[Congressional Record Volume 155, Number 194 (Friday, December 18, 2009)]
[Senate]
[Pages S13409-S13455]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




             DEPARTMENT OF DEFENSE APPROPRIATIONS ACT, 2010

  The PRESIDING OFFICER. Under the previous order, the Senate will 
resume consideration of the House message with respect to H.R. 3326, 
which the clerk will report.
  The assistant legislative clerk read as follows:

       House message to accompany H.R. 3326, a bill making 
     appropriations for the Department of Defense for the fiscal 
     year ending September 30, 2010, and for other purposes.

  Pending:

       Reid motion to concur in the amendment of the House to the 
     amendment of the Senate to the bill.NOTICE

If the 111th Congress, 1st Session, adjourns sine die on or before 
December 23, 2009, a final issue of the Congressional Record for 
the 111th Congress, 1st Session, will be published on Thursday, 
December 31, 2009, to permit Members to insert statements.
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2010.
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By order of the Joint Committee on Printing.
                                                                
CHARLES E. SCHUMER, Chairman.

[[Page S13410]]

       Reid motion to concur in the amendment of the House to the 
     amendment of the Senate with amendment No. 3248 (to the House 
     amendment to the Senate amendment), to change the enactment 
     date.
       Reid amendment No. 3252 (to Reid amendment No. 3248), to 
     change the enactment date.

  The PRESIDING OFFICER. Under the previous order, the time until 12 
noon shall be equally divided and controlled between the two leaders or 
their designees, with Senators permitted to speak for up to 10 minutes 
each.


               Recognition of the Acting Majority Leader

  The PRESIDING OFFICER. The Senator from Illinois is recognized.


                                Schedule

  Mr. DURBIN. Mr. President, following leader remarks, the Senate will 
resume the House message with respect to H.R. 3326, the Department of 
Defense Appropriations Act. The time until 12 o'clock, as the Chair has 
mentioned, will be equally divided and controlled between the two 
leaders or their designees, and I have been designated by the majority 
leader. The time from 12 until 4 p.m. will be equally divided and 
controlled in 30-minute alternating blocks of time, with the 
Republicans controlling the first block and the majority controlling 
the next block.
  If we are required to use all 30 hours of postcloture debate time, 
the vote on the motion to concur with respect to the Defense bill will 
occur around 7:30 a.m. tomorrow morning. Senators are encouraged to 
plan accordingly in light of an anticipated winter storm expected to 
hit the Washington, DC area and Virginia tonight and tomorrow morning.


               Measure Placed on the Calendar--H.R. 4314

  Mr. President, I understand that H.R. 4314 is at the desk and due for 
a second reading.
  The PRESIDING OFFICER. The clerk will read the title of the bill for 
the second time.
  The assistant legislative clerk read as follows:

       A bill (H.R. 4314) to permit continued financing of 
     Government operation.

  Mr. DURBIN. Mr. President, I now object to any further proceedings at 
this time.
  The PRESIDING OFFICER. Objection is heard.
  The bill will be placed on the calendar.
  The Senator from Illinois.
  Mr. DURBIN. Mr. President, pursuant to the unanimous consent 
agreement, we now have time equally divided for the next 60 minutes 
between the Republican side and the Democratic side.
  I see the Senator from Indiana is on the Senate floor, and certainly, 
if he is prepared to speak and could give me an indication of the time 
he will use to speak, I would appreciate it.
  Mr. LUGAR. Mr. President, in response to the distinguished Senator, I 
would like to speak for 10 minutes, perhaps 12 minutes.
  Mr. DURBIN. Well, I would say, in response to my friend from Indiana, 
that 30 minutes of the 1 hour between now and noon but for leader 
time--and I see your leader has taken the floor--is given to the 
minority, and I will yield to the Senator from Indiana, unless the 
minority leader is prepared to speak at this point.
  I yield to the Senator from Indiana.
  Mr. LUGAR. I thank the distinguished Senator.
  The PRESIDING OFFICER. The Senator from Indiana.
  Mr. LUGAR. Mr. President, as we debate the Defense appropriations 
bill, I want to take the opportunity to update my colleagues on the 
activities of the Nunn-Lugar Cooperative Threat Reduction Program that 
is funded in this bill. I am very pleased that the Defense 
appropriations bill contains $424.1 million for the Nunn-Lugar program 
this year. This amount of funding will ensure the continuation of 
current Nunn-Lugar projects and will permit Nunn-Lugar to take on new 
tasks in new countries, principally in the area of biological threat 
reduction.
  Eighteen years ago, Senator Sam Nunn and I, along with a bipartisan 
group of legislators, in the last hours of that 1991 session, 
determined that our government had to address the proliferation threats 
posed by the dissolution of the Soviet Union. In the waning days of the 
1991 congressional year, we passed legislation establishing the Nunn-
Lugar Cooperative Threat Reduction Program, which devotes American 
technical expertise and money for joint efforts to safeguard and 
destroy materials and weapons of mass destruction. Since that time, the 
program has amassed an impressive list of accomplishments in the former 
Soviet Union, and it has been expanded to address weapons of mass 
destruction contingencies around the globe.
  I have devoted much time and effort to overseeing and accelerating 
the Nunn-Lugar program. Uncounted individuals of great dedication 
serving on the ground in the former Soviet Union and in our government 
have made this program work. We have shared many productive adventures 
in locations and circumstances that few Americans have ever 
experienced. From snowy runaways at former Soviet bomber bases to 
biological weapons labs in Georgia; from the chemical weapon 
destruction facility in Siberia to submarine bases on the Kola 
Peninsula; from former nuclear weapons test sites in Kazakhstan to the 
mountains of Albania, it has been my privilege to support the talented 
professionals of the Defense Department and other agencies in reducing 
threats facing our country. I continue to be impressed by their 
commitment to the mission and their ingenuity in finding creative 
solutions to seemingly impossible tasks.
  Much of this work has been done outside the public eye. This is not 
to say that nonproliferation activities have lacked public support. 
Congressional votes have consistently backed funding for Nunn-Lugar and 
other nonproliferation projects. But few Members of Congress or 
American citizens fully understand the contributions that threat 
reduction programs have made to the United States and global security.
  During my conversations with Hoosiers and others around the country, 
I do my best to explain what is happening on the ground in Russia and 
many other locations. I put out monthly press releases describing 
exactly how many weapons were destroyed in the previous month. My 
office displays a large representation of the Nunn-Lugar scorecard and 
numerous photos and artifacts from my visits to weapon elimination 
sites. But, understandably, threat reduction programs rarely make 
headlines. We are engaged in an endeavor in which notoriety is likely 
to come if something goes wrong--if materials or weapons of mass 
destruction are not contained in some instance. This makes for an 
exceptionally painstaking standard that must be met day in and day out.
  As of this month, the Nunn-Lugar program has dismantled 7,514 nuclear 
warheads, destroyed 768 intercontinental ballistic missiles, eliminated 
498 ICBM sites, eliminated 155 bombers, destroyed 651 submarine 
launched ballistic missiles, dismantled 32 nuclear submarines, and 
destroyed 960 metric tons of chemical weapons.
  Together, the United States and Russia have eliminated more nuclear 
weapons than the combined arsenals of the United Kingdom, France, and 
China. In addition, American and Russian experts have worked together 
to remove nuclear material from vulnerable locations around the world 
and to secure it in Russia. In 2008, the last of the nuclear warhead 
storage facilities identified under the Bratislava Agreement received 
safety and security upgrades. In May 2009, the chemical weapons 
destruction facility at Shchuchye began its important work of 
destroying 2 million chemical munitions.
  I would point out, Mr. President, that in the case of each one of 
these shells, a hole is drilled in the bottom of the shell. The nerve 
gas is carefully extracted, bituminized, and placed in the ground, we 
hope, forever.
  Despite these successes, some question why we should continue our 
work in Russia given recent strains in the United States-Russian 
relationship. I believe that both the United States and Russia must 
accept the fact that we need each other. Kremlin rhetoric will swing 
from one end of the strategic spectrum to the other. Projects will be 
on and then off. Our frustration level sometimes will be high. But we 
must not lose patience or miss the possibilities of cooperative threat 
reduction. We should recall that the Nunn-Lugar program was created to 
safeguard U.S. national security interests, and those interests exist 
regardless of the state of our relationship with Russia. It is also 
vital that we understand the

[[Page S13411]]

verification utility of the Nunn-Lugar program, which provides for 
American technicians on the ground in Russia, systematically destroying 
Russian weaponry. The cooperative links established by such activity 
and the confidence-building value inherent in our on-site presence are 
assets of incalculable value.
  Beyond Russia, it is vital that we break new ground in safeguarding 
and destroying weapons of mass destruction. I have never considered the 
Nunn-Lugar Act to be merely a program, or a funding source, or a set of 
agreements. Rather, it is an engine of nonproliferation cooperation and 
expertise that can be applied around the world. And it is a concept 
through which we, as leaders, are responsible for the welfare of our 
children and grandchildren, as we attempt to take control of the global 
threat.
  The United States must send the clear message that we are willing to 
go anywhere to prevent the proliferation of weapons of mass 
destruction. New opportunities for partnership must be pursued 
creatively and relentlessly. Some may say that we cannot forge 
cooperative nonproliferation programs with the most troublesome 
nations. But the Nunn-Lugar program has demonstrated that the threat of 
weapons of mass destruction can lead to extraordinary outcomes based on 
mutual interest. No one would have predicted in the 1980s that 
Americans and Russians would be working together to destroy weapons in 
the former Soviet Union. Taking the long view, a satisfactory level of 
accountability, transparency, and safety must be established in every 
nation with a weapons of mass destruction program.
  This year, Congress enhanced our government's ability to pursue this 
goal by including language from the Nunn-Lugar Cooperative Threat 
Reduction Improvement Act of 2009 in the 2010 Defense authorization 
bill. These provisions give the Nunn-Lugar program additional 
flexibility to meet unexpected threats in locations around the world in 
which certain laws would bar the use of such funds. They provide the 
Defense Department with the authority to spend up to 10 percent of 
annual Nunn-Lugar program funds notwithstanding any other law to meet 
urgent proliferation threats. The Defense authorization bill also 
included important authority that allows the Secretary of Defense to 
accept contributions from foreign governments, international 
organizations, multinational entities, and other entities for 
activities carried out under the Nunn-Lugar program.
  The Nunn-Lugar program has made tremendous progress on the 
destruction and dismantlement of massive Soviet weapons systems and the 
facilities that developed them. But in the future, the program will be 
asked to address much more complex and diverse security threats in a 
large number of countries.
  I believe the proliferation of weapons of mass destruction remains 
the No. 1 national security threat facing the United States and the 
international community. Over the years, I have described international 
cooperation in addressing threats posed by weapons of mass destruction 
as a ``window of opportunity.'' We never know how long that window will 
remain open. We must eliminate those conditions that restrict us or 
delay our ability to act. The United States has the technical expertise 
and the diplomatic standing to dramatically benefit international 
security. American leaders must ensure that we have the political will 
and the resources to implement programs devoted to these ends. The 
funds in this bill are vital to these efforts, and I thank the 
Appropriations Committee for its thoughtful attention to this issue.
  Mr. President, I yield the floor.


                   Recognition of the Minority Leader

  The PRESIDING OFFICER. The Republican leader is recognized.


                           Health Care Reform

  Mr. McCONNELL. Mr. President, the majority leader has signaled that 
he will finally unveil the most significant piece of domestic 
legislation in modern history sometime on Saturday--and force a vote in 
the middle of the night about 36 hours later. This is truly outrageous.
  This will be a bill that none of my constituents have seen, that none 
of the majority leader's constituents have seen, that none of you have 
seen, and that nobody outside the Capitol has seen.
  You can fit into a phone booth the number of people who have seen 
this bill that will affect the lives of every single American in the 
most profound ways.
  Every American should have an opportunity to know what their Senators 
are being asked to vote on before anyone can see it. I doubt if anyone 
in this Chamber could come down here and defend the secrecy surrounding 
this bill.
  Earlier this week, the President said:

       I think it is important for every single Member of the 
     Senate to take a careful look at what is in this bill.

  Unfortunately, there is no bill to read. Let me repeat: There is 
literally no bill to inspect. Even Senator Durbin, my good friend from 
Illinois who is here on the floor, the second in command on the 
Democratic side, admits he hasn't seen the details of the bill.
  The only thing we know for sure about this bill is that it will raise 
taxes, raise premiums, and slash Medicare. That much we know for sure. 
The Medicare cuts will be nearly $\1/2\ trillion to pay for a vast 
expansion of government into health care that an overwhelming majority 
of Americans we now know oppose.
  That is what is at the heart of this bill no one has seen yet. So we 
may not know all the details, but we already know this bill can't be 
fixed, and we know Americans are outraged by what has happened in this 
debate. A bill that was supposed to lower costs and lower taxes and 
lower premiums will actually raise all three, making existing problems 
not better but worse. It is not too late to start over and deliver the 
reform Americans want--the step-by-step reforms we know would actually 
lower health care costs.
  The majority knows this bill is a colossal legislative blunder. That 
is why they are rushing it through. That is why the only argument they 
are left with is a call to history. Well, history will be made either 
way, and this much is clear: Passing this bill in this way would be an 
historic mistake that those who support it will come to regret.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Illinois.
  Mr. DURBIN. Mr. President, this is the bill that is before the 
Senate. It is 2,074 pages. It has been on the Internet now for 3 weeks 
in its entirety. You cannot only read it on the Democratic Senate Web 
site, you can read it on the Republican Senate Web site. So one might 
ask: Well, where is the Republican comprehensive health care reform 
bill? It is not to be found--not on the floor of the Senate, not on the 
Web site--because it doesn't exist.
  After 1 year of debate about America's health care system, the 
Republicans in the Senate have failed to produce any legislation that 
has gone through the scrutiny this legislation has faced in terms of 
its impact on America, its impact on our budget. They are emptyhanded. 
What they bring to us on the floor of the Senate are speeches, press 
releases, charts, and graphs, and an occasional criticism. I say 
``occasional'' because for 19 days on the Senate floor we have debated 
this measure--comprehensive health care reform--and let's take a look 
at the Record after 19 days of debate on the floor of the Senate.
  The Republicans in the Senate--there are 40 of them--have offered 
four amendments to the bill in 19 days. Four amendments. Oh, and they 
have offered six motions to take the bill off the floor and send it 
back to committee. They have looked at this--and you heard the minority 
leader and his criticism of this measure--and found four things they 
are willing to bring before the Senate to change. It doesn't strike me 
that this is a good-faith effort to try to bring us to closure in a 
bipartisan way. Instead, what we hear from the Republican side of the 
aisle in addition to only four specific amendments over 19 days is: We 
haven't had enough time to offer amendments. Nineteen days, four 
amendments.
  I guess some of us are reaching advanced stages in life and in age 
and maybe we don't have the energy we once did, but I honestly believe 
that even the Senate could come up with one amendment a day on health 
care reform, but the Republicans have come

[[Page S13412]]

up with four over 19 days. It tells us one of two things: Either this 
is hard work and they are not up to it or they like the current system 
of health care; and if they do, I would like them to defend the current 
system of health care. I would like for them to try to explain in their 
States what I have found in my State. Instead of soaring rhetoric and 
abstractions, let's get down to specifics.
  This is a gentleman who lives in Evanston, IL, named David Buckley. 
Evanston is a great town just north of Chicago. I enjoy going up there 
and I have a lot of friends there. David had insurance when he needed 
it, but it ended up costing him his financial health. He is a freelance 
videographer. He was paying $4,500 a year for health insurance when he 
was diagnosed with cancer at the age of 48. David Buckley had a prompt 
surgery followed by chemotherapy and radiation. He managed to rid his 
body of cancer. But that battle ended and another battle began.
  David's insurance company agreed to cover his cancer treatment but 
only after 3 solid months of investigations of his application for 
health insurance to determine whether they could find in that 
application a preexisting condition which would eliminate any 
responsibility to pay for David's bills. They couldn't. After covering 
his cancer treatment costs, they did the next thing that insurance 
companies do: They raised his premiums, and they didn't just raise them 
a little bit. In the year following his cancer diagnosis, David's 
insurance rates went up 80 percent, and that was just the beginning. 
Within 7 years, David was paying $28,000 a year in premiums. He had 
gone from roughly $400 a month to more than $2,000 a month in 7 years. 
He had a $2,500 deductible, not to mention out-of-pocket expenses. He 
is self-employed, makes a decent living--about $70,000 a year--but 
imagine taking $2,000 out of your paycheck every month just for health 
insurance. He tried.
  Incidentally, 12 days after his surgery, David, who is not lazy by 
any measure, flew into a war zone to shoot video. He was still wearing 
a chemo pump when he arrived for work. He pushes himself to pay his 
bills, but it has been a losing battle. What started as a $5,000 debt 
in the year 2000 grew to a $70,000 debt by 2003 and a large portion of 
it came from medical bills. David said:

       I thought the point of having insurance was to keep you out 
     of bankruptcy, not put you in it.

  It is a valid point. Insurance is meant to be a promise of 
protection, but for too many people it isn't enough. For David, the 
high costs and ballooning debt led him to drop his health insurance 
last year. Think about that. He battled cancer and won, and you know 
once you have been through that life experience, you are always 
vigilant. You need the best care to make certain that anything that 
recurs is caught early, but David had to walk away from health 
insurance coverage because he couldn't afford it. He decided it was 
health care or saving for retirement or meeting the costs of living. He 
is in his late 50s and he is worried about the years when he won't be 
able to work.
  Health reform is going to help people like David--people who have 
insurance but still find themselves vulnerable to financial ruin. It 
will stop insurance companies from running the rates up sky high when 
you get sick. For those with employer-sponsored, large-group coverage, 
it will provide access to a broader insurance pool where costs will be 
pooled and spread.
  Health reform will hold insurance companies to annual caps on how 
much they can charge for out-of-pocket expenses.
  Think about the battle this man went through and won over cancer and 
then went to battle with his health insurance company. It is not 
unusual. It happens every day. This bill, which has been criticized by 
those on the other side of the aisle, will give David and others like 
him a fighting chance.
  Let me tell my colleagues about another person. This is an 
interesting story. Valerie, this beautiful young woman, is from 
Arlington Heights, IL. She is a student, a doctoral student studying 
biochemistry at Cambridge University in England. When she was 4 years 
old, Valerie was diagnosed with type 1 diabetes. She decided early in 
life that she wasn't going to let her diabetes stop her career 
ambition. She couldn't become an artist or an entrepreneur; she knew 
she needed a stable job because she always needed to have health care. 
She had diabetes. Now, at 24, this brilliant young scientist, this 
doctoral candidate, worries that her diabetes and what she calls the 
``broken, insecure U.S. health system'' will keep her from returning to 
the United States from England and using her skills to help her home 
country.
  To control her disease, Valerie needs a lot of medical service, 
including regular doctor visits and insulin shots. For most of her 
life, her medical care was paid for by her parents, but those of us who 
raise children know what happens next. Most health care plans we have 
for our families cut off our kids at age 24, and that is Valerie's age. 
However, Valerie is going to school in England. If you listen to some 
of the criticisms on the floor here about England and Canada and other 
nations that approach health care differently, you might have an 
impression in your mind about what that means to be living in a country 
such as that.

  Valerie, because she is a student at Cambridge in England, receives 
free health care through England's national health service that she 
says is as good or better than anything she had in the United States. 
In addition to free doctor visits, insulin, and syringes, her care 
includes regular contact with a dietician and an endocrinologist, also 
free of charge.
  These medical professionals have encouraged Valerie to take a more 
active role in managing her own disease and she is in better health now 
than she has been for years. Eventually she hopes to open her own 
laboratory where she can use her great education and skills to continue 
research in mitochondrial biology and develop treatments and cures for 
disease. Valerie worries about whether she will be able to do that if 
she came back to the United States, and here is what she said:

       As long as the same broken, insecure health system remains 
     in place, I see little incentive to come home to the United 
     States with my talents and experience.

  We can't afford to lose talented scientists such as Valerie who one 
day might find a cure for a disease such as Parkinson's. We are the 
only industrialized Nation in the world where people can die for lack 
of health insurance, and that is a fact: 45,000 a year. They can't get 
the care they need to stay healthy and they lose their lives. If we 
don't change this system, if we don't reform it, we stand to lose 
talented people and we also stand to lose valuable lives.
  The last person I want my colleagues to see is a friend of mine, Dale 
Mizeur. Dale lives in Blue Mound, IL. The Mizeur family is well-known 
in my part of the world. I think I have met them all, and they are a 
big family. Over the years, I have visited with them in their homes and 
in their home towns. Blue Mound is a little town south of Decatur, IL, 
1,100 people. Everybody knows one another. They are all neighbors and 
friends. Most of them go to church together and have their community 
picnics; a great small town in Midwestern America. There are a lot of 
farmers there. There are retired factory workers from the Caterpillar 
plants up in Decatur and a lot of folks who like living in a small 
town. This used to be a thriving area. It has struggled with changes in 
manufacturing and changes in our economy, but it is a close-knit 
community.
  Dale Mizeur lives there. He was born in Owaneco 61 years ago. He was 
a hard worker at a Cat plant up in Decatur for 32 years. He decided to 
retire 11 years ago. Based on a simple calculation, he was told he 
would have a modest pension and his health care costs would be covered 
in his union contract.
  In the time since he retired, his expectations haven't been met. A 
difficult economy and new contract negotiations up in Decatur have 
resulted in the erosion of Dale's union health care coverage. As a 
result, he now has to spend more of his pension on filling the gaps in 
his reduced health care coverage. His monthly premiums have skyrocketed 
from nothing when he first retired to almost $400 a month, and that is 
20 percent of his pension check. In addition to these premiums, the 
quality of his coverage has gone down. What was once a generous health 
care plan has such high out-of-pocket

[[Page S13413]]

costs that Dale questions whether he can afford to stay with it.
  He is like most Americans; he doesn't worry about his health until he 
needs to do something about it. During the early years of his 
retirement when his insurance coverage was rock solid, he considered 
himself healthy and never saw the need to use it. But we all get a 
little older, our bodies aren't what they used to be, and things have 
changed for Dale. A few weeks ago he noticed some pain in his chest, 
some dizziness that was too noticeable to ignore. He saw his doctor who 
told him to go to the emergency room. He fretted about what this was 
going to cost him, but he went anyway. Thankfully, Dale is physically 
OK, but economically and emotionally is another story.
  Last week, Dale received his bill from the ER. His own personal out-
of-pocket expense: $600. He now has to figure out how he is going to 
pay that bill out of his pension. What other expenses will he have to 
delay? What about the mortgage and utility bills? He has to worry about 
the costs he will endure next time.
  Dale and his wife live on a fixed income. As I said, he is 61 years 
old. The money that comes in each month is accounted for and there 
isn't a lot of wiggle room.
  He is contemplating coming out of retirement after 11 years, 
primarily because he can't make ends meet and because of medical 
expenses. This isn't a very good economy for a 61-year-old retired 
factory worker to look for a job. He is one of the many early retirees 
who have found that health care costs threaten their financial 
stability. The unlucky ones lost their health care coverage completely, 
perhaps because their employer has gone bankrupt. Even those such as 
Dale, who still has coverage, are finding themselves in a much more 
precarious situation than they expected.
  I tell these stories because they are real-life stories of people I 
have either met or come to know because they have contacted our office. 
I listened to the minority leader come and say: Stop the presses, stop 
the debate, stop moving forward in this effort to have real health care 
reform in America. The minority leader, from Kentucky, said we need to 
start over.
  We have been starting over on health care for decades. We have never 
reached the finish line because there are always obstacles in our path. 
Right now, the obstacle is bringing this matter to a vote. Why were we 
in session at 1 a.m. this morning casting a vote? Because the 
Republican side of the aisle is determined that, regardless of the 
issue, they are going to stop us from bringing this matter to a debate 
and vote. They don't want us to have a vote on this. They don't want us 
to make a decision. They don't want to be on the record.
  That is unfortunate. The bill they have chosen to filibuster--the one 
before us in the Senate--is a bill that should have no controversy 
whatsoever. It is a bill to fund our troops. It is the Department of 
Defense appropriations bill. Can you imagine, in the midst of a war, 
when the bravest men and women in our Nation are risking their lives at 
war, the Republicans are filibustering the bill to pay their salaries, 
the bill to pay for the equipment they need to stay safe, the bill to 
pay for the medical care of these soldiers, sailors, airmen, marines, 
and their families. It is unthinkable.
  This is a bill that passed over in the House of Representatives 
overwhelmingly. I think the number was 394 to 35, and 164 Republicans 
voted for it because we want to stand behind our troops.
  Last night, only 3 Republican Senators out of 40 would step up and 
say we should go forward on this bill--only 3. The rest of them, led by 
the minority leader and the minority whip, said we will stop this bill 
if this is the only way we can stop the health care debate. Why did 
they pick this bill of all bills--a bill where we should be standing in 
solidarity behind our troops, and we now have split into partisan 
camps.
  There is nothing partisan about standing behind our troops. That vote 
early in the morning, unfortunately, was very partisan. There is also a 
provision in the bill that deals with the unemployed in America.
  We want to go home. I want to go home. I called my wife this morning. 
I have been here 3 straight weeks now, and it looks like there is 
another week to follow before the holidays and Christmas. I don't like 
this. You give up a lot in this job. There are certain pieces of my 
family life I hold dear, and this is one of them--to be back home for 
Christmas, not just at the last minute but to be there, and it doesn't 
look like we will be able to do that. The Republicans decided they will 
use every political and parliamentary device possible to delay this 
vote. So we will do nothing today because we are running the clock out 
under the procedures of the Senate, and then we will meet at 7:30 
tomorrow morning and have several votes on this Department of Defense 
appropriations bill, which should have been passed instantly when we 
received it from the House of Representatives. Then we will start the 
clock running again to move toward a vote on health care reform.
  Why? Let's be honest. We ought to bring this matter up for a vote and 
see if we, in fact, have 60 votes on this side of the aisle. I hope we 
do. We are working on it. The reason I am here and the majority leader 
is not is because he is working, at this very moment, to bring those 60 
votes together. Instead, the Republicans have said they are going to do 
everything possible, including asking Members to stay here Christmas 
Eve and Christmas Day, in order to stop this vote on health care 
reform. That is unfortunate.
  Let me tell you the bottom line of what this bill does for America. 
This bill is not perfect, and no bill we ever consider is. This bill, 
first, is the biggest deficit reduction ever introduced on the Senate 
floor. If we bring down health care costs, it not only will help 
families and businesses but even our Federal Government. As we bring 
down the increase in the cost in health care, Medicare for seniors will 
cost less to the government. The same thing is true of Medicaid, the 
health insurance program for the poor and disabled.
  First and foremost, CBO tells us this bill, at a time when we have 
great national debt, will actually bring down America's debt $130 
billion in the first 10 years and $650 billion more in the next 10 
years. So it is a fiscally responsible bill. That is what President 
Obama challenged us to do: If you are going to pass health care reform, 
don't do it at the expense of the next generation. Pay for it.
  We do. We more than pay for it. We also reduce the cost of government 
in the process. The second thing the bill does is start to bring down 
health care costs. It does it in a variety of different ways. I wish it 
were bringing it down faster. I commend the Presiding Officer, the 
Senator from Virginia, Mr. Warner, who joined with a group of freshman 
Democrats, and they introduced cost-containment amendments to the 
bill--to be part of the managers' amendment--which have been heralded 
by the major business and manufacturing groups in America--a thoughtful 
amendment that addresses the core issue of how to bring down health 
care costs. They rolled up their sleeves and went to work and made an 
amendment.
  You cannot say the same, I am afraid, for the other side of the 
aisle. Their amendments have not been as constructive as the one I just 
described. They have tried to stop this bill rather than improve it. 
Senator Warner of Virginia and his freshman colleagues have taken a 
more constructive and positive approach.
  Bringing down costs of health insurance and making it more affordable 
is job one for this health care reform. But it does something else. 
This bill extends the coverage of health insurance in America. 
Currently, there are 50 million Americans who don't have health 
insurance. They are people who have lost their jobs. They are folks who 
work for small businesses and cannot afford health insurance. They are 
people who have tried their best, but they can't get health insurance. 
There are 50 million of them. Imagine, if you will, going to sleep 
tonight, if you are a father or mother with a sick child, and you have 
no health insurance. Imagine, for one frightening moment, waking 
tomorrow morning to face a diagnosis from a doctor of a serious illness 
or to be involved in an accident that requires medical care and having 
no health insurance. One out of every six Americans--50 million--have 
no health insurance.
  This bill will change that. Thirty million Americans will be covered 
with

[[Page S13414]]

health insurance who currently don't have coverage, and 15 million in 
the lower income categories--the working poor and lower income folks--
will go into Medicaid at the State level; 15 million will go into 
private health insurance. At the end of the day, with this bill, 94 
percent of Americans will have health insurance. That has never 
happened in our history--ever; 94 percent will have the piece of mind 
of having health insurance.
  There is something else this bill does. It goes back to my 
illustration. It says to the health insurance companies it is over; the 
way you have been mistreating the people who pay your premiums is going 
to come to an end. We are not going to allow you to ``fly-speck'' 
applications for health insurance to find a preexisting condition. We 
are going to make sure those with preexisting conditions have a real 
opportunity for health insurance coverage and will not be denied when 
they need coverage. We are going to also make sure that when you get 
sick, the health insurance company cannot cut and run, as so many do. 
We are going to extend that coverage for young people through ages 24 
and 25. This is all good and positive. It will mean the Patients' Bill 
of Rights, which former and late Senator Kennedy and even Senator 
McCain worked for, will be part of the law of America.

  There are critics of this health insurance plan, for sure. We saw 
them come out at townhall meetings and protests and so forth. Some 
don't want to change the system; they like the system. They fear 
government or whatever it may be. Their motive is to stop this. There 
are also critics who say this bill doesn't go far enough. It doesn't go 
as far as I would like to go. I think there ought to be a public 
option. We ought to have a not-for-profit plan that competes with 
private plans. The realities of the Senate don't make it possible to do 
that in this bill at this time.
  When the Republican leader comes to the floor and says so many people 
oppose it--some oppose it because they may want to do nothing; others 
don't think it does enough--that is the nature of this process. I have 
been around long enough to know you can't satisfy everybody. Is it 
better if this bill passes or not? I think the answer is overwhelmingly 
it is.
  Howard Dean is my friend and a former Governor. He said he would vote 
against this. I say to Dr. Howard Dean: Don't you believe 30 million 
Americans with health insurance are worth the effort? I think you do. I 
think most people do. We can do better, and we will work to improve the 
bill.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Indiana is recognized.
  Mr. LUGAR. Mr. President, how much time remains on this side?
  The PRESIDING OFFICER. There is 16 minutes remaining on the 
Republican side and 3\1/2\ minutes on the Democratic side.
  Mr. LUGAR. Mr. President, the bill before us contains more than $128 
billion for operations in Afghanistan and Iraq. Since the President's 
announcement 2 weeks ago that he would be ordering tens of thousands of 
additional U.S. troops to Afghanistan, the Congress has held numerous 
hearings examining the military strategy to be employed, political 
issues in the region, and the dispensation of funding for the war.
  As we consider our course in Afghanistan, we should evaluate options 
according to how well they contribute to U.S. national security. The 
ultimate purpose of committing tens of thousands of new troops and tens 
of billions of additional dollars to the war effort in Afghanistan must 
be to enhance U.S. security and our vital national interests in the 
region.
  Sometimes during long wars, specific tactical objectives can become 
ends in themselves, disconnected from the broader strategic context or 
an accounting of finite resources. Congressional oversight of the funds 
in this bill is part of that accounting. We need to get the most value 
for our defense dollar in Afghanistan, as well as Iraq. This is 
especially true at a time when our Armed Forces have been strained by 
many years of high deployment rates, our capacity for new government 
debt is limited, and our Nation has not fully emerged from a severe 
recession. As we think through the implications of the defense spending 
bill before us, we need to be cognizant that even if the President's 
Afghanistan plan achieves the very best stabilization scenario, 
allowing for U.S. withdrawals on the schedule he contemplates, we may 
be responsible for most of the Afghanistan defense and police budgets 
indefinitely.
  Much of the debate in Congress has focused on the President's stated 
intention to begin withdrawing some U.S. troops by July 2011. Some 
Members have voiced the concern that such a date undercuts impressions 
of U.S. resolve and gives the Taliban and al-Qaida a target beyond 
which they can wait us out. Other Members, with a very different view 
of the war, worry that the July 2011 date is so flexible that it offers 
no assurance at all that troops will be withdrawn. This is a legitimate 
item for debate, but I am doubtful that success or failure hinges on 
this point nearly as much as it does on the counterinsurgency strategy 
employed by allied troops, the viability of the Afghan security forces, 
and most importantly, how the United States engages with Pakistan.
  I have confidence that the addition of tens of thousands of U.S. and 
allied troops, under the direction of Generals Petraeus and McChrystal 
will improve the security situation on the ground in Afghanistan. More 
uncertain is whether the training mission will succeed sufficiently to 
allow U.S. forces to disengage from combat duties in a reasonable time 
period. The most salient question, however, is whether improvements on 
the ground in Afghanistan will mean much if Taliban and al-Qaida 
sanctuaries in Pakistan remain or if instability within Pakistan 
intensifies.
  As hearings in the Foreign Relations Committee have underscored, the 
potential global impact of instability in a nuclear armed Pakistan 
dwarfs anything that is likely to happen in Afghanistan. The future 
direction of governance in Pakistan will have consequences for 
nonproliferation efforts, global economic stability, our relationships 
with India and China, and security in both the Middle East and South 
Asia regions, among other major issues. The President and his team must 
justify their plan not only on the basis of how it will affect 
Afghanistan, but also on how it will impact our efforts to promote a 
much stronger alliance with Pakistan that embraces vital common 
objectives.
  Secretaries Clinton and Gates and Admiral Mullen acknowledged the 
importance of Pakistan in the President's calculation. They underscored 
that the administration is executing a regional strategy. I am 
encouraged by press reports that have described the intense diplomatic 
efforts with the Pakistani government aimed at securing much greater 
cooperation.
  But we should remain cognizant that the focus of policy tends to 
follow resources. By that measure, Afghanistan will still be at the 
core of our regional effort.
  The President has said that the United States did not choose this 
war, and he is correct. But with these troop deployments to 
Afghanistan, we are choosing the battlefield where we will concentrate 
most of our available military resources. The Afghanistan battlefield 
has the inherent disadvantage of sitting astride a border with Pakistan 
that is a porous line for the militants, but a strategic obstacle for 
coalition forces. As long as this border provides the enemy with an 
avenue of retreat for resupply and sanctuary, our prospects for 
destroying or incapacitating the insurgency are negligible.
  The risk is that we will expend tens of billions of dollars fighting 
in Afghanistan, while Taliban and al-Qaida leaders become increasingly 
secure in Pakistan, where the long-term strategic stakes are even 
higher. If they are able to sit safely across the border directing a 
hit-and-run war against us in Afghanistan, plotting catastrophic 
terrorist attacks abroad, and working to destabilize Pakistan from 
within, our strategic goals in the region will be threatened despite 
progress on the ground in Afghanistan.
  Some reports indicate that Taliban leaders, aware of the threat from 
U.S. operated Predator drones, are moving out of remote areas into 
crowded Pakistani cities, including Karachi. If such reports are true, 
the United States will have even fewer options in pursuing Taliban and 
al-Qaida leaders in Pakistan, absent the active help of Pakistani 
authorities. Specifically, will

[[Page S13415]]

Pakistan work with us to eliminate the leadership of Osama bin Laden 
and other major al-Qaida officials?
  In addition to improving the cooperation of the Pakistani 
authorities, the United States and our allies will have to become more 
creative in how we engage with the Afghan and Pakistani people. We 
should understand that as a matter of survival, people in dangerous 
areas on both sides of the border will tend to side with whoever is 
seen as having the best chance of winning. We should also recognize 
that tribal loyalties, most notably Pashtun loyalties, are at odds with 
a strong central government and with acquiescence to external military 
power. As Seth Jones of the Rand Corporation has observed: ``The 
objective should be to do what Afghanistan's most effective historical 
governments have done: help Pashtun tribes, sub-tribes, and clans 
provide security and justice in their areas and manage the process.'' 
Meaningful progress in Afghanistan is likely to require tolerance, or 
even encouragement, of tribal administration in many areas, as well as 
convincing tribal leaders that opposing the Taliban is in their 
interest.

  In these circumstances, we should explore how cell phones and other 
communication technologies can be used more effectively, both as an 
avenue for public diplomacy to the Afghan people and as a means for 
gathering intelligence from them. Already, seven million cell phones 
are in Afghanistan--one for every four inhabitants. The Taliban's 
reported priority on destroying communications towers underscores their 
understanding of the threat posed by these technologies. For example, 
cell phones could be used by sympathetic Afghans to produce real-time 
intelligence, including photographs of IEDs being prepared or calls 
alerting coalition troops to movements of the Taliban. Phones eliminate 
the need for informants to take the risks of visiting a police station 
in person or of conversing openly with U.S. troops. Similarly, 
expanding the use of credit card transactions could prove revolutionary 
in addressing some vexing problems in a country that lacks an effective 
banking system. They can provide a way to reduce corruption, improve 
accounting within the Afghan government and security forces, and 
relieve soldiers from the need to go AWOL to deliver pay safely to 
their families.
  I want to recognize that the President has been confronted with 
extremely difficult choices in Afghanistan and Pakistan. He and his 
team have worked through the problem carefully and deliberately to 
reach their conclusions. There are no options available that are 
guaranteed to succeed. Every conceivable course, from complete 
withdrawal to maintaining the status quo to the plan outlined by the 
President, to an unrestrained and unlimited counterinsurgency campaign 
has its own set of risks and costs for the United States. The President 
deserves credit for accepting ownership of this difficult problem as we 
go forward. In this situation, the advocacy of the President and his 
national security team must continue to be as broad-minded and thorough 
as his policy review appeared to be.
  Within months, the President is likely to ask Congress for additional 
funds for Afghanistan, beyond what is contained in this bill. In the 
meantime, the administration must be prepared to answer many questions 
about its strategy as the American people study the potential 
consequences of the President's decision.
  The PRESIDING OFFICER. The Senator from Arizona.
  Mr. McCAIN. Mr. President, my friend, the Senator from Illinois, whom 
I see back on the floor--for the record, the Senator from Illinois and 
I entered the House together longer ago than we would like to mention, 
particularly for those who favor term limits. We have had our 
philosophical disagreements, but I have appreciated his leadership. I 
have appreciated his honest approach to the issues. We obviously have 
significant disagreements. Those disagreements have been respectful, 
and I look forward, during the next whatever period of time until we 
dispense with the issue of health care reform and the issue of DOD 
appropriations, to discussing this issue with him.
  The Senator from Illinois has been saying that the Republicans are 
holding up funding for our troops by not conceding to an immediate vote 
on the Defense appropriations bill after the House sent it to the 
Senate. I understand that, and I understand his zeal to get onto other 
issues, which is the job of the majority, to get legislation passed, 
but I would like to point out the real facts.
  The real facts about the Defense appropriations bill are that the 
House passed its version on July 30, last July 30. The Senate passed 
its version on October 6. By my calculation, that is well over 2 months 
ago. All they had to do then, of course, was go to conference and 
report it out to the floor of the Senate--something that could have 
been done in 24, 48 hours. Instead, over 2 months has gone by and the 
Democratic leadership in both the House and Senate held captive this 
bill for the troops. Why would they do that? Because they knew that at 
the end of the year, they would stuff in unrelated must-pass 
legislation which has nothing to do with the Department of Defense or 
the men and women in the military, they would have to put that in so 
they could get it passed. We have a number of additional pieces of 
legislation stuffed into the bill which the Democratic leadership knew 
had to be passed.
  I say in all due respect to my friend and colleague from Illinois--he 
and I, as I mentioned, have been around here the same amount of time--
the fact is, after the House and Senate both passed their bills over 2 
months ago, they could have brought it to the floor and we could have 
debated it and, of course, passed it into law.
  So now we have the Secretary of Defense calling around to people 
saying: We have to pass this immediately. Where was the Secretary of 
Defense, whom I admire and respect, on October 7, 2009, after the 
Senate passed its bill? Where was he then urging Members to not harm 
the men and women who are serving in the military?
  I will get from my staff the bills that are stuffed into this bill 
which have nothing to do with our Nation's defense and have everything 
to do with the agenda of the Democratic majority. I want to say again 
to my friend from Illinois, I understand that. I understand why they 
are doing what they are doing. But I don't understand why they are 
blaming us when after 2 months the bill has not been passed.
  Let me just add, there is a portion of the bill called division B, 
``Other Matters.'' Only in the Senate could we call it ``Other 
Matters.'' Let me tell you what they have larded onto the Defense bill.
  Food stamps. Food stamps are very necessary. Is anybody going to be 
against food stamps? Of course not. It extends appropriations for the 
Supplemental Nutrition Assistance Program in the USDA. Food stamps 
administration, $400 million in emergency funds through September 30, 
2011.
  Satellite Home Viewer Act extension. Perhaps the Senator from 
Illinois, my friend, can tell me what the Satellite Home Viewer Act 
extension has to do with defending our Nation. I know it has a lot to 
do with the ability of millions of Americans to watch NFL football, but 
I do not think it has a lot to do with defense spending.
  PATRIOT Act extension. Section 1004 provides a clean 2-month 
extension until February 28, 2010, of the three PATRIOT Act provisions 
expiring at the end of this calendar year. That has to do with 
investigation of business records and also roving wiretaps. Is there 
anyone who did not know the PATRIOT Act was going to expire? Was the 
Senator from Illinois unaware that we needed to extend the PATRIOT Act? 
Most people believe we do. We still have extremist organizations that 
want to attack the United States of America.
  Flood insurance extension. It extends the Flood Insurance Program 
through February 28, 2010.
  Small business extension. There is $125 million for the Small 
Business Administration to continue offering reduced-fee and higher cap 
loan guarantees under the American Recovery and Reinvestment Act. It 
extends the higher limits through February 28, 2010. It further 
designates such amounts as emergency spending; i.e., it is not included 
in the budget. But that is an argument for another day.
  The point is, again, small businesses are vital. Small businesses are 
what

[[Page S13416]]

have been ignored. Small business is the reason the stimulus package 
has failed. It has done a great job for Wall Street--boy, these 
bonuses, $16 billion, $18 billion, are going to be distributed. They 
are going to have a Merry Christmas up on Wall Street at Goldman and 
Morgan and all those places. It is going to be great, thanks to the 
TARP and the stimulus package. But what is it on Main Street where we 
have 10-percent unemployment?
  Of course we need to help small businesses. They have not done much 
so far, I tell you that. I will take you to my State and take you all 
over this country outside of Manhattan, and they will tell you small 
businesses are hurting very badly. We could not do that before. We had 
to put it on the Defense appropriations bill.
  We also have payment for a North Carolina construction project. Here 
is something that really has a lot to do with defending the Nation. It 
provides a $12.8 million appropriation for a construction project in 
North Carolina, of which--note designation of the State--of which $4 
million will be obligated immediately and the rest will be available 
120 days after the signing of an agreement between the Federal 
Government and several local authorities. This is paid for through 
rescission funds previously appropriated for this project. I don't know 
what the project is, I say to my colleagues, but I am not sure we are 
in dire need.
  In addition, highways extension. Section 1008 extends the authority 
for the highway trust fund to make and receive payments through 
February 28. It also provides $33.4 million for administrative 
expenses, paid for out of the earlier rescission from the highway trust 
fund. I am one who believes we need to make sure the highway trust fund 
is funded and we move forward with the highways. Again, what does that 
have to do with defending this Nation? Not a lot.
  Unemployment insurance extension. Here we are again. It extends the 
authority of expiring Federal unemployment insurance programs and 
benefits through February 28, 2010, continuing the current availability 
of up to 99 weeks of total unemployment. Of course, we have to extend 
unemployment. Unemployment, except up on Wall Street, is at 10 percent. 
In my home State of Arizona, real unemployment is 17 percent.
  In addition to that, I guess the conferees were beavering away by 
adding earmarks, and plenty of them--in fact, 1,720 earmarks, totaling 
$4.3 billion; $2.5 billion in unauthorized and unrequested C-17s. No 
one outside of those who are contractors believes we need to spend $2.5 
billion on unauthorized C-17s which cost $2.5 billion; $500 million in 
unrequested and unwanted funding for the Joint Strike Fighter 
alternative engine and Presidential helicopter. That is $7.3 billion. 
There is $18 billion in new non-offset funding for food stamps, 
unemployment assistance, COBRA benefits, physician payments, the so-
called doc fix, and small business lending. By designating the funding 
as an ``emergency,'' none of it is paid for. It is just another $18 
billion of debt that will be laid on our children and grandchildren and 
our national debt in 2010.
  I guess some Americans wonder why we are going to have a debt for 
this year of $1.5 trillion--trillion, ``t,'' trillion. Someone said to 
me--several times it has been said to me--we hope the President never 
learns what comes after a trillion.
  Here we are with another $18 billion of funny money. Here we are with 
a bill passed by the Senate 2 months 10 days ago and passed by the 
House months before that. Clearly, one can only assume--let me put it 
this way: One would question, if the Senate passed its version on 
October 6 and the House passed its version on July 30, then why would 
we wait until December 16 to bring it to the floor of the Senate? One 
might conjecture that they did not bring it to the floor of the Senate 
because they knew it was going to have to be passed by the Congress of 
the United States. Of course, we are going to pass it. So this is the 
best opportunity to add these programs and projects that would never 
otherwise be passed. So here we are with legislation to take care of 
the men and women in the military and our national security needs and 
we have loaded it up with $7.3 billion in pork and $18 billion in new 
offset funding, which is not paid for. So then my friend and colleague 
from Illinois comes to the floor and says: Republicans are holding up 
the passage of this bill, even though--even though--the Senate passed 
this bill on October 6.

  Mr. DURBIN. Would the Senator yield for a question?
  Mr. McCAIN. I would be more than happy to engage in a colloquy with 
my friend from Illinois, if he requests to do so or just has a 
question--either way.
  Mr. DURBIN. I have a question. When we were here at 1 a.m., bleary-
eyed and voting, there were two unanimous consent requests made to pass 
the Department of Defense appropriations bill immediately. Does the 
Senator from Arizona remember the objections to passing the bill 
immediately so we could get the money to the troops came from his side 
of the aisle when we tried to pass this bill?
  Mr. McCAIN. I do recall that, I say to my friend, and I also recall I 
was only allowed 10 minutes--10 minutes--to talk about this bill and 
the 1,720 earmarks such as the telescope in Hawaii and--I have a list 
here somewhere. But I was allowed 10 minutes, and I need a long time to 
talk about this.
  If the Democratic majority, which is their right, wants to wait until 
December 17 and then jam it through in the middle of the night, that is 
their right to try it. But we need to talk more about why the American 
people are angry. Here we have a bill to defend the Nation--to defend 
the Nation--and $18.9 million for a center at the University of 
Massachusetts ``dedicated to educating the general public, students, 
teachers, new Senators, and Senate staff about the role and importance 
of the Senate.''
  I hope this organization, this center at the University of 
Massachusetts, will somehow come into being, perhaps, but not by taking 
it out of money for Defense. If there is ever a time the American 
people need to understand the role and importance of the Senate--given 
our approval rating is about 4 percent, and I haven't met any of them--
I understand why someone would want to have a center to teach new 
Senators and Senate staff about the role and importance of the Senate. 
But $18.9 million, when people are not being able to stay in their 
homes, when they are unemployed, when they can't feed their families, 
when unemployment is 17 percent? Sure, let's add it on to the Defense 
appropriations bill. That is the way to do it.
  Here are some more: $500,000 for my old favorite--the old Brown Tree 
Snake Program. I totaled up the millions that have been spent on the 
old Brown Tree Snake Program. Of course, Historical Fort Hamilton 
Community Club, that needs $1.8 million. The old Historical Fort 
Hamilton Community Club, I am sure it is a nice place to visit.
  I am sure it is great to have $1.6 million to study human genetics at 
the Maine Institute for Human Genetics and Health in Brewer, ME; $3.5 
million for a microalgae biofuel project in Hawaii; $5 million for the 
Presidio Heritage Center, a museum, in San Francisco; $1.6 million for 
the Center for Space Entrepreneurship. I think that would match with 
the $2.9 million we appropriated on the previous bill to study surgery 
in outer space.
  I am telling you, the Trekkies are happy about these appropriations 
bills. Here are more: the $1.6 million for a Virtual Business 
Accelerator for the Silicon Prairie; $7.8 million to develop key 
technologies needed for the long-term operations in near-space 
conditions. So we have surgery in outer space and key technologies 
needed for near-space conditions for the Orion High Altitude Long 
Endurance Risk Reduction Effort, the Aurora Flight Sciences in 
Columbus, MI; $2.4 million for Fusion Goggle System; $800,000 for 
Advanced Tactical Laser Flashlight in Wyandotte, MI; $10 million for 
the Hawaii Technology Development Venture.
  My friends, this is kind of a classic example. I see my friend and 
colleague on the floor, Senator Coburn, a man of courage and integrity 
and one who I think has led, in many ways, this fight. But here is an 
earmark in this bill--it has never been authorized, never had a 
hearing--$10 million for the Hawaii Technology Development Venture. 
What could that be? What could that be? Did we ever have a hearing? Did 
we ever have a depiction of this? Did we ever have it? No. It is 
included by the appropriators.

[[Page S13417]]

  A few more: $3.9 million for Intelligent Decision Exploration. If 
there is ever a place that needed that, it must be, in my view, the 
Congress. So $3.9 million for Intelligent Decision Exploration. I 
think, frankly, the results of that exploration would be rather bleak. 
How about $2.3 million for marine species; $2.4 million for NAVAIR High 
Fidelity Oceanographic Library.
  The list goes on and on and on. Oh, here is Hawaii again--strange how 
Hawaii pops up--$2 million for Advanced Laboratory for Information 
Integration, naturally, in Hawaii; $1.2 million for the Model for Green 
Laboratories and Clean Rooms Project.
  Now, again, I wish to point out, as my colleague from Oklahoma has, 
these may be very worthwhile projects. They may be projects that maybe 
will help America. Maybe spending our Defense appropriations--$5.8 
million of it--for the Rock Island Arsenal Roof Replacement in Rock 
Island, IL, is something that is badly needed. Maybe the $800,000 for 
the Natural Gas Firetube Boiler Demonstration at the Rock Island 
Arsenal is also very necessary. But how are we to know? How are we to 
know?
  So the Senator from Illinois and the Democratic leader have come to 
the floor and are saying: The Republicans are blocking passage of 
vitally needed funding for the men and women in the military who are 
defending our Nation as we speak. My response is: Where were you for 
the last 2 months after the Senate passed this bill? The Senate and the 
House could have had a conference and we could have had this bill long 
ago.
  The fact is, it has been loaded up with food stamps, the Satellite 
Home Viewer Act extension, the PATRIOT Act extension, flood insurance 
extension, small business extension, payment for construction projects, 
highways extension, unemployment insurance, COBRA extension, the old 
doc fix--the old doc fix that we do year to year, which is another 
chapter in profiles of courage on the part of the Congress--poverty 
adjustment freeze, rescission of DTV funds, and it goes on and on. What 
does all that have to do with Defense? What does that have to do with 
defending this Nation? What does that have to do with giving the men 
and women, who are serving in our armed services today in harm's way, 
the best equipment, the best training, and the best support we can 
provide to them?
  I see my colleague from Oklahoma on the floor and so I yield the 
floor at this time.
  The PRESIDING OFFICER (Mr. Kaufman). The Senator from Oklahoma is 
recognized.
  Mr. COBURN. I thank Senator McCain. I think America looks at us and 
says: Here it is, a week before Christmas, and we are debating the 
Defense appropriations bill, but it is interesting to note that the 
first appropriations bill that passed out of the Congress was the bill 
to fund us.
  We put us first. We didn't put our troops first. We didn't put the 
Department of Defense first. We have had no inflation this year, and 
what did we do? We gave ourselves a 5.8-percent increase. The first 
appropriations bill to be passed and signed by the President. We put us 
first.
  So here we find ourselves a week before Christmas debating the 
Defense bill, while we are in the midst of two wars, and there is an 
increase of only 4 percent. Yet we have all these people who say they 
are for Defense. We pass a bill that increases our own expenses by 5.8 
percent and then we tell the Defense Department: You can't do that. You 
can't have what we have.
  The fact is, it is easy to return 15 percent of everything you take 
in up here, in what you are allotted. I have done it, on average, every 
year I have been here. My employees are well paid. They work hard, but 
they are well paid. So we gave ourselves a 5.8-percent increase, but 
this Defense Department bill, in the middle of two wars, has a 4-
percent increase.
  That is not the worst of it because the average of all the increases 
right now is almost 11 percent on all the rest of the bills and here 
they are. That doesn't include any of the spending for each of these 
agencies--which averaged around 30 percent of their budget--that they 
got in the stimulus bill. Here we go: We give ourselves a 5.8-percent 
increase; Homeland Security, 7.2 percent; T-HUD, 23 percent; Interior, 
16 percent; State and Foreign Ops, 33 percent. We did ours first to 
make sure we got us covered.

  All of this is very ironic to me, based on the fact that out of every 
dollar we spend this year, 43 cents of it is borrowed. Of every dollar 
the Federal Government spends, 43 cents out of that dollar is borrowed. 
We are borrowing $4.2 billion a day. That is not every business day, 
that is every day of the week. There is $350 billion to $380 billion 
worth of waste in the Federal Government. Yet not one place in any of 
these bills do we eliminate duplicative services; not one place in any 
of these bills did we eliminate fraud; not one place in any of these 
bills did we cut the value of earmarks--though the number is down, only 
slightly, but the total dollar is up.
  We made no attempt to do what every family in America is doing today; 
that is, to prioritize. Next year, it is going to be 45 cents of every 
dollar the Federal Government spends we are going to borrow. Why is 
that important? It is important because the people making the decisions 
to borrow the money are not the ones who will have to pay it back. We 
are going to transfer that. We are going to violate the tradition and 
heritage of our country because we are going to transfer a markedly 
lower standard of living to our children.
  I met this little girl. She is from Maryland. Her name is Madelyn. If 
you divide the total debt by the total population--just the debt we owe 
now--and that is truly Enron accounting because it doesn't count the 
internal debt we owe or money we borrowed from Medicare, money we 
borrowed from Social Security, and other transfer funds--it equals 
$38,375. That is what it was when this picture was taken. It is well 
over $39,000 for every man, woman, and child, and that is just on 
external debt. The only thing she owns is a dollhouse.
  The real tragedy is, when Madelyn is 45, everybody her age and 
younger will be responsible for $1.19 million worth of debt and over 
$70,000 worth of interest per year before they pay any other taxes, 
before they buy themselves a home or an automobile or before they send 
their kids to school. They will be $1.19 million in debt, plus combined 
unfunded liabilities.
  This is the U.S. debt clock. It sits in the doorway of my office in 
the Russell Building. I had it out in the hall, but the Rules Committee 
would not allow people to look at that. I don't know whether they 
didn't want them to see it or it truly doesn't fit with protocol. Now I 
have a door open in my office and I have this on the live computer 
screen and it changes every day.
  It is pretty interesting. This was as of November 21. So, November 21 
to December 18, that is 27 days, we have borrowed another $100 billion 
since we took this picture off the Internet. We are at $12.118 
trillion. Calendar year to date, the Federal Government had spent 
$3.285 trillion. The debt per citizen on the 21st was $39,000 and, per 
taxpayer, it was $110,000. Our deficit as of November 1, for the 
calendar year, was $1.409 trillion--all of it borrowed.
  The private debt in the country is $16 trillion. That is our private 
debt. That is what all of us owe on our own stuff. The mortgage debt is 
$14 trillion.
  If you look at the second screen that is outside my office, what you 
see is the total cost of the bailout so far--$11 trillion. We only have 
personal savings of $643 billion. Our savings per adult is less than 
$3,000. How do you take that $3,000 against the $39,000 and make any 
sense out of it?
  The final screen shows the personal individual debt, the credit card 
debt, and the payment debt. It also shows our GDP. We are good as a 
nation. Our workers are good. We produce $91,000 worth of product per 
person every year. That is going to decline because of what the Federal 
Government is doing.
  There was a guy once named Cicero and he warned of some things that 
were happening in one of the best known and most successful republics 
in the world. It happened to be Rome. Here is what he said. ``The 
budget should be balanced.'' I think 90 percent of America would agree 
with that:

       The Treasury should be refilled, the public debt should be 
     reduced, the arrogance of officialdom should be tempered and 
     controlled, and the assistance to foreign lands should be 
     curtailed lest Rome become bankrupt. People must again learn 
     to work, instead of living on public assistance.

  They didn't listen to Cicero, much like the Senate is not listening 
to the

[[Page S13418]]

citizens of this country and we are growing a Federal Government we 
cannot afford, outside the bounds of what this document, the U.S. 
Constitution, says is our legitimate role. If you go to it and look at 
article I, section 8, you see the enumerated powers and you go look at 
the 10th amendment and ask: How in the world is the Federal Government 
involved in all these things?
  We have before us a bill to fund our troops and fighting two wars. 
Other than one other appropriations bill, we gave it the smallest 
increase.
  By the way, in this bill is $18 billion of what we call emergency so 
we do not have to play inside the budget. We automatically transferred 
another $18 billion to Madelyn and her generation.
  How do we get out of this? What do we do? We actually, in Congress, 
should be following the lead of the families in this country. What are 
families doing? Families are sitting down and making priorities. They 
are saying what are the things we must do? What are the things we want 
to do? What are the things we would like to do? Most of the ``What are 
the things we would like to do?'' are going out of the window for 
American families today. A large portion of the things families want to 
do is going out the window so they can maintain the things they must 
do. It is called making hard choices.
  When you see that the Congress took care of itself before it took 
care of anybody else, it describes the problem in Washington. We are 
absolutely clueless as to what the average American is going through. 
We could have all the words on this Senate floor said that we want to 
say, but our actions speak far louder than any words we could ever say. 
What are our actions? Our actions are to steal the future and 
prosperity of our children. It is not a very noble cause.
  We are here this week not because of the Defense Department bill. We 
are not here the week before Christmas because of this bill. We are 
here the week before Christmas because somebody has set an artificial 
deadline that we must pass a health care bill, any health care bill, so 
we can say we passed a health care bill. That is why we are here. When 
we look at health care in our country, we recognize that we have 
significant problems in making sure everybody has access to care. We 
know what the problem is on access to care because we know per capita 
we spend almost twice as much as anybody else in the world on health 
care. The problem plaguing access to care--and as a practicing 
physician for over 25 years--is cost.
  We have some bill coming sometime that will not be available for 72 
hours for everybody in the country to read, that by the time you add 
the 2,074 pages to the couple of hundred pages we are going to add on, 
nobody is going to understand exactly what they are voting on. But we 
are going to vote on it because we said we would. We are going to 
impact one-sixth of our economy and we are going to destroy the best of 
our health care system in the name of fixing some of the problems in 
our system.
  We are totally disconnected with America, the America I know. There 
was a guy who said--I will paraphrase the statement:

       Freedom is a precious thing. It is not ours by inheritance 
     alone. It must be fought for and defended by each and every 
     successive generation.

  What is that freedom he is talking about and who was he talking to? 
He was talking to the American people. He wasn't talking to our troops. 
The freedom he was talking about was the liberty that comes when free 
people come together under a democratic Republic with a limited Federal 
Government to make the best choices they can make for themselves and 
their families, and the freedom to do just that. That person was Ronald 
Reagan.
  I got an e-mail from a constituent of mine. I can't use the exact 
words because they are not appropriate for the Senate floor. But he 
kind of paraphrased that statement and then he said: Every now and then 
somebody comes along and pees it all away. He said: Son, don't let it 
be you.
  Our freedom is being taken away in this country--not intentionally 
but unintentionally. Because as the Federal Government grows and 
expands, your opportunity to make choices for yourself and your family 
become limited. We have a health care bill that is going to spend $2.5 
trillion over the next 10 years. It is going to cause premiums to rise, 
it is going to cause quality of care to go down, it is going to cause 
us to lose 1.6 million more jobs, and it is going to involve the 
Government between the patient and the caregiver. That bill will create 
70 new government programs, 15,000 to 20,000 new Federal employees. It 
will create three panels that will ration care in this country 
directly. And it will in fact take Americans'--not just Americans on 
Medicare or Medicaid--Americans' freedom to make the best decision for 
them and their family as regard to their health care and stuff it in a 
box.
  That is because we are going to tell you what you can have, what you 
can buy. We are going to totally disregard the art of medicine and we 
are going to practice cookbook medicine in this country.
  A week ago we reversed the U.S. Preventive Services Task Force 
recommendation on breast cancer screening. We are going to have to do 
that hundreds of times every year under the bill that is being proposed 
right now because all of that is based on cost estimates. It was based 
on 1 out of every 1,970 women they find a breast cancer in between 40 
and 50; but what people didn't say is in 1 out of 1,400 women between 
50 and 60 they find a cancer. So on a cost basis they are right; on a 
clinical basis they are not.
  The majority whip earlier today said the Republicans didn't have any 
ideas on health care. The fact is we do have ideas on health care. What 
we know from a Thomson Reuters study that came out in April of this 
year is that there is $700 billion in our system today that is not 
helping anybody get well and isn't preventing anybody from getting 
sick. If we want to truly cut the cost of health care, what ought to be 
required reading for every Senator in this body is the Thomson Reuters 
report. Because they can go through the fraud and abuse--19 percent of 
everything we spend. Unwarranted use--that includes me as a doctor 
doing tests I should not be doing. That includes defensive medicine, 
administrative inefficiencies, provider inefficiency and errors, 
avoidable care and lack of care coordination--duplication.
  We have not attacked the disease of runaway health care costs in this 
country. What we have attacked is the symptoms. You do not cure people 
by treating their symptoms. You cure people by finding out what their 
disease is and curing the disease and treating the disease.
  We are accused of being the party of ``no.'' I want to tell my 
colleagues and the American public, ``no'' is a wonderful word. When 
your child is misbehaving, you say ``no.'' When your adolescent child 
is making bad judgments, you say ``no.'' When somebody is stealing 
something from somebody else, i.e. liberty, you say ``no.'' When you 
are stealing the future, in terms of opportunity, we should say ``no.'' 
When you are creating a government-centric health care system rather 
than a patient-centric health care system, ``no'' is a great word.
  We have heard all about why we do not have any ideas. We had two 
markups. The ideas we offered were rejected.
  I see Senator Wyden on the floor. He has a wonderful health care 
bill. It is somewhat different than the one I introduced but it is a 
great bill. It does not fall into any of the traps the bill that is on 
the floor today falls into. It also addresses many of the problems that 
are outlined in the Thomson Reuters study on health care in America.
  Saying ``no'' at the right time saves lives. Saying ``no'' at the 
right time saves money. Saying ``no'' at the proper time preserves our 
future. Saying ``no'' when no is the best answer is the correct, right 
thing to do.
  We have a government we cannot afford.
  The PRESIDING OFFICER. The time of the Senator has expired.
  Mr. COBURN. I ask unanimous consent for 30 seconds.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. COBURN. We have a government we cannot afford. We are borrowing 
money to buy things we do not need. We earmarked $18 billion worth of 
projects this year. Some were good and some were terrible.
  We eliminated no duplication in any agencies. We got rid of none of 
the fraud. We did nothing about efficiency,

[[Page S13419]]

and we did nothing about creating priorities. I agree with my 
Democratic colleagues that health care should be a priority. When we 
had the leadership, we didn't do anything with it, and we should have. 
But mark my words, this is a turning point in America if we pass this 
health care bill. It is a turning point from which we will not recover.
  I yield the floor.
  The PRESIDING OFFICER. The majority whip.
  Mr. DURBIN. Mr. President, it is my understanding the Democratic side 
has 30 minutes now.
  The PRESIDING OFFICER. The Senator is correct.
  Mr. DURBIN. I see the Senator from Oregon is here. If I could have a 
few minutes to respond and then turn the floor over to him for as much 
time as he would need--I thank the Senator from Oregon.
  First, a history lesson. Sometimes facts are tenuous, difficult, 
sticky things you can't get rid of. Let's look at the facts. When 
William Jefferson Clinton left the Presidency, America's budget was in 
surplus. For the first time in 30 years, we were generating more 
revenue than we were spending. We were adding life and longevity to the 
Social Security system, to Medicare, and many others. We did this with 
a prosperous, booming economy, one of the most prosperous we had seen 
in modern history. We created new jobs, new businesses, new home 
opportunities. When William Jefferson Clinton left office, we had a 
national debt of $5 trillion.
  In came the Republicans, billing themselves as fiscal conservatives. 
They were going to do it better, get government off our backs, reduce 
spending, and show us how they could manage. They took a $5 trillion 
national debt, and over the next 8 years more than doubled it. In other 
words, when George W. Bush left office, America had more debt, twice as 
much, as was the case when he took office.
  How did we reach a point where our debt mushroomed and more than 
doubled in 8 years? Because these fiscally conservative, flinty-eyed, 
styptic-hard Republicans engaged in a war they wouldn't pay for. Some 
of the Senators who just spoke this morning voted for us to go to war 
and not pay for it and just add it to the debt.
  Secondly, President Bush did something no President had ever done in 
history. It was counterintuitive. It made no sense, but he did it. What 
was it? He cut taxes in the midst of a war. It has never been done 
because you can't explain it. You have the ordinary expenses of 
government that still continue, and now you have a new expensive war. 
And instead of doing what Franklin Roosevelt did in World War II, 
saying we are going to sell bonds, we will do our best to pay for this 
war, they said just the opposite: We will go into debt even deeper to 
not pay for the war. That is what they did. They went into debt by 
cutting taxes on the wealthiest Americans.
  Unpaid for wars, tax cuts in the midst of wars for the wealthiest 
people, and then to add insult to injury, they passed the Medicare 
prescription Part D Program--a needed program, for sure--and didn't pay 
for it, adding hundreds of billions of dollars to the debt too. So at 
the end of 8 years, George W. Bush, who inherited a surplus from Bill 
Clinton, gave us twice the national debt, gave us the largest annual 
deficit we had ever seen, and left the economy in shambles.
  Witness the recession we are currently in just starting to inch away 
from. That was the record of the fiscally conservative, let's-get-
tough-on-debt Republicans for 8 years, and many of those years they 
controlled Congress. All of those years the President had a veto pen.
  When I come to the Senate floor and hear my Republican colleagues 
relate how they have a better vision of America--and their vision is in 
many respects a good one, to reduce debt for future generations--the 
record speaks for itself. They failed.
  Now comes President Obama, and he says to Congress: We have to get 
the economy moving again. Some Republicans are criticizing him saying 
it is a mistake for us to put money into our economy. The President 
said we have to put people back to work, give working families a tax 
cut, create jobs building highways and infrastructure, do the things 
that help small businesses expand their payrolls. It costs money for 
sure, and I know we are in debt, but if we don't get that engine of the 
economy churning and moving forward, then we will never get out of this 
hole and more suffering will be the lot of the American people.
  Not a single Republican would support that, not one. We didn't get 
one Republican vote for that in the House of Representatives. Over 
here, we had three--the two Senators from Maine and the Senator from 
Pennsylvania who has since crossed the aisle and joined the Democratic 
party. That was the reality. As a party, the Republicans opposed 
stimulating the economy in the midst of the deepest recession.
  Now comes health care. President Obama says to us: Before you pass 
this health care bill, there is one basic rule--do not add to the 
deficit. Find a way to reduce health care costs for individuals, 
families, and businesses. Do not add to the deficit. The Congressional 
Budget Office took a look at this bill--it took a year to prepare it--
and said it is the biggest deficit cutter in the history of the United 
States because over 10 years, this bill alone will save the Federal 
Government $130 billion and over the next 10 years, $650 billion. If we 
continue without changing the current health care system, it will mean 
more debt for everyone, higher premiums, higher costs, and more 
deficit. That is the fiscal choice we face.
  I hear Senator McCain, who is my friend--I respect him. We served the 
same period of time together in the House and Senate, and we disagree 
on a whole lot of things. But I like him. I think he likes me a little 
bit some days--come to the floor and say: Do you know what is wrong 
with this Department of Defense appropriations bill? In his words, the 
Democrats have ``larded it up.'' They have larded on things.
  What is the lard in this bill? The extension of unemployment benefits 
for millions of Americans out of work. Last time I came to the floor of 
the Senate it passed 97 to nothing--not exactly a hotly controversial 
issue. Sadly, it took us 1 whole month to get to a vote. Then it passed 
97 to nothing.
  We larded it up with food stamps. In the State of Michigan, one out 
of six people is on food stamps. Food stamps in this economy are a 
lifeline for people to feed their children when they are out of work 
and don't know where the next meal is coming from. Is that the kind of 
squandering of taxpayers' dollars that we often hear from Senator 
McCain. I don't think so. He is not a hardhearted man. He wants to feed 
children. He wants food stamps.
  How about COBRA? COBRA is an acronym for a program that allows people 
to pay for health insurance. One of the first casualties when you lose 
your job is your health insurance. We want people to keep that health 
insurance. We help them pay the premiums. That is in here. I don't 
think we are larding it up when we include that.
  The extension of the PATRIOT Act for a few months. Of course, if we 
are going to be vigilant against enemies, we want to extend it. We can 
debate what should be in it, but an extension of the PATRIOT Act is 
going to mean that America will be safer. The alternative is 
unacceptable.
  Money for the Small Business Administration--that is where jobs are 
created. If we don't give money in loans to small businesses, we will 
see people losing their businesses and cutting back on employment. This 
is just fundamental. There is no credible, respectable, mainline 
economist who argues that the way to get out of a recession is to cut 
spending at the Federal level. Exactly the opposite is true. You have 
to help people with the safety net. You have to try to create a 
catalyst for more job creation. That means spending money.
  I don't think this is lard and earmarks and porkbarrel. We are 
talking about the basic necessities of life. The Department of Defense 
appropriations should not be filibustered as the Republicans are 
currently doing.
  Before I hand the floor over to the Senator from Oregon, I salute 
him. He has given more hard thought as an individual Senator than 
almost anyone in this Chamber about what to do with the system. The 
Senator's premise in health care is the right premise--more 
competition, more choice. We may disagree on some concepts. That is 
what we are here for. But I want to salute

[[Page S13420]]

the Senator from Oregon and tell him this underlying health care bill 
is going to do things for America that need to be done. It is going to 
start--not as much as we would like--to bring down the increase in 
costs and provide affordability for families and businesses. It will 
extend the reach of health insurance to 94 percent of the American 
people. It is amazing. It is historic. It is going to create a 
Patients' Bill of Rights which gives every family in America the legal 
tools to fight back when the health insurance company says no to their 
doctor and no to what they or their families need. It has a lot of 
positive things in it.
  I want to salute Senator Wyden, as well as Senator Bernie Sanders of 
Vermont, for one particular provision in the bill. We don't have the 
details yet, but we believe this will result in the most dramatic 
expansion of health care clinics across America. Those of us who 
represent communities such as Chicago and even downstate Illinois know 
these clinics are the first line of defense for medicine. Men and women 
can walk through the front door and find primary care and have their 
needs taken care of even if they are poor. Some of the most dedicated, 
hardworking professionals in medicine are in those clinics.
  I have walked into many in Chicago, such as the Alivo Clinic where my 
friend Carmen Velasquez is the director. I have said: Carmen, if I were 
sick or my wife were sick, I would feel confident walking in the front 
door of your clinic. You have the best people on Earth who are doing 
dramatic things.
  I ask unanimous consent there be printed in the Record an article 
from the Chicago Sun Times that talks about the terrible health care 
disparities in the United States, particularly between African 
Americans and White Americans.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   [From the Suntimes, Dec. 18, 2009]

           Health Gap Kills 3,200 Black Chicagoans Every Year

                           (By Monifa Thomas)

       The wide racial gap in health is growing in Chicago, a 
     major new study has found.
       Already lagging far behind whites on most key measures of 
     health, blacks in Chicago have fallen even further behind in 
     11 of 15 areas reviewed by Chicago's Sinai Urban Health 
     Institute between 1990 and 2005--including infant mortality, 
     heart-disease deaths and diabetes.
       There's a stark, human cost in that: In all, the 
     researchers estimated that the toll of the black-white health 
     disparity is an additional 3,200 deaths of African Americans 
     in Chicago every year.
       It isn't that blacks' health is declining. In fact, 
     overall, the health of both African Americans and whites in 
     Chicago and across the United States has improved on most of 
     the measures studied between 1990 and 2005. But whites showed 
     gains at a sharply higher rate, resulting in a wider gap, 
     according to the Sinai institute, which is part of Chicago's 
     Sinai Health System and which works to find ``approaches that 
     improve the health of urban communities.''
       Nationally, the racial gap in health between blacks and 
     whites in the United States has remained fairly constant over 
     the same 15-year period, according to the new analysis, which 
     was abased largely on communicable disease reports and birth 
     and death records and was published online Thursday in the 
     American Journal of Public Health.
       In Chicago, areas where the divide between blacks and 
     whites in Chicago worsened significantly included: the death 
     rates from heart disease and breast cancer, rates of prenatal 
     care during the first trimester of pregnancy and the number 
     of cases of tuberculosis.
       The death rate from all causes for black Chicagoans was 36 
     percent higher than whites in 1990. By 2005, the difference 
     had grown to 42 percent. In contrast, at the national level 
     the racial gap in death rates shrank, going from 35 percent 
     to 29 percent.
       The researchers attributed the growing racial gap largely 
     to whites' greater ability to benefit from health care 
     advances because of ``racism and poverty.''
       ``What's happening is that, as advances become available 
     for these different diseases, white people are able to gain 
     access to advances, and black people are not,'' said Steven 
     Whitman, director of the Sinai Urban Health Institute. ``It's 
     absolutely essential to understand the underlying structural 
     issues that are causing these disparities: those are racism 
     and poverty.''
       Whitman said the segregated nature of Chicago puts 
     minorities at a disadvantage for accessing high-quality 
     health care. He also noted that blacks in Chicago often live 
     in poorer neighborhoods with underperforming schools, fewer 
     parks and recreation areas and more ``food deserts''--areas 
     that don't have supermarkets and the array of healthy foods 
     they carry.
       What isn't clear and needs to be studied, according to 
     Whitman, is whether the disparities seen in Chicago are worse 
     than in other cities.
       Romana Hasnain-Wynia, director of the Center for Healthcare 
     Equity at Northwestern University's Feinberg School of 
     Medicine, said the racial health gulf isn't helped by ``one 
     size fits all'' public health messages aimed at lowering 
     death rates from heart disease, cancer and other illnesses.
       ``We have to be targeted in our interventions,'' said 
     Hasnain-Wynia, who was not involved in the study.
       James Randell recently was diagnosed with heart disease at 
     Mount Sinai Hospital after coming in with chest pain. The 
     Chicago man said he was troubled--but not surprised--to learn 
     that African Americans aren't seeing the same level of 
     improvement in their health as whites. His layman's take? 
     It's the result of a lack of health literacy among 
     minorities.
       ``A lot of us, we don't know what we should be doing to be 
     healthy,'' said Randell, 47. ``If I had taken better care of 
     myself, I wouldn't be here.''
       The gap between blacks and whites in Chicago on a number of 
     health indicators has increased between 1990 and 2005. Here 
     are a few areas where the divide has grown significantly:
       Heart-disease deaths: 1990: 8 percent difference (meaning 
     deaths for blacks were 8 percent higher than whites). 2005: 
     24 percent.
       Female breast-cancer deaths: 1990: 20 percent difference. 
     2005: 99 percent.
       No prenatal care during the first trimester: 1990: 119 
     percent difference. 2005: 199 percent.
       Tuberculosis cases: 1990: 310 percent difference. 2005: 497 
     percent difference.

  Mr. DURBIN. In heart disease deaths in 1990, there was an 8-percent 
difference between African Americans and White Americans. Today it is 
24 percent. Female breast cancer deaths, there was a 20-percent 
difference between African Americans and White Americans in 1990. Today 
there is a 99-percent difference. Prenatal care during the first 
trimester, there was a 119-percent difference in 1990. Today it is 199 
percent; tuberculosis, 310 percent difference in 1990, 497 percent 
today.
  These gross health care disparities are the result of the lack of 
primary care in the neighborhoods and towns of America. Senator Wyden 
and Senator Sanders, thank you for leading the fight to expand that.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Oregon.
  Mr. WYDEN. Mr. President, before he leaves the floor, I commend the 
distinguished Senator from Illinois for his statement and want to make 
sure the body recognizes that it has been Senator Sanders who has 
championed this cause relentlessly, making the case that, dollar for 
dollar, there is no better investment in American health care than 
these community health centers. I was going to spend my time talking 
about the opportunities for Democrats and Republicans to continue to 
team up on this health reform issue. I think it is worth noting that 
Senator Sanders, who has championed this effort in this bill, is 
actually picking up on work that a number of the most influential 
Republicans in this country have been interested in for years.
  President George W. Bush was a great champion of community health 
centers. Bernie Sanders, now in this bill, is making sure we get a very 
significant increase so that there will be many new clinics across the 
country.
  There are opportunities for Democrats and Republicans to work 
together. I will talk about a way we can create a new marketplace in 
American health care through health care exchanges and get more value 
for the health care dollar. This is an opportunity for Democrats and 
Republicans to team up, much like with community health centers. I 
thank my colleague.
  I know because of our work together on health legislation the Senator 
shares my view that we can continue this effort to bring the Senate 
together on both sides around key principles of health reform. I want 
to do that again this morning by focusing on one of the most 
transformational and least understood parts of the health care debate; 
that is, the question of health insurance exchanges. My guess is across 
the country people are still trying to figure out what in the world 
these are and whether this is yet some other kind of health care lingo. 
It is fair to say, in basic English, these exchanges will be like 
farmers markets. This will be an opportunity for people to go to one 
place and to do what they can't do in the dysfunctional American health 
care system today; that is, actually shop and be in a position to 
compare

[[Page S13421]]

various kinds of products and services. When you invest wisely, you can 
put the savings in your pocket. The reality is, that has not been 
possible in our country ever since the middle of the 1940s. During the 
1940s, when there were wage and price controls, judgments were made 
about the delivery of American health care. The decision to tie 
insurance to someone's job made sense back then, when people went to 
work somewhere and stayed put for 30 years until their employer gave 
them a big retirement party and a gold watch.
  But today's economy is very different. On average, people change 
their jobs 11 times by the time they are 40. We need to make sure that 
no longer is the consumer insulated from the health care system, no 
longer are most consumers incapable of being rewarded when they shop 
wisely. People understand that they lose out in terms of their wages if 
health care costs continue to rise as a result of inefficiency. So 
these health insurance exchanges are the key to making health care 
markets work, in effect, for the first time since the middle of the 
last century.
  In the merged bill, Senator Reid, in my view, has laid an important 
foundation. There are three fundamental principles in Senator Reid's 
merged bill. Of course, we are going to continue to work on this. When 
the managers' package and this bill get out of the Senate, we are going 
to be working on this for quite some time. We are going to work on this 
long after 24/7 cable TV has moved on to other topics.
  But in Senator Reid's merged bill, there are three important features 
of the exchange. The first is, it is going to be possible for consumers 
to make apples-to-apples comparisons of various health care plans. 
Consumers will be able to see that one plan will cost them $20 in 
copays for a physician visit, but perhaps another plan will cost them 
$30. It will be much like you can do in a store, a Costco, a grocery 
store, where consumers look at products on a shelf, look at the price, 
look at the various offerings, and choose the best product for 
themselves.
  The second feature in the merged bill that Democrats and Republicans 
alike should appreciate is that it will be possible to keep low-quality 
plans out of the new marketplaces. This is especially important at the 
outset. I learned this back in the days when I was codirector of the 
Oregon Gray Panthers, the senior citizens group. One of the things the 
country learned in the early days of Medicare is a lot of the policies 
that were sold to supplement Medicare were just junk. They were not 
worth the paper they were written on, and people would buy 10, 12, 15 
policies, literally wasting money they could have used for food and 
fuel and paying the rent. It took us until the mid-1990s to drain the 
swamp, and finally we were able to do it, standardize those packages, 
stop the ripoff of older people with products that literally were not 
worth the paper they were written on.
  The consumer protection provisions Senator Reid has put in the merged 
bill, as it relates to exchanges, are going to keep low-quality plans 
out. This is going to offer customers the peace of mind of knowing that 
when they look at the plans, they can be certain they will have to meet 
minimum consumer protection standards. This is an important message to 
send in a new marketplace, and it will be an opportunity to have a very 
different start than we saw with Medicare, during those early days, 
when seniors were sold these policies to supplement their Medicare, 
private insurance policies that were a lot of junk.
  Finally, under the merged bill, you are going to be able to see the 
value you are getting for your health care dollar, in an important 
respect, through what are called loss ratios that insurance companies 
will have to make public. What this means, of course, is consumers want 
to know that when they put out a dollar for premiums, they will get a 
significant portion of that dollar back in actual benefits and 
services. With the exchange, it is going to be possible to finally get 
this kind of loss information in one place and make it public.
  So what I would like to do is talk about the steps from here and 
particularly build on principles the President talked to us about 
earlier this year in terms of ideas that bring Democrats and 
Republicans together; that is, more choice and more competition in the 
health care marketplace. What we are pointing to is the day when every 
consumer in America can say to their insurance company: I am giving you 
an ultimatum. You treat me right or I am taking my business elsewhere. 
That is what we are pointing to.
  Here are some of the steps it is going to take in the days ahead to 
build to that future.
  First, you have to have a big enough pool of people as soon as you 
can so as to maximize their clout in the marketplace. You have to make 
sure the exchanges are open to more than just folks who have been 
uninsured. If you open it just to folks who are uninsured, who have not 
seen a doctor, who have had chronic illnesses, who have not been able 
to get the preventive care they need, you have coming to the exchanges 
folks who are sicker and, of course, they are more expensive in terms 
of getting them good health care, and it is harder to hold down costs.
  Once you have a big enough pool, where the risk is spread across a 
large group of people who have a wide range of health risks, you will 
be in a better position to force the insurance companies to compete and 
drive down costs for everybody.
  In effect, in the days ahead, we will be in a position to put in 
place a cycle in the health care marketplace that will get more value 
for the American consumer. More and more people will come to the 
exchanges because the premiums are lower. More insurers will come into 
the exchange because they see that is the place you have to go in order 
to get business. Then you have what amounts to the beginnings of a 
revolution in the health care marketplace: get as many healthy people 
into the exchange; make it impossible for insurance companies to find 
loopholes and use slick marketing campaigns to cherry-pick just the 
youngest and healthiest; force them to compete on the basis of price, 
benefit, and quality and then you are on your way to taking a 
dysfunctional American health care system and getting the choice and 
competition that will finally pay off for the American consumer.
  There are some additional interim steps I wish to mention briefly. 
The majority leader, Senator Reid, and Chairman Baucus and I have come 
to an agreement that will also provide the opportunity to get more 
choice and more competition into the health care marketplace. What we 
have agreed to is, folks who spend more than 8 percent of their income 
on health care but are not eligible for subsidies--in effect, folks 
with what is called the hardship waiver--they would be able to get a 
voucher from their employer and go into the marketplace. With that kind 
of approach, which would be tax free to them, our estimate is that it 
will be less than one-third as expensive, in terms of getting health 
care for those folks, as the alternative--the system of subsidies. 
Again, we get more people covered in a more affordable way, building on 
these time-honored principles of choice and competition.
  Finally, Senator Collins, Senator Bayh, and I have a proposal, a 
proposal that has been endorsed by the National Federation of 
Independent Business, that would say that employers that are in the 
exchange can voluntarily say they want to give their workers more 
choices. In effect, it would say to those small employers in the 
exchange: You and your workers will have a choice to have a choice. No 
employer is required to do anything. But should they want to 
concentrate on making their widgets rather than being in the health 
insurance business, they would have the opportunity to do it.
  What they would give their worker would be tax free to the employer, 
tax free to the worker. Once again, you bring the principles of choice 
and competition into the health care marketplace and move us closer to 
that day when the consumer can give the insurance company the ultimatum 
I have envisioned; which is: Treat me right or I go elsewhere.
  I close by saying, in my view, the majority leader has laid the 
foundation for a new health care marketplace. I certainly would like to 
do more. As the distinguished Presiding Officer knows, as cosponsor of 
our bipartisan Healthy Americans Act, I would like to do more, and I 
would like to do it faster. But make no mistake about it, this is 
laying a foundation to create a new

[[Page S13422]]

marketplace in American health care, where that concept has been 
foreign.
  To let people make apples-to-apples comparisons, keep crummy products 
out of the exchange, make sure people can get information about loss 
ratios, that is a real foundation. Then we seek to go further. We have 
had the counsel of some of the country's leading thinkers about 
American health care.
  Let's get more healthy people into the exchanges. Let's make sure we 
have these big pools. Let's make sure the insurers cannot try to steer 
the marketplace because we know they are going to try, in ingenious 
ways through advertising and market promotion strategies, to still find 
the best risks. Let's build on what Senator Reid has laid out with 
respect to the exchanges in the days ahead.
  We are going to be at this a long time. You are not going to fix a 
dysfunctional health care marketplace in a matter of weeks. We are 
going to be at this the rest of this week, next week, well into 2010. I 
have been part of this debate since I was codirector of the Oregon Gray 
Panthers, going back 30 years now.
  I continue to believe there is an opportunity for Democrats and 
Republicans to work together. Our party has been right on the issue of 
coverage. You cannot fix this unless all Americans have good, quality, 
affordable coverage because otherwise there will be too much cost 
shifting. But as I have said to my colleagues on the other side of the 
aisle--I see Senator Bunning, and he and I have worked together on the 
Finance Committee--our colleagues on the other side of the aisle make 
important points with respect to choice, with respect to markets, with 
respect to competition. This is an area we can work on together.
  There is nothing partisan, in my view, about creating a new health 
care marketplace through these exchanges. This bill lays a foundation, 
and there will be opportunities for Democrats and Republicans to build 
on that foundation in the days ahead.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Kentucky.
  Mr. BUNNING. Mr. President, what is the current order of business?
  The PRESIDING OFFICER. The Republicans control 29 minutes at this 
point.
  Mr. BUNNING. Twenty-nine minutes?
  The PRESIDING OFFICER. Yes.
  Mr. BUNNING. The order of the day would be the Defense appropriations 
bill?
  The PRESIDING OFFICER. The Senator is correct.
  Mr. BUNNING. Thank you very much.
  Mr. President, I rise to talk about the 2010 Department of Defense 
appropriations bill. There are several parts of this legislation I 
would like to discuss. But first of all, I would like to talk about the 
process the majority has used for this bill.
  This past weekend, we passed an omnibus bill that jammed together six 
different appropriations bills. I had high hopes that this year we 
would not have to resort to an Omnibus appropriations bill. We have 
done it in the past. I was hoping this year we would not. I hoped we 
could go through regular order and give each bill the time and 
attention it deserves. In fact, I think we could have done that if we 
were not spending so much time on the floor with this monstrous health 
care bill. We have had a lot of floor time but not much action on 
health care. However, earlier this week, we passed a bill containing 
all the remaining appropriations bills, except the one for funding the 
Department of Defense.
  Why was this done? Why was this bill left for last? It was done 
because this bill was used as a political football. The majority felt 
that because this bill contains important funding for our troops, they 
could attach unrelated provisions to it and then insinuate that anyone 
who has concerns about these provisions and tries to slow down the bill 
to look at them is jeopardizing our fighting men and women. In fact, 
some Members of the majority have made those claims this week.

  My question to them is, why didn't the majority include the 
appropriations for the Department of Defense in the omnibus we just 
passed? The funding for our troops could have been signed by the 
President and made into law by now. However, the majority wanted to use 
this funding as a political hammer. This is not right, and the American 
people should know what is really going on here. Our troops deserve 
better.
  I wish to talk about some of the provisions contained in this bill, 
beginning with the detention facility at Guantanamo Bay.
  The bill before us does provide that no detainees from Guantanamo may 
be released into the United States. It also does not provide funding 
for the closure of the Guantanamo detainee facility. These are good 
provisions, but they are not good enough. This bill does not prevent 
sending these prisoners to the United States for trial and housing them 
in our own backyards. It would be much improved if it contained a 
complete ban on moving them to the United States.
  On January 22, 2009, President Barack Obama signed an Executive order 
to close the detention center at Guantanamo Bay. I am against the 
shutting down of that facility. It is absolutely irresponsible to order 
this closure and not have a plan in place to address what the United 
States will do with all the detainees held there. Under no 
circumstances should they be brought to the United States. The 
terrorists housed at Guantanamo Bay are the worst of the worst. I have 
personally visited these facilities and met with the brave men and 
women who guard these detainees. As long as the terrorists remain 
housed at Guantanamo, they cannot harm us or any of our allies. 
However, the administration has seen fit to push ahead on sending 
Guantanamo detainees to the United States. In fact, we learned they now 
plan to send some of the most dangerous terrorists in the world to 
Illinois. President Obama could not bring the Olympics to Illinois, but 
it looks as though he will bring terrorists there instead. The plan 
appears to be to use a currently empty supermax facility in 
northwestern Illinois to hold Guantanamo detainees.
  I think bringing these terrorists to the United States is a terrible 
idea. First of all, there are serious legal problems associated with 
bringing these terrorists to our soil. The Supreme Court has noted that 
it is ``well established that certain constitutional protections 
available to persons inside the United States are unavailable to aliens 
outside of our geographic borders.''
  The nonpartisan Congressional Research Service said that 
``noncitizens held in the United States may be entitled to more 
protection under the Constitution than those detained abroad.'' This 
means they could be afforded extra rights which are available to 
American citizens. They could include protection under the fifth 
amendment due process clause, which would cover how they are confined, 
or they also may raise claims regarding religious practices.
  Furthermore, while the Obama administration may not have the 
intention to release any detainees, their wishes could be overruled by 
a civilian judge. Guantanamo detainees who are cleared for release 
have, in fact, petitioned the court to be released into the United 
States. Last year, a Federal judge even approved such a request before 
being overruled by an appellate judge. The reason the higher court 
cited for overturning the ruling was that the government could not be 
forced to accept someone into the United States from outside the 
country. If we start bringing detainees to the United States, this 
legal safeguard will be removed.
  Throughout the debate on whether closing Guantanamo is good policy, 
supporters of the idea have consistently maintained that the facilities 
serve as a lightning rod for anti-U.S. sentiment and that it is used as 
a recruiting tool for terrorists. I don't buy that argument. I would 
argue that the greatest recruiting tool for these terrorists is the 
United States itself and our way of life with democracy and freedom of 
religion. What if it was found that the Statue of Liberty was being 
used as a symbol to incite attacks on our country? Would we tear it 
down? Of course not. The United States has suffered many terrorist 
attacks prior to the opening of the Guantanamo Bay facility, including 
the horrific events of September 11, 2001. If we close this facility, 
then those who hate us will simply find another tool of motivation for 
their followers.

[[Page S13423]]

  The bottom line is that the Guantanamo Bay detention facility works 
and we are putting ourselves at a disadvantage by not using it. I wish 
this bill had taken a stronger position on making sure this facility is 
not abandoned.
  As everyone here knows, this bill also provides further funding for 
the wars in Iraq and Afghanistan. I was glad to see that the President 
finally announced a plan for Afghanistan earlier this month. We waited 
far too long for this decision. I was very concerned that this wait was 
unnecessary and was putting the lives of our servicemembers at risk. I 
am glad he finally heeded the call of our commanders on the ground for 
more troops. In fact, I agree with the bulk of his strategy for waging 
the war in Afghanistan.
  However, I strongly disagree with him on one particular issue. I have 
serious concerns about the administration's decision to set a timetable 
for troop withdrawal. I could not disagree more with the announcement 
that U.S. troops will begin leaving Afghanistan in July of 2011.
  What makes this situation even more confusing is that the 
announcement also claimed that any withdrawal will take conditions on 
the ground into account. This is puzzling and it is a contradiction. 
What will the administration do if conditions on the ground dictate 
that no troops be removed from Afghanistan? Will it proceed with a 
withdrawal anyway? I don't want to keep any of our brave men and women 
in Afghanistan any longer than absolutely necessary, but we have work 
to do. Leaving before it is done is unacceptable.
  By announcing an arbitrary deadline for our forces to come home, 
possibly before the job is done, the President is telling our enemies 
how long they will have to hold out and wait until we leave. They will 
bunker down and emerge after we are gone. It is unimaginable what the 
horrible consequence of this would be. I was glad to see this strategy 
rejected in Iraq, and it is no less foolish to apply it to the war in 
Afghanistan. I fear we could be setting our efforts up for defeat and 
putting our fighting men and women in further danger, and I am deeply 
troubled by this.
  While I strongly oppose President Obama's notion for a timeline for 
withdrawing from Afghanistan, I do support his call for a surge of 
troops to stabilize the country. We learned a great deal from our 
counterinsurgency strategy implemented by GEN David Petraeus and 
Ambassador Ryan Crocker in Iraq. He knew that if the U.S. forces spent 
most of their time only in a small protected area such as the Green 
Zone in Baghdad, then little would be accomplished.

  The surge in Iraq was successful not only because there were simply 
more troops in Iraq; it was what they did that mattered. By simply 
going out into insurgent areas and being more visible, this gave 
reassurance to the local populations that Americans were still around, 
but it did not stop there. Previously, coalition forces would clear an 
area but then retreat. This time, they were there to stay.
  Our soldiers became involved with the local communities, assisting 
with infrastructure and even doing things such as helping to set up 
farm co-operatives. The strategy evolved from only clear, to clear, 
hold, and build. Soon, our forces had the trust of the locals. The 
citizens of Iraq began to help with the stabilization and rebuilding of 
their country. They began to cooperate with our military efforts and 
help us fight insurgents. Before, they were scared and powerless. Now 
they were safe and had the ability to make their lives better. These 
conditions have made it very difficult for our enemies to operate. It 
is now time to apply these lessons to Afghanistan. It is time to clear, 
hold, and build there.
  It is unfortunate but true that the Afghan Government suffers from a 
deplorable level of corruption. However, it will not do us any good to 
refuse to help until things get better. This is because they won't get 
better without our help. The citizens in Afghanistan by and large do 
not trust their government, and this creates an atmosphere that is very 
helpful to our enemies. When our forces move into communities, they 
create stability and undermine insurgent forces and corruption.
  Use of the proper strategy can help improve the government, as we 
have seen in Iraq. However, if it is not improved, then the people will 
never trust it and it will not protect them. They will have no choice 
but to comply with the wishes of the insurgents. Eventually, the 
government will slide into chaos and the Taliban and al-Qaida will 
return to power. We cannot let this happen. A return to Afghanistan's 
previous status as an unhindered launching pad for global terrorist 
plots is totally unacceptable. We know all too well what the 
consequences of this are. However, it could possibly get even worse 
than that.
  We have seen the difficulties Pakistan has had in fighting the 
Taliban on its own soil. Currently, U.S. and NATO forces are fighting 
and hopefully soon beating the Taliban and al-Qaida in Afghanistan. If 
we were to leave before finishing the job, the result could be 
disastrous for Pakistan. A Taliban-controlled Afghanistan would be a 
sanctuary and staging point for the radical Islamist terrorists to 
attack from. Pakistan is a nuclear power, and its fall to these groups 
would be utterly catastrophic.
  Victory in Afghanistan is essential.
  We learned a lot from the Bush administration's revised strategy for 
Iraq that put that war on a path to success. It would be a shame if we 
did not apply those hard-learned lessons to the current conflict in 
Afghanistan.
  As I mentioned at the beginning of my remarks, this is a large bill--
larger than it had to be. The use of this Defense appropriations 
measure as a political football is why it is so big. I think it is a 
shame that the majority chose to legislate in this manner.
  We did not need to do it this way. It is probably too late in this 
process for us to fix this mash-up of different bills and give all of 
these issues the individual attention that they deserve. However, 
hopefully, next year will be different. Hopefully, the majority will 
not try to once again politicize the bill that is supposed to be about 
funding our military. Hopefully, they will not hold this bill back and 
wait until the last minute like they did this year. It is the 
responsibility of the majority to set the schedule of the Senate.
  We will see this time next year if they are still devoted to playing 
politics with the funding of our troops. I sincerely hope they are not.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Alaska is recognized.
  Ms. MURKOWSKI. How much time remains on our side?
  The PRESIDING OFFICER. There is 10\1/2\ minutes remaining.
  Ms. MURKOWSKI. Mr. President, I rise to speak today on H.R. 3326, the 
Defense appropriations bill for fiscal year 2010. I appreciate all of 
the hard work that goes into the formulation of this bill and commend 
the leaders of the Defense Appropriations Subcommittee, Mr. Inouye and 
Mr. Cochran, on an outstanding product.
  It is a product that does justice to the men and women who wear the 
uniform of the United States in defense of peace and liberty. It is a 
product that does right by our military families who we must never 
forget also serve.
  I would like to take a few moments to share some comments about what 
this bill means for the fighting men and women in my State of Alaska. 
Alaska is home to about 21,000 men and women who serve on active duty. 
Add to that number approximately 4,700 members of the National Guard 
and Reserves.
  The bill that is before us supports the soldiers of Fort Richardson, 
Fort Wainwright and Fort Greely; the airmen of Elmendorf Air Force 
Base, Eielson Air Force Base, Clear Air Force Station, and 18 radar 
sites in remote, rural areas of the State; the Marine detachment hosted 
by Elmendorf Air Force Base; and Naval Special Warfare Center 
Detachment in Kodiak.
  It supports units big and small. Units like the 4th Airborne Brigade 
Combat Team, of the 25th Infantry Division based at Fort Richardson 
near Anchorage which number in the thousands of troops.
  The 4th Airborne Brigade Combat Team is known as ``the Spartans.'' 
This Spartan Brigade will be spending Christmas in Afghanistan.
  Also in Afghanistan this Christmas are 11 members of the Alaska Air 
National Guard 176th Wing who left Anchorage on November 5 after 
serving an early Christmas.

[[Page S13424]]

  We wish you well this Christmas. We are thinking about your families 
and we collectively pray for your safe return.
  Mr. President, I mentioned Christmas. We know that we are upon the 
holiday season, although in this Chamber it certainly doesn't feel that 
way. There is no sense of giving and sharing and the general 
cooperation and cheeriness that comes--at least in my family--with the 
holiday season.
  I think we have to also, as we approach the holidays, think about 
what is going on throughout the country as we face an economic 
recession. Families are choosing to do differently this year. They are 
squeezing back on their family budgets, and they are making some 
different choices--some hard choices. I think it is fair to say that 
folks are probably looking at us in Congress and saying: We wish they 
would be doing more of the same, making some of these hard choices when 
it comes to spending.
  To put it into context in terms of what we have seen in Congress this 
past week or so, last Sunday--less than a week ago--we passed a $1 
trillion-plus spending bill. These were six different appropriations 
bills, and three of those six bills were not subject to Senate 
amendment and debate. We went above and beyond the regular order and 
produced an omnibus package. Again, it was a package in excess of $1 
trillion in spending or about a 12-percent increase over the previous 
year.
  Shortly before that, about a week prior to the action on the omnibus, 
the EPA, the Environmental Protection Agency, issued an endangerment 
finding. This endangerment finding--for those who are following this 
issue, I think many recognize that the potential cost to this country, 
the financial burden that could be placed on this country if we advance 
through the regulatory process, as opposed to the legislative process, 
these regulatory burdens, I think it is clear the costs and impact to 
this country and our Nation's economy are truly dangerous.
  When we talk about an endangerment finding coming out of EPA, it is 
just that--it endangers our economy, it endangers jobs, and it 
endangers the competitiveness of those of us in this country.
  Again, people are looking at this and saying: What is going on in 
Washington, DC? Don't they realize we need to be working to save and 
create jobs? We need to do positive things that will help us as a 
nation and our economy, not those things that legislatively, or through 
regulation, would hurt us.
  Now we are in the midst of trying to move through a health care bill 
in the final days before Christmas--a $2.5 trillion reform package 
that, at this point in time, we are not quite sure what is in it. But 
when it is revealed, it is possible we will have about 36 hours to 
review it, to understand it, and to appreciate the implications for us 
in our States and the impact to our economy.
  Again, one of the aspects we do know about this is that the framework 
we are operating off of is one that will increase taxes on small 
businesses and individuals in this country. It will cause cuts to 
Medicare at a level that is incomprehensible, almost $\1/2\ trillion. 
For all that we can tell, it is going to increase premiums.
  Alaskans are looking at this package and saying: This isn't the 
reform we thought the Congress was going to be giving us.
  Following on the track of the spending, we are going to be discussing 
increasing the debt limit. Again, people in the rest of the country are 
wondering: What is going on in Washington, DC. What is in the water 
that is causing them to spend at levels that are almost uncontrollable?
  Our reality is that you and I are not going to be facing the 
financial consequences in the outyears so much as our children. During 
the holiday season--I have kids, and I still try to keep their presents 
secret. So I have a tendency to rat-hole them away, hide them.
  The one thing we cannot hide from our children this Christmas is the 
fact that what they will be receiving is an incredible debt. That is 
not a ``gift'' that we can afford to give our children. When it comes 
to the discussion about the health care bill and the consequences of 
it, there have been a great number of journalists who have been opining 
and commenting. We certainly have kept the press busy with this.
  There was an article on the opinion page in the Washington Post a 
couple days ago by Michael Gerson. He made a statement that I would 
like to read. He states:

       The entire Democratic health reform effort is foundering, 
     as its deep bow enters the shallow channel of fiscal reality. 
     And that splash you hear is the sound of various groups being 
     thrown from the ship to lighten the load. Instead of 
     beginning with affordable, realistic objectives, President 
     Obama and the Democratic Congress set the goal of guaranteed, 
     comprehensive coverage for everyone. This requires a lot more 
     money in the system, which must come from someone.

  Then I go to an article in this morning's Hill magazine. For this 
one, the headline is ``Senate Plan to Tax Health Plan is Bad Policy.'' 
It starts off:

       Millions of working Americans will pay thousands of dollars 
     more in taxes under the Senate proposal that taxes healthcare 
     benefits to finance reform.
       According to the Congressional Budget Office, this excise 
     tax will affect one in five Americans.
       Millions more will have their health benefits cut and see 
     their costs go up. This is the opposite of healthcare reform.

  You might think that was an article that I might have written or that 
some of my Republican colleagues wrote. Actually, this article was 
penned by Jim Hoffa, who is the Teamsters' general president, and Mr. 
Larry Cohen, the president of Communication Workers of America.
  Mr. President, my point in saying this is that as people understand 
more and more about what is contained within this health care 
legislation, they are coming to understand the impact to them and to 
their families. They are quite anxious because they know that as the 
years go out, the costs don't go down, the costs only go up.
  We are concerned in Alaska about access to care. I have stood on this 
floor many times and talked about how, in Alaska, we simply do not have 
the Medicare providers that we need to see the people in my State, 
particularly in our largest communities. We just learned that one of 
the medical clinics in Anchorage has made an announcement. They issued 
a letter to their patients saying that Northwest Medical had four 
practicing physicians who were seeing Medicare patients earlier this 
month, and three of the four physicians opted out of Medicare, 
resulting in 550 Medicare beneficiaries being without a physician.
  What is happening is that they are calling us for a doctor's 
appointment. The problem is that we can't get them in anywhere either. 
We have one facility in Anchorage where they are taking new Medicare-
eligible individuals. When we did a count--the institute of economic 
research did a count as to how many providers in Anchorage, AK, were 
taking new Medicare individuals. It was 13. We heard from a provider 
just last week that she is opting out. These three make a total of 
four. This is simply not sustainable.
  For us as a Senate and as a Congress to be moving forward in the name 
of health care reform, any provision that will further jeopardize 
access for the people of Alaska or the people of rural America or all 
over this country, that we would do anything that would jeopardize 
their access is foolish. It makes no sense.
  We must stop this reform effort. We must do our job in Congress to 
provide the people of my State, and all of our States, real health care 
reform that reduces the cost, provides for access, and does right by 
the American people.
  With that, I yield the floor.
  The PRESIDING OFFICER. The Senator from Ohio is recognized.
  Mr. BROWN. Mr. President, as we near Christmas, our troops are 
overseas, away from their families during this holiday season, facing 
dangers most of us cannot even contemplate. Many in this Chamber have 
long supported the wars in Iraq and Afghanistan, but the loudest 
supporters of war today are leading the charge in trying to block the 
Defense appropriations bill.
  It is irresponsible, plain and simple, to play politics with the 
funding of our troops. It is a disservice to them. It is a disservice 
to their families. It is a disservice to our great country.
  We do not agree on health care reform. I understand that. I get that. 
But to hold up the funding for our troops, I do not get that. This bill 
funds our overseas military operations and provides our troops with a 
hard-earned

[[Page S13425]]

pay raise. It includes funds for joint IED Defeat Fund, Mine Resistant 
Ambush Protected Vehicles, so-called MRAPs. It provides equipment for 
our National Guard and Reserve.
  The tired politics of delay and distraction offered by my Republican 
friends does a disservice to our troops, to their families, and to the 
Nation.
  It does a disservice to the millions of Americans also who would 
benefit from the provisions of the Defense appropriations bill that 
would extend the COBRA Premium Assistance Program.
  This month, thousands of Americans--hundreds in the Miami Valley were 
hit so hard, where in the Dayton area they were hit so hard from DHL to 
General Motors to NCR to the suppliers for those companies, hundreds 
and hundreds in the Mahoning Valley, where people in the Washington 
Post read about Warren, OH, what happened to people there with this 
terrible recession.
  It is a disservice to hundreds all over my State who saw a 65-percent 
spike in their monthly health insurance premium. That is because the 9-
month COBRA subsidy--one of the things we did right earlier this year. 
The government has never stepped in to do that to help people in tough 
times with their health insurance. The 9-month COBRA subsidy started 
phasing out in December.
  COBRA provides a much needed health insurance option to those 
Americans out of work. It allows workers to stay on their previous 
employer's health plan for 18 months, but it could be prohibitively 
expensive. That is why I introduced a bill 11 months ago--the Coverage 
Continuity Act--to provide a health insurance subsidy to laid-off 
workers. They simply cannot afford COBRA without it.
  Remember, COBRA is the health insurance program where if you lose 
your job, you can keep your same health insurance. You continue to pay 
your own premium, but you have to pay the employer contribution. If you 
have lost your job, it is pretty hard to do that, putting it mildly.
  This, for the first time, gives a very generous subsidy so people can 
keep their insurance. A version of that proposal I introduced in 
January was included in the stimulus. It provided a 65-percent subsidy 
toward the price of a COBRA premium for recently laid-off workers.
  Now that subsidy has expired for some. It is about to expire for many 
more. Nearly 16 million Americans are out of work still and 14,000 lose 
their health insurance every day.
  When I hear my friends on the other side of the aisle say: You have 
to slow down on health reform, we don't want to do this too fast, they 
need to go back to their States. I hope they get some time off at 
Christmas. I hope, after they spend time with their family, they go out 
and start talking to people getting hurt by this recession. They are 
not hard to find. They are in every neighborhood in every community in 
every State--people who lost jobs and are losing their health 
insurance.
  In Ohio--from Toledo to Millard to Mansfield to Ravenna, Gallipolis--
350 Ohioans every day lose their insurance. Across this country, 1,000 
people a week die because they do not have health insurance. Mr. 
President, 1,000 people a week die because they do not have health 
insurance. Yet too many people in this institution, too many people 
think we have to wait.
  They need to know, when you think about 1,000 people dying every week 
without health insurance in this country, they need to understand a 
woman with breast cancer is 40 percent more likely to die if she does 
not have insurance than a woman who has breast cancer with insurance. 
If that is not reason enough for them to get on board and stop their 
delay tactics and quit saying: Let's slow down; let's slow down, it 
clearly has not worked. That is why the COBRA extension is so 
important. The extension is similar to one included in S. 2730, the 
COBRA Subsidy Extension and Enhancement Act, which I introduced with 
Senator Bob Casey in November.
  The bill before us will ensure Americans receive the COBRA subsidy 
for 15 months, not 9. It means that most workers who first started 
receiving the subsidy last March when it started will continue to 
receive it until May of next year.
  It extends the day on which you can be laid off and still be eligible 
for the subsidy. Under current law, only those who lose their job in 
the next 2 weeks will be eligible. We need to extend that eligibility 
window at least to February of next year. This will help Americans, 
such as Don Hall from Castalia, OH. Castalia is a community west of 
where I live near Sandusky, OH, in the northwest part of the State.
  Don was laid off from an auto supplier in October of last year. As 
severance, the company gave him 6 months of paid COBRA coverage and 
then he became eligible for the premium assistance program we included 
in the stimulus.
  However, his ninth and final subsidy payment came through in 
November. He is still out of work. Earlier this month, on December 1, 
he and his wife were charged $763 for their coverage, up $500 from the 
month before. He was paying about $250. Now he is paying $763. Don is 
also fighting to save his house from foreclosure. He has cut back as 
much as he can, but he doesn't want to stop paying for a cell phone 
because that is his only way for potential employers to contact him. He 
has had six job interviews in the last 13 months. None have panned out 
because there are not enough jobs in Castalia, Sandusky, Toledo, and 
Lorain.
  Don worked hard and played by the rules. Similar to so many American 
men and women, he is experiencing hard times and needs some help. They 
on the other side of the aisle say: Let's slow down; we have to slow 
down.
  For Don, slowing down means the loss of his house. It means he is 
more likely to get sick and ruined financially because they want to 
slow down.
  Don's story is not unique. Take Tim Wolffrum from Milford, OH. His 
COBRA subsidy is scheduled to expire at the end of December, at which 
point he will owe $417 a month. That is nearly as much as he receives 
in unemployment benefits.
  When Tim started shopping around in the individual market knowing he 
would be forced out of COBRA, everything he found either had exorbitant 
premiums or bare-bones coverage. That is because Tim suffered a heart 
attack 2 years ago and suffers from a digestive disease. These 
preexisting conditions made him a liability for private insurance 
companies.
  Tim is confident he can find a job once the economy picks up. But in 
the meantime, he needs the COBRA subsidy.
  Carol Williams from Dayton, OH, is in a similar bind. She is 63 years 
old and was employed at R.J. Reynolds for 18 years before being laid 
off in October of last year. She started receiving the COBRA subsidy in 
March but was responsible for the entire premium this month.
  Remember, COBRA is what you were paying when you were employed. If 
you lose your job, you continue to pay COBRA to keep your insurance and 
you also have to pay your employer's contribution. Almost nobody can do 
that after they have lost their job for very long. That is why the 
subsidy we put in the stimulus package back in February and that is why 
the subsidy we want to put in this Defense appropriations bill is so 
darn important to so many Americans.

  Because Carol remains unemployed and suffers from minor thyroid 
problems and high blood pressure, her insurance options are limited.
  She decided to pay the full COBRA premium in December, with the hope 
that Congress will act to extend the subsidy. Here is her calculation: 
While they delay, while they say: Let's slow down, on the other side of 
the aisle, Carol says: My premium went up several hundred dollars. If I 
cancel, I will never have insurance. If I dig deep and do not heat my 
house as warm, do not eat as well for the next few weeks, I will pay 
more and hope Congress passes this so she can get that better rate 
again.
  That is what delay says; delay for their little political reasons and 
the little political games and tricks the other side of the aisle is 
playing, such as they did at 1 o'clock this morning, puts Carol 
Williams in a position where she has to make those hard decisions. I 
wish some of my friends on the other side of the aisle would meet the 
Carol Williams of the world. I wish for 1 day we could walk in the 
shoes of the Carol Williams of the world and see the kind

[[Page S13426]]

of horrible decisions they have to make because they want to play their 
political games.
  Let's not let Carol down and Don and Tim down. Let us in this Chamber 
hear their cries. I hope they hear the cries of thousands of people in 
Helena, Kalispell, Wilmington, Dover, and all over this country. It is 
too important for us to fail.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Montana.
  Mr. BAUCUS. Mr. President, I thank my friend from Ohio for his 
statement, for two reasons. It is very much on target and, second, a 
couple towns in my state of Montana have the same problems that some of 
the towns in his State of Ohio have. We are all in this together. So 
many people and so many towns all across the country need health care 
coverage or are denied coverage because some insurance company has said 
they have some preexisting condition.
  I thank my friend for his statement.
  The Defense appropriations bill before us provides essential support 
for American troops fighting for our freedom abroad. The bill before us 
also continues crucial safety net programs for American families, for 
those families struggling with tough economic times here at home.
  What our colleague and former majority leader, Robert C. Byrd, said 
in 1988 remains true:

       Without economic security, we cannot have national 
     security.

  Millions of jobless Americans struggle for economic security every 
day. Even people with jobs are seeing their paychecks stretched.
  For every six unemployed workers, there is only one job opening--only 
one for every six unemployed. We need to continue to work to help 
create jobs. We also need to address the challenges that unemployed 
Americans are facing right now. This bill takes action to help 
Americans who are seeking jobs.
  Without this bill, the three unemployment insurance provisions 
established or continued by the Recovery Act that we passed at the 
beginning of the year will expire in 2 weeks. If we don't pass this 
legislation, unemployed Americans will not be able to apply for new 
unemployment insurance benefits after December 31, and those who are 
currently receiving benefits will lose this vital help.
  The loss of these benefits will be devastating to many Americans, 
including a young father in my home State of Montana from whom I heard 
recently. He was working hard to support his family at a carwash in 
northwestern Montana. Then he was laid off. Since then, he has simply 
been unable to find work.
  His work situation only adds to his concerns because he recently lost 
a child to sudden infant death syndrome, and his wife is now pregnant 
with another child. They are living in a house 20 miles out of town. 
They heat their house entirely by burning wood because that is all they 
can afford on his unemployment benefits.
  Without this bill, his benefits would run out in 2 weeks, and his 
family would be left in the cold while he struggles to try to find 
work.
  This bill would extend emergency unemployment compensation for 2 
months. That program provides additional weeks of unemployment benefits 
for out-of-work Americans, such as my western Montana constituent, 
during this period of high unemployment.
  The bill would also provide 2 additional months of extended 
unemployment benefits. Those benefits provide targeted assistance to 
areas of our country that have been affected by particularly high 
unemployment rates.
  The bill includes a 2-month extension of the Federal Additional 
Compensation Program. That program increases all unemployment benefits 
by $25 a week. Together, these provisions will protect unemployment 
benefits for roughly 2 million Americans. Those are people who would 
lose unemployment benefits if we do not pass this bill.
  These extensions would provide much needed economic security for 
Americans who are struggling to find work in these uncertain times.
  I do not think enough of us realize the depths of angst people 
suffered when they are out of work and trying to find work and when 
potentially their unemployment benefits, which help a little bit, might 
not be extended.
  In addition to the critical unemployment insurance extensions in this 
bill, this package also includes an extension of what people call 
COBRA. What is that? That is assistance that helps unemployed Americans 
and their families to maintain their health care coverage.
  When workers lose their jobs, they lose more than just their 
paychecks. Unfortunately, they also lose their ability to afford health 
insurance coverage as well.
  To address this problem, the Recovery Act we passed earlier this year 
provided assistance to help their families to pay for health insurance 
while looking for a new job.
  Fortunately, in most cases, workers who lose their jobs have the 
right to keep their employer health care coverage for up to 18 months 
under the COBRA program. It is called that after the name of the 
Consolidated Omnibus Budget Reconciliation Act that set up the program. 
That is why it is called COBRA. To be eligible for COBRA health 
benefits, workers typically had to pay all the premium costs, plus an 
additional 2 percent for administrative costs.
  Can you believe that? People laid off have to pay all the costs, plus 
an additional 2 percent. That is a penalty. It is not a gift. It is not 
assistance. It is a penalty.
  Paying the full premium, plus administrative costs, is simply more 
than most families can afford when out of work. It is just plain wrong 
that we even had that in the law in the first place.
  Fortunately, this provision, the COBRA provision in the Recovery Act, 
provides relief to struggling workers. And what did it do? It made a 
change. That provision covered up to 65 percent of health premium costs 
for up to 9 months for unemployed Americans. Previously, it was zero 
percent, and now it is 65 percent of health premium costs for up to 9 
months for those who are unemployed.
  This premium subsidy has made a real difference in helping unemployed 
workers and their families maintain health insurance. Roughly 7 million 
Americans have benefited from this assistance. The bill before us today 
would extend that for another 6 months for those who remain unemployed. 
In addition, the legislation would offer similar assistance to people 
who lose their jobs between now and the end of February.
  This assistance is the right prescription for families in these tough 
economic times. For many Americans who have lost their health coverage 
because they have lost their jobs, this benefit provides critical help 
to ensure they can get their health care when they are in need.
  This bill also protects access to health care for seniors and 
military families. The legislation would ensure that doctors will not 
suffer a reduction in payments for their services. The bill would 
reverse planned cuts to physician payments under what is called the 
sustainable growth rate, otherwise known as the SGR. Blocking cuts to 
doctors' payments would keep health care available to seniors in 
Medicare, and it would help keep health care available to military 
families insured by the TRICARE program. Without this provision, 
Medicare and TRICARE providers would see a 21-percent cut in their 
payments. That could make it difficult, obviously, to continue to 
participate in the program. Doctors say they can't do it. They are not 
going to participate.
  I am committed to finding a permanent solution to the flawed payment 
formula that has caused this cut. In the meantime, this bill would make 
sure our physicians in Medicare and TRICARE will not face deep, unfair 
cuts. This bill would help ensure they can continue to care for our 
seniors and military families--another reason this legislation is so 
important. Not only does it help fund our troops, but all these other 
benefits are here, those I am outlining, which make a big difference 
and mean so much to so many people, basically people who are out of 
work in these tough economic times.
  The bill also includes a provision to protect access to critical 
safety-net programs for low-income families who would otherwise lose 
those benefits in already tough economic times.
  This legislation would hold the poverty level constant at the 2009 
level. That would prevent a decrease in the year 2010, because prices 
went down

[[Page S13427]]

this last year. This legislation would thus keep struggling families, 
who are right at the poverty line, from dropping off of critical 
safety-net programs. To keep up with the rising cost of living, the 
Federal poverty level is adjusted for inflation each year. Because of 
the great recession this year, prices actually went down. There was 
what is commonly called deflation instead of inflation. As a result of 
this deflation, the Federal poverty level could actually be lower in 
2010 than it was in 2009. That means American families right at the 
poverty line, who rely on programs such as Medicaid, home heating 
assistance, and food stamps, could actually lose their access to these 
vital services even though they did not have any additional income. 
This legislation would allow families who qualify for safety-net 
provisions today to stay on those critical programs if their 
circumstances don't change. These families cannot afford to bear any 
additional hardship in this recession, and this provision would ensure 
they do not lose the vital services they need to keep them afloat.
  This bill also extends vital funding for the repair and maintenance 
of our roads and our bridges. This would save hundreds of thousands of 
highway jobs. These are jobs that pay well and jobs that cannot be 
shipped overseas. This provision provides a 2-month extension of 
Federal highway funding--not very much but 2 months is better than no 
extension, and that will allow important repairs to America's roads and 
bridges to continue so we can, next year, pass a meaningful highway 
program, a multiyear program, hopefully 4 or 5 or 6 years.
  Without this provision, this 2-month extension, the Federal Highway 
Administration and construction projects across the Nation will be 
forced to shut down, taking thousands of jobs along with them. The 
safety of our Nation's roads and bridges is vital. And at a time when 
unemployment is already more than Americans can bear, we cannot afford 
to lose hundreds of thousands of good highway jobs. These provisions 
make sure we don't.
  Economists have seen some signs that the economy is starting to 
recover, but many American families, unfortunately, continue to 
struggle. This legislation will provide vital support and services that 
the economy and American families need to get through these tough 
times. Working together, we are going to get this economy back on 
track. Passing this bill is part of the answer. Passing this bill is 
important for both our national safety and our economic security. I 
urge my colleagues to support this vital legislation.
  Mr. President, I yield the floor, and 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. BOND. 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. BOND. Mr. President, earlier this month President Obama renewed 
his commitment to the counterinsurgency on a ``clear, hold, and build'' 
strategy for Afghanistan. As I have said several times before on this 
floor, I believe this strategy will allow our troops to return with 
success and put Afghanistan on the road to stability. But, as I have 
also said, when you go into a war, when you launch a major effort such 
as this involving tens of thousands of Americans who will be putting 
their lives on the line, we must go in with an attitude of success. We 
are going in to succeed. Let's be clear about that. We must succeed in 
Afghanistan unless we are to face the kinds of risks we faced on 9/11.
  Harkin back to the early 2000s when the Taliban ruled Afghanistan. 
Their friends from al-Qaida came into Afghanistan and used it as a 
ground for recruiting, training, issuing command and control, and 
preparing for attacks. From that part of Afghanistan came the 
directions and the leadership for the tragic attacks on 9/11.
  As President Obama has said many times over, fighting in Afghanistan 
is the war of necessity. It is one we cannot fail to win because we 
have seen what happens when Afghanistan falls into Taliban hands.
  I happen to disagree with him because Iraq was the next featured spot 
for al-Qaida, Osama bin Laden, and Ayman al-Zawahiri to go. We had that 
from the Clinton administration. Their intelligence chief, Security 
Chief Clark, said that when we drive Osama bin Laden out of 
Afghanistan, he will boogie to Baghdad. That is what all of the 
information we saw in the intelligence committee indicated. They wanted 
to make Iraq--Baghdad--at the confluence of the Euphrates and Tigris 
Rivers, headquarters for their operations. They call it the Caliphate.
  We went in and cleaned out Saddam Hussein, who was a vicious, 
murderous tyrant. We didn't find any weapons of mass destruction. 
People said we didn't need to go in. However, in the intelligence 
community, we found out that, No. 1, the intelligence was off base. 
They made assumptions they should not have.
  But we also sent in the Iraq Survey Group, headed by David Kay, who 
went in to look at the conditions in Iraq and found out what those 
conditions were prior to our going into Iraq to clean out Saddam 
Hussein. The conclusion Mr. Kay and his very skilled team came to was 
that Iraq was a far more dangerous place even than we knew. There were 
terrorist groups running around in there.
  Abu Mus'ab al-Zarqawi, who later became famous for beheading 
Westerners he captured, on television, for the edification of his 
twisted viewers, had a group called Ansar al-Islam. That group later 
morphed into al-Qaida and became al-Qaida in Iraq.
  Fortunately, very good intelligence work and the administration of a 
shot from a litening pod on an Air National Guard F-16--and I am proud 
to have been a sponsor of earmarks to put litening pods on Air National 
Guard aircraft--wiped out Abu Mus'ab al-Zarqawi.
  At the same time he was running around, he was looking for weapons of 
mass destruction. There is no question that Iraq had used weapons of 
mass destruction before. He had used them against the Kurds, his own 
people. He had the facilities to produce them. He had the scientists to 
produce them. He had the recipes to produce them and what we call a 
just-in-time inventory system. He could have started up chemical or 
biological weapons of mass destruction, had he not been taken out, and 
turned them over to terrorist groups.
  In Iraq, we successfully took out Saddam Hussein. Then we tried to 
prevail with a counterterrorism strategy. That is where you send in 
some of our elite forces and you take out the leaders of al-Qaida. Then 
you go back to your base. The problem we found was that once we left, 
al-Qaida would come back.
  Insurgency is different from a regular war. They would come back in. 
If anybody cooperated with the American forces, they would kill them or 
torture them first and kill them or even torture their families in 
front of them and then kill them. So we knew things were not going 
right.
  President Bush chose, with Secretary Gates--he and Secretary Gates 
chose GEN David Petraeus, who was a real scholar. He happened to have 
gone to the same college I went to, but he was a real scholar. He had 
developed a counterinsurgency strategy that he believed was the only 
way to deal with insurgency, so they instituted the ``clear, hold, and 
build'' approach in Iraq. They would send in the troops and clear out 
al-Qaida. Then they would embed or lock down with the Iraqi forces 
there. That way, they could maintain the security of the area. People 
would not dare come back in with American and Iraqi troops there.
  My son happened to see both sides of that. He was there in 2005, in 
the ground intel operation in Fallujah. They found that the locals were 
not interested in working with the Americans. We now know why. They 
were very fearful for their lives if they did.
  The second time he went, he went in with the 2/6 Marines, who drove 
al-Qaida out of Al Anbar Province. His scout snipers were assigned to 
capture his old stomping ground in Fallujah. They did it, and the 
difference was dramatic.
  By that time, General Petraeus had set up the Sunni citizens watch, 
working with the Iraqi Government. They had the Sunni police. When they 
went

[[Page S13428]]

in, they immediately started recruiting young Sunni men to serve in the 
police force in Fallujah. They offered people who had injuries medical 
help. They offered assistance for those who needed reparations, who had 
damage. They got that done.
  Within a month, my son said, the marines were not all needed, they 
were not active, because when somebody brought in an IED, an improvised 
explosive device, or an AQI--al-Qaida in Iraq--person came in, the 
Sunni citizens watch would turn it over to the Sunni police and they 
would take care of it.
  That is why we have made the progress, despite what some on this 
floor said--that the war is lost; we cannot win it; we ought to 
withdraw. The counterinsurgency strategy worked.
  When we moved into Afghanistan, we found that in the years since we 
had driven the Taliban out, we turned the task of keeping Afghanistan 
stable and secure over to NATO. NATO forces, regrettably, were not 
adequate. They employed a counterterrorism ``fire and fall back'' 
strategy, or even less. Some rode around in armored vehicles during the 
daytime and went back and had tea in the late evening. The Taliban 
owned the evening.
  So when GEN Stan McChrystal went there, he was assigned by President 
Obama to carry out his strategy. The President outlined a very clear 
strategy, which was, we need a counterinsurgency strategy, clear, hold, 
and build--what I refer to as ``smart power.'' You need military force, 
but you need economic development assistance, whether it be medical or 
governance assistance. You need to help people develop a better life. 
He tasked General Petraeus to do that.
  General Petraeus outlined a strategy--he outlined it in August; we 
first saw it then--and he outlined a good strategy. He said he needed 
40,000 troops. Since the President has said he is going to send 30,000, 
he has cut back on the objectives. He believes that will work.
  We are now getting the troops there. It is going to take time to get 
the troops there. I wish we had started 3 months earlier because we had 
been losing ground until we got the additional troops in. But he 
started getting the troops there.
  I believe we can provide stability and security in Afghanistan. Are 
we building a nation? No. But we are building stability and security. 
Before you can have a nation, before you can even have a working 
economy, you have to have security. You have to make sure the 
insurgents, the Taliban or occasionally their friends from al-Qaida, do 
not come back in and take over the area and destroy your crops.
  Previously, the Taliban had cut down all the pomegranates. 
Afghanistan was the breadbasket for that part of the world. They had 
destroyed agriculture so that only their colleagues in the drug trade 
could control the land. That is where a significant amount of the money 
for funding the Taliban has been coming from, poppy production and the 
drugs it produces.

  That process is ongoing. But we have found some test markets where 
that has worked. I was told by then-General Eikenberry in January 2006, 
and echoed by President Karzai, that they needed extensive agents from 
America to help them rebuild their agriculture. I tried for 2 years. 
With the help of my colleagues on the Appropriations Committee, we 
twice appropriated $5 million to the Department of State to get the 
USAID to send in extension agents. With $10 million, absolutely zero 
people went, as far as we know. So in 2007, I worked with the Missouri 
National Guard, good friends of mine. They sent a survey team over and 
said: We can help. In early 2008, they sent a 50-member agricultural 
development team to Nangarhar Province, Jalalabad. It was the No. 2 
poppy producing province in the nation, but they had an excellent 
Governor. They wanted to work. So the Guard team went in. These were 
trained soldiers and armed airmen and women who knew how to fight in a 
battle. But they also had agricultural backgrounds in their day jobs, 
in civilian employment. They were farmers, agronomists, soil 
specialists, foresters, food processors, veterinarians. They went in 
and helped the farmers of that province rebuild their agriculture.
  By the end of the growing season in 2008, President Karzai said they 
had made a tremendous difference. He said it was one of the great 
successes. Ten more National Guard teams are going. In December of last 
year, when I was there, before I went out to Nangarhar, President 
Karzai served us a wonderful dinner including broccoli from Nangarhar. 
I found that not only did they have security but poppy production in 
Nangarhar went from being second highest in the Nation to almost zero. 
We now have our third Missouri National Guard team over there. They are 
planning on going 7 more years, because they want to continue that 
partnership. Guard units across the Nation are lining up to partner 
with other provinces.
  This is a great model. Unfortunately, it is not enough to have Guard 
forces there. We have to have a national security budget that includes 
the civilian side, the economic and development side, the agricultural 
side, the educational side along with the military force. That is one 
of the things I am worried about. We have to make sure that we get the 
``build'' side of clear, hold and build, of smart power working in 
Afghanistan. We cannot expect them to maintain their security if they 
don't have a way of earning a good livelihood. Make no mistake, they 
are earning a better livelihood with legitimate crops than they were 
with poppies. They are not bowing down to the drug lords or to the 
Taliban. Most of all, producing flowers for drugs was against their 
religion so they are happier. But we need to do a lot more of that.
  I think the first and most significant part in doing that was sending 
the 30,000 more of our trained military volunteers deploying to 
Afghanistan. The bill before the Senate today is critical to ensuring 
these troops have the equipment, training, and resources needed to 
execute their mission. You can't send that many more troops there 
without giving them resources. This bill is essential for giving the 
resources.
  I especially thank the majority of the House and Senate for not 
loading this critical troop bill up with poison pills. I know there was 
some discussion--it must have been tempting--to use legislation to pass 
unrelated and controversial proposals. I have always voted for and 
continue to support funds our troops need. If we had seen on this bill 
things to add, for example, another expensive, doomed-to-fail stimulus 
bill, I would have had to vote no. We have seen that the majority's $1 
trillion stimulus bill, passed late last winter, has failed to produce 
the jobs promised and the budget which doubles the debt in 5 years and 
triples it in 10. It puts our children and grandchildren's financial 
future at hock. I didn't want to see that on legislation to appropriate 
the funds that our troops needed. I am delighted they didn't.
  I offer a very special thank you to my good friend Chairman Dan 
Inouye who heads our Appropriations Committee. He is a true American 
hero, and I have the utmost admiration for him and greatly commend him 
for the manner in which he is leading the Appropriations Committee. He 
tirelessly works to ensure that America's priorities in defense are put 
in the right place. I issue my strongest thanks to him and our 
distinguished Republican leader Thad Cochran. One of the things I think 
they did, which was absolutely necessary, was to add the most reliable, 
heavily used workhorses in the Air Force inventory, the C-17 cargo 
aircraft, to the bill. This is the modern transport plane used to move 
our warfighters into battle. It gives them the equipment and supplies 
to execute their mission. With the President's recent announcement of 
an additional 30,000 troops, there is going to be more need for them. 
It is only growing. Secretary Gates has said we must prepare for the 
fights we are in today. It is no secret that the C-17 is in the middle 
of the fights, getting equipment and troops to and from Iraq to 
Afghanistan today. It is a combat-tested aircraft, essential to the 
fight we are in.
  The CRS said it was designed to fly 1,000 hours per year over 30 
years. But overseas we have seen it flying 2,400 hours a year. The 
logistics are particularly responsive to the kind of delivery the C-17 
can make. Some people say: We have enough C-17s and C-5s. I agree with 
General Schwartz who stated ``too much iron is not enough.'' The C-5As, 
which must be retired and now can be retired, only have a 50-percent 
readiness level, a per-hour operating cost of

[[Page S13429]]

$29,000, and 40 maintenance man-hours per 1 hour of flight. It is time 
to retire them and replace them with the C-17.
  Dr. Ashton Carter hit the nail on the head. I commend him for his 
vision. He said:

       I feel industrial base issues are completely legitimate 
     because having the best defense industrial technology base in 
     the world is not a birthright. It's something we have to earn 
     again and again.

  As America's only large airlift production line, if we were to end C-
17 production, it would risk our Nation's long-term opportunity to 
produce the aircraft we need. It will also keep the scientists, 
engineers, designers, and dedicated workers who can turn out the future 
aircraft we need.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Texas.
  Mrs. HUTCHISON. Mr. President, I was listening to the remarks of the 
Senator from Missouri about his football team. I couldn't possibly 
follow that without mentioning my beloved Texas Longhorns who are going 
to play for the national BCS championship.
  Mr. BOND. I am on the Senator's side.
  Mrs. HUTCHISON. I appreciate the Senator from Missouri saying that he 
supports fully the Longhorns as the Big 12 champions. It is always good 
for the conference, of which the University of Missouri is a great 
member, that we win the national championship which I have all 
confidence that my beloved Longhorns will do.
  Moving right along to the other important issues of today, I 
certainly am serious when I start talking about the issue that is 
before us today. I see the distinguished chairman of the Appropriations 
Committee sitting on the floor. The winner of the Congressional Medal 
of Honor, the only Member of our body who has that great distinction, 
and well deserved, Senator Dan Inouye is one of the great leaders who 
fought in World War II, was a hero, was given the Congressional Medal 
of Honor, our Nation's highest military honor that can be bestowed. He 
has led our committee in such a commendable way.
  Senator Inouye has always assured that we have the support for our 
troops. I have served with Senator Inouye and Senator Cochran, our 
ranking member, and Senator Ted Stevens before him. I can tell you that 
all of these Senators have led our Defense Appropriations Committee. 
They have led it by assuring that our troops always have what they 
need, whether they are in the field of battle, which has been the case 
for part of our terms here, or whether they are not in the field of 
battle which has also been the case for much of our terms here. But it 
happens that our troops are on the field of battle today. That is why I 
have supported this appropriations bill, supported it as a member of 
the Defense Appropriations Subcommittee and certainly am assured that 
we have the appropriations that give our troops who are in harm's way 
today the support they need.
  I was in Iraq this year. I was in Afghanistan and Iraq last year 
visiting with those who are doing the work that keeps us free, that 
allows us to speak on this floor, that allow us to have Christmas 
holidays with our families. There is not a better experience in my 
entire time in public life than to get to visit with our troops on the 
field when they are in harm's way. I have been to Bosnia when we were 
in Bosnia, Kosovo, then Iraq, Afghanistan, Kuwait, where we have so 
many troops who are supporting our troops in Iraq, and also now 
supporting our troops with the equipment transfers into Afghanistan.
  Those troops are not going to be with their families this Christmas. 
We will pass this bill. We will support our troops. We will follow in 
the great tradition of the Senate. This will be a very bipartisan vote.


                           Health Care Reform

  I also wish to mention that the major issue we must face before we 
finish in the Christmas holidays and then hopefully go on into next 
year is the health care reform bill that is before us. This is of great 
concern to me because I don't think we ought to rush the health care 
reform bill. Health care affects every family, every person in our 
country. It is a quality-of-life issue. America has had the great 
tradition and now expectation that we will have the best health care in 
the world, that we will have a doctor-patient relationship that 
determines what treatment is best and what is needed, and the patient 
then makes the final decision.

  I very much fear this government takeover of health care is going to 
put government in between the doctor and the patient. This is a bill 
that, for the next 10 years, is going to transform our health care 
system with $\1/2\ trillion in new taxes, new mandates, which can only 
run up the cost of health care. For those who have coverage, it will be 
more expensive. For those who do not have coverage, I fear the 
alternatives are not going to be much better.
  I think we have alternatives that can work; I just do not think this 
one is it. What would work? What will Republicans support? Republicans 
have a plan with three basic principles. No. 1, we want to bring the 
cost of health care down so there could be more affordable access for 
more people in our country. That means we have medical malpractice 
reform to curb frivolous lawsuits. It means we have the ability to have 
risk pools that are bigger so premiums are lower.
  That means small business health plans. It means that we allow small 
businesses, without a bunch of bureaucratic nonsense, to come together, 
form bigger risk pools, and give lower cost options to employers to 
give to their employees. That is what every employer in this country 
wants. They do not want mandates. They do not want taxes. They do not 
want sticks. They want carrots; and that is, alternatives that are 
affordable for them.
  Last, but not least, why not give every individual who buys their own 
health care a tax credit that helps them buy their own health care at 
an affordable cost? I am supporting a bill. It is the DeMint-Hutchison 
bill that would have a $5,000 tax credit available for people who have 
to buy their own health care coverage because they do not have employer 
options. That would take away the burden that is so heavy on families 
today.
  So we have alternatives. We can do this right. We can do it right if 
we will take the time to do it right.
  The bill that is going to be voted on, surely within the next 3 or 4 
days, is actually a bill we have not seen. We have a bill before us. We 
have been debating it for 3 weeks. But there is another bill that 
supposedly is the consensus bill that is being written behind closed 
doors that we have not even seen, and we are going to be asked to vote 
on it in a 2- or 3-day period. We do not know how long it is, so we do 
not know how much time we are going to have to read it. But we know we 
cannot mess around with health care in this country and pass something 
that may not be right, that may not cover all the bases, that may have 
hidden things in it we cannot prepare for.
  We need the time to do it right. The Republicans are offering a hand 
to the other side and saying: Let's do this in a bipartisan way. I 
stated the Republican principles. We can do health care reform with 
those principles. Maybe the Democrats have certain principles they 
could lay out, where we could come together and have something that 
would not be a government health care takeover, that would not be $\1/
2\ trillion in Medicare cuts, that would not add $2.5 trillion to the 
debt of our country, which is about to sink in debt, and that would not 
have taxes and mandates and burdens on small business at a time when we 
want small business to hire people. We want small business to grow and 
help our economy thrive. But it cannot with more taxes and burdens.
  We know we can do better.
  The PRESIDING OFFICER (Mr. Burris). The time for the Republicans has 
expired.
  Mrs. HUTCHISON. Thank you, Mr. President. I hope we will go back to 
the drawing boards and create a bill that America will be proud of and 
that we will see the American people support.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Hawaii is recognized.
  Mr. INOUYE. Mr. President, first, I wish to thank the Senator from 
Texas for her very generous remarks.
  The measure before us represents the culmination of the work of the 
Appropriations Committee for the year. But in many respects, it is our 
committee's most important responsibility.
  What could be more important today, 1 week before Christmas, than 
demonstrating support for our men and

[[Page S13430]]

women in uniform, whose sacrifices and dedication to the people of this 
country are unmatched.
  If I may be a bit personal at this point, I have spent several 
Christmases away from home in my youth when I was serving in Italy and 
France during World War II. I have seen the anguish of wives without 
their husbands on Christmas Eve. I have seen the tears of mothers when 
they received the news of the death of their son. I have seen the 
blood. I have seen the misery.
  As has been noted by others, this measure before us provides the 
essentials for the Department of Defense. That is the least we can do 
for our men and women. Yes, the amount involved is tremendous, $636 
billion. The amounts in this measure will go to pay the troops, support 
their families, provide care for the wounded, and equip our forces. 
Funding of $128 billion is included in this total to give our men and 
women in harm's way the resources they need--the guns, the bullets, the 
bulletproof vests, helmets, and such.
  I know there are some who oppose the wars in Afghanistan and Iraq. I 
should like to remind my colleagues that I too voted against sending 
forces to Iraq. Yes, I did--1 of 23 of us here. Nonetheless, when the 
majority of both Houses voted to engage in that conflict, regardless of 
my personal view on the wars in which our Nation is involved, I have 
always supported the funding required to ensure that those who have 
responded to our Nation's call are provided all the equipment and 
resources they require to carry out their missions. That is the least 
we can do. While others may disagree, I will flatly state that it is 
unconscionable not to support them.
  This is a good bill. It is a good measure. Some will criticize the 
relatively small amounts which are allocated to items requested by 
Members of Congress. Some will question the overall level of resources 
for defense and, as noted earlier, there are some who oppose funding 
the war.
  But, despite the few loud voices who raise objections to this bill, I 
am certain the majority of my colleagues support this measure because 
this is a good bill which provides essential funding to provide for the 
common defense.
  I think we should remind ourselves that at midnight tonight the 
continuing resolution providing stopgap funding will expire. Tomorrow 
morning, if it is not clear that the Congress will pass this measure, 
the Department of Defense will begin to take steps to shut down some of 
their functions worldwide. And I can assure you, it will be costly, it 
will be inefficient, and totally unnecessary.
  The Senate has already voted overwhelmingly to cut off further debate 
on this measure. It is clear there is broad-based support. There is no 
reason to wait any longer.
  As we sit here 1 week from Christmas, we are engaged in an extremely 
partisan debate in a highly charged atmosphere over our Nation's health 
care system. Both sides of the aisle feel passionately about this 
issue. I do not fault my colleagues who oppose that measure. But this 
defense bill is too important to be caught up in partisan politics. 
This bill was drafted in a bipartisan agreement, and I think we should 
recall that it was reported out of the Appropriations Committee by a 
vote of 30 to 0, unanimously. In both bodies of this Congress, the 
respective versions of the bill were supported overwhelmingly.
  The compromise measure we are working on at this moment passed the 
House of Representatives by a 398-to-24 vote. That is almost unanimous, 
unheard of. So I plead with my colleagues, let's not force a wasteful 
shutdown of the Defense Department. Let's not continue the delay which 
has stalled action on this bill. And, above all, let's not raise doubts 
in the minds of our military men and women worldwide, who would follow 
our actions, and make them question us: Do we support them? Instead, 
let's come together in the bipartisan spirit in which this bill was 
created and crafted and vote to pass it today.
  As in ancient times, it was said: Peace on Earth, good will to all 
men.
  Mr. President, I would like to submit a short list of technical 
corrections to the Disclosure of Congressionally Directed Spending 
Items report that is attached to the explanatory statement for H.R. 
3326, the Department of Defense Appropriations Act for fiscal year 
2010. The following corrections are necessary to provide the most 
accurate description of congressionally directed spending items in this 
bill.
  Senators Bingaman and Udall of New Mexico should be removed from the 
list of sponsors for the Advance Propulsion Non-Tactical Vehicle in 
Research, Development, Test and Evaluation, Air Force.
  Senator Reed should be added in support of the Standoff Sensors, 
Detection of Explosives and Explosive Devices--IEDs--in Research, 
Development, Test and Evaluation, Army.
  Senator Schumer should be added in support of the WMD Civil Support 
Team for New York in National Guard Personnel, Army.
  Senators Crapo and Risch should be added in support of the Radiation 
Hardened Cryogenic Read Out Integrated Circuits in the Defense 
Production Act account.
  I yield the floor, Mr. President.
  The PRESIDING OFFICER. The Senator from Delaware is recognized.
  Mr. KAUFMAN. Mr. President, I thank you for your help in this, as 
always. I say to the Presiding Officer, you are a great colleague, and 
I appreciate it.
  Mr. President, I ask unanimous consent to speak as in morning 
business.
  The PRESIDING OFFICER. Without objection, it is so ordered.


                           Broadcast Stations

  Mr. KAUFMAN. Mr. President, I want to take a few minutes today to 
speak about television and to alert my colleagues to a troubling 
situation.
  Recently, the only VHF television station licensed in Delaware 
canceled the one nightly public affairs program which covered Delaware 
issues, closed its local studio, and moved almost all of its employees 
out of Delaware.
  That station--WHYY-TV--did this even though the community it is 
supposed to serve first, that should be its primary focus, is 
Wilmington, DE. This is offensive and it is wrong. These and other 
actions led the city of Wilmington, last week, to challenge the license 
renewal of WHYY. I understand and commend the city's complaint, and I 
hope it will bring about better service to Delawareans.
  Frankly, I think WHYY was emboldened to make these changes by the 
weakened oversight of the regulatory agency charged with making sure 
broadcast stations serve the public interest: the Federal 
Communications Commission. If this sort of snub to the community of 
license proceeds with no repercussions, we could be seeing less and 
less local service from stations all across the country.
  If the requirement to serve the public interest has no meaning, if 
the broadcast station provides its community of license with nothing 
more than what we can get from a national cable, satellite, or Internet 
channel, then the public is getting a bad deal for giving away spectrum 
at no charge.
  At the core of the FCC's licensing policies--right from the 
beginning--is a principle that every community of appreciable size 
needs and deserves its own station. As a nation, we have licensed 
broadcast stations to cities all across America. In America, we do not 
have nationwide broadcast channels. You get that on cable channels such 
as HBO or Discovery, either through cable or through DISH. TV channels 
are local. These stations that are granted free use of public airwaves 
are required to be responsive to local needs. Each has a duty to 
determine the programming appropriate for its viewing community and 
then make its programming decisions based on those needs. That is the 
deal. You get the spectrum, you take care of the local needs. 
Broadcasters are, for all intents and purposes, temporary trustees of 
the public airwaves. For that privilege, they must serve their own 
communities.

  It is exactly because broadcasters must address local issues and 
needs that the FCC required cable companies to carry local broadcast 
channels. For the same reason, satellite carriers have been restricted 
in their ability to bring distant network signals into homes that 
should be receiving their local stations. That all makes sense. Yet 
unless the FCC steps up and makes it clear to broadcasters that their 
duty to serve the public interest is real and includes making program 
decisions that are responsive to their communities of license, I fear 
the public is going to lose out and local needs will go unmet.

[[Page S13431]]

  As long as stations think they can get away with doing less, they 
will be tempted to do less. If there are no consequences to ignoring 
their obligations, they will take shortcuts and our communities will be 
the worse off for it. If that happens, our historic allocation of 
channels all across the country designed to ensure community-oriented 
service will become a sham.
  I call these concerns to the attention of my colleagues today because 
this is what is happening in my own hometown of Wilmington, DE. We have 
one VHF station in Delaware. It is Channel 12, WHYY-TV. Its city of 
license is Wilmington, DE, and it is a public television station.
  WHYY-TV is not always on Channel 12. In fact, it started out on a UHF 
channel in Philadelphia. But in the 1960s, when a commercial station 
operating on Channel 12 ran into problems, WHYY beat out the 
competition for the VHF license. It was no secret that WHYY made this 
move not because it wanted to relocate from Philadelphia to Wilmington 
but because it wanted to move from a UHF channel to a stronger VHF 
channel with greater viewership. However, this move nonetheless was 
tied to a promise that the station's primary duty was to serve the 
interests and needs of the people of Wilmington, DE, its new city of 
license. Unfortunately, it has been a near constant struggle for our 
community to get the attention it was promised.
  When its license was first granted, WHYY agreed to present 16.5 hours 
per week of Delaware-oriented programming. Let me repeat that. They 
promised and agreed to present 16\1/2\ hours per week of Delaware-
oriented programming. By the time its license came up for renewal in 
1978, it was providing less than 3\1/2\ hours per week. As renewal of 
its license was challenged, WHYY added some additional Wilmington-
oriented programming. Nonetheless, the FCC conditioned the grant of its 
license on demonstrating a commitment to local programs broadcast from 
Wilmington rather than Philadelphia.
  WHYY was again chastised for failing to serve Wilmington during its 
1983 license renewal proceeding. The criticism touched on such issues 
as the location of its main studio; its station log, staff, and 
management; the production of nonnetwork programming; and the amount of 
locally produced programming focused on Delaware. The FCC ordered WHYY 
to base personnel in Wilmington capable of addressing the many 
failures.
  With the diminishing of FCC oversight of broadcasters' responsiveness 
to local needs, WHYY service to Wilmington diminished as well. Its main 
studio has long been in Philadelphia, and the Web site for both the 
Corporation for Public Broadcasting and the Public Broadcasting Service 
list it as a Philadelphia station. This is even though its license was 
based on being in Wilmington, DE. In June of this year, WHYY announced 
it was closing and putting up for sale its studio in Wilmington, 
closing its news bureau in Dover, and eliminating most of the 16 
employment positions in Delaware. In short, it is virtually leaving our 
State and its city of license.
  WHYY's programming decisions also mock its community of license. Gone 
is the daily afternoon report that focused on issues of interest to 
those living in and around Wilmington. Today, Delaware's only VHF 
station has committed to producing merely a single, 30-minute weekly--
weekly--program focused on our State. The program is scheduled to air 
at 10 p.m. on Fridays and to be rebroadcast over the weekend.
  If you look at the listings of locally produced programs that are 
touted on WHYY's Web page, you would be hard-pressed to find programs 
focused on Wilmington.
  WHYY has the audacity to rationalize its cut in local programs by 
saying it will provide more Delaware-focused stories in its 
Philadelphia licensed FM radio station and online. So they get a 
broadcasting license and the programming is going to be on their radio 
station in Philadelphia and online. You don't have to be a genius to 
see this is not an acceptable substitute. This plan leaves entirely 
unserved those who look at television for information about the local 
community. Reporting through other media is not the same as reporting 
on television, and to do so WHYY does not need a TV license.
  The people of my State feel shortchanged and they should, and they 
are, especially because WHYY operates a noncommercial educational 
television station that receives support from tax revenues as well as 
individual and corporate donations. The public expects the licensee 
will be responsible and attentive to the obligations it holds to its 
community of license. There is no doubt WHYY has failed in this regard.
  Those of us who live in Delaware understand we are situated in one of 
those areas of the country where airwaves are crowded. Also, television 
channel assignments to major cities in adjacent States have left little 
room in the spectrum for allocations to communities in our State. I 
know other States face the same problem.
  The television stations to which Delawareans tune their sets 
predominantly broadcast out of Philadelphia, Pennsylvania, and 
Salisbury, MD. These out-of-State stations, however, owe only a 
secondary obligation to address the needs of their Delaware viewers.
  Broadcasting in this country is coming to a significant transition, 
but the promise that comes with digital transmission should mean States 
such as Delaware and communities such as Wilmington will receive more 
attention to the local needs and interests, not less. That was the 
promise of digitalization. That was the promise of high-def TV. That 
was the promise of broadband. The allocation of a channel to a 
particular community must bring with it some special duty or else it 
has no meaning at all.
  The FCC needs to reassert its role to insist that the licensees--
companies that get free use--that is free use--of the public's airwaves 
take their responsibilities to serve the public interests seriously. If 
they do not, we will see more stations such as WHYY take advantage of 
lax policies. We will have more citizens in more communities left with 
little or no local programming. The complaint filed by the city of 
Wilmington last week against WHYY's license provides the FCC with a 
perfect opportunity to give real meaning to a broadcaster's obligation 
to its community of license.
  I strongly encourage the FCC to use this chance and act decisively to 
protect the public interests.
  Mr. President, I yield the floor and suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. ISAKSON. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER (Mr. Reed). Without objection, it is so 
ordered.
  Mr. President, I rise today to support the DOD appropriations bill 
before us and to take a few minutes to talk about a couple of the 
provisions in the bill that are important to Georgia but, in 
particular, I think, also point out something important for us to 
recognize as Members of the Senate.
  In this appropriation is an appropriation to the Office of Economic 
Assistance for $40 million. That money is appropriated to be 
competitively granted back to communities for various economic 
difficulties they have suffered. One of those communities is 
Hinesville, GA, in Liberty County, the home of Fort Stewart. Fort 
Stewart is the base through which most of our troops who serve today in 
Afghanistan and Iraq pass and many are trained. It is an outstanding 
facility in a town with a population of about 29,000. It is a rural 
county near the coast and near the great Port of Savannah where almost 
all of the materiel and equipment is shipped from the United States to 
the theater in the Middle East.
  A few years ago, it was announced by the DOD that we would add three 
new brigade combat teams in the United States of America, and Fort 
Stewart would be the host of one of those new brigade combat teams. 
Immediately, the community has done what it has always done. It 
invested tens of millions of dollars in infrastructure, road 
improvements, community improvements, and it incentivized the private 
sector through the banks and the developing community to build the 
housing necessary to house the dependents

[[Page S13432]]

and families of those new troops who would come and be a part of that 
brigade combat team. So the construction work began over 2 years ago. 
Moneys were borrowed, developments were begun.
  A little earlier this year, it was announced quickly and summarily 
that the Department of Defense was dropping back those three brigade 
combat teams and that none of the three would be created or deployed. 
Unfortunately for the community of Liberty County and for the private 
developers and the banking system there, they cannot get a do-over. 
They have already borrowed the money. They have already deployed the 
capital. They already made the investment.
  Worst of all, the announcement came at a time when we are in great 
economic turmoil anyway, where our banking centers are under great 
stress. As I know everybody is aware, of all the States in the United 
States, the State of Georgia has had the most banks closed by the FDIC 
during the last 18 months. To have these assets become nonaccruing 
assets because the military changed its mind and the decision puts all 
of the banks that participated in that in a difficult situation.
  I rise to thank the committee and Chairman Inouye and Ranking Member 
Cochran and all the members of the House committee, especially 
Congressman Jack Kingston from Savannah, for adding this $40 million to 
the Office of Economic Assistance. It will be a help, but it also 
should be a warning. Whenever we announce to communities in our States 
an expansion of our military in that State, and we call upon them to 
provide the money, the infrastructure, and manpower as their cost to 
support those troops, if we pull the plug, we change our mind, 
unfortunately, they don't get a do-over. It is important for us to live 
up to the responsibilities we have to see to it that, to the maximum 
extent possible, those communities are made whole.
  In the months ahead, I will continue to work on behalf of Liberty 
County and the people of Hinesville, GA, who have made this investment 
to see to it we do everything we can to have the deployments necessary 
to make up the difference, and where that is not possible, to see to it 
that funds are available to hopefully mitigate some of the damage.
  The beginning of that starts with passage of this bill today or 
tomorrow morning. It will pass this $40 million program for the Office 
of Economic Assistance, so that Hinesville in Liberty County, and other 
communities damaged by the decision made to withdraw the brigade combat 
teams, will have a chance to be made whole.


                        Tribute to Bill Bolling

  Mr. ISAKSON. Mr. President, it is Christmas. We are all here in 
Washington working. Our troops are working for us around the world, in 
Afghanistan and in Iraq. There are a lot of other soldiers who have 
been working very hard this past year, the soldiers who support the 
Feed the Hungry programs and the community food banks all over the 
United States of America.
  In Atlanta, GA, our State, there has been an award sponsored by 
Atlanta Gas Light for many years, called the ``Shining Light award.'' 
The award is that a gas light is installed somewhere in Atlanta to pay 
tribute to an individual who has made a historic contribution to the 
community and for the betterment of mankind--people such as former 
President Jimmy Carter, such as Ambassador Andrew Young, such as the 
founder and the gem of our State, S. Truett Cathy, the founder of 
Chick-Fil-A.
  This year, the award has been named and will be given to Bill 
Bolling. Bill Bolling runs the Atlanta Community Food Bank. Bill 
Bolling, this year, will oversee the distribution of 20 million pounds 
of food to 800 nonprofit agencies to feed citizens of our State. It is 
his 29th year in building the Atlanta Community Food Bank into one of 
the finest facilities in our country.
  Bill Bolling is an unselfish, untiring, honorable man of our 
community, who unselfishly gives of his time to see to it that others 
in pain and in hunger have food, support, and nourishment.
  In this Christmas season of 2009, on the floor of the Senate, I pay 
tribute to Bill Bolling for his unselfish contribution to our State and 
to those less fortunate. But, equally, I do the same for those around 
the country who, in this difficult time of recession and this wonderful 
time of holiday, see to it that those who have little have food and 
those who have hunger have some nourishment, and see to it that America 
is what it always has been: a giving and compassionate country on 
behalf of its people.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Kansas is recognized.
  Mr. ROBERTS. Mr. President, the bill pending is, of course, 
appropriations for our national security, our defense. But within this 
bill is legislation containing a doctor fix--meaning to prevent any 
further cuts in reimbursements to our Nation's doctors. They now only 
get reimbursed up to about 80 percent. I think it is very important to 
do that--to do something for doctors. But it is equally important to 
prevent something that would be very disastrous to doctors and the 
entire health care delivery system of our country.
  In that vein, there are a lot of things in the bill that I object to: 
the $2.5 trillion cost, the 24 million people still left uninsured, the 
$\1/2\ trillion cut to Medicare, with another $\1/2\ trillion in job-
killing tax increases, the stunning assault on liberty, and the 
Orwellian policies making health insurance even more expensive--any one 
of these things would make me vote no on this ill-conceived and 
dangerous legislation. We don't even know what the last iteration, the 
manager's amendment, of the effort will look like. We don't even know 
what the cost of that will be.
  There is another issue that has troubled me the most, and that is the 
issue of rationing. I don't think this issue has sunk in with the 
American people, and especially within the media.
  I want everyone to understand this bill aims to control the 
government's spending by rationing your access to health care. That is 
not ``scare-mongering'' or a scare tactic. Facts are stubborn things.
  In this bill, there are at least four government entities, and we are 
going to call them the ``rationers'' over here to my right on the chart 
who will stand between you and your doctor. These four entities are 
represented by the four walls on this chart behind me standing between 
you and perhaps your wife and the doctor. These folks are obviously 
somewhat elderly, and that is the big issue in regard to rationing, 
which I will talk about in just a minute.
  Let's talk about the first one, the Patient-Centered Outcomes 
Research Institute. The acronym is PCORI. You haven't heard of that 
before, but it is the Patient-Centered Outcomes Research Institute. 
This one here, that is the first wall between this couple, or you, and 
your doctor. The Obama-Reid bill establishes the Patient-Centered 
Outcomes Research Institute to conduct something called comparative 
effectiveness research, or CER. Rest assured, every health care 
provider in the country knows what CER is. I am not sure the public 
understands it. I am not sure those in the media yet fully understand 
it. It is research that compares two or more options for the same 
condition to see which one works best.

  That sounds like a great idea, and it is a pretty good idea. But 
unfortunately, when CER is conducted by a government under pressure to 
meet a budget, it can be manipulated in some very sinister ways. That 
has been demonstrated by the United Kingdom's CER institute. Let's look 
at that as an example. It is the National Institute for Health and 
Clinical Excellence, the acronym being NICE--but it hasn't been very 
nice.
  NICE is notorious for delaying or outright denying access to health 
care treatments based on comparative effectiveness research that takes 
into account the cost of the treatment and the Government's appraisal 
of the worth of the patient's life or comfort.
  Some of the more shocking CER decisions handed down by NICE include 
restricting drugs to save seniors' vision from macular degeneration 
until the patient is blind in one eye; denying access to breakthrough 
treatments for aggressive brain tumors; and refusing to allow 
Alzheimer's therapy until the patient deteriorates. That is 
unbelievable, but that happens.
  This Patient-Centered Outcomes Research Institute will be the 
American version of NICE, using CER to save the

[[Page S13433]]

government money by rationing health care. We tried very hard in the 
HELP Committee to insert one word, ``prohibit,'' that CER could not be 
used in any way for cost containment. It should be used for patient 
care, and we tried to put in the word ``prohibit.'' It was talked about 
for 2 or 3 days, and then in a very partisan decision, ``prohibit'' 
became a thing of the past.
  I have offered several amendments, along with my friend and 
colleague, Senator Kyl, a real leader on trying to alert the Senate all 
about CER and the dangerous path it might be taking. Senator Coburn 
also talked about this, and he had an excellent article in the Wall 
Street Journal 2 days ago. Senator Enzi, the ranking member, also 
serves on the Finance Committee and has been involved with this effort. 
These amendments were to protect American patients from NICE-style 
rationing. Unfortunately, they have all been voted down on party-line 
votes. It is not that we haven't tried.
  Let's get to rationer No. 2, the independent Medicare advisory board, 
right here, the second wall between you and your doctor.
  The Obama-Reid bill establishes a new independent Medicare advisory 
board. It is to be an unelected body of 15 so-called experts who will 
decide Medicare payment policy behind closed doors with no 
congressional input. When they make this decision on reimbursement to 
all of the health care providers, and then all of the health care 
providers, some of which their national organizations have chosen to go 
along with this bill, when they wake up to the fact that they are not 
protected, they will come to the Congress, and some will say we cannot 
do anything about it because, obviously, the Medicare advisory board 
will make that kind of decision.
  That is a complete abrogation of our responsibilities, one way or the 
other, in terms of cutting reimbursements in the appropriate way to 
save money, or to make sure the reimbursements don't close down a 
particular vital part of our health care delivery system.
  Although this bill says this anonymous board ``shall not include any 
recommendation to ration health care,'' what else would you call 
denying coverage for Medicare patients based on cost? That is what it 
will do--deny payment for knee replacements or heart surgery or 
breakthrough drugs--all to achieve an arbitrary government spending 
target. I don't know what you call that, but I call that rationing.

  Also, notice that this board will necessarily ration access to health 
care based on age and disability, of all things, since its payment 
policies will only affect the elderly and disabled who receive 
Medicare. What will be a patient's recourse if Medicare refuses to pay 
for an innovative new therapy that could save or prolong their life?
  These are the reasons the Wall Street Journal dubbed this board the 
``Rationing Commission.''
  Let's go to No. 3. This is another rationer, the CMS Innovation 
Center. The Centers for Medicare and Medicaid Services, or CMS, 
currently administers the Medicare Program on which 43 million 
Americans rely. That is almost 15 percent of the population.
  Listen up: CMS already rations care. It is not authorized to do so, 
but it does. It does so indirectly through payment policies that 
curtail the use of virtual colonoscopies, certain wound-healing 
devices, and asthma drugs.
  Medicare already has a higher claims denial rate than most private 
insurance companies. Let me repeat that. Medicare already has a higher 
claims denial rate than most private insurance companies--something you 
are not going to hear my friends on the other side admitting, not when 
it is so convenient to simply demonize the big bad insurance companies. 
In fact, the courts recently had to intervene to prevent CMS from 
rationing a relatively expensive asthma drug in Medicare because 
rationing is now against the law. However, the Reid bill establishes a 
new CMS Innovation Center which will be, for the first time, granting 
CMS broad authority to decide which treatments to ration.
  Last one, the last rationer--it is like the four horsemen--the U.S. 
Preventive Services Task Force. They got a lot of headlines recently, 
and I will go into that in just a moment. It is yet another panel of 
appointed experts--we have four panels here, none of them elected or 
accountable. This particular task force will make recommendations on 
what preventive services patients should receive. Currently, the task 
force recommendations are optional. But the Reid bill bestows this 
unelected, unaccountable body with substantial new powers to determine 
insurance benefit requirements in Medicare, Medicaid, and even the 
private market.
  The task force has already revealed the types of recommendations it 
will be making. Just recently, it decided to reverse its longstanding 
recommendation that women get regular routine mammograms to detect 
breast cancers starting at age 40. One really has to wonder if the task 
force's abrupt about-face--and it was abrupt--has anything to do with 
the fact that the Federal Government's financial responsibility for 
these screenings and for the health care needs they would potentially 
reveal would be greatly expanded if this health care reform bill 
passes.
  In the words of one prominent Harvard professor:

       Tens of thousands of lives are being saved by this 
     screening, and these idiots want to do away with it. It's 
     crazy--- unethical really.

  The outcry from oncologists, the American Cancer Society, the 
American College of Radiology, and breast cancer survivors and families 
all across the country has forced Secretary of Health and Human 
Services Kathleen Sebelius to backpedal, to do a backstroke real quick 
from the task force's recommendations, saying that they do not affect 
government payment policy. But this bill relies on the task force's 
recommendations some 14 times throughout the legislation to set 
benefits, to determine copayments, to make grant awards, et cetera--all 
policy decisions. So contrary to Secretary Sebelius's assertion, if 
this bill passes, the recommendations of the task force will become 
government policy. Not only that, they would be forced onto private 
insurers as well.
  I know some may ask: Senator, why so cynical? Why not trust that 
these tools will be used only for good, to advance medical science and 
patient care? To those folks, I answer by showing this chart. This is 
my favorite chart, Dr. Ezekiel Emanuel's ``Complete Lives System.'' It 
sounds like something you would be hearing somebody selling over a Del 
Rio radio station. It is Dr. Ezekiel Emanuel's ``Complete Lives 
System.''
  As many of you know, Dr. Emanuel is the brother of White House Chief 
of Staff Rahm Emanuel. He is a bioethicist and one of those special 
advisers to the President. I am sure he is very intelligent, very 
smart. Maybe he should be the rationing czar.
  Dr. Emanuel has published some very disturbing ideas on how to ration 
care which can be summed up by this ``brave new world, humpback whale'' 
graph behind me. Dr. Emanuel's ``Complete Lives System'' basically 
works off the premise that the older you are--listen to this--the older 
you are, the more you have lived, and therefore the less you deserve 
health care. Let me repeat that. The older you are, the more you have 
lived, and therefore the less you deserve health care.
  You know something, the average age of my colleagues in this body is 
62 years old--just something to think about.
  President Obama has clearly been listening to Dr. Emanuel's counsel. 
Remember his observation in an interview this summer that, as patients 
get closer to the end of their life--from the President no less--
``maybe you're better off not having the surgery, but taking the shots 
and the painkiller'' instead.
  Telling someone they cannot have a knee replacement because they are 
too old--how old is too old? Who should be making that decision? The 
doctor and the patient or any one of these four task forces, more 
especially this ``Complete Lives System'' as a blueprint?
  The Wall Street Journal reported on the age rationing that occurs in 
Canada's government-run health care system. Apparently in that country, 
57 is too old for hip surgery. Luckily, many of those so-called old 
geezers can drive south and find care right here in the United States. 
I am not sure where they will go after this bill passes, however.
  The White House may complain that I am taking Dr. Emanuel's musings 
out of context. My response to that is this:

[[Page S13434]]

This is the context. This is how the government will contain costs. 
This is the blueprint right here, the ``Complete Lives System.'' This 
is what we are going to be basing decisions on in terms of 
reimbursement, not between a doctor and patient.
  All of the rationing policies in this bill must be viewed through the 
prism of Dr. Emanuel's ideas, of this chart, and consequently this is 
the goal--to save the government money by rationing care. That is what 
the President means all the time when he says we are going to squeeze 
money out of the health care delivery system by basing that rationing 
on something like a pseudoscientific graph such as this. At least in 
the United Kingdom they are honest about it. These are the tools of 
rationing. These tools will restrict your ability and your family 
member's ability to get a knee replacement or a breakthrough cancer 
drug or treatment for Alzheimer's or a mammogram.
  The four rationers--if we are not able to stop this, you are going to 
see the destruction of the American health care system, the best health 
care system in the world.
  They are among the main reasons I will vote no on this bill.
  Mr. President, I yield back the remainder of my time.
  The PRESIDING OFFICER. The Senator from Arizona.
  Mr. KYL. Mr. President, first, I compliment my colleague from Kansas. 
He and I have been working on this problem of delay and denial of care, 
the problem of rationing of care specifically as it comes about through 
the comparative effectiveness research that is in this legislation, for 
a long time. I appreciate what he has said today.
  Given the amount of time, if I am not able to get a little bit more 
time over there, I am going to speak off the cuff, commenting on a 
couple of things he said.
  I am concerned about the cost of this legislation. I am concerned 
about the cuts in Medicare. I am concerned about the taxes. I am 
concerned about the fact that premiums go up, not down, under the 
legislation. I am concerned about all sorts of things that are in this 
government takeover of health care in our country. But nothing concerns 
me more than the problem raised by my colleague from Kansas because, in 
my view, nothing is more important to all of us all over the country 
than the health of our families and ourselves, except, perhaps, our 
freedom.
  In many respects, this legislation takes that away by denying us the 
ability to work with a physician, a family physician who can help 
decide what is best for us and then provide that kind of treatment to 
us. When that is taken away from us in the name of cost cutting for the 
Federal Government, yes, we are bending the cost curve down all right 
and we are also hurting the quality of health care for all Americans 
from now on. That is what bothers me most about this legislation.
  I wonder why, if my colleagues on the other side of the aisle are so 
certain rationing is not going to occur, they have defeated over and 
over again the amendments my colleague from Kansas and I have proposed 
that very simply say: You will not use cost-effectiveness research to 
deny coverage. It is very simple. They say: The language already covers 
it. I don't think so. But if it is your view that we should not ration 
care, then let's just say it. No, they don't want to do it. I think the 
reason they don't want to do it is very clear--because throughout this 
legislation there are numerous ways in which rationing will occur, and 
it has to occur under their scheme of things because it is the only way 
to accommodate the promises that have been made relative to the amount 
of money they have to pay for it.
  In some countries, they basically set a budget and say--I will pick a 
number out of the air--$50 billion this year to spend on health care. 
It is kind of like we deal with Indian health care in our country. It 
is said on Indian reservations that you better get sick early in the 
year because when they run out of money, that is it. Your appointment 
will be next January. Get in line.
  We don't want the kind of care Great Britain, Canada, and some other 
countries have where the quality of your care depends upon how much 
money they have available to treat you. At first, it is done subtly. 
They simply don't inform you of things that might otherwise be 
available, so you don't even know the treatments are available. Then 
they begin delay. It takes long and longer to get an appointment with 
the doctor. Then, finally, it is actual denial of care. They simply 
don't make various treatments available, various pharmaceutical 
products available to you, and so on.
  I was going to mention one of the experiences in Great Britain where 
they finally figured out how to get the delay down to 4\1/2\ months and 
are really proud of that.
  The National Health Service in Great Britain launched what they 
called an End Waiting, Change Lives campaign. The campaign's goal was 
to reduce patients' waiting time from 18 weeks from referral to 
treatment--18 weeks. And that is supposed to be a good thing? That is 
not what Americans want. They know what starts with delay in getting an 
appointment eventually results in denial of care.
  But probably the most pernicious thing is what my colleague was 
talking about with comparative effectiveness research where panels of 
experts decide what kind of treatments work best and which ones are 
most cost-effective for most people most of the time. The difference 
between that and a physician treating a patient is the physician knows 
each one of his or her patients.
  He knows their needs, and they are not all average. They are not all 
the general rule. Some require special circumstances.
  Mr. President, let me just conclude by reading from what one of our 
colleagues, Senator Tom Coburn, wrote in the Wall Street Journal. As 
everyone knows, he is a physician. He wrote:

       The most fundamental flaw of the Reid bill is best captured 
     by the story of one of my patients I'll call Sheila. When 
     Sheila came to me at the age of 33 with a lump in her breast, 
     traditional tests like a mammogram under the standard of care 
     indicated she had a cyst and nothing more. Because I knew her 
     medical history, I wasn't convinced. I aspirated the cyst and 
     discovered she had a highly malignant form of breast cancer. 
     Sheila fought a heroic battle against breast cancer and 
     enjoyed 12 good years with her family before succumbing to 
     the disease. If I had been practicing under the Reid bill, 
     the government would have likely told me I couldn't have done 
     the test that discovered Sheila's cancer because it wasn't 
     approved under CER [comparative effectiveness research]. 
     Under the Reid bill, Sheila may have lived another year 
     instead of 12, and her daughters would have missed a decade 
     with their mom. The bottom line is that under the Reid bill 
     the majority of America's patients might be fine. But some 
     will be like Sheila--patients whose lives hang in the balance 
     and require the care of a doctor who understands the science 
     and the art of medicine and can make decisions without 
     government interference.

  Mr. President, I rue the day that government stands in between a 
patient and a physician, when the physician says: I don't care what the 
research says the average patient needs or generally what is indicated 
or what costs too much. I know what this patient needs, and unless she 
gets it, she is going to die. At that point, if our government has 
inserted itself between the patient and physician and says: We are 
sorry, it can't be done, then our freedom will have been taken away, 
the quality of our health care will have been taken away, and we will 
have succumbed to a government so powerful that it literally has life-
and-death control over us and our families.
  That is fundamentally wrong, and we cannot allow that to happen by 
adopting the legislation that is before us now.
  Mr. ROBERTS. Would my friend and colleague yield for just a moment?
  Mr. KYL. I would be happy to yield, but I think I only have about 30 
seconds left.
  Mr. ROBERTS. I promise to be brief. I thought about saying this, but 
I think the example Senator Coburn wrote about in the Wall Street 
Journal about Sheila made me decide to speak of it.
  I had a very close friend, a member of the British Parliament, who 
thought he had broken his wrist. He had a lot of pain. It took quite a 
while to get in to see a doctor for a broken wrist. He finally did, and 
it was put in a cast. Then he kept feeling bad and thought maybe it was 
set wrong. Finally, he got back in and never left the hospital. He died 
within about 2 or 3 days. He had bone cancer.
  That, to me, was incredible that in Great Britain, this could happen. 
It

[[Page S13435]]

was just inconceivable to me. You have to sort of equate it to what 
this bill would do and what other people would experience, very similar 
to that and the situation Sheila found herself in as well.
  So I thank the Senator for yielding.
  Mr. KYL. Mr. President, I believe my time has expired.
  The PRESIDING OFFICER. The Senator from Illinois is recognized.
  Mr. DURBIN. Mr. President, for those who are keeping score and 
following the Senate, you may wonder what we are doing. We are in the 
middle of a filibuster, which is an attempt to stop legislation from 
moving forward. It is a filibuster inspired by the Republican side of 
the aisle. The bill they are filibustering and trying to delay is the 
Department of Defense appropriations bill. This is the bill that funds 
our military. It is the bill that funds our soldiers, sailors, airmen, 
and marines who are at war in Iraq and Afghanistan.
  This is a bill that, almost without fail, passes overwhelmingly with 
a bipartisan majority in the Senate and the House each year. It has 
passed the House of Representatives with a substantial vote of about 
394 to 35, with 164 Republicans voting for it over there. There was no 
controversy associated with it. Yet when it came to the Senate, the 
Senate Republicans announced they were going to filibuster the Defense 
appropriations bill.
  Why? Do they disagree with any of the contents? I have yet to hear--
aside from Senator McCain and Senator Coburn, who went through two or 
three provisions in the bill they disagreed with--anyone say we 
shouldn't fund our military. We certainly should. Now some have come to 
the Senate floor and argued the reason we are in this predicament is 
because the Democrats, who are in control, have waited too long to 
bring this bill to the floor. But that statement fails to acknowledge 
the reality of what this calendar year has meant because day after day 
and week after week, month after month, with very few exceptions, the 
role and strategy of the minority--the Republicans--in the Senate has 
been to slow down and stop the consideration of important legislation.
  Mr. ROBERTS. Mr. President, would my friend and colleague yield?
  Mr. DURBIN. Pardon me?
  Mr. ROBERTS. Would my friend and colleague yield?
  Mr. DURBIN. Only for a question.
  Mr. ROBERTS. Only for a question.
  Mr. DURBIN. I will be happy to yield for a question.
  Mr. ROBERTS. I just want to assure him--in the form of a question--if 
he were asking me, am I filibustering, that is not the case. The 
problem was, as I see it--and I am asking the distinguished Senator 
whom I have known for a long time and whom I respect--what would he 
think about the response--this is the question--where we have only had 
seven amendments that have been allowed on this bill? I have one on the 
Medicare advisory board. We have the one on CER here--rationing--and I 
had another one in regard to a tax matter--about four amendments--all 
of which have been considered in the Finance Committee.
  All were defeated by a party-line vote, so I knew where it was 
headed, but I thought it certainly deserved some debate and some 
consideration on the Senate floor. To all of a sudden limit a bill of 
this size--the health care bill, not the Defense bill--to seven 
amendments seems to be very untoward and showing a lack of comity in 
regard to a bill of this size.
  The defense bill has the doc fix in it, and so, as such, I think you 
can pivot into the problems doctors face and at least have an 
opportunity to talk about it. But this is the first time I have had 10 
or 15 minutes to talk about anything about health care. It is not that 
I would choose to do it when we are considering a Defense 
appropriations bill. I have served on the Armed Services Committee, the 
Intel Committee, as the Senator knows. There is no person stronger for 
our warriors and our men and women in uniform, and they will get their 
money.
  This bill is going to pass. That is not the issue. The issue is we 
haven't had enough time, and I would ask the Senator to comment on my 
comments and tell me if I am wrong.

  Mr. DURBIN. I would say in response to the Senator from Kansas, he 
has a grievance with the consideration of this bill--the health care 
reform bill--a 2,000-page bill, which I will address in a moment. But I 
would say to the Senator from Kansas that we are considering this 
bill--the Department of Defense appropriations bill. And because of a 
grievance over the consideration of this bill, the Republicans are 
filibustering the Department of Defense appropriations bill. They are 
trying to slow down as much as possible the passage of the Department 
of Defense appropriations bill.
  Many of us think that is unfair, particularly when we have our best 
and bravest young men and women at war, that we would somehow make the 
bill funding their effort and funding the things they need to protect 
themselves the center of a political debate over another bill. And it 
is a filibuster. Twice last night on this floor, early this morning--I 
should say in the early hours of the morning--I made a unanimous 
consent request that on a bipartisan basis we fund our troops. I 
offered it on the floor and twice it was objected to--the last time by 
the Republican leader and the Republican whip in the well of the 
Senate. They had a chance to pass this bill.
  Now, the funding for our troops runs out at midnight tonight. We are 
going to come in at 7:30 tomorrow morning because the Republicans 
insist on this delay, and we are actually going to fund the troops. I 
really believe when push comes to shove, we will. I hope we do. I will 
be voting for it, and I hope the Republicans will join me. So I don't 
understand why the Republicans are holding the Department of Defense 
appropriations bill for our troops hostage to their anger or 
frustration over health care reform.
  Then let me address health care reform. I would say to the Senator 
from Kansas, we have been on this bill for 19 days. Do you know how 
many substantive amendments have been offered by the Republican side to 
this bill in 19 days? Four--not even one a day. And six amendments--or 
I should say motions--were made to this bill to send it back to 
committee and start over. So if the Senator has substantive 
amendments--and others do--the obvious question is, Where have they 
been? Nineteen days, four amendments.
  It appears to me that when a decision was made several days ago on 
the Republican side to order the reading of an 800-page amendment, it 
was very clear that this had nothing to do with debate and voting on 
amendments. It was all about slowing things down and stopping them, and 
they tried and couldn't on the reading of this bill. Now they are 
trying, as best they can, when it comes to an unrelated bill.
  You know, there comes a point when, I would say to the Senator from 
Kansas, there has to be a vote. I mean, we are here to vote. Let's get 
on with it. We either win or lose. You either win or lose, and we have 
to go forward. I know you don't support this from what you have said. I 
do. I may prevail; you may prevail. But at some point, don't we owe it 
to the American people to take a vote? Unfortunately, this delaying 
tactic that has been going on is just postponing what I think we are 
here to do, and it is doing it at a time of year when I have to tell 
you--and I always say, at least they told me when I ran for the House, 
if you don't like this job, you know, don't run for it. And if you get 
this job, don't complain about it.
  Well, I am not going to complain, but I do have to tell you, most of 
the Members of this Senate would like to be home with their families 
for Christmas, and we may not be.
  Mr. ROBERTS. Will the Senator yield to allow me to answer the 
Senator's question?
  Mr. DURBIN. I will yield for a question, otherwise I would be 
yielding the floor. But I will certainly yield to the Senator from 
Kansas for a question.
  Mr. ROBERTS. You could go for it, yield the floor, and see what 
happens.
  I think the question the Senator asked of me--and I will defer it 
back to him in the form of a question was, Was I taking part in the 
filibuster? The only reason I am here to talk about rationing--and I 
had that rationing amendment ready, along with the Medicare advisory 
board, along with several others, is because we have not had the time 
or opportunity to offer them. Why are we rushing and not allowing time 
to consider amendments?

[[Page S13436]]

  Consequently, I have four amendments sitting on my desk waiting to at 
least talk about them, as opposed to bringing them up. I don't think 
that is filibustering. I think I am taking advantage of whatever time 
we have to at least talk about these amendments, certainly on the 
health care bill.
  On the Defense appropriations bill, it is very unfortunate this 
situation has developed, but I want to assure the Senator, and my good 
friend, that I am not here trying to hold up anything. One other 
thing--is it not true there is a bill out there but nobody has seen it? 
More especially, the managers' amendment, which will be combined with 
what came over from the House, and we do not have a score. So whatever 
you have there, if that is the bill, I would sure like to get it up on 
the Web or something so we can take a look at it and also have the 
score.
  We keep talking about the bill. I would ask the Senator: Is that the 
bill? Is that the final bill with the score?
  Mr. DURBIN. I would say to the Senator from Kansas that it is not the 
final bill. There will be a managers' amendment offered tomorrow, and 
it will be considerably smaller than this. It will have specifics in it 
that have been reviewed by the Congressional Budget Office. That is 
underway. It will be introduced, I hope, tomorrow morning, and it will 
be up for consideration for a procedural vote early Monday morning, and 
then the remainder of the week, as long as the Republicans want us to 
stay.
  It is your decision whether we will be here for Christmas, and we are 
prepared to stay, if necessary, to get it done, if that is what it 
takes.
  But it is true there is a managers' amendment coming. It is also true 
the Congressional Budget Office--maybe one of the most powerful 
agencies of the Federal Government--can literally stop the Congress in 
its tracks while the people who work there pour through these bills and 
try to make some estimate as to whether they are going to add to the 
deficit; whether they will, in fact, reduce health care costs.
  The good news for all of us is they took a look at our bill--the 
Democratic health care reform bill--and concluded it would, in fact, 
reduce the deficit $130 billion over the next 10 years and $650 billion 
beyond that.
  It is also true this is the only bill that has been brought before 
us--the Democratic bill--which would expand the coverage of health 
insurance to 94 percent of Americans.
  There has been a lot of talk about rationing in other countries. 
Senator Kyl of Arizona speaks about England and Canada and rationing 
and waiting in line and how unfair it is--and there is a fundamental 
unfairness to waiting in line when a doctor says you need some medical 
treatment. But keep in mind there is rationing in America. Fifty 
million Americans have no health insurance. That is rationing. Many 
Americans have health insurance policies that are not worth anything. 
That is rationing.
  We know more and more people are filing for bankruptcy in America 
because of medical bills because they do not have the out-of-pocket 
money for medical care they need in America, and that is rationing. In 
the developed world, which America certainly leads, we are the only 
Nation on Earth where a person can die for lack of health insurance, 
and that is rationing and that is our current system.
  Some say these reforms are too complex--2,000 pages. I defy anyone to 
take 2,000 pages and write down and describe the current health care 
system in America. They cannot. It is much more arcane, complex, and 
bewildering than this bill itself.
  Also, I think this bill, it is critically important to note, is going 
to give people an opportunity to fight the health insurance companies 
who consistently turn down the requests of doctors and patients for 
care, saying they are not covered by the policy or the person failed to 
disclose everything they should in their application for health 
insurance.
  We take them on. It is about time we did. These health insurance 
companies make a fortune. Their CEOs are paid a fortune, and they have 
created a situation which rations care to Americans today. I have seen 
it firsthand. I know friends who are going through it, people right in 
my office. And anyone who is listening to their constituents back home 
knows this is true.
  There is also one other element I will mention before yielding the 
floor to the Senator from Minnesota. We will dramatically expand the 
Community Health Care Clinics in America with this bill. If you are 
aware--and you should be--of these clinics in your community, you know 
these are the clinics with the medical professionals, doctors, nurses, 
dentists, radiologists, who provide basic primary care to people who 
are not wealthy. They provide care at a fraction of the cost to people 
going into a hospital or emergency room for a fever or a child with an 
earache, and they do it well. They do it in Chicago, do it in 
Springfield, and do it all over my State--and we will expand it. You 
will see after this bill passes a dramatic change in primary care in 
America, more and more primary care physicians' costs being brought 
down with quality care at a local level.
  We need more of it. This bill does it, and there is nothing coming 
from the other side that even matches it. I am prepared at this point 
to yield the floor to the Senator from Minnesota for the remainder of 
the time until 4 o'clock.
  Mr. ROBERTS. I have one other question to ask of the Senator.
  The PRESIDING OFFICER. The Senator from Minnesota has the floor.
  Mr. FRANKEN. I will yield to the Senator from Kansas for a question.
  Mr. ROBERTS. OK. ``You again?'' Just a personal aside.
  When we get through with the Defense appropriations bill, which will 
be soon, and that issue will be settled--and I am not going to talk 
about it anymore with the exception that this is the only time I have 
had to speak to several amendments I feel very strongly about. But as I 
say, I don't know whether four is the accurate number being 
substantive. I think the three amendments I have on my desk are 
substantive.
  I would say to the Senator, when we take up health care again, would 
the Senator give me some assurances that I can offer these three 
amendments? One would be the Medicare advisory board; one would be to 
cut out the cuts in regard to the hospitals, $1.5 billion to Kansas 
alone; and then what we are talking about are the four rationing task 
forces and boards that we had when I was making my speech.
  If I could have some assurance I could offer those----
  The PRESIDING OFFICER. The Senator from Minnesota has the floor. If 
he has yielded for a question, the Senator from Kansas will propound a 
question.
  Mr. ROBERTS. That is the question, if he could give me some assurance 
that those would be considered? That would be fine. But that has not 
happened, which is why we are in the situation we are. I am done.
  Mr. FRANKEN. Thank you, Mr. President.
  Mr. DURBIN. If the Senator from Minnesota will yield for a kind of 
question?
  Mr. FRANKEN. Certainly.
  Mr. DURBIN. I would like to ask the Senator from Minnesota if he is 
aware of the fact that we have been debating health care reform for 19 
days on the floor of the Senate, and in that period of time there have 
been four amendments offered by the Republican side of the aisle to 
change the bill and six motions to commit the bill back to committee, 
stop the debate on the floor, and that is the sum total of all of the 
effort on the Republican side to date? We do not choose the amendments, 
the leadership chooses it on the Republican side of the aisle.
  I ask the Senator from Minnesota, is he aware of that?
  Mr. FRANKEN. I am now. I was aware of the general shape of things, 
which is the sort of dearth of substantive amendments offered and the 
delay--yes. That I am aware of. Thank you.
  Mr. President, I ask unanimous consent to speak for 10 minutes as in 
morning business.
  The PRESIDING OFFICER. Is there objection?
  Mr. ROBERTS. Reserving the right to object, and I will not object to 
my good friend, but I can't let this stand when the distinguished 
Senator from Illinois says there are only four amendments, and I have 
on my desk amendments I have tried to----
  The PRESIDING OFFICER. Does the Senator from Kansas have an 
objection?

[[Page S13437]]

  Mr. ROBERTS. I am reserving my right to object. Under my reservation, 
I point out to my distinguished friend, I would like to invite him to 
my office so he could see these amendments that this leadership has not 
allowed us the time to consider. I do not think that is right. I had to 
set the record straight.
  The PRESIDING OFFICER. The Senator from Minnesota.


           the school principal recruitment and training act

  Mr. FRANKEN. Mr. President, the American dream, and its promise of 
prosperity, has long been predicated on the simple idea that 
opportunity is a right, and not a privilege, and that every individual 
should be afforded a level playing field on which to set out into the 
world.
  To fulfill this promise to our children, we must close the school 
achievement gap that is leaving so many of our low-income and minority 
children behind.
  Closing the school achievement gap is one of the defining civil 
rights issues of our time. It is a cause that challenges our society to 
uphold its time-honored commitment to equal access and opportunity for 
all.
  Yet reversing decades of educational inequality is no easy task. We 
cannot expect our schools to go it alone. We also need to improve 
social services in low-income communities to help students address the 
numerous challenges they face outside the classroom that make it 
difficult for them to learn. At the same time, we cannot absolve 
schools of their responsibility to improve considerably. There are 
exemplary schools scattered across the country that are proving every 
day that while they cannot solve all of their students' problems, they 
can push them to increasingly higher levels of achievement under the 
most trying of circumstances.
  Our task now is to learn from these schools. While No Child Left 
Behind shined a light on the inequality of our educational system, it 
has done little thus far to address the problem. As we approach the 
reauthorization of No Child Left Behind, it's critical that we look to 
the schools that are beating the odds, and determine how to replicate 
their success.
  One of the most common features of successful schools in low-income 
and high-minority communities is the presence of an effective school 
principal. This should come as no surprise; it is a matter of common 
sense to expect a successful school, or any successful organization, to 
have a strong leader. Moreover, research underscores the importance of 
school leadership. In fact, research shows that school leadership is 
second only to teacher quality in its impact on student learning.
  Yet despite the importance of school leadership, the Federal 
Government has not devoted adequate attention and resources to 
improving the quality of principals in high-need schools, which serve 
high proportions of low-income and minority students.
  Senator Hatch and I intend to change this. Having seen the 
extraordinary impact of effective school principals in Minnesota and 
Utah, we believe that improving principal quality is essential to 
turning around high-need schools.
  That is why we have introduced the School Principal Recruitment and 
Training Act. The bill will create a pipeline of effective principals 
for high-need schools by providing high-quality programs with funding 
to recruit and train principals to take on the challenge of leading 
those schools.
  One principal who has made a particular impression on me is Principal 
Andrew Collins at Dayton's Bluff Elementary School in Saint Paul, MN. 
The Dayton's Bluff School is diverse and poor. Nearly all its students 
are eligible for free and reduced price lunch. One-third of its 
students are English language learners.
  Dayton's Bluff used to be one of the worst performing schools in 
Minnesota. Only 6 percent of its third graders and only 4 percent of 
its fifth graders were proficient in reading and math.
  But that was Dayton's Bluff 10 years ago. In 2001, the school was 
restructured. Today, Principal Collins is in his fifth year of leading 
the school, and under his leadership, student achievement is increasing 
at a truly amazing pace. Proficiency on State math tests at Dayton's 
Bluff has increased from 49 percent 3 years ago--10 points below the 
State average--to 71 percent, or 8 points above the State average. 
African-American students at the school have performed more than 20 
percentage points above African-American students statewide on both 
math and reading tests.
  It is the same school, the same neighborhood, and the same kids. Yet 
the school is achieving vastly different results. The success of the 
school is a testament to the hard work of Principal Collins and his 
staff. Principal Collins has led the school's transformation by working 
closely with teachers to help them improve their instruction and their 
use of formative assessments and student data. He has also supported 
the growth of his teachers by giving them time to collaborate with each 
other on improving their instructional practices.
  Principal Collins is, unfortunately, the exception to the rule. Many 
districts report shortages of qualified principals willing to lead 
schools that are particularly in need of a strong guiding hand. We need 
to recruit and prepare more principals like Principal Collins in order 
to improve student achievement, and close the achievement gap. We can't 
afford not to make this a priority.
  When schools are not performing adequately, we hold principals 
accountable. But it doesn't make sense to place underprepared 
principals in schools facing great challenges--and then be surprised 
when these schools experience high principal turnover rates and 
continue to struggle with student achievement.
  We need to provide principals with more intensive and hands-on 
training than most of them currently receive so they will be ready to 
tackle the challenges of leading high-need schools. They need to be 
ready to lead and inspire staff, create a positive atmosphere for 
students, engage families, and use data to drive a continuous process 
of improvement. The School Principal Recruitment and Training Act would 
provide principals with the high-quality and intensive training they 
need to address these challenges.
  We are fortunate to have principals in some schools who have put in 
long hours as school leaders, constantly striving to improve their 
schools for the sake of their students. We owe it to our children to 
provide the resources necessary to recruit, train, and support more 
principals of this caliber so every school, and particularly those in 
greatest need, can benefit from effective leadership.
  Senator Hatch and I will continue to work in the coming months to 
ensure that we invest in principal recruitment, training, and retention 
so that our schools have the leadership they need to do right by our 
students. We view this investment as key to closing the achievement 
gap, and, in the process, delivering on America's promise of 
opportunity for all.
  The PRESIDING OFFICER. The Senator from Utah.
  Mr. BENNETT. Mr. President, may I inquire as to what the status of 
the time allotment is?
  The PRESIDING OFFICER. The minority now has 30 minutes.
  Mr. BENNETT. I thank the Chair.
  I rise to discuss the Defense appropriations bill. We think of that 
in terms of funding the troops and taking care of challenges overseas, 
but there is an aspect to this bill I wish to focus on. In this bill, 
in addition to appropriations for the Defense Department, there is what 
has come to be known around here as the doc fix. That is, every year we 
face a situation with respect to physician reimbursements for Medicare. 
Every year the law that is before us cuts the level of reimbursements 
for Medicare to the doctors. Every year the doctors come back to the 
Congress and say: We can't survive this. We can't live with this. We 
have to have some more reimbursement. The cuts that are in the law 
can't be allowed to continue.
  Every year we come along and say: All right, we will fix that but 
just for this year. Every year we say: All right, we will give you the 
full amount of reimbursement that you feel you are entitled to and, 
thereby, postpone the amount of cuts in your reimbursement that are in 
the law. This has happened so often that it now has a generic name. 
Every time it happens it is called the doc fix. This year the doc fix 
is included in the appropriations bill for the Defense Department.

[[Page S13438]]

  The reason it is appropriate for us to be talking about the impact of 
the doc fix at this particular time is because of the impact of the doc 
fix on the health care bill which is what we will return to when we are 
through with the Defense appropriations bill. Given the fact that the 
doc fix is in the Defense appropriations bill, I think it appropriate 
that I talk about the underlying problem for a moment. When you get to 
the health care bill and try to figure out how it is going to be paid 
for, this multitrillion dollar bill, you find that one of the main ways 
it is going to be paid for is by cutting the reimbursement to doctors 
and hospitals under Medicare. Indeed, I believe the amount that will be 
cut is up to $\1/2\ trillion. The reason I say I believe that is the 
amount is because we have not seen the actual language of the bill we 
will be asked to vote on probably on Christmas Eve. The bill has been 
drafted. The managers package has been drafted. It has been referred to 
CBO for a score. But it has not been shared with any of the Members of 
the Senate. We are guessing as to what it will be.
  But there has been enough said and enough written about it that I 
think the guess of a $\1/2\ trillion cut in appropriations to 
physicians and hospitals is a legitimate number.
  All right. We have never seen a cut of this magnitude before. We have 
had much smaller cuts that have come along, and every time we have 
dealt with those cuts by passing a doc fix.
  Now what we are seeing here is the passage in the Defense 
appropriations bill of yet another doc fix. What that means is, we 
know, based on precedent, that the Congress will never allow the $500 
billion cut that is in the underlying health care bill to actually take 
place. If it is not going to take place, why is it in the bill? The 
answer to that is something I have a hard time explaining to my 
constituents, because they don't understand the ins and outs of the 
scoring situation by the CBO. But I will do my best to help make it 
clear.
  The Congressional Budget Office is called upon to score each bill 
separately. So if you have a bill with respect to defense, they score 
that bill, and they do not talk about the impact of that on the overall 
budget. They say: These are the numbers. If you have a bill that deals 
with Interior, they score that bill. If you have a bill that deals with 
Transportation, they score that bill. Each bill is scored separately as 
a single entity.
  Let's talk about the health care bill. The health care bill is going 
to increase costs dramatically. When it increases cost dramatically, in 
order to keep President Obama's pledge that it will not add one dime to 
the Federal deficit, there has to be something in that bill that cuts 
the cost. So we assume, based on previous versions, what will be put in 
the managers' amendment is a $500 billion cut in Medicare 
reimbursements. Now you begin to balance the dollars within that bill. 
Because if we have $500 billion more in spending but we are going to 
take $500 billion out of Medicare, then the two balance each other, and 
you can say, as the computers at CBO do say: This bill is in balance 
and will not increase the deficit.
  All right. But if you take the $500 billion that has been cut from 
Medicare reimbursement and pass a fix, if you will, for that $500 
billion in another bill, it doesn't get scored against this bill. That 
is what we are doing with respect to the Defense appropriations bill. 
We are taking the Defense appropriations bill and passing a bill that 
would pay doctors under Medicare, would take care of the shortfall 
under Medicare, but would not be scored against the health care bill.
  I don't know of any business that dares to keep its books that way. I 
don't know of any business that could possibly survive that would say: 
All right, we are going to calculate only in this one area the cost of 
the product against the sales of the product and say the two balance 
each other in such a fashion that this is a logical thing to do. But at 
the same time in a separate situation, we are going to say we are going 
to borrow X amount of money to pay for the shortfall in this product, 
and we are going to pretend that the borrowing of the money separately 
somehow doesn't affect the accounting with respect to the product. 
Nobody keeps books that way. Indeed, if a private entity were to try to 
keep its books that way, it would not only go out of business but 
possibly its owners or managers would end up going to jail. You cannot 
do that kind of sleight of hand in a private enterprise, but we do it 
all the time with respect to the government.
  The attempt was made, if you will recall, for us to do the doc fix 
prior to the time when we got to health care. The Senate turned it 
down. The Senate said: No, we are not going to engage in those kinds of 
smoke and mirrors with respect to the budget. We turned that down. As I 
was driving home that night and I had the radio on and listened to 
people talk about today in Congress, this is what I heard. They said 
two items with respect to today's activity. No. 1, it talked about the 
progress of the health care bill in the Senate. And then, No. 2, it 
said the House just passed a $200 billion doc fix to take care of the 
shortfall in reimbursements to doctors with respect to Medicare. Again, 
the computers at the Congressional Budget Office can't link these two 
events. But they were clearly linked in the comments and the report 
made on the radio, and they are clearly linked in the deficit.
  So the House is saying: We understand that we are not going to keep 
the pledges we are making in the health care bill, and we are going to 
appropriate $200 billion for the sole purpose of breaking the pledge 
that will be made in the health care bill. But because they are done in 
two separate pieces of legislation, we hope no one will notice. We hope 
the American people won't find out that this is the kind of bait and 
switch we are going through with respect to this bill. We are finding 
an example of this in the bill before us, the Defense appropriations 
bill. It has a doc fix in it to take care of the situation as far as 
the computers are concerned, but it will not take care of the situation 
as far as the deficit is concerned.
  This is not the only piece of smoke and mirrors that we have in the 
underlying legislation. Going along with it is another item that I find 
absolutely incredible. I have run a business. I have kept books. I have 
paid taxes. I have dealt with the government as they have come in to 
audit. I know that no one in a business could ever get by with the 
thing that is proposed in the managers' amendment, we think--we haven't 
seen the amendment--along with the doc fix that I have been describing.
  Let me try to put it in this form. Let's assume that you are the 
manager of a company and the sales manager comes to you and says: We 
have a new product. It is going to be a hot new product. It is going to 
be fabulous in terms of its return for the company.

  You say: Great, love that. Good news. How does it work?
  Well, we are going to manufacture this new widget and it will cost us 
X. But the revenue from it is going to be Y and that is much more than 
X so we will make all that money.
  You say: All right. How much does each widget cost?
  Well, each widget costs more than we are going to sell it for.
  OK, how in the world are you going to make so much money when you 
have a widget that costs more to make than you can sell it for?
  He says: Easy. This is the way we are going to do it. We are going to 
lay out a 10-year program of sales, and we are going to sell this 
widget for that entire 10 years. But we are only going to deliver the 
widgets for 6 years. So we have 10 years of revenue and only 6 years of 
cost. So we have 4 years of pure revenue and no cost whatsoever.
  At that point, I am sure you would say: Let's get ourselves a new 
sales manager. Let's get ourselves somebody who understands that the 
world doesn't work that way. You cannot balance your books by charging 
for 10 years and then only delivering for 6. But that is what the 
underlying health care bill does. It says the taxes to pay for this 
health care plan will start in 2010. Indeed, it will start within a 
week or two after the passage of the bill, if we pass the bill on 
Christmas Eve. But the expenditures under this plan to make things 
available for all of these people who have been telling us we need 
health care reform now, that we cannot wait, we have to have it today. 
I have seen the placards raised. I have seen the protests. We have to 
have it now.

[[Page S13439]]

  We say: All right. One thing you will get now are the taxes and the 
increases in premiums on people who already have health care. But you 
won't get any of the other benefits out of the bill for 4 years. We 
have to do it that way in order to make the books balance.
  You have the doc fix, which the underlying bill we are debating, the 
Defense appropriations bill, makes clear is not going to happen as part 
of the way you pay for the health care. And then you have the 10-year 
revenue, 6-year expense kind of scheme to pay for a good portion of the 
rest of it.
  So what is going to happen between now and 2014 when the bill finally 
kicks in? You are going to have three open seasons--for those who 
understand the language of the health insurance business--three open 
seasons in which people will look at their level of premiums and say: 
Wait a minute, how come my premiums are going up when nothing 
additional is being done with respect to health care reform? The answer 
will be: Your premiums are going up so the money can be charged by the 
computers as compensation for the new benefits that will kick in, in 
2014.
  If you are so impudent as to ask: Well, is the money that is going to 
come from the increased taxes and the increased premiums being put in a 
trust fund somewhere to be held solely for the purpose of paying for 
the increased health insurance benefits? The answer, of course, will be 
no. The money that is coming from the increased taxes and from the 
increased premiums will all go against the current deficit. It will all 
go to deal with the money we are talking about with the stimulus 
package. It will all go for other governmental purposes. There will not 
be a time of it saved to deal with health care. That is not the way the 
government keeps its books. The money comes in. It goes into general 
funds. It gets spent, and it gets spent immediately.
  Oh, so that means in 2014, when the expenses of this bill kick in, 
there will not be a dime that will have been accumulated to help pay 
for that? That is true, as far as cash flow is concerned. But it is not 
true as far as the CBO score is concerned, and that is all we care 
about. All we care about is what the CBO computers tell us about 
scoring this bill.
  One of the frustrations I have had coming to the Senate from a 
business background--having run a business, having understood the 
challenges of running a business--is the way the government keeps its 
books. I cannot think of a more devastating demonstration of how 
misleading the government accounting system is than the bill we will 
get to when we are through with the bill we are debating today. As I 
said at the beginning, one of the primary examples of that dishonesty 
is contained in the Defense appropriations bill, as it has this year's 
version of the doc fix.
  Let me move to a related subject because, as I say, this bill talks 
about the doc fix. The doc fix is connected to the way we try to deal 
with entitlements. Let me step a step beyond the specifics of this bill 
for just a moment and describe what we are dealing with, with the 
entitlements.
  First, I need to explain what an entitlement is. I have had 
constituents come to me and say: I hear all this conversation about 
Federal entitlements, and I don't understand. What is an entitlement?
  Simply put, an entitlement is a payment to which the individual is 
entitled, whether the government has the money or not. It is not the 
same thing as the government appropriating money and saying: Now we are 
going to give it to you or now we are going to buy this or now we are 
going to pay that bill.
  An entitlement means you are entitled to this money ahead of 
everything else. You are entitled to this money whether we have it or 
not. If we do not have the tax revenue that would give us the cash to 
pay you this entitlement, we have the legal obligation to go out and 
borrow the money and pay you the entitlement.
  Entitlements--or as they are known in the appropriations world: 
Mandatory spending--now comprise more than two-thirds of all Federal 
expenditures. Let me repeat that because I get gasps of disbelief when 
I say this to my constituents back home. Entitlement spending--money 
the government is required by law to pay whether it has it or not--now 
comprises more than two-thirds of the entire Federal expenditures. The 
largest portion of the entitlement spending we deal with is in--you 
guessed it--health care.
  If we allow the health care costs to continue to go up, as they have 
been going up, this is what we are looking at. We will be unable, by 
virtue of our tax base, to pay this entitlement spending. It will all 
be borrowed. The consequences to the national debt will be as follows. 
This is from the Congressional Budget Office. This is not an outside 
analysis. This is from within the own group we turn to in the Congress 
to tell us what is going to happen financially.
  At the end of 2008, the publicly held debt of the United States was 
$5.8 trillion. There were many who were very critical of the Congress 
and President Bush for allowing the debt to get to $5.8 trillion.
  If there is no diminution of the rate of increase of entitlement 
spending, if it goes as it has been going, if we take no steps to turn 
the cost curve down, what will it be in 10 years--not a long period of 
time in the Nation's history. It was $5.8 trillion at the end of 2008. 
What will it be in 2019? The Congressional Budget Office says it will 
have grown from $5.8 trillion to $17.1 trillion. It will triple in a 
10-year period if we do not do something about entitlements.
  So what are we talking about with respect to the health care 
proposal? We are talking about creating a new entitlement. We are 
talking about not turning the cost curve down in the entitlements we 
have already; we are talking about creating a new one and adding it on 
top.
  The best way to dramatize this, is to look at the 2010 budget, where 
we are right now, the 2010 budget on which we are drawing up 
appropriations bills. We passed that budget. I did not vote for it, but 
it was passed. Here are the details of the budget that was passed for 
2010. It projected Federal revenues in 2010 at $2.2 trillion. It seems 
like a lot of money. It should be enough to cover all our bills. Then 
you go to the next line, and it says: Mandatory spending--those are the 
entitlements--$2.2 trillion.
  That meant that in 2010, every single dime that came into the Federal 
Treasury was already committed to go out to an entitlement and not 
subject to the appropriations process in the Congress.
  That meant that everything we appropriated money for in the 
Congress--the Embassies overseas, the military, the war in Afghanistan, 
AID activities, transportation, the national parks, education--
everything else you can think of that the government does was paid for 
by borrowed money. Mr. President, $2.2 trillion in and $2.2 trillion 
out for entitlements meant that the additional $1.4 trillion, that 
actually grew to $1.7 trillion, that we spent had to be borrowed, added 
to the national debt.
  That is why the Congressional Budget Office says we are currently on 
track to go from a national debt, when President Bush stepped down, of 
$5.8 trillion to--10 years from now--a national debt of $17.1 trillion.
  I see my colleague from Texas has come to the floor, and I will be 
happy to allow him to take the rest of the time. It is up to him as to 
whether he wishes to enter into this.
  The PRESIDING OFFICER. The Senator from Texas.
  Mr. CORNYN. Mr. President, I would like to pose, through the Chair, a 
question to my colleague from Utah.
  Is the Senator aware that on October 6, eight of our colleagues on 
the other side of the aisle wrote a letter to the majority leader 
asking that when a bill is introduced, the so-called substitute--that 
presumably is going to be revealed tomorrow morning--that eight of our 
Democratic colleagues asked that that legislation be posted for a full 
72 hours, along with a score or cost estimate of the Congressional 
Budget Office, before they would be required to vote on it?
  Mr. BENNETT. I say to the Senator from Texas, I was aware of the 
letter. I was not aware there were that many Democratic signers to it.
  Mr. CORNYN. I would say to my colleague from Utah, Senator Lincoln, 
Senator Landrieu, Senator McCaskill, Senator Pryor, Senator Bayh, 
Senator

[[Page S13440]]

Lieberman, Senator Nelson, and Senator Webb were all signatories on 
that letter.
  I know at different points of the debate we have had some discussion. 
I think Senator Dorgan from North Dakota, who sponsored the amendment 
that would deal with drug prices, had expressed some concerns--I know, 
certainly, the Senator from Arizona, Mr. McCain, has expressed some 
concerns about drug price issues and what kind of deals had been 
basically cut on the side that Members of the Senate are not 
necessarily privy to.

  I would ask my colleague, is he aware the Obama administration has 
now been sued for the visitor list at the White House--which they have 
claimed privilege to--has been sued because they have withheld the 
names of the individuals who have come to the White House, some of whom 
may have been involved in negotiating these side deals we are not privy 
to? Was the Senator aware of that?
  Mr. BENNETT. I say to the Senator from Texas, I was not aware of the 
lawsuit, and I appreciate his calling it to my attention.
  Mr. CORNYN. Well, I would, finally, ask the Senator from Utah, you 
have heard, along with me and others, Senators say they are for the 
bill. But it is amazing how few people have actually seen it. 
Presumably, it will be revealed to us and the rest of the world 
tomorrow morning. Presumably, amendments will not be allowed on that 
bill. The majority leader can take procedures to block any amendments 
to the bill but we will then be put on a fast track, presumably, for 
passage--at least that is the intention of the majority leader--by 
Christmas Eve. Is that the Senator's understanding of the process we 
are looking forward to starting tomorrow morning?
  Mr. BENNETT. It is my understanding that is the process, but I am not 
looking forward to it. I had hoped to spend Christmas Eve with my 
family. In my family, the tradition is, we have the extended family get 
together on Christmas Eve. My house in Utah is being decorated on the 
assumption there will be anywhere from 60 to 70 people there to 
celebrate Christmas Eve. Regrettably, I will not be one of them.
  But I say to the Senator from Texas, I will be here doing whatever I 
can to see to it that this bill does, in fact, not pass on Christmas 
Eve, for all the reasons we have been talking about. I think the best 
Christmas present we can give to the people of America, and 
particularly to their children and grandchildren, would be to defeat 
this bill and see to it there is not another new entitlement created 
that will cause the national debt to go up even more extravagantly than 
it is currently projected to do.
  Mr. CORNYN. Mr. President, I ask unanimous consent that the two 
documents I referred to earlier be printed in the Record at the end of 
this colloquy.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  (See exhibit 1.)
  Mr. CORNYN. I would finally ask my distinguished colleague from 
Utah--he was alluding to this earlier--is he aware of any reason why 
this bill--much of the benefits of which will not kick in until 2014--
why there is such an urgency to pass this bill before Christmas?
  Mr. BENNETT. That has been the greatest logical disconnect of this 
entire debate. Because, as I said, I have seen the protest signs that 
are raised: We want health care reform now. I have seen the people come 
to the offices and pound on the doors and say: We have to get reform 
now. I have heard our friends on the other side of the aisle give 
examples of people who do not have health care coverage and say: They 
must get this coverage now. By the way, we have crafted a bill that 
will not do anything for them for 4 years.
  If the thing is 4 years away, we can certainly wait until January to 
allow people to read the bill and offer some amendments.
  Mr. CORNYN. I thank the Senator. I said that was my last question; 
this one really will be: Is the Senator aware of late-breaking news to 
the effect that not only Howard Dean, the former chairman of the 
Democratic National Committee, but several liberal pundits, including 
Keith Olbermann, and that now even moveon.org and the AFL-CIO have all 
come out in opposition to this bill? Is the Senator aware of the 
opposition not only on the right but apparently now on the left? We 
know the mainstream opposition of the American people as a result of 
the polling we have seen. Was the Senator aware of those developments?
  Mr. BENNETT. I have been aware of that opposition. My own sense is 
that in the end, that opposition will melt in the face of those who are 
trying to rush this bill through in the hope that by next November, the 
American people will have forgotten the details. I do not believe the 
American people will have forgotten the details of the bill by next 
November because even though the bill will not be in force in terms of 
benefits, it will be in force in terms of increased premiums and 
increased taxes.
  Mr. CORNYN. I thank my colleague.
  Mr. BENNETT. Mr. President, I believe the time for the minority has 
expired.
  The PRESIDING OFFICER. The Senator from Utah is correct.

                               Exhibit 1


                                                  U.S. Senate,

                                  Washington, DC, October 6, 2009.
     Hon. Harry Reid,
     Senate Majority Leader,
     Washington, DC.
       Dear Leader Reid: As you know, Americans across our country 
     have been actively engaged in the debate on health care 
     reform. Whether or not our constituents agree with the 
     direction of the debate, many are frustrated and lacking 
     accurate information on the emerging proposals in Congress. 
     Without a doubt, reforming health care in America is one of 
     the most monumental and far-reaching undertakings considered 
     by this body in decades. We believe the American public's 
     participation in this process is critical to our overall 
     success of creating a bill that lowers health care costs and 
     offers access to quality and affordable health care for all 
     Americans.
       Every step of the process needs to be transparent, and 
     information regarding the bill needs to be readily available 
     to our constituents before the Senate starts to vote on 
     legislation that will affect the lives of every American. The 
     legislative text and complete budget scores from the 
     Congressional Budget Office (CBO) of the health care 
     legislation considered on the Senate floor should be made 
     available on a website the public can access for at least 72 
     hours prior to the first vote to proceed to the legislation. 
     Likewise, the legislative text and complete CBO scores of the 
     health care legislation as amended should be made available 
     to the public for 72 hours prior to the vote on final passage 
     of the bill in the Senate. Further, the legislative text of 
     all amendments filed and offered for debate on the Senate 
     floor should be posted on a public website prior to beginning 
     debate on the amendment on the Senate floor. Lastly, upon a 
     final agreement between the House of Representatives and the 
     Senate, a formal conference report detailing the agreement 
     and complete CBO scores of the agreement should be made 
     available to the public for 72 hours prior to the vote on 
     final passage of the conference report in the Senate.
       By publicly posting the legislation and its CBO scores 72 
     hours before it is brought to a vote in the Senate and by 
     publishing the text of amendments before they are debated, 
     our constituents will have the opportunity to evaluate these 
     policies and communicate their concerns or their message of 
     support to their Members of Congress. As their 
     democratically-elected representatives in Washington, DC, it 
     is our duty to listen to their concerns and to provide them 
     with the chance to respond to proposals that will impact 
     their lives. At a time when trust in Congress and the U.S. 
     government is unprecedentedly low, we can begin to rebuild 
     the American people's faith in their federal government 
     through transparency and by actively inviting Americans to 
     participate in the legislative process.
       We respectfully request that you agree to these principles 
     before moving forward with floor debate of this legislation. 
     We appreciate your serious consideration and look forward to 
     working with you on health care reform legislation in the 
     weeks ahead.
           Sincerely,
     Blanche L. Lincoln.
     Mary L. Landrieu.
     Claire McCaskill.
     Mark L. Pryor.
     Evan Bayh.
     Joseph I. Lieberman.
     Ben Nelson.
     Jim Webb.
                                  ____


               Obama is Sued for White House Visitor List

                            (By Bill Dedman)

       The nonprofit conservative group Judicial Watch has sued 
     the U.S. Secret Service after the Obama administration again 
     denied a request for copies of the list of visitors to the 
     White House.
       The records are being sought by journalists and public 
     interest groups to help determine who is influencing White 
     House policy on health care, the economy and a host of other 
     issues.
       Under the Obama policy, most of the names of visitors from 
     Inauguration Day in

[[Page S13441]]

     January through the end of September will never be released. 
     After the Secret Service and the White House denied a request 
     for those records, Judicial Watch filed suit on Monday in 
     federal court in Washington.
       Like the Bush administration before it, the Obama White 
     House argues that the visitor records belong to the White 
     House, not the Secret Service. White House records are not 
     subject to the Freedom of Information Act, as agency records 
     would be. Federal Judge Royce C. Lamberth ruled twice during 
     the Bush administration that White House visitor logs belong 
     to the Secret Service, which creates and maintains them, and 
     must be released.
       To settle lawsuits against the Bush and Obama 
     administrations, filed by the liberal group Citizens for 
     Responsibility and Ethics in Washington, or CREW, the Obama 
     administration has released the names of hundreds of 
     visitors, out of the hundreds of thousands who have been to 
     the White House for meetings, events or tours. The 
     administration has promised to release more of the names of 
     visitors for the period from October onward. The first wave 
     of records is due near the end of this year.
       Even for the names it has released, the White House has not 
     provided a city or affiliation, such as a company name or 
     organization represented, making it difficult or impossible 
     to tell whether a person named on the list is a well-known 
     person with that name. And some names are not being released 
     at all, including potential Supreme Court nominees, personal 
     guests of the first family and certain security officials.
       The White House has set up a Web page where members of the 
     public can request the release of names of visitors, but that 
     system gives results only for the names of visitors that the 
     public can guess. If the public can't guess who may have 
     visited the White House between January and September, it 
     can't find out the names.
       In addition, although the White House system requires 
     requesters to submit their e-mail address, requests are not 
     acknowledged by the White House, and no reply is sent to the 
     requesters. The names sought, if they correspond to actual 
     visitors, just show up in the next batch of names released by 
     the White House. So far, each release of names by the White 
     House has happened on the evening before a holiday, the 
     classic Washington tactic for burying uncomfortable news.


                     Negotiations with White House

       Judicial Watch, in a press release, described being invited 
     to the White House to discuss its request. It met on Oct. 27 
     with Norman L. Eisen, special counsel to the president, who 
     happens to be a founder of CREW, which had dropped its own 
     lawsuits on this issue.
       ``During the meeting, the Obama White House officials asked 
     Judicial Watch to scale back its request and expressed hope 
     that Judicial Watch would publicly praise the Obama 
     administration's commitment to transparency,'' Judicial Watch 
     said. ``However, the White House refused to abandon its 
     legally indefensible line of reasoning that White House 
     visitor logs are not subject to FOIA law.
       ``If the Obama administration is serious about 
     transparency, they will agree to the release of these records 
     under the Freedom of Information Act,'' said Judicial Watch 
     President Tom Fitton.
       White House officials did not reply Wednesday to a request 
     for comment on the Judicial Watch lawsuit.


                    Request by msnbc.com also denied

       A similar request by msnbc.com was rejected by the Secret 
     Service, which referred us to the White House, which also 
     denied the request. The Secret Service denied an 
     administrative appeal of msnbc.com's request on Monday.
       The White House now says that national security is a reason 
     not to release the records for January through September, an 
     issue not raised by the Bush or Obama administrations in 
     their previous legal filings on this issue.
       ``The inherited visitor entrance system was not structured 
     to identify sensitive records,'' Eisen wrote to msnbc.com. 
     ``As a result, we cannot make a broad retroactive release of 
     White House visitor records without raising profound national 
     security concerns. For example, the release of certain 
     sensitive national security records encompassed in your 
     request could assist foreign intelligence agencies to 
     identify and target U.S. government officials working on 
     sensitive national security issues.''

  The PRESIDING OFFICER. The Senator from Pennsylvania is recognized.
  Mr. CASEY. Mr. President, I ask unanimous consent that we continue 
with alternating blocks of time until 6 p.m.
  The PRESIDING OFFICER. Is there objection?
  Without objection, it is so ordered.
  Mr. CASEY. Mr. President, I rise at this late afternoon hour to talk 
about what has transpired over the last 24 hours. As the Presiding 
Officer knows, we had a vote at 1 a.m. this morning. To say that is 
unusual is an understatement; to have the Senate voting at that hour is 
most unusual. What that vote symbolized--what happened here pursuant to 
that vote was I think an exercise in Washington game playing.
  We have now a health care bill that the American people have been 
debating for months--the bill in front of the Senate right now, a bill 
we have been debating intensively over the last couple of weeks, and we 
want to get to a vote on it. In order to prevent a vote on health care, 
the Republican side of the aisle decided they would use any tactic 
necessary to stop the bill, so they came out in full force at 1 a.m. 
and voted against the Department of Defense Appropriations Act for 
2010.
  It is hard to understand why. I can understand opposition to a health 
care bill, and we can debate that, but it is hard to understand why any 
political party--even one that is intent on killing a health care 
bill--would use the Department of Defense Appropriations Act to do 
that, but that is what they did. It is another example of what makes 
people angry about what happens or doesn't happen in Washington.
  We have seen over the last couple of months a real debate about what 
our policy will be in Afghanistan. We have had a debate for years about 
what has been happening in Iraq, in those two conflicts, and what our 
fighting men and women are doing around the world serving their 
country. We know now that there are more than 34,000--almost 35,000--
Americans deployed in Afghanistan.
  When I consider my home State of Pennsylvania, when you look at the 
number of Pennsylvanians overseas--Afghanistan, Iraq, as well as other 
places around the world where they are serving, where they are 
deployed--10,430 Pennsylvanians are serving around the world. There are 
6,431 active duty and 3,999 Guard and Reserve Pennsylvanians. Many 
other States could point to similar numbers. So we have tens of 
thousands of Americans serving around the world, especially those who 
are serving in Afghanistan and in Iraq right now, and yet we have the 
Senate, on the Republican side of the aisle, using a Defense 
appropriations bill to slow down the health care debate and to stop the 
bill. It is beyond insulting to the American people that they would use 
this tactic.
  What is the bill all about? Well, I won't go through all of it, but 
here is what the Department of Defense Appropriations Act entails. 
First of all, military personnel: Funding for more than 2.2 million 
Americans who are serving our country. More than 1.4 million are active 
duty and over 844,000 for the Reserve component.
  Military pay: The bill provides for a 3.4-percent military pay 
increase above the requested amount.
  Operations and maintenance, readiness and training: The bill includes 
$154 billion for Defense operations and maintenance.
  Procurement, research, development, testing and evaluation, a whole 
series of expenditures that our fighting men and women need to have in 
place to help them around the world, and a whole list of vehicles and 
other equipment that are paid for by this bill.
  It goes on from there, a long, important list of what our fighting 
men and women need. What they don't need is a group of Washington, DC 
politicians using the Defense appropriations bill to play a game on 
health care. If the Republicans want to slow down health care or stop 
it, they have every right to do that, and they have every right to use 
lots and lots of tactics and procedures. What they should never do--
there may not be a rule against this per se, but one would think as 
Americans who are supposed to be supporting our fighting men and women 
in Afghanistan and in Iraq and other places around the world, one would 
think they would draw the line and not cross the line of using the 
Defense Appropriations Act to enforce their will as it relates to 
health care.
  What our fighting men and women expect of us is they expect us to 
give them the resources they need to fight those battles and not to 
play petty, insulting political games in the midst of that, but that is 
what we have had. We had Republican Senators come down to this floor at 
1 o'clock in the morning last night and vote one after another after 
another against moving the Department of Defense Appropriations Act 
forward.
  I will note that in the midst of all that, the Secretary of Defense, 
Secretary Gates, who we know served several Republican Presidents--he 
served

[[Page S13442]]

now former President Bush and President Reagan and served under the 
first President Bush as well--recently wrote that delay of this bill, 
delay of the Department of Defense Appropriations Act, would result in 
a ``serious disruption'' in the military's ability to pay troops. The 
Secretary of Defense continued:

       It is inconceivable to me that such a situation would be 
     permitted to occur with U.S. forces actively deployed in 
     combat.

  I couldn't say it better myself. It is inconceivable. We know 
political parties fight and both parties have battled and they carry it 
too far once in a while, but I don't know of an example where a 
political party, in order to stop a domestic bill that deals with 
domestic issues--in this case health care--to stop that from moving 
forward would use the Department of Defense appropriations bill as its 
vehicle.
  As it stands now, we know the vehicle that keeps our government 
moving and paying for government programs--the so-called CR, which is 
an acronym for continuing resolution--which, to get out of the 
Washington-speak for a moment, means the way we are paying for 
government to operate over a limited period of time, we know that 
resolution, the funding in that resolution as it relates to Pentagon 
operations runs out at midnight. I recognize there is some flexibility 
that will allow operations to move forward, but it is outrageous and 
insulting when a political party feels the need to unreasonably delay 
funding for the troops because they want to put something in the way of 
having health care move forward. There are lots of ways to obstruct. 
There are lots of ways to slow things down.
  Under the Senate rules, the minority party--in this case the 
Republicans in the Senate--have rights to do that. But one would think 
when we have people on the battlefield they would draw the line at 
this, but they haven't. They have crossed this line, and I think the 
American people know what is going on here. It is a game. It is a big 
Washington game. The only problem here, the fundamental problem here is 
that it is in direct conflict with our obligation to make sure that we 
move legislation as it relates to our military as fast as we can. This 
isn't something that people have been working on for a couple of days. 
There have been hearings that are the undergirding or the foundation of 
this appropriations act. There have been debates about what the 
spending increases should be. All of that took place over many months, 
and now we want to move a Defense Appropriations Act forward, and what 
are the Republicans doing? They are using that vehicle to stop the 
health care bill.
  So, even as I said before, to say it is insulting or outrageous 
doesn't begin to capture it, but I think the American people know what 
we are talking about. They understand a game when they see it, and they 
are seeing it with this shell game that has been played over the last 
couple of hours.
  We are going to continue to make sure that we do everything possible 
to move this legislation forward, and then, after we get this 
legislation moved forward, then we are going to get back to health care 
and pass a health care bill before Christmas.
  With that, I yield the floor.
  I note the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The bill clerk proceeded to call the roll.
  Mr. BENNETT. 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. BENNETT. Mr. President, I understand there is a member of the 
Democratic Caucus who is headed to the floor. I will immediately cease 
speaking as soon as he or she arrives. I simply wish to make a few 
comments with respect to statements made with respect to the schedule. 
The question was asked by my colleague from Texas: Why would people 
want to rush this bill through when the effective date is not until 
2014?
  The other question was: Why would someone want to delay the vote? I 
think the answer to both questions is the same. The American people are 
looking at this bill. Admittedly, they are not looking at the specific 
bill, because no one knows what it is. It is still, for the umpteenth 
time, being rewritten. They are looking at the general outline of the 
bill, and the more they see, the more they don't like it.
  Every poll that comes out shows increasingly decreasing support for 
the bill and increasingly opposition to the bill. The gap between these 
two positions is growing wider and wider. This is quite remarkable, 
because when we began the debate in the Spring, support for the idea of 
health care reform, and particularly for some of the specifics, was 
very high, and disapproval was very low. We have seen, over time, those 
two lines cross. Now opposition to the bill is, according to some 
polls, as high as 60 percent or more, and support for the bill has 
dropped.
  I can understand that those who want the bill passed want to rush the 
process as fast as possible, because they don't want any more erosion 
in popular support. Those who want the bill stopped want to stretch the 
process out so that the polls can have their impact on Members of this 
body. It should not, therefore, come as a surprise to anybody that the 
procedures will be handled in the way they are--with the one group 
saying, let's get it done quickly before people find out more about it, 
and the other group saying let's slow it up as much as we can while 
people find out more about it.
  I think that is the answer to the questions that have been raised 
here with respect to the procedure.
  I see other Senators may well be coming. Until they arrive, I suggest 
the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The bill clerk proceeded to call the roll.
  Ms. COLLINS. I ask unanimous consent that the order for the quorum 
call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The time currently is all located to the Democratic side The Senator 
must ask unanimous consent to do so at this time.
  Ms. COLLINS. I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The bill clerk proceeded to call the roll.
  Ms. COLLINS. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Ms. COLLINS. Mr. President, I ask unanimous consent that, 
notwithstanding the fact that there are few remaining moments on the 
other side of the aisle, I be permitted to proceed.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Ms. COLLINS. Mr. President, let me emphasize that it was cleared with 
my colleagues on the other side of the aisle.
  I rise today in support of the fiscal year 2010 National Defense 
Appropriations Act. Let me begin by thanking the committee's 
distinguished chairman, Senator Inouye, and the ranking member, Senator 
Cochran, for their leadership in crafting this bill and for their 
strong commitment to our Nation's Armed Forces.
  I am very proud of the work that the State of Maine does that 
contributes to our national defense. The appropriations bill provides 
vital resources that our troops need and recognizes the enormous 
contributions made by the State of Maine to our national security. From 
the Portsmouth Naval Shipyard in Kittery, to the Pratt & Whitney Plant 
in North Berwick, to the Bath Iron Works shipbuilders to the University 
of Maine's engineers, to the Maine Military Authority in Aroostook 
County, Mainers all over our great State are leading the way to a 
stronger national defense.
  This legislation will provide funding for essential training, 
equipment, and support to our troops as they bravely and skillfully 
engage in national security efforts at home and abroad. This is a 
critical time in our nation's history and the Committee has, once 
again, demonstrated its strong support of our soldiers, airmen, 
sailors, and marines.
  This legislation also will fund critical force protection and health 
care initiatives for our troops, while continuing development of 
important technologies and acquisition programs to counter existing and 
emerging threats.
  The legislation before us includes a strong commitment to 
strengthening

[[Page S13443]]

Navy shipbuilding. Our nation needs a strong and modern naval fleet 
allowing us to project power globally and to respond to threats. This 
bill authorizes $1 billion in funding for construction of the third 
DDG-1000, a priority of mine. The Pentagon's decision to have Bath Iron 
Works, BIW, build all three of the DDG-1000s demonstrates well-deserved 
confidence in BIW and will help ensure a stable work load for the 
shipyard and more stable production costs for the Navy.
  In addition, this legislation authorizes $2.2 billion for continued 
DDG-51 procurement and nearly $150 million for the DDG-51 modernization 
program. The lessons and technology developed in the design of the DDG-
1000 can be incorporated into the DDG-51 program to reduce crew size 
and to improve capabilities.
  The legislation fully funds the F-35 Joint Strike Fighter request for 
both the Navy and the Air Force. This aircraft, powered by the superb 
engines made by Pratt & Whitney, will enable our servicemen and women 
to continue to maintain our air superiority.
  At the request of Senator Snowe and myself, the Committee provides an 
additional $20 million for Humvee maintenance to be performed at Maine 
Military Authority's, MMA, Army National Guard Readiness Sustainment 
Site, RSMS, located in Limestone, ME. For nearly 13 years, the Army 
National Guard has relied on Maine Military Authority to provide a 
dependable service to our Nation's war fighters. The dedicated and 
talented professionals at MMA have demonstrated their value to the Army 
and to the Nation and consistently have performed Humvee refurbishment 
at a lower cost than the Army's own depots. This funding would help to 
ensure that MMA's valued workforce and high quality product remain a 
national asset supporting the defense of our country.
  The bill also provides $250 million for cancer research through the 
Defense Health Programs with $150 for the Breast Cancer Research 
Program, $80 million for Prostate Cancer Research program, and nearly 
$20 million for the Ovarian Cancer Research Program. I believe that 
there is simply no investment that promises greater returns for America 
than its investment in biomedical research. These research programs at 
the Department of Defense are important to our nation's efforts to 
treat and prevent these devastating diseases that also affect our 
veterans and servicemembers.
  The bill provides $307 million to address the Tricare private sector 
shortfall in fiscal year 2010 as identified by the Department of 
Defense. I know Tricare funding is vital to so many Maine veterans. We 
must continue to support robust funding for this important program and 
limit increases in Tricare premiums and copayments.
  I strongly support the additional $15.6 million to strengthen the 
Office of the Inspector General in order to keep pace with the growth 
in the size of the defense budget and the number of defense 
contractors. More vigorous oversight of defense contracts to prevent 
waste, fraud, and abuse of taxpayer dollars will complement the 
procurement reforms we approved earlier this year.
  This bill also includes funding for other defense-related projects 
that would benefit Maine and our national security.
  Funding is provided, for example, to Saco Defense in Saco, Maine, to 
enable the company to continue manufacturing weapons that are vital to 
the Armed Forces.
  In addition, at my urging, the legislation appropriates $5.28 million 
for the University of Maine. This funding would support the development 
of LGX High Temperature Acoustic Wave Sensors and allow the University 
of Maine to continue to investigate fundamental sensor materials and 
design concepts as well as demonstrate functional prototypes of 
acoustic wave sensors that will be tested under extreme temperature 
environments. The funding for the University will also provide for 
woody biomass conversion to JP-8 fuel, which will provide affordable 
alternative sources for military aviation fuel.
  Mr. President, I want to comment further on the health care bill 
currently before the Senate. I have talked about my concerns previously 
regarding the impact on premiums, my belief that the bill will actually 
cause many middle-income Americans to pay more for health insurance. I 
have also talked about my concerns about the impact on our small 
businesses.
  I want to talk about a couple of other issues that are particularly 
important to the State of Maine. The first is the impact of the nearly 
$500 billion in Medicare cuts on Maine's home health, hospital, and 
other health care providers, including our nursing homes.
  I am concerned that the bill before us is financed, in large measure, 
through these enormous cuts in the Medicare Program--a program that 
already has long-term financing problems. According to the CMS Actuary, 
these proposed deep cuts will threaten Medicare's fiscal stability and 
push one in five hospitals, nursing homes, and home health care 
providers into the red. Many of these providers, I fear, would simply 
stop taking Medicare patients, which would jeopardize care for millions 
of seniors.
  I want to make clear that I do believe there are savings that can be 
found in the Medicare Program. For example, far too much is lost each 
year to fraudulent claims. That is an area where we need to crack down. 
As we put in place the health care reforms that have widespread support 
on both sides of the aisle, we could also achieve real breakthroughs 
that would improve the quality of care while lowering costs. But that 
is not what we are talking about in the underlying bill. Instead, we 
are talking about essentially across-the-board cuts, deep cuts, cuts 
that are going to hurt some of the most vulnerable people in our 
country--our seniors and our disabled citizens.
  This became even more clear to me as a result of a conversation I had 
this past week with Peter Chalke, the CEO of Central Maine Health Care. 
He runs not only the tertiary hospital in Lewiston, ME, but also rural 
hospitals in western Maine, in Rumford and in Bridgton, as well as a 
smaller hospital in Brunswick, ME. So you can see from that 
description, if you are familiar with the State of Maine, that the 
hospital network he covers makes a huge difference in the lives of so 
many Mainers. Here is what he told me. He first pointed out that Maine 
is one of the oldest States in the country. So we have a substantial 
Medicare population.
  Despite being recognized nationally for providing high-quality care, 
Maine's hospitals currently receive the second lowest Medicare 
reimbursement in the country relative to their costs. There is no fat 
to cut in the reimbursements of hospitals in the State of Maine. They 
have very high quality, some of the highest quality in the Nation, 
according to health care experts, and according to Medicare itself. Yet 
they get the second lowest reimbursements.
  The CEO of this hospital network put it bluntly to me. He said 
passage of this bill in its current form would be disastrous for the 
State of Maine. He said the bill would saddle Maine's hospitals with 
some $800 million in Medicare cuts over the next decade, with very 
little upside benefit from expanded coverage since about 90 percent of 
Maine residents are covered by some type of insurance policy today.
  We also have a large Medicaid population in our State, which led him 
to another concern. Mr. Chalke told me that a further expansion of the 
Medicaid Program is simply not sustainable, since Maine has repeatedly 
demonstrated its inability to pay for the current Medicaid Program.
  In Maine, that program is known as MaineCare. It pays Central Maine 
Health Care just 60 percent of its allowable costs. Moreover, MaineCare 
will owe Central Maine Health Care more than $50 million by the end of 
the year.
  The failure on the part of Medicare and Medicaid to pay their full 
share, to pay the amount that it actually costs to provide the care, 
simply results in cost shifting to private payers. In Maine, this cost 
shifting means that individuals who have private insurance cover 130 
percent or more of hospital costs. That should not be a surprise to us. 
If both Medicare and Medicaid are not paying at a sufficient level to 
truly cover the cost of care, what happens? The cost gets shifted to 
private insured patients. This big gap is one reason Maine's insurance 
rates are the fourth highest in the Nation.
  This is an untenable situation. The CEO told me that if Congress 
passes

[[Page S13444]]

this bill, Maine's hospitals and physicians will be forced to expand 
cost shifting, further increasing the pressures on private insurance 
markets, further making that cost an extraordinary burden on middle-
income families.
  Medicare, which is so critically important to our Nation's seniors, 
should not be used as a piggy bank for new spending programs when the 
revenues are needed to shore up the current program. I know my 
colleague from Tennessee has been talking about that issue for a long 
time. I joined him in a letter that said if there are savings to be 
found in Medicare, let's use those savings to shore up Medicare. We all 
know that Medicare is not financially sustainable. So what are we 
doing? We are cutting nearly $500 billion out of a program that does 
not have sufficient funds to deal with the influx of the baby boom 
generation, much less with the costs it is now incurring. It is 
fiscally irresponsible to raid Medicare to pay for a new entitlement 
program.
  Mr. McCONNELL. Will the Senator from Maine yield for a question?
  Ms. COLLINS. I will be happy to yield.
  Mr. McCONNELL. I think I heard some of our colleagues say these 
Draconian Medicare cuts would actually lead to the closure of some 
rural hospitals. I am wondering if the Senator from Maine thinks that 
may even be possible given the magnitude of these Medicare cuts we are 
hearing complaints about all across America.
  Ms. COLLINS. Mr. President, the minority leader brings up a very good 
point. I know the Republican leader is familiar with the analysis that 
was done by Medicare's own Actuary that says that one out of five 
hospitals--and these are likely to be the small rural hospitals that 
are so important in our States--would be so jeopardized by these cuts 
that they may not survive. Another thing that will happen is that 
physicians are going to start turning away Medicare patients.
  Mr. McCONNELL. I ask my friend from Maine, isn't that beginning to 
happen in some States already before we even take this additional step?
  Ms. COLLINS. It is. My friend from Kentucky is exactly right. In my 
State, there are already severe shortages of primary care physicians, 
particularly in the more rural areas of the State--the northern, 
eastern, and western parts of the State. Their practices are full to 
start with. What we are asking them to do is to keep accepting new 
Medicare patients whose reimbursements will not cover the cost of their 
care. That is why in many States you see physicians limiting how many 
Medicare patients they will take. I know how painful that is for our 
physicians. After all, they became physicians to care for people. They 
want to ensure people have the care they need. But there is a limit to 
what they can do.
  I share the concerns of the Senator from Kentucky that the result of 
this bill will be to jeopardize the very existence of rural hospitals, 
small nursing homes, home health care providers, which, in my State, 
are absolutely critical. After all, I know my colleagues from Tennessee 
and Kentucky have had the same experience I have had of talking to 
seniors who are getting home health care. They are so happy to receive 
health care in the privacy and the comfort and security of their own 
homes rather than being forced into a hospital setting or a nursing 
home. Yet the bill before us singles out the Medicare home health 
benefit for a disproportionate share of the cuts. It proposes that home 
health care and hospice care--hospice care, Mr. President--would be 
slashed by $42 billion over the next 10 years. That makes no sense 
whatsoever. That's $42 billion in cuts for home health care and $8 
billion on top of that for hospice care.
  A home health care director in my State, a nurse whom I know well, 
really summed it up well. First, she described the impact on Visiting 
Nurses of Aroostook, the county I am from in northern Maine. It had 
total revenues of $1.9 million last year. It estimates that it will 
lose $313,000 in the first year of the House bill, if that were to 
pass, and $237,000 under the Senate bill.
  According to the director of this agency, cuts of this magnitude 
would cause this home health agency to consider shrinking the area 
served or discontinuing some services. They cannot afford to cover such 
a geographically huge area as Aroostook County with that kind of cut.
  Here is another thing I want to share with my colleagues, because 
this is what this debate is really all about. What she told me is the 
following: It is going to be hard for our staff--and our staff is 
scared--but it is our patients who will pay the price if Congress makes 
these cuts in home care.
  That is what concerns me. It is not just the impact on our rural 
hospitals, our dedicated physicians, our struggling nursing homes, and 
our valiant home health agencies. It is their patients. It is the 
vulnerable senior citizen who lives on a rural Maine road who may lose 
access to home health care. It is families who want to live in rural 
communities but cannot if there is not a hospital nearby. It is a 
nursing home that closes, forcing families to move a loved one far away 
from the home. Those are the real-life consequences of slashing 
Medicare.
  I hope we will reconsider the cuts in this bill. It is so 
disappointing that the Senate has repeatedly rejected attempts to try 
to mitigate those cuts.
  There are so many other problems with this bill.
  I see the Republican time is about to expire. I hope as we proceed 
that we can also talk about the impact of the 4-year gap between when 
all the new taxes under this bill go into effect and when the subsidies 
are proposed to go into effect. $73 billion in new taxes and fees will 
go into effect by 2014, and some of those new taxes start in 2 weeks--2 
weeks--if, in fact, this bill is passed. And I hope it will not be. For 
example, the bill taxes pharmaceuticals and medical devices. The bill 
taxes health insurance. Next year, the bill imposes a penalty for 
health savings accounts, which makes no sense to me. We want people to 
be able to save money to help cover their deductibles.

  Next year, the bill proposes to restrict flexible spending accounts--
again, this makes no sense to me.
  The $73 billion in new taxes and fees imposed by the bill over the 
next four years are going to be passed on to consumers, without a 
doubt. CBO says that and the Joint Committee on Taxation says that. But 
when do the subsidies go into effect to mitigate this upward pressure 
on premiums? Not until 2014. I do not see how imposing these new taxes 
now--before the exchanges are set up that the chief benefits of the 
bill are supposed to become available--makes health care more 
affordable.
  Mr. President, the health care legislation that the Senate is 
currently considering would have enormous consequences for our economy 
and our society. It would affect every single American and 17 percent 
of our economy. There are many reforms that have strong, bipartisan 
support, that could have been the basis of our efforts here in the 
Senate. It has therefore been disappointing that this process has been 
so divisive and partisan. While I continue to believe that our health 
care system is in need of fundamental reform, the bill before us takes 
us in the wrong direction and will do more harm than good. In keeping 
with the Hippocratic oath of ``first of all, do no harm,'' I plan to 
oppose this legislation.
  Mr. President, I yield the floor.
  The ACTING PRESIDENT pro tempore. The Senator from Minnesota is 
recognized.
  Ms. KLOBUCHAR. Mr. President, I ask unanimous consent to speak as in 
morning business for 5 minutes.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.
  Ms. KLOBUCHAR. Mr. President, I come to the floor today to voice my 
support for the Department of Defense appropriations bill we are 
currently considering and my disappointment that some of my colleagues 
have chosen to hold up this important legislation for reasons 
completely unrelated to anything to do with this bill.
  We have been debating health care in this Senate for months, and in 
the coming days we will continue to debate health care. There are many 
honest disagreements about the best ways to reform our Nation's health 
care system. They deserve discussion.
  I will say, hearing my colleague from Maine speak, that I am 
concerned about Medicare as well. I am concerned because Medicare is 
going in the red in 2017 if we don't do anything about it. I

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look at my mom, who is 82 years old, who wants to make sure she stays 
on Medicare. I look at friends who are in their fifties and who want to 
make sure they get Medicare when they are 65. We need to make sure we 
put in place those cost reforms that are going to give us the high-
quality kind of care we have in Minnesota.
  But what I want to talk about today is the Defense appropriations 
bill. Whatever disagreements we may have on health care, they have 
absolutely nothing to do with the Defense spending bill. Funding for 
our troops in Iraq, Afghanistan, and around the world, as well as for 
defense health and other critical programs should not be dragged into 
this debate. We should be able to separate the two issues and pass this 
Defense bill swiftly and overwhelmingly.
  Senator Inouye and several of my other colleagues have already 
discussed the importance of this bill's funding provisions to our 
ongoing operations in Iraq, Afghanistan, and to our Nation's overall 
defense. I would like to spend a few minutes on the importance of this 
bill to my home State of Minnesota and where the Acting President pro 
tempore also resides.
  There are currently over 1,300 members of the Minnesota National 
Guard deployed in Iraq. These deploying members are with the 34th 
Infantry Division, the famous Red Bulls--the longest serving unit in 
Iraq. They assumed command of all U.S. forces in Iraq's southern 
quadrant in May of this year, taking over from the New York-based 10th 
Mountain Division. This means these Minnesota National Guard soldiers 
have command responsibilities for 9 of Iraq's 18 provinces. For the 
last 7 months, they have overseen the continuing transfer of security 
responsibility to Iraqi forces, which will ultimately enable the 
responsible withdrawal of U.S. forces from Iraq. In order for these 
Minnesota National Guard soldiers to successfully complete their 
mission and return home to their families early next year, as 
scheduled, we need to provide them the funding included in this bill.
  I know all of my colleagues share my belief that we have a 
responsibility to the brave men and women we send overseas to provide 
them with the resources they need to carry out their mission. And there 
is simply no reason for delay.
  In addition to providing our troops with what they need when they are 
overseas, we also have the responsibility to take care of them when 
they return home.
  As the Chair knows, in Minnesota, we are proud to have created the 
Beyond the Yellow Ribbon reintegration program. This groundbreaking 
initiative, pioneered by the Minnesota National Guard, helps soldiers 
make the transition from their life as a soldier to civilian life 
through counseling and other services.
  Due to its overwhelming success in Minnesota, this program now serves 
as a model for the national Yellow Ribbon program that I have worked 
with my colleagues to authorize and fund in recent Defense bills. The 
bill on the floor right now includes funding that will continue the 
Minnesota Yellow Ribbon program, as well as funding for similar 
reintegration programs in States across the Nation.
  These are soldiers who don't have a base to come home to. They come 
home to small towns all over the country. The idea here is to bring 
them in to meet with their commanders again, to see if they have a job, 
to see if they have the right health care, to see if they have their 
education benefits set. That is the idea with Beyond the Yellow Ribbon.
  When the 1,300 Minnesota National Guard soldiers return home early 
next year, they and their families need the funding in place in this 
bill in order to resume civilian life. Any delay makes it harder for 
commanders to have the necessary resources in place.
  When our brave soldiers signed up to fight for us, there wasn't a 
waiting line. When they come home to the United States of America, 
there shouldn't be a waiting line. When they need health care, when 
they need their education or they need a job, there shouldn't be a 
waiting line. When they signed up to fight, there wasn't a delay, and 
there shouldn't be a delay in Washington, DC, when it comes to funding 
for our troops.
  I urge my colleagues on the other side of the aisle to support this 
bill and get this voted on as soon as possible--in fact, immediately.
  I yield the floor.
  The ACTING PRESIDENT pro tempore. The Senator from Tennessee.
  Mr. CORKER. Mr. President, I agree with my friend and colleague from 
Minnesota, there shouldn't be a delay in funding our troops. I do find 
odd the urgency of the bill that has come to us a week before 
Christmas, something we passed out of here months ago.
  I know that history has shown and certainly the Members who are part 
of the Republican side of the aisle have shown constantly that we care 
deeply about our troops and want to make sure they are funded. But the 
fact that this bill has come up at this time just demonstrates the 
tremendous hypocrisy with regard to what is happening as this sausage 
is being made in the majority leader's office on this health care bill.
  The reason I speak to that is this is must-pass legislation. The 
Senator from Minnesota--as we all do--wants to see this passed. And all 
of us know this will pass. But I want to point out that in this bill, 
there is $1.2 billion in money to go to physicians so that their pay 
will not be cut.
  What this bill does is just point out again the tremendous fallacies 
of the process taking place beyond the ultimate passage of this bill, 
and that is the health care bill we have been discussing now for months 
and months. The fact is, we are taking $464 billion out of Medicare if 
this bill passes and we are using that money to leverage a whole new 
entitlement program. The fact is, we are not dealing with the physician 
pay cuts, which we all know are looming. We all know there is $250 
billion worth of cuts that will take place in physician pay over the 
next 10 years. We know this bill does not deal with that. Yet, somehow 
or other, on this Defense appropriations bill, we are dealing with that 
for a few months because everybody in the world who can wake up and put 
one foot in front of the other knows that right after this health care 
bill passes, in the name of being budget neutral--again, using all the 
gimmicks the Senator from Maine just talked about a minute ago; using 6 
years' worth of cost and 10 years' worth of revenue; taking money from 
an insolvent program to create another program that will become 
insolvent over time--what it doesn't deal with is the SGR and the doc 
fix.
  So what will happen is the majority leader, the chairman of the 
Finance Committee will come forth with a bill--right after this passes, 
I am sure, ironically--and pass another $250 billion or try to pass 
another $250 billion piece of legislation, unpaid for, just so that we 
can say--so that you can say--so that they can say that, in fact, a 
piece of health care legislation passed that was budget neutral.
  Mr. President, I have to tell you, I came from a world where we 
focused more on results, and the process really wasn't much a part of 
it. But in this body, with 100 Senators and 435 House Members on the 
other side of the building, process matters some. It matters because it 
really keeps each of us feeling, hopefully, if we have the right 
process, that there is integrity in what is happening.
  I think between the way this body and my friends on the other side of 
the aisle have used the CBO office and 6 years' worth of cost and 10 
years' worth of revenues and all this to make it look as if this bill 
is budget neutral, yet knowing we haven't dealt with this very 
important aspect, it points to one part of this process. The fact that 
in the morning the majority leader is going to lay down about a 300-
page amendment--one I haven't seen yet--that a few people working in 
close quarters developed--and I don't know if the Acting President pro 
tempore has seen this piece of legislation--and then he will file 
cloture on an amendment with 300 pages worth of changes, which I 
understand are going to be fairly important changes, without our having 
the ability to amend this legislation, to me, is pretty incredible. 
This is an important piece of legislation. It is going to affect every 
American in this country.
  I was talking with some of my colleagues earlier today--and I know 
the Senator from South Dakota has been very concerned about the 
provisions of this bill--and Senator Thune pointed

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out the other day, as the Senator from Maine did, about the taxes that 
start in 2 weeks and the benefits starting in 4 years, mostly. I know 
there are some benefits that start on the front end. But what my 
friends on the other side of the aisle were saying is that once this 
bill passes, that is just the beginning. There will have to be multiple 
changes over the next 4 years to actually cause this bill to work. This 
points to the fact that this is about a political victory.
  I guess I would ask my friend from South Dakota, if we were going to 
pass a landmark piece of legislation and do so in a way that would 
stand the test of time, wouldn't you think we would vote on more than 
seven amendments? Wouldn't you think we would actually debate the bill 
in a real way and try to work out these difficulties in advance?
  Again, just a few hours ago, my friends were telling me we are just 
going to try to pass this thing, then we are going to try to fix it 
over the next 4 years before all these problems hit Americans 
throughout our country, because what we are really doing on the front 
end is just collecting a lot of money. That is what we are doing to 
make this budget neutral. And then the real changes to the health care 
system take effect over time. We know we have problems, but we will fix 
those down the road. That is not exactly a process that I think passes 
muster with most people back home.
  Mr. THUNE. Mr. President, would the Senator yield?
  Mr. CORKER. I would love to hear from the Senator from South Dakota 
as to what he thinks about this type of process.
  Mr. THUNE. If I might, through the Chair, Mr. President, ask a 
question of the Senator from Tennessee, if he will yield, because he is 
absolutely right. This is being rushed. This is a massive reordering 
and restructuring of one-sixth of our economy, which we are going to be 
expected to vote upon in just a few days, on a managers' amendment 
which will be the so-called latest deal struck behind closed doors, as 
the Senator mentioned. We are going to be expected to vote upon that 
without having seen it today. In fact, I don't think any of our 
colleagues on the other side, or very few of them, have seen it, nor 
have the American people.
  I have listened as the other side has gotten up here today with all 
these statements of outrage and that it is insulting, it is 
unconscionable that this side would be holding up funding for the 
troops, and what strikes me about that is the deadline for passing the 
appropriations bills is September 30. I think that feigned outrage is 
all about a bigger, grand sort of cynical plan at work here to try to 
push this health care bill through.
  But would the Senator from Tennessee be able to answer a question 
regarding this. The Defense appropriations bill passed the House last 
summer. It passed the Senate in October, I think October 6. So we are 
talking 8, 9, 10 weeks ago now. Clearly, the Democratic majority's 
clock management is either very bad or this was part of some big, grand 
plan to push this thing to the very end and to jam this thing through, 
to try to set it up so that the health care bill could be passed right 
before the Christmas holiday without the American people having had an 
opportunity to see it, and the Defense appropriations bill, which 
carries a bunch of other unrelated items, would pass as well.
  Does it seem a little odd and coincidental to the Senator from 
Tennessee that you would be debating the Defense appropriations bill 
right now when it could have been done weeks ago, if not months ago? In 
fact, these bills are supposed to be done by September 30, which is the 
end of the fiscal year.
  Mr. CORKER. I do think it is odd. As my colleague knows, I think the 
two of us--all three of us on the Senate floor on our side of the aisle 
signed a letter to the Appropriations Committee and to the leader of 
the Senate asking that these be taken up one at a time so we would be 
finished with this work by the time the fiscal year ended. So it is 
ironic.
  Let me tell you the purpose, in my opinion. I certainly do not know 
all the inner workings of what is happening on this floor in the 
Senate. But this is sort of a filibuster. In other words, there is a 
segment where we discuss this must-pass piece of legislation, where 
some things can be added in that have not been dealt with that are 
unrelated--unrelated to defense but also 1,720 earmarks, many of which 
are mighty suspect. But this is a filibuster, in my opinion, where 
during this period of time we can be drafting, or the majority leader 
can be drafting what I would call the ``bad actors amendment.''
  What I mean by that is, if you have had opposition to the health care 
bill, which is the real issue we are going to be dealing with over the 
next few days, if you have had some trouble with the bill, then you can 
go in and get some niceties.
  For instance, I am sure if I decided I was going to support this 
bill, the health care bill--which I am not--I am sure there are all 
kinds of things that might spring up in Tennessee as a part of this 
health care legislation to make it so that the bill was more suitable, 
if you will, to the people of Tennessee and to me myself. My guess is 
this managers' amendment is going to be quite interesting to read. I 
look forward to seeing the details because my guess is it not only will 
fix technical issues, but my guess is it will also fix some wants and 
needs of some people who might otherwise have difficulty supporting 
this legislation. So, yes, I think this Defense appropriations bill--
give it a little time for this to germinate. We will have a chance to 
see that tomorrow for the first time when cloture is filed on it--as I 
understand, no debate, no amendments. I think it is a shame the Senate 
has gotten to the point where this is the type of process that is in 
place.
  I understand my time may be up. If not, I would love to yield to the 
Senator from South Dakota.
  The PRESIDING OFFICER. The time for the Republicans has expired.
  The Senator from Pennsylvania is recognized.
  Mr. SPECTER. Mr. President, I have sought recognition to comment 
briefly on the proceedings in the Senate in the last few days. I call 
upon my fellow Senators to reconsider the tactics which are being used 
to defeat the pending legislation. This body prides itself on being the 
world's greatest deliberative body. But that designation has been 
destroyed with what has occurred in the last several days.
  We have seen a filibuster on the Defense appropriations bill. We are 
at war, and we have 68,000 young men and women in Afghanistan today who 
are giving life and limb for this country. We are debating whether they 
ought to be funded. I have heard the question raised by those in the 
military: Doesn't the Congress support the troops?
  The impact on morale is potentially devastating when the Senate is 
not moving ahead to provide the funding, the money to support their 
efforts. I have no hesitancy in extolling their virtues at the highest 
level of patriotism. I wouldn't want to make any comment about a 
corollary negative, as to what is going on in this body. But it is 
hardly in the spirit of patriotism that we are asking these young men 
and women to be in harm's way and to give life and limb.
  We have seen procedures involved on the reading of the amendments.
  Rule 15 does provide for reading: Amendments shall be reduced to 
writing, read, copies deposited on the desks of the majority leader and 
the minority leader before being debated.
  Those are the purposes involved. But there is no intent in the rules 
of the Senate to have hours spent reading an amendment for dilatory 
purposes. The intent of the rule and the spirit of the rule is to 
inform people but not to have this body paralyzed by this kind of 
conduct.
  We have passed the point of civility. We have passed the point of 
decency in the way this body is being conducted. I call upon my 
colleagues to reconsider these tactics and to try to move ahead and do 
the people's business. The American people are perplexed, mystified--it 
is hard to find words strong enough on what the public reaction is. The 
public opinion polls show that approval ratings are plummeting--
plummeting. People have no confidence on what is happening in this 
body, no understanding as to what is going on, and they see partisan 
political gridlock of the worst sort in the time since my election in 
1980, and from my conversations with those who have been in this body a 
good bit longer and from my own study of the history of the Senate.

[[Page S13447]]

  I urge my fellow Senators to reconsider these kinds of tactics and to 
try to get on with the people's business because that is why we are 
here.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Massachusetts is recognized.
  Mr. KERRY. Mr. President, I thank the Senator from Pennsylvania for 
his comments. I associate myself with them and appreciate what he just 
said.
  We find ourselves in a remarkable situation, where, frankly, there is 
an extraordinary amount of distortion and fakery taking place on the 
floor of the Senate. There is a great strategy of deception which the 
Republicans have engaged in and in which they continue to engage, 
claiming they are being left out of the process; claiming we ought to 
go back and start over; claiming they haven't been included; claiming 
they do not know what is going on. We are where we are today after a 
year and a half of effort in this initiative specifically--years and 
years beyond that if you want to go back to Teddy Roosevelt and Harry 
Truman and every President since then.
  But right now we have a specific effort going. We began in the 
Finance Committee a year and a half ago, the summer of a year ago, 
where we assembled over at the Library of Congress, and we had an 
entire day during which time we had Republicans and Democrats. We 
listened as a committee to experts from across the country about how to 
do health care.
  Subsequent to that we began hearings, constant hearings. And then at 
the beginning of this year, 11 months ago, we began what we hoped would 
be a bipartisan process. No chairman in the 25 years I have been here 
and working here has ever reached out as much as I watched Chairman Max 
Baucus reach out in an effort to try to get a bipartisan effort. How 
many Senators from the other side came to the table? For the entire 
summer, 3 months were taken up with the so-called Gang of 6, 6 
Senators--3 Republicans and 3 Democrats.
  Unfortunately, several of the Republicans have already walked away 
because they didn't like something that 60 Members of the Senate might 
want to do. So they walked away. The Senator from Utah is one. He was 
part of those early negotiations. Then he said: I am not going to 
do this.

  In the end, the Senator from Colorado, Senator Enzi, and Senator 
Grassley, the Senator from Iowa, walked away. And Senator Snowe, to her 
credit, has stayed at the table, worked hard with people, and continues 
to try to have a dialog about what it might need or not need. But 
somehow they come here with the notion that they have a right to 
dictate what is in the bill that 60 Senators might think otherwise 
about, and because they just cannot get their way on the big picture, 
they are even willing to try to block the funding for the troops in 
Afghanistan and Iraq. That is just stunning to me.
  I learned full well firsthand what it is like to be fighting in a war 
when people back home are not supporting it. I vowed when I came back 
that would never be a mistake we might make again. We might disagree 
with the war, but we would never confuse the war with the warriors, the 
people fighting it.
  In fact, these folks don't care, the folks on the other side. They 
are willing to just hold it hostage, do anything they can--not just to 
defeat health care because they don't like it because it is different 
philosophically from how they would approach it.
  Incidentally, they opposed Medicare. I hope America hears this. This 
is the party over here that opposed Medicare when it was put in. They 
opposed Medicaid. They do not believe in that. They run around talking 
about the ills and dangers of a government program for health care. 
Which of them has brought an amendment to the floor ever or a bill to 
the floor to say: Stop Medicare, end it? They never do that.
  It is a government program. How many of them want to take away 
veterans health care, a government program? They never do that. But 
they come to the floor and they jumbo mumbo the words around on the 
floor and confuse America and make everybody believe this bill is 
somehow what it is not. These are tried and true tactics. In a lot of 
places you call it demagoguery.
  They have come here relying on crude but effective emotionally laden 
buzz words, tried and tested in focus groups, funded with millions of 
dollars. Where do the millions of dollars come from? They come from the 
people who want the status quo. Fourteen thousand people a day in 
America lose their health insurance. Where is their plan to put those 
14,000 people back on the rolls? They don't have one. But we do; we do. 
That is what we are here to do.
  There is so much good in this bill. Is it perfect? Of course it is 
not perfect. I will talk about that in a minute. But it is 
extraordinary to me that the folks who oppose it philosophically--they 
are never going to change. They keep talking about let's go back and 
start over. Going back and starting over to them means let's write the 
bill the way we want it even though there are only 40 of us and 
literally to hell with the rest of you 60 who represent the majority of 
the country. That is their idea of going back to the beginning.
  It is not going back to the beginning and coming up with a 
constructive way to approach it because they had that chance. All year 
long they had that chance. All they want to do is beat President Barack 
Obama. That is their theory.
  I was here in 1994. Unfortunately it has some potency out there. You 
make the institution look bad, make the entire Congress look bad, and 
then the voters will say: O, my God, who is running it? Oh, it is those 
guys. We better go to the other guys now. Just make it look bad because 
people will not discern who is really responsible.
  Let me be very clear. We are trying to move this forward. We have 
tried and tried, again and again, to reach out in a bipartisan way 
which requires compromise. Some people have come to the Senate in 
modern times with a new definition of compromise. Their definition is 
``do it my way,'' not meet you halfway, not give in to what a majority 
might believe they have a right to say is a fundamental bedrock 
principle of the way they want to approach a particular piece of 
legislation.
  Here we are with some of our folks now on our side of the fence 
actually being emboldened by the comments they hear that distort the 
bill on the other side, to say: Oh, you guys better throw it in. Don't 
vote for it.
  Yesterday we heard a person I admire and like and have become a good 
friend of, Howard Dean, who worked his heart out in 2004 to try to win, 
and then worked his heart out in 2008 to help elect this President.
  Yesterday he wrote something which, incidentally, had some errors in 
fact about what was included and not included in the bill. But he said 
yesterday:

       Let's kill the bill and start over.

  As another person whose work I greatly admire because I think he 
holds things accountable, Keith Olbermann said Wednesday night:

       This is not health, this is not care, this is certainly not 
     reform.

  I respectfully--and I mean that--respectfully disagree with both of 
them. I don't think they fully evaluated what is in this bill and what 
it accomplishes for America, nor fully evaluated the realities of what 
it would mean if you said kill it and start over. There is no President 
who is going to step up in the next few years if we don't make 
progress. There is no Senator who is going to invest in a process after 
this, if we don't make this reform work now.
  If you follow that kind of advice and give up now because this bill 
isn't everything you want it to be individually, then the very reforms 
people have spent their life working for, reforms that the Democratic 
Party has been proposing for decades that are in this bill, many of us 
ran on them and said: This is why we want to come to Washington to 
accomplish this--they would be destroyed. That would be it. It would be 
gone. What a mistake that would be.
  The fact is, there are things I wanted that are not in this bill. I 
am a passionate supporter of a public option. Do you know what our 
public option was in this bill? Our public option, ultimately, in this 
bill required the people who take part in it to carry the option with 
their premiums, not very different from a regular plan, except that it 
wasn't for profit. It had no public money to support it, and it 
wouldn't allow public money to come in and bail it out. It had to abide 
by the actuarial

[[Page S13448]]

values and rules of the marketplace, the way private insurance 
companies do. But it just wouldn't have shareholders and a for-profit 
structure. It could drive competition in order to have those companies 
that we all know have not stepped up when it comes to making sure that 
they are there for the patients. Why? Because if you are for profit and 
you are one of these insurance companies answerable to Wall Street and 
your shareholders, your principal concern is to drive that profit. So 
what do they do? They hold onto the money until the last minute because 
they get the float in the market. As long as the money is in your 
coffers, then you are working the interest on it or you have it to use 
for your company. If you pay out at the last moment, you make more 
money. If you pay less than you have to pay, you make more money. If 
you cut people off, which they would do all the time, you make more 
money. If you tell people who bought their insurance, who thought they 
had the insurance: Sorry, we don't have that insurance for you because 
of a little clause down here that you didn't read, too bad for you, but 
you don't have the insurance, even though you have stage 4 cancer and 
you have two kids and you are a divorced parent, too bad for you, you 
don't have insurance. They do that because then they make more money. 
These are real stories. You can find thousands of them across America. 
How else do you lose 14,000 people a day who lose the insurance they 
thought they had or wanted?
  This wasn't easy for Franklin Roosevelt when he tried to do it. It 
wasn't easy for Harry Truman when he tried to do it. It wasn't easy for 
Bill Clinton when he tried to do it. Some of us were here and tried 
with him. We understand how difficult it is. But you don't sound 
retreat. You don't ignore history and say: We are going to be better 
off by giving in to 40 people who are trying to destroy a Presidency 
and simply can't stand the fact that there are 60 votes here and there 
is a President who has an agenda to fix things. So the best thing they 
can do is try and stand and stop it.
  Some of our progressive friends have said because it doesn't have the 
public option, we ought to do that. Even though it doesn't have a 
public option, the bill encourages the creation of more not-for-profit 
insurers, which I will say a little more about in a minute, that have 
the ability to drive costs and increase competition. We don't have that 
today. Is that not worth fighting for on the Senate floor and putting 
into this bill?
  Again, my friend, Howard Dean, wrote in the Washington Post that real 
health care reform needed this public option to ``give all Americans a 
meaningful choice of coverage.''
  I happen to know this because he and I spent some time combating each 
other for the Presidency. In 1993, Howard Dean said of Medicare:

       One of the worst Federal programs ever and a living 
     advertisement for why the Federal Government should never 
     administer a national health care program.

  That shift of opinion on something as important as this leaves me 
asking whether they have analyzed, all these folks, the level of reform 
in this bill.
  We need to step back and see the forest for the trees of what this 
legislation does. I believe this legislation, even though it doesn't 
have the public option I want--and there are a lot of other things it 
doesn't do that could make the bill more effective--I believe when you 
take the totality of this bill and measure it against the problems we 
have in America today in delivery of health care and you look at the 
ways in which this bill increases coverage for seniors, provides lower 
cost drugs for seniors, expands the number of people who will be able 
to afford health care, helps to promote any number of individual 
reforms, almost every single idea that is worth considering that has 
been put forward by any think tank or any group in America is in this 
legislation in an effort to do what we call bending the cost curve--a 
terrible phrase, a Washington phrase.
  It just means lower the cost increase in health care. Bring it down 
so it is reasonable with respect to what people can afford in relation 
to the rate of increase of inflation and other costs in our lives.
  The Senate bill that is attracting all this trumped up, completely 
inapplicable but effective politics of destruction, this Senate bill, 
in fact, provides a provision that will allow the States to establish 
health care coverage for people between 133 percent and 200 percent of 
poverty. It allows States, not the Federal Government telling them what 
to do, no government from Washington, as everybody is trying to pretend 
this does, it doesn't tell the States what to do, but it allows the 
States to contract directly with plans that provide insurance. It 
allows those States to have the authority. This is States rights. This 
is the party that always talked about States rights. We are empowering 
Governors, we are empowering States individually to have the right to 
negotiate the premiums, the cost sharing, and the benefits for their 
citizens.
  Something else the Senate bill does. It provides $6 billion in 
startup funding under the Consumer Operated and Oriented Plan, CO-OP 
program. This money fosters the creation of a new nonprofit member-run 
health insurance that offers coverage in the individual and small group 
markets. Those are the markets where the costs have gone up most 
rapidly and where Americans have the hardest time surviving.
  I just came back from Boston. A fellow came up to me, an unemployed 
pilot, at the airport and talked to me about the $1,100 a month he pays 
for his family premium and how it was killing them. It goes up 20 
percent a year. It is the market that is squeezing most Americans out. 
We lower those costs. We dampen down that increase, and we make it more 
affordable for people who are at the lowest end of the income scale, 
who deserve to buy insurance, deserve to have insurance. We make it 
more accessible to them and affordable for them.
  The press has reported that one of the options being considered in 
the managers' amendment is the creation of the Office of Personnel 
Management-administered plan. That is a plan administered by the 
Federal Government that would offer individuals an option to get a 
national nonprofit plan. I would say to Keith Olbermann and Howard 
Dean, take a look at this. Look at the OPM-managed and co-op-managed 
plans that actually provide a not-for-profit option at the Federal 
level.
  When I ran for President, I proposed allowing everyone to have access 
to the same health care coverage offered to Federal employees and to 
Members of Congress. Ask any American, do you think you should have 
access to the same health insurance that the Members of Congress 
give themselves? They will say yes. That is exactly what we do. We give 
Americans the option of participating in a plan administered by the 
same entity that administers the health insurance for Members of 
Congress. I think leveraging the role of OPM to encourage creation of a 
national nonprofit plan is a key way to lower health care costs and to 
roll more Americans into plans that devote a higher premium portion of 
dollars to medical dollars.

  Some of our progressive friends have also said we ought to kill this 
bill because it has an age-rated premium. They want us to kill this 
bill because it has an age-rated premium. I don't like age-rated 
premiums. It would be wonderful to get rid of them altogether. An age-
rated premium is a premium, let's say for a lot of young people, 
because young people are healthier. When an insurance company looks at 
the young person, they say the odds of that young person having high 
blood pressure, any number of other diseases that seniors tend to have 
more because they are older, is less, therefore, we ought to charge 
those people less and we are going to charge the seniors a whole bunch 
more because they are much more likely to be a lot sicker, and it costs 
the system more. That does make sense to some degree. But the whole 
theory of insurance is to spread the risk of being sick among 
everybody.
  Those young people are going to be old people one day--not a bad idea 
that they are going to be able to pay an affordable premium for good 
health care when they are older too. So maybe there is a sharing across 
the board. That is how you do your home insurance. That is how you do 
car insurance. It is spread across the entire population of users and 
risks that are within those user fields. Although there is some 
allocation, even in automobile insurance, we all understand, for age 
ratings and the likelihood that if you are young and a new driver, you 
may have

[[Page S13449]]

an accident, more prone, and we have some deferential there, as we do 
in this bill.
  People who are criticizing this bill ought to stop and take a look at 
what it does. Insurance companies are going to be prohibited from 
denying coverage or charging more because of a preexisting condition. 
How many people in America complain: I can't get insurance. They turned 
me down because, once upon a time, I had this or I had cancer 4 years 
ago, but now I am cured but they won't give me insurance because they 
think it may come back and I am going to be sick later on. That is what 
insurance is for. But companies have been allowed to say no. This bill 
will prohibit companies from denying insurance to people because they 
have a preexisting condition.
  I introduced the Women's Health Insurance Fairness Act, which 
prevents insurers in the individual market from charging women higher 
premiums than men. That is what has been happening all this time. I am 
happy to say that in this legislation, in our bill, we prohibit 
discrimination in those premium increases for women. Insurance 
companies will also be prohibited from dropping coverage once someone 
becomes seriously ill, and they are going to be required to renew your 
coverage each year. Why would Americans across the board not say: Wow, 
you guys are going to protect me so I can't be kicked off. You are 
going to guarantee that I can buy it, even though I had a preexisting 
condition. That sounds pretty reasonable to me.
  Our colleagues don't come to the floor and talk about that. They just 
use a lot of scare tactics, pretending they don't know what is in the 
bill. They know what is in this bill because we did it in the HELP 
Committee, and we did it in the Finance Committee, and we have been 
doing it for 11 months. So insurance companies are going to be 
prohibited from providing a lifetime cap or an unreasonable annual 
limit on coverage. That sounds pretty reasonable to me.

  Now, I also wish the bill would include an age rating so that 
insurance could not charge older Americans more. I hope older Americans 
are listening to this carefully because the fact is, the Senate bill 
imposes a 3-to-1 limit on age rating, i.e. the rating charged seniors 
is restricted to three times the level of premium that is charged to a 
young person.
  A lot of people are going to react: Oh my God, you mean I am going to 
pay three times more than a young person? That doesn't sound fair to 
me. Guess what. When it began in the bill, it was 5 to 1. Under current 
state, premiums can be 25 to 1. There are States that charge 25 to 1, 
20 to 1, 15 to 1. That is the way it is today. That is what seniors 
face today without this bill.
  Guess what. In this bill, in the Finance Committee, we knocked it 
down from 5 to 1 to 4 to 1, and then, in the merged bill, we knocked it 
down to 3 to 1. In the House bill, it is 2 to 1. I ask a simple 
question: Is 3 to 1 or 2 to 1 better than 25 to 1 or 20 to 1? That is 
what is in this bill. This limits the age rating disparity in America. 
I offered an amendment to try to limit it to 2 to 1, but we were not 
able to carry that in the committee. Republicans spoke out against 
imposing a cap age rated premiums.
  Charging older Americans nearly three times as much for health 
insurance is by no means ideal. I know that. But, boy, when you look 
around the country, the majority of States have no rating structure in 
the individual market at all, and there is a huge rate disparity, as I 
described, in the small group market. So you have no rating restraints. 
So we get down, at least, to 3 to 1. The House is at 2 to 1. Today, in 
most places in America, there are no restraints, nothing--zero--for the 
individual market, and there are high rating bands, as I said, of 20, 
25 percent for the small group market.
  Let me give you an example for Kentucky. We have a couple Senators 
from Kentucky on the Republican side. The rate bands in the small group 
market in Kentucky are as high as 25 to 1. I guess that is OK with them 
because they do not want this bill.
  In Utah, the rate bands in the small group market can be as high as 
34 to 1. I guess that is OK with them.
  As I said, the 3 to 1 is too high, but, boy, is it a vast improvement 
over current law.
  Some of our friends have said we should kill this bill because the 
exchanges are not strong enough. Well, I have been working on the 
exchanges with about 70 different groups in America ranging from 
seniors' representatives, union representatives, small business, and 
other representatives, all of whom are concerned about the exchanges 
being strong. I am pleased to say those who claim the exchanges in this 
Senate bill are not strong enough have not read the bill. You do not 
have to get past the first 200 pages in this bill to see how the 
exchanges have been strengthened.
  In the Finance Committee, I offered an amendment to allow State 
exchanges to engage in prudent, selective purchasing of insurance. 
Under my proposal, exchanges would negotiate with plans for lower bids, 
encourage plans to form select networks, and exclude plans that did not 
offer good cost and good value.
  The Senate bill we are looking at now provides exchanges with strong 
authority to certify whether a plan can participate in the exchange 
based on a number of criteria, including whether the plans meet certain 
marketing requirements, whether it has broad provider networks, whether 
they deliver quality benefits for the price. They can literally 
negotiate for all of those things. You do not have that today. You just 
have plans, and you have no control over what is in them.
  So we actually create an exchange that can negotiate down the prices. 
And they have the power to approve the participation of plans if they 
are determined to be in the best interests of qualified individuals and 
qualified employers in the State.
  I have advocated for these provisions because of a simple reason. In 
Massachusetts today we have this ability. We do this, and it has driven 
down the premiums. In Massachusetts, we have something called the 
Connector. In fact, the exchange that is in this bill is significantly 
based on the Connector in Massachusetts. In that, the Connector has the 
ability to negotiate contracts for what is called Commonwealth Care, 
and it has placed pressure on the carriers to reduce the rates overall. 
We have had this in place for 3 years now. The average premium 
increases have been only 4.7 percent compared to 8 percent average 
premium increases for private insurance.
  The language in the Senate bill is modeled after the strength of the 
exchanges in Massachusetts, and I believe it will ensure that taxpayer 
dollars are spent in a smart way. That is what this does. It guarantees 
you can go negotiate for lower premiums, so you are driving down the 
cost to the taxpayers.
  This bill also will ensure that all Americans have access to quality, 
affordable health care and will create the transformation within the 
health care system necessary to contain costs. The Congressional Budget 
Office has determined that it is fully paid for--fully paid for--and it 
is going to provide coverage to more than 94 percent of all Americans. 
Even as it does that, it stays under the $900 billion limit President 
Obama established. It reduces the costs of health care in America, and 
it reduces the deficit over the next 10 years and beyond.
  I cannot think of how few the times were over the course of 25 years 
where we had a piece of legislation that accomplished a social goal 
that managed to simultaneously lower the deficit. That is an enormous 
accomplishment.
  This bill includes immediate changes to the way health insurance 
companies do business to protect consumers from discriminatory 
practices, and it provides Americans with better preventive coverage--
something we do not do enough of in America. We spend an amazing amount 
of time in our health care system just responding to symptoms, 
addressing disease, hospitalizing people with expensive procedures. A 
classic example of that is diabetes because we do not screen people. 
Because a lot of Americans do not have coverage, they do not get 
screened at an early stage. Therefore, when they are discovered to have 
diabetes, it becomes a far more acute treatment as a consequence of 
having gone all those years without the discovery. So you wind up with 
expensive alternatives, such as the amputation of limbs, dialysis, 
instead of having treated them earlier with oral intake of a pill or 
other treatments, diet, and other kinds of things that ultimately would 
save billions.

[[Page S13450]]

  Well, this bill tries to encourage the embrace of better coverage for 
prevention and wellness. It empowers people in America. It does not 
say, in Washington: You have to do this or that. It is not command and 
control. It puts information at the disposal of Americans, so every 
American can decide what they want, where they want to go get it, who 
will treat them. That fundamental principle of American health care is 
absolutely, totally preserved and sacrosanct in this bill. Every 
American can choose their own doctor, choose their own plan. No one is 
told to go do this or go do that.
  Uninsured Americans with a preexisting condition can have access to 
an immediate insurance program and help them avoid medical bankruptcy. 
One of the huge bankruptcy causes in America is health care. How many 
seniors have had the situation where they have had to spend down by 
selling their homes, selling--if they are lucky enough to have any 
stocks--whatever assets they have, sell the family farm, sell the small 
business because they are very ill and they do not have the money, the 
kids do not have the money? But they hope to leave that money to their 
kids. They hope to leave something to their children. Instead, we just 
wipe it out because we do not provide a lot of those folks with the 
insurance they deserve.
  The new health insurance exchanges will make coverage affordable and 
accessible for individuals and small businesses. Premium tax credits 
and cost-sharing assistance is going to help people who need 
assistance. Insurance companies are going to be barred from 
discriminating based on preexisting conditions, health status, and 
gender.
  The bill also improves the quality and efficiency of health care 
itself. As the Presiding Officer knows, we are strengthening the 
Medicare Program for America's seniors. I cannot believe the distortion 
that has been taking place over the course of these last weeks, months. 
Time and again, someone on the other side of the aisle will come to the 
floor and say this is attacking Medicare or this is going to tax the 
benefits.
  Well, we believe--we, the party that created Medicare; we, the party 
that expanded Medicare; we, the party that has lifted a huge percentage 
of Americans out of poverty over the last 50, 60 years through 
Medicare--that it is a sacred trust, and we are going to keep it. This 
bill helps, in fact, to extend the life of Medicare. The cost of 
inaction is unacceptable for seniors and the Medicare Program that 
serves them. In fact, the Medicare hospital trust fund, as we know, is 
expected to go broke in over 7 years. This bill makes Medicare 
stronger. It makes it more sustainable. It extends the solvency by 9 
years.
  Medicare currently reimburses health care providers on the basis of 
the volume of care they provide rather than the value of the care they 
provide. For each test, scan, or procedure conducted, Medicare provides 
a separate payment. So we do that regardless of whether that was 
necessary or whether it had anything to do with the outcome for that 
particular patient. That does not make a lot of sense. We do not pay 
people to build our home the wrong way, or to build something we did 
not ask for and charge us more, or a whole bunch of other kinds of 
examples. But Medicare is doing that.
  I think Americans deserve to get something better out of their 
taxpayer dollar. This bill includes a number of proposals to move away 
from what we call the ``a la carte'' Medicare fee-for-service system so 
that we begin to pay for quality and value, and that reduces costs to 
America's seniors.
  This bill promotes, as I said, preventive care and improves the 
public health to help Americans live healthier lives and to help 
restrain the growth of health care costs over time. It, importantly, 
eliminates copays and deductibles for recommended preventive care, and 
it provides individuals with information they need to be able to make 
good decisions about their health care and improves education on 
disease prevention, public health, and invests in a national prevention 
and public health strategy. It does all of that. All of those things 
just put to shame the idea of just scrapping this legislation.
  Currently, 65 million Americans live in communities where they cannot 
access a primary care provider. An additional 16,500 practitioners are 
required to meet their needs. If you scrap this, that number is going 
to go up, and the number of millions--65 million today--of Americans 
who do not have access to a primary care provider is going to go up.
  This bill addresses the shortages in primary care in other areas of 
practice by making necessary investments in the Nation's health care 
workforce.

  Specifically, this bill will invest in the National Health Service 
Corps, scholarship and loan repayment programs. It will expand the 
health care workforce. The bill includes incentives for primary care 
practitioners and for providers to serve underserved areas.
  Don't listen to me on the transformational changes. Listen to a 
fellow by the name of Jon Gruber, who is a very respected and renowned 
economist from MIT, and here is what he writes:

       The United States stands on the verge of the most 
     significant change to our health care system since the 1965 
     introduction of Medicare. The bill that was passed by the 
     House and the parallel bill before the Senate would cover 
     most uninsured Americans, saving thousands of lives each year 
     and putting an end to our status as the only developed 
     country that places so many of its citizens at risk for 
     medical bankruptcy. Moreover, the bill would accomplish this 
     while reducing the Federal deficit over the next decade and 
     beyond. They would reform insurance markets, lower 
     administrative costs, increase people's insurance choices, 
     and provide ``insurance for the insured'' by disallowing 
     medical underwriting and the exclusion of preexisting 
     conditions. The Senate bill in particular would move us 
     closer to taming the uncontrolled increase in health care 
     spending that threatens to bankrupt our society.

  That is what this bill does. That is what the Republicans are 
opposing.
  These aren't minor things. These are things we have been striving to 
accomplish here for decades. I see colleagues who were here with me 
back when we struggled with the Clinton administration's effort on 
health care and every one of us would have been more than happy back 
then to have accepted--right then and there, we would have accepted 
what we have here today. I will tell you something: We would have had 
Republicans, such as Senator John Chafee, and I think Bob Packwood and 
others at that time, who would have tried to get a compromise passed, 
not totally dissimilar from the direction we are moving in here, and it 
was totally rejected by the Clinton administration.
  So now is the time to examine what we have promised our people and 
decide where we stand. We know where the other side stands when they 
say ``let's begin over,'' pretending to America there is some place to 
begin over here. They have engaged in fear-mongering and deliberate 
misinformation. Those have been the core of the arguments they have 
used, fundamentally, to stop the success of President Obama.
  They are also continuing now, obviously, to use procedural tactics, 
chewing up the Senate's time. The week before Christmas: Boy, let's see 
if we can back this right up and make it look as bad as possible and 
try to make the Congress look as bad as possible; make them fold. So 
they use this idea, and they are willing to block the funding for our 
troops so we can go on with this delay. We could have voted today, but 
they have said no.
  There is no reason to do this. I think there is a snow storm coming 
to Washington. I suspect they are hoping the snow will prevent some 
Senator from getting here and then they won't be able to vote, because 
normal decency would have said, Hey, why don't we convenience everybody 
and have the vote before the snowstorm, but no. So they link it to 
blocking the money for the troops. I hate to think what some of those 
troops think is going on here. It is embarrassing.
  We have heard repeatedly from Republicans that our health care reform 
bill is going to drive insurance premiums sky high for families. That 
is what they say, but the Congressional Budget Office says the 
opposite. It says that the 134 million Americans who get their 
insurance through their employer would end up paying 3 percent less for 
their premiums if we passed the reform measure before us. In addition, 
the CBO says the subsidies included in the measure would result in a 
59-percent reduction in costs for nearly 18 million Americans who 
purchase their own insurance--a 59-percent reduction for a

[[Page S13451]]

lot of Americans out there who buy their insurance individually. You 
don't think they want a 59-percent reduction? And despite the fact that 
the CBO says there is a 59-percent reduction, they continually come out 
here and tell people otherwise. Because one of the things we have 
learned in American politics is that if you throw the mud out there, 
throw the lie out there, throw the distortion out there enough, enough 
people will hear it and they won't know the difference.
  Health care reform has dramatically reduced the premiums in 
Massachusetts. Premiums fell by 40 percent. We are not here 
conjecturing as to what is going to happen. This isn't some pie-in-the-
sky theory that if we do this, here is what is going to happen. We have 
done it. In Massachusetts, we are insuring over 97 percent of all of 
our citizens, the highest level of insurance in the United States of 
America. Guess what. The number of companies participating in the 
program has gone up since it was passed, and they like it. The premiums 
fell by 40 percent, from $8,537 at the end of 2006 to $5,143 in mid 
2009, while the rest of the Nation saw a 14-percent increase. So in 
Massachusetts, premiums go down for the individual market by 40 
percent; the rest of the Nation they go up 14 percent. What do you 
think most Americans would rather have, the 40-percent reduction or the 
14-percent increase? Our bill gives Americans the opportunity to 
experience the same success we have enjoyed in Massachusetts.
  We have also heard repeatedly from Republicans that this bill will 
add billions of dollars to the Federal budget deficit, despite the fact 
that the CBO analysis concludes that the bill is not going to add one 
dime to the Federal deficit--not one dime. From the very beginning of 
this debate, our colleagues on the other side of the aisle have tried 
to make the case that seniors' Medicare benefits--benefits--are 
jeopardized by our reform measure. Well, it is patently false, but we 
keep hearing it. It gets repeated again and again no matter how many 
times it has been shown to be false. The bill before us, in fact, does 
exactly the opposite. It actually adds benefits for seniors.
  For example, there are new screening benefits. The bill shrinks the 
so-called doughnut hole in the Medicare prescription drug benefit. When 
we passed the prescription drug benefit, millions of seniors had a 
large gap in coverage. In 2009 seniors will experience a $3,454 
coverage gap. Even though they must continue to pay their monthly 
premium, they will receive no assistance with their drugs costs between 
$2700 and $6,154. That is a lot of money out of pocket for seniors. 
Well, we have reached an agreement where now that will be closed, and 
no longer will those seniors be out of pocket for the costs of drugs in 
the middle of that bracket.
  In addition, the nonpartisan National Committee to Preserve Social 
Security and Medicare sent a letter to every Senator a few days ago. 
The Republicans and Democrats alike got this letter, but it hasn't 
stopped them from continuing to make the argument, but here is what the 
argument says: Not a single penny in the Senate bill will come out of 
the pockets of beneficiaries in the traditional Medicare Program. In 
fact, the letter adds that our reforms: ``will positively impact 
millions of Medicare beneficiaries by slowing the rate of increases and 
out-of-pocket costs and improving benefits, and it will extend the 
solvency of the Medicare trust fund by 5 years.''
  To me, and to I think all of my colleagues here on our side of the 
aisle, that is a win-win for seniors, and it is a win-win for the 
Medicare Program.
  Since sending that letter, the CMS actuary released a report saying 
that the solvency of the Medicare trust fund would be extended by 9 
years as a result of the Senate bill. So it has been interesting to 
watch Republicans speak about protecting Medicare, as I said earlier, a 
program that their party has opposed since the very beginning. While 
claiming to be trying to protect Medicare, they have simultaneously 
warned us many times about the evils of a government-run program. 
Again, I would ask, if they are so opposed to a government-run program, 
why don't they come to the floor with an amendment or a proposal to do 
away with Medicare? They won't, of course, because Medicare prevents 
millions of seniors from falling into poverty due to health care costs.
  They also always promote the idea that competition is good for the 
marketplace, yet they adamantly oppose adding an option that could help 
provide some of that competition. President Obama said it clearly, that 
a public plan would help keep the private plans honest. I couldn't 
agree more.

  Like some of our friends, some of our progressive friends, the 
Republicans have argued again and again about starting over. Let me 
remind my colleagues about one of the greatest legislators of the 
Senate's attitude about that, and one of the greatest champions of 
health care. Ted Kennedy fought for health care from the day he came 
here. One of his early speeches on the Senate floor was about health 
care. He often said that the biggest political mistake that he 
personally made in the 46 years he legislated was turning down a health 
care deal with Richard Nixon in 1971 that for the first time would have 
required all companies to provide a health plan for their employees, 
with Federal subsidies for low-income workers. That is how far the 
Republican Party has drifted from one of their own Presidents who, most 
people would agree, despite what happened in terms of what cost him the 
presidency, that he was a strong and capable President with respect to 
social policy in America.
  The fact is that for the first time, all companies would have been 
required to cover their employees. That is the plan Richard Nixon 
offered Ted Kennedy and Ted Kennedy made the mistake of turning it 
down. He backed away from that deal under heavy pressure from fellow 
Democrats who wanted to hold out for a single-payer system once the 
party recaptured the White House in the wake of the Watergate scandal.
  Well, 38 years have passed and single payer is still out of reach; 
not even on the table. Some people want to give up what we have 
available to us here and repeat that greatest mistake.
  The lesson Teddy learned is this: that when it comes to historic 
breakthroughs in America, especially in social policies, you make the 
best deal you can and then immediately start pushing for ways to 
improve the deal.
  Let me share a quick story with my colleagues. We all remember how 
Ted Kennedy on the floor of the Senate kept pushing and pushing to 
raise the minimum wage, which hadn't been raised in years. Finally, he 
pushed so hard that Robert Dole, who was then the majority leader and 
who was then running for President, decided he couldn't run for 
President while Ted Kennedy was pushing that hard, tying up the Senate, 
to get the legislation passed. It might raise people just a little bit; 
it wouldn't even get them up to par. Robert Dole resigned from the 
Senate to go run for President. He said, Ted Kennedy doesn't run the 
world, but he did.
  Trent Lott came in. Senator Lott from Mississippi became the majority 
leader. He vowed the same thing. He said: This isn't going to happen. 
Within months, within months, Senator Kennedy was doing the same thing 
again, pushing for the rise in the minimum wage. Senator Lott acceded 
to him. We got the minimum wage passed. And at a rally where he was 
celebrating the rise of the minimum wage, which was then not even up to 
par, he was in the victory moment and he turned to Congressman George 
Miller and he said: I am introducing a bill to raise the minimum wage. 
George Miller said, What do you mean? We haven't even let the dust 
settle. He said, We have to move on this.
  That is what is going to happen with this bill. We all know there are 
things we are going to have to watch, there are things we are going to 
have to do, things we are going to have to improve, things that aren't 
in it that we want to get in it. But to pass up the opportunity for all 
of the things I have talked about and listed would be an enormous--an 
enormous--mistake.
  Since 1965, when Medicare and Medicaid were created, they have 
involved and improved over the years.
  When Medicare first passed, it didn't cover individuals with 
disabilities or individuals with end-stage renal disease. Now it does. 
Similarly, Medicaid evolved to allow States to cover additional 
services such as home- and community-based care. Now, both Medicare and 
Medicaid are indispensable elements of the social contract of the 
United States.

[[Page S13452]]

  Our march to this point has been too long and too slow--almost a 
century, in fact. It began in 1912 when Teddy Roosevelt ran for 
President promising government protection against, as he put it, ``the 
hazards of sickness.'' There have been fits and starts ever since--
through the shouting and distortions and big interests clinging to the 
status quo, and we cannot allow that to continue any longer.
  We know the legislative process is a long one. But 97 years is way 
too long for America to finally join the other major industrialized 
nations in guaranteeing health care for all of our people. That we are 
here today, with an opportunity to take a giant step, shows not only 
what a challenge this undertaking has been, but it shows what hard 
work, skill, and dedication a lot of Senators have shown trying to get 
us here.
  I particularly applaud the effort of Senator Reid, who personally has 
sacrificed the effort to help move this, and the entire leadership, 
including Senator Baucus, chairman of the Finance Committee, and 
Senator Dodd, of the HELP Committee, who was carrying that load for 
Senator Kennedy. Tom Harkin is now doing that job, and he and Barbara 
Mikulski and Jeff Bingaman were central to shaping what is coming to 
the floor.
  Hundreds of Republican amendments were accepted during that process. 
Senator Baucus considered hundreds of amendments on the Republican 
side. The bill is not perfect. Tell me what bill is. All of us would 
like to change it here and there, but none of us can credibly claim we 
didn't get a chance to have input to this bill.
  Make no mistake, this legislation, with cooperation and 
bipartisanship, can make history and improve the lives of Americans for 
decades to come, and that is important to this country and to our 
economy. It can help change who we are as a country. Ninety-four 
percent of Americans will have health care. Just think of that. If we 
do nothing, things are only going to get worse--more expense, more 
bankruptcies, and more people without coverage.
  I can't help but think how often we have private conversations around 
here at the Prayer Breakfast, at the National Prayer Breakfast, at the 
Senate Prayer Breakfast, and in private conversations about what the 
duties and obligations are of good adherence to most of the organized 
religions of the world and certainly most of the philosophies of the 
world. They all embrace a component of the Golden Rule. You can go to 
any Scripture and you can read about one person's human responsibility 
to another human. These kinds of opportunities to live up to those 
guidelines, these values, don't come very often. Many of us here saw 
that pass in 1993. We learned a lot of tough lessons then.
  I say to my progressive friends in this country, after that, we did a 
little better with the Children's Health Insurance Program, and we did 
better with portability and little pieces here and there. But still the 
system is out of whack and gets more expensive, and still more 
Americans lose their health insurance. Still, we wind up with 
institutionalized unfairness.
  I remind my colleagues of when Ted Kennedy worked on the Children's 
Health Insurance Program. Do you know who the minority cosponsor was? 
It was Orrin Hatch. He said that passing it was the mark of a 
compassionate, caring Congress. We still have millions of kids who are 
not covered by health insurance.
  Compassion can be the mark of this Congress, if we act with respect, 
courage, and with cooperation. I don't think we can stop now. I don't 
think there is any object but to get this job done after all these 
years.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from New Jersey is recognized.
  Mr. MENENDEZ. Mr. President, my distinguished colleague from 
Massachusetts has been talking about the urgency and the importance of 
this legislation, and he has done so masterfully. We have been debating 
health care for weeks. We have been debating it for months if you think 
about the markup that took place in the HELP Committee, as well as in 
the Senate Finance Committee. We have been debating it even more if you 
consider the times of negotiation that took place between a group of 
six Members of the Senate--three Democrats and three Republicans--in 
search of a bipartisan effort. So all of this talk that this is a rush 
to judgment doesn't square itself with the facts.
  But there is another bill that is pending before the Senate, a bill 
that should have passed without any difficulty.
  Mr. President, the tactics of delay and obstruction we have seen on 
this floor for the last few weeks on the part of the minority have now 
reached critical mass. We are fighting two wars. It is nice to be home. 
It is nice to be home for the holidays. It is nice to be here in the 
comfort of the Senate. It is nice to be able to see your family. But we 
are fighting two wars abroad. We have work to do for the American 
people, and these continued unnecessary delays from the Republican side 
of the aisle are now impacting our military men and women on the ground 
in Iraq and Afghanistan. These delays come at a time when we are seeing 
greater success in Iraq, a time when we are more focused on wiping out 
al-Qaida along the Afghanistan-Pakistan border.
  Our colleagues on the other side of the aisle are engaged not in 
governing, not in the bipartisanship they claim to embrace, but in pure 
politics--a political game that does not threaten the majority, does 
not benefit the minority; what it does is threaten the health, safety, 
and in some cases the lives of military men and women in harm's way.
  Never have so few been asked to sacrifice so much on behalf of their 
country. Never have a relatively small group of Americans in uniform, 
in harm's way, been asked to sacrifice so much, with multiple tours of 
duty, while the rest of America enjoys security at home because of 
their sacrifice. You would think that our friends on the other side of 
the aisle would want to join expeditiously to make sure that their pay, 
their health care, and the equipment they need would be there as 
quickly as possible.
  Our friends on the other side of the aisle have determined that their 
only strategy is to bring the work of the Senate to a halt--to diminish 
the effectiveness of the Senate they serve in an effort to diminish the 
majority. It is a shame, but our Republican colleagues have come to 
their view as a political tactic, the road to electoral victory next 
year in the midterm elections of 2010 and then preparing themselves 
already for the Presidential election of 2012, wanting this President 
to fail and this Congress to fail. If you looked at it as a political 
tactic, you might say, well, as a political tactic it might make sense 
for them.
  It is a horrid political tactic because it is not about this 
President failing. It is not about this Congress failing. It is about 
the failure for the country in one of its most precarious moments.
  This President inherited the worst economy since the Great 
Depression, and I don't think people understand how close to the abyss 
we were from facing a real depression once again in our history. 
Financial institutions were collapsing, and we cared but not for the 
sake of them as big institutions but what they would have meant to the 
economy as a whole. There was a free-fall in the housing market and the 
reality of two wars raging abroad, which he inherited, in Iraq and 
Afghanistan. There is a nuclear North Korea and nuclear-thirsty Iran, 
an energy policy that sends $1 trillion to countries that are despotic 
and wish us ill. Ultimately, we give them the money to act out on their 
despotism. This is what this President inherited.
  Instead of working with him, our colleagues on the other side of the 
aisle have determined that the politics of failure will lead them to 
electoral victory, and that is more important than the future of the 
country. They have come to the floor of the Senate to say no to 
everything--first, health care, and now to providing for our troops in 
harm's way. They have come armed with an arsenal of parliamentary 
maneuvers--not to govern or do what is best for the American people, 
not to do what is best for the Senate, but to do what is politically 
expedient for them.
  Diminishing the Senate's ability to pass the Defense appropriations 
as well as health care reform in order to score political points--and 
then call it victory--is an insult to the American people. It flies in 
the face of what our Founders intended of a true representative 
democracy--not to tear down the

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institutions of government and bring them to a halt but to make them 
work for the people.
  Sam Rayburn once said:

       A jackass can kick a barn door down, but it takes a 
     carpenter to build one.

  My friends on the other side of the aisle seem intent on kicking the 
barn door down. In my view, that is not victory. Doing nothing, 
delaying, obfuscating, saying no, no to everything, blocking the 
ability of this Chamber to fulfill its duty to the people is no 
victory.
  Saying no to funding our troops serving bravely overseas in Iraq and 
Afghanistan is hardly victory. Delaying it is hardly victory. Saying no 
to funding medical care for our military men and women and their 
families is not a victory; it is shameful delay of needed care. Saying 
no to $120 million for traumatic brain injury and psychological health 
research at a time when so many of our troops are coming home from Iraq 
and Afghanistan with such injuries is by no means a victory. Saying no 
to necessary funding to train and equip Afghan security forces so they 
can stand up for their own country and get our people out is contrary 
to the President's surge policy, which our friends on the other side 
publicly supported.
  Imagine if the tables were turned and it were the Democrats delaying 
funding for mine resistant vehicles to protect our troops in Iraq and 
Afghanistan. What would our friends on the other side say then? Imagine 
if it were this side of the aisle delaying passage of $636 billion for 
the military, including $128 billion in funding for contingency 
operations in Iraq and Afghanistan. Imagine if it were this side of the 
aisle delaying $154 billion to increase readiness and training of our 
troops. Imagine if it were this side of the aisle delaying funding for 
Bradley Fighting Vehicles, Stryker Combat Vehicles, and three E-2D 
Hawkeye aircraft. Imagine if it were this side of the aisle delaying 
all of this critical equipment. Imagine if Democrats were standing in 
the way of funding military health care for service men and women and 
their children. This is all included in the Defense appropriations 
bill. But that is what our Republican friends on the other side are 
doing. Imagine if the Democrats were holding up needed assistance in 
health coverage for Americans who lost their jobs and are unemployed in 
this economy at this time of the year. That is included in the bill as 
well. But that is what our friends on the other side are doing. What 
would our colleagues on the other side say of our patriotism if we on 
this side were delaying funding for our troops?
  Patriotism doesn't shift with the political tides. It is not 
something used to advance a political agenda because if it is, it is 
not patriotism.
  We can disagree on the issues. We can disagree on substance. We can 
hold opposing views. That is what happens in a democracy. But there is 
no victory in diminishing the functions of government, the 
responsibilities of government, the duties of this Chamber for 
calculated political gain. There is no victory in holding up extending 
desperately needed unemployment benefits included in this bill. There 
is no victory in blocking the extension of COBRA health insurance 
subsidies in this bill for people who have lost their job, their health 
care, and may be in danger of losing everything--everything--they have 
worked for, especially at this time of the year.
  As I think about this time of the year, it is not a stretch to look 
at the delaying tactics of our friends on the other side of the aisle 
on this legislation and think of that famous Christmas movie, ``A 
Christmas Carol,'' and think of Ebenezer Scrooge who, when asked for a 
contribution to those who were in need, replied: What, are there no 
poor houses?
  Our colleagues on the other side are holding so tightly to their 
tactics that they are forgetting the very democratic values they 
profess so fiercely to protect.
  I urge my colleagues on the other side to see victory not in delay 
and obstruction but in doing what is right for the American people. Do 
what is right for our military men and women who will spend this 
holiday season in Iraq and Afghanistan in harm's way.
  I say if the tables were turned, my colleagues on the other side 
would come to this floor, wave the flag, proclaim themselves the only 
true patriots and vilify this side of the aisle as un-American, 
unpatriotic, undemocratic.
  The fact is, we are all patriots, and as patriots, though, we have a 
job to do. That job is to make sure our men and women have everything 
they need, even when we disagree as to whether it is an appropriate 
engagement. Once they are engaged, it is our responsibility to ensure 
they are appropriately taken care of.
  The tactics of delay for political advantage can never--never--be 
accepted. I urge my colleagues: Do not play politics with the Defense 
appropriations that includes funding necessary to protect our men and 
women in uniform. Let's not play politics at the expense of unemployed 
Americans in need in this economy at this time of the year. It is not 
time for those debates. Those debates should be behind us. And it is 
not time for the political tactics that, in essence, put people at 
risk.
  There are many other ways to try to achieve political victory. You 
can do it with the power of your ideas, but you certainly do not have 
to do it by a political tactic that puts the country in jeopardy, that 
puts our men and women in jeopardy, that at the end of the day says we 
would rather see failure than success so we can win an election. That 
is not acceptable.
  I yield the floor.
  Mr. JOHNSON. Mr. President, I rise today to recognize the momentum 
propelling us forward in the health care reform debate.
  Today, one-sixth of our economy is consumed by health care. In the 
absence of reform, the Congressional Budget Office projects total 
health care spending to consume an ever greater share of our economy, 
up to 30 percent by 2035. What should we expect in return for the 
staggering amount of money our nation spends on health? Shouldn't one-
sixth of our economy buy us health care for every American? I believe 
that it can. Not only will the Senate health care reform proposal 
extend access to health insurance to 30 million Americans, but it will 
reduce health spending in the long run. This is vital to the future of 
our economy and our continued competitiveness in the international 
community.
  We may be at the global forefront of medical innovation, but we 
remain the only industrialized nation to not guarantee each of its 
citizens access to basic health care. Americans are being priced out of 
our private health care market at alarming rates. Health care premiums 
have risen 98 percent since 2000 and continue to rise four times faster 
than wages. In South Dakota, where incomes are lower than in most other 
States, families making $50,000 per year can expect to pay on average 
10 percent of their income for a policy on the individual market. And 
this share will only grow if we fail to reform the system.
  Families and small businesses are faltering under the weight of 
increasing health care costs and medical bankruptcies. A 2005 study 
linking medical bills to bankruptcy found that even brief lapses in 
coverage, such as during a job change, expose individuals to 
significant risk. I have heard from far too many South Dakotans forced 
into bankruptcy due to a health emergency. I would like to share one of 
those specific stories with my colleagues. Mary had just started a job 
when she was diagnosed with breast cancer. Her new policy required a 3-
month waiting period before coverage began, but cancer treatment could 
not be postponed. She frequently traveled over 50 miles to the nearest 
facility for radiation, chemotherapy and follow-up appointments, but 
often went without necessary care because she could not afford it. Her 
brief lapse in coverage left her with thousands of dollars in out-of-
pocket medical bills and, after 2 years of garnished wages, she was 
ultimately forced into bankruptcy.
  Her problems didn't end there. The aggressive radiation and 
chemotherapy treatment for her breast cancer has caused her other 
health problems. She now requires dental care to address her weakened 
tooth enamel, but can't afford to pay out-of-pocket and doesn't qualify 
for low-income public programs. At one point, this woman was securely 
employed and carried health insurance, but misfortune left her in 
financial ruin and with poor health. Like millions of underinsured 
Americans,

[[Page S13454]]

she discovered the inadequacies of our health care system the moment 
she needed it most.
  Most insured Americans have a false sense of security and don't 
realize that many health insurance policies prove inadequate in the 
face of serious illness. The Patient Protection and Affordable Care Act 
holds health insurance companies accountable, creates competition and 
provides assistance to those who need help buying insurance. As the end 
of the year approaches, we stand on the brink of passing historic 
legislation. Never before have we been this close to reforming our 
health care system in such a positive way. I urge my colleagues to 
seize this opportunity to provide all American with the security of 
health insurance through all of life's transitions.
  Mr. INHOFE. Mr. President, we may be quickly approaching the end of 
this health care debate in the Senate. It has been a partisan event. 
Republican amendments have consistently failed roughly along party 
lines. However, I don't want to overlook some of my Democratic 
colleagues who have voted with us on a number of the Republican offered 
amendments. However, I want to focus my remarks on the half a trillion 
dollar increase in taxes this health care bill imposes on individuals, 
families, and businesses. I would also like to focus my remarks on one 
of the 471 amendments filed to this bill highlighting the new taxes on 
assistive medical devices under this bill.
  President Obama repeatedly promised during his campaign that no one 
making under $250,000 per year would see their taxes increase. However, 
the Democrats plan to spend $2.5 trillion in new healthcare promises at 
a time when the country can't afford the promises we have already made 
and we have a record 1-year budget deficit of $1.4 trillion. This 
health care reform bill, currently under consideration in the Senate, 
raises revenues to a large extent on the backs of middle class 
Americans despite Obama's pledge--his firm pledge--that this would not 
happen.
  Reading through the legislation, I am struck by the myriad of ways 
this bill raises taxes on American citizens, from job-creating small 
businesses to middle class families. I count about a dozen of them, 
adding up to about $500 billion in tax increases over the next few 
years. Half a trillion dollars in new taxes. So everyone should get 
ready to pay a higher health care bill and a higher tax bill should 
this measure become law. I mentioned the tax increases in this 
legislation last week, but I believe it bears repeating and I plan to 
specifically point out a tax increase in this bill I find particularly 
objectionable.
  First let me remind the Senate and the American people that when the 
bill is fully enacted, the nonpartisan Joint Committee on Taxation, 
JCT, found that, on average, individuals making over $50,000 and 
families making over $75,000 would see their taxes go up in this bill. 
Let me repeat that: if you make over $50,000 as an individual or 
$75,000 as a family, your taxes are going up under this bill. Indeed, 
according to the JCT 42 million middle class families and individuals, 
those making less than $200,000, on average will pay higher taxes in 
this bill.
  If you have health insurance, you get taxed. According to the 
nonpartisan Congressional Budget Office, new excise taxes applied to 
health insurance providers will end up taxing the beneficiaries. This 
tax also has the effect of increasing premiums as well. So you are 
double taxed on this deal. That is if you do have health insurance.
  If you don't have health insurance, you get taxed. Under the bill, 
you get taxed if you don't carry health insurance as a penalty. Where 
does this burden fall? You guessed it, middle class Americans. CBO has 
said that half of the Americans affected by this provision make between 
$22,800 and $68,400--for a family of four.
  If you take prescription drugs, you get taxed. According to JCT and 
CBO, new taxes in this bill applied to the provision of prescription 
drugs will end up raising the cost of those drugs. Taxed again.
  So those are some examples of what you can do to pay higher taxes 
under this bill: have health insurance, don't have it, take 
prescription drugs. All of these activities are taxed mercilessly under 
this legislation. There is yet another tax provision that I find 
extremely detrimental and objectionable. If you happen to need a 
medical device, you get taxed. Section 9009 imposes a new $2 billion a 
year tax on assistive devices which includes items like pacemakers, 
ventilators, prosthetics, hearing aids, glucose monitors for diabetics, 
and incubators for premature babies. It has no regard for the age or 
status of the individual requiring the device. It's totally 
indiscriminate. I have filed an amendment that will exempt assistive 
devices for individuals with disabilities from this tax. It is 
amendment No. 3053.
  Let's look at some of the individuals impacted by this $2 billion a 
year tax.
  My son-in-law, Brad Swan, installs pacemakers and defibrillators. One 
morning last week, at 1 a.m., he was called to an emergency involving 
an 8-year-old boy with no heartbeat. He was born with congenital heart 
disease, had a pacemaker put in, and was healthy that morning. My older 
sister, Marilyn, faced a similar situation 9 years ago and is alive and 
healthy today. Additionally, Dr. Stanley DeFehr, a cardiologist in my 
hometown of Tulsa, explained to me that ``the decision of who needs a 
pacemaker could be complicated, particularly the decisions to put in a 
pacemaker on someone we might consider quite elderly. But it's a false 
economy to deny putting one in because of their risk of falling and 
breaking a hip or shoulder. In the case where they fall, the costs 
become quite high. The cost of a pacemaker ($5,000, lasting 10 years) 
pales in comparison to the cost of a stroke or multiple fractures.''
  Let's look at the impact this tax will have on our servicemen and 
women.
  We all remember when Congress passed the Wounded Warriors Act as part 
of the Fiscal Year 2008 National Defense Reauthorization Act, which 
required the Department of Defense and Veterans Administration to 
jointly develop a comprehensive policy on improvements to care for our 
servicemembers. The bill created three Centers of Excellence in the 
prevention, diagnosis, mitigation, treatment, and rehabilitation of 
traumatic brain injury, post-traumatic stress disorder, PTSD, and eye 
injuries.
  The very next year, I successfully amended the Wounded Warriors Act 
in the Fiscal Year 2009 National Defense Reauthorization Act to expand 
the Center of Excellence care network in the Wounded Warriors Act to 
include amputations and traumatic extremity injuries. Eighty-two 
percent of injuries from the global war on terror involve the 
extremities, and are often severe, including multiple injuries to the 
arms, legs, head and neck.
  In fact, Congress has found, ``Extremity injuries are the number one 
battlefield injury. Dynamic research and treatment is necessary to 
provide servicemembers the greatest ability to recover from injuries 
sustained on the battlefield.'' When limbs cannot be saved, often these 
injuries are treated with the use of state of the art prosthetic 
devices enabling our service men and women in some part to regain the 
use of arms or legs lost from combat injuries.
  I have long supported the innovations in prosthetics and assistive 
devices for our Nation's service men and women. Today, there are nearly 
2 million Americans with limb loss. Prosthetic technologies developed 
for military medicine are almost universally dual-use, meaning the 
technology can be applied for civilian use as well. Much of this 
research is being done at the University of Oklahoma and by Oklahoma 
companies such as Hanger Prosthetics, Martin Bionics, and Sabolich 
Prosthetics. Oklahoma has a long, proud history of excellence in 
prosthetic care. For the past twenty-five years, persons who have lost 
limbs have traveled to Oklahoma from around the world to receive the 
finest in prosthetic care. Only this past October, I visited the 
Oklahoma City-based company, OrthoCare Innovations, which is developing 
a robotic prosthetic alignment system which builds on its prosthetic 
innovations.
  The Democrat health bill includes a tax on all assistive devices. In 
fact, to add insult to injury, the Democrat health bill contemplates 
the detrimental effect the bill may have on our veterans. Section 9011 
calls for a study on the impact of this tax on our veterans after the 
fact. However, a study after the damage is done is too little,

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too late. This is simply irresponsible and damaging for those veterans 
who need these devices.
  The Democrat agenda and this bill clearly include more taxes on 
Americans. The new taxes may be hidden but they are there. It is 
disingenuous. It is costly. This bill is expected to cost $2.5 trillion 
on top of our already exploding debt. This bill is exactly what America 
does not need, and that is why Americans oppose it. It is common sense.
  Mr. ENZI. Mr. President, I rise to express my concerns about the 
Fiscal Year 2010 Defense Appropriations Act which is currently pending 
before the Senate. I was one of the seven Members of the Senate to vote 
against our version of this bill in October and I regret that I must 
vote against it once again. This time it was also held to a time when 
they thought Christmas would force fast action even on things that 
don't belong on a defense bill that should have been last October.
  Congress has gotten into a bad habit of using our military funding 
bills as ``must pass'' legislation to get approval for other unrelated 
items. This year, the items are a number of extensions on legislation 
we were not able to finish as part of our regular business. The 
majority leadership wouldn't allow us to work together to get our job 
done so some are using a troop bill as cover. There are 13 sections 
attached to this bill that have nothing to do with our troops.
  Now folks might wonder why Congress attaches unrelated items to 
military bills. Because doing what is right is a difficult stand to 
take and say no to military funding. The majority party is hoping that 
enough Senators will want to avoid voting against military funding and 
be willing to take the bad or the unknown with the good.
  We are also now considering this defense bill not as a conference 
report that has gone through our regular process, but as a message 
between the House and Senate in order to avoid normal Senate 
procedures. The Senate has our rules and procedures for a reason. Our 
procedures are designed to allow Senators the opportunity to fully 
consider what legislation does and does not do. When Senate leaders 
avoid Senate rules and procedures, they dodge their responsibility to 
those who elected us.
  I want to make very clear my strong support for the members of our 
Armed Forces and the vital work they are doing around the world every 
day. My State of Wyoming currently has about 900 soldiers deployed with 
our National Guard in Iraq and Kuwait our largest deployment ever.
  I have the greatest admiration for all of them for their commitment 
to preserving our freedoms and maintaining our national security. They 
are all true heroes and they are the ones who are doing the heavy 
lifting and making great sacrifices in our country's name so that we 
might continue to be the land of the free and the home of the brave.
  I am extremely disappointed that our troops must continue to pay the 
price for political posturing in a must-pass military funding bill 
loaded with unrelated and unquestioned provisions.Do our troops at home 
and deployed need the funding for the programs in this legislation? Do 
they deserve better from their elected congressional representation 
than being used as cover to enact unrelated legislation? The answer is 
yes.
  Mr. LEVIN. Mr. President, I support the Department of Defense 
Appropriations Act for 2010.
  This legislation provides the funding our men and women in uniform 
need to continue their efforts on behalf of our Nation. The $128.3 
billion included in this bill to fund operations in Iraq and 
Afghanistan is an important statement of support for the troops who are 
serving so bravely so far from home.
  This bill also includes important measures that will help Michigan 
and other states weather the economic strain they now face.
  Most important of these are provisions that will extend unemployment 
benefits and Federal assistance to offset the costs of health insurance 
for those who have lost their jobs. Existing unemployment benefits are 
expected to expire at the end of this year. I am pleased that under 
this bill, benefits will be extended to February 28, 2010, making many 
Michiganders and other Americans eligible for expanded benefits that 
provide more support, and for a longer duration. This is crucial 
assistance to families coping with the devastation of job loss.
  In addition, the bill extends from nine to 15 months the American 
Recovery and Reinvestment Act's assistance to workers who have 
involuntarily lost their jobs to pay for health coverage under COBRA. 
That assistance pays up to 65 percent of workers' COBRA premiums. Under 
current law, workers who lose their jobs after December 31 would not be 
eligible for this assistance, but the bill extends that deadline to 
February 28, 2010, ensuring that thousands of Americans will not have 
to deal with the loss of health care at the same time they face the 
loss of a job.
  The legislation also would continue improvements in Small Business 
Administration loan programs, improvements enacted in the American 
Recovery and Reinvestment Act to make SBA loan guarantee programs more 
attractive to borrowers and lenders. Through February 28, 2010, the SBA 
would be able to continue offering guarantees up to 90 percent of loan 
amounts, and to continue waiving or reducing loan fees. Access to 
capital is among the biggest factors keeping companies from hiring, and 
continuing these measures is an important step toward boosting 
employment.
  This bill also includes provisions to ensure that the Supplemental 
Nutrition Assistance Program, SNAP, has the funding required to meet 
increasing demand, and to provide States with funding to process the 
growing number of applications for the program more quickly. And it 
will maintain 2009 poverty guidelines for Health and Human Services 
programs through February 28, 2010, preventing a loss of eligibility 
for many recipients of means-tested programs, including Medicaid, SNAP 
and child nutrition programs. These provisions will prevent the opening 
of holes in our social safety net just as Americans are most in need of 
support.
  These provisions are much needed to help blunt the impact of 
recession on America's workers as we work toward a brighter economic 
future.

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