[Congressional Record (Bound Edition), Volume 155 (2009), Part 18]
[Senate]
[Pages 24448-24472]
[From the U.S. Government Publishing Office, www.gpo.gov]




 COMMERCE, JUSTICE, SCIENCE, AND RELATED AGENCIES APPROPRIATIONS ACT, 
                            2010--Continued

  The PRESIDING OFFICER. The Senate will continue consideration of H.R. 
2847.


                           Motion to Recommit

  There will now be 2 minutes of debate, equally divided, prior to a 
vote on the motion offered by the Senator from Nevada, Mr. Ensign.
  The Senator from Nevada is recognized.
  Mr. ENSIGN. Madam President, this is a simple motion to recommit the 
bill to put it at last year's funding level, plus the money for the 
census. The census is once every 10 years, and it will allow for that 
funding increase.
  But in this era of record deficits and uncontrolled Washington 
spending, we are living under last year's spending levels with this 
motion. We need to get serious in this body about getting our spending 
under control. We have to start with appropriations bills. We know we 
have to cut spending on entitlements.
  Let's start now by living under last year's spending levels, instead 
of the large increases we are having on appropriations bill after 
appropriations bill.
  My motion allows the Appropriations Committee to determine what 
levels programs would be at, but we are not going to allow across-the-
board increases.
  The PRESIDING OFFICER. The Senator from Maryland is recognized.
  Ms. MIKULSKI. Madam President, I vigorously oppose the motion.
  First, the bill is consistent with the budget resolution and the CJS 
subcommittee 302(b) allocation.
  Second, the bill is a product of bipartisan cooperation reported out 
of the Appropriations Committee unanimously.
  Third, the consequences of cutting the CJS bill to 2009 levels by 
excluding the census would be devastating. If you take out the census 
and do a cut, guess whom you are cutting. First of all, you are cutting 
Federal law enforcement. If you think this is a simple resolution, tell 
that to the FBI. If you think it is simple, tell it to the marshals who 
are chasing sexual predators. If you think it is simple, tell it to the 
astronauts, who are waiting to make sure we put the money in the budget 
to keep them safe as they go into space.
  There is nothing simple about this motion to recommit. I simply ask 
you to reject the Ensign motion.
  Madam President, I ask for the yeas and nays.
  The PRESIDING OFFICER. Is this a sufficient second? There is a 
sufficient second.
  The question is on agreeing to the motion.
  The clerk will call the roll.
  The assistant legislative clerk called the roll.
  Mr. DURBIN. I announce that the Senator from West Virginia (Mr. Byrd) 
and the Senator from Massachusetts (Mr. Kerry) are necessarily absent.
  The result was announced--yeas 33, nays 65, as follows:

                      [Rollcall Vote No. 319 Leg.]

                                YEAS--33

     Barrasso
     Bayh
     Brownback
     Bunning
     Burr
     Chambliss
     Coburn
     Corker
     Cornyn
     Crapo
     DeMint
     Ensign
     Enzi
     Graham
     Grassley
     Gregg
     Hatch
     Hutchison
     Inhofe
     Isakson
     Johanns
     Kyl
     Lugar
     McCain
     McCaskill
     McConnell
     Risch
     Roberts
     Sessions
     Thune
     Vitter
     Voinovich
     Wicker

                                NAYS--65

     Akaka
     Alexander
     Baucus
     Begich
     Bennet
     Bennett
     Bingaman
     Bond
     Boxer
     Brown
     Burris
     Cantwell
     Cardin
     Carper
     Casey
     Cochran
     Collins
     Conrad
     Dodd
     Dorgan
     Durbin
     Feingold
     Feinstein
     Franken
     Gillibrand
     Hagan
     Harkin
     Inouye
     Johnson
     Kaufman
     Kirk
     Klobuchar
     Kohl
     Landrieu
     Lautenberg
     LeMieux
     Leahy
     Levin
     Lieberman
     Lincoln
     Menendez
     Merkley
     Mikulski
     Murkowski
     Murray
     Nelson (NE)
     Nelson (FL)
     Pryor
     Reed
     Reid
     Rockefeller
     Sanders
     Schumer
     Shaheen
     Shelby
     Snowe
     Specter
     Stabenow
     Tester
     Udall (CO)
     Udall (NM)
     Warner
     Webb
     Whitehouse
     Wyden

                             NOT VOTING--2

     Byrd
     Kerry
       
  The motion was rejected.
  Mr. LEAHY. Madam President, I move to reconsider the vote.
  Mr. REID. I move to lay that motion on the table.
  The motion to lay on the table was agreed to.


                  Unanimous Consent Request--H.R. 3548

  Mr. REID. Madam President, I ask unanimous consent that the Senate 
proceed to the immediate consideration of H.R. 3548, which was received 
from the House. I further ask unanimous consent that a Reid substitute 
amendment which is at the desk be agreed to; the bill, as amended, be 
read a third time and passed; the motion to reconsider be laid upon the 
table, with no intervening action or debate, and that any statements 
relating to the bill be printed in the Record.
  The PRESIDING OFFICER. Is there objection?
  Mr. KYL. Reserving the right to object.
  The PRESIDING OFFICER. The Senator from Arizona.
  Mr. KYL. Madam President, it is my understanding that we received 
this an hour and a half ago. I have no doubt at the appropriate time we 
will be able to work out some kind of agreement. But our side is going 
to need some time to look at it. We will need some Republican ideas or 
amendments as well, and we will need a CBO score.
  At this time, I will have to, on behalf of Members on our side, pose 
an objection.
  The PRESIDING OFFICER. Objection is heard.
  Mr. REID. Madam President, if I can just say--and I know others wish 
to speak on this issue--we have found a new stalling tactic. It is 
pretty new. It is CBO. Now I am sure everything is going to be ``CBO.'' 
I am sorry the consent request was not granted.
  The PRESIDING OFFICER. The Senator from Vermont.
  Mr. LEAHY. Madam President, I was going to call up an amendment, but 
I think the Senator from New Hampshire wishes to speak. I ask unanimous 
consent that the Senator from New Hampshire be recognized and I be 
recognized after her.
  Mr. REID. Madam President, if I may ask my friend, the chairman of 
the Finance Committee, does he wish to speak?
  Mr. BAUCUS. That is correct, 2 minutes.
  Mr. REID. Why don't we let the chairman of the Judiciary Committee go 
for 30 seconds to offer an amendment.
  I ask unanimous consent that Senator Baucus be recognized following 
Senator Leahy and then Senator Jack Reed.
  Mr. REID. And then Senator Shaheen.
  The PRESIDING OFFICER. Is there objection to the leader's request?
  Mr. GRAHAM. Reserving my right to object, and I don't intend to, I 
would advise my colleagues that somewhere in this line, I need a minute 
to call up an amendment I wish to have pending.
  Mr. REID. Why don't you do that--you will have a minute following 
Senator Leahy.
  The PRESIDING OFFICER. Without objection, the Senator from Vermont is 
recognized for 30 seconds.

[[Page 24449]]




                           Amendment No. 2642

  Mr. LEAHY. Madam President, I ask unanimous consent that the Senate 
set aside the pending business and call up my amendment at the desk, 
amendment No. 2642.
  The PRESIDING OFFICER. Without objection, it is so ordered. The clerk 
will report.
  The assistant legislative clerk read as follows:

       The Senator from Vermont [Mr. Leahy] proposes an amendment 
     numbered 2642.

  Mr. LEAHY. I ask unanimous consent that further reading of the 
amendment be dispensed with; and I ask unanimous consent that I be 
allowed to continue for 1 minute.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The amendment is as follows:

 (Purpose: To include nonprofit and volunteer ground and air ambulance 
        crew members and first responders for certain benefits)

       On page 170, between lines 19 and 20, insert the following:

     SEC. 220. BENEFITS FOR CERTAIN NONPROFIT EMERGENCY MEDICAL 
                   SERVICE PROVIDERS.

       (a) Short Title.--This section may be cited as the ``Dale 
     Long Emergency Medical Service Providers Protection Act''.
       (b) Eligibility.--Section 1204 of title I of the Omnibus 
     Crime Control and Safe Streets Act of 1968 (42 U.S.C. 3796b) 
     is amended--
       (1) in paragraph (7), by striking ``public employee member 
     of a rescue squad or ambulance crew;'' and inserting 
     ``employee or volunteer member of a rescue squad or ambulance 
     crew (including a ground or air ambulance service) that--
       ``(A) is a public agency; or
       ``(B) is (or is a part of) a nonprofit entity serving the 
     public that--
       ``(i) is officially authorized or licensed to engage in 
     rescue activity or to provide emergency medical services; and
       ``(ii) is officially designated as a pre-hospital emergency 
     medical response agency;''; and
       (2) in paragraph (9)--
       (A) in subparagraph (A), by striking ``as a chaplain'' and 
     all that follows through the semicolon, and inserting ``or as 
     a chaplain;'';
       (B) in subparagraph (B)(ii), by striking ``or'' after the 
     semicolon;
       (C) in subparagraph (C)(ii), by striking the period and 
     inserting ``; or''; and
       (D) by adding at the end the following:
       ``(D) a member of a rescue squad or ambulance crew who, as 
     authorized or licensed by law and by the applicable agency or 
     entity (and as designated by such agency or entity), is 
     engaging in rescue activity or in the provision of emergency 
     medical services.''.
       (c) Effective Date.--The amendments made by subsection (b) 
     shall apply only to injuries sustained on or after January 1, 
     2009.
       (d) Offset.--The total amount appropriated under the 
     heading ``salaries and expenses'' under the heading ``General 
     Administration'' under this title is reduced by $1,000,000.

  Mr. LEAHY. Madam President, more than three decades ago Congress 
created the Public Safety Officers Benefits Program at the Justice 
Department to provide assistance to the surviving families of police, 
firefighters, and medics who lose their lives or are disabled in the 
line of duty.
  The benefit, though, only applies to public safety officers employed 
by Federal, State, and local government entities.
  With volunteers providing emergency medical service to many 
communities all across the country, my amendment would remedy this gap 
in the P-S-O-B program by extending benefits to cover nonprofit EMS 
personnel who provide critical prehospital care.
  We have been working to address this gap in the Federal program for 
some time, and the tragic loss earlier this year of Dale Long--a 
decorated EMT from Bennington, VT--reminded everyone that first 
responders of many uniforms literally put their lives at risk every 
day.
  These brave emergency professionals never let their communities down 
when a call comes in, and no one ever asks the lifesavers at an 
emergency scene whether they work for the Federal government, a State 
government, a local government, or a nonprofit agency. My amendment 
will erase that unnecessary distinction from the P-S-O-B program.
  I would like to thank a number of first responder groups--including 
the American Ambulance Association, the International Association of 
Fire Fighters, the International Association of Fire Chiefs, and the 
Fraternal Order of Police--for their assistance on this matter. I also 
would note that this amendment is fully offset and cosponsored by 
Senator Sanders.
  I hope the Senate can move quickly to approve this amendment, and I 
yield the floor.
  The PRESIDING OFFICER. The Senator from South Carolina.


                           Amendment No. 2669

  Mr. GRAHAM. Madam President, I ask unanimous consent to set aside the 
pending amendment and call up amendment No. 2669.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The clerk will report.
  The assistant legislative clerk read as follows:

       The Senator from South Carolina [Mr. Graham], for himself, 
     Mr. McCain, and Mr. Lieberman, proposes an amendment numbered 
     2669.

  The PRESIDING OFFICER. Without objection, it is so ordered.
  The amendment is as follows:

 (Purpose: To prohibit the use of funds for the prosecution in Article 
    III courts of the United States of individuals involved in the 
                 September 11, 2001, terrorist attacks)

       At the appropriate place in title II, insert the following:
       Sec. __. (a) Prohibition on Use of Funds for Prosecution of 
     9/11 Terrorists in Article III Courts.--None of the funds 
     appropriated or otherwise made available for the Department 
     of Justice by this Act may be obligated or expended to 
     commence or continue the prosecution in an Article III court 
     of the United States of an individual suspected of planning, 
     authorizing, organizing, committing, or aiding the attacks on 
     the United States and its citizens that occurred on September 
     11, 2001.
       (b) Article III Court of the United States Defined.--In 
     this section, the term ``Article III court of the United 
     States'' means a court of the United States established under 
     Article III of the Constitution of the United States.

  Mr. INOUYE. Mr. President, the Senate is now considering the 8th of 
12 Appropriations bills reported by the Appropriations Committee this 
year, the fiscal year 2010 Commerce, Justice, and Science 
Appropriations bill.
  This bill includes total resources of $65.15 billion, an increase in 
funding of $7.2 billion above the fiscal year 2009 enacted level. While 
on first blush this level of funding may appear generous, Members need 
only to look at the accounts in this bill to understand the need for 
these additional funds.
  Specifically, fiscal year 2010 is the peak funding year for 
preparations for the constitutionally mandated decennial census. As a 
result, an additional $4.1 billion above the fiscal year 2009 omnibus 
enacted level is required for this account alone.
  The next largest increase is for science. On August 9, 2007, then-
President Bush signed into law the America Competes Act, legislation 
that moved through this Chamber with 69 cosponsors and passed the 
Senate by unanimous consent.
  That legislation called for the doubling of science, technology, 
engineering, and mathematics funding for the purpose of investing in 
scientific innovation and education to improve the competitiveness of 
the United States in the global economy.
  This bill includes an increase of $1.7 billion for NASA, NOAA and NSF 
science programs, all of which contribute to the goals of the America 
Competes Act and bolster our economic competitiveness.
  Finally, the bill provides for an increase of $580 million for the 
FBI which allows that agency to continue its efforts to fight both 
terrorism and violent crime in this country.
  Senators Mikulski and Shelby have worked diligently to offer a strong 
bipartisan bill that tackles the needs of law enforcement, supports 
scientific research in both space and in our oceans, and invests in 
scientific innovation and education. I applaud them for their hard work 
and bipartisan cooperation.
  As with the other seven bills that have come before the Senate for 
consideration to date, the committee supported their recommendations 
unanimously, and the bill was reported out of the Appropriations 
Committee on June 25 by a recorded vote of 30 to 0.
  This bill has been available for review by members for more than 3 
months, so if a Member has an amendment, they should be willing to come 
to the floor today and offer it. At this

[[Page 24450]]

point, it makes no sense for Members to delay.
  Vice Chairman Cochran and I, along with the other subcommittee chair 
and ranking members have worked diligently to restore regular order to 
the appropriations process. We have come a long way in responding to 
what was asked of us at the beginning of the year.
  But for us to succeed, it takes the cooperation of all Members of the 
Senate. Therefore, I strongly encourage my colleagues not to delay 
action on this bill.
  Mr. LEAHY. Mr. President, I am pleased to cosponsor today an 
amendment to require the antitrust division of the Department of 
Justice to carry out oversight, information-sharing, and joint 
activities concerning competition in the agriculture sector. Our 
Nation's antitrust laws exist to promote competition, which ensures 
that consumers will pay lower prices, and receive more choices of 
higher quality products. The Department of Justice is charged with 
enforcing these antitrust laws. Yet there are few industries in which 
there are more serious concerns about the state of competition than the 
agriculture sector. Small farmers are suffering because the prices they 
can charge for many of their products continues to decline, and the 
level of concentration throughout the industry could have a negative 
long-term impact on the prices that consumers pay and the choices they 
have.
  Since first coming to Washington, I have fought to help our family 
farmers by ensuring a level playing field in American agriculture. The 
consolidation in recent years throughout the agriculture sector has had 
a tremendous impact on the lives and livelihoods of American farmers. 
It affects producers of most commodities in virtually every region of 
the country, and in my home State of Vermont, it affects dairy farmers. 
Farmers need a fair opportunity to compete in the marketplace and we 
must prevent giants in corporate agriculture from repeatedly hurting 
them with unfair, discriminatory, deceptive, and anticompetitive 
practices.
  I held a field hearing last month in Vermont to assess competitive 
issues in the dairy industry. During that hearing, we heard from 
officials from the Department of Justice and the United States 
Department of Agriculture. We also received first hand testimony from 
farmers whose businesses are suffering at the hands of large 
distributors. This crisis is real, and the Department of Justice has 
pledged to take a renewed look at competitive issues in the agriculture 
sector as a whole. This amendment is another step to help ensure that 
competition exists in the agriculture sector.
  Mr. GRAHAM. Madam President, this amendment is simple, direct, and to 
the point. It would prohibit the use of funds for the Department of 
Justice to prosecute the perpetrators of 9/11 in article III courts.
  What does that mean? That means that Khalid Shaikh Mohammed, and 
people like him, who organized the attacks against our Nation on 
September 11, 2001, would be tried by military commissions, not Federal 
courts. They are not common criminals, they are war criminals. They 
should be tried in a military setting, like other people throughout the 
200-year history of this country have been tried regarding acts of war 
against the United States.
  The military commissions have been reformed. Thanks to Senator Levin 
and others, we have a great process that I would not mind our own 
soldiers being tried in. At the end of the day, we need not criminalize 
this war. There is a law of armed conflict awaiting the defendants that 
is fair and it is robust. It has adequate due process, but it 
recognizes we are at war. And military commissions have been used 
throughout the history of this country. They are better able to protect 
classified information.
  We need to be consistent. The people who planned the attacks of 9/11 
are not common criminals. They are people who have taken up arms 
against the Untied States, and they should be adjudged accordingly in a 
military tribunal, which I think we have now designed as the best in 
the world.
  There will be more to follow in this important debate.
  With that, I yield the floor.
  The PRESIDING OFFICER. The Senator from Montana.
  Mr. BAUCUS. Madam President, what is the parliamentary situation? 
What is pending?
  The PRESIDING OFFICER. The Graham amendment is pending to the CJS 
appropriations bill.


                    Unemployment Insurance Extension

  Mr. BAUCUS. I thank the Chair.
  Madam President, on another subject, I wish to say I am very 
distressed that the other side objected to a request by the majority 
leader to pass legislation offered by himself, by myself, and Senators 
Reed and Shaheen to extend unemployment insurance benefits.
  Our country faces very high unemployment rates nationwide. In some 
States, it is much worse than other States. It is only fair. It is the 
right thing to do for the U.S. Government to recognize those folks who 
don't have jobs--to help tide themselves over until they get a job--
with extension of unemployment insurance benefits.
  I think for every job that is available in the United States today 
there are about six applicants. There are too many people unemployed--
people seeking jobs who cannot get jobs. So the right thing to do, as 
we come out of this great recession, is to recognize those who are 
unemployed and help them tide things over to make sure they are 
compensated.
  The legislation we have introduced does that with 14 additional weeks 
for all States, and also would provide additional weeks for the hardest 
hit States--6 weeks of additional benefits for those States hardest 
hit, those States with the highest rates of unemployment. This 
unemployment rate we are facing is going to continue. It is not just a 
short-term phenomenon. There are estimates that we will see rates up to 
9.8 percent through most of even next year.
  I am very disheartened myself, but more so for the folks who are 
going to be denied benefits by the action taken by the Republican side 
to object to extending benefits to those folks who are in need of them. 
I am hopeful at a later point in time--very soon in fact; hopefully by 
next week--the other side will see fit to let this legislation pass 
because it is sorely needed. I urge my colleagues to vote for it when 
it does come up next week.
  The PRESIDING OFFICER. The Senator from New Hampshire.
  Mrs. SHAHEEN. Madam President, I rise today to add my voice to 
Senator Baucus in strong support of the Unemployment Compensation 
Extension Act. This bill, as the Senator said, is designed to help 
those families who are struggling in all 50 States by extending at 
least 14 weeks of unemployment benefits to workers across the country 
who are going to exhaust their benefits by the end of this year.
  I thank Majority Leader Reid and Chairman Baucus for bringing this 
bill to the floor, and the many Senators and staff who have worked so 
hard to get this done, particularly Senator Jack Reed, who is going to 
be speaking, Senators Chris Dodd and Amy Klobuchar.
  Through no fault of their own, many of those who lost their jobs 
months ago still cannot find work. Five million workers have been 
unemployed for more than 6 months. That is an all-time high, and it is 
why extending unemployment benefits in all 50 States is so important.
  When I am back in New Hampshire and meeting families trying to get 
by, one thing is very clear: People want to go back to work, but they 
face one of the weakest job markets since the Great Depression. Until 
that job market improves, we have a responsibility to help those 
workers pay their mortgages and keep food on the table.
  Another very important reason why we should support this, and why I 
am disappointed that our colleagues on the other side of the aisle have 
refused to come forward in support of this, is that extending 
unemployment benefits is a proven boost to our economy. Unemployment 
compensation is money that gets spent immediately on necessities.

[[Page 24451]]

People who are out of work need this money to help pay the rent, pay 
their mortgages, buy food, pay for gas. Extending unemployment benefits 
is one of the most effective actions we can take to help get this 
economy moving again, and I urge my colleagues to support this 
important extension and to quickly pass this critical legislation.
  Madam President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Rhode Island.
  Mr. REED. Madam President, I commend Leader Reid and Chairman Baucus 
for the work they have done to get this bill to the floor. I also 
commend Senator Shaheen for her valuable contribution to moving this 
forward.
  I am disappointed, to say the least, that we cannot move this 
legislation quickly. There are millions of Americans who are looking at 
the prospect of losing their unemployment compensation, others who have 
already lost it and, frankly, millions who may be working but, sadly, 
may qualify shortly for unemployment compensation.
  As my colleagues have pointed out, there are six job seekers for 
every job. This unemployment crisis will continue, and the least we can 
do is to provide people with some support while they look for jobs and 
try to maintain their families.
  One point I wish to make--which should be very clear--is that this 
legislation is fully paid for. This is not something that requires a 
CBO score in order to determine how it is used and what the cost will 
be and how it will be paid for. It is paid for by a continued extension 
of the FUTA surtax for a year and a half--through 2010 and the first 
six months of 2011. So this is responsible legislation as well as 
critically important legislation.
  Again, as my colleagues indicated, this legislation will provide an 
additional 14 weeks of unemployment insurance benefits throughout the 
country. But as we have done on numerous past occurrences, it will 
recognize that even though there is pain everywhere, the pain is not 
distributed equally. There are States, such as my home State, where the 
unemployment rate is extraordinarily high. It is a critical need in 
Rhode Island where the unemployment rate is nearly 13 percent. So for 
those States, there will be an additional 6 weeks, for a total of 20 
weeks, for all States with an unemployment rate of 8.5 percent or 
above.
  This has to be done quickly, because as we speak there are 5.4 
million Americans who have been unemployed for 6 months or more. There 
are signs that the economy may be recovering--credit markets, equity 
markets--but the unemployment markets still remain, unfortunately, in a 
deep decline. We are trying all we can do to reverse that, but in the 
interim we have to be able to give people a chance to simply get by, 
and that is what this does.
  We are poised to pass this, and this unnecessary delay is not only 
inappropriate but inexcusable. This is something that affects every 
State in the country and it affects people who have worked hard all 
their working lives and now face unemployment, many for the first time. 
The psychological shock is great. Add to that the financial reality 
that they can't pay their bills, they can't pay the mortgage, and that 
adds another problem which I think cries out for immediate action, not 
waiting for a score from CBO, not waiting to see if there is something 
ancillary to this that could be attached. This is a time and a moment 
to meet the needs of the American public, to do so responsibly--and we 
have because it is fully offset--and not to delay. I urge the speedy 
passage of this critical legislation. I hope Leader Reid will be 
prepared to make a UC the next time we are convened and that at that 
time this measure can be passed unanimously.
  Madam President, I yield the floor, and I suggest the absence of a 
quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. SCHUMER. Madam President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. SCHUMER. Madam President, I want to support the words of the 
Senator from New Hampshire and the Senator from Rhode Island about 
moving the unemployment insurance extension forward.
  We all know that joblessness is a tremendous problem in this country. 
We can argue about which States should get the unemployment benefits 
and for how much time, but if you are unemployed, your household is 100 
percent unemployed. It doesn't matter to you whether you are in a State 
where it is a 6-percent or a 9-percent or a 12-percent rate. If you 
have been looking for a job for 26 weeks, you are in trouble and your 
family is in trouble.
  It is hard to believe on an issue such as this, where you would think 
there would be some comity--you know, I was on one of the TV shows with 
the Senator from Texas and he agreed unemployment benefits should be 
extended. We talked about it on that show. Yet we are now holding 
things up. But people can't wait. They have food to put on the table; 
they have families to keep together. They have a work ethic. When you 
can't find a job, try as you might, it eats at you. It is one of the 
great things about Americans.
  I hope my colleagues will reconsider. I hope they will reconsider--
yes, because the politics is not on their side here, but more 
important, because of the substance. We have the worst unemployment we 
have had over a period of time since World War II, since the Great 
Depression. We can debate what we should ultimately do. We have to do 
more, in my opinion, to get this country out of the economic problems 
in terms of jobs. We do not want to wait 2 or 3 or 4 years for 
unemployment to gradually come down. We can debate all that. Should 
there be a second stimulus? Should we do other things? What should we 
do about highway building? Should we extend the home credit? These are 
all legitimate considerations we should debate. There will probably be 
some differences. But in terms of helping those unemployed, the vast 
majority of whom are unemployed through no fault of their own, I don't 
think there can be much of a debate. I don't think there will be much 
of a debate. When it comes to the floor through the good efforts of the 
Senator from Montana and the Senator from New Hampshire, my guess is it 
will be overwhelmingly voted on.
  Let's not delay. Let's move forward as quickly as we can to help 
those who, through no fault of their own right now, cannot find a job, 
try as they might themselves.
  I yield the floor and suggest the absence of a quorum.
  The PRESIDING OFFICER (Mrs. Shaheen). The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. DURBIN. I ask unanimous consent that the order for the quorum 
call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. DURBIN. Is there a pending order of business before the Senate?
  The PRESIDING OFFICER. The appropriations act is pending, and there 
is an amendment pending to that.
  Mr. DURBIN. Madam President, I rise to discuss an amendment I filed 
that takes an important step to address the disturbing level of youth 
violence in the city of Chicago. My amendment would allow the Attorney 
General to dedicate up to $5 million from the Office of Juvenile 
Justice and Delinquency Prevention to community-based, street-level 
violence prevention efforts.
  It breaks my heart to read the Chicago newspapers and see the stories 
of senseless violence that occurs on a regular basis. Stories such as 
that of Chastity Turner, a 9-year-old girl who was shot and killed last 
June while she washed her pet dogs outside her home in Englewood. Or 
Simeon Sanders, an Army soldier who was on furlough back home in the 
south suburbs when he was fatally shot in front of a community center 
this past July. Or 17-year-old Corey McClaurin, a high school senior 
shot and killed by a gunman while sitting in his car just a few weeks 
ago. Many of us have seen the shocking, startling videotape of the 
beating

[[Page 24452]]

death of 16-year-old Derrion Albert, buried in Chicago last Saturday.
  These stories simply overwhelm us. My heart goes out to the families 
and all the loved ones grieving for their loss. No one ever should have 
to face the tragedy of losing a child to such senseless violence.
  All too often this violence ends up involving school-age children. We 
lose a classroom's worth of schoolchildren each year to deadly 
shootings in Chicago and hundreds more are injured. Chicago is a great 
city. I love representing that city and being part of it. It breaks my 
heart to think that for many people across America, this is a new 
image, an image of children being killed in the streets, shot, beaten. 
It isn't what the city is all about. It isn't the values of the city. 
But we have to do better. Youth violence is devastating to families, 
communities and schools in Chicago and other urban centers.
  Wednesday, Mayor Daley and the CEO of the Chicago public schools, Ron 
Huberman, met with Attorney General Eric Holder and the Secretary of 
Education, Arne Duncan, to talk about ways to stop this epidemic of 
violence. As this meeting demonstrated, officials at the local, State, 
and Federal level are committed to taking bold action. Starting this 
year and using Department of Education dollars that were made available 
through the economic recovery package, the Chicago public school system 
will provide an unprecedented degree of intervention and support for 
school children who, according to statistical indicators, are at the 
greatest risk of being caught up in violence.
  This plan provides employment and adult mentoring for at-risk 
students. It provides structure and guidance to help prevent them from 
becoming victims. This comprehensive youth violence plan will also 
involve coordination with law enforcement, particularly to help secure 
areas on the way to and from schools where kids tend to congregate and 
where violence often flares.
  Ron Huberman is a very smart man. He runs our public school system in 
Chicago. Previously, he had been a Chicago policeman. He tried to 
analyze the school violence and come up an approach. What they did was 
to enlist some experts who did basically a statistical profile of both 
the victims and perpetrators of violence over the last few years in 
Chicago. Who are these young people? How do they find themselves in 
these predicaments? What are indicators that they are likely to become 
violent in their own lives or become victims of violence? He found 
recurring patterns. What he has suggested, with the cooperation of 
Mayor Daley, is intervention at an early age so we can get to these 
children before they become victims, before they turn to violent ways. 
It is an innovative and thoughtful approach. I support it.
  I am pleased the Justice Department is providing substantial 
assistance to Chicago to combat crime. It has been one of my priorities 
in recent years to make sure the Justice Department is doing all it can 
to partner with Chicago to try and stop youth violence.
  Last year, then-Senator Obama and I asked Attorney General Mukasey to 
include Chicago in the Department of Justice's Comprehensive Anti-Gang 
Initiative. This is a program which provides extra money for selected 
cities for gang enforcement, prevention, and prisoner reentry 
initiatives. At our request, the Justice Department included Chicago 
and has provided $2 million in additional Federal funding for this 
purpose.
  I have also strongly supported the COPS Program and Byrne-JAG grants, 
and so many other areas where we have assisted law enforcement. Over 
the last 2 years, we have been able to provide dramatic increases in 
law enforcement funding for Chicago and Cook County. In fiscal year 
2008, Chicago received $1.4 million in Byrne-JAG local law enforcement 
grants. But this year, through the stimulus act passed by Congress at 
the inspiration of President Obama and through the fiscal year 2009 
Justice Department spending bill, we increased that amount to $35 
million, bolstering police efforts in that area.
  The Chicago Police Department recently was awarded funding for 50 new 
cops on the beat through the $1 billion program the stimulus act 
provided for hiring new cops.
  I know Attorney General Holder's commitment to this issue. I know he 
is genuine. I raised the matter with him at a Senate hearing earlier 
this year. He made clear the administration's dedication to helping 
solve this problem.
  Arne Duncan also is a true champion of the city of Chicago, its 
schools and kids and families who depend on him. He wants to reduce 
violence and is dedicated to it.
  The efforts we are putting into Chicago have helped some. In the 
first 7 months of 2009, we saw an 11-percent drop in homicides and a 9-
percent drop in all crimes. This is due, in large part, to the 
dedicated efforts of law enforcement. But while beefed-up law 
enforcement is essential, it is not enough. We have to do more to 
prevent children from turning to violence.
  I have worked with a group called CeaseFire, which goes into the most 
violent neighborhoods of Chicago and tries to treat violence as if it 
is a public health issue. How do you eradicate a public health issue? 
With intervention. They do it on the streets. I have put--and I will 
use the word--earmarks in continuing appropriations bills year after 
year for CeaseFire, a community-based program to bring peace to the 
streets of Chicago. No apologies. It is an earmark. I will put it in 
again, if I get a chance, because I believe they are saving lives, and 
it is money well spent.
  CeaseFire was reviewed by the Justice Department in an evidence-based 
study and was found to have a significant impact in reducing shootings 
and killings. The amendment I will offer, when we get a chance to 
return to this bill, will help enhance the efforts of crime prevention 
organizations such as CeaseFire. It only permits--it doesn't mandate--
the Attorney General to devote up to $5 million of grant money from the 
Office of Juvenile Justice and Delinquency Prevention for community-
based violence prevention.
  As Attorney General Holder mentioned Wednesday in Chicago, the 
administration supports community-based programs. This gives them the 
resources to make that work. It doesn't require an offset. It simply 
broadens the purposes for which the administration can use existing 
funds.
  The problem with youth violence is not new, and it is not exclusively 
Chicago's problem. But it is not inevitable either. We must help 
provide a safer, more stable environment for these kids. It will take a 
sustained commitment to do so. My amendment is a step in that effort I 
hope my colleagues will support. I urge adoption of the amendment when 
we return to the bill.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Ohio.
  Mr. BROWN. Madam President, I thank the Senator from Illinois for 
speaking out for justice in his community and across the country.
  I ask unanimous consent to speak for up to 2 hours, time which I will 
control and disperse to others, as in morning business.
  The PRESIDING OFFICER. Without objection, it is so ordered.


                           Health care reform

  Mr. BROWN. Madam President, I take the floor tonight with my 
colleagues Senators Merkley, Stabenow, Udall of New Mexico, Casey, and 
Whitehouse to talk about the public option and why the public option is 
so important to our Nation and to improving our health care system. I 
will speak for the first 10 minutes. Then I will turn to Senator 
Merkley, who serves with me on the HELP Committee and has done such a 
terrific job helping to write the health care bill. I wished to start 
with something I have done for several weeks and that is to share 
letters from people in Ohio who, by and large, have health insurance 
they were satisfied with.
  They thought they had a good health insurance policy. In these 
letters, typically, people tell me when they get sick, they have very 
costly health problems, long hospital visits, doctor

[[Page 24453]]

visits, tests. They end up losing their health insurance. The insurance 
company cuts them off because they have become too expensive, which is 
not even insurance. That has happened too many times. That is one of 
the reasons this is so very important.
  I know Senator Stabenow gets letters from Lansing and Detroit. I know 
Senator Merkley gets the same kind of letters from Eugene and Portland, 
from all over his State.
  Joyce from Ottawa County, west of where I live on Lake Erie, writes:

       I am a 77-year-old great-grandmother who knows how the 
     expenses of health care create a constant worry for families. 
     My oldest daughter and her husband have three children and 
     they are in dire straights. He might lose his job soon and 
     she recently lost hers after 13 years with the company. Their 
     health coverage is due to expire in December and they have 
     received estimates for coverage of $1,000 a month. There is 
     no way for them to pay, and at age 54 and 61, they are not 
     [close to being] eligible for Medicare. My fear for my 
     grandchildren and great grandchildren is that they struggle 
     day after day to find a job, care for themselves with pride. 
     They want to go to college but they know they will owe tens 
     of thousands of dollars when they graduate and still not be 
     able to find a job or afford health care. Please fight for a 
     public option to help my family.

  Joyce understands what the public option will do. It will bring 
discipline to the market to keep prices in check. It will make health 
insurance companies honest so they can't dump people from their plans 
because they are more expensive or because they have a preexisting 
condition. They can no longer discriminate based on disability or age 
or gender or geography.
  Jill from Defiance, in northwestern Ohio near the Indiana border, 
writes:

       Later this month, I'll be losing my job due to the economy. 
     I will no longer have health insurance. Based on my 
     unemployment pay, I will not be able to afford COBRA . . .

  COBRA is the extension of insurance for people who have lost their 
jobs. Under COBRA, the insured person has to pay both her side of the 
insurance policy and her employer's side. When they lose their jobs, 
they rarely can to that.

        . . . I will not be able to afford COBRA and pay for my 
     house, utilities, [other] bills, and food. Me and the other 
     150 people losing their job at the plant will be lucky to 
     find new jobs, let alone afford health insurance. We need 
     health reform now with a strong public option.

  Jill understands, as does a majority of my colleagues and an 
overwhelming number in the House of Representatives and an overwhelming 
number of the public--by 2 to 1--that the public option matters because 
it will make sure people who don't have insurance now will go into an 
insurance exchange and will have choices. They can choose CIGNA. They 
can choose Blue Cross, Aetna. They can choose Medical Mutual, an Ohio 
not-for-profit company, or they can choose the public option. It is all 
about choice. People can decide: Do I want the public option? I like 
Medicare. Or do I want to go into a private plan.
  The last letter I will share is from Brenda in Lorain County. She 
writes:

       My husband is retired but has to get insurance through a 
     private insurance company. Neither of us will be eligible for 
     Medicare. My husband for 3 years, me for 4 years. Our plan is 
     ridiculously overpriced and the premiums, deductibles, and 
     co-pays have almost doubled in the 3\1/2\ years since my 
     husband retired. All this is happening as we get older and 
     need health care. Please fight for health reform including a 
     public option. Every American citizen should have affordable 
     health care without exception.

  As Brenda points out, people who are so often losing their jobs are 
in their fifties and sixties. Their health problems are increasing. 
People in their fifties and early sixties obviously have more health 
problems than people in their thirties and forties. And that is when 
they are losing their insurance.
  That is why this legislation is so important for people and why the 
public option will make our health insurance plan significantly better.
  Some 77 years ago, President Roosevelt addressed the class of 1932 in 
my mother's home State of Georgia. His task was not an easy one: to 
give hope to young people beginning careers at the worst moment 
possible. He may as well have been giving hope to Americans today who 
have lost a job and with it their health care.
  FDR said:

       The country needs and, unless I mistake its temper, the 
     country demands bold, persistent experimentation. It is 
     common sense to take a method and try it: If it fails, admit 
     it frankly and try another. But above all, try something. The 
     millions who are in want will not stand by silently forever 
     while the things to satisfy their needs are within easy 
     reach.

  It is time to try something different. The insurance industry has had 
nearly a century to provide coverage to all Americans. It is safe to 
say, if we rely on that industry to cover all Americans now, we will be 
disappointed. If we rely on them to take charge of our health insurance 
system, as they have now--if we rely exclusively on them, we will be 
disappointed again.
  We need a public insurance option, one that is designed to compete 
fairly with private insurers but differs from them in two crucial 
aspects. No. 1, the public plan will not pick and choose where to 
locate. Instead, it will offer coverage in every corner of this 
country--from the Presiding Officer's State of New Hampshire, to 
Senator Merkley's Oregon, to Senator Stabenow's Michigan, to Ohio, and 
to Florida--it will offer coverage in every corner of the country that 
is affordable, continuous, and patient-focused. You do not see Medicare 
turning down somebody for a preexisting condition like the insurance 
industry habitually does in the country.
  Second, if the public plan takes in more premiums than it needs, it 
will return those dollars to enrollees. Not a dollar will go to Wall 
Street, not another dollar will go to huge CEO salaries--more on that 
in a moment--and not another dollar will go to massive ad campaigns.
  For these and many other reasons, we need a public option. The public 
option will protect the public from price gouging. It will protect the 
public from rescission tactics. That is an insurance company word--
``rescission''--that disqualifies people who have insurance from 
keeping their insurance. It will protect the public from insurance 
loopholes that deny you coverage, deny you care, and deny you financial 
protection. The public option will protect the public from premium 
markups that pay for outrageous CEO salaries and sales trips to Tahiti.
  I want to show, just for a moment, some of these CEO salaries for 
2008. This is in millions, in case you cannot see that directly on the 
chart: Aetna's CEO's salary, $24 million; CEO of CIGNA, $12 million; 
CEO of Well Point, $9.8 million; CEO of Coventry--it is not even an 
insurance company I am particularly familiar with--$9 million; CEO of 
Centene, $8.8 million; CEO of AmeriGroup, $5.3 million; CEO of Humana, 
$4.8 million; CEO of HealthNet, $4.4 million; CEO of Universal 
American, $3.5 million; and the poor man or woman at UnitedHealth 
Group, that CEO is only bringing in $3.2 million.
  The point is, these CEO salaries are from these same companies that 
turned down somebody in Findlay, OH, or denied care to somebody in 
Warren, OH, because of a preexisting condition, or they take a patient 
in Springfield, OH, who has been a little bit too expensive for their 
company, and they have this cap on their insurance costs, this annual 
cap, and they disqualify them from further care. They practice their 
rescission in order to pay these kinds of CEO salaries.
  The public option will also protect the public from insurance that is 
unaffordable, unresponsive, and unreliable.
  Our Nation should try something new when it comes to health reform, 
something that gives Americans more options and the insurance industry 
a reason to cut out the fat from health insurance premiums.
  Some of my colleagues in Congress believe a public insurance option 
will harm the private insurance industry. That industry, however, has 
profited from competing with Medicare. Taxpayers did not profit from 
that deal, but that is a story for another day.
  The insurance industry profited from competing with Medicare, and it 
will profit from competing with the public option. There is simply no 
reason, when we have this competition, that

[[Page 24454]]

the insurance companies will not continue to make money. They are going 
to have 40 million new customers--40 million new customers. Several 
million will join the public option, to be sure. But these insurance 
companies will continue to find a way to make money because they are 
competing. They will be competing on a level playing field with the 
public option.
  The insurance industry claims to be infinitely more cost-efficient 
and capable than a public plan could ever hope to be. The same 
industry, though, on the other hand, insists it will go under if forced 
to compete--level playing field or not--against a public option.
  So think of it this way: On the one hand, the insurance industry 
tells us: We are going to be put out of business. The first thing the 
insurance companies say is, the government cannot do anything right. 
The government is bloated. The government is bureaucratic. The 
government is inefficient. They just cannot do anything right. But then 
they say: This public option, it is just going to put us out of 
business because it is going to be so efficient.
  So which way is it? Of course, we know how efficient Medicare is. 
What the public option is going to do is make these private insurance 
companies a lot more efficient and make them approach the levels of 
efficiency in Medicare.
  The private insurance industry is not trying to help our Nation make 
the right reform choices. It is trying to help our Nation put more tax 
dollars into insurers' pockets. I do not want to see all these 45 
million people with government subsidies who are going to get insurance 
forced into insurance company plans with no choice.
  The opponents to the public option are saying: These people should 
not have choice, they should have to go with their tax dollars--in some 
cases, their subsidies or their own money--they should have to go into 
private insurance. We say: Let them choose to go into private 
insurance, but give them the opportunity to go into the public option.
  In my comments, I am not saying the insurance industry is evil. The 
insurance industry is loyal to their shareholders. They want to make a 
buck. They do not have rules. They are allowed to disqualify people. We 
are going to change the rules so they are not allowed to do that.
  We need a public-private solution that addresses the needs of every 
American and discourages wasted spending. That is why I support a 
public option. That is why I believe my colleagues should too.
  As FDR said, it is time to do something. It is time to do the right 
thing.
  Madam President, I yield as much time as he would need to Senator 
Merkley.
  The PRESIDING OFFICER. The Senator from Oregon.
  Mr. MERKLEY. Madam President, I thank very much my colleague from 
Ohio, and I appreciate his advocacy for the working people of America, 
working to make America work for working Americans, both in terms of 
jobs and in terms of our health care system.
  I rise tonight as well to address the importance of a public option. 
Here is where we are right now. We are within reach of a historic 
opportunity to provide accessible health care to every single American, 
and that would be tremendous. But if that accessible health care is 
unaffordable, then we have not reached our goal.
  Right now, the cost of health care is doubling about every 6 to 7 
years, and the pace is accelerating. It doubled over the last 9 years, 
and now it is on pace to double in 6 or 7 years. So folks who could 
afford insurance just a few years ago cannot afford it today, and 
families who can afford insurance today are not going to be able to 
afford it a couple years from now. So it is essential--essential--we 
bend the cost curve. Perhaps the most powerful instrument for bending 
the cost curve is the public option because it is the public option 
that brings competition and choice. This is as American as apple pie. 
competition and choice result in better service and lower costs.
  Much of our Nation--our health care consumers--do not have a real 
choice. A couple companies dominate the market, dictate the terms, deny 
folks coverage, or drop coverage. So doesn't it concern all of us a 
little that after someone has paid their premiums for a decade or 15 
years or 20 years, and they get really sick, the insurance company 
says: We are not renewing your insurance? That certainly is not a 
health care system.
  When you do not have choices, you do not have improved service, you 
do not have lower costs. But a public option changes that equation 
because it introduces real competition in every health care market in 
America. It adds another choice for our citizens in every health care 
market in America.
  This is important to stress. This is a choice. My colleague from Ohio 
pointed out this point, but I will point it out again. Sometimes as to 
the idea of introducing a community health plan or a public option, it 
is attacked by saying: What does government do well? Why would we want 
a plan from the government? Then the same critics turn around and say: 
The government is going to create a public option that is going to work 
so well it is going to drive every other option out of existence.
  You cannot have it both ways, and neither extreme is accurate.
  We have seen this idea work in many States in related areas. For 
example, in the State of Oregon, 20 years ago, Oregon's workers' 
compensation market was a mess. It is a form of insurance, and it is a 
form of health insurance. It is a form of insurance for workers on the 
job. We made reforms to that market in the last 20 years, including a 
redesigned public option that resulted in premium rates that are today 
less than half of what those rates were 20 years ago.
  Let me repeat that. As a result of our reforms with a redesigned 
public option in Oregon's workers' compensation market in the last 20 
years, it has resulted in premium rates today that are less than half 
of what they were 20 years ago. That is the result of introducing 
competition. That is the result of introducing choice.
  The public option for workers' compensation was successful. It came 
under fire from insurers who did not like competition. But it was our 
business community that stepped up and saved it. Think how powerful it 
is for the success of a business to have good service and low premiums 
on workers' compensation. Translate that: how important it is to the 
success of our families to have good service and low premiums in their 
family health care premiums.
  The public option in workers' compensation has been an economic 
development tool for the State of Oregon. During the last downturn, we 
recruited Amy's Kitchen--an organic food producer--into southern Oregon 
because they could save $2 million a year in workers' compensation 
rates from the place they were formerly doing business.
  Well, this is what we need to do with health care. We need to have 
competition in every corner of this country. We need to have choice in 
every corner of this country. We need to empower consumers by giving 
them a community health option or a public option.
  Madam President, I am pleased to speak to the public option tonight, 
and I look forward to comments from my colleagues. I thank Senator 
Brown from Ohio.
  The PRESIDING OFFICER. The Senator from Ohio.
  Mr. BROWN. Madam President, I thank the Senator from Oregon. We will 
hear in a moment from Senator Stabenow, who is a member of the Finance 
Committee, and who on that committee has been so active in helping 
preserve people's plans who have insurance who are satisfied with it, 
and building those consumer protections around those plans. She has 
also been a strong advocate in the Finance Committee for the public 
option and all that comes with that.
  I yield to Senator Stabenow.
  The PRESIDING OFFICER. The Senator from Michigan.
  Ms. STABENOW. Madam President, I thank Senator Brown.
  I want to thank my friend from Ohio--and before he leaves, my friend 
from Oregon as well. We are so proud

[[Page 24455]]

and happy to have the Senator from Oregon with us as one of our 
terrific Members, coming from being the speaker of the house in Oregon, 
and leading on energy and being passionate on health care and jobs. It 
is just wonderful having the Senator with us. So we appreciate his 
advocacy on this important issue.
  I want to thank my friend from Ohio. I think we have States that are 
more alike than any two States I can think of in the Senate because of 
the challenges that have undergone the auto industry and 
manufacturing--the extent to which we understand that fair trade is 
important, that health care and jobs are critical. We also fight to 
protect our Great Lakes. So we have many ways in which we are team 
partners in the Senate, and I want to thank the Senator from Ohio for 
his leadership in bringing us together again to speak about a critical 
part of this health care reform effort.
  I also want to recognize the Senator from New Mexico, whom I see on 
the floor, whom we are very proud to have with us, as well, coming from 
the House of Representatives, who has done such a wonderful job in 
transitioning, hitting the ground running. And with the Presiding 
Officer, the Senator from New Hampshire, who is presiding, we have a 
fantastic group of Members who have joined us who are going to help us 
get health care reform done, as well as tackle energy and a number of 
different issues. So it is a pleasure and honor to work with you.
  As I speak about health care and the importance of having a public 
insurance option, I first want to take just a moment to note another 
issue that is very much tied to health care but an action that was 
taken a while ago--a very concerning action, again, where the Senate 
Republican leadership chose to block us moving forward on the extension 
of unemployment insurance.
  As our Presiding Officer from New Hampshire knows, having been a 
leader in bringing us together and putting forth a plan to be voted on, 
it was incredibly concerning to me that, in fact, the effort and the 
proposal to extend 14 weeks of benefits for all of the people in all of 
our States who are currently unemployed or who will soon be unemployed, 
with an additional 6 weeks for States such as mine with the very 
highest of unemployment levels, was blocked one more time on the Senate 
floor. This is not what we ought to be doing.
  When we look at what is happening in our State with about 15 percent 
unemployment, everyone understands the challenges we are going through. 
We have people who want to work. They want to work. They are looking 
for work. They may be piecing together income in a variety of ways. The 
difference between their being able to keep a roof over their heads for 
their families and food on their tables right now has been the efforts 
of extending unemployment that we did with our great new President, 
President Obama, coming into office and making that a priority. We made 
it a priority in the Recovery Act. Now we are at a point where we need 
to extend that.
  We expect in Michigan alone that 99,000 people will exhaust their 
unemployment benefits by the end of this year; tens of thousands of 
people coming to the unemployment offices. So this is critical for us. 
We are not going to go away. We are going to keep right back at it 
until we get this done.
  The same thing is true with health care reform because there is a 
direct relationship. As I start to speak about health care, I wish to 
say one of the very positive things of the many positive things about 
the legislation we will be voting on is that we want to strengthen it 
with a strong public option. One of the very important pieces of this 
legislation we worked on in the Finance Committee, and supported by the 
HELP Committee as well, creates a real safety net so if you lose your 
job, you don't lose your insurance. This is absolutely critical.
  We are talking about extending unemployment benefits for people who 
have been trying to find work and can't find work. Well, what we all 
know is that when you lose that job, too many people also lose their 
insurance. Then they lose the house. Then they lose whatever comes 
next--the car or the kids can't go back to school. So it is all 
related. In our health care bill, we make sure there is a real safety 
net and that people who lose their jobs know they will be able to have 
insurance, and that is very important.
  It is also critical, for people who are looking to purchase 
insurance, that they can get the very best price. It is important that 
people who have insurance can keep it; that they know what they are 
paying for they actually get, by the way, which is why the insurance 
reforms are so important; so you are not dropped right when you get 
sick or blocked from getting coverage. We know in order to create this 
new pool for individuals and small businesses that can't find or afford 
insurance that it is absolutely critical, if we are going to say 
everybody in the United States of America needs to have insurance, that 
it be affordable, that it be competitive in the marketplace, and that 
people be able to have every choice possible available to them. That is 
what we are talking about tonight because, ultimately, this is about 
providing real stability and security for American families.
  I received a letter from a constituent of mine, Lynn, in Marshall, 
MI. She wrote:

       In the space of two months, my husband's income was cut 25 
     percent because of the economic downturn. At the same time, 
     our oldest son, 21 years old, was diagnosed with leukemia.

  Every parent's worst nightmare.

       To date his bills have totaled about $450,000 for 
     treatment. While we currently have insurance, I worry about 
     my son and how his ability to obtain adequate health care 
     will forever be affected by his illness. His leukemia has an 
     exceptionally high cure rate, but how will he afford his own 
     health insurance which will likely affect his ability to stay 
     healthy for the rest of his life. He is only 21 and on the 
     verge of graduating from college. Once he graduates, he will 
     lose his coverage under my husband's plan. His treatment 
     won't even be finished by the time he graduates. I lay awake 
     at night and worry how we will finish his treatment.

  Lynn, everybody who has ever had a child worries about this kind of 
scenario and what could happen for their children. That is why we are 
here tonight. In the richest country in the world, no parent should 
have to lay awake at night worrying about how their son or daughter 
would be able to find the health care they need.
  In our reform in the Finance Committee, there is great news from part 
of what Lynn talked about, and that is we have extended health 
insurance for young people on their parents' policies until age 26. 
That is incredibly important and very positive. But when he then goes 
into the marketplace to find insurance, will he be able to find 
affordable insurance in this new exchange we set up? The way to 
guarantee that happens is through a strong public option, a public 
choice. You don't have to choose it. That is the great thing about 
America. We are all about choices.
  So we make sure there is a real competitor in the marketplace that is 
pegged to the real costs of health care and that doesn't have to worry 
about making a profit, that doesn't have to worry about marketing, that 
doesn't have to worry about other costs, but strictly providing health 
care and the costs of providing health care in the marketplace. Having 
that kind of competitor will make sure everybody is honest about the 
real costs associated with providing health care.
  We know there are very powerful interest groups that have lined up to 
slow down or to stop this bill from passing, and they are bitterly 
opposed to a public insurance option. They know it will bring down 
costs, it will hold insurance companies accountable, and will bring 
down the overall costs for taxpayers because of what we are doing in 
health care reform, now and on into the future. We don't need to hear 
from more of those voices. We need to hear from our own constituents 
who are struggling every day with the rising costs of health insurance.
  That is why I created my online Health Care People's Lobby, so people 
in Michigan can have their voices heard. We have had over 7,000 people 
respond. I am very grateful we have had

[[Page 24456]]

hundreds of stories that have been shared with us. I am so grateful for 
all of those.
  Lisa from Novi, MI, signed up for the People's Lobby, and she wrote:

       I am one of the lucky ones. We have health insurance and 
     everyone is healthy. However, with just routine doctor 
     visits, the time spent deciphering bills and reconciling what 
     the insurance company paid and what we owe can be 
     overwhelming.

  Haven't we all been through that?

       Our insurance is a primary reason my husband has stayed 
     with his current employer at a lower salary, because most new 
     job opportunities don't offer coverage. I strongly believe in 
     a public option.

  The reason we are here on health care reform and the reason we have a 
sense of urgency about it is because, as Lisa said, many new job 
opportunities don't provide health insurance, and we know we have to do 
better in this country. That is the point of creating a large pool for 
people who can't find insurance, don't have it through their job, to be 
able to pool people together and have an insurance exchange. But as I 
said before, to make sure that works, to make sure it is really 
affordable for families and for small businesses, we need real 
competition of a public insurance option.
  Another constituent, Glenn from Sterling Heights, is 62 years old. He 
got laid off in December, and it doesn't look like he will be called 
back. He writes:

       I am too young for Medicare. I have a preexisting 
     condition, so nobody wants to insure me. If I get sick before 
     I can get Medicare, my savings and everything will be wiped 
     out. This is not the way I pictured retirement was going to 
     be. I raised four children, got them through school, and 
     married. Paid taxes and did what I thought was right and 
     moral things to do. I didn't create this mess, but I am sure 
     paying for it.

  There are many people in Michigan in that very same situation that I 
am fighting for every day. In our insurance bill, first we have 
positive responses to this issue. We are going to stop the banning of 
insurance because of preexisting conditions. That is extremely 
important. We have help in this bill for early retirees to make sure we 
can help with the costs. But to make sure this whole system works 
together, we need a public insurance choice for Glenn so that if the 
other options don't work for him at 62 years old, he has a choice where 
he can go to an option that is affordable and is focused totally on 
providing health care for him. A public health option would give Glenn 
some hope. It would give him security until he is able to get to 
Medicare, so that he wouldn't lose everything if he had a medical 
crisis.
  Glenn is not alone. We know 62 percent of bankruptcies occur because 
of the medical crisis. We know 5,000 people every day lose their homes 
to foreclosure because of the medical crisis.
  I have literally received thousands of e-mails and stories from 
people around Michigan, and I wish to thank everyone who has e-mailed 
me, who has shared their story. We have literally thousands of stories 
of people who have gone through so many different experiences of 
worrying about whether they are going to lose their insurance, trying 
to figure out how to pay for their insurance, not being able to find 
insurance because of a preexisting condition, not being able to find 
something affordable as an individual going out into the marketplace. 
We have heard thousands and thousands of stories from Michigan, and 
they all say act now. Give us choice, real choice and competition.
  We know having a public insurance option is the way we guarantee all 
of this fits together. So for my constituents--for Lynn, for her son, 
for Lisa and Glenn, for the 11,000 others who have signed up for the 
People's Lobby--I urge all of my colleagues to join with us to make 
sure with all of the pieces we have put into these bills that are so 
important and so positive that we bring it all together by including a 
public health insurance choice for people so that if the private, for-
profit companies in the exchange are not able to give people affordable 
insurance, they know ultimately they can find it.
  I thank you very much, Mr. President. I wish to thank my friend from 
Ohio again for his passion and his time and efforts, and I yield the 
floor back to him.
  The PRESIDING OFFICER (Mr. Begich). The Senator from Ohio.
  Mr. BROWN. Thank you, Mr. President. I thank the Senator from 
Michigan for her steadfast leadership advocating for workers in 
Michigan and across the country.
  We have been joined by Senator Udall of New Mexico, as well as 
Senator Whitehouse from Rhode Island, and Senator Sanders from Vermont. 
Senator Whitehouse and Senator Sanders played a role on the HELP 
Committee to put this legislation together.
  Before turning to Senator Udall, I wish to read another letter from 
Phil in Franklin County in central Ohio about his situation and then 
talk to the Senator from New Mexico for a moment.
  Phil writes:

       When I was 8 years old, my father suffered a stroke despite 
     being a physically fit nonsmoker. Despite having employer-
     based insurance, I still recall my mother in tears on the 
     phone with the insurance company arguing for something she 
     shouldn't have had to: That the insurance company cover the 
     care my father deserved and the care for which he paid.

  In America, we are supposed to prize competition. It is the lack of 
competition that drives inefficiency in our health care system.
  It has become clear that health insurers are either incapable or 
unwilling to reform themselves and control costs. Among the many 
reforms our system desperately needs, we need a public option to 
promote competition and keep private insurers honest.
  We, your constituents, need help; we need you to represent us, not 
the insurance companies. As consumers, the more choices we have, the 
better off we will be.
  Phil understands this from his mother, who was pleading with the 
insurance company to be fair and to live up to their side of the 
agreement. His father paid for insurance for years. He suffered a 
debilitating stroke, and she had to push and push and push. With the 
competition that a public option would bring, those kinds of things 
won't happen.
  A moment ago, I was speaking with Senator Udall. We were talking 
about competition. In my State, Ohio, one health insurer, WellPoint, 
controls 41 percent of the market. WellPoint and one other insurer 
control nearly 60 percent of the market. We were looking at this map. 
On this map, the dark purple illustrates those States where more than 
80 percent of the market is controlled by 2 companies. I am not a 
lawyer--and I am sure not an antitrust lawyer--but I know if 2 
companies have 80 percent of the market, there are a lot of games being 
played.
  When two companies have that percent of the market, you can see why 
those CEO salaries I put up earlier are so high. Look at these 
salaries. You can see what the CEO of Aetna makes, $24 million; Cigna, 
$12 million; and WellPoint, almost $10 million, in my State. In 
Montana, 2 companies have more than 80 percent of the market; North 
Dakota, more than 80 percent of the market; Minnesota, more than 80 
percent of the market. Two companies. In Iowa, 2 companies have more 
than 80 percent of the market. The same is true in Arkansas, Alabama, 
Alaska, Hawaii, and Maine, 2 companies have more than 80 percent of the 
market. The lighter color on the chart--the medium color is where 2 
companies have 70 to 80 percent of the market. No wonder these 
companies charge so much. No wonder insurance company salaries are so 
high. No wonder people are denied care and have nowhere to turn, 
because there isn't any real competition when you have 2 companies that 
have 70, 75, 80, 90, or maybe 100 percent of the market.
  In Senator Udall's State, which is not quite like mine, 2 companies 
have only 50 to 70 percent. In Maine, it is 58 percent. I am not sure 
exactly what his State is. Even then, two companies have more than half 
the market. Insurance prices in Santa Fe, Albuquerque, and Truth or 
Consequences--my favorite name of a town in New Mexico--are too high, 
just as they are in Lima, Findlay, Zanesville, and Cleveland, in Ohio; 
and the service those companies bring to customers isn't particularly

[[Page 24457]]

high quality. Those customers are denied care because of preexisting 
conditions, because of discrimination, and because of annual caps and 
lifetime caps.
  Again, I thank the Senator from New Mexico, Mr. Udall, for joining us 
to discuss some of these issues about his support for the public 
option.
  Mr. UDALL of New Mexico. Mr. President, I ask unanimous consent for 
those of us on the floor to be able to carry on a colloquy about a 
public option.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. UDALL of New Mexico. Mr. President, I say to Senator Brown that 
the number in New Mexico--the Senator from Ohio has a range on his 
chart, but the number in New Mexico is actually 2 companies controlling 
65 percent of the market. So we are talking about a situation that 
isn't very competitive. I think that is the bottom line of what we have 
been hearing.
  We have had our colleague from Oregon, Senator Merkley, and we have 
had Debbie Stabenow from Michigan, and other colleagues are here on the 
floor, speaking to that situation in their States, and why we should 
proceed with a public option.
  Let me first say to the Senator from Ohio, I appreciate his 
leadership. I know he was on the HELP Committee, which is the one that 
wrote the public option we have the opportunity to put in the final 
legislation. He was on the committee. Some of us are getting into 
writing the legislation now. But one of the best public options out 
there is the one that came out of Senator Kennedy's committee. It has 
been passed for a couple of months. It is sitting right there ready to 
go, if we just put it in.
  When we talk about a public option, what exactly are we talking 
about? I think people have a right to know a little bit about what we 
are talking about when we say public option. I think if I outline that 
a little bit, people will see why it is so important to have a public 
option, so let me give a little bit of an outline.
  First, it would be voluntary. We are not forcing anybody to get into 
it. We are talking about a voluntary system. So you would have a choice 
to get into it, based on whether it would fit your particular 
circumstances.
  The public option would not be subsidized by the government. It would 
be fully financed by premiums. So this would be something where people 
would be paying premiums, the premiums would come in, and we wouldn't 
be adding to the deficit. We would be creating a good, solid insurance 
situation and insuring people.
  We have heard, as Senator Brown has talked about here--he put up a 
chart about these incredible salaries. One of the things a public 
option would do is you won't make profit for the shareholders. You have 
the opportunity to take those premiums and put them all back into 
health care. So that, once again, is something that is very important.
  Let's look here at this chart Senator Brown has loaned me. Look at 
the total compensation for CEOs of major health insurance companies in 
2008: Aetna, $24.3 million; Cigna; WellPoint; Coventry--look at these 
salaries. There is a total, for these 8 or 10 companies, of $85 million 
in salaries.
  What we are talking about is money being spent on health care for 
people through a public option. One of the other things that I think 
would be a hallmark of a public option would be having low 
administrative costs, since it operates on a nonprofit basis. One of 
the things you should know about these insurance companies where you 
have these CEOs working is that they have administrative costs in the 
range we have heard about, 30 percent administrative costs. So what 
happens here is that the money comes in on the premiums, but they spend 
an incredible amount of time going back and forth denying claims, 
telling doctors they should not put that in, they are not going to 
cover it, and it builds up into a big administrative cost.
  The great thing about a public option is you don't have high 
administrative costs. One of the comparisons there, as Senator Brown 
and Senator Sanders know, is that I think Medicare has 3 percent 
administrative costs. Here you have a comparison of 30 percent to 3 
percent.
  One of the other parts of a public option I think makes a difference 
is exerting bargaining power to obtain discounts from providers. That 
could make a big difference with the public option operating out there. 
We would offer savings to subscribers with lower premiums. We should 
follow the same insurance requirements as private plans. What we would 
offer, through a public option, would be low cost and high value.
  Basically, what we are talking about here is keeping insurance 
companies honest, driving the costs down, and having a competitive 
market.
  Senator Sanders well knows that the situation right now isn't serving 
the American people. I know he wants to comment on his situation in 
Vermont and what's going on there.
  Mr. SANDERS. I do. I thank the Senator from New Mexico for his 
remarks and Senator Brown for his leadership efforts here. I will say a 
few words.
  If anyone in America does not understand what the function of a 
health insurance company is, let me give you the bad news. If you think 
the function is to provide health insurance for people, sorry, you are 
wrong. The function of a health insurance company is to make as much 
money as it possibly can. Do you know what. They do that very well. We 
have to acknowledge that. Insurers have increased premiums 87 percent 
over the past 6 years. Premiums have doubled in the last 9 years, 
increasing four times faster than wages.
  Profit at 10 of the country's largest publicly traded health 
insurance companies in 2007 rose 428 percent from the year 2000 to 
2007, from $2.4 billion to $12.9 billion, according to the U.S. 
Securities and Exchange Commission.
  What we are seeing is that people are thrown off of health insurance 
because they committed the crime of getting sick, and they cannot get 
health insurance because of preexisting conditions. Well, that is the 
bad news. The good news is that CEO salaries are very high, and profits 
are doing very well.
  At the very least--and I speak as somebody who believes in a 
Medicare-for-all, single-payer system--this country deserves a strong 
public option to give people the choice about whether they want a 
private insurance company.
  With that, I yield back my time.
  Mr. UDALL of New Mexico. Mr. President, I thank the Senator from 
Vermont.
  I want to also yield to a Senator here and give him the floor--with 
Senator Brown's permission. Sheldon Whitehouse, from the great State of 
Rhode Island, I believe was also on the committee and was intimately 
working through the bill. It is wonderful to have him here with our 
colleagues talking about the idea that we have to have a public option.
  Mr. WHITEHOUSE. I thank the Senator. I had the real pleasure and 
honor, along with Senator Brown, of being among the principal draftsmen 
of the public option in the HELP Committee. When I think back on the 
effort we put into it, and the plan we came up with, it is astonishing 
to me that it is now the public option that appears to be the most 
contentious part of the American health care debate right now, because 
the bill we passed out of the HELP Committee in July was very 
thoughtful. It includes a community health insurance option--a national 
plan, administered by the Secretary of the Department of Health and 
Human Services. It will be available in every State and territory. It 
would offer benefits that are as good as those available through the 
private insurance plans, or better. The Secretary would negotiate 
provider payment rates to encourage doctors and hospitals to 
participate. Americans who need financial help to participate in the 
public option would get it. And local advisory councils would assure 
that the public option was sensitive to local conditions and local 
needs.
  To be clear, this plan includes no mandate for doctors to 
participate, no rate setting by the Secretary, no requirement that any 
American buy a

[[Page 24458]]

public option policy, and absolutely no direct link to the Federal 
Treasury. Other than the initial capitalization, this plan would 
operate solely on premium revenue--a completely self-sufficient 
financial model. It would have absolutely no baseline advantage over 
private insurance companies. The HELP Committee got here by approving a 
number of amendments by our friend from North Carolina, Senator Burr, 
to make sure of this.
  Because this version of the public option was so sensitive to these 
concerns from across the ideological spectrum, the House Blue Dogs, 
moderates in the House, used a number of our provisions in the House 
bill to gain moderate support. In fact, the community health insurance 
option makes so much sense that Republicans have had to resort to 
illogical arguments to justify their opposition.
  For example, they argue that the government should not be in the 
business of providing health insurance, that it is a slippery slope to 
socialized medicine. Well, hello, government-sponsored health insurance 
serves nearly half of Americans--78 million Americans--who are enrolled 
in Medicare, Medicaid, TRICARE, VA, and they get benefits from the 
Federal Employee Health Benefits Program, and so forth. We don't hear 
our colleagues on the other side talking about ending Medicare, closing 
up the trust fund, throwing our parents and grandparents out to the 
tender mercies of the private insurance companies. We don't hear that. 
I have not heard one Republican say they want to deny our Iraq and 
Afghanistan veterans all the Federal medical care they need when they 
come home. I don't see Republican Members of Congress opting out in 
droves or criticizing the Federal Employee Health Benefits Program.
  Why? Because these programs work, because Americans rely on them, 
because they provide dignity and stability in the lives of millions of 
American families and they have not led to a government takeover of our 
entire health care system. Indeed, ironically, the very best program is 
probably the VA program where the level of government involvement is 
the highest, where they own the hospitals and where they employ the 
doctors.
  Republicans have also been arguing that government involvement in the 
private health insurance market will be uncompetitive and will push 
private companies out of business. We see the government competing 
competitively in a variety of markets in this country--private versus 
public universities, private versus government student loans, workers' 
compensation insurance, the Postal Service versus UPS and FedEx. The 
existence of public options in these markets has not swallowed up 
private industry. What it has done is broadened the market and enhanced 
the variety of competition consumers enjoy. Think how many people in 
America right now have a higher education because a State university 
was there as an affordable option, an alternative to private colleges.
  Similarly, a public insurance option adds choice for consumers and 
adds competition in the market, and it gives private insurers a strong 
incentive to behave fairly and to keep their costs down. In fact, if 
one thinks about it, there is hardly an industry in this country where 
the big players are so far from being pushed out of the market. In 
fact, if you ask me, the for-profit health insurance industry has been 
doing the pushing--pushing the American people around--for far too 
long.
  Let me give one example from my home State of Rhode Island. Two years 
ago, United Health Care of Rhode Island proposed to send $37 million in 
excess profits to its parent company, United Health Group, hundreds of 
miles away instead of investing that $37 million back into the system. 
That is $37 million in 1 year out of a State of only 1 million people 
in which this company only had a 16-percent market share. With a public 
option, that $37 million would have gone back into improving the health 
care infrastructure in Rhode Island, into lowering premiums, into 
increasing provider payments, into investing in our health information 
and chronic care sustainability projects and helping doctors buy 
electronic health records and supporting our Rhode Island Quality 
Institute. But no. And this after United had already sent $16.5 million 
out of our State in 2004, $13.4 million out of our State in 2005, and 
$17.1 million out of our State in 2006.
  Competition is supposed to lower prices for consumers, create demand 
for a better product, and push bad actors out of the marketplace. I 
don't see that in the health insurance market. I see 10 States with the 
two largest health insurance companies controlling over 80 percent of 
the market. I see a 120-percent increase in premiums from 1999 to 2007, 
while wages only went up 29 percent. I see a 109-percent increase in 
administrative costs from 2000 to 2006--a 109-percent increase--as 
insurers increasingly game the system rather than competing on better 
quality of care, better health, and lower cost.
  As I have traveled around Rhode Island, I have seen how these 
circumstances work out for individual Rhode Islanders.
  David, a self-employed resident in Central Falls, described the 
astronomical rise in the cost of health insurance for him and his wife. 
Years ago, he paid $85 a month for his plan. Today, it is $19,000 for 
their annual health insurance. Despite the dramatic jump in price, the 
health insurance does not cover as much as it used to. David has been 
forced to drop dental coverage and increase the out-of-pocket expenses 
he and his wife pay on their plan.
  He wrote to me:

       I'm almost afraid to get sick because today's health plans 
     have so many holes in them they can nickel and dime you to 
     death.

  Charlotte is a self-employed consultant from Providence. She wrote to 
share the difficulties she has faced as health insurance became the 
single largest expense for her company. She buys one of the least 
expensive plans she can through a small business alliance, but the 
premium for her current coverage increased by 35.6 percent--more than a 
third--just this past year, it is covering fewer and fewer tests and 
procedures, and she has to pay more out of pocket for needed medical 
treatments. She wrote to me that we needed to move forward on health 
care reform because ``the cost of health care is pulling the plug on my 
livelihood.''
  For these Rhode Islanders and for millions more, there has to be a 
better way. There has to be a new challenge in this marketplace, a new 
business model, a new entrant to change the landscape of competition. 
Instead of competing to lure the healthiest patients, plans should have 
to compete on quality. Instead of developing a better claims denial 
procedure, plans should have to develop a better customer service 
department. Instead of paying executives tens of millions of dollars 
per year, they should make sure working-class Americans can afford safe 
and secure health coverage.
  Need I remind us that our health care system is teetering on the edge 
of collapse and the status quo is not sustainable. Over 80 million 
Americans were uninsured at some point during 2007 and 2008. As many as 
100,000 Americans are killed every year by unnecessary and preventable 
medical errors. Life expectancy, obesity rates, and infant mortality 
rates are embarrassing by most international measures. The annual cost 
of our system is closing in on $3 trillion and is expected soon to 
double. We spend more of our GDP on health care than any other 
industrialized country, double the European Union average. More 
American families are bankrupted by health care costs than any other 
cause. There is more health care than steel in Ford cars. There is more 
health care than coffee in Starbucks coffee. It is out of control.
  We have two choices: We can derail and delay this debate until 
unpalatable solutions, such as throwing people off Medicare, 
drastically cutting coverage, or paying doctors much less, are our only 
remaining options or we can do what Americans have always done when 
faced with a tremendous challenge, and that is to innovate our way out.
  Government is not the enemy in this undertaking. Americans, with a 
helping hand from their government, have

[[Page 24459]]

done great things time and time again. We put a man on the Moon and an 
explorer on Mars. We built a Peace Corps and the Marine Corps. We 
virtually eliminated polio and smallpox. We built the National 
Institutes of Health and the Federal Highway System. We have mapped the 
human genome. Government helped then, and it can help now through an 
innovative public plan.
  Let me make one last point. My Republican colleagues have argued that 
a public option would drown out private competition and amount to a 
government takeover. In many places from which they made that argument, 
the facts at home disprove that contention. Twenty-five States actually 
provide health insurance benefits through public plans. They actually 
provide health insurance benefits through public plans in their 
workers' compensation systems.
  For example, Kentucky, represented so ably by our distinguished 
minority leader, is home to Kentucky Employers Mutual Insurance, a 
State-run public fund which has operated in the State since 1995 and 
now provides health insurance benefits to 24 percent of the workers' 
compensation market in a competitive market.
  In Wyoming, the home State of the ranking member of the HELP 
Committee, Wyoming's Worker Safety and Compensation Division delivers 
all the health care in the workers' compensation system. They have a 
single-payer public plan. There has been concern expressed that a 
government plan will give terrible customer service. I doubt that the 
Wyoming plan would last very long if it gave terrible customer service.
  In Arizona, so ably represented in this Chamber by Senators McCain 
and Kyl, since 1925 SCF Arizona has provided health insurance benefits 
through the workers' compensation system, and it now has a 56-percent 
market share in a competitive market environment. To those who have 
said you cannot have a government plan because it will necessarily 
crowd out private insurance by virtue of an unfair competitive 
advantage, Arizona belies that argument. It has been that way for 80 
years, since 1925.
  To my knowledge, those who criticize the idea of a Federal public 
option for health insurance have not criticized the role--often a 
decades-old one--of public insurance plans in their own States' 
workers' compensation insurance markets.
  We have in front of us an opportunity for a new day in the American 
health care system where affordable, quality health care is available 
for everyone; where doctors and hospitals are paid for value, not 
volume; where you cannot lose coverage because of an illness or 
preexisting condition; where insurance company bureaucrats do not come 
between you and your doctor; where care is not rationed by your 
family's ability to pay; where every American gets the best health care 
the country's medical system has to offer.
  I support the public option because I see that vision for the future, 
and I think a public option can get us there. I also see this lesson of 
the past: that an industry--the private insurance industry--that has 
put its own financial welfare in front of the physical and mental 
health of its customers for years, over and over again, cannot now be 
trusted on its own to lead us into that future, not without a push in 
the marketplace, not without the kind of push in the marketplace a 
public option will give.
  Mr. BROWN. Mr. President, I thank the Senator. I was intrigued by 
much of what he said.
  We are also joined on the floor now by Senator Bennet from Colorado, 
and Senator Casey and Senator Udall are still with us.
  When the Senator from Rhode Island talked about the Rhode Island 
experience, I remember while we were drafting the public option 
language in the Health, Education, Labor, and Pensions Committee, on 
which Senator Casey and now Senator Bennet sit, the Senator talked 
about what a disaster Rhode Island's workers' compensation system was 
because of the corruption in private insurance and the high costs and 
that the Senator from Rhode Island introduced a public option into 
private insurance there. Many States--I believe roughly half the 
States--have a public option as Rhode Island does and the experience of 
the Senator from Rhode Island with bringing in this competition.
  My understanding--and correct me if I am wrong--is that the public 
option not only made private insurance operate more efficiently and 
made private insurance more honest, if you will, and helped to sort of 
flush the corruption out, but I would guess competition from the 
private insurance industry made the public system a little bit more 
nimble, too, right?
  Mr. WHITEHOUSE. We actually pretty much had a complete meltdown in 
the private insurance market, so we had to put in a public option to 
provide any workers' compensation insurance. But the private insurance 
companies had written off our marketplace because their business model 
was impossible to maintain for any reasonable cost. We knew that with 
good reform in the system and with a public option to implement that 
reform, we could reduce those costs.
  What has happened is two things. It used to cost $3.93 for 100 hours 
of payroll for workers' compensation, the year after this went through 
and got stood up. Today, it is $1.74. It is more than 50 percent 
cheaper in Rhode Island. The model that was set by the public option, a 
new business model that focused on prevention, on getting people back 
to work, on better quality medical care, has actually attracted the 
private industry back into the market.
  Mr. BROWN. So the private companies are making money.
  Mr. WHITEHOUSE. They are back in and making more with the leadership 
of the public option.
  Mr. BROWN. A lot more honest and a lot more efficient.
  Mr. WHITEHOUSE. And they improved their business model, so they are 
now delivering better quality care, getting people back to work sooner, 
reducing medical costs by getting people back to work, and providing 
better quality care. It has been a very successful story from a cost 
point of view.
  It used to be the worst issue for the Rhode Island business 
community. They were nuts about workers' compensation. We literally had 
torch-lit parades, and nobody has heard about the issue in a decade 
because the public option has led the way.
  If you think the business community is scared about a public option, 
go to a State where there is a workers' compensation public option. I 
think you will find they support it.
  Mr. BROWN. I think we can safely predict that 10 years after the 
President signs a good health care reform bill in November or December 
which has a strong public option similar to the language our Health, 
Education, Labor, and Pensions Committee drafted and the House Energy 
and Commerce Committee passed, we will see the same kind of thing; we 
will see a more efficient but still profitable health insurance 
industry, with a public option disciplining the market and keeping 
prices in check. We no longer will have people denied care because they 
have a preexisting condition or denied care because of an annual limit 
or a lifetime limit on coverage. We will no longer see the kind of 
discrimination in the marketplace we have seen from all of these 
private companies.
  Before turning to Senator Casey, who has brought the bill to the 
floor with him tonight to talk about the legislation itself which he 
helped draft in the Health, Education, Labor, and Pensions Committee, I 
want to mention that today we submitted a letter to Majority Leader 
Reid that pretty much all of us on the floor signed. Some 30 Senators 
signed a letter to him today calling on him to support the public 
option and putting that on the bill when we bring the bill to the floor 
in the next couple of weeks.
  Again, before turning to Senator Casey, I wanted to read another 
brief letter I received from Ohio--Kathy from Medina. Kathy writes:

       I own a small business with three employees. With the 
     current economy, I can no longer make payments on our health 
     plan. We were paying $2,000 a month for our plans

[[Page 24460]]

     and were told we needed at least 10 workers to negotiate a 
     more affordable plan. After dropping our plan, I had to see a 
     doctor because I had difficulty breathing. I now have to see 
     a cardiologist and endocrinologist. I am still in shock at 
     how quickly my health turned into a serious condition. In 
     just a month's time, I have almost $7,000 in medical bills 
     and I still have further tests and treatment ahead. Unless 
     there is health reform, I will be just another 55 and over 
     American not taking my meds or seeing a specialist when I 
     should because of the high medical bills. It's been upsetting 
     just being seriously ill, let alone facing financial 
     hardship.

  I am certainly not a doctor, and I don't know Kathy except through 
this letter, but you have to figure the anxiety of figuring out her 
business and trying to manage her health insurance; going without 
health insurance and her fears are probably making her health and her 
situation worse. That is why Senator Casey worked on helping us write 
the legislation on what you do to give incentives to small business 
owners to buy insurance, understanding this whole bill will mean that 
everybody has insurance and so those with insurance no longer will have 
to subsidize--a tax, really, at $1,000 a year--all those uninsured.
  Everyone who pays insurance pays about $1,000 a year more for their 
insurance to compensate for those who go to emergency rooms without 
insurance and go to doctors and don't pay. They have to recapture that 
money from somewhere, and it comes from all those who have health 
insurance. That is one of the most important parts of this bill, to get 
at the cost.
  Senator Casey.
  Mr. CASEY. I wish to, first, thank Senator Brown for keeping us 
organized and focused on this issue. When we went through the work of 
our committee this summer--some 60 hours of hearings and many hours 
prior to that walking through the bill--there came a point in time when 
we realized that if we were going to be strong supporters--and we were 
and still are--of the public option, we needed to define it, we needed 
to make it readable and understandable to people, and also we needed to 
fully articulate what it means to have a public option.
  A number of people went to work on that--and the two principals of 
that are with us tonight: Senator Brown and Senator Whitehouse--
spending hours and hours trying to get this right. Contrary to what we 
have seen in some of the debates and some of the coverage of this 
issue, this is not very mysterious and it is not theoretical. If you 
look at the bill--and I will get to sections of the bill in a second--
this is meant to be a choice for people. It is voluntary. It is the 
first word of the section--and I will go through that in a moment.
  What we did today, when we sent the letter to the majority leader 
that Senator Brown referred to, we outlined very succinctly what this 
is all about. Let me read two or three sentences from the letter we 
sent today. In the second paragraph, we say:

       Without a not-for-profit public insurance alternative that 
     competes with these insurers based upon premium rates and 
     quality, insurers will have free rein to increase insurance 
     premiums and drive up the cost of Federal subsidies tied to 
     those premiums.

  In other words, unless we have some competition, the insurance 
companies have free rein to keep jacking up prices. That is what we are 
living through right now. That is what virtually every American has a 
concern about. We have a concern about cost. If we don't have 
competition for insurance companies, they will have that free rein to 
keep driving up cost.
  What is wrong with competition? I thought that was the American way. 
But I think some people have lost their way in part of this debate. 
Competition and choice, that is what this public option is all about.
  Later in the letter we say this:

       It is possible to create a public health insurance option 
     that is modeled after private insurance--rates are negotiated 
     and providers are not required to participate in the plan.

  Very simple. Part of this legislation has features to it that are 
very similar to Medicare--a public insurance program that has worked 
real well for generations of Americans. But it will also have some of 
the requirements that insurance companies have to live by. Let me go 
through a couple of those.
  First of all, a public option, in terms of the process starting, 
would have to get government funding to start. In the way of resources, 
the government would pay for the first 3 months of claims as a way to 
capitalize it initially, but then it has to pay back any kind of 
capitalization over a 10-year time period.
  What we are talking about is a program, State by State, that would be 
self-sufficient. It is very important for people to understand that. 
This would be self-sufficient. Senator Whitehouse talked about this a 
moment ago, and it needs repetition and reiteration. It would follow 
the same rules as private plans by defining benefits, by protecting 
consumers--we hope any entity would do that--finally, by setting 
premiums that are fair based upon local costs.
  So this isn't some theory. This isn't some idea we don't know how it 
will work. We know exactly, and the American people know exactly, how 
this will work because we understand what it is like to deal with a 
system where the insurance companies have virtually unlimited power to 
deny you coverage if you have a preexisting condition, for example. The 
bill also makes that illegal under the bill we passed in the HELP 
Committee this summer. But also, insurance companies right now have 
free rein to jack up their prices.
  I know there are some State-by-State limitations on that, but mostly 
free rein exists to do whatever they want. Without a public option, 
that is what we will have going forward. So if you like costs going up, 
then you should be against our proposal because costs going up is what 
we are going to have more and more of if we don't have a public option.
  One of the important features is that there be State advisory 
councils--councils set up in each State, made up of providers and 
consumers to recommend strategies for quality improvement. So this 
isn't going to be some Washington control here. You are going to have 
lots and lots of accountability at the State level, and States would 
share in the savings that result from that kind of accountability.
  Finally, the notion it is a voluntary program. The providers would 
have a choice of participating in the public option and there would be 
no obligation to do so. I point to the bill for this reason. When we 
were in our States this summer, I remember going back to Pennsylvania 
and reading about Senator Brown's public forum in the State of Ohio and 
I was reading about others as well and learning about what was 
happening in other States. We had our public forums. I spoke to 
thousands of people over the course of a couple weeks.
  One of the things I would say to the audience when we had our public 
forums is, Look, if you walked in here today and you don't support the 
public option, I ask you to do one thing: Read the bill. Well, the 
final version of the HELP Committee bill that I am holding right here 
was 839 pages. I wasn't asking them to read every page, but what I said 
to them was: If you don't support the public option, just read that 
section, which is right now 19 pages in the bill. Section 3106, 
Community Health Insurance Option. In the bill, it is from page 110 to 
129. So it is 19 pages in the bill. I said: Look, spend some time 
taking a look at it.
  I remember at the one public forum, someone who disagreed with my 
point of view on the public option went at me verbally and said: You 
are going to force people to go into these public options. I said: That 
is not true. Of course, saying it doesn't always end the argument. So, 
then, I would hold up the bill and I would say: Let's go to section 
3106, and I would read from section 3106--I know the camera can't see 
this--subsection (a). The first two words of this section--other than 
the heading of it--are ``voluntary nature.'' That is the subheading. So 
I would read part of that section and say: This is voluntary. Voluntary 
for any American who goes into the exchange and may decide they want to 
stay with their own private insurance coverage or may want another--a 
different--choice. So they can choose this.

[[Page 24461]]

  It was important for people to understand that in a long bill we at 
least spent 19 pages to get this right.
  There is a solvency standard in here, for example. This isn't some 
theory we dreamed up in Washington. We know solvency is important; that 
a program such as this, in an option such as this, has to meet basic 
solvency standards. Senator Whitehouse spent some time talking about 
that and helping Senator Brown and others craft that, along with 
Senator Udall, who is with us here tonight. It is voluntary. It has to 
be self-sufficient.
  There is even an audit section. If you want to get into the detail, 
there is even an audit section. So that when you have administrators, 
there is a measure of accountability, in terms of auditing.
  There are a lot of parts to this that we could go through. The 
important point, though, is that unless we inject some choice into this 
and some competition, I am not sure the American people will believe we 
have done our job. We have said over and over again that among the 
basic elements of any final health care bill is that we have to have a 
total commitment to prevention, so we can prevent disease and 
conditions from leading to bad results for an individual and their 
family, and prevention will also help us save money at the same time; 
that any health care bill would have to have choices. If someone wanted 
to stay with their private coverage, they could do that, but if they 
wanted other options, we are trying to give them a public option; that 
any kind of health care reform would have to have quality standards. 
This will help ensure more quality standards in our system. So I don't 
believe we can get to where we want to get to in the end unless we have 
a public option.
  Let me make two or three more points, and then I wish to have my 
colleagues rejoin this discussion and also talk about what we are 
trying to do. There are a lot of discussions--and I know my colleagues 
saw these in these public forums where we would have someone stand and 
say: I don't like a government program or I don't like government in 
our health care, as if we have a system now that is 99 to 1--99 percent 
private and 1 percent public. I would remind them--and these are some 
overall numbers, but it is important to remember--that we have a 
Medicaid Program right now that at last count had over 60 million 
people in it--60 million Americans. We have a Medicare Program with 
about 45 million Americans. Then you go to VA health care, and at last 
count it has 7.8 million Americans.
  So when you go down the list of programs right now that are 
government-run programs for health care, you get a large number of 
Americans--well over 100 million Americans--and their families who 
benefit from those programs, and you get a commitment from the Federal 
Government year in and year out to make sure we have that kind of 
coverage for those who happen to be poor, those who happen to have 
particular health care challenges, those who happen to be over the age 
of 65, those who happen to be veterans and who need health care 
coverage. So we have an American system right now that has a lot of 
private coverage, but there is a lot of coverage through government 
programs that even people who oppose some parts of this bill, the last 
time I checked, don't want to repeal. I haven't found anyone who wants 
to repeal VA health care or who wants to repeal Medicare.
  I think we have a system right now that is not working in large 
measure, but there are some things that are working well. We are trying 
to improve both ends of this, the public health care end of this and 
the private health care part of our system.
  Mr. WHITEHOUSE. Will the Senator yield for a question?
  Mr. CASEY. Sure.
  Mr. WHITEHOUSE. With respect to your observation that we don't see a 
lot of outcry about ending Medicare, about ending VA health care, and 
other government programs, Senator Brown has been remarkable about 
coming to the floor regularly to read the true-life horror stories that 
our present health care system inflicts on Americans and American 
families across the board. I have brought a great many Rhode Island 
stories to the floor. We all have this experience.
  I am interested in the evaluation the Senator from Pennsylvania might 
make in terms of his own experience and his own constituent contacts in 
terms of those heartbreaking stories you get. Do you hear a lot of 
heartbreaking stories from people in Medicare; people being thrown off 
for preexisting conditions? Where in your experience have the real 
heartbreaking stories come from in Pennsylvania?
  Mr. CASEY. I will give you an example. In our State, just in terms of 
age categories, we have, in terms of children up to the age of 18--we 
have a 5-percent uninsured rate. It is still too high. Until it gets to 
zero, we have not done enough, but that number is way down. So we have 
a diminishing number of children who are uninsured largely because of 
efforts and initiatives such as the Children's Health Insurance 
Program. Then, on the other end, those who are over the age of 65, they 
have Medicare.
  Where I am getting the real-life stories from people, people who send 
e-mails to our office just like to Senator Whitehouse, or people who do 
it the old-fashioned way, who actually write a letter or people you see 
in a public forum or on the street--they are coming to us in that age 
category, 19 to 64. In our State, that number of uninsured is 12 
percent, more than double the number of uninsured children.
  For example, I got a letter in February from Trisha Urban from the 
eastern end of our State near Reading in Berks County. Here was her 
story in summary.
  She was working; her husband was working. But he was trying to 
advance, as we always tell people we want them to get more education. 
So he was trying to finish his doctorate. In order to finish that he 
had to take an internship. The internship did not have health insurance 
coverage. The coverage they had, ultimately they lost.
  Here is Trisha Urban who was working, and her husband was working as 
well. She was working four different jobs. They lost coverage and then 
they started to run up bills. Then she became pregnant. While she was 
pregnant, her husband, who had a heart problem, missed an appointment 
because they were worried about paying for the doctor visit for her 
pregnancy and also worried about the doctor visit for his heart 
ailment. So he skipped his appointment because of his heart problems.
  Time goes by, a couple of weeks go by, and all of a sudden her water 
broke. She was preparing to go to the hospital in a couple of hours, 
her husband went out and did a few errands, came back to the house, and 
as she was walking out of the house to go into the driveway to join him 
in the car to go to the hospital to deliver her baby, she looked in the 
driveway, and her husband is on the pavement of the driveway dead 
because of his heart condition, a preexisting condition which, thank 
God, in our bill, in the first section of our bill, we make illegal. It 
should have been illegal a long time ago. I still find it hard to 
believe that we live in a country where we have allowed insurance 
companies to do that to people.
  She went out and found her husband dead. An ambulance came to take 
her to the hospital to deliver her baby, and the other ambulance came 
to pick up her husband.
  That is the kind of story we hear in Pennsylvania and across the 
country because of our system. There is no reason we should tolerate 
this and let it go on any longer. We have a chance to change it.
  One of the ways to move it forward is by making sure we have choices 
and competition in a public option.
  Mr. BROWN. Could I ask Senator Casey a question? I thank him for that 
story. Of these stories of people in private insurance, that is as 
tragic a story as you will ever hear. We have these letters I have read 
and these stories from Senator Whitehouse, Senator Bennet, Senator 
Udall, who have come to the floor and read these letters from people 
who thought they had pretty good insurance and something

[[Page 24462]]

happened and they lost it because they have gotten too sick or they 
lost their job and they can't afford COBRA and all that.
  I want to ask the Senator a question. You mentioned early in your 
comments about the costs going up. I want to put this chart up and ask 
about this. Senator Bennet from Colorado will speak in a moment. These 
are costs under Medicare Advantage. The government, as you know, 
provides, in large part because of insurance company lobbying, plain 
and simple--the government provides all kinds of subsidies to Medicare 
Advantage plans.
  These are not most of the Medicare beneficiaries. Most Medicare 
beneficiaries, 75 to 80 percent of them, are in what is called regular 
fee-for-service Medicare. Some are in a more privatized Medicare. The 
government writes checks to insurance companies. You can see how 
insurance companies have extracted more and more taxpayer dollars as 
their salaries have jumped and jumped. The poster that Senator Udall 
was showing, that I showed earlier, the executive salaries of Cigna and 
Aetna and these companies have gone into the tens of millions of 
dollars, in some cases. These subsidies--in 2004 they got $4 billion; 
by 2005, $5 billion. Now the insurance companies basically get a check 
from the Federal Government for $11 billion.
  Talk for a moment, if you would, Senator Casey, about what if the 
public option is competing with these insurance companies. What will it 
do to these costs as these insurance companies continue to extract more 
and more money, with their lobbyists, from the government, as they have 
tried to privatize Medicare?
  The public option, talk about what it would do about cutting costs so 
people like your friend in eastern Pennsylvania--those kinds of things 
don't happen to them.
  Mr. CASEY. I think it stands to reason if you have, as we do in a lot 
of States, one or two or a very small number of insurance companies 
that dominate the marketplace, sometimes a lot more than 50 percent of 
the marketplace but in other cases--in our State we have two that have 
control over at least half of the marketplace. That alone is bad 
enough.
  Mr. BROWN. In this poster--we talked about it earlier; Senator Udall 
mentioned it too--some States, yours and mine are a little bit better. 
In some States--Montana, Alaska, Hawaii--lets go down to Minnesota, 
Iowa, Arkansas, Alabama, Maine--two companies have more than 80 percent 
of the market. Two companies control 80 percent of the market, which 
means there is no price competition. In some States it is 70 to 80 
percent, in Ohio, Pennsylvania, Rhode Island--I am sorry Rhode Island 
has two companies more than 80 percent also. In all, about almost 10 
States.
  But in our States--Pennsylvania, Ohio--large States, States with 
populations over 10 million people, each of those has more than 50 
percent. In my State one company has 41 percent; the two largest 
companies have 58 percent. In Pennsylvania, two companies also have 
more than 50 percent.
  Mr. CASEY. It just stands to reason. If you don't have competition, 
you have no incentive, no pressure to keep your rates at an affordable 
level. I do not understand why anyone, in the midst of this debate, is 
against choice and competition. Both are the central pillars of why we 
need a public option. What do we do for our health care system? I don't 
understand the logic.
  One point we should make, and we address it in the bill--we will not 
spend a lot of time on it--we should all remember, you look around, we 
have 100 Senators. Everyone in the Senate, and all of our families, 
everybody in the House, and then you add other millions of Federal 
employees, we have a pretty good deal because we have a system where, 
as I look at some of the features of the public option, we have a 
pooled purchasing power.
  If you have millions of Federal employees and their families who are 
in the same pool, that brings costs down. We are trying to get more and 
more Americans the same opportunities we have, to be in a pool that big 
and to keep costs down. For the life of me I cannot understand why 
someone would not like that, especially people who benefit from it and 
their families who benefit from what the Senate gets.
  I have been blessed to have that kind of coverage because I happen to 
be in the Senate. But every seat here, and then add millions more 
Federal employees, gets this opportunity because we are in a large 
purchasing pool. I don't know why a small business owner should not get 
the same opportunity, a business owner paying through the nose.
  I know Senator Brown has seen this in the State of Ohio. You have 
heard from small business owners, time and again, haven't you, about 
what they are paying every day? What we are saying is, if it works for 
and if it is good enough for Federal employees to get the lower cost/
benefit of a large and open purchasing pool, why isn't it good enough 
for the rest of America?
  I say it is not only good enough for them, but we should make sure 
they have the same opportunities as small business owners or as part of 
a family. That is one of the reasons the public option makes lots of 
sense.
  Mr. BROWN. Let me read a note from a small business person. I get so 
many letters from small businesses. You know, like most Americans, they 
care enough about their employees, their fellow employees, their 
friends, they want to provide insurance. Almost every small business 
person I have talked to who is struggling with health insurance wants 
to find a way to pay for insurance for her or his employees, and so 
often they can't.
  Let me read a letter, Kathy from Crawford County, which is Bucyrus, 
Gallion, Crestline, just west of where I grew up. She says:

       I am the owner of a small telephone contracting firm. 
     Needless to say, we've been hit hard by the recession.
       But our main concern is the staggering cost of health care 
     for our employees. We started the company in 1990 when we 
     were able to fully pay for health insurance for our 
     employees.
       But since 2000 our premiums have increased over 250 
     percent. In 2008 our increase was 37 percent. In 2009, it was 
     24 percent. We have searched for other health insurance 
     companies but because of the pre-existing conditions of [some 
     of] our employees we cannot switch to anyone else.
       Along with the economy, the cost of health care makes it a 
     challenge to stay in business.

  This happens too often. That is why in the legislation we wrote in 
the Health, Education, Labor, and Pensions Committee, we made special 
provisions for small businesses. If you have 20 people or you have 5 
people, if 1 of them gets very sick and costs the pool of 15 or 20 
people exorbitant amounts of money, the insurance company either raises 
premiums so high--increases, as Cathy said, 37 or 24 percent--or the 
insurance company sometimes cancels the insurance. Either way, it is a 
terrible hardship and a tragedy for the small business and a tragedy 
for so many employees.
  If we do this right, we enlarge the pool by allowing these insurance 
companies to go into the insurance exchange or the public option, if 
they choose--an option. They also get a tax credit. They get a break 
that way and they are much more likely to be able to afford their 
insurance.
  Let me turn to Senator Bennet, who is a new member of the Health, 
Education, Labor, and Pensions Committee. He has been outspoken for the 
public option. Senator Bennet?
  Mr. BENNET. Mr. President, I actually am here to talk about something 
else, but I was so inspired by what the Senator from Pennsylvania and 
the Senator from Ohio and the others have said, I want to spend a few 
minutes on this issue. Part of it is I just don't understand what 
Washington doesn't understand about what our working families and small 
businesses are going through.
  In my State over the last 10 years, median family income has actually 
gone down by $800 in real dollars. The cost of health insurance 
premiums have gone up 97 percent during the same period of time.
  There are people who want to leave the system just the way it is, but 
the result of having flat income for our working families and small 
businesses, and for those costs going up 97 percent--by the way, in my 
State the cost

[[Page 24463]]

of higher education has gone up 50 percent at the same time. The cost 
of health insurance, up 97 percent; the cost of higher education up by 
50 percent--this is tough on the middle class. It is tough on small 
business owners in my State.
  The result is, if we keep the status quo--there is a great irony of 
the arguments to keep the status quo--by default, we are putting more 
and more people off private insurance and more and more people either 
on public insurance or having the benefit of uncompensated care.
  We have seen in my State, you can see it on this chart--probably not 
all that well--small business spends 18 percent more for insurance than 
large business just because they are small, and fewer and fewer people 
in Colorado are able to get coverage at work. Before this recession 
started it had already dropped roughly 10 percentage points; the 
percentage of folks who were getting insurance from their employer, 
from our employer-based system. You can see, the Senator from Ohio 
certainly can see, the percentage of small businesses in my State able 
to offer health insurance has declined dramatically.
  Where do these people go? They either end up on Medicaid or they end 
up showing up in the emergency room where they are treated with 
uncompensated care, the most expensive way we can deliver health care 
in the United States of America.
  We have a wonderful public hospital in Denver called Denver Health, 
where they do an amazing job at a much lower cost than a lot of other 
hospitals.
  I was told by the woman who runs the hospital--her name is Patty 
Gabow, a gifted administrator--that they had done a study and they 
discovered they had spent $180 million in 1 year on uncompensated care 
for people who were employed by small businesses. These were not 
unemployed people, these were not people who could have had access to 
Medicaid, but people employed by small businesses who could not afford 
health insurance.
  So I think one of the ironic things about the debate we are having is 
the failure to recognize that the status quo is creating a situation 
where fewer and fewer people have private insurance and more and more 
people are moving into public insurance. But it is not being done in a 
thoughtful way. It has not been constructed that way. So I think that 
is one of the reasons it is very important that we are having this 
debate.
  I tell the Senator from Ohio, I am sure he had this reaction when he 
was on recess. I certainly did. I had townhalls all over the State. 
What I kept hearing from people is this, and this is the reason I 
support a public option. They would say to me: Michael, we paid every 
single year, year after year after year, into private insurance. Every 
year, we did what we were supposed to do, and then when we needed it, 
it was not there for whatever reason. Because somebody on the other end 
of the telephone told them: You are not covered, or the fine print did 
not cover you for that problem or your child for that problem. They 
deeply resented the fact, as I would, that someone earned a profit off 
that commercial transaction.
  That is the thing about insurance. It is not like going to the store 
and buying a loaf of bread or a gallon of milk where you know what you 
are getting in return. Many people who buy private insurance year after 
year don't know what they have until they need it and they don't know 
what they have lost until they lose it.
  Having a choice, just another option that is out there, not a 
government takeover of health care but a choice that empowers working 
families in my State to make the decisions that are in the best 
interests of their family or their children--as a father of three 
little girls under the age of 10, I can understand why people would 
want that choice. I am not scared by the choice. We have to design it 
properly, and the HELP Committee did a very good job designing it, in 
answering a number of the charges that have been made against it. We 
may be able to do a better job in the final legislation.
  The final thing I am hearing from people in Colorado is: If you are 
going to mandate that we have insurance, if you are going to require 
that we have insurance, you better make it affordable. You better not 
tell me I have to have insurance and make it unaffordable. You better 
not tell me I have to have insurance and I have to change the plans I 
have for my family.
  The public option provides one more choice for people, an affordable 
choice for people. We have to do a lot more to drive down costs, as I 
and others have talked about on this floor. But we need to do this 
right.
  I understand, I come from a State where we have a lot of diversity of 
opinion on a lot of things, and there is a lot of concern about the way 
the system works today, and there is a lot of concern that we are going 
to make it even worse. I think we need to elevate the standard of the 
discussion we are having to the standard that we had, that the people 
of Colorado had in townhall after townhall, which, by the way, no one 
would ever have any interest in putting on TV, I am proud to say. We 
need to elevate the standard of the discussion in Washington so that we 
can produce a result that has something other than double-digit cost 
increases year after year for working families.
  Mr. BROWN. Will the Senator yield for a question? I heard what you 
said about buying a loaf of bread and how buying insurance is 
different. Before you were in the Senate, you were the superintendent 
of the Denver public schools and were very successful in business 
before that. When you talk about how insurance companies deny care and 
insurance executives get paid well, talk for a moment about the 
business plan. When you were an entrepreneur and you were a 
businessperson, you obviously had a business plan. Talk to us. Share 
with Senator Udall and me and others what the business plan of a health 
insurance company is in particular.
  Mr. BENNET. I appreciate the question. I will say that I used to make 
my living buying bankrupt companies. So these were companies that were 
actually fairly well managed but capitalized really poorly, and our 
opportunity was to buy them, capitalize them properly, produce a 
business plan, as you are describing, and make sure the people who 
worked for them, the people who benefited from them continued to be 
able to do that.
  You know, as a capitalist, I look at the state of our health 
insurance industry and our health delivery system and I can almost not 
believe what I see. We have 44 counties in Colorado. Every one of those 
counties has a convenience store, at least one, some many more than one 
but at least one. With the exception of the loose beef jerky that is on 
the counter, there isn't anything in there that doesn't have a barcode 
on it. It is 1970s technology that our small business owners in 
Colorado know is critical to managing their inventory, critical to 
allowing them to be competitive and giving their customers what they 
need.
  Only 3 percent of hospitals in this country have that technology. One 
out of every 25 doctors has that technology, which is a really simple 
thing. And it is the reason why--as a parent of three little girls or 
if you are caring for a parent of your own, it is so frustrating when 
you go in and you have to explain over and over again what the last 
person just told you simply because we don't have a system of 
electronic medical records.
  Then, on top of that is a business model where, unlike everything 
else in our society, every year the cost goes up and the quality to the 
customer goes down, which is what we see with insurance. We don't see 
that in other parts of our private marketplace. We don't see that in 
other parts of our private marketplace where people are incentivized to 
compete on price, on quality, on customer service. And it is why it is 
not just enough to have a public option. We need a public option, but 
we also need commonsense regulation of insurance so that we start 
driving a marketplace that actually makes sense.

[[Page 24464]]


  Mr. UDALL of New Mexico. Senator Bennet, one of the things that is 
happening--and your chart there really explains it, and I wanted to get 
you to talk about this a little bit--your chart says: Rising health 
care costs are hitting small businesses the hardest and forcing all 
Colorado businesses to make tough choices.
  That is exactly what is happening in New Mexico, exactly what is 
happening in Ohio. And really what we have going on here is very hard-
working, good small businesspeople who want to give their employees 
insurance. I hear that. I know the Senator from Ohio said that a number 
of times when he read letters. They want to give that insurance, but 
they can't. They search around, they can't find policies they can 
afford, and so they are really stuck. And I can give you a list of 
examples in New Mexico.
  One of the things you pointed out on your chart is that even before 
the recession--even before the recession--fewer Colorado small 
businesses could offer coverage. I was wondering if you could talk a 
little bit about the small business situation because most of these 
people are working without insurance.
  Mr. BENNET. I appreciate the Senator from New Mexico raising that. I 
remember a florist I talked to, a family-owned business since 1972 in 
my State, and he is now down to no employees, just his wife and 
himself. They are running the shop. They had health insurance for many 
years, and they took it, as so many small businesses do, as an article 
of faith that part of their job was to offer insurance to their 
employees, to make sure their employees had the benefit of insurance. 
Now they are the only two employees. There is no one working for them. 
They do not have health insurance themselves.
  Their daughter has been admitted to the University of Colorado. He 
said to me last week: Michael, what was she supposed to do when she got 
to the box that said check the box if you have health insurance? If you 
don't, you have to pay this terrible fee.
  So, first of all, people are having to make choices they should not 
have to make and they would not have to make in a rational private 
market that was working well. That is one of the issues.
  The second thing is, as you know--I am sure it is true in New Mexico, 
and it is certainly true in Ohio--most of our jobs are created by small 
businesses. Depending on the numbers you look at, roughly 70 percent of 
our jobs are created by small businesses. And a higher percentage of 
those jobs are going to be responsible for the recovery that hopefully 
we are about to have in this country. It is harder and harder to do 
that if you are carrying the freight of double-digit cost increases in 
insurance every single year.
  The last point I want to make--every small business owner understands 
this--as small business owners try to hang on to insurance for their 
employees and the price of that goes up and up, what that leads to is a 
choice between holding on to the insurance and compressing the wages of 
the employees because you can't do both. You can't give people the 
increases they deserve in their compensation and at the same time hold 
on to health insurance. So that is a reason we have seen all across 
this country, actually, a decline in median family income. It has gone 
down by $300 over the last decade in the country, $800 in my State, 
while the cost of insurance has gone up by 97 percent. That wage 
compression is directly linked to the problems people have holding on 
to insurance.
  I appreciate the question. I yield.
  Mr. BROWN. I thank the Senator from Colorado for his good work and 
his very good description particularly of how the cost of health care 
affects small businesses in such a negative way.
  We will wrap up in the next 10 or 15 minutes.
  Earlier today, a group of Democratic women Senators came to the 
Senate floor to talk about health care. And some of the things that 
amaze a lot of us as we work through this, some of the things we hear--
in several States in this country, being a victim of domestic violence 
is considered a preexisting condition. There are women in this country, 
believe it or not, who have been victims of domestic violence. 
Insurance companies have said: You cannot get insurance because of that 
because, presumably, you might be abused again, you might be hit again, 
and it would cost us, the insurance company, far too much money. So, 
believe it or not, they actually can't get insurance because of that. 
Obviously, this legislation makes that--as Senator Casey says, there 
will be no more preexisting condition denials of care, no more 
discrimination based on gender, based on geography, based on 
disability, based on age.
  One of the other things the bill does that is important is it will 
eliminate copays for things such as mammograms. We want people, 
particularly when they get to be my age, when they are in their 
fifties, we want people to go in and get the right kind of preventive 
care and get the right kinds of tests. People should have a colonoscopy 
when they are 50, and people should be tested by mammography and should 
have mammograms and all of that. I mean, none of us probably goes in as 
often as we should for the preventive care and the tests, but an awful 
lot of people would like to do that and simply can't because of the 
cost.
  This legislation would say: If you are going in for something like a 
mammogram or for something like a colonoscopy, there will be no copays. 
It will encourage people to get into the system. Then, if they are 
diagnosed with cancer, they are diagnosed typically in the early 
stages, and it is certainly more likely to save their lives, and it is 
much less expensive as a result of going into the system earlier. So it 
ultimately saves us money by telling insurance companies: You are not 
going to do that anymore.
  That is so clear to me, that if we are going to do this right, we 
need to make sure women are treated better by this system, no longer 
preexisting conditions and all that.
  I will close and then turn to Senator Udall or Senator Bennet, if 
they would like.
  I have another letter I got--exactly what I was talking about.
  Darlene from Mahoning County:

       I lost my job in May 2007 after 27 years with the company. 
     For a while, I did not have any health problems. I paid for 
     private coverage with my unemployment check and savings. 
     Within the last year, I started having medical problems. I 
     was diagnosed with diabetes. I had back surgery in July to 
     relieve severe back pain. I now have to pay premiums with my 
     savings. When my savings run out, so will my insurance. 
     Please do something to help.

  She is not yet eligible for Medicare.
  So many of these letters just cry out: I am trying to get through the 
next year or the next 3 years, the next 6 years, whatever, until I am 
eligible for Medicare, I am just trying to get through. And it really 
is a call for help, and it really is a plea from people in my State, 
people in Warren and people in Bellaire and people in Gallipolis and 
people in Crestline: Please help us in these years when we are in our 
late fifties, early sixties. We are going to be in Medicare pretty 
soon. We know Medicare works for us. We know this government program 
works, a program that doesn't look much different from the public 
option. But I need just a few more years. It is a time in my life when 
I am starting to get more aches and pains or worse. It is a time in my 
life when I am much more likely to get sick, to get an expensive 
illness, when I am 56, 58, or 63.
  These are people who know they will be embraced with a decent health 
care system. They know they will be in a decent health care system when 
they get to Medicare age, when they get to be 65.
  They have friends who are in Medicare, and they know Medicare works 
for them. That is as good a testament to the public option as there is. 
Those are the kind of letters I am getting from people saying: Please 
include a public option. I am 58 years old. I am not yet eligible for 
Medicare. I was diagnosed with diabetes. I need to do this; I need to 
do that. That is what is so very important about the public option.
  I yield to Senator Udall.

[[Page 24465]]


  Mr. UDALL of New Mexico. One of those charts you put up over there 
emphasized the point of competition in the marketplace and how much we 
need competition. We joined together with the majority of our 
colleagues in the caucus to sign a letter to our leadership. I think 
one of the paragraphs in this letter is particularly persuasive. The 
Senator's signature is the No. 1 signature on this letter, but we 
wrote:

       Opponents of health care reform argue that a public option 
     presents unfair competition to the private insurance 
     companies. However, it is possible to create a public health 
     insurance option that is modeled after private insurance. 
     Rates are negotiated and providers are not required to 
     participate in the plan. As you know, this is the Senate HELP 
     Committee's approach.

  This is the public option we are talking about that was passed out of 
the Kennedy committee and is available to be inserted in the bill on 
which we are going to vote.

       The major differences between the public option and for-
     profit plans are that the public plan would report to 
     taxpayers, not to shareholders, and the public plan would be 
     available continuously in all parts of the country.

  So small businesspeople in New Mexico would have an opportunity to 
get into this public option insurance plan.

       The number one goal of health reform must be to look out 
     for the best interests of the American people--patients and 
     taxpayers alike--not the profit margins of insurance 
     companies.

  We have to get competition into the market. We know that health 
insurance markets are effective monopolies or in some cases duopolies. 
In New Mexico we have two companies that hold 65 percent of the market. 
There is no incentive for competition. There is no incentive for lower 
cost. In fact, what we do under the law is, we allow these insurance 
companies to be exempted from antitrust laws. For most of the other 
businesses in America, we have those antitrust laws out there, and the 
Justice Department and various State attorneys general can move in to 
bring competition when there gets to be too much consolidation of 
power. We don't have that when it comes to insurance companies. As a 
result, we see premiums skyrocket; in my home State of New Mexico, 120 
percent skyrocketing premiums.
  As I wrap up, I want to talk about a New Mexican, a woman from Raton. 
I met her at a townhall in August. She received a renewal notice. Her 
premium had gone up 24 percent alone this year. She can't afford an 
increase, but she doesn't have any other option. A public option would 
bring that woman the ability to get into a health care plan and take 
care of herself. That is what you and I are fighting for. We are going 
to keep doing this. We are going to keep doing this because we have a 
lot of days to keep pushing forward. We will make this happen.
  With that, I know the Senator has a couple more things to say. You 
should show the Presiding Officer Alaska on that map. What does it say?
  Mr. BROWN. More than 80 percent of insurance is controlled by two 
companies in Alaska. That is a pretty compelling case.
  I thank Senator Udall and also Senator Bennet from Colorado, as well 
as Senators Sanders, Whitehouse, Casey, Merkley, and Stabenow. It shows 
the breadth of support for the public option because it injects 
competition into the system. It will keep the insurance companies 
honest, and it will bring pressure to keep prices down.
  My last 5 minutes I yield to Senator Bennet who has a sobering issue 
he wishes to discuss.
  Mr. BENNET. Mr. President, I thank the Senator from Ohio for letting 
me have the last 5 minutes.
  (The remarks of Mr. Bennet are printed in today's Record under 
``Morning Business.'')
  The PRESIDING OFFICER. The Senator from Oklahoma.
  Mr. COBURN. Mr. President, I listened very patiently to the last 2 
hours about why we need a government-run plan. I want to concur with my 
colleagues about the problems in the insurance industry. There is no 
question they are great. But the reason the problems are great is 
because there is no real competition today. The rhetorical question is, 
you can't have it both ways. Nobody wants it both ways. The fact is, I 
saw this on the Internet this week. I thought it was appropriate for 
where we are. Here is a youngster walking on a street. She says:

       I'm already $38,375 in debt and I only own a doll house.

  Everybody agrees we have a too costly health care system. Everybody 
agrees we need to fix that. What we don't agree on is how to fix it. We 
have heard 2 hours of what is wrong with the private insurance industry 
that has not been allowed to be competitive, has not been forced to be 
competitive. And yet the answer to that question is that we want the 
government involved. The Senator from Pennsylvania talked about all the 
government programs. Sixty-one percent of all health care today comes 
through the government. Every government program is over budget, 
associated with fraud, and ineffective in its implementation on a cost 
basis. That doesn't mean we want to get rid of them. It means we want 
to make them better. The real problem with having the government do 
more is, right now 43 cents out of every dollar we are spending we are 
borrowing. We create a government plan. We put $60 billion into it, and 
we can create competition. But we don't have competition now. Everybody 
agrees with that. Nobody denies that we don't have good competition. 
But we don't have good competition because we have failed to act.
  The Senator from Ohio showed a chart of CEOs' pay. If they were 
having to compete, that pay wouldn't be there, especially not at that 
level. I don't disagree with that. But the way to control that is real 
competition. Forty-three cents of every dollar we spend this year we 
will borrow. And it will be worse next year. It will be 45, 46 cents 
next year of what we spend we will borrow.
  This picture doesn't talk about what she owes. This is just what the 
debt is now, just the $11.8 trillion. What she owes is another 
$400,000, because we are paying out of Medicare what we have never 
created the tax base to fund. So in fact what we are doing is, we are 
going to charge this little girl for our Medicare. The impact of that 
is when she was born she owed $400,000. By the time she is 20, she will 
owe $800,000. What will happen to her?
  There is no question we have positive benefits with Medicare. There 
is no question we are taking care of people who can't take care of 
themselves through Medicaid. There is a question of how effective we 
are doing with Native American tribes in terms of that. We are seeing 
improvements in veterans health care. We have all these different 
programs that are run through the government. So when you only have 39 
percent of the health care in the country to put into the market, it is 
going to be very difficult to lower costs.
  What is the problem with health care in America today? The problem is 
cost. It is too expensive. It is about 40 percent more expensive here 
than anywhere else in the world. Why is that? Well, there are a lot of 
reasons for it. But the first reason is, we will not allow real markets 
to develop in the health insurance industry. We have stopped it. And 
now we come and say: We are unhappy with it, so we want to create a 
government plan--a government plan that will compete.
  I do not have any problem if you create a government plan if you fund 
it and make it competitive. But that is not what we are going to do. 
Because what we are going to do with a government plan is we are going 
to turn it into another Medicare. It will supply people health care. It 
will lower their costs. But we are going to transfer the cost to this 
little girl. It is just $440 billion spent on Medicare this year, of 
which $80 billion of it was fraud.
  So the problem is, which solution do you think works better? Do you 
think we have the history that says government-run health care is 
efficient and effective and, therefore, we ought to do more of it or 
should we say: We know what works in the rest of the industries and 
markets in this country. Maybe we ought to allow markets to truly 
compete--which nobody wants to do--to force the insurance industry into 
a competitive structure where you can actually see what you are getting 
and you can see what you are paying.

[[Page 24466]]

  The other problem about this little number is, not only does she have 
$38,000 in debt right now, and another $800,000 when she gets ready to 
buy her insurance, we are going to tell her what she is going to buy. 
We are going to take the freedom away from her to decide what is best 
for her and her family. Then we are going to yoke her with a whole 
bunch more taxes.
  There is no disagreement in this body that we need to make changes in 
health care; and the assumption that anybody would say that is 
absolutely erroneous and fictitious. We recognize that. The question 
is, which way do you fix health care? Do you fix it with a government 
that is bankrupt already, that has stolen the future from the next two 
generations, and add more on to them or do we get common sense back in 
and say: Well, first of all, we can eliminate 8 percent of the cost if 
we have good tort reform in this country because 8 percent of the cost 
of health care is defensive medicine.
  I read a study this week. It is interesting--and I have some passion 
about this because I have been on the end of those lawsuits--I would 
note that the vast majority of those who have been discussing health 
care for the last 2 years are lawyers. They are not doctors. They never 
laid their hands on a patient. They never stayed up 20 hours in a row 
to take care of somebody who needed them. They have all the answers, 
but they have never been in health care.
  Here are what the numbers are on malpractice lawsuits in the United 
States: Eighty percent of all the cases that are filed are thrown out 
of court. Of the remaining 20 percent, 89 percent are thrown out of 
court. So 3 percent of the cases are legitimate in this country. What 
do you think that is costing us? And we ignore it? We are not even 
going to talk about the fact that we have an extortioned service going 
on in health care that does not cost the lawyers a thing? It costs 
everybody else in this country billions of dollars a year because we 
are doing tests that nobody needs, except the doctors to defend 
themselves. And that is $200 billion a year out of $2.4 trillion. That 
is what the number is.
  So when less than 3 percent of the people--and I am all for 
compensating people who are truly injured. I have no problems with 
that. As a physician practicing over 25 years, there is no question I 
have made mistakes. There is no question. There are no doctors who are 
perfect, and, consequently, sometimes people are injured because of 
doctors' mistakes. Most of the time they are not. And it is not about 
not compensating the injured. It is about changing the mindset in this 
country that you can extort people into settling when you have no real 
claim, and that is what is going on with 85 to 90 percent of the cases.
  So the answer for health care is: controlling costs. So how do we 
best do that? It is interesting, we have had the accusation that there 
are no other plans out there. My colleague from North Carolina and I 
introduced the first plan in Congress for health care.
  What does it do versus what the Baucus bill or the public option bill 
will do, according to CBO? We cover 94 percent of Americans--identical 
to what the Baucus bill does. So 94 percent of all Americans will get 
covered under our bill. We save the Federal Government $70 billion in 
the first 10 years, close to $1 trillion in the second 10 years.
  What does the Baucus bill do? It saves $88 billion, and nobody knows 
what it is going to save after that. But it costs the States billions. 
Our bill saves the States, in the first 10 years, $960 billion. We 
cover more people, with no increase in the cost to the Federal 
Government, versus a marked increase in the cost to the States by the 
Baucus bill, or by the public option plan.
  It eliminates preexisting condition. We all agree we need to do that. 
Nobody is fighting that. The question is, how do you do it? Do you do 
it in a competitive model that costs insurance companies pain if they 
are not covering the people properly? And if, in fact, there is an 
incentive to cover preexisting conditions, then you have an incentive 
for the insurance companies to invest in the management of chronic care 
rather than ignore covering somebody.
  I do not deny there is cherry-picking going on right now, but it is 
only because we allow it. We do not have to allow it. But the answer 
does not have to automatically be another long-term, bankrupt plan run 
by the government. Nobody can deny the $95 trillion, 100-year unfunded 
liability for Medicare. That is GAO, that is CBO, and that is the 
Medicare trustees. You cannot deny that.
  So we have a program that seniors are fairly happy with, except the 
Baucus plan is going to cut a half a trillion dollars out of it. But we 
cannot pay for it. So we are not doing anything to drive that cost 
down, to drive in efficiency. What we are going to do is create more 
government, to have another plan that is going to get in the same shape 
as Medicare.
  We all want the same thing. We want to get everybody covered in this 
country. We want the cost of health care to be affordable. And we do 
not want to bankrupt our children. We have already bankrupted them. So 
the danger of having a government-centered, government-centric, 
government-run, government-devised, government-managed health care 
program--just by history, look at what we have done.
  Medicaid costs tons more than it was ever supposed to cost. SCHIP 
costs tons more than it was ever supposed to cost. Medicare costs tons 
more than it was ever supposed to cost. Indian health care--it does not 
cost more because we just let them suffer. We do not put the money into 
it. VA costs tons more than it was ever supposed to cost. TRICARE costs 
more than it was ever supposed to cost. They are all government 
programs. They are all way over budget.
  So the question the American people ought to ask is: If we all want 
to get everybody covered, and we all want to drive down costs, does the 
government have a track record that says it has done that? No. As a 
matter of fact, it has done the opposite of that.
  So it is not a matter of whether you trust in government. We have 61 
percent of health care running through government. And as a physician 
who has practiced for over 25 years, I will tell you, it is my opinion 
the reason costs are out of control is not because of the insurance 
industry--and I am not a defender of them; as a matter of fact, I hate 
them about as bad as I hate anybody telling me what I am going to do to 
my patient--the problem is, we have directives coming from the 
government that have disrupted the market in health care and created 
this tremendous differential.
  The other difference that we have in the Patients' Choice Act is that 
we do not put another burden on the States, which all these bills do. 
The States are swimming in debt. They are struggling to stay ahead, and 
we are transferring billions, almost--we are transferring trillions of 
dollars of expense to the State. We are making it nice for four States. 
We have picked four States and we have said: You don't have any cost 
the first 5 years. We just, out of the hat--because they are having a 
little worse economic time than others, we have said: You don't have 
it. But for the rest of the States, it is the mother of all mandates, 
and they will never be able to afford it.
  There is also another little sneaky provision in the bills--both in 
the HELP bill, the House bill, and the Baucus bill--which is, we know 
we are not going to cut doctors' fees 21 percent. The Presiding Officer 
would agree to that, the Senator from Colorado knows we are not going 
to do that. But we are not going to recognize it. We are not going to 
recognize that cost. So we are playing games with the American people. 
We are saying: Here is what it costs, when we know it is going to cost 
a lot more than that because we know we are not about to do that. But 
we do not have the courage to admit that. We do not have the courage to 
ask for an honest score.
  The other difference is, we empower patients and States, not 
bureaucrats. We preserve the right, the inherent individual liberty 
right, of an individual to decide what is best for them rather than 
having the government decide

[[Page 24467]]

what is best for them. In our bill, 9 out of 10 Americans get a tax 
cut.
  So let me draw the parallel again. We do not have a government-run 
program. We save the Federal Government money. We save the States $1 
trillion. We get more people covered than any other plan that is out 
there. Nine out of 10 Americans get a tax cut. We eliminate preexisting 
illness. And we bend the cost curve down considerably.
  And, oh, by the way, we do not destroy innovation in health care, 
which is 75 percent of the innovation in the world, which will go away 
if any of these other plans are instituted--the incentive to put 
capital at risk to create opportunity for medical innovation.
  There is a lot I could say, but I think what I would like to do is 
yield to my colleague from North Carolina in terms of someone who has 
been with me, who knows health care, who has been from the start 
working with us to try to put forward a plan that says we can 
accomplish this same thing and save tons of money.
  Mr. President, I yield to my colleague from North Carolina.
  The PRESIDING OFFICER. The Senator from North Carolina.
  Mr. BURR. Mr. President, I thank the doctor from Oklahoma, my 
colleague, my friend. Let me say from the start, 3\1/2\ years ago, Tom 
Coburn and I sat down and realized health care was unsustainable at its 
current level of investment.
  The American people have complained because they have seen a process 
that has gone too quickly. Well, in the Patients' Choice Act you find 
3\1/2\ years worth of work--a bill that was designed to take 4 years 
before we thought we had the right information we needed to do health 
care reform adequately.
  With the change in the administrations, the new President and his 
timeframe, we accelerated it. But let me say, right from the start, it 
is unsustainable at its current level of investment. It is 17 percent 
of our gross domestic product. Health care has to be reformed.
  I personally believed the debate we were going to have in Washington 
was over what type of reform. Dr. Coburn raises a good point: cost. 
Where are we from the standpoint of our Nation?
  I happened to gaze, as I was waiting for the last speakers to finish, 
on the page of this publication. It says: Baucus Bill Projected at $829 
billion. In the small box down at the bottom of the page--CBO: Deficit 
Hits Record $1.4 trillion for Fiscal Year 2009.
  Common sense would tell you that when you are in the type of 
financial shape the United States of America is in, not only do you 
stop spending, you begin to look for ways to curb spending and a way to 
invest to reduce the deficit. Because the deficit is what our children 
and our grandchildren will inherit. If you believe it is unsustainable 
at its current level of investment, then you sort of understand where 
Dr. Coburn and I are coming from.
  The worst place we can start is: How much more money do we need to 
spend to do health care reform? But the truth is, the Baucus plan is 
not health care reform. It is health care expansion. The debate in 
Washington is not about how to reform health care. It is about how to 
expand health care. And once you determine the pool you are going to 
expand it to, the $64 million question is: How do we pay for it so the 
CBO says we have paid for it?
  What I would like to do is spend a little bit of time exploring how 
the Baucus plan pays for it with the caveat up front of saying--as it 
relates to Dr. Coburn and myself--we don't believe we have to spend 
more to reform health care. I think from what he said about the 
Patients' Choice Act, we have made the point. We were the first two 
people in the Congress--House or Senate--to introduce comprehensive 
legislation. We cover the same amount of additional Americans that the 
Baucus plan covers. We do it without making additional taxpayer 
investments in the expansion of coverage. Why? Because in addition to 
expanding coverage, we reform health care. We actually bend the cost 
curve. We change the tax application to where it is fair and equal for 
all people.
  What we have to realize is, the Baucus plan is a 10-year plan. We 
collect revenues for 10 years and we pay out for the expansion in 6\1/
2\ years. Let me say it again. We are collecting tax revenues for 10 
years, but we are only paying benefit expansions for 6\1/2\ years. We 
have to look at years 10 through 20 if you want to see 10 years' worth 
of revenue collection and 10 years' worth of expenses. As a matter of 
fact, if you took the first 10 years and you applied what is done in 
the bill and said: Well, if they started making payments in the first 
year, this bill would actually cost $1.8 trillion, not $829 billion but 
$1.8 trillion.
  Incorporated in the Baucus bill are cuts to Medicare, cuts that equal 
$449 billion. Dr. Coburn talked about the imminent reduction to 
physician reimbursements: 21 percent projected. We all agree we are 
never going to make that. One of the attractions for health care 
professionals was the Baucus bill said in year one, we are not going to 
make those cuts. Well, they are going to cut Medicare over 10 years by 
$449 billion. This is giving with one hand and taking away with the 
other hand. Health care professionals around this country have realized 
that, even though their association that represents them doesn't.
  The Baucus bill cuts $117.4 billion in Medicare Advantage. My 
colleagues are probably saying: What is Medicare Advantage? Well, it is 
the preferred plan of 20 percent of America's seniors. Twenty percent 
of our seniors on Medicare have chosen Medicare Advantage, a private 
sector option to traditional Medicare, where they have looked at the 
two and they said: I would rather have Medicare Advantage, because when 
I go in the hospital, Medicare is going to charge me a $750 deductible 
right off the bat. Medicare Advantage? Zero. For traditional Medicare, 
you are going to have to have Part A, Part B, Part D. Medicare 
Advantage, you get it all as one lump sum. You don't have to make 
separate selections. They provide you the doctor coverage, the hospital 
coverage, the drug coverage all in one plan.
  Why is it under the target of some in Washington to cut $117 billion? 
They say it is because we pay 114 percent of Medicare per person 
allocations to Advantage, where we pay 100 percent in traditional fee 
for service. That is exactly right. I remember the debate we had in 
Washington when we did it. Because the objective then was: How do you 
get Medicare Advantage to offer this plan in rural America? To offer it 
in rural America meant you had to offer a greater reimbursement. This 
isn't reflective of a windfall for the insurance companies; it was an 
incentive to offer this choice not just to urban seniors but to seniors 
everywhere in America. In my State of North Carolina, 17 percent of all 
the Medicare beneficiaries are enrolled in Medicare Advantage. When 
anybody gets up and says pass this bill, the Baucus bill, and you can 
keep your health care if you like it, there is a caveat to that. Unless 
you are 17 percent of the seniors in North Carolina or you are 23 
percent of the seniors nationally, you lose your plan. You are going to 
go back into traditional Medicare. You are going to go back to where, 
when you enter the hospital, they are going to say write me a check for 
$750 annually; where your Part B is a separate payment; where your Part 
D is something you have to figure out as to which plan you want versus 
something that is seamless and covers everything. I will assure 
everybody a $117 billion cut to Medicare Advantage will eliminate that 
product from the marketplace. Nobody will offer it. Twenty percent of 
America's seniors will lose the insurance they prefer, not keep it.
  Medicaid expansion. It seems like a sensible way to go if you want to 
expand coverage, which is where the debate has been in Washington. 
Well, let's simply take a coverage tool that is out there today--
Medicaid--and let's raise the income limit so more people qualify for 
it. So instead of 100 percent of poverty, we raise it to 133 percent of 
poverty. It costs $345 billion. There is $33 billion in direct State 
spending. As Dr. Coburn said, four States are sort of split out of it, 
and they say: Well, we

[[Page 24468]]

are not going to charge you because you are in tough economic times. 
Well, North Carolina is at 10.8 percent. Why aren't we included? Our 
cost, when the Federal Government makes North Carolina ante up, is 
going to be south of $1 billion a year for a State that had a $4 
billion shortfall. Where is my Governor in her outrage at the proposal 
to expand Medicaid to 133 percent of poverty?
  The tough thing is, this plan has been sold that it is not going to 
cost anybody anything, and the truth is it is going to cost seniors, it 
is going to cost taxpayers, it is going to cost the unemployed but, 
more importantly, it is going to cost people who have health care 
insurance today. People who have the money to purchase theirs and 
people whose employer offers them health care, their cost is going to 
go up because of the restrictions and the mandates that exist within 
the Baucus bill.
  The Baucus bill would impose an annual $6.7 billion fee on insurance 
companies; $6.7 billion a year; over 10 years, $67 billion. So a $67 
billion new fee on the insurance companies that we are trying to make 
the American people believe are going to reduce premiums, reduce costs, 
and we are sticking them with a $67 billion pricetag. There is nobody 
in America when they hear this who believes that health care is going 
to go down for the American people. For every person who currently has 
a plan today, I will assure my colleagues their premium will go up. 
They will pay more money, not less money.
  We grow the IRS. There is something we haven't talked about because 
of the requirements in this bill to collect fees and to collect taxes. 
It is estimated by the Lewin Group that the IRS would need a 25-percent 
increase in their budget. The IRS currently gets $12 billion annually 
for their administrative costs. The administration costs for 
implementing the exchange subsidies would add nearly $40 billion from 
the Baucus bill. We have additional costs at the IRS because we have to 
increase by 25 percent the IRS requirements to go and collect and 
enforce this.
  We tax the chronically ill. I thought this one was one of those myths 
that late night TV talks about. We tax the chronically ill in the 
Baucus bill. Let me explain what I mean. Current law says that if your 
health care charges exceed 7.5 percent of your annual income, then you 
can deduct that off your taxes. Clearly, the lower your income, the 
more likely you are to utilize the 7.5 percent exclusion. So what does 
the Baucus bill do to raise money? It raises the exclusion to 10 
percent. Instead of at 7.5 percent of your adjusted gross income being 
able to deduct anything that exceeds that, it says you have to exceed 
10 percent of your adjusted gross income. For somebody who makes $1 
million a year, this is no big deal. They probably have more than 
enough insurance to take care of it. For somebody who is on a limited 
income; for somebody who maybe doesn't have all the insurance they 
need; for somebody who walks in and is chronically ill, has a chronic 
disease and they are making payments, they are covering their copays, 
they occasionally go to the hospital, they have that $50 charge for 
walking in the door, even though they have insurance. They are making 
it at the end of the year, even though they make $20,000 or $25,000 a 
year, and all of a sudden, 2\1/2\ percent of their adjusted gross 
income is no longer a deduction they get. What is that? That is taxing 
the chronically ill in this country.
  Listen, I have to give them credit. They have left nobody out of this 
bill from taxes. They have left nobody out of this bill from 
instituting a new fee. As a matter of fact, some of it we are going to 
have to take for granted is going to be applied to us in an indirect 
way because incorporated in the Baucus bill we collect a new device 
tax. To the heart patient who goes in and gets a heart catheterization, 
to the senior who goes in and gets a hip replacement, it is a device. 
For any medical device that is used, there is a $40 billion device tax 
over 10 years.
  What does that do for the innovation of new devices? Dr. Coburn can 
speak to it better than I can. When we were able to switch from open 
heart surgery to bypass surgery, we probably went from $40,000 or 
$60,000. When we were able to catheterize somebody and put a stent in, 
we reduced significantly the cost, we reduced significantly the 
invasion, we were able to raise the quality of life. We couldn't have 
done that if somebody hadn't innovated a cath and a stent. We would 
still be doing all bypass surgeries. You think through all the medical 
procedures we do in this country and you think about all the devices 
that have been created by companies and by doctors so they can be less 
invasive because they understand every time they go into somebody, 
every time they cut in, there is a fear of infection today; there is a 
consequence of recovery. It means a stay in the hospital is longer.
  When you see a new device enter into the marketplace, you actually 
see a new efficiency come into health care. You see reduced health care 
costs because you are taking either somebody out of an inpatient 
setting and you are putting them in an outpatient setting, or you are 
taking an inpatient patient and you are getting them out of the 
hospital faster. Actually, you could make the case that innovation of 
medical devices is health care reform because it is driving down costs, 
because it is moving patients out, and the net result is the quality of 
life goes up. But, in this bill, we raise $40 billion over 10 years, or 
$4 billion a year on taxes on devices.
  If you listen to the things I have talked about, you are probably 
sitting at home trying to figure this out: I am going to pay more in 
health care because they are taxing devices. I am going to pay more in 
health care if, in fact, I have a chronic illness because I am not 
going to be able to deduct that out-of-pocket cost that is between 7\1/
2\ percent and 10 percent of my adjusted gross income. I am going to 
have to cover, as a taxpayer, a 25-percent expansion in the IRS. They 
are going to impose a $6.7 billion so-called fee on the insurance 
industry, or $67 billion over 10 years, while I have an insurance 
policy, so that fee is going to be passed through to me as a covered 
life under the insurance plan.
  I am going to pick up, in the State in which I live, the increase in 
the limitations on Medicaid when we go from 100 percent of poverty to 
133 percent of poverty. How can you make a claim that this bends the 
cost curve? If you tried to make the claim, it bends the cost curve up 
not down.
  Dr. Coburn and I listened very intently as the President kicked off 
this debate: Create a program that provides coverage for as many 
Americans as we possibly could. We did that. Bend the cost curve down. 
Well, we make a direct investment in prevention, wellness, and chronic 
disease management--the only three direct areas of savings in health 
care. We can talk all night about tort reform and about different 
aspects. They are indirect and there are significant savings we can 
achieve by incorporating those reforms into health care.
  In the Patients' Choice Act, we elected to keep it narrowly targeted, 
and we invest in prevention, wellness, and chronic disease management. 
Why? Because we went to States, businesses, and self-insured companies 
that went 4 years and didn't have an increase in health care costs. 
Why? Because they changed the lifestyle of their workers. They actually 
paid their workers, in some cases, to quit smoking, to lose weight, to 
get exercise, or to take an education program on a chronic disease they 
had to make sure they got the treatment they needed.
  The net result? In every case, the per-enrollee savings were so 
significant that the companies continued to try to figure out how they 
could spend more to reduce health care costs. The quality of life for 
their employees was better. The productivity of the employees was 
better, and they had no annual increase in their health care costs.
  We are sitting here ignoring everything that has been learned in 
America by private self-insured companies and by some insurers who are 
doing creative things, targeting chronic disease, and actually paying 
doctors to educate.

[[Page 24469]]

We have ignored all of this. Why? Because we are having a debate in 
Washington with the Baucus bill about coverage expansion, not about 
health care reform.
  Coverage expansion costs a lot of money--$829 billion. We are having 
that debate and telling the American people this is about reform. If 
you read the fine print, the bottom of the page, and if you read the 
part they don't want you to remember, it says this year alone there is 
a $1.4 trillion deficit. That is $1.4 trillion we didn't have that we 
had to borrow.
  The last thing we need is more money in health care. It is 16 percent 
of our GDP, and we cannot maintain that level of investment. The 
challenge is on us to come up with the reforms that continue to invest 
and promote innovation, that expand coverage and, more important, 
reduce costs.
  What do the American people want? They want health care costs to go 
down, and they want quality to go up. We don't accomplish that in the 
Baucus bill, but you do in the Coburn-Burr bill. It is not perfect, but 
it heads in the right direction.
  I yield to my good friend from Oklahoma.
  Mr. COBURN. I thank the Senator. I am sitting here thinking, if I was 
sitting at home tonight listening to this, how do I hear the story that 
I heard for 2 hours on having a government-run plan and how bad the 
insurance industry is? As a physician, I don't like them a whole lot, I 
can tell you that. I don't like some of their tactics. I certainly 
don't like the way they cancel insurance policies on people. There is a 
lot about them I don't like. But I don't want to eliminate them. What I 
want to do is create a real market where they have to be savvy and 
compete and they have to be efficient and they have to help us help one 
another get well.
  We are going to hear a lot over the next month on health care. We are 
going to hear all these claims, much like we did from Congressman 
Grayson, who made an outlandish claim that my side of the aisle wants 
people to die. That is what was said in the House of Representatives. 
What I want is people to live. I want this little girl in the picture 
to live too.
  Do we have an unsolvable problem? No. Do we have ways of making 
health care costs much less in this country? Yes. Do we have ways of 
ensuring increased innovation and advanced disease prevention in this 
country? Yes. Do we have ways to protect this little girl in the photo? 
Yes. But the debate is over how we do that. One side says we do it by 
making the government a whole lot bigger--$1 trillion bigger, $3 
trillion bigger over the next 20 years. That is one side of the debate.
  Our side of the debate says this is inefficient health care. We want 
to cover everybody. We never want anybody to go bankrupt or to be 
denied care. We think you can do that without growing the government by 
25 percent. We think there are other ways to do it. We are honestly 
worried about our track record in Washington when we have a $1.4 
trillion deficit this year and a Medicare Program that is absolutely 
bankrupt--it will run out of money in less than 7 years from now, 
totally out of money--and we are going to be borrowing it all then. Is 
there another way to do it? So either we make a large jump in the size 
of the Federal Government and add to the $838,000 that this little girl 
is going to have, or maybe we can work together and say the insurance 
companies are bad, but can we keep something like that and make them 
efficient? Can we allow people to buy across State lines? Can we give 
people opportunities to buy what they want to buy rather than being 
limited? Do we trust people to make good enough decisions for 
themselves?
  The Baucus plan doesn't do that. It says we have three or four plans 
from which you get to choose, but we are going to tell you what you 
have to buy. And, by the way, you have to buy insurance in this 
country. Think about that.
  I carry with me a copy of the the U.S. Constitution all the time. 
Every bill out there has said you don't have liberty because the 
Federal Government is going to tell you where you have to spend your 
money. You have to buy an insurance policy. So if you make a quarter 
million dollars a year, it doesn't matter if you want to fund that 
self-insurance, it doesn't count. You still have to do that. If you 
don't, you are liable to a tax. If you don't pay the tax, a $25,000 
fine. If you don't pay the fine, you are in jail for a year.
  How do we get off telling people that and taking away that liberty, 
that freedom that is supposed to be guaranteed under the Constitution? 
The answer is, well, it is better for everybody because if we don't 
have everybody covered, then it is going to cost more because that is 
the big government answer to it. Maybe it will cost more if we force 
and drive competition, if we create transparent markets, where you know 
what something costs before you get it in health care. In fact, there 
is a real connection with the purchase of health care and the payment 
because everywhere we have tried that, it is working to control health 
care costs. But we refuse to do it.
  Frankly, the reason our idea is rejected, which is changing the Tax 
Code to treat everybody the same under the Tax Code, is because the 
labor unions don't want that to happen. That is exactly why. Everybody 
knows that is the problem. Everybody in the country knows that is the 
problem, but we don't have the political courage to face up to how to 
fix the problem.
  As soon as you make everybody the same under the Tax Code, you 
empower 35 million Americans who don't have insurance today to get it. 
You save the States $1 trillion over the next 10 years, and you give 95 
percent of Americans a tax cut, and guys like me will pay a little bit 
more for my health insurance and income tax. But we will not do that 
because the powers that deliver politicians to Washington are more 
powerful than the principles and the character to follow the pursuit of 
the Constitution.
  This little girl in the picture, and everybody like her in this 
country, is at risk today. We are going to have this great big debate 
and say how bad the insurance companies are and how bad the government 
programs are. But the fact is, we don't have a bipartisan bill. Our 
ideas were thrown out, 13-10, at both the Finance Committee and the 
HELP Committee--13-10, 13-10, 13-10--because the idea is they didn't 
want a compromise bill. They didn't want to solve the problems. They 
wanted their way or the highway.
  So, consequently, we are going to get a bill. I have no doubt. But my 
little Lucy right here and her football--she is going to lose her 
football. She is not going to have any little Lucys because she is not 
going to be able to afford them. She is going to be paying off her 
$800,000 worth of government obligations starting at age 20, and she 
will never climb out of the pit.
  So when America thinks about health care, there are a lot of ways to 
solve it. One is to trust what makes America great--granted, with some 
changes--or the other is to trust the government to create more 
government programs.
  I will just add this one point. Do you realize that in the bill that 
passed the HELP Committee there are 88 brandnew government programs--
88; 219 times we have held the Secretary of HHS to write in-depth 
regulations. Now, 88 programs interfering in health care are going to 
be problem enough. But 219 new sets of regulations--oh, by the way, we 
created the comparative effectiveness committee with the stimulus bill, 
and we are going to have 26 people tell every doctor in the country how 
they are going to practice medicine, what is right and what is not 
right. And, by the way, in all the committees a prohibition on 
rationing was voted down.
  What are we to think? We are going to create a large government 
program and grow the government by $1 trillion over the next 10 years, 
$2 billion-plus, maybe $3 trillion in the next 10 years, and we are 
going to have Washington tell people how the physicians and caregivers 
will treat, what they will use to treat, and all the time little Lucy 
will not matter if she gets sick. We will have already made her sick 
because we have stolen her future, her absolute future.
  It is a cute picture, but it sends a devastating message to us as 
leaders in

[[Page 24470]]

this country. How dare we do that. I wanted to bring out my other 
charts tonight, but I didn't want to bore everybody. The fact is, the 
appropriations bills that were passed--if we keep doing what we are 
doing--America, hear this--we are going to double the size of the 
Federal Government in 3\1/2\ years.
  We passed the Agriculture bill today, which is 22 percent bigger, and 
it was 15 percent last year, and that doesn't count any of the 
supplemental and the stimulus money. It doesn't take long, if you are 
growing something at 22 percent, for it to double.
  My gray hair comes from the fact that I think we are missing a great 
opportunity to work together. I think we can solve the health care 
problem. I think we can do it without enlarging the Federal Government. 
Especially when we pay 40 percent more than anybody in the world, there 
ought to be savings that we can get to make health care cost less and 
to cover everybody else. I know we have seen the studies that show 
that.
  So why isn't it going to happen? Why isn't there going to be a 
bipartisan bill? It is all political. It is not about the people in 
this country, it is about the political power structure in this 
country.
  Problems can be solved, common sense applied to limited government 
and restoring freedom to individuals.
  There are going to be so many lawsuits in this country, most of them 
legitimate, over the health care bill. You will not be able to uphold a 
challenge to the Constitution of forcing me to pay, take my money that 
I earn privately and spend it on what you say I have to spend it on. It 
is one of the greatest denials of liberty I ever heard of, and it is 
going to get challenged. It is going to go through the courts fast, and 
I suspect the courts are going to uphold the citizens of this country 
rather than the power center.
  I yield the floor or I yield back to my colleague from North 
Carolina.
  Mr. BURR. Mr. President, I thank Senator Coburn for yielding. Let me 
just say the reason he is gray is because he cares. This is a Member of 
the Senate who typically on Monday morning delivers babies, and all 
weekend long. Before he comes back to Washington, he practices 
medicine.
  This institution looked at what he did and said: You can't charge for 
what you do even though it costs you $200,000 a year to keep your 
practice open, your license in place, to buy your liability insurance. 
They said that is illegal under Senate rules.
  So Tom Coburn is a unique individual. He sees women who are pregnant. 
He delivers babies. But he doesn't take any payment for it. He keeps 
his license up to date. To some degree, it is charity care because he 
believes it is the right thing to do. More important, he understands 
that what we do here affects what our children and our grandchildren 
get in inheritance from us--not financial inheritance, in opportunity.
  Why are we passionate about the debt? Why are we passionate about 
trampling on the Constitution? Because every time we do it, we take an 
opportunity away from the next generation. We reduce their ability to 
be successful, whatever their definition is.
  Tom Coburn covered it very well. We are somewhat impassioned about 
our criticism toward the bills that passed out of the HELP Committee, 
the Finance Committee soon, and the three bills in the House. Why? 
Because we introduced our bill first. We laid our cards on the table. 
We offered to work in a bipartisan way with anybody, and we had no 
takers.
  I believe when you lay it out there and you come up with a successful 
plan, you have every right to be critical. I do question the ones who 
do not offer an alternative. But we have offered a solution, and that 
solution was based on three fundamental principles:
  One, it had to cover everybody. The way our bill is structured, every 
American receives the same financial stipend regardless of whether they 
work or whether they don't, regardless of where they live. We treat 
everybody the same.
  Two, if you are going to get cost savings, then you have to make 
direct investments in prevention, wellness, and chronic disease 
management. The Patients' Choice Act makes direct investments in 
prevention, wellness, and chronic disease management.
  Three, is it financially sustainable into the future? We probably 
should have started with this one versus save it for last. Why in the 
world would we create a health care system in America if it is not 
sustainable? If it is not financially sustainable, why would we even 
consider that legislation in the Congress of the United States? If it 
did not pass the test of time, why would it even be worthy of debate?
  Unless we expect people outside of America to continue to finance our 
urge to spend, then I have to tell you, we are not going to have any 
money--either that or we are going to have to tax the American people 
to a point where they are not going to want to be successful, they are 
not going to want to work overtime, they are not going to want to 
switch jobs because the benefit to them of being successful is to be 
punished by taxes.
  This bill is filled with new fees, new taxes. True reform that 
expands coverage would pay for itself. Think about that. If you truly 
reformed health care, would the reforms through savings not pay for the 
expansion? Shouldn't this be a net sum game?
  We have left out of the bill shopping across State lines for 
insurance. It saves money. The American people are sitting there: Why 
aren't you doing this? Tort reform saves money. The American people are 
sitting there: Why aren't you doing this?
  Let me end on one that I think the American people are really plugged 
into. Congress, which plan are you putting yourself under? You designed 
this plan for everybody in America. Is it the plan you are going to 
have? You know what, in the Finance Committee, in the HELP Committee, 
in the House committees, there have been amendments that said Congress 
has to take the plan they create for the American people. That 
government option, that is what Congress has to be under. It has been 
rejected every time it has been offered.
  But you see, Dr. Coburn and I took a different approach because in 
the Patients' Choice Act, we had to set what the basic minimum plan was 
going to be. Do you know what we put? The Federal Employees Health 
Benefits Program. We didn't put them into the FEHBP, but we said it had 
to be equivalent to what Members of Congress had. How could we ask the 
American people on a plan we create to have less than we have? The 
American people expect us to look after them, they don't expect us to 
give them less than we have.
  It was rejected every time that was offered to move Congress to their 
plan. But I think it tells you a lot about the way Tom Coburn and I 
approached the bill we worked on because we never thought about taking 
us and putting us into their plan, we thought about taking them and 
raising them to our plan. There is a big difference in that. There is a 
big difference in looking at the American people and saying, you should 
be here; not the American people saying, you should be where we are.
  We want people to be successful in this country. Tom Coburn said this 
is not a bipartisan bill. He is right. But I will end with this 
tonight: This is also not a reform bill. If you want to talk about 
expanding coverage, it does an equal job to what the Coburn-Burr bill 
does. If you want to judge it based upon reform, it accomplishes no 
reform.
  I encourage those who are not satisfied with the options that have 
been presented in the House or the Senate or that will be debated, go 
on Tom's Web site, go on my Web site, Google ``Patients' Choice Act.'' 
Read the bill. It is only 200-some pages, it is not 1,000.
  The truth is, if we have a real debate--at some point, we will have 
one about health care reform--I could suggest to the American people 
one word that would drastically reform health care, that could replace 
all 1,000 pages of a House or Senate bill. It is called portability. It 
is called the ability for an individual employee to take their 
insurance from one employer to another, not to be construed in any way

[[Page 24471]]

because they have a preexisting condition, but also to recognize the 
fact that when you do portability, you change drastically the way 
insurers look at covered lives.
  I think the American people would be shocked to know the average 
person is under a health care plan for an average of 4\1/2\ years right 
now. Ask yourself: If I am an insurer and I am going to invest in 
somebody's lifestyle changes and I am only going to have them 4\1/2\ 
years--how much are you going to invest? The answer is, probably very 
little. By the time they lose weight or quit smoking, you haven't 
reaped the benefits of those savings, and all of a sudden you create 
portability. That means a 24-year-old covered by an insurance company--
that insurance company has an opportunity to keep him until he is 64 
years old, 40 years. How much are you going to invest in that insured 
if you are going to have them for 40 years? You are going to invest a 
heck of a lot because you will want to keep him well as long as you 
can. You are going to reimburse doctors to do the education; you are 
going to make sure you keep them out of the hospital; you are going to 
make sure that if they go into the hospital you get them the treatment 
they need to get them out as quickly as you can. You are not going to 
deny a prescription a doctor wrote for them. You are not going to 
question a treatment a doctor chose because all of a sudden the doctor 
is a partner to the insurance versus just a cost to the insurance.
  You see, true reform has to change health care across the board. It 
has to change the relationship between patients and insurers, between 
doctors and insurers, between hospitals and insurers.
  Ask yourself: Does the Baucus plan accomplish any of it? The simple 
answer is no, it does not. That is why it costs $829 billion, and that 
is why to pay for it you don't get it through savings, you get it 
through taxing and fees. You get it through the insurance costs of 
everybody who has it. You achieve the costs by cutting Medicare, by 
knocking seniors off the health care plan they prefer. You get there by 
increasing the income limitations on Medicaid, making States actually 
pay for the expansion of 11 million Americans who are going to be 
covered under the most inefficient health care system in the country, 
Medicaid, where only 60 percent of the health care professionals will 
even see Medicaid beneficiaries because the reimbursements are so low. 
But we are going to grow that population by 11 million people.
  We are doing an injustice to these people to put them in a plan where 
only 60 percent of the health care professionals will see them. They 
will not get the education they need for chronic disease management. 
They will not make the lifestyle changes because Medicaid does not pay 
for prevention, wellness, or chronic disease management, nor does 
Medicare, nor does the VA, nor does Indian Health. Show me a government 
plan that pays for prevention, wellness, and chronic disease 
management, and I will quit coming to the floor and quit talking about 
the lack of reform.
  The truth is, the Baucus plan tries to replicate what the Federal 
Government has, and it does not have prevention, wellness, and chronic 
disease management today. It will not have it tomorrow, and it will not 
have it next year.
  Mr. President, I thank you for your patience. I assure you and our 
other colleagues that Dr. Coburn and I will be frequent visitors here 
as we get ready for this debate, as we have this debate, and probably 
after this debate is over, depending upon the outcome of it.
  But let me make it perfectly clear, if any Member in this debate is 
looking to try to achieve a bipartisan solution to health care, you can 
sign Tom Coburn and Richard Burr up today to sit at the table with you, 
to forget about who is the author of legislation, to talk about real 
solutions to real problems that deal with health care. I am committed 
to doing it, but I am not committed to rolling over and just accepting 
another expansion of the Federal Government and Federal Government 
spending.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Colorado.
  Mr. BENNET. Mr. President, as you could hear from the remarks of the 
Senator from North Carolina and the Senator from Oklahoma, there is 
agreement on some issues. We know the status quo is not going to work 
when it comes to health care. We know our families cannot endure 
another decade of double-digit cost increases every single year in 
their health insurance premiums. We know we can do better than devoting 
a fifth of our GDP to health care, when every other industrialized 
country in the world devotes less than half that to health care. We 
know the biggest drivers of our outyear budget and debt--which we do 
need to be enormously concerned about--are rising Medicare and Medicaid 
costs, and the biggest drivers of those are rising health care costs.
  I would say, again, as I have said before, I hope we can start on 
where the areas of agreement are and try to work from there. Because 
our small businesses and working families all across this country, 
including in my State of Colorado, cannot endure another 10 years like 
the 10 years they have endured. We will not be able to compete 
effectively in this global economy, where we are devoting more than 
twice what any other industrialized country in the world is devoting to 
just one sector of our economy--health care--and we are not going to 
keep the kind of commitment the Senator from Oklahoma was talking about 
to the young girl in the photograph or, for that matter, to my three 
daughters at home, who are 10, 8, and 5. I am deeply concerned about 
where we are with respect to our deficits and our debt.
  So while we are disagreeing about the outcomes, I think there is a 
growing understanding that the current system just will not do.


                              Afghanistan

  Mr. President, I am here to talk a little bit about Afghanistan, and 
just for a few minutes because yesterday we reached the 8-year 
anniversary of the war in Afghanistan. On this occasion, we should 
remember how unified our entire country was over our mission there when 
it began. The Nation came together after 9/11 to support our military 
as it bravely took the fight to the Taliban and the terrorists in 
Afghanistan. We had one ultimate goal: Removing al-Qaida's safe haven.
  Our military succeeded in toppling the Taliban government, which had 
allowed al-Qaida to use Afghanistan as a staging ground and a hiding 
place. Once the Taliban was removed from power, an international 
coalition, led by U.S. forces, went about the long and difficult task 
of defeating al-Qaida for good.
  Yet now, 8 years later and with a new administration trying to 
determine America's best way forward, many Americans are understandably 
concerned and frustrated. Afghanistan is not where any of us want it to 
be, and our ultimate goal has not yet been met. Al-Qaida is still there 
and in Pakistan as well. Afghanistan's Government has not been able to 
take centralized control of the country. Elections there have not added 
to the legitimacy of the Karzai government. We have been left to 
reassess our position, and we must do this reassessment together.
  Policymakers are asking the important and right question: What are 
the proper goals for our military effort in Afghanistan? How best can 
we accomplish them? Are these goals purely military goals? Can they be 
better solved with more troops or fewer? Do we need a more complex new 
mission in our future, which the military aspect is only one small 
part?
  Unless we are sure, unless all of us are sure that more troops can 
help us meet our goals, we should not send them. Our soldiers already 
have sacrificed much. This time, in particular, is a difficult one for 
servicemembers and their families, and it is also proving to be a 
difficult one for those of us making policy.
  As we decide what our direction will be in Afghanistan, the fallen 
brave soldiers we lost from Fort Carson this week are solemn reminders 
of how consequential our decisions have been and

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will be. Those of us who opposed going to war in Iraq, including 
President Obama, believed then it was the wrong war at the wrong time. 
We believed that Washington's focus on Iraq was diverting precious 
resources from our efforts in Afghanistan. We are still dealing with 
the consequences of the decision to focus on Iraq, both in Iraq and in 
Afghanistan.
  Recalling recent history is so important because now we have to find 
new wisdom on Afghanistan. At the same time, all 100 Members of this 
body know we must take great care as we make decisions that will affect 
the lives of our men and women in uniform and their families. For every 
soldier who answers our Nation's call to serve in combat, a new 
deployment is akin to a new decision to go to war. That is why our 
national purpose and their mission must be absolutely clear.
  That is also why, as Members of this body, we must be willing to ask 
hard questions. The country will be counting on the Senate to 
scrutinize and understand the purpose of any decision to deploy 
additional troops. As we, together, debate a new approach to 
Afghanistan, I will be motivated by the memory of the Fort Carson 
soldiers who died this past week, as well as all those who have fallen 
in rank and Afghanistan. I know all of us feel the same way. They 
served honorably. So must we.
  Mr. President, I yield the floor.
  Mr. BEGICH. Mr. President, I suggest the absence of a quorum.
  The PRESIDING OFFICER (Mr. Bennet). The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. BEGICH. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.

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