bill represents the hard work over the past year of all the 
members of the Defense subcommittee. It contains funds that we believe 
will best meet the needs of the men and women who volunteer to serve 
our Nation in the military. The bill provides funding to increase their 
pay by 3.4 percent. It provides more than $30 billion to care for their 
health and the health of their families.
  It provides support to families with loved ones serving in harm's way 
overseas and funding to ensure that their workplaces and quality of 
life back home are protected.
  Of equal importance, the funding in this bill ensures that our forces 
in the field have the equipment and other tools required to meet their 
missions. Funding has been added to the President's request to provide 
for more MRAP vehicles to protect our forces from IEDs in Afghanistan.
  Funds are provided for more medical evacuation and combat rescue 
helicopters to save our wounded troops. Funds have been added to 
sustain production of the C-17 Program so our forces in the field can 
be adequately resupplied, no matter where they are based.
  This bill enhances research in lifesaving technologies and increases 
funds to care for our wounded personnel. It fully funds the priorities 
of Secretary Gates and our military commanders.
  While I know some will criticize the fact that funds have been 
included at the request of Members of Congress, I remind my colleagues 
that, in total, this amount is less than 1 percent of the funding in 
the bill.
  Moreover, all the so-called earmarks in the defense portion of this 
bill were in either the House or Senate bills. There are no 
``airdropped'' earmarks in the defense funding included in this 
measure.
  In addition to the defense portion of the bill, the House has added a 
little

[[Page S13308]]

more than 1 dozen provisions to provide a 2-month safety net to 
unemployed and nearly impoverished Americans and to extend critical 
provisions which are set to expire this month.
  For individual Americans, provisions were included to extend, through 
February 28, 2010, expiring unemployment insurance benefits that were 
established in the American Recovery and Reinvestment Act.
  Likewise, provisions were included to extend the 65-percent COBRA 
health insurance subsidy from 9 to 15 months for individuals who have 
lost their jobs and to extend the job lost eligibility date also 
through February 28, 2010.
  Further, a provision was included to freeze the Department of Health 
and Human Services' poverty guidelines at 2009 levels in order to 
prevent a reduction in eligibility for programs such as Medicaid, food 
stamps, and school lunch programs through March 1 of next year.
  This provision keeps struggling families from falling through the 
cracks.
  In addition, provisions were included to provide $125 million to 
extend the Recovery Act program for small businesses. The program 
reduces lending fees charged to borrowers under the Small Business 
Administration's guaranteed loan programs and increases the Federal 
guarantee on certain small business loans.
  The Recovery Act supported a resurgence in SBA small business 
lending, but funds were exhausted in November. The additional funding 
in this bill will help support lending for small businesses during the 
economic recovery by continuing fee relief for borrowers and 
encouraging lenders to extend credit to small businesses.
  Further, this bill includes a short-term extension of the highway, 
transit, highway safety and truck safety programs. Without this 
extension, the highway program would be brought to a standstill and the 
Department of Transportation would be unable to reimburse States for 
eligible expenses.
  In addition, several agencies--including the Federal Highway 
Administration, the National Highway Traffic Safety Administration, and 
the Federal Motor Carrier Safety Administration--would not have the 
funds necessary to pay their employees.
  This is not your typical end-of-the-year Christmas tree; to the 
contrary, it is the bare minimum of programs which must be continued to 
provide for our less fortunate and our struggling small businesses.
  It also allows for a 2-month extension of laws such as the PATRIOT 
Act, in order to allow more time for our authorizing committees to come 
to agreement on more permanent legislation.
  The House has passed a compromise measure and forwarded it to the 
Senate because of the calendar. Today is December 16, and our 
Department of Defense has been operating on a continuing resolution for 
more than 2 months.
  It is time we get on with the process and get this bill to the 
President. It is a good measure. Our troops deserve our support. Let's 
show we support those who volunteered to serve all of us by voting 
today to send this bill to the President.
  As I close, I wish to thank the Defense Subcommittee staff for their 
dedication and hard work in putting this bill together. I wish to put 
into the Record the names of these staff members who have worked on 
this bill in a bipartisan fashion. They are:

       Charlie Houy, Nicole Diresta, Kate Fitzpatrick, Katy Hagan, 
     Kate Kaufer, Ellen Maldonado, Rachel Meyer, Erik Raven, Gary 
     Reese, Betsy Schmid, Renan Snowden, Bridget Zarate, Rob 
     Berschinski, Stewart Holmes, Alycia Farrell, Brian Potts, 
     Brian Wilson and Tom Osterhoudt.

  Mr. President, it is my pleasure and privilege to be chairman of the 
committee. It is a great honor. I wish to make certain we express our 
gratitude to all these staff people. Without them, I would not be 
standing here at this moment.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Mississippi is recognized.
  Mr. COCHRAN. Mr. President, I am glad I was here to hear the remarks 
of the distinguished Senator from Hawaii. I serve on that subcommittee 
of Defense Appropriations with him and get to observe, at close range, 
the skill and effort and courtesy that is reflected in his service as 
chairman of our committee. It is a pleasure to serve with him and it is 
an honor. He has provided leadership and cooperation in working with 
all Senators--not just members of our committee--to move forward in 
carrying out of duties by the Department of Defense through our 
appropriations process.
  It is very important that the Senate approve, as soon as possible, 
the funding that is contained in the bill that our committee has 
reported to the Senate. It will help support and provide the resources 
necessary to carry out the missions of our men and women have in 
Afghanistan, Iraq, and around the world, safeguarding our freedom, 
protecting our security interests.
  The Department of Defense is now operating under a continuing 
resolution that expires on Friday. This is an inefficient way of 
managing the support for our Department of Defense. It causes too much 
effort to be made by employees and men and women in the Defense 
Department, focusing on management, how to manage day-to-day operating 
expenses dealing with the challenges that too few dollars are provided 
in a way that gives people time to plan and then execute efficiently 
their missions and responsibilities.
  This affects the support that is available to the men and women who 
are overseas and in harm's way.
  The act contains funds necessary to provide medical care as well as 
family support for members of our Armed Forces and their families. 
During this time of war, it is very important that every effort be made 
to provide good medical care for those who are injured and wounded 
serving our country.
  It is also important we support the families. There are funds in this 
legislation that do just that, trying to address the stresses that are 
associated with combat and deployment and separation.
  I am disappointed the normal process has been circumvented, or at 
least delayed, and the other body has not appointed conferees to the 
Defense Appropriations conference committee. It is a disappointment 
also that the Defense Appropriations bill is used as a vehicle to move 
other initiatives that seem to be slowing down the process. These 
measures should be considered separately and addressed in a more 
thoughtful way, based on their own merits, not on the legislation they 
are tied to, to carry them through the legislative process.
  I think attaching nondefense-related legislation to the Defense 
Appropriations Act for this fiscal year has been a mistake. It has been 
unnecessary, unfortunate, and it has resulted in delays and 
uncertainty.
  I am sure there are Senators who can make suggestions for improving 
this bill. We are open to hear those concerns and do our best to 
respond to the suggestions from all Senators. We don't individually 
support all aspects of the agreement, but we think that, in total, it 
is a good bill. It ought to be passed, and it ought to be passed as 
soon as possible in recognition of our respect for our service members 
and their families.
  Mr. INOUYE. Mr. President, there is nothing in rule XLIV which 
governs a message between the Houses in regard to disclosing earmarks. 
However, as chairman of the Appropriations Committee it is my belief 
that the committee should none the less attest that all earmarks have 
been fully disclosed. Accordingly I note that in the bill H.R. 3326 as 
passed by the House and explained in the statement offered by the 
chairman of the Subcommittee on Defense of the House of Representatives 
on December 16, 2009, each earmark in the bill has been disclosed in 
accord with rule XLIV.
  Mr. CONRAD. Mr. President, section 401(c)(4) of S. Con. Res. 13, the 
2010 budget resolution, permits the Chairman of the Senate Budget 
Committee to adjust the section 401(b) discretionary spending limits, 
allocations pursuant to section 302(a) of the Congressional Budget Act 
of 1974, and aggregates for legislation making appropriations for 
fiscal years 2009 and 2010 for overseas deployments and other 
activities by the amounts provided in such legislation for those 
purposes and so designated pursuant to section 401(c)(4). The 
adjustment is limited to the total amount of budget authority specified 
in section 104(21) of S. Con. Res. 13. For 2009, that limitation is 
$90.745 billion, and for 2010, it is $130 billion.

[[Page S13309]]

  The Senate is considering H.R. 3326, the Department of Defense 
Appropriations Act, 2010. That legislation includes amounts designated 
pursuant to section 401(c)(4). Since this is the last of the 12 regular 
appropriations bills for 2010, I am revising previous adjustments made 
to the discretionary spending limits and the allocation to the Senate 
Committee on Appropriations for discretionary budget authority and 
outlays to reflect the final amount of designations made pursuant to 
section 401(c)(4). When combined with all previous adjustments, the 
total amount of adjustments for 2010 is $130 billion in discretionary 
budget authority and $101.178 billion in outlays. In addition, I am 
also further revising the aggregates for 2010 consistent with section 
401(c)(4) to reconcile the amount of outlays estimated by the 
Congressional Budget Office for designated funding with the amount 
originally assumed in the 2010 budget resolution.
  I ask unanimous consent that the following revisions to S. Con. Res. 
13 be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:


CONCURRENT RESOLUTION ON THE BUDGET FOR FISCAL YEAR 2010--S. CON. RES. 
 13; FURTHER REVISIONS TO THE CONFERENCE AGREEMENT PURSUANT TO SECTION 
401(c)(4) ADJUSTMENTS TO SUPPORT ONGOING OVERSEAS DEPLOYMENTS AND OTHER 
                               ACTIVITIES

                        [In billions of dollars]

        Section 101
(1)(A) Federal Revenues:
    FY 2009...................................................1,532.579
    FY 2010...................................................1,623.888
    FY 2011...................................................1,944.811
    FY 2012...................................................2,145.815
    FY 2013...................................................2,322.897
    FY 2014...................................................2,560.448
(1)(B) Change in Federal Revenues:-
    FY 2009.......................................................0.008
    FY 2010.....................................................-42.098
    FY 2011....................................................-143.820
    FY 2012....................................................-214.578
    FY 2013....................................................-192.440
    FY 2014.....................................................-73.210
(2) New Budget Authority:-
    FY 2009...................................................3,675.736
    FY 2010...................................................2,910.707
    FY 2011...................................................2,842.766
    FY 2012...................................................2,829.808
    FY 2013...................................................2,983.128
    FY 2014...................................................3,193.887
(3) Budget Outlays:-
    FY 2009...................................................3,358.952
    FY 2010...................................................3,023.691
    FY 2011...................................................2,966.921
    FY 2012...................................................2,863.655
    FY 2013...................................................2,989.852
3,179.437............................................................
                                  ____


 CONCURRENT RESOLUTION ON THE BUDGET FOR FISCAL YEAR 2010--S. CON. RES.
  13; FURTHER REVISIONS TO THE CONFERENCE AGREEMENT PURSUANT TO SECTION
   401(c)(4) TO THE ALLOCATION OF BUDGET AUTHORITY AND OUTLAYS TO THE
      SENATE APPROPRIATIONS COMMITTEE AND THE SECTION 401(b) SENATE
                      DISCRETIONARY SPENDING LIMITS
                        [In millions of dollars]
------------------------------------------------------------------------
                                     Initial                   Revised
                                   Allocation/   Adjustment  Allocation/
                                      Limit                     Limit
------------------------------------------------------------------------
FY 2009 Discretionary Budget         1,482,201            0    1,482,201
 Authority.......................
FY 2009 Discretionary Outlays....    1,247,872            0    1,247,872
 
FY 2010 Discretionary Budget         1,219,651            1    1,219,652
 Authority.......................
FY 2010 Discretionary Outlays....    1,376,195         -157   1,376,038-
------------------------------------------------------------------------

  The PRESIDING OFFICER. The Republican leader is recognized.


                           Setting Precedent

  Mr. McCONNELL. Mr. President, I rise to make some observations about 
a matter that occurred in the Senate earlier this afternoon.
  The plain language of the Senate precedent, the manual that governs 
Senate procedure, is that unanimous consent of all Members was required 
before the Senator from Vermont could withdraw his amendment while it 
was being read--unanimous consent.
  Earlier today, the majority somehow convinced the Parliamentarian to 
break with the longstanding precedent and practice of the Senate in the 
reading of the amendment.
  Senate procedure clearly states:

       Under rule 15, paragraph 1, and Senate precedents, an 
     amendment shall be read by the clerk before it is up for 
     consideration or before the same shall be debated unless a 
     request to waive the reading is granted.

  It goes on to state that:

       . . . the reading of which may not be dispensed with, 
     except by unanimous consent, and if the request is denied, 
     the amendment must be read and further interruptions are not 
     in order.
  Nothing could be more clear.
  You may have heard that the majority cites an example in 1992 when 
the Chair made a mistake and allowed something similar to happen. But 
one mistake does not a precedent make.
  For example, there is precedent for a Senator being beaten with a 
cane in the Senate. If mistakes were the rule, then the caning of 
Senators would be in order. Fortunately for all of us, it is not.
  It is now perfectly clear that the majority is willing to do 
anything--anything--to jam through a 2,000-page bill before the 
American people or any of us have had a chance to read it, including 
changing the rules in the middle of the game.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Georgia is recognized.
  Mr. CHAMBLISS. Mr. President, I rise today to speak about the 
decision to move the remaining detainees held at Guantanamo Bay Naval 
facility, or Gitmo, to the Thomson Correctional Center in Illinois.
  The decision to transfer Gitmo detainees to the heartland of our 
country is irresponsible, a waste of taxpayer dollars, and contrary to 
the wishes of the American people.
  Congress has included language permitting the transfer or detention 
of Gitmo detainees to the United States only under certain limited 
conditions in every relevant appropriations bill passed this year, 
including the recently passed Omnibus Appropriations Act. That is one 
of the reasons I voted against every single one of those bills.
  The President now has made the decision to purchase the Thomson 
Correctional Center from the State of Illinois for the purpose of 
transferring and detaining Gitmo detainees.
  Further, the President stated he will need to expend millions of 
additional dollars renovating and securing the facility when much has 
already been invested in the state-of-the-art facility at Guantanamo 
Bay. This unnecessary spending is an abuse of our tax dollars and one 
that holds dire national security consequences.
  The administration claims that many of these detainees will continue 
to be held by the military in the same prison where the Department of 
Justice will hold average, ordinary criminals. What the administration 
fails to tell the American people is that these detainees will obtain 
the same rights as U.S. citizens the moment they step inside the United 
States. We have already seen detainees attempt to gain these same 
rights as Americans in our courts and have seen the courts grant them 
limited rights without them being inside the United States.
  In habeas corpus cases where the court has ruled, 30 out of 38 Gitmo 
detainees have been found to be unlawfully detained and their release 
has been ordered. After reviewing the classified biographies on some of 
these individuals, it is clear from these decisions that the courts are 
not in a position to judge matters of war and cannot when they are 
bound by our criminal justice system. It is not designed to handle war 
criminals.
  The courts do not adequately consider the threat these individuals 
pose to U.S. interests or will pose in the future when they return to 
terrorism. President Obama cites the authorization for the use of 
military force as legal justification for continuing the detention of 
these terrorists. However, the courts have already indicated that these 
detainees cannot be indefinitely held. I wonder if the administration 
considered this when it decided to move Gitmo detainees to the United 
States.
  This administration may face the same problem as the last 
administration did in justifying to a U.S. court the continuing 
detention of these terrorists. Only this time, the court will have a 
remedy.
  It is foreseeable that some, and possibly many, of those detainees 
will be ordered released by our courts. The administration has tried to 
assure the public that our immigration laws will prohibit the release 
of those individuals into the United States. But, once again, this 
administration fails to appreciate the limits of our legal system.

[[Page S13310]]

Once these detainees are physically present in the United States, prior 
judicial precedent indicates that the government can only detain an 
individual while immigration removal proceedings are ongoing for a 
maximum of 6 months. If a detainee cannot be transferred or deported, 
they will be released, freed into the United States, after 6 months. 
This is much more than just moving Guantanamo north.
  On the other hand, if the administration is able to secure the 
transfer of these detainees to another country, we can be sure to watch 
the recidivism rates rise. The Department of Defense's last 
unclassified fact sheet on recidivism reported that 14 percent of the 
former Gitmo detainees returned to terrorism after their release or 
their transfer. This is almost one out of every seven detainees 
transferred. This number is much larger now after 8 months and 
countless transfers of the most serious terrorists.
  Some of the detainees transferred openly admit their affiliation with 
a terrorist organization or that they were combating U.S. forces in 
Afghanistan. Confirming this, two former Gitmo detainees transferred to 
Saudi Arabia announced earlier this year that they were now the leaders 
of al-Qaida in the Arabian peninsula. Another detainee, Ali bin Ali 
Aleh, lived with Abu Zubaydah in Pakistan and was identified on a list 
of names in Khalid Shaikh Mohammed's possession when KSM was captured. 
Ali bin Ali Aleh was determined not to be an enemy combatant and 
ordered to be released by a U.S. court in May of this year. He was 
transferred to Yemen in September.
  Maybe some of my colleagues have seen the recent headlines indicating 
that some European countries are willing to accept these detainees. In 
fact, detainees have recently been transferred to Belgium, Ireland, 
Hungary, and Italy. However, the American people are not fooled by 
these headlines. Of the 779 detainees held since 2001 at Guantanamo 
Bay, our European partners have accepted only 37. The vast majority of 
detainees--almost 400--have been transferred to four countries: 
Afghanistan, Saudi Arabia, Pakistan, and Yemen. These four countries 
are either currently in conflict or actively combating al-Qaida. In all 
four of these countries, the threat from al-Qaida and associate 
militants has done nothing but increase over the past few years. Yet 
the United States is sending back hundreds of terrorists to the most 
volatile regions of the world--South Asia, which poses the greatest 
terrorist threat currently to the homeland and to the Arabian 
peninsula, which I believe will present itself as the next greatest 
threat to the United States.
  The decision to move these terrorists to the United States may force 
the administration to choose between freeing terrorists into Illinois 
or transferring them back to the center of the battle. Is this the 
policy position we want to put our country in while we are still 
combating terrorism?
  No one doubts the security of our prisons to safely hold these 
individuals. I doubt the ability of our laws and judicial system to 
ensure that these terrorists are convicted or kept in prison. 
Prohibiting the detainees from entering the United States is the only 
guarantee. However, the decision to move the remaining terrorists at 
Gitmo to the heart of this country shattered any remaining hope for 
this guarantee. This is yet another step in a series of poor policy 
decisions which is leading our country in the wrong direction.
  I am disappointed by this decision, obviously. But I can only imagine 
how the residents of Illinois feel about it. I know Georgians would not 
be pleased with housing over 200 of the most serious and hardened 
terrorists in the world in their backyard.
  I yield the floor and suggest the absence of a quorum.
  The PRESIDING OFFICER (Mrs. Shaheen). The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. DURBIN. Madam President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. DURBIN. Madam President, I wish to respond to my friend from 
Georgia, who just stepped off the floor, about the transfer of 
detainees from Guantanamo because he misstated a few things that I do 
not want to stay on the record.
  First, he suggested that these detainees would be freed in Illinois. 
Not so. The plan of this administration is not to free them; the plan 
is to imprison them in the most secure prison in the United States of 
America. It is in Thomson, IL, 150 miles from Chicago. I was there a 
few weeks ago. It is a supermax prison built 7 years ago and never 
fully occupied. Now they are going to build an additional fence around 
it. It will be more secure than any prison in America. They will be 
freed into the most secure prison in America and they are not coming 
out until such time as there is a resolution of whatever their issues 
may be or they pass away.
  I might also say that the current law in the United States prohibits 
the President of the United States from releasing these detainees in 
the United States. Those statements by the Senator from Georgia are 
just flat incorrect.
  He is entitled to his position--and others share it--that we should 
not close Guantanamo. I believe we should. On my side of this argument 
would be the following people who have called for the closure of 
Guantanamo: President George W. Bush; Secretary of State and former 
Chairman of the Joint Chiefs of Staff Colin Powell; Secretary of 
Defense under President Bush and under President Obama, Robert Gates; 
former Secretary of State and domestic policy adviser Condoleezza Rice; 
GEN David Petraeus, and 33 other generals, in addition to President 
Barack Obama.
  This argument that closing Guantanamo endangers the United States 
ignores the obvious. The people entrusted with the responsibility of 
protecting the United States have called for the closure of Guantanamo. 
Yesterday, Robert Gibbs, press secretary to President Obama, was asked 
about this decision to transfer. He said that on more than 30 
occasions--I am not sure of the timeframe, whether it was this year or 
a longer period of time--but on more than 30 occasions, they have found 
direct linkage of terrorist recruitment activity and the use of 
Guantanamo as an illustration of why people needed to convert to 
terrorism around the world. It is still being actively used for 
recruitment.
  If the Senator from Georgia would go back a few weeks and read 
Newsweek magazine, one of their reporters was captured in Tehran and 
held in captivity for almost 4 months. He told a story of how he was 
first incarcerated in a prison in Tehran. As he arrived, his jailer 
said to him: Welcome to Abu Ghraib and Guantanamo, American.
  So for us to believe that the rest of the world does not have a 
negative image of Guantanamo and it is not being used against our 
troops is to ignore the obvious.
  There are some in this body who are hidebound to keep Guantanamo open 
at any costs. I will tell you, the cost is too high. If the 
continuation of Guantanamo means danger to our troops, we owe it to 
them to close it. Presidents have reached that conclusion, people in 
charge of national security have reached that conclusion, and we should 
as well.
  Then there is this notion about the danger of incarcerating 
terrorists in the United States. For the record, over 350 convicted 
terrorists are currently imprisoned in the United States, all over the 
United States. In my home State of Illinois, 35 convicted terrorists 
are in prison today. The most recent incarceration involves a man 
arrested shortly after 9/11 in Peoria, IL, an unlikely hotbed of 
terrorism and spy activity, but, in fact, this man going to school in 
Peoria, IL, through his communications was linked with al-Qaida. He 
served time in a Navy brig in South Carolina, if I am not mistaken, and 
eventually was tried in the courts of Peoria, IL, convicted and now 
incarcerated in Marion, IL, in southern Illinois.
  I heard not one word of criticism when this took place under the 
previous administration. The belief was this man had to answer for the 
crimes he was charged with and serve time in our prison system as a 
result of it. Never--not once, not one time--did I ever hear any 
Congressman of either political party say: Boy, it is unsafe to try him 
in Peoria or it is unsafe to incarcerate him in southern Illinois. It 
has never been said.

[[Page S13311]]

  What happens to these people when they go into our supermax prisons, 
where no one has ever escaped? They disappear, as they should. They are 
where they ought to be--isolated and away from causing harm to anyone.
  When President Obama was looking for an alternative to Guantanamo, we 
came forward. One of the mayors of a small town in Illinois--Thomson, 
IL--with just several hundred people living there, wrote to the 
Governor of our State and to me and said: I have a big old prison the 
State built and never opened--built it in 2001. It has the capacity of 
several thousand prisoners, and the State could never afford to open 
it. We had hoped that this prison would create a lot of local jobs for 
us. Can you find a use for it at the Federal level?
  The Obama administration took a hard look at this for a long period 
of time. Part of it was done confidentially, and then they came out 
publicly and said: We are seriously interested.
  The Senator from Georgia said earlier: Well, the people of Illinois 
are against this.
  Well, I would say to my friend from Georgia, come on down to Thomson, 
IL. Come down and see the people who are overwhelmingly supportive--and 
not just Democrats, believe me. Local State representative Jim Sacia is 
a Republican and a former FBI agent. He said we would be idiots not to 
take this offer from the Federal Government. He is right. Three 
thousand jobs. I don't know that there is a Senator here if you said to 
him: Would you be interested in 3,000 jobs in the midst of a recession, 
who wouldn't stand up and say: Let's talk.
  Well, we did. So it is 3,000 new jobs at this prison when it is 
opened as part of the Bureau of Prisons and part of the Department of 
Defense.
  How many Guantanamo detainees will be sent there? Fewer than 100. We 
have 35 in our prisons already. Life has not changed in my home State 
of Illinois, nor has it changed in any other State where they are 
incarcerated. It would not change in Thomson, IL. These people can be 
held safely and securely. I trust our men and women in the military to 
do that, and the Members of the Senate should do so as well.
  These 3,000 jobs are going to be a Godsend to an area with 11 percent 
unemployment. First, there will be a lot of construction jobs, and we 
can use those. Those are good-paying jobs for Americans right here at 
home. Then those who work for the Bureau of Prisons are going to be 
paid a good salary and receive good benefits, the kind of salary you 
can use to build a family, a community, a neighborhood. These will be 
people who will be buying homes--3,000 of them. They will be buying 
homes, cars, shopping for appliances, and going to the local shopping 
malls. Is that going to be good for the economy? You bet it is. It is 
just what we need, and it is just what this area of the State wants. 
This argument that we somehow will oppose it is just wrong.
  There is a local Congressman, who is a friend of mine--a Republican 
Congressman--who opposes it. We have talked about it. We just don't see 
eye to eye on it. But even in Rockford, IL, the largest city in his 
district, which is northeast of Thomson, the city council in Rockford 
passed a resolution of approval of this Thomson prison, 12 to 2. In 
county after county, State and local governments--I should say local 
county governments are coming out in favor of this Thomson prison. 
Those who come to the Senate floor and argue otherwise don't know the 
facts. When they know the facts, they will realize we are prepared to 
do this.
  Now the question is whether the Senate will stand behind the 
President, stand behind our security advisers who believe this is in 
the best interest of the United States. I think it is. It isn't the 
first time Illinois has been called on to do something extraordinary 
for our country. The first supermax prison in our Federal system was 
built in Marion, IL, years and years ago. There was controversy. This 
was the most secure prison in America. But I will tell you, the people 
of southern Illinois rallied behind it. It has been a prison with a lot 
of great professionals who have worked there. They have done their jobs 
and done them well.
  When I go down to Marion, IL, and talk to them about Guantanamo 
detainees, they say: Senator, listen. Send them here. We will take care 
of them. We can point out among those who are incarcerated at Marion 
prison those who were engaged in al-Qaida terrorism, Colombian drug 
gangs, Mexican drug cartels, some of the meanest, toughest most violent 
gang bangers from the cities in the Midwest--and they are held safely 
every day.
  I will tell you, when I hear people say they do not trust our prison 
system to hold a handful or 50 or whatever the number may be--less than 
100--of these Guantanamo detainees, they ought to meet the men and 
women who do it every single day in America, and do it well. They 
should realize these detainees will be held by our military, the 
Department of Defense employees. Those are the ones we can trust to do 
it.
  So I would urge my friends and others who have spoken earlier--
Senator McConnell came to the Senate floor earlier. It has become, 
unfortunately, a party position now that it is a bad idea. Earlier, 
Senator McCain and Senator Graham on the Republican side of the aisle 
didn't argue against the transfer of these detainees. They understand 
these prisoners aren't larger than life. They have been in prison for 8 
years. Frankly, I don't know how much longer they will stay there. But 
as long as they are a threat to the United States, they will.
  Madam President, I would like to at this point address an issue which 
came up earlier on the Senate floor.
  Something unusual happened on the floor of the Senate today, Madam 
President. It happens but rarely. Under the rules of the Senate, 
amendments and bills can be read, if a Member requests, and we usually 
ask unanimous consent to dispense with the reading. And, routinely, 
that is done. It is done every day on scores of different things.
  Today, Senator Sanders of Vermont offered an amendment near and dear 
to his heart on single-payer health care reform, and it turned out to 
be a voluminous amendment--800 pages long. When the time came to ask 
consent that it not be read, there was an objection from Senator Coburn 
of Oklahoma. He insisted that it be read. Our poor clerking staff up 
here--the clerks of the Senate--started reading this bill, and they 
read on for almost 2 hours or more.
  As they were reading it, it came to our attention that Senator 
Sanders of Vermont had authority under the Senate rules to withdraw his 
amendment and to stop the reading of the amendment.
  I wasn't aware of that because I can't recall that has ever happened 
since I have been here. But I made a point--since many years ago I was 
a parliamentarian of the Illinois State Senate and tried to at least 
read the rules from time to time--to turn to rule XV, section 2, in the 
Standing Rules of the Senate, and here is what it says:

       Any motion, amendment, or resolution may be withdrawn or 
     modified by the mover at any time before a decision, 
     amendment or ordering of the yeas and nays, except a motion 
     to reconsider, which shall not be withdrawn without leave.

  In other words, until action was taken on the Sanders amendment, he 
had the authority under rule XV, paragraph 2 to withdraw his amendment, 
which he did.
  Some have come to the floor and protested and said this was 
extraordinary, and it can't be backed up by the Senate rules. But I 
refer them to this rule, which is explicit, and that no action had 
taken place on this amendment other than the introduction of the 
amendment and reading. So, as it says here, ``any time before a 
decision, amendment, or ordering of the yeas and nays.'' I think that 
is a clear case.
  I have since read an earlier ruling by the Chair relative to the same 
rule that goes back several decades, so the ruling of the Chair today, 
or at least the finding of the Chair, was consistent with the rules of 
the Senate. But the strategy that came out in the ordering of this 
amendment to be read is pretty clear when it comes to health care. The 
Republican strategy is clear to anyone who is watching the debate: They 
do not want amendments. In fact, they just don't want us to vote on 
health care reform. There comes a time when people make the best 
arguments they can and the Senate makes a decision, and that is what we 
are facing. That is what we want. We would like to do that in a timely 
fashion.

[[Page S13312]]

  Members here believe we can do that in a responsible way and move 
this health care reform bill to a point of a vote--a cloture vote, with 
a 60-vote requirement--and do that in a way that we can find the 
sentiment in the Senate on this important measure and just maybe go 
home for Christmas, which a lot of us would like to do. We have been 
away from our families for quite a while.
  During the course of this debate, we have been spending a lot of time 
on the bill itself. I usually like to give people an idea by holding up 
this 2,074-page bill. It took a lot of work to get to this point. The 
managers' amendment to this will be several hundred pages, I imagine.
  People say: Why is it so big? It is big because we are changing the 
health care system in America, which is one-sixth of our economy. You 
can imagine all the different moving parts in this complicated health 
care system that we address with this bill.
  During this period of time, the Republicans have not offered any 
alternative or substitute. I thought that would be their first motion, 
to come forward and say: That is the Democratic plan to change the 
health care system in America, but you should see the Republican plan, 
how much better it is. They didn't do that because there is no 
Republican alternative. There is no Republican substitute.
  Last week, when I went to the Senate Republican Web site--and I 
invite people to do the same--I found there was only one bill printed 
there on health care reform. It was the Democratic bill, not any bill 
that has been offered by the Republican side. The reason is this is 
hard work. Putting a bill like this together, getting experts to look 
at it and decide whether it is going to save money or cost money, it 
takes time. We have taken that time to do it, and do it right, and they 
have not. So they are either not up to the challenge of preparing an 
alternative bill, or they are content with the current system.
  I guess some people are content with the current system. Among those 
who are content with it are the CEOs of health insurance companies. 
They like this system. They make a lot of money. They do it at the 
expense of a lot of people who need health care and end up being turned 
down. So, unfortunately, the Republicans have no constructive proposals 
to improve our bill. Each and every amendment, almost without 
exception, has been to send the bill back to committee; to stop working 
on it, and let's do this another day. All they want to do on the bill 
is to delay it, as they tried to do today with the reading of the 
Sanders amendment.
  Senator Judd Gregg of New Hampshire is a friend of mine. He and his 
wife Kathy and my wife Loretta and I have traveled together on official 
business of the Senate. I like him. He is a smart guy. He is going to 
retire, and he, in his wisdom, decided to leave a playbook for the 
Republican side of the aisle, which they shared. It is page after page 
of ways to slow down and stop the Senate from acting. Senator Gregg is 
entirely within his rights as a Senator to do it. What I read in his 
memo was accurate, but the intent and motive are clear: He wanted to 
stop this bill from moving in order, and that became the real cause on 
the Republican side of the aisle. They took a page out of Senator 
Gregg's playbook today with Senator Coburn's demanding the amendment be 
read. But it didn't work.
  Madam President, I ask unanimous consent to have printed in the 
Record a colloquy between former Senators Adams and Packwood on the 
floor of the Senate on September 24, 1992.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                        Tax Enterprise Zones Act

              (Senate--September 24, 1992), [Page: S14919]

       The Senate continued with the consideration of the bill.
       The PRESIDING OFFICER. The Senator from Washington is 
     recognized.


                           AMENDMENT NO. 3173

   (Purpose: To amend the Internal Revenue Code of 1986 to deny the 
benefits of certain export subsidies in the case of exports of certain 
  unprocessed timber, and to establish rural development programs for 
certain rural communities and small businesses that have been adversely 
    affected by a declining timber supply and changes in the timber 
                   industry in the Pacific Northwest)

       Mr. ADAMS. Mr. President, I send an amendment to the desk 
     and ask for its immediate consideration.
       The PRESIDING OFFICER. The clerk will report.
       The assistant legislative clerk read as follows:
       The Senator from Washington [Mr. Adams] proposes an 
     amendment numbered 3173.
       Mr. ADAMS. Mr. President, I ask unanimous consent that 
     reading of the amendment be dispensed with.
       Mr. PACKWOOD. Mr. President, I object.
       The PRESIDING OFFICER. Objection is heard. The clerk will 
     read the amendment.
       The assistant legislative clerk continued reading the 
     amendment.
       Mr. ADAMS. Mr. President, I ask unanimous consent that 
     further reading of the amendment be dispensed with.
       Mr. PACKWOOD. I object.
       The PRESIDING OFFICER. Objection is heard.
       Mr, ADAMS. Mr. President, parliamentary inquiry? I have a 
     parliamentary inquiry of the Chair. Is it in order, during 
     the reading of the amendment, without it being dispensed 
     with, for the floor leader and the opponent of the amendment 
     to have a discussion?
       The PRESIDING OFFICER. The regular order, as the Chair is 
     advised by the Parliamentarian, is that the amendment is to 
     be read because objection has been heard to the unanimous-
     consent request.
       The clerk will read the amendment.
       The assistant legislative clerk continued reading the 
     amendment.
       Mr. ADAMS. Mr. President, I ask permission to withdraw the 
     amendment.
       The PRESIDING OFFICER. The Senator has a right to withdraw 
     the amendment.
       Mr. ADAMS. I withdraw the amendment.
       The PRESIDING OFFICER. The amendment is withdrawn.
       The amendment (No. 3173) was withdrawn.
       The text of the amendment (No. 3173) is as follows:
       At the end of title VIII, insert the following new 
     sections:

  Mr. DURBIN. Incidentally, Madam President, that is the colloquy I 
referred to earlier where the Chair made exactly the same ruling on 
that day as was made today, the finding in terms of rule XV, paragraph 
2.
  I also ask unanimous consent to have printed in the Record the 
memorandum prepared by Senator Gregg for the Republican side of the 
aisle concerning the rights of the minority in the Senate, which I have 
mentioned earlier, and largely includes the rights to slow down and 
stop the activity of the Senate.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

  Foundation for the Minority Party's Rights in the Senate (Fall 2009)

       The Senate rules are designed to give a minority of 
     Senators the right to insist on a full, complete, and fully 
     informed debate on all measures and issues coming before the 
     Senate. This cornerstone of protection can only be abrogated 
     if 60 or more Senators vote to take these rights away from 
     the minority.
       I. Rights Available to Minority Before Measures are 
     Considered on Floor (These rights are normally waived by 
     Unanimous Consent (UC) when time is short, but any Senator 
     can object to the waiver.)
       New Legislative Day, An adjournment of the Senate, as 
     opposed to a recess, is required to trigger a new legislative 
     day. A new legislative day starts with the morning hour, a 2-
     hour period with a number of required procedures. During part 
     of the ``morning hour'' any Senator may make non-debatable 
     motions to proceed to items on the Senate calendar.
       One Day and Two Day Rules--The 1-day rule requires that 
     measures must lie over one ``legislative day'' before they 
     can be considered. All bills have to lie over one day, 
     whether they were introduced by an individual Senator (Rule 
     XIV) or reported by a committee (Rule XVII). The 2-day rule 
     requires that IF a committee chooses to file a written 
     report, that committee report MUST contain a CBO cost 
     estimate, a regulatory impact statement, and detail what 
     changes the measure makes to current law (or provide a 
     statement why any of these cannot be done), and that report 
     must be available at least 2 calendar days before a bill can 
     be considered on the Senate floor. Senators may block a 
     measure's consideration by raising a point of order if it 
     does not meet one of these requirements.
       ``Hard'' Quorum Calls--Senate operates on a presumptive 
     quorum of 51 senators and quorum calls are routinely 
     dispensed with by unanimous consent. If UC is not granted to 
     dispose of a routine quorum call, then the roll must continue 
     to be called. If a quorum is not present, the only motions 
     the leadership may make are to adjourn, to recess under a 
     previous order, or time-consuming motions to establish a 
     quorum that include requesting, requiring, and then arresting 
     Senators to compel their presence in the Senate chamber.
       II. Rights Available to Minority During Consideration of 
     Measures in Senate (Many of these rights are regularly waived 
     by Unanimous Consent.)
       Motions to Proceed to Measures--with the exception of 
     Conference Reports and Budget Resolutions, most such motions 
     are fully debatable and 60 votes for cloture is needed to cut 
     off extended debate.

[[Page S13313]]

       Reading of Amendments and Conference Reports in Entirety--
     In most circumstances, the reading of the full text of 
     amendments may only be dispensed with by unanimous consent. 
     Any Senator may object to dispensing with the reading. If, as 
     is often the case when the Senate begins consideration of a 
     House-passed vehicle, the Majority Leader offers a full-text 
     substitute amendment, the reading of that full-text 
     substitute amendment can only be waived by unanimous consent. 
     A member may only request the reading of a conference report 
     if it is not available in printed form (100 copies available 
     in the Senate chamber).
       Senate Points of Order--A Senator may make a point of order 
     at any point he or she believes that a Senate procedure is 
     being violated, with or without cause. After the presiding 
     officer rules, any Senator who disagrees with such ruling may 
     appeal the ruling of the chair--that appeal is fully 
     debatable. Some points of order, such as those raised on 
     Constitutional grounds, are not ruled on by the presiding 
     officer and the question is put to the Senate, then the point 
     of order itself is fully debatable. The Senate may dispose of 
     a point of order or an appeal by tabling it; however, delay 
     is created by the two roll call votes in connection with each 
     tabling motion (motion to table and motion to reconsider that 
     vote).
       Budget Points of Order--Many legislative proposals (bills, 
     amendments, and conference reports) are subject to a point of 
     order under the Budget Act or budget resolution, most of 
     which can only be waived by 60 votes. If budget points of 
     order lie against a measure, any Senator may raise them, and 
     a measure cannot be passed or disposed of unless the points 
     of order that are raised are waived. (See http://
budget.senate.gov/republican/pressarchive/PointsofOrder.pdf)
       Amendment Process
       Amendment Tree Process and/or Filibuster by Amendment--
     until cloture is invoked, Senators may offer an unlimited 
     number of amendments--germane or non-germane--on any subject. 
     This is the fullest expression of a ``full, complete, and 
     informed'' debate on a measure. It has been necessary under 
     past Democrat majorities to use the rules governing the 
     amendment process aggressively to ensure that minority 
     Senators get votes on their amendment as originally written 
     (unchanged by the Majority Democrats.)
       Substitute Amendments--UC is routinely requested to treat 
     substitute amendments as original text for purposes of 
     further amendment, which makes it easier for the majority to 
     offer 2nd degree amendments to gut 1st degree amendments by 
     the minority. The minority could protect their amendments by 
     objecting to such UC's.
       Divisible Amendments--amendments are divisible upon demand 
     by any Senator if they contain two or more parts that can 
     stand independently of one another. This can be used to fight 
     efforts to block the minority from offering all of their 
     amendments, because a single amendment could be drafted, 
     offered at a point when such an amendment is in order, and 
     then divided into multiple component parts for separate 
     consideration and votes. Demanding division of amendments can 
     also be used to extend consideration of a measure. Amendments 
     to strike and insert text cannot be divided.
       Motions to Recommit Bills to Committee With or Without 
     Instructions--A Senator may make a motion to recommit a bill 
     to the committee with or without instructions to the 
     Committee to report it back to the Senate with certain 
     changes or additions. Such instructions are amendable.
       After Passage: Going to Conference,Motions to Instruct 
     Conferees, Matters Out of Scope of Conference
       Going to Conference--The Senate must pass 3 separate 
     motions to go to conference: (1) a motion to insist on its 
     amendments or disagree with the House amendments; (2) a 
     motion to request/agree to a conference; and (3) a motion to 
     authorize the Chair to appoint conferees. The Senate 
     routinely does this by UC, but if a Senator objects the 
     Senate must debate each step and all 3 motions may be 
     filibustered (requiring a cloture vote to end debate).
       Motion to Instruct Conferees--Once the Senate adopts the 
     first two motions, Senators may offer an unlimited number of 
     motions to instruct the Senate's conferees. The motions to 
     instruct are amendable--and divisible upon demand--by 
     Senators if they contain more than one separate and distinct 
     instruction.
       Conference Reports, Out of Scope Motions--In addition to 
     demanding a copy of the conference report to be on every 
     Senator's desk and raising Budget points of order against it, 
     Senators may also raise a point of order that it contains 
     matter not related to the matters originally submitted to the 
     conference by either chamber. If the Chair sustains the point 
     or order, the provision(s) is stricken from the conference 
     agreement, and the House would then have to approve the 
     measure absent the stricken provision (even if the House had 
     already acted on the conference report). The scope point of 
     order can be waived by 60 Senators.
       Availability of Conference Report Language. The conference 
     report must be publicly available on a website 48 hours in 
     advance prior to the vote on passage.

  Mr. DURBIN. Madam President, I would just say that when Senator 
McConnell came to the floor after the ruling and the decision of the 
Chair, he said the plain language of the Senate precedent--the manual 
that governs Senate procedure--is that unanimous consent of all Members 
was required before the Senator from Vermont could withdraw his 
amendment while it was being read. He said it required unanimous 
consent. But that is not what the language of the Senate rules say that 
I have read. They say a Senator has, as a matter of right under rule 
XV, paragraph 2, to withdraw his amendment before action is taken. In 
this case, as I mentioned earlier, the argument back in 1992 backs up 
the Parliamentarian's decision in that interpretation of the rule.
  So I would say it didn't work today to stop or slow down the Senate. 
Currently, we are not technically debating health care reform. What is 
before us now is the Department of Defense appropriations bill from the 
House, which I hope we can move on quickly. I think it is not 
controversial. It is a matter of finding money for our troops who are 
risking their lives overseas and supporting their families at home and 
providing health care for members of the military and their families. I 
don't think there is much debate about that.
  It also extends the unemployment benefits that people need across 
America, which passed with a 97-to-0 vote, if I am not mistaken, not 
that long ago--the last time it was considered. So these are matters 
which should move along, and we should be able to do it in a fairly 
straightforward way. I would hope we can show some bipartisanship when 
it comes to our men and women in uniform and approve the Department of 
Defense appropriations bill, which does not contain anything 
controversial beyond what I have just described. We can then get back 
to the health care reform bill. I think it is important that at some 
point we bring this to a vote, to find if we indeed have the 60 votes 
for health care reform. I sincerely hope we do.
  I will close by saying this health care reform bill has its critics, 
but it also has several features which can't be denied.
  The first of those features that have been verified by the 
Congressional Budget Office: This bill does not add to the deficit of 
the United States; it reduces the deficit by $130 billion over 10 years 
and $650 billion, moreover, the following 10 years.
  We have also received reports from the Congressional Budget Office 
that the result of this bill will be a decline in the increase in the 
cost of health insurance premiums--something we desperately need.
  It is a bill that will also extend health insurance coverage to 30 
million more Americans who do not have it today--50 million uninsured 
Americans; 30 million of them, 60 percent of them, will have the 
protection of health insurance coverage. Ninety percent of Americans 
will have health insurance coverage--the highest percentage in the 
history of the United States of America--as a result of this bill.
  This bill addresses directly the issue of whether health insurance 
companies can continue to deny coverage when people need it the most. 
We know stories from our own life experience and our families' and 
people who write to our offices, that people in the most need of health 
insurance protection are often turned down by the companies. They pore 
through the applications and say: You failed to disclose a preexisting 
condition. They say: Your amount of coverage has lapsed; your child is 
too old to be covered by your family plan--the list goes on and on.
  Finally, some of the most egregious abuses by health insurance 
companies are addressed in this bill, and consumers across America are 
given the legal power to fight back and the legal power to be 
protected. That is why this bill is important and why it is worth 
passing, all the criticism notwithstanding.
  I might also say that it is a bill that is critically important for 
the future of Medicare. If we do nothing, Medicare is going broke in 7 
or 8 years, but we are told this bill will extend the life of Medicare 
up to 10 more years. That is good news, to put Medicare on sound 
financial footing, so our seniors like that.
  The majority leader of the Senate came to the floor 2 days ago to 
announce something else that will be part of the conference committee 
here. The so-called doughnut hole, that gap in coverage for 
prescription drugs under

[[Page S13314]]

Medicare, is going to be filled so that seniors will no longer have 
that period of uncertainty where their bills have reached a level where 
they are disqualified from payment--the so-called doughnut hole. It 
will be filled. It will give them peace of mind that if they have 
expensive pharmaceuticals, they will have no interruption in coverage 
in the future when it comes to those pharmaceuticals.
  For seniors, these are two major things--to put Medicare on sound 
financial footing and to fill the doughnut hole under the Medicare 
prescription part of the program.
  It also is going to give seniors for the first time access to the 
kind of preventive care--regular checkups--they need for peace of mind 
and so doctors and professionals can catch problems before they get 
worse.
  This bill is a positive bill, a positive step forward.
  Yesterday, we had a chance as a Senate Democratic caucus to meet with 
President Obama. We went to the White House, the Executive Office 
Building, and the President talked to us about what this bill means. He 
reminded us that seven Presidents have tried to do this and failed. He 
told us when he started this trek that he wanted to be the last 
President to deal with health care reform because he wanted to get it 
done. I feel the same way. I think the American people feel the same 
way.
  I am sure there is confusion. There have been a lot of misstatements 
made about death panels and things that really have no basis in fact. 
But people should be confident that when the AARP, the American 
Association of Retired Persons, stands up and says this is a good bill 
for the seniors in America under Medicare and Social Security and for 
their families; when medical professionals, doctors and medical 
professionals, stand up and say this is a good bill, that we have the 
kind of support we need to say to the American people that this is an 
important step forward in health care protection in America.
  It is time for us to make history and pass this bill. Let's do it and 
do it in time for Members to enjoy Christmas with their families.
  I yield the floor and suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. DURBIN. Madam President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.

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