[Congressional Record (Bound Edition), Volume 155 (2009), Part 18]
[Senate]
[Pages 24845-24871]
[From the U.S. Government Publishing Office, www.gpo.gov]




 ENERGY AND WATER DEVELOPMENT AND RELATED AGENCIES APPROPRIATIONS ACT, 
                   2010--CONFERENCE REPORT--Continued

  The ACTING PRESIDENT pro tempore. The Senator from West Virginia is 
recognized.


                           Afghanistan Reset

  Mr. BYRD. Mr. President, few subjects weigh more heavily upon a 
President of the United States than the decision to send America's sons 
and daughters into war. Such a commitment demands the clearest of clear 
thinking, including a thoroughly dispassionate assessment of goals--
objectives, in other words--risks and strategies. This is difficult, 
very difficult terrain for any American President, especially when 
faced with conflicting views from advisers, from Congress, and from the 
American public.
  I have become deeply concerned that in the 8 years since the 
September 11 attacks, the reason for the military mission of the United 
States in Afghanistan has become lost, consumed in some broader scheme 
of nation building, which has clouded our purpose and obscured our 
reasoning.
  General McChrystal, our current military commander in Afghanistan, 
has requested 30,000 to 40,000 additional American troops to bolster 
the more than 65,000 American troops already there. I am not clear as 
to his reasons and I have many questions.
  What does General McChrystal actually aim to achieve? So I am 
compelled to ask: Does it take 100,000 U.S. troops to find Osama bin 
Laden? If al-Qaida has moved to Pakistan, what will these troops in 
Afghanistan add to the effort to defeat al-Qaida? What is meant by the 
term ``defeat'' in the parlance of conventional military aims when 
facing a shadowy, global terrorist network? And what of this number 
100,000? Does the number 100,000 troops include support personnel? Does 
it include government civilians? Does it include defense and security 
contractors? How many contractors are already there in Afghanistan? How 
much more will this cost? How much in terms of dollars? How much in 
terms of American blood? Will the international community step up to 
the plate and bear a greater share of the burden?
  There are some in Congress who talk about limiting the number of 
additional troops until we surge--where have I heard that word before--
until we ``surge to train'' more Afghan defense

[[Page 24846]]

forces. That sounds a lot like fence straddling to me. I suggest we 
might better refocus our efforts on al-Qaida and reduce U.S. 
participation in nation building in Afghanistan.
  Let me say that again. I suggest we might better refocus--in other 
words, take another look--our efforts on al-Qaida and reduce U.S. 
participation in nation building in Afghanistan. Given the lack of 
popularity and integrity of the current Afghan Government, what 
guarantee is there that additional Afghan troops and equipment will not 
produce an even larger and better armed hostile force?
  Let me ask that question again. Given the lack of popularity and 
integrity of the current Afghan Government, what guarantee is there 
that additional Afghan troops and equipment will not produce an even 
larger and better armed hostile force? There is no guarantee. The 
lengthy presence of foreign troops in a sovereign country almost always 
creates resentment and resistance among the native population.
  I am relieved to hear President Obama acknowledge that there has been 
mission creep in Afghanistan, and I am pleased to hear the President 
express skepticism about sending more troops into Afghanistan unless 
needed to achieve our primary goal of disrupting al-Qaida. I remain 
concerned that Congress may yet succumb to military and international 
agendas. General Petraeus and General McChrystal both seem to have 
bought into the nation-building mission. By supporting a nationwide 
counterinsurgency and nation-building strategy, I believe they have 
certainly lost sight of America's primary strategic objective; namely, 
to disrupt and defang--in other words, pull the teeth right out of the 
bone. I believe they certainly have lost sight of America's primary 
strategic objective to disrupt and defang al-Qaida and protect the 
American people--protect the American people--from future attack.
  President Obama and the Congress must--I do not say ``should,'' I say 
``must''--reassess and refocus on our original and most important 
objective; namely, emasculating--I mean tearing it out by the roots--
emasculating a terrorist network that has proved its ability to inflict 
harm, where? On the United States.
  If more troops are required to support the international mission in 
Afghanistan, then the international community should step up and 
provide the additional forces and funding. The United States is already 
supplying a disproportionate number of combat assets for that purpose.
  I yield the floor.
  I suggest the absence of a quorum.
  The ACTING PRESIDENT pro tempore. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. VITTER. Mr. President, I ask unanimous consent the order for the 
quorum call be rescinded.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.


                           Amendment No. 2644

  Mr. VITTER. Mr. President, I rise to talk about my pending amendment 
to the Commerce-Justice-State appropriations bill, amendment No. 2644. 
Apparently, this has created some interest and some opposition. It 
apparently is one of the major, if not the major, reason the majority 
leader felt the need to file cloture on the Commerce-Justice-State bill 
rather than simply come to an agreement regarding pending amendments 
and votes. It saddens me that--although that agreement was all worked 
out, basically--it was out the window, and he just decided to file 
cloture and bar votes on all of those amendments, including my 
amendment No. 2644. I think we should have a reasonable debate on my 
amendment and then a straightforward vote on the amendment because it 
is an important topic, directly related to that bill.
  What does the amendment do? My amendment is about the next census. It 
simply says no funds in that appropriations bill can be spent on the 
next census unless we ask about citizenship. I believe that is a basic 
requirement for the next census, to give us adequate tools to deal with 
a whole host of issues, including illegal immigration, including 
properly handling congressional reapportionment. Again, I find it very 
sad and, frankly, telling that the majority leader is going to such 
lengths to avoid having a vote on that simple concept, that simple 
idea.
  Why should we ask a question about citizenship? A couple of reasons. 
First of all, the census is supposed to give us in Congress important 
information, detailed information, the tools we need regarding how to 
handle a host of Federal programs and Federal issues. Certainly a major 
issue we need to deal with in this country and in this Congress is 
immigration, including illegal immigration. It seems like basic 
information we would want to collect. How many folks covered in the 
census are citizens and how many are noncitizens? That is basic 
information that would help us in a whole host of ways with regard to 
Federal programs and with regard to dealing with the immigration issue.
  There is another even more important reason, in my opinion, we should 
collect this information, and that is because one of the most important 
things any census is used for is reapportioning the U.S. House of 
Representatives; determining how many House seats each State in the 
Union gets in terms of representation. As it stands now, the plan is to 
do the census, to not distinguish in any way between citizens and 
noncitizens, and therefore to have noncitizens counted in congressional 
reapportionment. I think this is crazy and goes against the very idea 
of a representative democracy, people being elected by voters to 
represent citizens in the Congress. I don't think the Founding Fathers 
set up our democracy to have noncitizens represented in the Congress.
  As it stands now, without asking that simple, basic, fundamental 
question, noncitizens will be counted in congressional reapportionment. 
That means States with a particularly large number of noncitizens, 
including illegal aliens, will be rewarded for that, will get more 
representation, more say, more clout in the House of Representatives. 
States that do not have that issue will be hurt. They will get less 
say, less clout, less Members of the House of Representatives. I think 
that is fundamentally wrong.
  I also have a very specific interest in finding against that because 
Louisiana is one of nine States that would specifically be hurt. There 
are at least nine States that will have less representation in the 
House of Representatives if we count all people in congressional 
reapportionment, including noncitizens, versus if we just count 
citizens. It is important to say what those nine States are, and I 
specifically reached out to the Senators representing those nine 
specific States to make it clear to them that their States lose out in 
terms of that equation.
  Those States are Indiana, Iowa, Michigan, Pennsylvania, Mississippi, 
North Carolina, South Carolina, Oregon, and Louisiana. Those nine 
States would have less representation, less say, less clout in the 
House of Representatives if all people, including noncitizens, are 
counted in congressional reapportionment versus if only citizens are 
counted. Once again: Indiana, Iowa, Michigan, Pennsylvania, 
Mississippi, North Carolina, South Carolina, Oregon, and Louisiana.
  I particularly implore my colleagues, Democrats and Republicans, from 
those States to be aware of that, to support the Vitter amendment, and 
so we get to a vote on the Vitter amendment, No. 2644, to vote against 
cloture on the entire bill.
  Unfortunately, there are several Senators from those States who voted 
for cloture yesterday. I hope they will reconsider. I hope they would 
see, if they vote for cloture again, that they would be preventing us 
getting to this issue. They would be preventing us getting to a 
reasonable and full debate and vote on this issue. I implore all 
Senators from Indiana, including Senator Bayh, who voted for cloture 
previously; from Iowa, including the Senators there who voted for 
cloture previously; the two Senators from Michigan; the two Senators 
from Pennsylvania; the Democratic Senator from North Carolina; the 
Democratic Senator from Louisiana--please don't vote for cloture

[[Page 24847]]

again until we can get a reasonable vote on this amendment.
  Let me specifically address some of the arguments that have been made 
against this amendment because I think they are completely erroneous. 
One argument is this will intimidate folks and discourage noncitizens 
from filling out the census form. I think it is important to note, No. 
1, this citizenship question is asked on the long form. The long form 
gets millions of responses, and the census has never noted any 
difficulty in getting folks to fill out the long form.
  This question is also asked in the American Community Survey which 
the Census Bureau does. Again, the same citizenship question is asked 
here, and we get plenty of responses. The Census Bureau has never noted 
a big problem in terms of getting those responses.
  To make this perfectly clear, I am perfectly willing to revise my 
amendment so that we only focus on citizenship, not immigration status. 
I will be happy to revise my amendment so it only mentions and only 
focuses on citizenship versus immigration status.
  The other argument, that the Census Bureau itself has apparently 
made, is that this would be cumbersome and cost money at this stage in 
the census. Frankly, I find this pretty ironic coming from a 
bureaucracy which is spending $13 billion on this new census, up from 
$4.5 billion from the last census. Here is a bureaucracy where the cost 
of the new census versus the last census has tripled. The last score 
they are getting $13 billion, but asking this one question, which they 
already ask in the long form, which they already ask in the American 
Community Survey, is a huge problem and will cost too much money. That 
simply is silly on its face. It is important to do this right. 
Certainly asking a basic question about citizenship is central to doing 
it right.
  In summary, I urge all my colleagues to demand a vote on this 
important issue and to vote against cloture on the bill until we get 
that vote. Then, when we get that vote, I urge all my colleagues to 
support the Vitter amendment, No. 2644. It is very simple and 
straightforward. It will say: Ask the citizenship question. Let us know 
how many folks in the overall count are citizens and how many are 
noncitizens. That is absolutely essential, No. 1, so we can use the 
census information as a full tool in many of the programs and policies 
we debate and implement in Congress. No. 2, it is particularly 
important for congressional reapportionment.
  I do not believe noncitizens should be counted in congressional 
reapportionment. I don't believe States which have particularly large 
noncitizen populations should have more say and more clout in Congress 
because of that than States that do not, and that States such as 
Louisiana should be penalized. I don't believe those nine States in 
particular--Louisiana, Indiana, Iowa, Michigan, Pennsylvania, 
Mississippi, North Carolina, South Carolina, Oregon--should be 
penalized by including noncitizens in congressional reapportionment. I 
certainly do not believe Senators representing those nine States should 
vote either for cloture, cutting off a vote on my amendment, or should 
vote against my amendment.
  Again, I particularly urge all Senators from those nine States to 
stand up for their States, to vote for the interests of their States, 
to vote for their States getting full and proper representation, to 
vote against their States being penalized in terms of the census and in 
terms of congressional reapportionment.
  It is a simple issue but a very basic, fundamental issue. The census 
is an important tool. It only happens once every 10 years. We need to 
get it right for a whole host of reasons, particularly with 
congressional reapportionment in mind.
  I daresay if any Members of this body go back home to their States 
and have a discussion in a diner, have a townhall meeting, just ask a 
representative group of citizens: Did you know that noncitizens, 
including illegal aliens, are not only counted in the census-- but we 
do not discriminate--we do not know the numbers of noncitizens versus 
citizens? And, because of that, did you know all of those noncitizens 
are factored into determining how many House seats each State gets so 
that States with very large noncitizen populations, including large 
numbers of illegal aliens, are rewarded for that; they get more clout 
and say and vote in the House of Representatives, and other States, 
particularly the nine States I mentioned, are penalized because of 
that?
  I daresay the average citizen would be stunned about that and would 
say, hardly with any exception: That is not right. We should know those 
numbers, and we should not count noncitizens in terms of House 
representation. I certainly think citizens and voters in Indiana, in 
Iowa, in Oregon, in Michigan, Pennsylvania, Mississippi, North 
Carolina, South Carolina, and Louisiana would certainly say: Wait a 
minute, we are being penalized because noncitizens are being counted or 
being worked into the formula for representation in Congress? That is 
crazy.
  It is crazy. It doesn't meet the smell test, it doesn't meet the 
commonsense test of the American people, and we should act to make sure 
the next census is done right, starting by having a vote on the Vitter 
amendment, No. 2644, and by passing that amendment to the bill.
  With that, I yield the floor.
  The ACTING PRESIDENT pro tempore. The Senator from North Dakota is 
recognized.
  Mr. DORGAN. Mr. President, my understanding is that we are now in 
what is called a 30-hour postcloture period. We had a cloture vote this 
morning on the energy and water conference report. I chair the 
committee that brought that to the floor, the subcommittee on 
appropriations which funds the water projects, the energy projects, the 
nuclear weapons, among other things. It is a very important piece of 
legislation. We could not just bring it to the floor from conference. 
We actually had to file cloture, wait for the cloture petition to 
ripen--2 days--then we have a vote. I think we had 79 votes in favor of 
it. And now we are in a period where we can't yet adopt it because some 
are insisting we have the 30 hours postcloture expire. My hope is that 
whoever feels that way might relent so that later this afternoon we can 
pass this piece of legislation.
  But this legislation is very much like almost everything else we are 
trying to do in appropriations. We have tried very hard to do the 
appropriations bills as we are supposed to do them--one at a time, 
bring them to the floor, have votes, debate the amendments, and so on. 
In the last couple of years, in my judgment, the appropriations process 
has been a failure because we have had to do omnibus bills, which is 
not the right way to do it. We were forced to do that, in many 
respects. But now we are trying to do one bill at a time, and we have 
done many of them. Credit goes to the majority leader, who has said we 
want to finish the individual appropriations bills. But the fact is, we 
are getting almost no cooperation--almost none.
  I think we have had a relatively noncontroversial Legislative Branch 
appropriations bill, which is generally pretty noncontroversial. As I 
recall, I believe we had to file a cloture petition to shut off debate 
on the motion to proceed--not the bill, just the motion to proceed to 
the bill. That takes 2 days to ripen, then you have 30 hours 
postcloture.
  Virtually every step of the way, we have had this problem, with no 
cooperation at all. It is like trying to ride a bicycle built for two 
uphill and the person on the backseat has their foot on the brakes. 
That is what is happening around here all the time. All we would like 
is just a little cooperation so we can get these bills completed.
  When we bring a conference bill to the floor, it shouldn't take us 2 
to 3 days. The bill I brought to the floor myself, the Energy and Water 
bill, took us a fair amount of time. We sat on the floor waiting for 
people to come and offer amendments. They didn't. That is why I 
sometimes refer to the Senate as 100 bad habits. It is not very easy to 
get people to come over, even when they have amendments to offer. And 
then from time to time somebody

[[Page 24848]]

comes over and has an amendment that has nothing to do with the 
subject, which is fine--the rules allow that--but then they insist they 
have a vote on their specific two or three or four amendments or they 
will hold everything up forever.
  So we are getting no cooperation, and it would be nice to get just 
some so we can get the appropriations bills done. It is the right way 
to do it--bring the bills to the floor, do them, debate them, and have 
votes on them. That is the way the Senate should work. Lord knows we 
have tried this year to do that, but we have had almost no cooperation. 
At every turn, we have had people stand up and say: Well, I have my 
four amendments, but, no, I am not going to come over and offer them. I 
am going to tell you I have four amendments to offer, and if you try to 
shut this down and shut off amendments, then we will filibuster and we 
won't give you the 60 votes you need to shut it off. So there you are, 
stuck in the middle, unable to get things done.
  Again, the cloture vote yesterday failed on Commerce-State-Justice. 
Normally speaking, Senator Mikulski would bring a bill like that to the 
floor of the Senate and it would be on the floor maybe 1 day, maybe 2 
days. Instead, I watched last week as she was out here waiting for 
people to offer amendments--sitting here waiting, and no one was coming 
to offer amendments, by and large. Then the majority leader sat here 
until I think 9:30 or 10 o'clock at night one evening trying to reach 
an agreement, and no agreement was forthcoming.
  My only point is that it would be nice if we could get some 
cooperation and some understanding. It is not Republican or Democrat or 
conservative or liberal to do the work on time and finish our 
appropriations bills with some amount of cooperation; it is just common 
sense. If we could just get a bit of that cooperation, we could get the 
work done around here.
  I did want to mention as well, with respect to the agenda, that while 
we are trying to get these appropriations bills done, we will also 
begin the process of debating health care on the floor of the Senate--a 
health care bill that will be brought to the floor reasonably soon. I 
want to mention that certainly one of the efforts I will make when the 
health care bill comes to the floor--and I have mentioned this before--
is to try to address the issue of the expanding cost of prescription 
drugs. That is not dealt with in the legislation which is coming to the 
floor, I assume, and if not, then there are 30 of us, Republicans and 
Democrats, who have legislation that will give the American people the 
freedom to import FDA-approved drugs sold at a fraction of the price 
elsewhere. That will be one of the amendments I and many others will 
come to the floor to offer.
  Another amendment I intend to offer is a piece of legislation called 
the Indian Health Care Improvement Act. We passed that through the 
Senate last year. We have modified it just a bit this year, and I 
believe we will reintroduce it later this afternoon.
  The Indian Health Care Improvement Act has not been reauthorized for 
a long time. I believe it has been 17 years since the Senate last dealt 
with Indian health care--an authorization bill--except for last year 
when we failed because one of our colleagues, who previously spoke, 
offered an abortion amendment that had the effect of stopping the bill 
when it got to the House of Representatives.
  Having said all that, I intend to offer the Indian health care 
legislation as an amendment to the broader health care bill because I 
don't think we should go on to pass a health care reform bill if we 
don't address the health care obligations we have made to the first 
Americans, the American Indians. The fact is, American Indians were 
promised by treaty--were promised time and time again and in treaties 
the Federal Government signed--that we would provide for their health 
care, and we have not met those promises. We have both a trust 
responsibility and a treaty responsibility to fix the health care 
system for American Indians. It has not been fixed, and it would be a 
tragedy if we moved forward with health care and didn't include the 
important part that is required by us to reauthorize the Indian Health 
Care Improvement Act. So I intend to offer that as well.
  I also want to say that when we get health care completed--and I 
spoke earlier today about the need to bring up the Energy bill, but 
there is another bill that is very important that I have spent a lot of 
time on that has to be considered by the Senate and the entire 
Congress. That is the FAA reauthorization bill.
  The Federal Aviation Administration reauthorization bill is 
critically important. It has a wide range of issues dealing with safety 
in the skies, and it has the important provisions dealing with 
modernizing our air transportation system--our air traffic control 
system, I should say--and that modernization can't wait. We have to 
move forward, and it requires a lot of things.
  Senator Rockefeller and I have brought a bill out of the Commerce 
Committee that is ready for floor action, but we need to get it to the 
floor of the Senate and get it passed so we can get it into conference 
with the House of Representatives. If I might, I want to describe for a 
moment why this is important.
  We have the skies full of airplanes. I know the carriers have shrunk 
their size by 8 or 10 percent in terms of commercial carriers, but 
nonetheless we have the skies full of airplanes flying around 
transporting people and cargo, and the fact is, we are still flying to 
what is called ground-based radar. What happens is, we put an airplane 
in the air someplace with a couple hundred people on board, and it 
flies around being guided by ground-based radar. Of course, that is 
better than the old days, when in order to haul the mail at night, in 
the early days of airplanes, they first used bonfires every so many 
miles so that you could fly to a bonfire and see where you were headed. 
That was the only way you could fly at night. The second thing they did 
was to use flashing lights, and now, of course, ground-based radar for 
many decades. But ground-based radar is clearly obsolete, and it only 
tells someone where an airplane was just for a nanosecond.
  The transponder on the airplane being shown on a tube someplace or by 
a monitor somewhere in the air traffic control center shows, when the 
arc goes around on the radar, where that jet airplane was. Then for the 
next 6 or 7 seconds, as it is going around again, that jet airplane is 
someplace else because it is traveling very fast. It only tells you 
about where the airplane is and only tells you exactly where it was for 
a nanosecond.
  The fact is, we need to go to a GPS system so we can save money, use 
more direct routing, make it safer for passengers, and use less energy. 
You also don't have to space the planes as far apart because you know 
exactly where an airplane is, not where it was.
  We need to move on this newer technology. Europe is moving to it, and 
many other countries. But it is complicated, and it requires us to pass 
legislation that includes the modernization of the air traffic control 
system. Again, we brought that out of the Commerce Committee, and it is 
awaiting action on the floor of the full Senate.
  I hope that following health care and following a number of other 
issues--including, I hope, an energy bill at some point--the FAA 
reauthorization bill will have its day on the floor of the Senate. I 
also hope we will have substantial cooperation. I know Senator 
Hutchison from Texas worked with us, Senator DeMint worked with us to 
bring that out of the Commerce Committee, and I look forward to having 
that as part of the agenda so that all of those who have worked for a 
long time on these issues dealing with safety in the skies and dealing 
with modernizing our air traffic control system will be able to feel as 
if we have made progress and have been able to get this bill to 
conference with the House.
  Mr. President, I know the majority leader has a lot to try to plan 
for the agenda now as we near the end of the year, and these are big, 
difficult issues. I want to help him, as do most of my colleagues. We 
are going to need a little cooperation here and there. If we continue 
to have to vote on cloture petitions, on motions to proceed, it

[[Page 24849]]

means every single thing we bring to the floor of the Senate takes a 
week just to get up. Cloture petitions take a couple of days to ripen, 
then there is 30 hours postcloture. All we need is a little 
cooperation. That ought not be too much to ask in order to get the 
business of the Senate done.
  Mr. President, I yield the floor, and I suggest the absence of a 
quorum.
  The ACTING PRESIDENT pro tempore. The clerk will call the roll.
  The assistant bill clerk proceeded to call the roll.
  Mr. UDALL of New Mexico. I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER (Mr. Sanders). Without objection, it is so 
ordered.
  Mr. UDALL of New Mexico. I ask unanimous consent to speak as in 
morning business.
  The PRESIDING OFFICER. Without objection, it is so ordered.


                           Indian Health Care

  Mr. UDALL of New Mexico. Mr. President, I rise to speak about Indian 
health care legislation. This is legislation introduced by the chairman 
of the Indian Affairs Committee, Senator Dorgan.
  I wish to talk a little bit about Native Americans and their health 
care situation. We have spent the last 6 months talking about health 
care. We have debated the quality of care, the cost of care, access to 
care. I am glad to say we are making progress in fixing what is broken 
in our health care system. But there is one group of Americans that has 
not engaged in this national conversation, Americans who suffer from an 
inadequate health care system and alarming health disparities. I am 
talking about the first Americans, the American Indians and Alaska 
Natives who are suffering because the Federal Government is not living 
up to its promise to them.
  Right now Native Americans are being diagnosed with diabetes at 
almost three times the rate of any other ethnic group. Right now too 
many Native American families don't have access to preventive health 
care. Right now Native American teens are attempting and committing 
suicide at alarming rates. The bottom line is, too many Native 
Americans are struggling to receive quality health care. For too many 
years, America has stood aside and let it happen.
  Today is a new day. It is time for America to make good on its 
promises to Native Americans. I believe Senator Dorgan's bill would 
help us do just that. This legislation will bring much needed reforms 
to the Indian health care system and will allow us to connect Indian 
health improvements to national reform efforts. By tying these 
initiatives together, we will increase the likelihood of success not 
only today but for years to come. This legislation would make 
reauthorization of the Indian Health Care Improvement Act permanent so 
Indian country can better predict and plan for its health care needs. 
It will also build on what works by expanding services for mental 
health and prevention. We encourage stronger collaboration with the 
Veterans' Administration. We provide resources so that more Native 
Americans can train to become health care providers. We promote new 
ideas and future progress through funding of demonstration projects.
  Finally, we begin addressing a tragedy that is tearing apart too many 
Native American families, especially in my home State of New Mexico. 
That tragedy is the epidemic of teen suicide which I spoke of a moment 
ago. New Mexico's suicide rate is almost two times that of the national 
average, and far too many of these suicides are happening in Indian 
country. This summer, over the course of a little more than a month, 
four people from the Mescalero Apache Reservation committed suicide, 
all of them teenagers or young adults. The latest was a 14-year-old 
girl just last week. In this bill we will take the first steps in 
addressing this crisis. We will fund new grant programs and telehealth 
initiatives, and we will expand a program that has proven successful 
for the Zuni tribe in New Mexico. It is a program that connects schools 
and parents with the community, where students learn to be peer 
educators, and middle and high school students learn life skills to 
prevent suicide.
  America has an obligation to provide quality, accessible health care 
for our country's first Americans. That begins with engaging American 
Indians and Alaska Natives in the national conversation about health 
reform.
  I am honored to cosponsor this bill and look forward to its passage 
by the Senate.
  I thank the Chair.
  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. SANDERS. Madam President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER (Ms. Stabenow). Without objection, it is so 
ordered.


                  Emergency Senior Citizens Relief Act

  Mr. SANDERS. Madam President, for more than three decades, seniors 
have relied on a COLA in their Social Security benefits to keep up with 
their increased expenses. Tomorrow it is expected that the Social 
Security Administration will announce that for the first time in 35 
years, seniors will not be receiving a COLA. Based on the formula that 
by law they are obliged to use, they came to the conclusion that there 
is no inflation for seniors and, in fact, the prices for seniors have 
declined.
  In my view, the current formulation for determining Social Security 
COLAs is wrong in terms of the needs of seniors because it does not 
accurately take into account their purchasing needs. In other words, if 
you are 19 years of age and you buy a laptop computer or an iPod or a 
new cell phone, the likelihood is that prices may well have gone down 
over the last year. On the other hand, most seniors are not buying 
iPods. What they are buying is prescription drugs and health care 
needs, and those costs have gone up.
  I have long argued and when I was a Member of the House I introduced 
legislation with a whole lot of support to develop a separate index for 
seniors. Be that as it may, where we are right now is that the Social 
Security Administration will announce tomorrow a zero COLA.
  I have some very good news. I have introduced legislation, and I and 
a number of us have urged the President to be cognizant of the fact 
that in the midst of this terrible economic recession, we just cannot 
turn our back on seniors. Many seniors are not only paying increased 
costs for prescription drugs and for their health care needs, they have 
seen a decline in their pensions. They have seen a significant decline, 
in many cases, in the value of their homes. Some have lost their 
pensions. Basically, we cannot say to them right now that we are not 
going to reach out and try to help you in whatever way we can.
  I am very happy to announce that just this afternoon, President Obama 
will be supporting support for senior citizens. He will be supporting a 
$250 payment to disabled veterans and those people who are on Social 
Security, some 50 million Americans in all. I applaud the President for 
not turning his back on seniors.
  In his announcement, the President says:

       Even as we seek to bring about recovery, we must act on 
     behalf of those hardest hit by this recession. That is why I 
     am announcing my support for an additional $250 in emergency 
     recovery assistance to seniors, veterans, and people with 
     disabilities to help them make it through these difficult 
     times. These payments will provide aid to more than 50 
     million people in the coming year, relief that will not only 
     make a difference for them, but for our economy as a whole, 
     complementing the tax cuts we've provided working families 
     and small businesses through the Recovery Act.

  That is the statement President Obama is about to release. I thank 
the President for his support.
  Obviously, the ball now comes to our court, and we have to move it 
forward. I think that in these hard times, when so many seniors are 
worried about how they are going to pay for their medicine, how they 
are going to pay for their health care, how they are going

[[Page 24850]]

to pay to heat their homes in the wintertime, how they are going to 
take care of other basic needs, it is absolutely imperative we not 
forget about them.
  I applaud the President for his action, and I look forward to working 
with Members of Congress to pass this legislation as soon as possible.
  Madam President, I yield the floor and suggest the absence of a 
quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The bill clerk proceeded to call the roll.
  Mr. KAUFMAN. 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. KAUFMAN. Madam President, I ask unanimous consent to speak as in 
morning business.
  The PRESIDING OFFICER. Without objection, it is so ordered.


                        In Praise of Zalmai Azmi

  Mr. KAUFMAN. Madam President, I rise once again to recognize the 
service of one of America's great Federal employees.
  This Monday, Americans across the country marked Columbus Day. It is 
a day that holds different meanings for different communities. I had 
such a meaningful experience attending the Columbus Day Mass and 
breakfast at St. Anthony's of Padua in Wilmington. I know in the 
Italian-American community, Columbus Day is a vibrant cultural 
celebration. But Columbus Day, above all, reminds us all that America 
is a patchwork; that we are--in the words etched on the wall behind 
you, Madam President--one Nation from many. This has always been a 
source of great strength for our country.
  This is as true for our Federal workforce as it is for America as a 
whole. So many of our outstanding civil servants were not born in the 
United States. Some came as students and found in America jobs and a 
new home. Others came as infants, carried onto airplanes in the arms of 
loving parents seeking a new beginning for their families. Some 
traveled halfway around the world driven by the dream of a better life. 
Others braved the short but perilous journey over turbulent waves 
fueled only by the hope of freedom on our shores. The diversity of our 
Nation is reflected in the diversity of those who choose to serve it.
  The Federal employee I am recognizing this week has had a 
distinguished career in the Department of Justice, both in the 
Executive Office for U.S. Attorneys and at the Federal Bureau of 
Investigation.
  Zalmai Azmi was 14 years old when he fled with his family from 
Afghanistan. He arrived in the United States speaking very little 
English, and he became fluent while in high school. Zalmai, wishing to 
give back to the Nation which gave him refuge, eventually joined the 
Marine Corps. He served in the corps for 7 years as a communications 
and intelligence specialist, and he also trained in special operations. 
While in the Marines, Zalmai studied computer science, and he later 
obtained a bachelor's degree in the field from the American University 
and a master's from George Washington University.
  In the 1990s, Zalmai continued his Federal career by moving from the 
military into the civil service. He was working as chief information 
officer for the Executive Office for U.S. Attorneys when the September 
11 attacks occurred. Zalmai helped implement the Justice Department's 
continuity of operations emergency plan, and by September 12, he was at 
Ground Zero in New York setting up departmental field offices.
  Just weeks after the attacks, he volunteered to be dropped into 
Afghanistan as part of a Marines special operations team. In the 2 
years that followed, Zalmai, who is fluent in Dari, Farsi, and Pashto, 
served two tours of duty in Afghanistan. While at home, he was detailed 
to the CIA's Counterterrorism Center.
  In 2004, FBI Director Robert Mueller appointed him as the Bureau's 
Chief Information Officer. In that role, Zalmai led the effort to 
revamp the FBI's virtual case file system and helped transform its IT 
infrastructure to meet the needs of a post-9/11 environment.
  He was honored with the prestigious Arthur S. Fleming Award for 
Applied Science and Technology in 2002, which is presented annually to 
an outstanding public servant. Additionally, he won the Distinguished 
Presidential Rank Award.
  Zalmai retired from the FBI late last year. His story, while unique, 
is reflective of the commitment to service and patriotism embodied by 
all of the immigrants who work in government and serve in our military. 
Just as America would not be as strong without our great Federal 
employees, that workforce would not be as vibrant or successful without 
those who, like Zalmai, came to this country from other lands.
  I hope all my colleagues will join me in honoring his service, that 
of the men and women in the Department of Justice, and all immigrants 
who work in the Federal Government.
  Madam President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Wyoming.
  Mr. BARRASSO. Madam President, I wish to speak about the conference 
report we are currently discussing, but I want to first take a second 
to commend the Senator from Delaware for his fine effort over these 
many months to continue to call to the attention of America wonderful 
people who have committed their life to make the lives of other 
Americans better. He has done a wonderful job, and this is just one 
more example of both the Senator's job of bringing the news to all of 
America but also the story of a wonderful individual who has committed 
his life to improving our great Nation.
  Madam President, I would like to spend a moment thanking the Senators 
from North Dakota and from Utah for their hard work on this bill we are 
currently considering. It represents a truly bipartisan effort. The 
energy investments in this bill will foster technological innovations 
and will harness the creativity and hard work of the American people. I 
believe it will help us move forward on clean coal technology. It will 
also promote energy efficiency and accelerate research into renewable 
energy.
  I want to highlight one issue in particular, if I could, and it deals 
with our domestic uranium production. The uranium industry provides 
good-paying jobs across the country, and certainly good-paying jobs in 
Wyoming. A strong uranium workforce is essential to expanding America's 
nuclear energy capacity. Uranium production means American jobs and 
American energy.
  In August, the Department of Energy proposed transferring--
transferring--a significant amount of uranium to the U.S. Enrichment 
Corporation. The uranium transfer was designed and intended to pay for 
an environmental cleanup at a facility in Portsmouth, OH.
  This is a laudable goal. Unfortunately, the proposal of the 
Department of Energy would have serious unintended consequences. The 
proposed transfer would flood the uranium market, artificially forcing 
down spot prices for uranium, and create significant uncertainty in the 
marketplace. This action would have a devastating impact on domestic 
uranium mining. It would cost plenty of jobs in my home State of 
Wyoming but also jobs all across the United States. It would undercut 
an integral part of America's energy portfolio.
  The Department's plan, in my opinion, is shortsighted and lacks 
common sense. Why create jobs in one State by killing jobs in another 
State? The environmental cleanup can be accomplished without hurting 
jobs in Wyoming and elsewhere.
  The conferees recognized the problems with the proposal of the 
Department of Energy. The conference report directs the Government 
Accountability Office to evaluate the Department's management of its 
excess uranium supplies. The bill increases funding for the Portsmouth 
facility and the cleanup. These steps provide the opportunity to 
address the necessary environmental cleanup issue without causing the 
collateral damage in other States.
  So I thank the Senators from North Dakota and Utah for their work to 
address this problem. The Department of

[[Page 24851]]

Energy should rethink its uranium transfer proposal. By working within 
the framework of the Excess Uranium Management Plan, the Department can 
get maximum value for its uranium and fund the cleanup of Portsmouth 
without hurting jobs--good jobs--in other States.
  With that, 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. McCAIN. 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. McCAIN. Madam President, as we take up the conference report to 
accompany the fiscal year 2010 Energy and Water appropriations bill, it 
spends approximately $33.9 billion. Let's not forget Congress has 
already appropriated over $92 billion to energy and water-related 
projects between the emergency appropriations provided in the 2009 
supplemental, the continuing resolution, and the stimulus bill.
  Equally as important is what this bill doesn't fund. The bill 
provides only $197 million for the Yucca Mountain nuclear waste 
repository, putting this project on life support.
  The Department of Energy has spent billions of dollars and decades 
studying the suitability of Yucca Mountain as the Nation's repository 
for spent nuclear fuel and defense waste. Consistently, the science has 
borne out that Yucca Mountain is the best site to dispose of nuclear 
waste. The President has made a point of telling all who would listen 
that his administration would be guided by science and not politics. At 
the same time, the President and the Secretary of Energy are saying 
that Yucca Mountain is no longer an option, even though science has 
proven that Yucca is safe.
  The fact that this administration has political problems with moving 
forward with the Yucca Mountain storage facility doesn't change the 
fact that the government has a legal obligation to take this spent 
waste and that the licensing process is already underway. Shelving the 
Yucca Mountain facility will slow the deployment of new nuclear 
generating facilities, constrain our most abundant clean energy source, 
and hinder efforts to combat climate change.
  The conference report that accompanies this bill contains 1,116 
congressionally directed spending items--a fancy term for earmarks, 
which is a fancy term for porkbarrel spending, which is a fancy term 
for corruption--totalling over $1.05 billion and almost doubling the 
number of earmarks that were included in the Senate-approved bill. Get 
that: 1,116 earmarks in this bill--over a $1 billion.
  I know that is not much when we consider we have already run up a $9 
trillion deficit over the next 9 years, but a lot of Americans would be 
surprised and think it is a fair amount of money.
  None of these projects were requested by the administration. Many of 
them were not authorized or competitively bid in any way. No hearing 
was held to judge whether or not these were national priorities worthy 
of scarce taxpayer's dollars. They are in this bill for one reason and 
one reason only--because of the self serving prerogatives of a select 
few members of the Senate--almost all of whom serve on the 
Appropriations Committee. Sadly, these Members chose to serve their own 
interests over those of the American taxpayer.
  During Senate consideration of this bill I filed 24 amendments to 
strike these earmarks. The American people are tired of this process, 
and they are tired of watching their hard-earned money go down the 
drain. Not surprisingly, my amendments were defeated at every turn by 
appropriators and Members on the other side of the aisle.
  ``Here are some examples of the earmarks contained in this bill: $2 
million for the Algae Biofuels Research, WA; $750,000 for the Algae to 
Ethanol Research and Evaluation, NJ; $1.2 million for the Alternative 
Energy School of the Future, NV; $6 million for the Hawaii Energy 
Sustainability Program, HI; $6 million for the Hawaii Renewable Energy 
Development Venture, HI; $2.25 million for the Montana Bio-Energy 
Center of Excellence, MT; $10 million for the Sustainable Energy 
Research Center, MS; $450,000 for the Vermont Energy Investment 
Corporation, VT; $1.2 million for the Hydrogen Fuel Dispensing Station, 
WV; $1.25 million for the Long Term Environmental and Economic Impacts 
of the Development of a Coal Liquefaction Sector in China, WV; $1 
million for the Alaska Climate Center, AK; $5 million for the Computing 
Capability, ND--whatever that is; $1 million for the Performance 
Assessment Institute, NV; $1 million for the New School Green Building, 
NY.
  This bill also includes a $106 million increase in funding over the 
President's request for hydrogen fuel cell research. The Secretary of 
Energy had pushed for the elimination of this funding but has since 
changed his mind after bullying from Senate appropriators. Before his 
change of heart, Dr. Chu explained his reasoning for cutting the 
funding by stating, ``We asked ourselves, `Is it likely in the next 10 
or 15, 20 years that we will convert to a hydrogen car economy?' The 
answer, we felt, was no.'' Unfortunately, Dr. Chu caved to demands and 
has decided to no longer object to funding research investments that 
many call a ``dead end.''
  This bill dedicates $5.3 billion to the Army Corps civil works 
program, which is $180 million higher than the President's request. As 
my colleagues know, the Corps is burdened with a $60 billion backlog as 
a result of years of abusing the energy and water appropriations bills 
and the Water Resources Development Acts as hot tickets for loading up 
new pet projects. As one would expect, this year's appropriations 
process was no different from previous years as the Senate 
Appropriations Committee received 256 requests to fund new projects. 
Imagine our surprise when we learned that the committee rejected every 
single one of these requests for funding new projects--a nod, albeit a 
modest one, to the tenets of fiscal responsibility.
  While I applaud appropriators for attempting, in a way, to address 
our current backlog, we can't deny that our system for funding existing 
Corps projects is not working. Currently, there is no way to know which 
projects warrant taxpayer dollars because the Corps refuses to give 
Congress any kind of idea of what it views as national priorities. In 
fact, even when Congress specifically requests a list the Corps' top 
priorities, they are unable to provide them. That leaves it up to 
politicians on Capitol Hill to blindly throw money at flood control, 
hurricane protection, navigation and environmental restoration 
projects--in some cases matters of life or death--without knowing which 
projects may or may not benefit the larger good. We owe it to the 
American people to do better.
  Our current economic situation and our vital national security 
concerns require that now, more than ever, we prioritize our Federal 
spending. But our appropriations bills do not always put our national 
priorities first. It is abundantly clear that the time has come for us 
to eliminate the corrupt, wasteful practice of earmarking. We have made 
some progress on the issue in the past couple of years, but we have not 
gone far enough. Legislation we passed in 2007 provided for greater 
disclosure of earmarks. While that was a good step forward, the bottom 
line is that we don't simply need more disclosure of earmarks--we need 
to eliminate them all together.
  The time has come to get serious about how we are spending 
hardworking American's tax dollars and there is no better way to prove 
we're serious than by ending the wasteful practice of earmarking funds 
in the appropriations bills. The process is broken and it is long 
overdue to be fixed.''
  Madam President, we are here in this postcloture motion period, 
consuming it because of the simple fact that the Senator from Oklahoma 
had an amendment which required greater transparency. The Senator from 
Oklahoma, while wanting a recorded vote, was assured by the managers of 
the bill that

[[Page 24852]]

a transparency provision would be added to the final conference report 
which would then be passed by both Houses of Congress and for the 
President's signature. Unaccountably, that provision, which was simple 
transparency so that all Members of the Senate would know what 
information the Senate appropriators received, would be shared by all, 
was dropped in conference. Understandably, the Senator from Oklahoma, 
Senator Coburn, whom I view in many ways as the conscience of this 
body, is upset and concerned that the American people--much less now 
their Representatives--are not able to obtain information which is 
obviously very important in the decisionmaking process that goes on 
here.
  It is unfortunate and it shows, again, what has happened here in the 
process of legislation, that the Appropriations Committee now seems to 
override not only the wishes of the American people with projects such 
as those I outlined but also even the other Members of the Senate.
  The good news, probably, for Members of the body and for the citizens 
of this country--but bad news for the appropriators--is that we will be 
back. We will be back again and again and again. The American people 
all over this country are having tea parties, they are having 
uprisings. They know the debt and deficit that we have laid on future 
generations of Americans and they are not going to stand for it. They 
are going to find out whether we need to spend $450,000 for the Vermont 
energy investment corporation; whether we need $1 million for a 
performance assessment institute in Nevada; and whether we need to 
spend $1 million for the new school green building in New York, not to 
mention all those projects that abound that will send our tax dollars 
to the State of Hawaii as well as Mississippi.
  I can warn my colleagues again, we will be back. We will be back. We 
will talk not only here on the floor of the Senate but across this 
country about this egregious practice of the waste of their taxpayers' 
dollars, of their hard-earned dollars, and the way this earmark and 
pork-barreling process is still completely out of control and a 
disgrace.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Colorado is recognized.
  Mr BENNET. Madam President, I rise today to speak about a development 
folks in the southeastern corner of my State have been waiting on for 
the better part of 47 years. This week, maybe even today, thanks in 
large part to the advocacy of our partners at both the local and 
Federal levels, the vision of the Arkansas Valley Conduit--long a 
priority of rural communities in my State--moves one significant step 
closer to reality. Today, we will send a bill to the President that 
finally funds this important water project that represents the best of 
regional government, with multiple communities cooperating for the 
greater good.
  Our success today owes to the support of many who took it upon 
themselves at one time or another to move this project forward. In 
particular I would like to thank Congressman John Salazar, a good 
friend and tremendous leader who has championed this project since his 
first days in office.
  The effort to build the conduit has been a journey that has its 
origins in post-World War II America, a time when members of ``the 
Greatest Generation'' were coming home to raise a family, plan their 
lives and build a new America with the same energy that they used to 
save it on the battlefield.
  In the Arkansas River Valley, enthusiasm for the future was also 
high, but their enthusiasm was soon tempered by one significant 
limitation: the water needed to build and sustain that future was in 
short supply.
  Yet geographic limitations were no match for the resilience and 
determination of the valley's residents. They came together and crafted 
a plan to satisfy the water needs of the valley's ranchers, farmers and 
rural communities.
  The project came to be known by proponents and detractors alike as 
the Fryingpan-Arkansas Project. After a long and sometimes bitter 
battle, the project was authorized and signed into law by President 
John F. Kennedy in August of 1962.
  The Arkansas Valley Conduit was a key piece of the Fryingpan-Arkansas 
Project. The vision was simple: deliver clean drinking water to 40 
ranching and farming communities of the lower Arkansas Valley.
  As the years went by, that vision developed. Civic leaders and 
citizens came together to call for a water delivery system to bring the 
West's scarcest natural resource to over 40 communities, across a 140-
mile stretch of southeastern Colorado.
  Unfortunately, the resources necessary to put that plan into place 
did not advance with the larger plan. While other parts of the 
Fryingpan-Arkansas Project moved forward, the Arkansas Valley Conduit 
languished and doubts began to grow about whether the Federal 
Government would ever live up to its part of the bargain.
  Earlier this year, my predecessor, Senator Salazar and Colorado's now 
senior Senator, Mark Udall, gave the conduit the jumpstart it needed by 
introducing legislation authorizing a Federal cost-share for the 
project.
  After visiting southeast Colorado upon my appointment to the Senate, 
I immediately lent my strong support to the project and cosponsor this 
important legislation. I believe you would be hard pressed to find many 
bills that have the support of three Senators from the same State 
during one session of Congress.
  With that support, as well as the strong support and leadership of 
Representatives John Salazar and Betsy Markey, Congress authorized the 
Arkansas Valley Conduit in the Omnibus Public Land Management Act, 
which was signed by the President in March of this year.
  Unfortunately, this authorization did not happen in time for funding 
to be included in the administration's budget request for fiscal year 
2010.
  Our team advocated as strongly as we knew how for the conduit. And I 
can tell you, that after communicating how important this project is to 
the people of my State on many, many occasions, the chairman of the 
subcommittee, Senator Dorgan of North Dakota, soon emerged as a 
committed partner in the effort.
  Let me say that the people of Colorado have a good friend in the 
Senator of North Dakota, and that the people of his State have a 
tremendously capable person representing their needs.
  I am pleased that Senator Dorgan and his partners on the subcommittee 
considered the conduit along with many, many worthy requests nationwide 
and determined that $5 million of Federal resources was what could get 
this project off to a promising start.
  This first round of funding will be used for environmental analysis, 
planning, and design. The final project will enable these communities--
all of which have average incomes well below the national average--to 
comply with Federal drinking water standards.
  I hope that it is just a matter of years--not decades--before the 
people of the lower Arkansas Valley have a conduit to call their own.
  When President Kennedy traveled to Pueblo to sign the bill 
authorizing the Fryingpan-Arkansas Project, he proclaimed it ``an 
investment in the future of this country, an investment that will repay 
large dividends.''
  ``It is an investment in the growth of the West,'' he continued, ``in 
the new cities and industries which this project helps make possible.''
  Today, for the first time in 47 years, we recommit to making that 
investment in earnest. Today, we begin the difficult, but long overdue 
task of building a brighter, stronger future for generations of 
Arkansas River Valley residents to come.
  Madam President, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant bill clerk proceeded to call the roll.
  Mr. BURRIS. I ask unanimous consent that the order for the quorum 
call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.

[[Page 24853]]


  Mr. BURRIS. I ask unanimous consent to speak in morning business.
  The PRESIDING OFFICER. Without objection, it is so ordered.


                           The Public Option

  Mr. BURRIS. Madam President, for almost 100 years, Washington has 
been wrestling with the complicated question of health care reform. On 
some points, we have broad consensus. Costs are up. Health outcomes are 
down. Our system is broken. Americans deserve better.
  We are faced with a crisis that breaks businesses, bankrupts 
families, and leaves millions of hard-working Americans out in the 
cold. This is why we must not fail in our efforts to make reform a 
reality. That is why we need to include a public option in our reform 
package--to foster competition, reduce costs, and extend quality care 
to tens of millions of Americans. I believe a public option is the only 
way we can accomplish these objectives. That is why I will not vote for 
any health care bill that does not include a public option. I believe 
the American people overwhelmingly support our efforts.
  The American people overwhelmingly support our efforts, but not 
everyone agrees we need meaningful reform. There are some who seem 
satisfied with the status quo. For example, between 2000 and 2007, 
profits for America's top 10 insurance companies grew by an average 
rate of 428 percent. While the rest of us suffer the effects of a 
recession, these corporations hold American families and businesses in 
a vice grip, and they are squeezing them for extraordinary profits. Of 
course, they oppose any measure that would make them compete with a 
not-for-profit public plan. Of course, they want to maintain their 
virtual monopoly over the health insurance industry. In Illinois, two 
companies control 69 percent of the market. People don't have a real 
choice anymore. This is simply unacceptable. We need the competition 
and accountability a public option would provide.
  Insurance giants have done everything they can to block such a plan. 
That is why I was surprised to see the study released this weekend by 
an insurance trade group called America's Health Insurance Plans. On 
the surface, it looks like the same twisting of facts, the same scare 
tactics and disinformation we have seen since the beginning of the 
debate. For instance, our opponents contend that the government wants 
to take over health care and create death panels. These claims have 
been debunked many times. In much the same way, this new industry study 
claims health care reform will drive costs up instead of down. They say 
the Senate Finance Committee bill would cost an average family an 
additional $4,000 over the next 10 years.
  But, as the committee has made clear, this analysis is fundamentally 
flawed. The study overlooked key parts of the bill in order to produce 
skewed numbers designed to deceive the American people. 
PricewaterhouseCoopers, the company that conducted the study for the 
insurance agents, freely admitted this data was deceptive and 
incomplete. I quote:

       The reform packages under consideration have other 
     provisions that we have not included in this analysis . . . 
     [and] if other provisions in healthcare reform are successful 
     in lowering costs over the long term, those improvements 
     would offset some of the impacts we have estimated.

  According to the very people who performed the study, it is deeply 
flawed.
  This is the same tired rhetoric we have seen time and again from 
those who stand to profit from our broken system. By itself, I would 
say this new round of disinformation is hardly surprising. But in the 
context of our current debate, I believe opponents of reform have 
actually hurt their cause.
  So let's take another look at the study. It actually lays out a 
strong case in favor of a public option. By releasing the study, these 
insurance giants are saying the Finance Committee bill does not do 
enough to contain cost. They are warning us that unless we provide 
Americans with a public option that can compete with private companies, 
these companies will raise their rates by 111 percent. That is what 
this study really means. It was meant to be a hatchet job, but instead 
it has reinforced the need for real competition and cost containment in 
the insurance industry.
  The need for a public option is as plain as day. Over the last 
century, Presidents from Roosevelt to Truman to Clinton to Obama have 
laid out a strong case for reform. Legislators on both sides of the 
aisle have spoken out on this issue.
  This weekend, the insurance giants finally tipped their hand. In 
their rush to discredit health care reform, these corporations 
inadvertently laid out a strong case for the kinds of reforms I have 
been talking about for months. They tried to threaten the American 
people with higher premiums so they can maintain their out-of-control 
profits. But we will not fall for their tricks--not this time, not 
anymore. This study proves that the insurance industry will stop at 
nothing to block reform. The only way to keep them in check is by 
restoring real competition and choice in the insurance market. That is 
a strong argument in favor of a public option. It is an argument some 
of us have been trying to make for several months.
  Last Friday, I was proud to join 29 other Senators to sign a letter 
in support of a public option. My colleagues and I know the American 
people deserve nothing less than meaningful reform that only a public 
option can provide. I never guessed the insurance industry would 
actually help us make the case.
  After a century of inaction, the momentum is finally building. Real 
health care reform is almost within our reach, and we must not stop 
now. Yesterday, my colleagues on the Finance Committee voted out their 
version of a reform bill. I congratulate them on reaching this 
milestone. This is the farthest any such bill has ever gotten. But 
there is much work left to do. Before we take up this legislation on 
the Senate floor, we need to merge the Finance bill with the HELP 
Committee version, and we need to make sure the combined bill includes 
a public option.
  I look forward to working with my colleagues to shape the final 
legislation. It is time for us to come together on the side of the 
American people. It is time to deliver on the promise Teddy Roosevelt 
made almost 100 years ago. It is time for health care reform that 
includes a public option.
  I thank the Chair.
  The PRESIDING OFFICER. The Senator from Iowa.


                           Health Care Reform

  Mr. GRASSLEY. Before I speak, Madam President, from my text, this 
year, for the most part, I haven't spoken on the Senate floor much on 
health care reform because so much of this period of time I have either 
been in consultation with Chairman Baucus or with what has been called 
the Group of 6, three Republicans and three Democrats, trying to 
negotiate a bipartisan health care reform package. I didn't speak 
during that period on the floor because in intense negotiations, you 
can say things sometimes that might upset the negotiations. I didn't 
want to do anything to do that. I want people to know that those 
negotiations, obviously, were not fruitful in the end because the 
leadership and the White House thought they had gone on long enough and 
that we ought to move ahead. I am not sure that was to Chairman 
Baucus's liking because I think he was comfortable thinking we could 
get to a bipartisan negotiation. Everybody in the Group of 6 wanted to. 
But, of course, they came to an end. Then, of course, it took a 
partisan approach from that point on.
  I want everybody to know, though, that during that period of talks we 
had in the Group of 6 and what Senator Baucus and I were doing 
individually, it ended in a way that was congenial in the sense that up 
to that point everything was moving along, and during the 2- or 3-month 
period of time we were negotiating, there was never a period that 
anybody walked away from the table. There was never a period that there 
was ever a harsh word. There was a sincere effort during all that time 
to reach a bipartisan agreement. I am sorry that didn't materialize, 
but I have no regrets that I participated in the process because you

[[Page 24854]]

never know, you take it a day at a time around here. You never know, it 
could be very fruitful. And if it had been fruitful, it probably would 
have been better for this process in the Congress and better for the 
country as a whole.
  For sure, this issue of health care reform is, in a sense, 
redirecting one-sixth of the economy because $1 out of every $6 spent 
in America involves health care. Of course, the issue of health care 
itself is a life-or-death situation with every American. That is what 
health care implies. Never before has Congress done stuff so 
encompassing and affecting such a large segment of the economy.
  So in the process of 6 months of negotiation on health care reform, I 
feel much better informed about health care than I otherwise would have 
been, and I want to thank Senator Baucus for his patience in 
negotiating that and for every courtesy he gave to me and Senator Enzi 
and the Senator from Maine, Ms. Snowe.
  (Mr. Burris assumed the Chair.)
  Mr. GRASSLEY. Mr. President, the bill is now out of the Senate 
Finance Committee. I commend the chairman for bringing the markup to 
where it was yesterday. It seems a long time since we started that 
markup on September 22. We have been able to air our differences, and 
we have been able to have votes. I think Senator Baucus tallied up 61 
different rollcall votes we had during that 7- or 8-day period of time.
  I would have to say to my colleagues in the Senate, I wish I felt 
better about the substance of the bill and would not have had to vote 
no. The chairman's mark underwent many changes during the process since 
the bipartisan talks ended, and I think the changes that happened since 
then are not for the good. I want to highlight a few of the changes I 
find most disturbing. As I highlight these issues, it will be clear 
that this bill is already sliding rapidly down the slippery slope to 
more and more government control of health care.
  It has been the biggest expansion of Medicaid since it was created in 
1965, and I think that is going to add up to 11 million more people 
being on Medicaid.
  It imposes an unprecedented Federal mandate for coverage backed by 
the enforcement authority of the Internal Revenue Service. I could put 
that another way as well: In the 225-year history of our country, never 
once, to my knowledge--and I would be glad to be informed if I am wrong 
on this, but the Federal Government has never said any citizen in this 
country, anytime in that 225-year history of our country, has ever had 
to buy anything. They do not tell you what you have to buy or not buy. 
You make a consumer choice.
  So for the first time in the history of our country, enforced by the 
power of the Internal Revenue Service, people are going to have to buy 
health insurance. And if they do not buy health insurance, a family is 
going to be fined $1,500.
  Additionally, it increases the size of government by at least $1.8 
trillion when it is fully implemented. I want to emphasize ``fully 
implemented'' because right now we would read the papers as saying it 
is $820-some billion and fully paid for, et cetera, et cetera. But this 
program really does not start until 2013. Oh, the taxes and the 
increase in premiums will start more immediately, but the program does 
not take off until 2013. If we figure 2013 to 2023 as the 10-year 
window, at that particular time--being fully implemented--$1.8 
trillion.
  Additionally, it gives the Secretary of Health and Human Services the 
power to define benefits for every private plan in America and to 
redefine those benefits annually. That is a lot of power over people's 
health insurance and over people's lives.
  Further, it will cause health care premiums for millions to go up, 
not down. It tightens further the new Federal rating bands for 
insurance rates. That means millions who are expecting lower costs as a 
result of health reform will end up paying more in the form of higher 
premiums. The new rating reforms alone will raise premiums by as much 
as 50 percent on millions, particularly in those States where there is 
not a lot of regulation of insurance and requirements on insurance.
  I would say in regard to premiums going up, I will bet most of the 85 
percent of the people out there who have private health insurance--we 
are talking about health insurance reform--that one of the things they 
would expect is that we would not have these big increases in premiums, 
as has happened over the last 10 years--terrible increases in premiums. 
Right now, we have the Congressional Budget Office and CBO saying that 
premiums are going to go up.
  Part of this is because it is going to impose new fees, but it also 
has increases in taxes. These new fees and taxes will total about a 
half trillion dollars over the next few years. On the front end, these 
fees and taxes will cause premium increases as early as 2010, even 
before most of the reforms take place.
  So let me say that a second time but yet another way: By saying that, 
a lot of the increases in revenue coming into the Federal Treasury or 
the money that is going to be saved in certain programs that is going 
to help pay for some of those start next year, but the benefits from 
the program and the policy does not kick in until the year 2013. So one 
of the reasons we can say it is revenue neutral is from the standpoint 
that there are 10 years of revenue or savings but only 6 years of 
policy costs that are there.
  Then, of course, after making health premiums go up, this bill makes 
it mandatory to buy that insurance. That is what I previously referred 
to as the first time in American history--the first time in American 
history--the Federal Government has said we had to buy anything.
  On several occasions, Republicans tried to take the chairman's mark 
in a different direction. We tried to ensure that the President's 
pledge to not tax middle-income families or tax seniors or veterans or 
change seniors' and veterans' programs was carried out. We were 
rebuffed every step of the way.
  Republican efforts to provide consumers with lower cost benefit 
options were consistently defeated. This means that despite these 
promises, a lot of people are not actually going to be able to ``keep 
what they have.'' We heard the President say that during the campaign, 
and we heard the President say that in September when he gave an 
address to a joint session of Congress.
  It imposes higher premiums for prescription drug coverage on seniors 
and the disabled, it creates a new Medicare Commission with broad 
authority to make further cuts in Medicare, and it makes that 
Commission permanent.
  In our Group of 6 negotiations--which I said broke up when the White 
House decided it was taking too long to do things right because they 
wanted to do it right now--during our Group of 6 negotiations, I 
resisted making the Commission permanent. I certainly was not going to 
agree to target prescription drug premiums. But this bill now requires 
the Medicare Commission to continue making cuts to Medicare forever. 
The damage this group of unelected people could do to Medicare is very 
unknown. In fact, we will not know for quite a few years because it 
does not even start operation until the year 2014, as I recall.
  What is more alarming is so many providers got exempted from the cuts 
this Commission would make that it forces the cuts to fall on those who 
are covered, to fall directly, more so, on seniors and the disabled.
  The Congressional Budget Office has confirmed that the Commission 
structure requires it to focus its budget axe on the premiums seniors 
pay for Medicare Part D prescription drug coverage and for Medicare 
Advantage. Sooner or later, it has to be acknowledged that by making 
the Commission permanent, those savings are coming from more and more 
cuts to Medicare.
  Finally, I cannot help but note the incredible cynicism in an 
amendment that took benefits away from children. That amendment was 
offered and passed because the chairman's mark had the audacity to let 
children get covered through private insurance where, of course, there 
is a great deal of choice. In 41 States, children would have received 
access to a program that

[[Page 24855]]

is called the EPSDT benefit--basically diagnostic services. These 
benefits cover vitally needed services for children such as 
rehabilitation services, physical, occupational, and speech therapy, 
particularly for children with developmental diseases.
  But those benefits were deleted by Rockefeller amendment No. C21. Now 
children in 41 States will not have access to health care, and they 
will be left in a grossly underfunded public program. They lost these 
important benefits.
  What this mark has shown is that there is a clear and significant 
philosophical difference between the two sides. Throughout this markup, 
we have focused on trying to reduce the overall cost of the bill. We 
were told, flatout, no.
  We focused on trying to reduce the pervasive role of government in 
the chairman's mark. We were told, flatout, no.
  We tried to make it harder for illegal immigrants to get benefits. We 
were told, flatout, no.
  We tried to guarantee that Federal funding for abortions would not be 
allowed under this bill. We were told, flatout, no.
  We tried to allow alternatives to the individual mandate and also to 
the harsh penalties associated with that part of the bill that requires 
everybody, for the first time in the 225-year history of this country, 
to buy something that maybe they do not want to buy. We were told, 
flatout, no.
  We tried to reward States with extra Medicaid dollars if they passed 
medical malpractice reform. We were told not just no, but, shockingly, 
we were told Medicaid is not even in the committee's jurisdiction.
  We have watched while the other side has expanded public coverage. We 
saw Democratic amendments move millions from private coverage to public 
coverage. We saw Democratic amendments create new government programs 
that cover families making close to, would you believe it, $90,000 a 
year.
  At the end of the day, after raising billions in new taxes and 
cutting hundreds of billions from Medicare and imposing stiff new 
penalties for people who do not buy insurance and increasing costs to 
those who do, we still have 25 million people who are going to be 
uninsured.
  I do not think this is what the American people had in mind when we 
promised to fix the health care system. As I said when this process 
started, the chairman's mark that was released 27 days ago was an 
incomplete but comprehensive, good-faith attempt to reach a bipartisan 
agreement. But then the modifications pulled that attempt at bipartisan 
compromise very far toward a partisan approach on several key issues.
  With this markup being completed yesterday, we can now see clearly 
that the bill continues its march leftward. The broad bipartisan 
character of the reform proposals have very dramatically changed. This 
partisan change is precisely what Republicans feared would have 
occurred at the later stages in the legislative process. Today, as we 
saw yesterday, we see that those fears that were expressed when the 
bipartisan process ended were legitimate, and we now see they were 
justified. The product proves that justification.
  Nevertheless, I want people to know I still hope that at some point 
the doorway to bipartisanship will be opened once again. That might 
happen because I have read in the newspapers, and I guess I have talked 
to one of the Senators who is involved in promoting a great deal of 
transparency in this process--making sure things are on the Internet 
for 72 hours before we take up the bill; making sure it is paid for or 
at least we have a CBO score--maybe there is a chance there are enough 
Democrats out there who have some questions about the movement of this 
bill leftward that we would be able to have that doorway to 
bipartisanship opened again.
  I also hope that at some point the White House and leadership will 
want to correct the mistake they made by ending our collaborative 
bipartisan work. I hope, at some point, they will want to let that 
bipartisan work begin again. Then they need to go back to that effort 
and give it the time needed to get it right instead of getting it done 
right now. I am open to that. I hope to speak to people on the other 
side of the aisle about that process moving forward because, here 
again, I get back to something I heard Senator Baucus probably say 
first, but I totally agree with him. It was said many months ago, and I 
think Senator Baucus still believes it. We may not be in a process that 
gets him to where he said he wanted to go, but something as serious as 
health care reform and something as serious as redirecting one-sixth of 
our economy ought to be done on a fairly consensus basis. During the 
process of bipartisan talks of the six of us, and even before that when 
Senator Baucus and I were talking one on one, we were talking in terms 
of getting a bill that 75 to 80 people would support in this body 
because of the significance of the issue we are dealing with: 
Redirecting one-sixth of the economy. At the same time, the words 
``health care'' imply life or death. It affects the lives of all 306 
million Americans who are here. It is clear that yesterday was not the 
day when that was going to happen, but you take a day at a time around 
here.
  I think, eventually in this city, right wins out. Maybe not always. 
Maybe some people would think Chuck Grassley by saying that is very 
naive about the process, but there is something about ``I believe,'' 
and I believe in the process of democracy. I think we saw that at work 
in the last several months. I am not referring to the raucous things we 
saw on television that went on in town meetings. I only saw the ones 
that went on in Pennsylvania, Maryland, and Missouri; maybe they went 
on elsewhere. The town meetings we had in my State of Iowa were not 
raucous. Everybody was able to speak their piece. In every instance, I 
was asked a question, I was given the opportunity to answer it. I saw 
some of my colleagues not even being able to control their respective 
town meetings. It wasn't that way in my State. But I say this process, 
whether it is raucous or whether it is more civilized, is a process of 
representative government. I think the people of this country now have 
about a month to weigh in on this issue, both from those who want a 
single payer yet, those who want public option yet, and for those who 
think things ought to be done in an incremental way; and people who 
think we should not have a bill go through here that doesn't take into 
consideration what to do about the practice of defensive medicine and 
correcting that through medical malpractice reform in other words, 
getting rid of the frivolous lawsuits that get doctors to give patients 
every test under the Sun because they think that patient may someday 
sue them.
  That is just one of many items that people back at the grassroots of 
Iowa, and I think the grassroots of America, think we ought to be 
dealing with. Well, there will be a month now to weigh in on these 
things. There is at least a week or two where we have to have a merging 
of the Senate HELP Committee bill with the Senate Finance Committee 
bill. There is still time, as Speaker Pelosi puts together a bill out 
of three committees in the House. There is an opportunity for democracy 
to work as it has during all the massive amounts of mail we are getting 
that we have never gotten before on a single subject and the turnouts 
at our town meetings and the telephone calls that come in. I think 
people made an impact, and I am suggesting they can make the same 
impact on health care reform as they made on the stimulus bill. It 
didn't get quite the results constituents wanted, but I can tell my 
colleagues that during a 10-day period of time, 5,000 Iowans called my 
office on the stimulus bill, and during that period of time about 83 
percent were opposed to the stimulus bill. Those calls were coming in 
from all over the country into everybody's office.
  As my colleagues remember, the Thursday before the Presidents Day 
break in February, everybody was being told that constituents would 
have 72 hours to read the stimulus bill, but an agreement was hastily 
reached that Thursday before that break and

[[Page 24856]]

the constituents didn't have 72 hours to read that product, because I 
think the leadership of this body and the White House were reading the 
grassroots objections to a $787 billion stimulus bill, and if they 
waited around for the 72 hours for constituents to read it and it laid 
around over the week-long break, that it would never have been passed a 
week later, after the Monday of the Presidents Day holiday.
  So people are listened to. This is an opportunity for the grassroots 
of America to speak up. If they speak up in the same way they did on 
TARP legislation, on stimulus, and they do it on this health care bill, 
it may make an impact. It may surprise people that Washington does 
respond to the grassroots of America. It may prove to the American 
people that representative government does work. What is representative 
government all about? It is about those of us who were elected being 
one-half of the process of representative government, and it is our 
constituents who are the other one-half of representative government. 
If there is no dialogue between constituents and those of us who are 
elected, we don't have representative government.
  This is an opportunity, over the next month, for representative 
government to work for the people of this country, both for this 
legislation or people who think this legislation ought to be revised 
because I don't think we are going to have anybody calling in saying 
everything in America on health care is OK, but we are going to have a 
lot of people calling in and saying how they think it ought to be done. 
There will probably be a great deal of disagreement with a bill that 
constitutes the most massive involvement of health care in the United 
States since Medicare and Medicaid, with all its taxes and with all its 
premiums going up and all the cuts in Medicare that are going to scare 
the devil out of our senior citizens, et cetera.
  I hope people will take notice now that all these bills are out of 
committee and they are coming to the floor because this is serious 
business. I hope the American population takes it seriously.
  I yield the floor. I don't see other colleagues ready to speak, so I 
suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  The PRESIDING OFFICER. The Senator from New Hampshire.
  Mr. GREGG. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. GREGG. Mr. President, I ask unanimous consent to speak as in 
morning business for 15 minutes.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. GREGG. Mr. President, I wish to speak briefly. I know we are 
going to get a lot of debate on this issue as we go down the road 
relative to the health care package which was reported out of the 
Finance Committee and the health care package which was reported out of 
the HELP Committee, of which I am a member, and how they are being 
pulled together and what the implications are for health care and for 
Americans, generally, who are all affected by these bills. This is 16 
percent of our national economy. There isn't an American who isn't 
impacted by health care. So when the Congress decides to fundamentally 
change--and that is what is being proposed--fundamentally change the 
way health care is delivered in this country, it will have an impact on 
everyone and a very significant impact on everyone who has to interface 
with the health care system in the immediate future.
  The bill that came out of the committee known as the Kennedy-Dodd 
Committee at the time, which is now the Harkin committee, which I am a 
member of, was a bill which basically subscribed to the view of a large 
majority, I think, of the House Democratic membership and a fairly 
significant group of Members on the Democratic side in the Senate, 
which essentially said the government should start to take very 
significant control over the health care delivery system in this 
country.
  In fact, they would propose a public plan, a plan that would 
basically put the government allegedly in competition with the private 
sector. But we all know the government isn't a fair competitor, because 
the government doesn't have to play by the same rules as the private 
sector, and that would put us on a slippery slope toward a single-payer 
system or a nationalized system, much like you have in Canada and 
England. They have some very severe problems in those countries. There 
isn't a lot of innovation in those nations in the area of health care. 
Health care isn't of the quality that we have here, and they have 
significant delays and, in many instances, actual rationing where 
certain people cannot get certain treatments because of their age or 
they don't qualify under the rules that are set up. It is not the type 
of system we want in this country.
  The purpose of health care reform should be to make health care 
insurance affordable to everyone, while in the outyears reducing the 
rate of growth of health care costs, and to allow people who have an 
insurance policy today to keep it. Those are the goals we set off when 
we stepped into the arena of trying to change the health care delivery 
system. Neither the Harkin bill--although it wasn't offered by him, but 
was offered by Senators Dodd and Kennedy--nor the Baucus bill 
accomplishes any of those three goals. In each of those situations--
take, for example, that everybody should have access to affordable 
health care. The Harkin bill, as scored by CBO, says that of the 47 
million people who don't have health insurance, approximately 34 
million would still not have it after that bill is fully phased in. The 
bill coming out of the Finance Committee varies and looks as if it is 
in the vicinity of about half of the people who don't have health care 
today will still not have it after that bill is phased in. As to the 
outyear costs, neither the Harkin bill nor the Kennedy bill controls 
outyear costs. In fact, the costs go up rather dramatically in the area 
of health care.
  As to letting people keep their insurance if they like it--no, that 
doesn't happen either. In fact, large numbers--in the millions, 
according to CBO--would migrate out of their private system into a 
public plan because basically the employer would drop their plan. That 
is also true, I believe, of the Baucus plan, although we haven't gotten 
a final score on that. When you set penalties for an employer at a 
level that says to them it is fiscally prudent for them to pay the 
penalty rather than insure people, many will give up the insurance and 
push people into the subsidized program, called the exchange. Thus, a 
lot of people will lose the insurance they have today.
  None of the three goals is met by these proposals. What do these 
bills do--especially the Baucus bill, which is the center of attention? 
First, they create a massive expansion of the size of the government. 
We are a government today that is running a deficit of $1.4 trillion 
this year. That is three times more than we have ever had in the 
history of this country--$1.4 trillion, which is about 12 percent of 
our economy. Historically, deficits have been about 3 percent of the 
economy. Today, it is $1.4 trillion or 12 percent of our economy. That 
deficit doesn't come down dramatically. We continue to run deficits 
under the President's plan, prior to this health care bill being 
passed, of approximately $1 trillion a year for the next 10 years. 
Average deficits over that 10-year period are between 5 and 6 percent 
of GDP, and we take the public debt from 40 percent of the GDP up to 80 
percent. What do all these numbers mean? They are not just numbers 
thrown up in the air. They are obligations--debt we are running up on 
our children, because we have a government that is so large today that 
we cannot afford to pay the bills for it.
  Almost every economist of any note or credibility says that when you 
run deficits that exceed 3 percent of GDP for an extended period of 
time or when you take your public debt from 40 percent to 80 percent of 
GDP, you are basically creating an unsustainable situation--a situation 
where you cannot pay the debt, and where your children and our 
children's children, who will be

[[Page 24857]]

subject to these deficits and debts, will end up with a government they 
cannot afford and which will lead inevitably to devaluing the dollar. 
We are already seeing a reaction to that in the international 
marketplace, and probably a massive increase in the tax burden, which 
reduces productivity and reduces, therefore, job creation.
  Those are not good scenarios for our kids. It means a lower standard 
of living, less opportunity to buy a home, to send their children to 
college, and less opportunity to do what our generation has been able 
to do, because they are having to bear such a burden of the Federal 
Government--on top of this government that is, today, already projected 
to run deficits as far as the eye can see of $1 trillion a year, to a 
public debt that will go from 40 percent to 80 percent of GDP. The 
proposal is that we are going to spend another--when it is fully phased 
in--$1.8 trillion over 10 years on this brandnew entitlement program. 
And then the almost laughable--were it not being presented in such a 
way that is claimed to be sincere--proposal is: but we are going to 
reduce the cost of government.
  A brandnew entitlement will be created, which costs us approximately 
$1.8 trillion over a 10-year period. It scores at $823 billion in the 
first 10 years because it is phased in. In the first 4 years, they take 
revenues in from the bill, but they don't start the program. The 
numbers are all skewed in the first 10 years. If you look at it in the 
10-year tranche, where the program is fully implemented, it is $1.8 
trillion. We are going to create this massive expansion of the size of 
government with these brandnew entitlements being put into place and, 
in the process, grow the government at a rate that it hasn't grown in 
recent history, taking government from about 20 percent of GDP up to 
about 23, 24 percent--unsustainable levels--and we claim we are going 
to do it while reducing the cost of government, which is absurd on its 
face.
  Some would argue that we need to do that in order to take care of 
health care, and that this is revenue neutral because, as a practical 
matter, we have put a cut in Medicare of $400 billion and tax increases 
of $500 billion, and those will pay for this over that 10-year period.
  What they fail to tell you, of course, is when it is fully 
implemented, neither the cut in Medicare is large enough, nor are the 
tax increases, to make those numbers. To give them the benefit of the 
doubt, let's say that this Congress is going to cut Medicare by $400 
billion and create a new entitlement for uninsured people--take it from 
seniors and give it to the uninsured people. And this Congress is ready 
to raise taxes by $500 billion. Let's give the benefit of the doubt to 
the Congress, which I know isn't going to happen because, just 5 years 
ago, I was chairman of the Budget Committee and I suggested we reduce 
the rate of growth of Medicare by about $15 billion, and we could not 
get any votes on the other side of the aisle for that, and now they are 
suggesting they are going to cut it by $400 billion. That is what is 
called ``bait and switch.'' It doesn't happen. This proposal won't 
occur.
  As a practical matter, giving them the benefit of the doubt and 
saying they are able to raise close to $1 trillion in new taxes, or 
spending cuts in Medicare, over the next 10 years, recognizing in the 
following 10 years it is not nearly enough, why is that incorrect to 
have a program if it is paid for? I will tell you why. This government 
is running so much debt to the extent that if we are going to use 
resources like that, we ought to reduce the debt of the country, not 
use them to create a new program on top of a government that is too 
large as it is. We know for a fact--an absolute fact--that Medicare has 
a $34 trillion unfunded mandate. Try to think of that. That means we 
know that we have expenditures in Medicare that will exceed income in 
Medicare by $34 trillion.
  So why on Earth would we cut Medicare spending by $500 billion, or 
$400 billion, and use that money to create a new program? We should use 
that money, if we are going to take that action--and some of that 
action is responsible--and use it to make Medicare more solvent. If we 
are going to raise taxes by $500 billion--tax the rich, as the House 
claims, and they always end up taxing middle-class America, or are we 
going to add special fees against special industries, such as the 
pharmaceutical, hospital, medical device, and other industries? If we 
are going to do that and assess a penalty on people who don't buy 
insurance, and we are going to assess small businesses that don't buy 
insurance a penalty, should we not use that money to reduce the burden 
of the debt of this country as it is being driven by the present health 
care system, not by adding a brandnew entitlement that absorbs all 
those resources?
  There are a lot of ways we can do health care reform here that are 
much more responsible than what is being proposed. The recent claim by 
the White House and Members of the other side is that this bill isn't 
going to affect people's premiums at all. The premiums will go up, but 
no more than usual. That is so unbelievable on its face. Think about 
this. This bill suggests that insurance companies are going to have to 
pick up a massive increase in the cost of insuring people because--for 
a lot of technical reasons, but basically it sets up a system where not 
enough people will be coming into the insurance pool; a lot will be 
opting out to cover the additional costs, which is going to have to 
occur as a result of the very rich benefits package under this bill and 
the fact that there is no longer any exclusion. Everybody gets covered 
by insurance. So on the face of it, insurance companies aren't going to 
be able to absorb those costs. They are going to pass them off to the 
people who pay the premiums.
  Then the bill suggests they are going to put another 14 million 
people under Medicaid--take Medicaid coverage from 100 percent up to 
133 percent of poverty. We already know Medicaid only pays 60 percent 
of the cost of health care. We already know that for the people under 
Medicaid, 40 percent of the cost is being borne by people with private 
insurance, who are paying for not only the cost of their health care 
but for the 40 percent of health care costs that are not reimbursed 
under Medicaid. So when you add another 14 million people, that goes 
onto the premiums of the people in the private sector. Thus, the 
premiums have to go up because they cannot absorb all the costs.
  Then we know that a large number of people will come into the system 
but not enough to cover the fact that everybody is going to be required 
to be covered. There is going to be something called ``adverse 
selection,'' where some folks basically buy coverage at the last minute 
because they are suddenly finding they are sick and haven't been paying 
into the pool very long. They will be able to do that under this system 
and, thus, drive up the cost of insurance for everybody else.
  We know the insurance prices will go up there. We know the premiums 
are going to go up significantly. That is just common sense. Whether 
you accept the study by the insurance companies or look at what--it is 
like 1 and 1 makes 2. It is an obvious fact. Then we ought to know 
something else. The hospitals, under this proposal, have agreed to chip 
in--in order to basically be at the table--for something like $20 
billion or $40 billion. The drug companies have agreed to chip in $80 
billion. When you add that all up--all of which is passed back to 
consumers--none of them will absorb all of the costs, and you end up 
raising the cost of health care.
  In the end, people's premiums will go up--people who have private 
insurance. You might say: Why would somebody do that? Why would 
somebody drive up premiums on people? I will tell you why. Because the 
goal here is to basically eliminate private insurance. The goal here is 
to create a structure where essentially people who get private health 
care through private insurance or their employer will be forced out of 
that health care insurance and into an exchange, where there will be a 
public plan, when this is all over. The government will essentially 
absorb all insurance. This is not a good idea. Why isn't it a good 
idea? Because the government basically, in order to control costs, can

[[Page 24858]]

only do two things: it can limit access or it can control prices.
  I ask unanimous consent for an additional 5 minutes.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. GREGG. It can limit access or control prices. Either way, it 
significantly undermines the quality of health care.
  There are about 180 million people in this country--or more, I 
guess--who already have health care and are fairly comfortable with the 
health care they are getting under the private system. There are about 
190 million, actually. But they are going to be at deep risk.
  There is something else here that is very serious that we have to 
think about. As you start to put these types of pressures on the system 
and you start to regulate prices and you start to regulate access and 
you start to regulate reimbursement and you have the government doing 
all of this, you start to stifle innovation. A lot of the drugs that 
come on the market today come on after a massive period of time of 
research--I think it averages 15 years--and a huge amount of 
investment. I think it is $800 million to bring a new drug to the 
market. That $800 million does not appear from out of the sky. People 
who are investing money say: I am willing to invest in that drug 
because I think it will work and it will do social good, but I also 
think I am going to get a reasonable return on my investment. But if 
you set up a system where you have price controls and where the return 
on investment is artificially low, you basically don't allow people to 
recover their costs or their costs plus a reasonable return on their 
investment. Then the money will not go into those research activities, 
the money will go somewhere else. It will go into new software. It will 
go into new machinery. It will go into real estate ventures where the 
return is better. You inevitably chill the investment in the 
innovation, especially in the area of pharmaceuticals, which is where 
most of the great research is being done today that is making better 
health care outcomes more available.
  Mr. CHAMBLISS. Mr. President, will the Senator respond to a question?
  Mr. GREGG. I am honored to respond.
  Mr. CHAMBLISS. Mr. President, the Senator mentioned a little bit 
earlier about the previous attempt to slow the growth of Medicare. I 
remember during my House days--it has probably been a decade or more 
ago--when the Senator from New Hampshire was on the Budget Committee on 
the Senate side. We were looking at a rapid growth of Medicare, 
somewhere in the 7 to 8, 9 percent rate. What the Senator from New 
Hampshire is talking about is that in order to try to achieve a 
balanced budget and to make reforms in Medicare, instead of it growing 
at that rate, we were going to reduce the rate of growth, not reduce 
the amount of money, just reduce the rate of growth to about 5 percent 
per year to help achieve a balanced budget and at the same time 
continue to provide the services under Medicare that we did then.
  I ask the Senator what he thinks is going to happen if we are not 
reducing the rate of growth, but in this plan coming out of the Finance 
Committee that will be on the floor and the one that came out of the 
HELP Committee that will be melded with that bill, there is going to be 
a reduction in Medicare spending by about $500 billion over 10 years. 
Will we be able to provide the same services under Medicare that we do 
now if we reduce the amount of money spent on Medicare?
  Mr. GREGG. The Senator from Georgia asks a very appropriate question 
because the practical effect of the reductions which are being proposed 
is that people who are on Medicare Advantage, which is a program many 
seniors like, will be eliminated. They will no longer have the 
opportunity to use Medicare Advantage or it will be contracted so much 
that it will be a shell of its former self. This is being done not in 
order to make Medicare solvent--and there are very serious issues about 
Medicare solvency--it is being done in order to move that money over 
and start a new entitlement for a new group of people who are not 
seniors and who have not paid into the health insurance trust fund and 
who have no relationship at all to Medicare.
  Mr. CHAMBLISS. The Senator from New Hampshire has been here a lot 
longer than I have, both in the House and his service in the Senate. 
Mr. President, has the Senator from New Hampshire ever seen a mandatory 
spending program that has been created by the Federal Government reduce 
its spending?
  Mr. GREGG. The Senator asks another good question. ``No'' is the 
simple answer. We all know that once you start a mandatory program, it 
always grows and grows significantly. That, of course, is why we are in 
such trouble as a nation, because we have a number of mandatory 
programs to which so much has been added that we simply cannot afford 
them any longer under our present structure of a government.
  Now we are going to take that problem and compound it by $1.8 
trillion, which is pretty irresponsible of us and fiscally 
irresponsible, but it is also irresponsible in the sense of stewards of 
our children's future because our children are going to inherit a 
government that cannot be afforded and they are going to get bills or 
get a devalued dollar.
  Mr. CHAMBLISS. If the Chair will allow me, I wish to ask another 
question about Medicaid.
  The proposal coming out of the Finance Committee to the floor of the 
Senate has a huge effect on my State, and I am sure it has a similar 
effect on Senator Gregg's State, and that is this: The eligibility for 
Medicaid will move from 100 percent of poverty level to 133 percent of 
poverty level, which will add a significant number of additional 
individuals all across America to the Medicaid rolls.
  In my State, where the Federal Government will pick up the tab for 
the first 3 years, there is going to be an additional cost of $1.2 
billion for those additional Medicaid-eligible individuals in Georgia. 
Beginning in the fourth year, the State of Georgia is going to have to 
pick up that $1.2 billion.
  The Senator from New Hampshire is a former Governor, and I assume New 
Hampshire probably has a balanced budget requirement, as we do. We are 
furloughing teachers today. We are furloughing State employees. Schools 
are operating 4 days a week instead of 5 days a week. We are doing 
everything we can to decrease spending at the State level and even 
below that to try to make sure we achieve that balanced budget. If we 
as Georgians are asked to come up with another $1.2 billion to fund a 
health care program, we simply do not have the money to do it.
  I ask the Senator if he has a similar situation in New Hampshire.
  Mr. GREGG. The Senator from Georgia is expressing a problem which I 
think most State Governors are extraordinarily worried about, whether 
they are Republicans or Democrats, which is that this bill, as it 
starts up, covers the additional people who will be pushed into 
Medicaid, which is about 14 million nationally, but that coverage drops 
off in the outyears, and it will put many States in dire straits.
  The Senator from Georgia talked about the numbers in Georgia. New 
Hampshire will have the exact same problem, only we do not have a 
balanced budget amendment. We are not that foresighted. I wish we were. 
So we already have a problem. We are already running major deficits in 
the State of New Hampshire, and if you throw these new Medicaid costs 
on, you are going to make it very difficult to do things such as spend 
on school systems and, especially in New Hampshire, on our college 
systems and our mental health care systems which are key to our quality 
of life in New Hampshire.
  This will be a massive unfunded mandate. I saw the number $33 billion 
as being what the States will end up picking up over the 10-year 
period. That is a big number for States to pick up. It will put massive 
strains on State budgets. It is another example of the Federal 
Government saying: Here, look at the wonderful things we have done for 
everybody, and then sending the bill to the States, which is totally 
inappropriate.
  Mr. CHAMBLISS. Lastly, if I may ask one more question through the

[[Page 24859]]

Chair, as we reform health care--and 100 percent of the Members of this 
Senate agree that we need to reform health care. We have the best 
delivery system in the world, but it can get better. We can have a 
better delivery system. We have the best insurance system in the world, 
but it needs reforming. It can be made better.
  Does the Senator from New Hampshire, who I know is familiar with the 
details of the plan that came out of the Finance Committee, know of any 
provision in that bill that is designed to reduce the costs of health 
care delivery in this country, which will help make that system better, 
which will help make the insurance system better by making premiums for 
insurance more affordable for folks who cannot afford it today?
  Mr. GREGG. The Senator from Georgia leads in the way I want to close 
this discussion. There are ways to do what the Senator from Georgia is 
suggesting. There are ways to reduce the cost of health care in this 
country and to make it better.
  Let's take, for example, malpractice reform, abusive lawsuit reform. 
None of that is in the Finance Committee bill. We should have something 
there. The President says he is for it. We should do something in that 
area. CBO scores this as a $54 billion savings. That is not chicken 
feed--not in Georgia, not in New Hampshire. That is a big number. So we 
should have malpractice reform.
  We should have proposals which basically incentivize employers to 
have their employees with healthier lifestyles. It is called HIPAA 
reform. That is not in the Finance Committee. It is very easy to do. 
You give people the incentive and employers the ability to say to 
someone: If you stop smoking, if you live a healthier lifestyle by 
reducing your weight, if you take the tests you need to take in the 
area of better health care, such as colonoscopies, we actually will 
give you a cash reward. We cannot do it under the Finance Committee 
bill and, to a lesser degree, under the Kennedy-Dodd bill or the Harkin 
bill but not as much as we would like.
  There are specific diseases we should target, such as obesity and 
Alzheimer's. There are a whole series of healthy lifestyles. There are 
things we can do in a step-by-step manner which will get us much 
farther down the road toward quality health care for all Americans 
rather than this massive expansion of health care through a massive 
expansion of an entitlement which will lead inevitably to, in my 
opinion, a huge debt being passed on to our children.
  Three groups are going to pay for this $1.8 trillion: One is seniors 
citizens who are going to pay for the cuts through Medicare; two is 
small businesses that are going to have to pay through massive 
increases in premiums for their insurance, and they will probably have 
to give up a lot of coverage of their people; and three is our 
children, who are going to have to pay the debt.
  I appreciate the thoughts and questions of the Senator from Georgia. 
They are right on point. I thank him for getting involved in this 
discussion. In fact, I yield the floor to him right now.
  The PRESIDING OFFICER. The Senator from Georgia.
  Mr. CHAMBLISS. Mr. President, I appreciate the comments of the 
Senator from New Hampshire, who has certainly been in the forefront 
trying to make sure, No. 1, that the budget of this country is in a 
very positive situation as we move forward and that we do not leave our 
children and grandchildren burdened with a debt they simply cannot pay. 
As he has said, they are the ones who, at the end of the day, along 
with senior citizens and the small business community, are going to 
wind up paying for this bill if it comes out crafted the way it is 
presented in the Finance Committee and the way it appears it is going 
to come out of the Finance Committee to the floor of the Senate.
  Mr. President, I ask unanimous consent to speak for 5 minutes on 
another subject.
  The PRESIDING OFFICER. The majority leader.
  Mr. REID. Mr. President, I have been waiting to come here for a bit. 
I have no problem with 5 minutes. I am patient. I want to alert the 
Senate what is going to be happening the rest of the day. I will wait 
for my friend from Georgia.
  Mr. CHAMBLISS. If the majority leader wants to go----
  Mr. REID. No, that is fine. I am happy to do this. I want everyone to 
know what is happening here tonight. I will do that when the Senator 
from Georgia finishes.
  The PRESIDING OFFICER. Without objection, it is so ordered.


                       Recognizing Vernie Hubert

  Mr. CHAMBLISS. Mr. President, it is with great pride and yet much 
regret that I stand here today to recognize a dear friend and longtime 
servant of American agriculture who is retiring from public service.
  Through nearly 25 years of serving in various capacities on the House 
and Senate Agriculture Committees, Vernie Hubert has exemplified 
tremendous character, an infectious personality, and an astute 
knowledge of the law, for which I admiringly respect and thank him. I 
would like to issue a special thanks to his wife Kathleen and daughter 
Mary Phillips for allowing us to have him in Washington for the past 3 
years while they have lived in Texas. I am eternally grateful for his 
dedication to agriculture. His encyclopedic knowledge and valuable 
input will certainly be missed.
  What began as an internship in the House Agriculture Committee for 
Vernie in 1982 has since blossomed into a distinguished agricultural 
law career. Before entering law school, he earned a bachelor's degree 
in biomedical science at Texas A&M University and even served as a 
first lieutenant in the U.S. Army Reserve Medical Service Corps after 
graduation.
  Upon graduation from St. Mary's University School of Law in 1985, 
Vernie returned to his beloved South Texas for a brief stint as an 
assistant prosecutor in Brazos County. Though his heart has always 
remained in Texas, Vernie returned to the House Agriculture Committee 
to work with then-chairman Kika de la Garza and ranking member Charlie 
Stenholm, where he served for almost 20 years in various roles--as 
associate counsel, staff director, and legislative director.
  In 2004, I was fortunate in luring Vernie to the Senate, where he has 
served as chief counsel on the Senate Agriculture Committee for me 
since then. We were successful in passing a farm bill last year, and a 
big reason for that success is due to the tireless, diligent efforts of 
Vernie Hubert.
  Seeing that the 2008 farm bill was the fifth farm bill that saw 
passage during Vernie's tenure, it goes without saying that his 
experience in negotiating agriculture policy is not going to be easily 
replaced.
  In fact, it is impossible to replace a person like Vernie Hubert, not 
only for his wealth of knowledge but also for the richness of his 
character.
  In the years I have known and worked with him, he has remained a 
loyal confidant and has always kept American agriculture's best 
interests at heart. Vernie, you will sincerely be missed by everyone 
who has had the pleasure of working with you, and I wish you nothing 
but the best in all your future endeavors.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The majority leader.
  Mr. REID. Mr. President, I appreciate the usual courteousness of my 
friend from Georgia.
  There will be no more votes today, but I want to say a word about a 
statement made by my friend, the senior Senator from New Hampshire. He 
talked about the CBO saying there would be $54 billion saved each year 
if we put caps on medical malpractice and put some restrictions--tort 
reform. Fifty-four billion. Sounds like a lot of money, doesn't it? The 
answer is yes. But remember, we are talking about $2 trillion--$54 
billion compared to $2 trillion. You can do the math. We can all do the 
math. It is a very small percentage.
  I have said in meetings before that people who practice medicine are 
negligent. What does that mean? The Presiding Officer is a lawyer, my 
friend

[[Page 24860]]

from Illinois who is next to me is a lawyer, my friend in the aisle 
from Maryland is a lawyer, and we learned early on in law school what 
the definition of negligence is. If someone runs through a stop light 
or a stop sign and hurts somebody, they have been negligent. And our 
system of justice, carried over from the common law in England, allows 
people to seek redress for the injuries they received as a result of 
someone's negligence. Doctors are negligent. They are human beings and 
they make mistakes and they hurt people.
  I have said before--and I will be very quick with a little story. My 
friend, Senator Coburn, is on the floor. He is a medical doctor. I used 
to spend hours and hours on the floor, and one day I felt in my left 
foot that my sock was kind of gobbed up on the bottom of my foot. I 
thought: What is wrong? I don't know what that is. So I went into my 
office and took my shoe off and the sock was fine. To make a long story 
short, I had a problem with my foot. As some know, I have run thousands 
of miles on my feet and one of them reacted. It was tired of running 
those thousands of miles, I guess. I was diagnosed with having a 
Morton's neuroma on my foot, which required surgery. They tried all the 
other things and they didn't work.
  So I go into the hospital to have this surgery. Remember, it is my 
left foot. I am on the gurney--the hospital bed, whatever it is--and 
they are getting ready to do the surgery. I look down and I have a big 
mark from a Magic Marker on my right foot. I say: Why is that big mark 
on my foot? And the doctor and the personnel say: That is where we are 
going to operate--on that foot. That is why we put that check. I said: 
The wrong foot.
  If I hadn't said something, they would have operated on my good foot 
and left my bad one for a surgery later on. That is negligence. I said 
something about that. But as I have said before, my wife was born shy 
and she will die shy. She is a very shy person. She would have been on 
that surgical table ready to have that surgery and she wouldn't have 
said a word about that big mark on her foot. I know her. We have been 
together these many decades, and I know she wouldn't have said a word. 
That is medical malpractice. We need to protect people from doctors who 
commit negligence.
  In talking about the great report Senator Gregg cited, he failed to 
mention one thing I think is kind of important--important to me. If 
this went into effect, 4,853 Americans would be killed every year by 
medical malpractice. Over a 10-year period, I repeat, 48,000 Americans 
would die because of medical malpractice. So I would suggest people not 
wave that around because I don't think the American people want to be 
part of the 48,000-plus people being killed because of medical 
malpractice--malpractice by doctors, not other personnel.
  We haven't done a thing today. Why? Because the Republicans will not 
let us. We had cloture invoked on an important piece of legislation and 
they are using the 30 hours postcloture. For what? For nothing. For 
nothing. No one is coming here from the other side saying how important 
it is they have the extra time to talk about this legislation. It is 
wasted time.
  The Republicans have made the political calculation they would rather 
have no progress made. No suffering American gets help. They would 
rather do that than work with us to move forward on the most pressing 
issues in this country. It is not just limited to the health care 
debate we have heard about for months on end. Because they refuse to 
move forward, to hold up the legislative process for no substantive 
reason, we are wasting America's precious time and money.
  We could be working on extending unemployment benefits at a time when 
unemployment is high in virtually every State--some States higher than 
others. Unemployment is running out in some States. We could be 
supporting the Department of Defense conference report--the 
authorization bill. It is the bill we do every year for our fighting 
men and women around the country and around the world. We are not doing 
that. Why? Because we are wasting time here. We could have a couple of 
hours of debate on it at the very most. But, no, we are wasting our 
time.
  I came to the floor last night and said: Why are you doing this? They 
said: Well, if we could work a little longer, we could come up with a 
list of amendments. I repeat what I said last night. I was here until I 
don't know how late on Thursday. Everybody had vacated this building. I 
could have yelled down the hall and no one but a police officer would 
have heard me. Why? Because we were waiting for them to come up with 
some amendments so we could fill the bill. But they were just killing 
time. There was no intention of completing that bill. They were 
stalling for time. So I had to file cloture on that bill.
  Department of Homeland Security. We have a conference report we would 
like to complete on appropriations. Are we doing that? No. Are we 
completing our appropriations bills? We got a letter from the 
Republican leadership saying: Let's do the appropriations bills. We are 
trying. But, again, they are stalling and will not let us. In the 
Department of Defense and Department of Homeland Security, we have two 
critical agencies that need all the support they can get at a time when 
our Nation is fighting two wars--two wars plus homeland security trying 
to protect our borders and protect the homeland.
  We could be passing appropriations bills to keep our country running, 
including Commerce-State-Justice that they held up last night. Instead, 
we are doing the Republican shuffle. If it sounds familiar, it should. 
Last year, Republicans broke the blindly partisan record of pointless 
filibusters--nearly 100. Not nearly; 100 is how many it was--more than 
any other session of Congress in the history of our Nation. What does 
this accomplish? Zero. Nothing.
  The American people didn't demand paralysis, they demanded change, 
and we are trying our best. It is long past time for the Republicans to 
listen to what the American people want. Their strategy of stubbornness 
is shortsighted. I am confident that, in the end, these Republican 
tactics will once again prove to be self-defeating, just as they were 
last November. I am so concerned that we have the same Republican 
shuffle time after time and we spend hours and days on this floor doing 
nothing.
  Mr. LEVIN. Mr. President, I wonder if the leader would yield for a 
question.
  Mr. REID. I am happy to yield to my friend.
  Mr. LEVIN. The leader mentioned the Defense authorization bill is 
awaiting action by this Senate. We have a conference report. We have 
spent months and months and months on this bill. There are critical 
provisions that everyone knows about. Some of those, it can be argued, 
well, doesn't that require an appropriation? The answer is: Yes, 
technically, some of these provisions do.
  For instance, the pay increase requires an appropriation. But by 
holding up this bill--the conference report--we are holding up 
legislative provisions as well that are critically important that do 
not rely on appropriations. So I want to----
  Mr. REID. I would say to my friend, the majority of your bill is 
legislative language that has nothing to do with appropriations.
  Mr. LEVIN. And I want to ask the leader, if he can bear with me for a 
moment. I wish to spend a couple moments talking about a few of the 
legislative provisions. One, to remedy the military commissions law. It 
has been basically thrown out by the Supreme Court. We cannot hold 
people in front of military commissions and try them before military 
commissions under the current law. We have to modify this law. We have 
spent months doing it. The modifications are in the Defense 
authorization bill. Until these modifications are signed into law by 
the President of the United States, we cannot have detainees tried 
before military commissions.
  We want to get equipment to Afghanistan. Many of us are focusing on 
strengthening the Afghan Army as a way that we can succeed in 
Afghanistan, to get their numbers up, to get their equipment up. But in 
order to get

[[Page 24861]]

nonaccess property from Iraq to Afghanistan, we have to authorize it. 
That is in the bill that is now being held up because, apparently, 
there is an unwillingness on the part of some of the Republicans to 
agree to a unanimous consent agreement with a time agreement for 
debate. No one is trying to preempt anybody from talking.
  There is one other example. Unless we act, soldiers who are getting 
care at TRICARE facilities are going to have to pay $100 a day extra. 
We have to stop that from happening--to continue the provision in law 
to extend the limitation on charges for patients who are getting 
TRICARE. On and on and on.
  We have critically important legislative provisions, and my question 
to the leader is this: Am I correct in my understanding that we have 
offered a unanimous consent agreement, given a willingness to enter 
into a time agreement on how many hours of debate--and I know there are 
people who oppose the hate crimes provisions, for instance, in our 
bill. We are not trying to preempt debate. It is the opposite. We are 
trying to get on with the debate. So my question is: Is it true we have 
offered a unanimous consent agreement on the Defense authorization bill 
and that it has so far been rejected?
  Mr. REID. Yes, yes, yes. I say to my friend, you have only mentioned 
a few of the most important things that satisfy and take care of the 
military and our fighting men and women in our country.
  I say to my friend, I went to the first ever Reid family reunion in 
Searchlight. It was interesting. You should have seen the invitation--
``sobriety requested.'' That was fine. Not everybody followed that, but 
it was pretty interesting. A child of one of my cousins was there and 
she said: I want to tell you that my husband is 30 years old and just 
joined the Army.
  Because of the downturn in the economy, we have had huge numbers of 
people joining the military, and we need to take care of those people, 
such as my relative I learned about in Searchlight.
  So I thank the chairman very much.
  Mr. LEVIN. I thank the leader, and I hope our Republican friends will 
reconsider their objections to letting us proceed to the Defense 
authorization bill, which is critically important to the country.
  The PRESIDING OFFICER (Ms. Cantwell). The assistant majority leader 
is recognized.
  Mr. DURBIN. Madam President, I will be very brief. I want to back up 
the comments recently made by Senator Levin of Michigan, the chairman 
of the Armed Services Committee, and our majority leader.
  How can we, in the midst of two wars, stop the Department of Defense 
authorization bill on the floor when our sons and daughters, husbands 
and wives, Americans across this country are risking their lives? We 
have this stall tactic on the floor, where they will not even allow us 
to bring this up for a vote for the Department of Defense 
authorization. A lot of people around here go back home for parades and 
wave the red, white, and blue and salute our troops and tell us how 
much they love them and then come to the floor and engage in stall 
tactics and filibusters to stop this.
  I would say to the other side of the aisle: Don't go home and wave 
the flag of patriotism if you will not at least give us a chance to 
vote on the bill our men and women in uniform are counting on. Too many 
of them are doing just that. I might also tell you that when it comes 
to unemployment benefits, we know what is going on in America. Hundreds 
of thousands of people have lost their jobs. As of September of this 
year, the end of September, 400,000 Americans lost their unemployment 
benefits, another 200,000 will occur within this month and then 1.3 
million total by the end of the year. We have asked the Republicans: 
Will you let us extend unemployment benefits for people who have no way 
to sustain their families? No. They want to filibuster this. They want 
to offer amendments that have nothing to do with this whatsoever. They 
want to drag it out. They have no sensitivity to these people who have 
lost their jobs and are struggling to keep their families together 
under the most difficult circumstances. The Homeland Security 
conference report is another one. That is going to pass soon, and we 
are having difficulty from the Republican side getting any kind of 
agreement getting this measure enacted. This is a measure about the 
safety and security of our country.
  The Commerce-Justice bill, this is one Senator Mikulski brought to 
the floor. It includes the Federal Bureau of Investigation and law 
enforcement. We could not get a single Republican yesterday to agree 
with us to bring this bill to a vote after it sat on the floor for an 
entire week, waiting for amendments that were promised and never 
delivered.
  Now we have the Energy and Water conference which could pass, an 
important bill to put people to work in America. We had a vote earlier 
today, it was 79 to 17--people thought it was a great bill. Now it is 
being stalled. It is being stopped.
  The bottom line is we came here to do some work, not to dream up ways 
to stall and not do the people's work. Too many people are being 
disadvantaged by this tactic. It is the tactic of the minority. It is 
one they will pay for because the American people understand they have 
no proposal when it comes to health care reform--nothing. Now they have 
no agenda when it comes to these important items for our men and women 
in uniform, for the people who are unemployed across America to keep us 
safe through homeland security and basic bills for law enforcement and 
for Energy and Water appropriations. They want to stop them all, stall 
them all.
  That may be a good tactic that some of their political consultants 
have given them but don't think the American people are going to accept 
it.


                           ORDER OF PROCEDURE

  I ask unanimous consent that when Senator Udall is recognized, 
Senator Udall of New Mexico is recognized this evening, he control up 
to 1 hour of that time as in morning business and it be in order for 
him to engage in colloquies during this time; at the conclusion of that 
hour, Senator Coburn be recognized to speak for up to 1 hour; at the 
end of that hour, it be in order for Senator Udall to be recognized for 
another hour under the same conditions as identified above; and at the 
conclusion of that hour, Senator Coburn again be recognized for 1 hour 
as identified above.
  The PRESIDING OFFICER. Is there objection? The Senator from Oklahoma.
  Mr. COBURN. I ask the unanimous consent be modified that I be given 3 
minutes to speak prior to the start of that unanimous consent.
  Mr. DURBIN. I have no objection.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. DURBIN. I yield the floor.
  The PRESIDING OFFICER. The Senator from Oklahoma is recognized.
  Mr. COBURN. I wanted to answer a few of the points of the 
distinguished majority whip. The reason the Energy and Water bill is 
being held up is because the conference took out transparency that the 
people of this country need to see. It could easily be fixed by the 
majority agreeing that we will send that back, we will send a 
resolution back and ask the House to put the transparency back in. That 
is the purpose for it. It is not a delaying tactic. The fact is, we 
didn't defend what we actually voted for. That is the answer to the 
first question.
  The unemployment benefit, we all want to extend it. We just want to 
pay for it. We don't want to charge it to our children. We want to get 
rid of some of the waste. We want to either take some money from the 
stimulus account and pay for it, but we do not want to charge the 
unemployment extension to our grandkids. We think you ought to make 
those hard choices.
  Finally, on the cloture vote yesterday, as far as I could count, 
there are 60 of you and all you had to do was bring 60 votes to the 
floor, which you chose not to do. There were only three amendments that 
have been voted on on the Commerce, Justice, and State. I have three 
amendments pending. I

[[Page 24862]]

agreed to have votes on them yesterday. Instead of having votes, we 
decided to do cloture, which was not achieved.
  The final point that the Senator from Illinois makes, the very claim 
that we have no health care proposal--the first health care proposal 
that was filed and published was my health care proposal that is a 
comprehensive health care proposal that saves the government money, 
covers more people than any of the bills we have today, saves $70 
billion, saves the States $1 trillion, and solves most of the problems 
as far as access and cost, it covers people with any preexisting 
illness.
  It is not we do not have a plan, it is that we couldn't get our plan 
agreed to or listened to.
  I understand the frustration of my friend from Illinois; there is no 
question. We do want--we almost had an agreement yesterday to finish 
Commerce-Justice. There is no question. Everybody knew that. Then we 
decided to vote cloture.
  I am happy to finish. We can finish it tomorrow if we can come to 
agreement on the amendments. We vote on the amendments and finish that 
bill tomorrow and finish this tomorrow. They can both be finished 
tomorrow easily, so it is not about structure; it is about growing the 
Federal Government, expanding the size and scope of the Federal 
Government and charging the cost of that to the next two generations. 
That is the objection. It is not about slowing the process.
  I understand it is frustrating being in the majority when, in fact, 
there are minority rights, but when the amendments aren't agreed to, 
aren't allowed to have majority votes, then you can understand our 
predicament.
  The PRESIDING OFFICER. The Senator from New Mexico is recognized.
  Mr. UDALL of Colorado. Madam President, it is great to be here with 
you this evening. I see Senator Durbin is still on the floor, and I 
know he may want to speak to the issue that was just raised. We are 
here discussing the public option. I hope Senator Durbin has a minute 
or two to talk about that.
  Mr. DURBIN. I thank the Senator, and under the hour he has been 
given, I thank him for yielding a few minutes. Let me say, what 
happened to you in the conference committee has happened to all of us. 
You had an amendment adopted in the Senate. As I understand it, we all 
supported it. It died in conference. It is frustrating, something you 
believe in, something we all voted for, and you didn't get your way. 
But does that mean we are going to stop consideration of this 
conference report; we are not going to pass an Energy and Water 
appropriations bill because your amendment didn't survive in 
conference? If all 100 Members in the Senate took that position, we 
would never pass anything.
  Mr. COBURN. Will the Senator yield?
  Mr. DURBIN. When I finish. The fact is, each of us has to accept the 
reality here. We don't always get what we want. I have been denied 
opportunities in conferences for things I cared for.
  One of them, for example, was to say the Federal Government was going 
to make up the difference in pay from activated Federal workers who 
served in our Guard and Reserve. Year after year it would be adopted on 
the Senate floor and killed in conference by the chairman from Alaska. 
Did I stop the money for the Department of Defense because of that? Of 
course not. I said: Tomorrow is another day and I will fight for it 
another day. But to stop the bill and say we are going to hold on for 
30 hours or more because I didn't get my amendment in conference?
  When it comes to the unemployment benefit, we are paying for these 
the same way every President has paid for them, through the FUTA tax. 
It is paid for. Frankly, it should be. These are people who paid into 
unemployment compensation for the day when they would need it and now 
the money is coming back out to pay them. But some people here have a 
different theory how they want to pay for it. So hundreds of thousands 
of unemployed Americans are waiting for the latest Republican theory on 
how to finance unemployment benefits. It is cold comfort to them to 
know we are having this great academic debate when a question about 
food on the table and taking care of their family is No. 1 in their 
minds. That is the problem with what has happened here.
  You can always dream up a reason to vote no. You can always dream up 
a better idea. But at some point the business of government has to get 
on. People count on us--in this case, hundreds of thousands of 
unemployed people.
  Let me say a word about public option, and then I will yield the 
floor back to the Senator from New Mexico. If we didn't get the message 
loudly and clearly Monday night about the public option when the health 
insurance industry threatened us and said: If you pass health care 
reform, we are going to raise your premiums, if the message didn't come 
through loudly and clearly that they not only have the power to do 
that, we empowered them to do it in ways no other company can because 
they are exempt from antitrust laws, the only way to keep them honest 
is to make sure health care reform does not disadvantage workers and 
businesses and families is to have a not-for-profit option, a public 
option that people can choose for health insurance. I fully support 
that public option. Those who say I am not sure if I would go that far 
have to accept the reality. Health insurance, private health insurance 
companies will impose premiums, they will fix prices because they can--
they are exempt under McCarran-Ferguson--and they can allocate 
marketplaces so they can own markets. They are in a dominant position. 
The only thing that can stop them is competition and the only 
competition that can work is a public option, one that comes in and is 
not profit driven but tries to provide quality care for people at 
affordable cost. I fully support the public option. I thank the Senator 
from New Mexico for yielding.
  Mr. UDALL of New Mexico. I thank the Senator from Illinois. I think 
he makes some very strong points.
  We are being joined here in the majority, Senator Whitehouse is here, 
Senator Cardin is here, Senator Brown from Ohio is going to be here. We 
are going to be carrying on a colloquy about the public option for the 
next hour, so any of our friends in the majority who want to come down 
to the Senate floor and join us, I urge them to do that.
  Senator Cardin, I know, has a couple things to say about the public 
option. Please.
  Mr. CARDIN. If the Senator will yield, I thank him very much. I thank 
the Senator from New Mexico for bringing us together. He has been not 
only a real champion on the public insurance option within the health 
care debate but a real leader in that we need to do something.
  I listened to my Republican friends. They take the position the 
status quo is acceptable. The status quo is not acceptable. Health 
insurance reform is vitally important for the American public. I thank 
the Senator for bringing us all together to talk about it.
  There is some general consensus among the Democrats. The first is we 
need to reform our health insurance marketplace. It is important for 
the Federal Government to take action to deal with preexisting 
conditions so people can get health insurance without discrimination, 
they get the ability to renew their policies, there is no cap on the 
annual amounts that preventive care covers without copayment or without 
deductibles. These are all important changes that are included in the 
health insurance reform that is making its way through the Senate.
  Let me tell you, the main reason for all this is cost. I will be 
honest with my colleagues. We cannot sustain the current health cost 
escalation in this country. Let me give you a few numbers: 6, 12, 23. 
Ten years ago in Maryland, a family health insurance policy cost about 
$6,000. Today it is about $12,000. If we don't do anything, in 2016 it 
is going to be $23,000. That is not sustainable.
  We are currently spending, in America, about $7,400 per person for 
health insurance, $2.4 trillion. We have to do better.
  Let me tell you something. Every family in Maryland who has health 
insurance is paying an extra $1,100 a year

[[Page 24863]]

for those who do not have health insurance. So the status quo is 
unacceptable to the people in Maryland. It is unacceptable to the 
people of this Nation.
  Our objective is simple. Our objective is to reduce the cost of 
health care to make sure every American has access to affordable, 
quality care, and we are going to do it in a fiscally responsible way 
that will not add to the Federal deficit. We want to build on the 
current system. Those who have insurance, we want to make sure they can 
continue to keep that insurance; that it remains affordable; that they 
have the right to choose their doctor. We want to make sure Medicare is 
strengthened. One of the best ways to strengthen Medicare is to bring 
down the escalating cost of health care.
  We understand that. Democrats want to make sure the Medicare system 
remains strong and that is one of the reasons why we think health 
insurance reform today is so critically important and we want to help 
small businesses have more choice.
  That brings me to the public insurance option. Why do we think the 
public insurance option is so important?
  First, I have heard some of my colleagues come down to the floor and 
say we want to protect you against the Democrats' bill that is a 
government takeover. This is not a government takeover. Was Medicare a 
government takeover? Of course, that is what our Republican friends 
said when we were considering Medicare in 1965, and if they had had 
their way we would never have passed Medicare.
  But Medicare allows you to choose private doctors, private hospitals. 
It is all about providing an affordable way that our seniors and 
disabled population can get access to affordable care. It maintains the 
private network. We want to make sure we continue that.
  Let me tell you the problem in Maryland today. That is that 71 
percent of the people in Maryland who have private insurance are in one 
or two plans. That is not competitive. That is not competitive. One out 
of every three Marylanders has no choice on the private insurance plan 
that their employer offers. They must take that. That is not choice.
  So the reason I am such a strong proponent of the public option is to 
bring down costs, to add more competition, to make sure we have an 
affordable product there to save taxpayers' dollars. That is why I want 
to see us make sure that we maintain a public insurance option, to be 
able to maintain your ability to choose your own doctor.
  I will give you one more comparison; that is, take a look at what has 
happened in Medicare. We have Medicare Advantage. You can go to a 
private insurance option within Medicare itself. It would be one thing 
if they competed on a level playing field. They do not. Today we are 
paying 12 to 17 percent more for every senior who chooses private 
insurance. Let me repeat that. For every senior who goes into private 
insurance, the taxpayers of this Nation have to spend more money.
  The Congressional Budget Office has indicated to us that that amounts 
to about $150 billion over 10 years. We cannot afford that. I am for 
private insurance, but I want to make sure it is affordable and that we 
are not oversubsidizing as we are today. Let them compete on a level 
playing field.
  The reason we want the public option is to keep costs down, to keep 
basically the private insurance marketplace straight and honest in a 
way they make their profit, to make sure that in every part of 
Maryland, indeed every part of this Nation, there is an affordable 
insurance plan available.
  Marylanders know what happened with what was called Medicare-Plus 
Choice when we had private insurance plans in Medicare and they left 
overnight. They had no insurance available. Fortunately they still had 
the public insurance option called Medicare. We want to make sure there 
is affordable coverage for all Americans, to keep the cost down.
  I applaud my colleague from New Mexico for allowing us an opportunity 
to talk about this. I really do applaud the work that is being done by 
all of our committees, by the HELP Committee, by the Senate Finance 
Committee. Their options give us hope that we are going to move forward 
with health insurance reform and health care reform this year, to bring 
down the cost of health care, to make sure that every American has 
access to quality, affordable care and do it in a way that will be 
fiscally responsible. Democrats are giving us hope that we are going to 
be able to achieve that in 2009.
  Mr. UDALL of New Mexico. I thank the Senator from Maryland. I think 
the Senator from Maryland has made such a strong case of why we need a 
public option. You know many of the folks who are out there wondering: 
Well, what is a public option? I think we need to go through a little 
bit of what we are talking about, because this is something that the 
American public understands. They know it in their heart. But let's go 
through a few of the details.
  First, this is not going to be subsidized by the government. It is 
going to be fully funded by premiums. So we are going to be out there 
in the private sector. Premiums will be flowing in to this nonprofit 
entity, and it will be able to function and compete with other 
businesses. It is not going to make a profit for its shareholders 
because it is a nonprofit.
  It would have low administrative costs since it operates as a 
nonprofit. That would allow it in the marketplace to serve as a 
competitor with these big insurance companies that are out there. It 
would offer savings to its subscribers through lower premiums, greater 
benefits, or lower out-of-pocket expenses. It will have the same 
insurance requirements as private plans. So we are talking about 
something that will offer low cost and high value.
  Let's take a look here at why it costs so much. You can see by this 
chart right here that in New Mexico, we have a situation where we have 
two companies controlling 65 percent of the market. All of us know the 
way the market system works. It works best when you have a lot of 
competitors. When you take a market and drive it down and only have two 
competitors, what you end up getting is those two competitors that are 
able to push up the cost. So that is something a public option would 
inject into the market, a competitiveness that we have not seen in a 
long time.
  One of the things it would do is it would start lowering those 
premium costs we are seeing in New Mexico. I know Senator Whitehouse is 
here from Rhode Island. One of the things I want to say about the 
Senator from Rhode Island is he has participated in this process 
already. Everybody knows he was on the HELP Committee. He had the 
opportunity to help write this bill. He has got a great deal of 
knowledge about what the public option is.
  I believe it is only about 19 pages of the bill that passed out of 
the HELP Committee. People can read it. It is out there on the 
Internet. That 19 pages sets up the public option. So all we need to do 
is make sure that is in the bill that comes to the Senate floor, or 
that we amend it on the Senate floor if it is not in the base bill, or 
that we have the President of the United States say he wants a public 
option. He can weigh in to the conference and say those 19 pages, the 
public option, we want them in there.
  I want to ask the Senator from Rhode Island to talk a little bit 
about the way he sees things from his perspective. What is happening up 
in Rhode Island on the public option?
  Mr. WHITEHOUSE. I thank the Senator from New Mexico. I am committed 
to that. I am also delighted to follow the Senator from Maryland. 
Senator Cardin and Senator Udall have been, for many years before they 
even came to the Senate, when they were serving with such distinction 
in the House of Representatives, strong advocates for the elderly, 
strong advocates for the disabled, and strong advocates for consumers.
  That is what a public option is all about. It is helping out people 
as consumers and providing better health care, the kind that the 
elderly and disabled get when they are on Medicare. They do not have so 
many worries that regular families have of whether they are going to 
get coverage.

[[Page 24864]]

  The public option makes so much sense that it is very hard to argue 
against it as it is. So a great number of my friends on the other side 
of the aisle are arguing against things that actually are not being 
proposed, such as socialized medicine, or the government taking over 
health care.
  None of that is suggested by our bill, anyway. The first words of the 
HELP bill are ``voluntary plan.'' It is a voluntary option. As the 
President said when he was running for election: If you like the plan 
you have, you get to keep it. But if you do not like the plan you have, 
you have a public option, an alternative, a choice.
  Why does that matter? Well, it matters to people such as Stephanie, a 
28-year-old from Warwick, who recently learned that her insurance plan 
is refusing to cover the most costly and important medication that she 
has to take for a chronic rheumatic condition. She thought she had 
insurance. But when this condition appeared, and she realized the kind 
of treatment she needed, and her doctor said: This is what you need, 
Stephanie, the insurance company said: Oh, no, I am sorry. We are not 
going to cover that.
  Our friends like to talk about how this will put the government 
between you and your doctor. Folks, the private insurance industry is, 
all over this country, getting between Stephanie and her doctor and 
millions of others just like them and telling them what kind of care 
she can and cannot have.
  The public option will actually help free that up by providing 
alternatives where they can provide better service and broader 
coverage, at lower cost. Why might they be able to do that? Our friends 
on the other side of the aisle say: Well, it is because they will 
compete unfairly. Because they will necessarily take over any insurance 
market that they get into.
  That is, frankly, a bunch of baloney. In my home State of Rhode 
Island, just two insurance companies dominate the market now. In fact, 
one of our health insurers reported $37 million of profits, excess 
profits, that it wanted to take out of Rhode Island and repatriate to 
its home State outside of Rhode Island; $37 million. Rhode Island has 
only 1 million people in it. We are a small State. This was a company 
with 16 percent market share in Rhode Island. So out of 16 percent of 
the Rhode Island market, in 1 year, they were going to pull $37 million 
and send it out of State.
  You do not have to do that if you are a not-for-profit company. That 
is $37 million that can serve those 16 percent of folks with better 
coverage, with better quality service. The profit and huge executive 
compensation is money that could go instead into health care.
  I also heard from Charles from Pawtucket. For 20 years he and his 
wife have worked. They are freelance musicians. They have not had 
anybody providing them coverage through the business. But they have 
scrupulously and faithfully paid for health insurance and coverage. 
Recently his wife was in an accident. They are both in their late 50s. 
The insurance company took a look at them and said: You are out. They 
tossed them out; threw them off the insurance plan.
  That is not the kind of choice people need. They need a public plan 
they can go to that will be reliable, and that will be there for them 
once they get sick. It is said about our private health insurance 
industry that they give you all the coverage you need until you need 
it. Suddenly it is loophole city. There is a better alternative and a 
better way.
  Another way the public plan can help to fund that and to make up that 
difference is with less administrative cost. We have heard that on the 
private insurance side, 15 to 30 percent of the health care insurance 
dollar gets burned in administrative costs; Medicare, maybe 3 to 5 
percent. So they are running probably five times as expensive as 
Medicare in their administration.
  And what do you get for that? Well, you get told that you cannot have 
the care you need when you actually get sick. You get your doctors 
hassled so badly by the private insurance industry that they have staff 
to fight with the insurance companies. As I travel around Rhode Island, 
doctors tell me that very often 50 percent of their personnel is 
devoted to fighting with the insurance industry, fighting about prior 
approvals, fighting about getting paid.
  So the 15 to 30-percent costs that the private insurance companies 
have for administration creates what I call a ``cost shadow'' in the 
health insurance provider community, because they have got to pay all 
of those people to fight back. You add the two together and it is big 
dollars. A public plan will work more effectively, will try to figure 
out the better way to provide care that does not invest its dollars in 
trying to fight with providers and figuring out how to deny you care. 
There is a huge amount of money that can go back into better quality 
care.
  Another story is Tim from Warwick. He is a husband and he is a 
father. Right now his family health insurance has a $3,500 deductible. 
Tim and his wife are not high-earning people. The $3,500 deductible is 
a real risk. Because of it, they actually avoid care, miss appointments 
and do not take as good care of their health as they should, because 
they simply cannot afford the out of pocket. They save it for the big 
catastrophe.
  They have tried. They looked around to try to find other things. They 
cannot find anything better because the costs are so high. So right now 
Tim sees his family as tethered to that job, tethered to that insurance 
plan. If there were a public option and he did not have to get it 
through his job, then they could look and they could find an 
alternative and they would not feel as tied down.
  How many people in America feel trapped in their jobs because they do 
not have an alternative for health care? And to protect their family's 
health care, they continue to slug away at a job, they defer the 
innovation and entrepreneurship they could do. They do not open their 
own business. They feel they have no choice.
  The public option could give them a choice. Another way that could 
help save money is by providing a new model of service.
  Over and over again, we find in health care that if you improve the 
quality of care, you can actually lower the cost. The waste in the 
health care system is phenomenal. The Lewin Group says there is $1 
trillion in excess health care costs--$1 trillion in excess health care 
costs--every year in America; $1 trillion every year.
  The New England Health Care Institute has looked at this, and they 
say there is $850 billion in excess health care costs in America every 
year.
  President Obama's Council of Economic Advisers looked at how much 
excess costs there are in health care. They looked at it by comparing 
our share of gross domestic product to other countries' shares of gross 
domestic product that gets burned by their health care systems. We are 
the highest in the world. We are far ahead of everybody else. We are a 
complete outlier. We are at 18 percent of GDP. The next worse country 
is Switzerland at 11 percent, and the EU average is half of ours, and 
they get better health care results. We spend a fortune on health care. 
They looked at that comparison.
  They also looked at the comparison of regional outcomes and how in 
some States you can get very high-quality health care with great 
outcomes and results, and it is a lot cheaper than in other States 
where you get very expensive health care and lousy results. They 
crunched all those numbers, and they looked from both sides, and they 
came up with the number of $700 billion a year in excess health care 
costs. It is there.
  We have a terrible model of service in this country. Anybody who has 
ever had a sick family member, who has had a chronic condition, who has 
been sick themselves--you have seen it. You know the inefficiencies in 
this system: the electronic health record that is not there, so your 
tests cannot be located and you have to carry your own file around; the 
insurance companies being just brutal to your doctors and arguing with 
them about your care, and you cannot get the care while that fight

[[Page 24865]]

goes on, while they sort it out; the doctors who cannot talk to each 
other. You have five specialists, and you are the one in the middle, 
and you are the one who is sick, and nobody is sorting it out for you, 
and nobody knows what the other person is doing. One person prescribes 
a prescription and another person prescribes a prescription, and those 
two interact in a way that makes you sick, and nobody saw that coming 
because it is disorganized.
  All that stuff does not need to be there. It is excess cost. When you 
get rid of it, you improve the quality of care. A public option can go 
after that, and it will because it is not bound to try to make a profit 
every minute, it is bound to try to do the right thing. So there are 
innumerable reasons why a public option makes sense.
  But, finally, I think the strongest one is that by not having to 
extract all this profit out of the system--by not having to pay CEOs 
tens of millions of dollars a year, by not having to maintain that huge 
administrative war with doctors and hospitals and war with their 
customers as soon as they get sick, trying to deny their coverage--by 
actually trying to find that newer, better model of care that provides 
better health care cheaper, they can actually drive down costs--and a 
lot.
  I do not know if the right target number is $700 billion a year or 
$850 billion a year or $1 trillion a year, but there is a big target 
number to find, and what a difference that would make for Lisa in 
Providence, who turned 55 this year. Her birthday present from her 
insurance company was a 30-percent premium increase--a 30-percent 
premium increase. She was at the point where she was just able to 
afford what she had. Madam President, 30 percent more is more than she 
could afford, so Lisa has now become yet another uninsured American. A 
public option will help because it will make health care affordable for 
people who want to have insurance, can be insured, but are not always 
insured. Lisa is a good example.
  Our friends on other side often talk about the people who are 
uninsured as if they are some like alien species; that it is actually 
less than we think and we do not really need to worry about it; it is 
only just a few million here and there. The fact is, in the last year 
and the year before, 87 million Americans like Lisa had a period in 
which they were uninsured. They went without health insurance. You know 
how scary that is. Somebody is not just uninsured; they are a mom, they 
are a worker, they are part of a family, and something goes wrong and 
suddenly they cannot afford their insurance, and for a while they are 
uninsured, and then maybe they try to come back again. They get lucky; 
somebody in the family gets a job who gets coverage; they find a way to 
afford it. But there were 87 million Americans who, in those 2 years, 
went without health insurance.
  Do you want to know what 87 million Americans is? That is why this 
chart I have in the Chamber is colored yellow and red. If you go west 
of the Mississippi River and take the population of every single State, 
including the State of New Mexico, which is Senator Udall's home 
State--and you just take out California--if you take every single one 
of those States and add them all up, that is 87 million people. That is 
the population of every single one of those red-marked States, from 
Minnesota, Iowa, Missouri, Arkansas, and Louisiana, and go all the way 
west--except for California--all of those States, if you add them all 
up, the population of every single one of those States, that is the 
number of people who in those 2 years at some point were without 
insurance. So it is important that we take that burden off these nearly 
90 million American families.
  Even for those who have insurance, this is a big deal because folks 
who have insurance find they go bankrupt very often. Right now in 
America, 62 percent of all bankruptcies are health care related. That 
is why American families go to bankruptcy more than any other reason--
because of health care. I tell you, you can make fun of systems like 
Canada's or England's or France's; you do not see families going into 
bankruptcy because of health care in those countries.
  This is a national tragedy that is happening to those families, which 
is totally unnecessary. Of that 62 percent of bankruptcies--where the 
family was doing fine, and a health care emergency put them over the 
edge and forced them to go into bankruptcy, where they lose their home, 
they lose their credit--78 percent of those bankruptcies--four out of 
every five of those bankruptcies happened to families who had health 
insurance.
  So if you are listening to this and you are wondering why it is 
important we get this reform, because you think: I am insured, I am all 
set, I am not part of the problem, well, you are very lucky you have 
not yet had the experience of finding all those holes in your insurance 
coverage, because I will tell you what, for these families--four out of 
every five of the health care bankruptcies in this country--they 
thought they were covered too. It was a rude and sad awakening when 
their insurance companies started calling them up and saying: Sorry, we 
are not actually going to be able to cover you. We found an exception. 
We are rescinding the policy. We are throwing you off. We do not cover 
that. And they had to pay and pay and pay until everything they set 
aside, everything they worked for, everything they tried to build up 
for a secure future for themselves and their families was down the 
spout, lost in a bankruptcy because their health insurance was not 
there when they needed it. That is another reason we need a solid 
public option, so there is an alternative to that kind of behavior, 
because it does not just keep people out of the insurance market, it 
clobbers people who think they are safely insured.
  Madam President, I yield to Senator Udall.
  Mr. UDALL of New Mexico. Madam President, I say to Senator 
Whitehouse, I want to ask you a question and see what evidence there 
was in the HELP Committee because what I understand in New Mexico is, 
if you look at the uninsured--I showed a chart in the Chamber a little 
bit earlier--one in four New Mexicans is uninsured. The big question 
is, Who are the uninsured? Who are the folks out there who are 
uninsured? As shown on this chart, adults under the age of 65, 31 
percent; working New Mexicans, 31.4 percent; Hispanic Americans, 49 
percent. So the uninsured are people we fight for every day, people we 
know, people we run into.
  I know in the HELP Committee one of the things really focused on was 
the fact that we are talking about working people, working families who 
do not have insurance. They are out there in these smaller businesses. 
I know when you worked on the bill in the committee, you heard that 
kind of evidence. And you know your Rhode Island situation. Could you 
talk a little bit about that because I think people somehow think, like 
you said--I think you said earlier that being uninsured is from a 
foreign planet or something. These are people who are in our midst all 
the time. They are working hard, but they cannot afford insurance, and 
these small businesses cannot afford insurance to cover them. I was 
wondering if you could talk about that a little bit.
  I see Senator Burris from Illinois has also joined us.
  Mr. WHITEHOUSE. Madam President, I will speak briefly so the 
distinguished Senator from Illinois can follow up. I thank the Senator 
from New Mexico for the question.
  In 2007, 2008--2 recent years--nearly 90 million Americans went 
without health insurance at one point or another. That is close to one 
in every three Americans, which means as you go around your 
neighborhood, the fellow with the truck delivering oil to heat your 
home; the lady in the corner at the bookstore; the guy who owns the gas 
station down the road--innumerable people whom you know in your real, 
regular life are in those nearly one in three Americans who are going 
through a period being without health insurance coverage. Some of them 
are going to be young people who choose not to do it. Some are between 
jobs,

[[Page 24866]]

and they rely on an employer to provide coverage because good luck 
buying coverage on your own in this country if you do not have an 
employer to argue the price down for you.
  But I think it is really important that we press back against the 
notion that some of our colleagues are pushing forward: that there is 
this little group of uninsured who just kind of are not regular people 
and are different and are a problem, that they are not part of the 
American fabric. It is one in nearly three Americans who goes in and 
out of health insurance coverage.
  As a parent, I have to tell you, if I had to go home at night and 
tuck my kids in and then go to bed myself and talk to my wife and be 
thinking about what might happen the next day if they got sick because 
we did not have health insurance for them--what an agony for a family 
to go through that period, when everything is at risk, when you are one 
illness away from losing everything you have. We put 90 million people 
through that in the last 2 years. It is real people, working people, 
real families, and they feel a lot of pain. That is one of the reasons 
we have to act. We have to get the reform bill done. It is for them, 
not for the special interests.
  Mr. UDALL of New Mexico. Madam President, I say to Senator 
Whitehouse, thank you very much.
  One of the things I have just realized now, one of the things the 
three of us have in common is we were all attorneys general. I am proud 
of that fact. I am very proud of my service as attorney general. I know 
you both are. We were out there as attorneys general fighting for these 
working Americans we are talking about, whether it was consumer 
protection or doing law enforcement.
  Madam President, I say to Senator Burris, I know those working 
families the Senator worked for back in the 1990s are the same working 
families he is fighting for on the public option. Could you jump in 
here? I know you have a situation in Illinois where you have traveled 
throughout the State. You have taken a measure of what is happening in 
Illinois with regard to health insurance. What would you say?
  Mr. BURRIS. Well, Madam President, I say to the distinguished Senator 
from New Mexico and the distinguished Senator from Rhode Island, it is 
certainly an honor for me to be able to participate in this discussion.
  I just left my 50th college reunion down in southern Illinois, where 
I had attended Southern Illinois University. I was introduced at the 
football game, by the way, which SIU won 46 to 23 or something like 
that. We beat Illinois State University. They announced me in about the 
third quarter.
  Well, after the game was over, I say to the Senators, there was a 
line of people lined up to talk to me. What were they saying in that 
line? Most of them were saying: Senator, whatever you do, we want you 
to keep a public option in that insurance bill.
  I said: Well, there are three bills in the House, and they have a 
public option in them. The bill that came out of the HELP Committee 
here in the Senate has a public option. And we have not gotten the 
Finance Committee bill--as of last Saturday. But we just passed that 
bill the other day. Now, it does not carry a public option. What I am 
saying is, I do not see how we can address all of these issues dealing 
with health care rather than sick care, which is what has been taking 
place in America, without dealing with something that is going to 
create competition, create a reduction in costs, and, of course, cover 
millions of Americans. Senator Whitehouse just talked about that 90 
million--well, 47 million who are underinsured, and another 25 million 
to 30 million who are uninsured. So those are the problems we are 
having, and that is what it is going to take in order for us to get 
reform in America.
  It is unconscionable to think we could do insurance reform and think 
that the insurance companies are going to not continue to make their 
profits. As a matter of fact, I spoke about this on the floor a few 
moments ago. Would you believe that what they have done is criticize 
the bill that came out of the Finance Committee? They have played into 
our hands. They have criticized that bill, talking about how much money 
it is going to cost, which gives us the best reason we would need a 
public option: because the premiums are going to go up if they don't 
have any competition.
  When we look at their profits over the years, we see a 428-percent 
increase in their profits from 2000 to 2007. That is unacceptable. It 
is just unacceptable.
  Mr. WHITEHOUSE. Mr. President, would the Senator yield for a 
question?
  Mr. BURRIS. Yes.
  Mr. WHITEHOUSE. As a former attorney general who had antitrust and 
consumer responsibilities, how many industries can the Senator think of 
that would get to announce to the world, if this bill passes: We are 
going to raise our prices! If you are in a competitive marketplace and 
you are not colluding with each other, how on Earth do you know as an 
industry that you are going to get to raise your prices, you are going 
to be able to decide to raise your prices? Isn't the market supposed to 
do that?
  Mr. BURRIS. It is market driven, that is correct. If they do, they 
have collusion going on in terms of everybody raising their prices so 
they would be competitive, and they couldn't then go to choice and 
thereby keep the rates up and their profits up. So we are talking to 
the current AGs. If they would do this, we might have an antitrust 
action, but that certainly is a circumstance we must be concerned with 
in terms of how they are seeking to increase their prices, and they 
might even be involved in a little price fixing.
  Mr. UDALL of New Mexico. Senator Whitehouse and Senator Burris, if 
you would just give me a second, I want to make sure he talks about the 
situation of workmen's compensation in the State of Rhode Island. I 
believe several States--and you have had experience with this--have 
experimented with a public option in the workmen's compensation 
context. It tells us a lot about what public option would mean if we 
put this in our health care bill.
  Could the Senator speak to that a little bit?
  Mr. WHITEHOUSE. We have heard a lot about how, if we let a public 
option go forward, it will give terrible customer service, horrible 
customer service. Senators have said it will be the worst combination 
of the IRS and the local Department of Motor Vehicles. But we can go to 
a State such as Wyoming, which is the home State, for instance, of the 
very distinguished ranking member on the HELP Committee who is also on 
the Finance Committee and, indeed, was one of the negotiators with 
Senator Baucus. When he goes home, he goes home to a workers' 
compensation system that is a single-payer, government-run system. The 
Wyoming business community doesn't seem to complain about it. So 
obviously, the customer service can't be that terrible because they 
would be thrown out if they were that terrible.
  The other thing we hear about the public option is that if we let it 
in the door, it will take over the system because a public insurance 
plan can't compete fairly with private plans. There are predators who 
will be let loose in the system, we have heard people say. Well, half 
the States in the country have public plans that sell insurance in the 
workers' compensation market which provides--about half of it is health 
insurance. Some of it is paid back wages that were lost, but the rest 
of it is health insurance. It is little things such as carpal tunnel, 
it is terrible wrecks that occur, chronic conditions. All the different 
aspects of health care that get provided by health insurance also get 
provided by workmen's compensation insurance.
  If we go to Arizona, for instance, which is the home State of the 
very distinguished Senator McCain who ran for President on the 
Republican ticket, and Senator Kyl who is the assistant Republican 
leader of the Republican Party--they go home to a State where there is 
an Arizona public workers' compensation plan that has been competing 
with the private sector in that market, I believe, since 1925. I don't 
have my notes in front of me, but my recollection is that it was from 
1925. So for 80 years, they have been running in competition with the 
private sector.

[[Page 24867]]

  That doesn't sound to me as though once we let the government in, 
competition is doomed.
  The distinguished minority leader, Senator McConnell, goes home to 
Kentucky. In the Kentucky workers' compensation system there is a 
private plan. The Kentucky workers' compensation plan, run by the 
State, is a public plan. It goes out and competes day to day with the 
private plans. It adds to the healthy marketplace. It adds to the 
choices that Kentucky business owners have. I have never heard Leader 
McConnell or Senator McCain come to the floor to criticize the workers' 
compensation public plans that operate at home.
  So I think there are at least some examples that disprove some of the 
worst arguments that have been made about the public option: that it 
will give us terrible public service--well, the single-payer, all-
government plan in Wyoming seems to disprove that--and that half of the 
States in which there is a competitive plan, including Arizona and 
Kentucky, would seem to disprove the notion that as soon as we let a 
public plan in to compete, it will take over. It just hasn't, it just 
doesn't, and the actual facts--what the military calls the facts on the 
ground--are different than the rhetoric in the air.
  Mr. UDALL of New Mexico. Senator Whitehouse, if I can interject at 
this point, I think you have given great examples of why we need a 
public option. As part of health care reform we are going to be doing 
in the next couple of weeks in the Senate--we have a Senate Finance 
Committee bill out of the Finance Committee now and we have the HELP 
Committee bill and our leadership is putting those two bills together--
we have to have a public option be a part of the bill.
  Senator Burris was visiting a little bill earlier about Illinois and 
the Illinois citizens and their comments on the public option. The 
Senator from Illinois may want to join in with what Senator Whitehouse 
said about that competitive factor with workmen's compensation.
  Mr. BURRIS. Mr. President, I think we must also give what is a very 
simple definition because I think the term has gotten misconstrued in 
terms of what the public option is. I hope our colleagues will 
understand it is nothing but choice. It will give the person who is 
uninsured, if they cannot get insurance--let's say the person has a 
preexisting condition and they lose their job and that person goes to 
get insurance and they will not insure that person. Hopefully, our bill 
would take away the preexisting condition problem.
  Let's just say the premiums are too high. Well, if there is a public 
plan, that person can go in and then acquire his or her insurance based 
on his or her income and ability to pay. That is what we are talking 
about. That is the option an uninsured person would have. That option 
will entitle that person to get health insurance. It also, under this 
legislation, would entitle that person to get preventive care, which 
would prevent that person from getting a chronic disease or getting to 
the point where a disease gets chronic and they end up going to the 
emergency room in order to get service.
  So we are talking about saving funds. We are talking about cutting 
down on the cost. We are talking about eliminating premiums.
  So I say to the distinguished Senator from New Mexico, it is crucial 
the words ``public option'' don't turn people off because it has gotten 
to the point where it is creating problems in itself, the definition. 
But the purpose is to make sure those persons who don't have insurance 
will get insurance.
  The President has said this. President Obama said: If you have your 
insurance and you like your doctor, we are not going to touch you. The 
reform would not interfere with you. Therefore, we are going to have it 
so that all of those almost 90 million Americans can get insurance, 
which will mean it will cut down on the costs we are all paying because 
of those persons who have to go to emergency rooms and who are not 
insured.
  So I hope our colleagues will understand how important this piece in 
the whole reform bill is, where there will be choice for Americans, 
choice so they can select a company and not be paying premiums through 
their nose because premiums are going to go up. If we don't get reform, 
if we don't have reform for competition, if we don't do public option--
this document says if we compete with private companies, these 
companies will raise their rates during this critical time by 111 
percent. If we look at the profits they are making now and over the 
years, we will find those profits have been exorbitant. Therefore, I 
will say to my colleagues, it is key, even to my State of Illinois 
where we have only two insurance companies doing 69 percent of the 
insurance--that is almost a monopoly on who gets insurance--but two 
companies in Illinois, and we are a State of 13 million people. When 
two companies cover 69 percent of those who are insured, that, to me, 
is just not enough competition for rates to be reasonable so it is 
affordable.
  Mr. WHITEHOUSE. Would the distinguished Senator from Illinois yield 
because he has made such an important point.
  Mr. BURRIS. Yes.
  Mr. WHITEHOUSE. He made the point about the lack of competition out 
there right now. I know that in Illinois, the lead company has nearly 
50 percent market share, and the second company, a 22-percent market 
share, for a grand total of 70 percent market share, just in those two 
companies.
  Mr. BURRIS. Yes.
  Mr. WHITEHOUSE. But it is not just a problem in Illinois. There are 
39 States--39 States--in which the top two insurers--just the top two 
insurers--have the majority of the market; more than 50 percent of the 
market, just between two companies. In nine States, one insurance 
company--one insurance company--has more than 70 percent market share, 
one company.
  So the notion that there is a lot of competition going on out there 
isn't supported by the facts. If you are in one of those nine States 
where there is one insurer that has more than 70 percent of the market, 
you don't have a lot of choice. That insurer has extraordinary market 
power, particularly since they are immune to the antitrust laws.
  Mr. BURRIS. Yes.
  Mr. WHITEHOUSE. Extraordinary market power, and in the 39 States 
where more than 50 percent of the market is captured by only two 
insurance companies, they have extraordinary room to raise prices and 
fix prices and work with each other to make sure they maximize profits 
instead of taking care of regular folks, the folks I talked about 
earlier, real people who suffer real consequences. The result of it is 
that our health care expenditures are going through the roof.
  I was born in 1955. In 1955, we spent $12 billion a year on health 
care. In 1979, I just got out of college. It grew nearly 20 times, to 
$219 billion that we spent on health care as a country. In 1987, I was 
just about to have my first child, my daughter, half a trillion 
dollars, $500 billion. In 1992, we spent $850 billion. Here we are in 
2009, $2.5 trillion. Look at the direction on the chart--the direction 
of that spending curve. We have to turn that around. Everybody in 
America, the insured, uninsured, doctors, nurses, hospitals, everybody 
has an interest in us getting this right and getting this bill passed 
so we can turn it around. I don't want to make a joke out of this, but 
do you remember the last time we had tried for health insurance reform, 
the insurance industry, which has turned on us now, turned on us then 
with Harry and Louise, who were that nice couple who raised all these 
worries and fears. They always worked with fear. I said the other day 
that Harry and Louise are not the problems; now it looks like Thelma 
and Louise. With those health care costs climbing, we are headed for 
the cliff, and we are all in the car together. It will be Democrats who 
have to work together to solve that problem before we go off that 
cliff.
  Mr. BURRIS. That is key. I am looking at 29 of our colleagues in this 
body calling for a public option. That is a tremendous number.
  Mr. WHITEHOUSE. I wouldn't be surprised if it were more.
  Mr. BURRIS. Maybe there are 30 of us who signed the letter at this 
point.

[[Page 24868]]

Just what the Senator said--it is crucial that we now think about 30 
more. We have to work on that.
  Mr. UDALL of New Mexico. We have now been joined by Senator Brown 
from Ohio. As the Senators who are on the floor know, he led an effort 
like this last week to put the public option forward. He has been 
amazing in terms of being dogged and being here on the floor fighting 
for the public option. I know he talks frequently about how people in 
Ohio have a real passion for this.
  Mr. BROWN. I thank the Senators. Back in our States, Rhode Island, 
New Mexico, Illinois, Ohio, and Washington, we all hear from 
constituents all the time who are unsure of what their future is with 
health care. Too often they are denied coverage with preexisting 
conditions. Too often they have annual caps or lifetime caps on 
coverage. They thought they had good insurance. In fact, what I found 
in the mail I got from Springfield, Cleveland, Dayton, Oxford, and 
other communities is people thought they had pretty good insurance, and 
they find out, once they get circumstances when they needed insurance, 
it is not so great. They get sick and they have huge hospital bills and 
they have huge doctor costs or other expenses and they get a note from 
the insurance company that they are not going to cover that.
  Some of the letters that break my heart are from people who clearly 
are under so much stress because of breast cancer or because their 
child is sick and they are spending hours a week fighting with 
insurance companies. It is those people who thought they had good 
insurance who find out it is not so great after all and they really 
support the public option. They understand we are going to change the 
rules in this legislation. No more disallowing care for preexisting 
conditions, no more caps or discrimination based on gender, race, or 
disability. They also know insurance companies are good at gaming the 
system. Without a public option, so many people think insurance 
companies will continue to game the system, even though we have written 
better rules in this bill. They understand insurance companies such as 
Medicare doesn't--excuse me, the public option, like Medicare, won't 
disallow somebody for a preexisting condition and throw them off 
insurance. They will keep the costs down. We know what the insurance 
companies said a couple days ago when they talked about costs going way 
up as if they have not doubled that anyway in the last 8 or 9 years. 
That was one more call and is actually is the best endorsement yet of 
why we need the public option.
  Mr. WHITEHOUSE. If the Senator will yield for a question.
  Mr. BROWN. Yes.
  Mr. WHITEHOUSE. Not to belabor the obvious, but could he comment on 
why it is that a for-profit private insurance company might pursue 
things such as rescission, which is when they throw you off a policy 
when you get sick because they found an error in your form, and you 
have been counting on the policy for years, but suddenly you are sick 
and they throw you out the door? What might the difference be between a 
for-profit insurance company and a public option when they are looking 
at that circumstance?
  Mr. BROWN. Right. I will answer it in a fairly unusual way. I have a 
friend who is a lawyer for a company that produces soap. She said to 
me: I am glad we have a strong EPA because we are doing what I want to 
do anyway, and now our competitors have to.
  If you are an insurance executive--if the four of us were insurance 
executives and I disallow people and I put caps on coverage because of 
preexisting conditions, and I do rescission, you are all going to have 
to do that. A lot of people may think this group of Senators up here 
hates insurance companies. I think insurance companies operate in their 
own short-term financial self-interests. That is why we need different 
rules, so they cannot deny care this way, and that is why we need a 
public option, which sets a gold standard. Public option will not use 
rescission. Public option will not deny care or put a cap on coverage 
or discriminate. Public option will not use preexisting conditions to 
keep people off. The public option will set the standard. So if these 
other private companies want to compete--and Senator Whitehouse and I 
and our staffs in the HELP Committee wrote most of the language for the 
public option in a way that there would be a level playing field, and 
they will compete with Cigna and Aetna and United and WellPoint and 
these other companies in a fair way. We may not see the Aetna or Cigna 
CEOs making $22 million next year because you can make that kind of 
money because you are cutting people off, you are using rescission. 
Once these insurance companies have to go under a set of rules, 
enforced in part by the public option, these salaries and profits may 
not be so gargantuan as the insurance companies have enjoyed all these 
years.
  Mr. WHITEHOUSE. I mentioned earlier that in Rhode Island a for-profit 
insurer with only 16 percent market share, in a State of only a million 
people--you are all from bigger States; Rhode Island is a million 
people. It had 16 percent market share. It extracted in 1 year $37 
million in profit to repatriate to its headquarters out of State--$37 
million. Imagine how much care you could provide to 16 percent of a 
market of a million people with $37 million, if you put that back into 
health care instead of taking it out in profit.
  Mr. BROWN. As the public option mostly will do.
  Mr. WHITEHOUSE. Yes, as the public option would do.
  Mr. UDALL of New Mexico. We are near the end of our time.
  The PRESIDING OFFICER. The time of the Senator has expired.
  Mr. UDALL of New Mexico. I ask unanimous consent to have 3 additional 
minutes.
  Mr. COBURN. I have no objection.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. UDALL of New Mexico. I thank the Senator. I point out tonight 
that we have had a number of Senators come down here, and we have also 
been presided over by the gracious Senator from the State of 
Washington, Senator Cantwell. I know she is a strong proponent of a 
public option. We have had Senator Cardin from Maryland, Senator Brown 
from Ohio, Senator Whitehouse from Rhode Island; we had our 
distinguished majority whip, Senator Durbin, here talking about public 
option. We have also had Senator Roland Burris from Illinois. So we 
have had a key group here.
  We are going to continue to do this because, as Senators Brown and 
Whitehouse and Burris know, we have to get this done. Our constituents 
want it. The American people want it. There was a poll done, and 72 
percent of the American people want to see a public option here.
  I don't know if any other Senators want to sum up.
  Mr. BURRIS. Well, 72 percent of the doctors also are supportive of 
the public option.
  Mr. BROWN. I know one doctor who may not be for it on the other side 
of the Chamber.
  The Robert Johnson Foundation found that more than 70 percent of the 
physicians supported the public option.
  Mr. UDALL of New Mexico. I thank Senator Coburn for not objecting. I 
thank all Senators who appeared here today.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Oklahoma is recognized.
  Mr. COBURN. Madam President, I listened off the floor to the debate 
of my colleagues. Many of the things that they identify as problems, I 
certainly agree with. Where we part company--having been in the health 
care field for over 25 years, and having practiced medicine during that 
period of time--is on the solutions they propose. Oftentimes, that will 
destroy the best of medicine that we have in America today and will 
render a larger government with less freedom in our country.
  I want to address a couple of the issues. From the start, the 
assumption of those for the public option is that the government has 
done a good job with the health care programs they run today. I wanted 
to give a little history and put forth a little history.
  There is no question that Medicare has benefited millions of 
Americans,

[[Page 24869]]

and will continue to do so if we can figure out a way to pay for it, 
which is one of the sad things about the pay-fors in this bill--that we 
are going to borrow $500 billion and take another $500 billion out of 
Medicare and create another program, when Medicare is not funded. If 
you go through health care today in the country, 61 percent of all 
health care expenditures in this country go through the government. If 
61 percent is already going through the government and we are having 
health care inflation at 7 or 8 percent, why is it that if we are so 
good in 61 percent of it, we still have these kinds of problems as a 
whole? And actually health care inflation inside government programs is 
higher than outside government programs, which proves the point that we 
should not eliminate health insurance companies, but we should make 
them more efficient and streamlined.
  The assumption behind the public option is this: They look at 
Medicare and at the administrative costs of Medicare and say that is 
all it costs to run Medicare. Then they look at the 10(k)s, the profit 
and loss statements of the insurance industry, and say look how high 
that is. If you take all of the health care insurance industry as a 
percentage of the dollars spent in health care and look at their 
expenses and their profit and their costs for running their business, 
in terms of cost of capital, and compare it to the true cost of running 
Medicare, what you find is Medicare costs about 3 or 4 percent more to 
run than private health care.
  Nobody could be more disturbed as a practicing physician than I am 
about wanting to rein in the abuses in the insurance industry. Their 
answer is to create competition with a government plan. I believe you 
create competition by creating real competition. A government plan, 
government option isn't competition. It is the elimination of any other 
market in health care. How do we know that? We know that the way people 
are going to sign up for a government plan is because it is going to be 
cheaper. If you take the same factors--for example, the 15-percent 
fraud rate in Medicare and Medicaid--and add that to the cost of the 
plan, what you are going to see is we are going to end up subsidizing 
the government plan to a greater extent than even CBO would put 
forward. I will have a report in the next couple weeks that will 
outline CBO's accuracy on health care costs since they have been 
scoring them since 1965. I can tell you right now that the record is 
atrocious. Sometimes they missed it by 15,000 percent. They 
underestimate what the costs are.
  I want to share a story about two of my patients over the last 6 or 7 
years. I also want to share another story about somebody I talked to 
this week, whose son dropped out of medical school and chose to not go 
to medical school. He was accepted, but he chose not to go because of 
this very debate and the likelihood that the government will become 
more involved in health care.
  The story I want to tell goes to the very real need that my 
colleagues were addressing, which is true changes in health insurance. 
Everybody in this body wants to address the cost issue because that 
issue is what is driving the problems with health care. If somebody 
doesn't have access, it is not because it is not available out there, 
it is because they don't have the money to buy the access. So cost 
becomes the first stumbling block. Whatever we do, the No. 1 thing we 
ought to do is try to decrease the costs associated with health care. 
How do we do that? Do we do that by modeling Medicare, Medicaid, SCHIP, 
Indian health care, VA? Is that how we do it? Or can we do it in a way 
that will truly drive down the costs? There is no estimate out there 
about the actual cost reductions in the bills that are coming forward, 
either the Finance Committee bill or the HELP Committee bill. The HELP 
Committee bill actually raises the cost of health care. Should we be 
about figuring out how to lower costs? Let me give some examples.
  Safeway has had no increase in health care costs for the last 4\3/4\ 
years. How did they do it? They created incentives for their employees 
to stay healthy. When I say incentives, they were paying their 
employees cash money to change their behavior. They are limited on how 
much they can do that by a law called HIPAA, and, in fact, if they 
could do more, then they actually could have had a marked decline in 
their health care costs.
  Then there is a company called MedEncentive where they run the 
insurance program for communities' municipal employees. Everywhere they 
have been they have lowered the cost of health care. How do they do it? 
They incentivize doctors by paying them more and incentivize patients 
by agreeing to do what the doctor says by cutting off their deductible 
or lowering the cost of their prescriptions if, in fact, they will 
follow good practices, best practices in terms of their care.
  There are other examples such as Asheville, NC, where they have had a 
marked decrease. On average, what we have seen is a 20 to 30-percent 
decrease in health care. There is not a government involved in any of 
that.
  I want to go back. Why is it that we view a government option as the 
answer? Because we perceive that the government can do it more 
efficiently and we perceive that is the only way you force competition 
in the health insurance industry. I agree, there is no significant 
competition in the health insurance industry. But having the government 
compete in it versus forcing competition is where we divide and go 
away.
  The second reason they want a government option is the following: If 
you are my age, in your early sixties, what is going to happen to you 
in Medicare is you are not going to have the same care that the people 
in the last 10 years have had because the reason they want a government 
option and the reason we want what is called a comparative 
effectiveness board is because the real reason for having a public 
option and a comparative effectiveness board is to mandate what can and 
cannot happen to you.
  As a physician who has delivered thousands of babies and cared for 
every complication in gynecology and obstetrics one can imagine, as a 
physician who has cared for thousands of children from birth to high 
school, as a physician who has taken care of grandmas and grandpas in 
their elder years with complications from heart failure to cancer to 
chronic obstructive pulmonary disease to pneumonia to anything else, 
what is going to happen is the options are going to be limited.
  The ultimate undercurrent of why we need and want a public option is 
that we will eventually create a system where most of America, about 82 
million people, who have private insurance today will be in that public 
option and they will decide what you can and cannot have, which is 
counterintuitive to how we allocate scarce resources everywhere else in 
the country. We do allow the forces of competition to allocate it, but 
it requires individual personal responsibility. It requires a 
transparent market, which I agree we do not have. It requires real 
competition, which I agree we do not have. But the answer is not 
another government program.
  Now back to the two examples in my practice. I give these examples 
because I want people to see what is going to happen as the government 
becomes more and more involved in health care.
  These are two patients I have cared for over 20 years each presented 
at different periods of time with no true signs or symptoms of 
significant disease other than the fact that having known these people 
for years, I sensed something was different. I ordered a test. It was 
denied by the insurance company. I managed to get my friends, who 
happen to have an MRI who also practice medicine on a not-for-profit 
basis, do an MRI on this one gentleman. It just so happens the 
gentleman had the same disease that Senator Kennedy recently succumbed 
to. No signs, no physical diagnosis.
  The only thing that allowed me to query that was the art of medicine. 
Not the book training, not the gray hair, not the experience, but the 
gut of knowing and having seen and been experienced with a patient over 
a long period of time to say something has changed. In fact, the 
insurance company came back and paid for the MRI.

[[Page 24870]]

  An identical thing happened about 4 months later with another 
individual. One of those individuals, by the way, is still alive. The 
other, unfortunately, succumbed.
  So we do need real competition in the insurance industry. We need to 
make sure we create that. The debate between what my colleagues on the 
other side of the aisle offered tonight is how do you best do that. Do 
you do that by setting up a government program that is infinitely 
funded and will actually charge rates that will be under the true costs 
and will be just like another Medicare Program where we have an 
unfunded, long-term liability that our kids are going to have to pay 
for, close to $75 trillion? That is the worry. That is what the real 
debate is.
  I thought I would spend a minute talking about can we fix health care 
without tremendously growing the size and scope of the Federal 
Government. You cannot even talk about health care until you are 
willing to talk about what we are doing today. What we are doing today 
and what we are going to be doing tomorrow, and, if this bill passes, 
what we are going to be doing for the next 20 years is borrowing a 
large percentage of the money we will spend from our grandkids. That is 
an unsustainable course. It is not one that we can achieve.
  As we do that, we end up with youngsters such as this. If you cannot 
read this, it says: ``I'm already $38,375 in debt and I only own a 
dollhouse.'' That is a pretty stark statement. Here is a cute little 
girl on whom her parents have put a placard. Her parents obviously 
recognize that we are spending money we don't have on things we don't 
need.
  I am not saying there isn't anybody in this body who doesn't want 
health care reform. Nobody probably wants it more than I do. It is the 
type and how we get there that is important and do we make her 
situation worse. Do we raise the amount of money we are borrowing to be 
able to fix a problem that is going to be a government-centered problem 
rather than a patient-centered focus?
  Then we have this quote from Thomas Jefferson:

       I predict future happiness for Americans if they can 
     prevent the government from wasting the labors of the people 
     under the pretense of taking care of them.

  That is a pretty interesting statement and pretty insightful and 
foretelling because that is exactly where our Nation finds itself 
today--``wasting the labors of the people under the pretense'' that the 
government will take care of them.
  In about 10 years, government spending is going to be about 35 
percent to 40 percent of our economy, and that is if we make it in the 
next 10 years given the present financial difficulties we have. But if 
we think and ponder a little bit about what Jefferson had to say and we 
look at the Constitution, what we find is that through the last 20, 30, 
40 years in this country, back to 1965, we started stepping outside the 
bounds of the enumerated powers that our forefathers brought forth. We 
have ignored them. Consequently, now we have government program after 
government program and agency after agency and we cannot afford it. We 
are borrowing the money. Under the guise of taking care of U.S. 
citizens, we can rationalize it.
  America's health care is the best in the world. It just happens to be 
the most expensive. There are lots of ways to drive that cost down that 
are not at all considered in the bills in front of the Congress. 
Incentivizing people to do the right thing, the best thing, 
incentivizing the elimination--do you realize that 80 percent of the 
cost of health care today is defensive medicine; that if you attacked 
it slightly, not by eliminating lawsuits but by eliminating frivolous 
lawsuits--let me give the details. Ninety percent of all the suits that 
are filed never go to court and never get settled and never get 
answered. In other words, they are extortion claims. There is not a 
real medical claim. There is not a real issue, and it is not carried 
forward. Of the 10 percent that are either settled or carried forward, 
89 percent of those are decided in favor of the medical community. So 
that is 11 percent of 10 percent, which is 1 percent of the cases.
  If, in fact, we did not have the 90 percent of the cases that are 
frivolous, that are extortion attempts, what we know is that we could 
save about--CBO says under their score with limited liability changes, 
$54 billion over the next 10 years. Other sources say it is closer to 
$74 billion, $75 billion. Madam President, $74 billion to $75 billion a 
year does a lot to help individuals in terms of free care, in terms of 
lowering the cost of care because, in fact, every insurance company in 
the country is paying for that care.
  Finally, I will make one other point, and it is this. What most 
Americans do not recognize is that in this new bill that is coming out 
of the Finance Committee, there is a significant number of taxes. 
Actually, you are going to recognize the fourth tax on health care in 
this country. Right now you pay income taxes and a large portion of 
that income tax is now paying for Medicare and Medicaid--57 percent of 
it and 43 percent we are borrowing.
  The second tax you pay is a Medicare tax of 1.45 percent and your 
employer pays 1.45 percent of every dollar you earn no matter how much 
you earn.
  The third tax you pay is your private health insurance, whether you 
buy it through your employer or you buy it yourself, costs $1,700 more 
per year because of the underpayment for the cost of health care for 
Medicare and Medicaid. So the cost of actually purchasing your health 
care goes up by about $150 a month per family because we underpay the 
true cost of care under Medicare and Medicaid, and they are both broke.
  Now we have a fourth tax of which 50 percent is going to be levied on 
people from $40,000 to $140,000 a year, billions and billions of 
dollars of new taxes.
  Then we have taxes on the insurance industry. I don't have any 
problem with that--taxes on medical devices, taxes on PhRMA. But who is 
going to pay those taxes? Those taxes are going to get filtered down to 
the increased cost of health care. When we pay a tax when we go to a 
store to buy something, we pay that tax on top of the price.
  So the groceries or the TV or whatever it did cost--what we thought 
it cost--it would cost that plus tax. That tax, in terms of the 
insurance industry, in terms of the Medicare, in terms of the drug 
industry, in terms of the medical device industry, in terms of PhRMA, 
is going to get passed on, causing an increase in cost. That does not 
include the tax you will incur if you choose not to buy health 
insurance because you think you are healthy or you want to self-insure 
yourself. You are going to pay a tax for that. Oh, by the way, if you 
happen to have a great health care plan or maybe a moderate health care 
plan, the way the bill is written, you are eventually going to pay a 
tax because it is going to be too good a plan. So we are all going to 
have four taxes on health care.
  I wish to make one other comment. We all traveled during the month of 
August and we met with our constituents. This is the HELP bill that 
came out of the committee after 3 weeks of hard work. This is not the 
complete bill that the Senate will be considering. This is just part of 
the bill, and it is 840-some pages long. The standard protocol in 
committees, if you vote a bill out of committee and you have changes to 
it, what you do is put a modified bill on the floor--a substitute bill 
when the bill comes to the floor. Well, there are 85 changes to this 
bill that have not been approved by the committee. Yet this is the 
committee bill.
  So not only do we have a debate that is erroneous in terms of the 
direction it is taking--in creating a larger government, taking away 
individual freedom, individual choice, limiting one's availability of 
insurance, increasing premiums, increasing taxes, and taking away an 
individual's ability to choose--we also have a bill that has been 
modified, outside the rules of the Senate, 85 times versus the bill I 
voted on in committee. That shouldn't surprise us, however, because of 
the way we are handling health care.
  So I will sum up with just a couple other points. I don't believe 
there is an

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American out there who doesn't think we need to do something about 
making health care more affordable, more available, and fairer in its 
treatment. I don't think there is an American who doesn't agree that we 
have a lot of waste in the health care system that can be eliminated. I 
don't think there is a physician out there who doesn't think we need to 
make some changes in terms of competitiveness in insurance and how that 
interferes with the decisionmaking by physicians and other caregivers. 
But I also don't think it is truly appreciated that in this country, if 
you are sick, you are going to get the best treatment anywhere in the 
world. It is just that it costs too much.
  So how do we address that? Do we address that by growing the Federal 
Government and creating in this bill 88 new government programs with 
the bureaucracies that come with it or do we enable people to have the 
freedom to choose, to make their own choice about what they want and 
they need? With the finance bill, we are going to tell you what you 
have, we are going to tell you what the minimum is, we are going to 
limit your choices, and we are going to see a run toward either a 
regional co-op plan or a public plan.
  But there is no question that what we are going to see is government-
centered involvement in what we do and how we do it. That may be the 
direction we ultimately go. But the loss that comes with that is the 
loss of freedom, a loss of choice, and a diminished demand for personal 
responsibility and accountability, which is the very thing this young 
lady is counting on us doing the opposite of.
  We are going to double our debt in the next 5 years. We are going to 
triple it in the next 10 years. It is going to be worse than that 
because we are spending money like drunken sailors. What do we owe the 
generations who follow us? What is it that we owe them? Do we owe them 
the heritage that was given to us? Are we going to transfer that 
heritage on, or are we going to ignore it?
  In terms of health care, what is the best thing for our country in 
the long term? Can we take on another $1.3 trillion of government at a 
conservative estimate, especially when you count what is going to 
happen with what is called SGR--the physician payment reform? Can we 
take on $1.3 trillion? Will it only be $1.3 trillion? Will we move 
another 10 percent of our GDP to the government? Because that is what 
we are doing. At what point in time does the American experiment quit 
working?
  I look forward to the debate on health care. The plans before us will 
raise premiums, decrease care, limit choice, and bankrupt our 
grandkids. By saying no to that plan, it doesn't mean you don't want to 
fix health care. There are some great plans out there to fix health 
care that don't cost money; that, according to CBO and others, will 
give the same results but will not create the massive new Federal 
bureaucracies and take away personal freedom to make decisions about 
you and your children and your family based on what your needs are, 
what your perception is, and what your ability is.
  Madam President, I thank you for the time tonight, I yield the floor, 
and I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. BROWN. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER (Mr. Warner). Without objection, it is so 
ordered.
  Mr. BROWN. I ask unanimous consent to speak as in morning business 
for up to 10 minutes.
  The PRESIDING OFFICER. Without objection, it is so ordered.

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