[Congressional Record (Bound Edition), Volume 155 (2009), Part 24]
[Senate]
[Pages 31964-31979]
[From the U.S. Government Publishing Office, www.gpo.gov]




             SERVICE MEMBERS HOME OWNERSHIP TAX ACT OF 2009

  The PRESIDING OFFICER. Under the previous order, the Senate will 
resume consideration of H.R. 3590, which the clerk will report.
  The assistant legislative clerk read as follows:

       A bill (H.R. 3590) to amend the Internal Revenue Code of 
     1986 to modify the first-time homebuyers credit in the case 
     of members of the Armed Forces and certain other Federal 
     employees, and for other purposes.

  Pending:

       Reid amendment No. 2786, in the nature of a substitute.
       Hutchison motion to commit the bill to the Committee on 
     Finance, with instructions.

  The PRESIDING OFFICER. Under the previous order, the first hour will 
be equally divided and controlled between the two leaders or their 
designees, with the minority controlling the first half and the 
majority controlling the second half.
  The Senator from Montana is recognized.
  Mr. BAUCUS. Under current law, the estate tax disappears next year--
in 16 days--but snaps back to a 55-percent rate the year after. I 
believe that is not sound policy. The estate tax should not be zero in 
1 year and then be snapped up to a very high rate in the subsequent 
year. As the Chair knows, current law has the rate slowly declining and 
the exemption slowly increasing. The individual exemption now is $3.5 
million. If Congress takes no action, then beginning on January 1 of 
next year, that could be zero. The estate tax could be zero.
  But another consequence that will occur too is that all heirs of the 
estate will find that the property they receive will be subject to a 
carryover basis. Currently, today, property received by heirs is 
subject to a step-up basis. They get the new basis and the value of the 
estate as of the date of the decedent's death. If this law expires, 
there would be no estate tax paid next year on any estate, but also the 
heirs will no longer have a step-up basis on the assets they receive.
  There are several problems with letting the current law expire next 
year. One is the yo-yo effect. It is an outrage if Congress allows 
estate taxes to change so much, particularly near the end, that is, a 
lower rate this year with an expiration to a zero rate next year, and 
also changing a step-up to a carryover basis, and the following year up 
at a much higher rate.
  The second problem, frankly, is I do think there should be an estate 
tax on the highest value estates. I think that is good policy.
  Third, people don't talk much about this, but I think we should focus 
on it. If current law expires, every heir will be subject, as I said, 
to a carryover basis in determining his or her taxes when that 
taxpayer, the heir, at a later date sells the property and has to pay 
capital gains. What are the problems with that? First of all, massive 
record-keeping confusion--massive.
  Soon, I am going to propose an extension in the current law. If that 
is not passed and if we do not extend the estate tax law, all 
taxpayers, all heirs, will be subject to massive confusion in trying to 
determine the value of the underlying assets when they later try to 
sell. The value of the step-up basis to the heir obviously is a lower 
capital gains tax, but there is also certainty. People pretty much know 
the value at the death of the decedent.
  I cannot emphasize strongly enough how much confusion there will be 
on January 1, if my consent is not agreed to. There will be such 
confusion because of the heirs receiving property subject to a 
carryover basis, not a step-up basis, let alone the capital gains tax 
they will have to pay when they sell that capital asset at a subsequent 
date. Currently, when the heir receives that capital asset, because it 
is a step-up basis, there is much less capital gain paid, presumably, 
by that heir who sells the asset.
  Here it is mid-December. The only responsible thing to do to prevent 
the yo-

[[Page 31965]]

yo effect--how in the world can people look at planning in their 
estates if the law goes up and down and changes all the time? It has 
kind of leveled off, as I said, at the 2009 rates and people have a 
pretty good idea what those are. Some in this body would like to see 
the rate go lower and exemptions go higher. Some in this body would 
like to see other changes. We kind of leveled off at 2009 estate tax 
laws, where the rates are set and the exemptions are set. Most people 
in the country are anticipating Congress will eventually pass that.
  It would be irresponsible to further the yo-yo effect by allowing 
current law to expire and create all this massive confusion, this chaos 
that will apply to heirs of the estates on January 1 because of this 
change in capital assets from step-up to a carryover basis, among other 
things.


                  Unanimous Consent Request--H.R. 4154

  Mr. President, I ask unanimous consent that the Senate proceed to the 
immediate consideration of H.R. 4154, which was just received from the 
House and is at the desk; that the Baucus substitute be considered and 
agreed to, the bill, as amended, be read the third time and passed, the 
motion to reconsider be laid upon the table; that any statements 
relating to the measure be printed in the Record without any further 
action or debate.
  The PRESIDING OFFICER. Is there objection?
  Mr. McCONNELL. Mr. President, reserving the right to object, there is 
nothing more outrageous to the American people than the thought that 
they will have to visit both the IRS and the undertaker on the same 
day.
  Surveys indicate that Americans, even after informed that estate tax 
may not apply to them, object to it in principle.
  I am going to ask that the chairman of the Finance Committee modify 
his request in the following way:
  That there be an amendment considered that reflects a permanent, 
portable, and unified $5 million exemption that is indexed for 
inflation, and a 35-percent top rate; and further, that the amendment 
be agreed to, the bill then be read the third time and passed, with the 
motion to reconsider laid upon the table.
  Before the Chair rules, I want to acknowledge my good friend Senator 
Kyl, the Republican whip, who has been our leader on this side of the 
issue. He has crafted a proposal, along with the leader on this on the 
other side, Senator Lincoln of Arkansas, that is consistent with the 
consent agreement and with the modification I am now asking the 
chairman of the Finance Committee to make. This approach would provide 
certainty and clarity to all taxpayers, especially small businesses and 
farmers; whereas the UC propounded by the chairman would only create 
additional confusion, with three different rates coming into effect in 
the course of a 12-month period.
  Summing it up, I ask that my friend from Montana modify the agreement 
in the way I described.
  Mr. BAUCUS. Mr. President, I don't think this is the way to do 
business here; that is, to enact estate tax law here on the floor of 
the Senate without any notice, and also because there are so many 
considerations Senators on both sides want to look at. It would be 
improper. I object.
  Mr. McCONNELL. I object.
  The PRESIDING OFFICER. Objection is heard.
  Mr. BAUCUS. Mr. President, I yield 5 minutes to the Senator from New 
Mexico.
  The PRESIDING OFFICER. The Senator from New Mexico is recognized.
  Mr. BINGAMAN. Mr. President, let me speak in support of what Senator 
Baucus, the Senator from Montana, attempted to do just now--to get a 
short-term extension of current law with regard to the estate tax, so 
we would have a $3.5 million exemption from the estate tax into next 
year for a short period, while we actually settle on what type of 
permanent change in estate tax law is appropriate.
  As the Senator from Montana pointed out, the circumstance we find 
ourselves in right now, given the current state of the law, is 
untenable and irresponsible. What the current status is that if a 
person dies in the next 16 days, if their estate exceeds $3.5 million, 
they will be subject to an estate tax, and a couple whose estate--when 
the second member of the estate dies and their estate would exceed $7 
million, they would be subject to an estate tax.
  After the next 16 days, beginning on January 1 of next year, we have 
no estate tax under the law as it now exists. But at the end of next 
year--or the beginning of 2011--the estate tax comes back at a 55-
percent rate.
  That is not a reasonable set of circumstances for the American public 
to have to face. Not only is it a 55-percent rate that comes back on 
January 1, 2011, the exemption--the amount that is exempt from the 
estate tax--is reduced to $1 million. That is, obviously, adverse to 
many families in this country.
  What has happened on the Senate floor is that the Senator from 
Montana has said let's do a short-term extension of the current estate 
tax provisions for a few months and get a resolution of what should be 
done on a permanent basis. The Republican leader has said: No; here is 
a permanent solution. Take this permanent solution or we object.
  That is not a responsible way for this body to proceed, in my 
opinion. I do think this issue that both Senator Reid and Senator 
Baucus have spoken about of this problem with a stepped-up basis going 
away for inherited assets is a very real problem. It is arcane, I 
understand that. It sounds like accounting speak. But it is a very real 
problem for American families when they inherit property in the future 
to have to take the value for purposes of paying capital gains tax. If 
that property is ever sold, they will have to go back and try to 
determine what was the basis that their parent or the person from whom 
they inherited the property had in that property. It is a bookkeeping 
nightmare and will create great confusion for American families.
  Clearly, the right course is for us to do a short-term extension of 
the current estate tax provisions and then get agreement between the 
two parties as to what a long-term solution could be in the next couple 
of months.
  That course, evidently, is being blocked. The request was made 
yesterday, I understand, by Senator Pryor to have a short-term 
extension. The Republican leaders objected to that request. The same 
objection has been raised to the request by Senator Baucus today.
  I do think this is an unfortunate circumstance. It is a great 
disappointment to me to see us doing business in this fashion. I know 
there are many who think there should be no estate tax. I do not agree 
with that perspective. The estate tax in my State--I went back and got 
the IRS figures. There were 80 individuals in the year 2008 who wound 
up having to pay some estate tax, whose estates had to pay some estate 
tax in the State of New Mexico. It does not apply to most individuals.
  I do believe it is appropriate that there be an estate tax for large 
estates. I do believe we should have a consistent policy, and it should 
not be something that is here today, gone tomorrow, and back again in a 
much worse form at the beginning of January 2011. That is the course we 
are on today. I think it is very unfortunate.
  Again, I strongly support what the Senator from Montana was trying to 
accomplish with his unanimous consent request.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Montana.
  Mr. BAUCUS. Mr. President, I ask unanimous consent that Senator Kyl 
be permitted to speak for up to 5 minutes and that following his 
remarks, the hour of controlled time on the health care legislation 
begin.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The Senator from Arizona.
  Mr. KYL. Mr. President, the argument that the chairman of the Finance 
Committee made reminds me of a story told in law school of the fellow 
accused of murdering his parents. He pled for mercy on the court since 
he was an orphan.

[[Page 31966]]

  I asked the chairman of the committee numerous times this year to 
address this problem, and the response always was: We are too busy. We 
are too busy with health care was the usual response. Now we find 
ourselves at the end of the year, and it is odd that the chairman 
argues that we have a big emergency on our hands and we have to act.
  It is not as if we have not known this issue was out there. Nor, as 
Senator Bingaman just suggested, has it been a big mystery that the 
rate on the estate tax was going to go to zero next year. That is the 
2001 law. We have known that for years.
  Frankly, people have applauded the fact there is not going to be an 
estate tax next year. The only problem is if the people on the other 
side of the aisle intend to repeal that law so we do have an estate 
tax. I know that is their intention. They are creating the confusion 
because the law has been known about for 10 years that we are going to 
have a zero rate. Now all of a sudden they say we cannot let that 
happen. We are going to have to change it next year. Since we think we 
may be able to do that, we should extend what we have right now and not 
let the zero rate take hold.
  I suspect the great dilemma that is being posed is one most folks 
would love to have as a problem. The dilemma being proposed is that if 
the rate goes to zero and the heirs of the property decide to sell the 
property at some point, they will have to pay a capital gains tax. That 
is just fine. That is what most people would like to do.
  Since this income is taxed twice--it is taxed once when you make the 
income, then it is taxed again if you have any of that left over when 
you die--that is unfair. What we have always argued is that the estate 
tax, therefore, should go away and just leave the existing Tax Code 
where it is, which says: If somebody inherits property and later sells 
that property, sure, they should pay a capital gains tax on it. I would 
think most people would think that is a pretty good deal.
  The capital gains tax is 15 percent; whereas the estate tax under the 
proposals of my friend from Montana would go to 45 percent. As between 
paying 45 percent and 15 percent, I think it is pretty clear what most 
small business folks and farmers would like to do.
  Of course, the original basis of the property is the basis for paying 
the tax. Again, if you put that question to small business folks or 
farmers, they would tell you they would rather pay the capital gains 
tax than they would an estate tax of 45 percent.
  Mr. President, I ask unanimous consent to have printed in the Record 
at the conclusion of my remarks an editorial from the Wall Street 
Journal from December 11 called, ``The Tax That Won't Die, Death Blow, 
Night of the Living Death Tax, Estates of Pain.''
  The PRESIDING OFFICER. Without objection, it is so ordered.
  (See exhibit 1.)
  Mr. KYL. Mr. President, among the things pointed out in this 
editorial, they say:

       We've long argued that the economically optimal and fairest 
     death tax rate is zero. The tax is applied to income that was 
     already taxed when it was earned, so it is a double tax on 
     savings and capital. The correct way to tax a gain in the 
     value of assets bequeathed to an heir is with a capital gains 
     tax of 15 percent when the assets are sold, rather than at 
     the time of the funeral of the original owner.

  I think that says it all. I hope the problem my friends are so 
concerned about--first of all, they recognize a problem they themselves 
manufactured by not getting around to doing anything about this until 
the eleventh hour. Second, it is a problem that does not have to exist 
if they will leave the existing law alone and let the rate go to zero, 
which is what everybody wants it to be.
  Sure enough, if your heirs sell property after that, they will have 
to pay capital gains. Ask them what they would rather do--pay a 15-
percent rate or a 45-percent rate. I think the answer to that is pretty 
clear.

                               Exhibit 1

             [From the Wall Street Journal, Dec. 11, 2009]

                         The Tax That Won't Die

       Well, the moment of truth has arrived, and House Democrats 
     recently voted 234-199 to cancel the 2010 repeal and hold the 
     rate permanently at 45% with a $3.5 million exemption. Senate 
     Majority Leader Harry Reid now wants to do the same. But to 
     suspend the Senate's health-care debate and turn to the 
     estate tax, he needs 60 votes. All Republicans and some 
     Democrats are saying no. Blanche Lincoln of Arkansas and Jon 
     Kyl of Arizona will accept no more than a 35% permanent rate 
     with a $5 million exemption.
       We've long argued that the economically optimal and fairest 
     death tax rate is zero. The tax is applied to income that was 
     already taxed when it was earned, so it is a double tax on 
     savings and capital. The correct way to tax a gain in the 
     value of assets bequeathed to an heir is with a capital gains 
     tax of 15% when the assets are sold, rather than at the time 
     of the funeral of the original owner.
       Study after study, including one co-authored years ago by 
     White House economist Larry Summers, finds that a powerful 
     motivation for entrepreneurs to grow their businesses is to 
     pass that legacy to their children. The left disparages this 
     as building ``family dynasties,'' but most Americans think 
     that it is immoral for the government to confiscate the 
     fruits of a life's effort merely because of the fact of 
     death.
       Democrats also say their rate would apply only to the 
     richest 2% of estates. But a new study by economists Antony 
     Davies and Pavel Yakovel of Duquesne University finds that 
     the estate tax ``impacts small firms disproportionately 
     versus large firms'' by encouraging well-capitalized 
     companies to gobble up smaller ones at the owner's death. The 
     study shows the result is to ``promote the concentration of 
     wealth by preventing small businesses from being passed on to 
     heirs.''
       Republicans and willing Democrats shouldn't give up on 
     eliminating the death tax. The Kyl-Lincoln amendment to 
     create a permanent 35% rate is far better than the 
     confiscatory House bill. But the best strategic outcome now 
     is to let the death tax expire in January as scheduled under 
     current law, and return to this debate next year when the tax 
     rate is zero. Then let liberal Democrats explain to voters on 
     the eve of elections that they must restore one of the most 
     despised of all taxes.

  The PRESIDING OFFICER. The Senator from Montana.
  Mr. BAUCUS. Mr. President, clearly, the right public policy is to 
achieve continuity with respect to the estate tax. If we do not get the 
estate tax extended, even for a very short period of time, say, 3 
months, we would clearly work to do this retroactively so when the law 
is changed, however it is changed, or if it is extended next year, it 
will have retroactive application.
  The uncertainty for tens of thousands of middle-class families needs 
to stop. That is why retroactive application of anything that passes 
next year makes sense.
  Right now, 99.7 percent of estates do not have to worry about the 
estate tax. If we do not extend current law, many heirs are going to 
have to worry about capital gains. There is the potential for high-
income households to take advantage of the temporary reductions in the 
rates for gift taxes and temporary elimination of GST to do massive 
estate planning--potentially benefiting those households by billions of 
dollars at the expense of U.S. taxpayers. Beyond this, what Congress is 
doing is a huge benefit for lawyers and accountants who do all the 
estate planning.
  The right thing to do is to extend current law for a brief period of 
time to get our act together to decide what estate laws should be. That 
is the right thing to do. I am very disappointed that the other side of 
the aisle does not let us do the right thing--at least extend current 
law for a while until we know what the estate tax law should be.
  Mr. COBURN addressed the Chair.
  The PRESIDING OFFICER. The Senator from Montana has the floor.
  Mr. BAUCUS. Mr. President, for the benefit of Senators, we are now 
back on the health care bill. Let me lay out today's program.
  It has been nearly 4 weeks since the majority leader moved to proceed 
to the health care reform bill. This is the 16th day that the Senate 
has considered the bill.
  The Senate has considered 23 amendments or motions and conducted 18 
rollcall votes.
  Today the Senate will debate the motion to commit regarding taxes 
offered last night by the Senator from Texas, Mrs. Hutchison. Under the 
previous order, later this morning, we expect

[[Page 31967]]

that the Senator from Vermont, Mr. Sanders, will offer his amendment 
No. 2837 on a national single-payer system.
  This morning, the first hour of debate will be equally divided and 
controlled between the two leaders or their designees. The majority 
will control the first half hour and the Republicans will control the 
second half hour.
  We expect the Senate to conduct votes today in relation to the 
Hutchison motion and the Sanders amendment.
  Also, today, the House of Representatives is scheduled to act on the 
Department of Defense Appropriations Act which also contains a number 
of vital year-end measures. We look forward to receiving that measure 
in the Senate as well.
  I yield 10 minutes to the Senator from Ohio and then 15 minutes to 
the Senator from Delaware.
  The PRESIDING OFFICER. The Senator from Ohio.
  Mr. BROWN. Mr. President, I thank Senator Baucus for yielding, and I 
thank Senator Kaufman also for him yielding.
  Less than 5 percent of cancer patients enroll in clinical trials. 
Only 6 percent of people who suffer from severe chronic illnesses 
participate. These low participation rates mean it is harder to conduct 
a timely trial. In fact, delays in patient recruitment for clinical 
trials account for an average of almost 5 months lost per trial. Nearly 
80 percent of trials run over schedule by more than a month. Only 6 
percent are completed on time.
  Clinical trial delays lead to treatment development delays, whether 
it is the next breakthrough drug or some other lifesaving therapy. 
Without clinical trials, medical innovation would come to a halt.
  Unfortunately, one major reason more patients do not enroll in 
clinical trials is that their insurance company coverage discourages 
it.
  Insurers today take advantage of lax regulations that allow them to 
deem all care for a person in a clinical trial as ``experimental''--
even routine services they would get if they were not in the trial, 
such as x rays, blood tests, and doctor visits.
  This draconian policy predictably scares many patients away from 
potentially lifesaving trials. Patients simply cannot afford to pay out 
of pocket for all of their own care. Understand, they do not expect the 
insurance company to pay for the trial itself. No one is suggesting 
that. No one thinks that. But insurers should not be allowed to use a 
patient's participation in a clinical trial as an excuse to deny them 
coverage for standard care.
  To address this problem, Senator Hutchison of Texas and I have filed 
amendment No. 2871. This amendment would require all insurance 
companies to simply live up to the promises they have made to their 
premium-paying policyholders. It means covering the cost of routine 
care for clinical trial participants.
  More than 30 States have already enacted a similar clinical trials 
policy for their State-regulated insurance plans. Medicare has already 
enacted a similar clinical trials policy for its beneficiaries. The VA 
and DOD have already enacted similar clinical trials policies for their 
members. Even some insurance companies are already doing the right 
thing in covering the routine costs associated with clinical trials.
  But because many are not and because there is no standard criterion 
by which appeals can be adjudicated, countless patients who would 
otherwise enroll in clinical trials do not.
  Take, for example, Sheryl Freeman from Dayton, OH. Sheryl and her 
husband Craig visited my office in Washington in 2007. Sheryl was a 
retired teacher suffering from multiple myeloma. Thankfully, she had 
health insurance through her husband's employer. Yet when Sheryl tried 
to enroll in a promising clinical trial at James Cancer Hospital at 
Ohio State, her insurance company balked, refusing to cover the routine 
care costs.
  Understand this: She had insurance, she had good insurance--she 
thought she had good insurance. She enrolled in a clinical trial paid 
for by the people doing the clinical trials--the hospital, the drug 
company, whomever. But the insurance company pulled back and said: We 
are not going to cover routine care for her anymore since she is in a 
clinical trial, something she was entitled to with or without the 
clinical trial. Regardless of whether or not Sheryl enrolled in a 
clinical trial, she still needed to visit her oncologist in Dayton once 
a week for standard cancer monitoring, including scans and blood tests. 
But her insurance company would stop covering these services if she 
enrolled in the clinical trial.
  Sheryl wanted to enroll in a clinical trial because she hoped it 
would save her life. She hoped it would give her more time with her 
loved ones. She hoped it would help future patients diagnosed with the 
same type of cancer, but she was not willing to force her family into 
bankruptcy. So instead of devoting her energy toward combating cancer, 
Sheryl spent the last months of her life haggling with the insurance 
company. By the time her insurance company relented, it was too late. 
Sheryl died December 7, 2007.
  Sheryl's husband Craig, with whom I have spoken a couple of times and 
met with, wrote the following about the ordeal:

       No patient should have to fight insurance when battling a 
     disease such as cancer.

  How many times have we heard that in this Chamber? Tragically, 
Sheryl's experience is not an isolated case.
  In Ohio--my State--one cancer hospital has reported that over one-
third of patients who tried to enroll in a clinical trial over a 6-
month period were automatically denied access by their insurance 
company. Again, I understand how that happens. You have decent 
insurance, you think. Then you decide to enroll in a clinical trial 
that your doctor suggests. The insurance company then quits covering 
you for the things it used to cover you for--the routine care you need 
as a patient.
  Take Gene Bayman. I met and talked to Gene--a courageous man who 
loved his family. His family was so fond of him, as you could see, when 
I saw him in Columbus with his family. He was diagnosed in February 
2007 with multiple myeloma. Gene's doctor recommended a combination of 
standard treatment and clinical drugs, but Gene's insurance company 
threatened to stop paying for the routine care otherwise covered under 
the policy if he enrolled in the clinical trial.
  If that is not rationing, Mr. President, I don't know what is.
  Gene died in June of this year, never having the chance to 
participate in the cutting-edge research that might have saved his 
life. Gene wrote, before he died:

       I don't want my health options limited by insurance 
     companies concerned with the bottom line rather than the 
     medical research my doctor prescribes.

  Mark Runion, also from Ohio, faced the same barrier. Mark was being 
treated for multiple myeloma with standard care--a stem cell transplant 
and chemotherapy. His doctor recommended he enroll in a clinical trial 
to try out a new drug that might help him recover quickly. The 
insurance company refused to comply, telling Mark if he were to enroll 
in the clinical trial they wouldn't pay for any of his cancer care. 
Another terrible lost opportunity. The clinical trial would have helped 
us learn more about which drugs we should administer to patients after 
stem cell transplants. In other words, while this most directly, most 
tragically, most painfully affected Mark Runion and his family, it also 
affects all of us who have loved ones or who might ourselves come down 
with this disease. The clinical trial that Mark wanted to enroll in 
would have given him an opportunity and would have given all of us more 
scientific knowledge and information that would have been helpful.
  Instead, the insurance company took a shortsighted view and denied 
Mark the recommended care. Mark writes:

       I personally would rather make my medical decisions with my 
     doctor--the expert in my care--rather than my insurer.

  These stories should have ended differently. Sheryl, Gene, and Mark 
all paid premiums to health insurance for years. But when they got sick 
and were

[[Page 31968]]

referred to a clinical trial, the insurance company refused to pay for 
the benefits guaranteed under its policy.
  Health insurance reform should be about making sure insurance 
companies can't renege on their commitments. It is about ensuring that 
insurance companies can't write sham policies that allow for 
rescissions and riders and exceptions and bring about more horror 
stories than we all care to recount. It is about closing loopholes that 
health insurance companies are great at taking advantage of, and as 
some say, staying one step ahead of the sheriff.
  This amendment is consistent with those goals. It would help advance 
important research in the most serious diseases. This is a public 
health issue for all of us.
  In closing, if we are ever going to find a cure for cancer and 
diabetes and cardiovascular disease and Alzheimer's and ALS and the 
hundreds of other diseases killing millions of Americans each year, we 
need to encourage in every way possible participation in clinical 
trials and not put up barriers against participation.
  This amendment is endorsed by the Lance Armstrong Foundation, the 
American Academy of Pediatrics, the Susan G. Komen for the Cure 
Advocacy Alliance, the American Cancer Society, the Alzheimer's 
Foundation of American, and dozens of other national organizations.
  Along with Senator Hutchison, this bipartisan amendment is also 
sponsored by Senators Franken, Whitehouse, Sanders, Specter, and 
Cardin. Please join us in supporting amendment No. 2871.
  I yield the floor.
  The PRESIDING OFFICER (Mr. Kirk). The Senator from Delaware is 
recognized.
  Mr. KAUFMAN. Mr. President, I ask unanimous consent to speak as in 
morning business for up to 15 minutes.
  The PRESIDING OFFICER. Without objection, it is so ordered.


                     Financial Markets and Job Loss

  Mr. KAUFMAN. Mr. President, my colleagues have heard me speak in 
recent weeks about the troubling trends in our financial markets--the 
growing use of dark pools and high-frequency trading, increasing market 
fragmentation and looming regulatory gaps at the Securities and 
Exchange Commission. Today, I want to talk about an economic threat 
that encompasses these developments and why I think they are negatively 
affecting the long-term health of our economy.
  After suffering through the most severe recession in decades, we are 
now in the midst of the most fragile of recoveries. It is evident to 
all that we are in a jobs crisis. We need a laser-like focus on 
innovation policies that encourage industry to create jobs. But this 
challenge comes not just from the financial crisis and the recession 
that followed, the American economy has slowed in its efforts to create 
jobs for the past decade.
  According to the Bureau of Labor Statistics, the United States had 
108.5 million private, nongovernmental jobs as of September of this 
year. But while our population has grown 9 percent in the last 9 years, 
the number of jobs now available is essentially the same as June of 
1999.
  Let me repeat that: The number of jobs now available is essentially 
the same as June of 1999--over 10 years ago.
  Many of the jobs this economy did create in the past decade were in 
the financial, housing, and consumer-led retail sectors. Two of those--
financial and housing--were bubbles that have now burst. Without these 
sectors playing a key role in providing new jobs, many Americans are 
asking: Where will the future job creation most likely occur?
  In the past, job creation would often come from the raft of small, 
newly financed, often innovative companies that raised their capital 
with the help of Wall Street underwriters. Thousands of times I have 
heard in the last months that the recovery is going to come because of 
small businesses, and many of those raise their capital with the help 
of Wall Street underwriters.
  Now I am deeply concerned there is a choke point in our efforts to 
return to economic vibrancy, a choke point that can be found on Wall 
Street. Our capital markets, which have long been the envy of the 
world, are no longer performing one of their most essential functions; 
that is, the constant and reliable channeling of capital through the 
public sale of company stock, known as initial public offerings--or 
IPOs--which small companies use to innovate and, most importantly, to 
create jobs.
  Look at this chart. There is an IPO crisis in this country. Indeed, 
according to a report released last month by the accounting firm Grant 
Thornton, the IPO market in the United States has practically 
disappeared. That, in turn, according to a second Grant Thornton study, 
has had a ripple effect on the U.S. stock markets, with the number of 
stock listings since 1991 dropping 22 percent in absolute terms and 53 
percent when factoring in inflation-adjusted GDP growth.
  New companies have been shed from the NASDAQ, New York, and American 
Stock Exchanges faster than being created, from almost 7,000 publicly 
listed companies in 1991 and nearly 8,900 in 1997, during the dot-com 
bubble, to 5,400 listed in 2008, a turn of events Grant Thornton has 
dubbed the ``Great Depression of Listings.''
  The United States is practically the only market in the world where 
this phenomenon is occurring. The major stock exchanges--as you can see 
from this chart--in Hong Kong, London, Milan, Tokyo, Toronto, Sydney, 
and Frankfurt, have all grown from their 1997 levels, Grant Thornton 
reports. Just look at this chart. This is what is going to take us out 
of the recession. Look at where we are--the United States--in relation 
to Hong Kong, Tokyo, Australia, and the other markets.
  The effects of the IPO crisis have rippled throughout the U.S. 
economy. Because 92 percent of job growth occurs after a company goes 
public, job creation may have been stunted by these developments. In 
fact, according to the Grant Thornton study, if the IPO market was 
working properly today, we would have as many as 10 million to 20 
million additional high-quality jobs for middle-class Americans. Even 
if that estimate is off by a factor of 10, this failure of Wall Street 
to provide capital to small companies may be costing our economy 
millions of jobs.
  Mr. President, most every large company begins as a small company. 
That is axiomatic. The IPO market has been hit hardest at the smallest 
end of the market. The medium IPO in the first 6 months of 2009 was 
$135 million. Let me say that again--$135 million. Twenty years ago, 
IPOs at $10 million were routine, and routinely succeeded.
  Take a look at this chart and look at these companies. Venture 
capitalists play a critical role in long-term investment, in growing 
our economy and creating jobs. Indeed, when you look at these 17 
venture-backed companies that raised a total of $367 million in capital 
and today provide 470,000 U.S. jobs, they are among our economy's 
biggest success stories.
  Look at this list. Think of where we would be today if these 
companies were not able to get IPS: Adobe, Computer Associates, Intel, 
Oracle, Yahoo. These are all the companies where growth came from. 
Right now, in our present market, they cannot go public the way they 
went public originally.
  What has happened? A host of well-intentioned changes--some 
technological, some regulatory--with many unintended consequences have 
created this situation. Online brokerage firms, with their $25 trades, 
first appeared in 1996, hastening the decline of traditional full-
service brokerage firms who charge $250 a trade. There was an advantage 
to those hefty fees, however. They helped maintain an underwriting 
apparatus that encouraged small businesses to go public and supported a 
substantial research base that attracted both institutional and retail 
clients.
  The rich ecosystem of investment firms, including the Four Horsemen--
Robertson Stephens, Alex Brown & Sons, Hambrecht & Quist, and 
Montgomery Securities--that helped their institutional buy-side clients 
take part in IPOs and marketed follow-on offerings, no longer exists 
today.

[[Page 31969]]

  Structural changes in the U.S. capital markets dealt the final coup 
de grace. There were new order handling rules--decimalization, which 
shrank spreads significantly and made it increasingly difficult for 
traditional retail brokers to remain profitable; Regulation ATS and 
NMS, which vastly expanded the electronic marketplace.
  Finally, there has been an explosive growth in high-frequency 
trading, which takes advantage of the market's now highly automated 
format to send more than 1,000 trades a second ricocheting from 
computer to computer.
  The result, as The Economist magazine wrote last week, is that high-
frequency traders who have come to dominate stock markets within their 
computer-driven strategies pay less attention to small firms, 
preferring to jump in and out of larger, more liquid shares.
  The economist quoted:

       Institutional investors wary of being stuck in an illiquid 
     of the market are increasingly following them.

  This is a situation that stands as a veritable wall against a 
sustained economic recovery.
  One of the very vital tasks before Congress is to help unemployed 
Americans by crafting innovation policies that will rebuild our 
economy, catalyze growth, and create high-quality jobs for struggling 
Americans. That is our No. 1 job in the Congress right now. I think if 
you asked every 1 of the 100 Senators, they would say that is the case.
  We must identify the causes of last year's debacle and apply them to 
our current economic challenges in order to help the millions of 
struggling Americans and to avert a future disaster. The fact that Wall 
Street has resumed its risky and--as we know all too well--potentially 
disastrous behavior is simply inexcusable.
  In order to reverse this ominous trend and help companies raise 
capital to innovate, create jobs, and grow, we must restore the 
financial sector's historical role as a facilitator of long-term growth 
and not the source of one bubble after another.
  The question, finally, is this: How can we create a market structure 
that works for a $25 million initial public offering, both in the 
offering and the secondary aftermarket? If we can answer that question, 
this country will be back in business.
  Mr. President, I yield the floor, and I suggest the absence of a 
quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. KAUFMAN. Mr. President, I ask unanimous consent the order for the 
quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. KAUFMAN. Mr. President, I ask to speak as in morning business for 
up to 5 minutes.
  The PRESIDING OFFICER. Without objection, it is so ordered.


                     In Praise of William Phillips

  Mr. KAUFMAN. I rise once again to recognize one of America's great 
federal employees.
  Last week, in Stockholm and Oslo, the 2009 Nobel laureates accepted 
their prizes. I am particularly proud that 11 of this year's 13 prizes 
were won by Americans. This is a reminder of our Nation's global 
leadership in science, medicine, economics, and peacemaking.
  My honoree today holds the distinction of having been the first 
Federal employee to win a Nobel Prize in physics for work performed 
while serving the public.
  Our Federal workforce is composed of citizens who are both highly 
educated and incredibly motivated.
  Dr. William Phillips is the perfect example. A native Pennsylvanian, 
William learned the importance of public service and hard work from a 
young age. His mother, an immigrant from Italy, and his father, a 
descendent of American revolutionaries, were the first in their 
families to attend college. They both pursued careers as social workers 
in Pennsylvania's coal-mining region. William, along with his brother 
and sister, grew up in a home where reading and education were 
emphasized.
  As a boy, William fell in love with science, and he tinkered with 
model rockets and chemical compounds in the basement of his family's 
home. While attending Juniata College in the 1960s, William delved into 
physics research. He spent a semester at Argonne National Laboratory 
and, after graduation, pursued his doctorate at M.I.T.
  During his time at M.I.T., the field of laser-cooling was just 
heating up, and William wrote his thesis on the collisions of atoms 
using this new technology.
  In 1978, William began working at what is today the National 
Institute for Standards and Technology--or ``NIST''--at the Department 
of Commerce. At NIST, he pursued further research into laser-cooling, 
and his discoveries have helped open up a new field of atomic research 
and expand our knowledge of physics. His findings have found important 
application in precision time-keeping, which is important for both 
private industry and for national security.
  In 1997, William received the Nobel Prize for Physics along with two 
other scientists. One of his fellow-laureates that year was Dr. Steven 
Chu, who now serves as Secretary of Energy.
  After winning his Nobel Prize, William made a commitment to using his 
fame to promote both science education and public service. He regularly 
speaks to student groups, and he serves as a mentor to graduate 
students in his field.
  William won the prestigious Arthur S. Flemming Award for Public 
Service in 1987, and he was honored by the Partnership for Public 
Service with its 2006 Service to America Medal for Career Achievement.
  He and his wife, Jane, live in Gaithersburg, MD, and are active in 
their community and church. Today, after a 3-decade Federal career, 
William continues to work at NIST as the leader of its Laser-Cooling 
and Trapping Group.
  I hope my colleagues will join me in honoring Dr. William Phillips 
and all those who work at the National Institute of Standards and 
Technology for their dedicated service and important contribution to 
our national life. They keep us at the forefront of science and human 
discovery. They do us all proud.
  I yield the floor and suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. McCAIN. Mr. President, I ask unanimous consent the order for the 
quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. McCAIN. Mr. President, before my colleagues begin, I think it is 
important for us to point out where we are here on December 16, 2009. 
We are now almost a year into the discussion and debate about 
``reforming health care in America'' and we still do not know what is 
in the bill. We still do not know the specifics of what we are 
considering here.
  I have had the honor of serving here for a long period of time, but I 
have never seen a process like this. I have never seen a situation 
where a major piece of legislation is not before the body and is 
somehow being negotiated and renegotiated amongst the other side. 
Meanwhile, according to the Washington Post this morning, a newspaper I 
always have the utmost trust and confidence in--I wish to say the title 
is ``Public cooling to health-care reform as debate drags on, poll 
finds.''

       As the Senate struggles to meet a self-imposed, year-end 
     deadline to complete work on legislation to overhaul the 
     nation's health-care system, a new Washington Post-ABC News 
     poll finds the public generally fearful that a revamped 
     system would bring higher costs while worsening the quality 
     of their care.

  A remarkable commentary about where we are in this legislation. One 
of the interesting things is this poll goes back to April, where in 
April, 57 percent of the American people approved and 29 disapproved of 
the President's handling of health care. Today it is 53 disapprove and 
44 approve, which means the American people, the more they find out 
about this, the less they like it and the more concerned they are. 
According to this poll again:

       Medicare is the Government health insurance program for 
     people 65 and older. Do you

[[Page 31970]]

     think health-care reform would strengthen the Medicare 
     program, weaken Medicare or have no effect on it?

  American people have figured it out. Amongst seniors, those who are 
in Medicare, 12 percent say it would strengthen, 22 percent no effect, 
and 57 percent of seniors in America believe--and they are correct--
that this proposal would weaken Medicare, the benefit they paid into 
and that they have earned.
  Let me say it again: I plead with my colleagues on the other side of 
the aisle and the majority leader. Let's stop this. The American people 
do not approve of it. Let's sit down and work together; let's have real 
negotiations; let's even have the C-SPAN cameras in, as the President 
promised October a year ago. This present legislation spends too much, 
taxes too much, and reduces benefits for American citizens as far as 
overall health care is concerned, including Medicare, as the American 
people have figured out.
  I welcome my colleagues here. I see Dr. Coburn is here. Let me 
restate: It is time to say stop. It is time to start listening to the 
American people. It is time to start being straightforward with the 
American people because the American people need to know what we are 
doing and they do not. The distinguished Senator from Illinois, last 
Friday when I asked him what is in the bill, said none of us know what 
is in the bill.
  I ask my friend from Oklahoma, isn't what is happening--we have a 
proposal, we send it to CBO, CBO sends back numbers they do not like so 
they try to fix it, send it back to CBO, they send it back again. That 
is why only one Senator, the majority leader, knows what is going on.
  Mrs. HUTCHISON. Mr. President, parliamentary inquiry.
  Mr. McCAIN. What is the parliamentary situation, I ask the President?
  Mrs. HUTCHISON. Mr. President, I was under the impression there would 
be a 30-minute allocation for colloquy for our side. I am not sure when 
we start that process.
  The PRESIDING OFFICER. The Republican side has 25 minutes 15 seconds.
  Mrs. HUTCHISON. How many?
  The PRESIDING OFFICER. There is 25 minutes 15 seconds.
  Mr. McCAIN. Mr. President, I thank the Chair. I think I have made my 
point here. I wish to yield. I ask unanimous consent to have a colloquy 
with the Senator from South Dakota, the Senator from Texas, the Senator 
from Oklahoma, and the Senator from Wyoming.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. COBURN. If I might respond to the question of the Senator, one of 
the things our President has promised is transparency. We are going to 
see at sometime in the next week or 10 days another bill--whatever the 
deal is. It would seem to me that 72 hours with a complete CBO score, 
much like was asked by 12 Members on their side, before we have to take 
up or make any maneuvers on that, would be something everybody could 
agree to since nobody knows, except Harry Reid and the CBO, what is in 
this bill now. At a later time, after we finish this colloquy, I will 
be making that unanimous consent request.
  Mrs. HUTCHISON. I thank the Senator from Oklahoma. I think it is very 
important that before we start talking about passing a bill or having a 
cloture on a bill--I think the Senator from Oklahoma is making the main 
point. I think the Senator from Oklahoma was making a very good point 
that I was hoping to work with him on and that is: Where are we now? 
The Republicans have put forward reform alternatives for our health 
care system that are not a government takeover and are not going to be 
$\1/2\ trillion in taxes and are not going to be $\1/2\ trillion in 
Medicare cuts.
  The Republican proposals would do what health care reform should do--
they would lower cost. They would increase risk pools so that small 
business would be able to offer health care coverage for their 
employees. They would have medical malpractice reform so we would be 
able to lower the cost of frivolous lawsuits, cutting over $50 billion 
out of the costs of health care, making it more accessible for more 
people. They would give tax credits for individuals who would buy their 
own health care coverage to offset that cost.
  None of that would be a big government takeover of health care. That 
is what we have been trying to put forward here. But we have not had a 
seat at the table. We have not had the capability to say what our 
proposals would be because we have not even seen the proposed new bill 
yet. We have been talking about the tax increases that are going to 
burden small business at a very hard time for this country's economy 
and we have also been talking about $\1/2\ trillion in Medicare cuts, 
which I think has caused many senior citizens to say: Wait a minute, I 
don't want my Medicare options cut. I don't want Medicare Advantage to 
be virtually taken away.
  That is why we are here today, because the pending business before 
the Senate is the Hutchison-Thune motion to recommit this bill to do a 
simple thing. It is to say that you will not start collecting the taxes 
until the program is in place. It is very simple. It is the American 
sense of fair play, and that is that you do not start collecting taxes 
before you have a program that you might want to buy into. That is what 
the Hutchison-Thune motion to recommit does. It is very simple. It is a 
matter of fair play. I even question whether we have the right to pass 
taxes for 4 years before you would ever see a program put in place.
  We are going to try to do what is right by this body. That is to say, 
the $100 billion in new taxes that will start next month--3 weeks from 
now--will not start until there is a program put in place. Because 
right now $100 billion in new taxes starts next month but there is no 
program that anyone can sign up for that will supposedly make it easier 
to get health care coverage in this country until 2014, 4 years away.
  I ask my colleague, the distinguished ranking member of the Finance 
Committee, if he believes all these new taxes would be fair to start 
before we could ever see a program--not 1 year from now, not 2, not 3 
but 4 years from now. I ask the distinguished ranking member of the 
Finance Committee if he believes it would be fair for us to start the 
taxes in 3 weeks and then not start the program for 4 years. Does that 
seem like a fair concept?
  The PRESIDING OFFICER (Mr. Casey). The Senator from Iowa.
  Mr. GRASSLEY. Mr. President, the Senator is absolutely right. Let me 
emphasize it this way. I was on a radio program in Iowa yesterday, 
where a lady called me, and I had been saying, as the Senator has just 
said, that you have to wait until 2014 for this program to go into 
effect. She said: You are telling me you are going to pass this bill 
right now, but we have to wait until 2014 until we get any benefit from 
it? She didn't talk about the taxes, as the Senator is, but the taxes 
go into effect. Another smokescreen is, you have 10 years of tax 
increases, fee increases, and the program is 6 years long, but the 
taxes are 10 years long. So it is nice for the CBO to say: Yes, this is 
balanced and maybe even has a surplus in it. But over the long term, 
this program does not cost just $848 billion. I hope I answered your 
question.
  Mrs. HUTCHISON. You did. It is interesting because you say maybe it 
is going to be break even. How is it going to break even? I ask my 
colleague from South Dakota, who is a cosponsor of this motion: How is 
it going to break even? With $\1/2\ trillion in Medicare cuts, $\1/2\ 
trillion in tax increases, is that the way we ought to be saying to the 
American people we will reform health care? Have we lost the purpose of 
the bill, to make health care more affordable and accessible to the 
American people? I ask my colleague, the Senator from South Dakota, who 
has worked on this issue for a long time, is that the concept of break 
even?
  Mr. THUNE. The Senator from Texas has touched on a very important 
issue. The motion she offers, and which I cosponsor, does lay out what 
is a simple principle of fairness that most Americans understand. When 
you implement public policy, if you are going to raise taxes, you ought 
to align the tax increases and the benefits so they start

[[Page 31971]]

at essentially the same time. What this bill does is it starts 
collecting taxes, increases taxes on Americans 4 years before the major 
benefit provisions kick in. On January 1 of 2014, 99 percent of the 
spending under the bill kicks in. But the tax increases begin less than 
3 weeks from today. Sixteen days from now is when the tax increases in 
the bill start. A tax on prescription drugs, a tax on medical devices, 
a tax on health plans--all begin 16 days from now. A lot of those taxes 
will be imposed upon the American economy and passed on to people and 
small businesses in the form of higher premiums. People are going to 
get higher premiums 4 years before they are likely to see any benefit. 
Ninety-nine percent of the spending under the bill doesn't kick in 
until January 1, 2014, or 1,477 days from now. Most Americans, as they 
listen to the debate, believe as I do, as a simple principle of 
fairness, you ought to align the benefits and the taxes. We had a vote 
yesterday on the Crapo motion that would recommit all the tax 
increases. Many of us believe raising taxes on small businesses when 
you have an economy in recession is not a smart thing to do; it is 
going to cost us a lot of jobs. Small businesses have made that clear. 
I also think, in addition to the principle of fairness that is at play, 
when it comes to raising taxes 4 years prior to the benefits kicking 
in, you also need to have a transparent sort of understanding about 
what the cost of the bill is going to be.
  One of the reasons the revenue increases, the tax increases were 
begun immediately or 16 days from now, but the majority of the 
spending, 99 percent, doesn't occur until January 1 of 2014 and beyond 
is to understate the true cost. They wanted to bring the cost of the 
bill in under $1 trillion.
  If you can see, starting this year and going through 2019, it ends up 
at about $1 trillion or $1.2 trillion on this chart. But if you look at 
the fully implemented period; that is, 2014, when the benefits and 
spending begin, and take that through the next 10 years, the total 
spending in the bill is $2.5 trillion over a 10-year period.
  That is one thing the American people need to know. One of the 
reasons this is being done, tax increases starting January 1 next year 
or 16 days from now, most of the benefits not starting until 1,477 days 
from now, is so they can say this is only a $1 trillion bill or under 
$1 trillion, the way it has been advertised, when, in fact, it is going 
to cost $2.5 trillion when fully implemented.
  We are here 16 days before the Christmas holiday, and there are 
things Congress needs to do. There are a number of fairly urgent 
matters that need to be dealt with before the end of the year, some of 
which have been mentioned this morning. But trying to jam through a new 
health care program, a $2.5 trillion expansion of the Federal 
Government in Washington, 70 new government programs, trying to jam it 
through in the next 9 days or so before Christmas seems to be done more 
out of a political necessity, the need for a political accomplishment 
or a political victory, than it does with making good public policy. As 
the American people are approaching this holiday season, the best thing 
we can do, the best Christmas gift we could give the people, frankly, 
is for Congress to adjourn and go home before passing this $2.5 
trillion expansion.
  What does it mean? If you are a small businessperson, the Christmas 
gift you get this year is a big lump of coal from the Congress in the 
form of higher taxes. If you are a senior citizen, 1 of the 11 million 
who are on Medicare Advantage and this bill passes, your Christmas gift 
this year is benefit cuts. The same thing applies to many of our 
providers--hospitals, nursing homes, home health agencies, hospices. If 
you are an average American family who is worried about the high cost 
of health care, your Christmas gift this year is, if this bill passes, 
that your health insurance premiums will continue to go up year over 
year at twice the rate of inflation. You lock in higher premiums for 
most people across the country, you raise taxes on small businesses, 
you cut benefits to Medicare beneficiaries and, for future generations, 
you create a $2.5 trillion new entitlement program they will be paying 
for, for as far as the eye can see.
  The CMS Actuary, last week, said, in addition to all the other things 
they mentioned--the overall cost of health care is going to go up, 20 
percent of hospitals will close--that the Medicare cuts that are being 
proposed cannot be sustained on a permanent basis. If that is true, how 
will this be financed? Either with more taxes or borrowing, putting it 
on the debt and handing the bill to future generations. That is what we 
are left with. Once you lock in a $2.5 trillion expansion of the 
Federal Government, it is going to be hard to reduce the cost. The 
spending is not going to go away. The way it will be paid for, if the 
Medicare cuts are not sustainable, is the tax increases. The increases 
that are already in here would have to be increased even further or, 
worse yet, for future generations, if you are a young American, it will 
be put on your bill.
  The Senator from Texas and my colleagues who are here this morning 
all voted yesterday to get rid of the tax increases in the bill. But 
the motion she offers and that I cosponsor would at least, as a 
principle of fairness, make sure those tax increases don't begin before 
the benefits do.
  Mrs. HUTCHISON. Mr. President, the 2 physicians out of the 100 
Members of Senate are here this morning. They have talked for a long 
time about the quality of care. They are the two who have the 
credibility on this. I would like to ask the Senator from Wyoming, Dr. 
Barrasso, to talk about what is going to happen to the quality of 
health care when you have $\1/2\ trillion in Medicare cuts, which we 
have discussed, and the bill we are discussing today and the motion 
Senator Thune and I are offering, that is going to put a higher cost on 
every prescription drug, every piece of medical equipment. Perhaps you 
would expand on what kind of medical equipment is needed for people to 
have the quality of life we have in our country today and then the 
insurance companies, which are, of course, going to raise the premium 
of every person who already has coverage.
  I ask the Senator from Wyoming, Dr. Barrasso, in your experience, how 
is this going to affect the quality of health care?
  Mr. BARRASSO. I am grateful to the Senator for bringing this up. I 
had a telephone townhall meeting last night, and this specific motion 
the Senator is bringing today came up with great praise from the people 
of Wyoming who said: She is doing it right, leading the good fight. 
After I answer the question, I will ask: How do we know the money is 
even going to be there? That is the question that came up in my 
telephone townhall. People of Wyoming are concerned, if this passes, it 
will make health care harder for people in rural States, such as 
Wyoming and Montana. My colleague from Montana is on the floor. The 
doctor shortage will worsen. This is the headline on the front page by 
the Wyoming Tribune Eagle: ``Doctor Shortage Will Worsen.'' There is a 
lot of concern for the folks in Wyoming and communities where there is 
a sole hospital, a sole physician provider trying to recruit nurses and 
physician assistants and nurse practitioners. The doctor shortage will 
worsen as we see a situation where they will be cutting Medicare $500 
billion, raising taxes $500 billion, and people who had insurance on 
this telephone townhall were very concerned that their insurance 
premiums are going to go up, in spite of the fact that the President 
has promised families would see insurance rates go down. We know those 
rates are going to go way up for people who buy their own insurance. 
People say: Don't cut Medicare, don't raise taxes, don't make matters 
worse than they are right now. For the people of Wyoming, they are 
afraid that matters will be made worse.
  The Washington Post had a major poll in the paper today specifically 
asking seniors the question about Medicare. We are talking about health 
care quality, the quality of care. The question is: Do you think health 
care reform will strengthen the Medicare Program or weaken the Medicare 
Program? They asked specifically and

[[Page 31972]]

broke it down to seniors. Only 1 out of 8 seniors in this poll said it 
actually would get better. But the rest are saying: No, it is going to 
get worse. The seniors who watch this most carefully know what it means 
to try to get health care under the Medicare Program, a program that we 
know is going broke. Yet they are taking all this money not to save 
Medicare but to start a new program. We know the quality of care is 
going to go down. That is what the people of my home State and the 
people I talked to from around the country are concerned about. They 
are delighted the Senator offered this motion.
  I did a poll in the townhall meeting: Are you for or against the 
bill? Some of them say: What is in it? We don't know. Which is exactly 
what the junior Senator, a Democrat from Indiana, said in today's 
national press release: We are all being urged to vote for something, 
and we don't know the details of what is in it. The junior Senator from 
Indiana is a Democrat. He doesn't know what is in it. The people of 
Wyoming don't know what is in it. But they do know taxes start 
immediately, benefits not for 4 years. That is why they are happy you 
offered this motion. They want to know: How do we know the money will 
be there 4 years from now?
  Mrs. HUTCHISON. That is a very important question. Here we are going 
to start collecting the taxes for 4 years before the program is put in 
place. The distinguished Senator from Oklahoma, the other physician in 
this body, knows we have had promises from the Federal Government 
before. But I can't remember a time when we started collecting a tax 
for a purpose that would be 4 years away. What on Earth could people 
expect to actually be there when the program kicks in?
  The program is going to have to be implemented. It is going to have 
to be brought up to speed. I am sure there will be changes. What would 
you think your patients whom you still care for in Oklahoma or the 
ones, in the experience you have had, how do you think people are going 
to react to having higher costs in all these areas of health care for 4 
years, even a tax on the high-income plans, not high-income people 
having those plans but high coverage that a union member might have 
that will start being taxed in 2013, 1 year before the program takes 
effect?
  How do you think that is going to affect the quality of health care 
people can expect and the cost to them out-of-pocket when there would 
be nothing even on the drawing boards for 4 years?
  Mr. COBURN. To answer the Senator's question, No. 1, as we already 
know, the Oklahoma State employees' health insurance plan, in 2013, 
will be considered a Cadillac plan. That is every State worker in the 
State of Oklahoma. And they can hardly afford their copays and their 
premiums in that plan today. So what we know is, we are going to tax 
all the Oklahoma workers. Many of those are schoolteachers who happen 
to be my patients, and they are struggling today.
  So this disconnect between when the taxes are----
  Mrs. HUTCHISON. I ask the Senator from Oklahoma, you are saying that 
a schoolteacher is probably not making $200,000 or more?
  Mr. COBURN. Not at all.
  Mrs. HUTCHISON. Yet we were promised there would be no taxes, no harm 
to people making under $200,000. Remind me if there is a teacher in 
Oklahoma--because I know there is not one in Texas--making over 
$200,000.
  Mr. COBURN. Well, our teachers wish they made what the teachers in 
Texas make, but they do not. But they do not make anywhere close to 
$200,000. It does not just affect the Department of Human Services 
workers, it is also going to impact the premium increases that are 
going to come about before this plan is implemented. We are going to 
see premium increases. So the small businesses that are now covering 
people are going to have massive premium increases. The individuals who 
are buying insurance in the open individual market themselves are going 
to see premium increases. The fact is, that is all going to happen 
before the first benefit, the first real benefit--other than 
preexisting illnesses--before anybody sees any benefit to that.
  The other thing that is not talked about is, with the skewing of this 
and with the relatively low tax on not complying with it, our youngest, 
healthiest people are going to say: I don't want any insurance because 
all I have to do is pay, in the first year, $250--or even less--up to 
$750, and I can save thousands of dollars every year by not buying 
insurance, and buying it when I get sick.
  So we are going to see everything skewed in the insurance market. 
That is what is going to drive up the premiums.
  My constituents, plus my patients, are not happy about the delay. If 
we are going to make this, what I believe, is a fatal mistake for our 
country in terms of the quality of health care, then we ought to at 
least match the revenues with the expenses.
  Mrs. HUTCHISON. That is exactly what the Senator from South Dakota 
and I are trying to do. We are trying to make sure Americans will not--
will not--pay taxes and increased prices on prescription drugs, on 
coverage we do have, the policies we do have, and the equipment that is 
so necessary for health care services.
  Senator Thune and I want to do what is basic fairness and very 
simple; that is, to say the program starts and the taxes start at the 
same time. That is a tradition we have had in this country for years. 
We do not tax people 4 years from having any kind of program in place 
that they could choose from that might benefit them. We do not do that. 
That is not the American way, and it is certainly not anything we have 
done before.
  What in the world would people expect to happen in 4 years? What if 
this plan is changed? What if the people rise up and say: We don't want 
this plan, and they say: No way, and they would have been paying higher 
premiums and higher health care costs already. It is a downpayment 
where you are not sure what the end is going to be.
  It is like buying a house and saying: Now, in 4 years we are going to 
give you the key to the house, we are going to give you the key to the 
house that you bought 4 years from now. Oh, maybe there will be a 
change in condition, but you are going to get it. Maybe it will be 
damaged. Maybe it will be worn. Maybe it will have a fire that starts 
in part of it. But you will get those keys and then something will be 
there for you. We promise you. We are from the government, and we are 
going to promise you that.
  That is not good enough. That is not what we owe the American people. 
And it is not health care reform.
  I would just ask my colleague from South Dakota, who is the cosponsor 
of this motion, if he agrees that as a matter of simple fairness, 
openness, and transparency to the American people, health care reform 
should not mean 4 years of taxes before any program is put in place.
  Mr. THUNE. I will say to my colleague from Texas, as to the taxes, 
the fees, the tax increases, everything in our motion very simply 
states they ought to be aligned with the beginning of the benefits. The 
benefits and the exchanges and, frankly, all the major policies--the 
substance of this bill--begin in 2014; the individual mandate, the 
State exchanges, the subsidies, as I said, premium tax credits, 
Medicaid expansion, the employer mandate, 2014; the government plan, 
2014. The substance of this bill begins in 2014. Unfortunately, the tax 
increases begin 4 years earlier, 16 days from now. Sixteen days from 
now, January 1 of this coming year, is when the taxes start being 
raised. And, of course, the CBO has said those tax increases are going 
to be passed on in the form of higher premiums to people across this 
country. The benefits start 1,477 days from now.
  So what we simply say in this motion is, let's commit this bill and 
bring it back out with the tax increases--if there are going to be tax 
increases; and many of us believe there should not be any, which is why 
we voted for the Crapo motion yesterday--but if you are going to raise 
taxes on America's small businesses, families, and individuals, at 
least align those so the policy, the substance of this bill, which 
begins 4 years

[[Page 31973]]

from now, is synchronized so we are not slapping a huge new tax 
increase on America's small businesses in the middle of a recession and 
passing on those higher costs, which is what they will do, to people in 
this country in the form of higher insurance premiums.
  So I say to the Senator from Texas, this is a very straightforward, 
simple motion. I hope our colleagues on both sides will support it. It 
is a matter of principle, of fairness when its comes to making policy 
that I think the American people have come to expect. We ought to be 
honest and give the American people a complete understanding of what 
this bill really costs. Because they have done what they have done--by 
instituting the tax increases immediately and the spending 4 years from 
now--it understates the overall cost of this legislation. The American 
people need to know this is a $2.5 trillion bill when it is fully 
implemented. The only reason they can bring that in under that number 
is because they start raising taxes immediately and do not start paying 
benefits out for another 4 years.
  So I say to the Senator from Texas, I hope when we get to this vote, 
it will be a big bipartisan vote in the Senate, and I hope we will make 
a change in this legislation that implements some semblance of fairness 
and also gives us a true reflection of what the bill really costs.
  Mrs. HUTCHISON. I thank the Senator from South Dakota.
  Just to recap, the amount that would actually be collected before any 
program is put in place would be $73 billion--already collected. That 
will include, as the Senator from Oklahoma mentioned, schoolteachers 
from Oklahoma who are considered to have these high-benefit plans, a 
schoolteacher making $50,000, $60,000 a year with a high-benefit plan. 
And do you know what the tax is on that high-benefit plan? Do you know 
what the tax is on that Oklahoma schoolteacher? A 40-percent excise 
tax--40 percent.
  The PRESIDING OFFICER. The Senator's time has expired.
  Mrs. HUTCHISON. Mr. President, I thank the Senator, and I would just 
say I hope we get a bipartisan vote on this motion. I hope we get a 
bipartisan vote to say the one thing we ought to do, if nothing else, 
is be fair to the American people. You do not pay taxes until the 
program is up and going.
  Thank you, Mr. President.
  The PRESIDING OFFICER. The Senator from Oklahoma.
  Mr. COBURN. Mr. President, I ask unanimous consent to offer some 
unanimous consent requests to the chairman of the Finance Committee.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. COBURN. Mr. President, I offer a unanimous consent request that 
it not be in order for the duration of the consideration of H.R. 3590 
to offer an amendment that has not been filed at the desk for 72 hours 
and for which there has not been a complete CBO score.
  The PRESIDING OFFICER. Is there objection?
  The Senator from Montana.
  Mr. BAUCUS. Mr. President, reserving the right to object, I would 
like to just remind our colleagues, I have sought it, and I think it 
has been basically a very forthright, open process we have conducted 
here. Certainly in the Finance Committee--I see my colleague from Iowa 
on the floor--it was totally transparent for months upon months, with 
hearing upon hearing. We posted amendments in the Finance Committee on 
the Internet in advance of consideration.
  I have never been part of a more transparent process since I have 
been here, frankly, at least for something of this magnitude over this 
period of time. In fact, one reporter even said to me: Senator, is this 
the new way we do things around here? It is so transparent, so 
bipartisan, and so forth. I said: I don't know. I sure like it that 
way.
  I also remind all of us that Senator Reid's amendment was made 
available on November 18 of this year, and 3 days later, on the 21st, 
we voted for cloture on the motion to proceed. Then, 12 days after the 
Reid amendment was made available, we finally began debate on the bill. 
And here we are, nearly a month later. So this bill has been out here.
  The Senator mentioned, I note, having in mind the managers' 
amendment, which he has not seen and, frankly, this Senator has not 
seen either. I have some ideas what is in it, but I have not seen it 
myself.
  I think as a practical matter this will be available for 72 hours, as 
the Senator suggests. Why do I say that? I say that because it is my 
expectation that Senator Reid's managers' amendment will be filed very 
quickly, maybe in a day or two. It is also my expectation that we will 
then proceed, according to expectations here, to the Defense 
appropriations conference report, which we will then be working on for 
several days. And probably a cloture motion might be filed on the 
health care bill--on the managers' amendment probably not until after 
we do Defense appropriations. So during the interim, everyone is going 
to be able to see, at least for more than 72 hours, the contents of the 
managers' amendment in the health care bill which Senator Reid is going 
to be filing. So as a practical matter, I think it is going to happen.
  I cannot at this point agree to the request to lock that in for 72 
hours, but I think as a practical----
  Mr. COBURN. Will the Senator yield for a question?
  Mr. BAUCUS. Yes.
  Mr. COBURN. One of the reasons I want this, is it not his belief that 
the American people ought to get to see this for 72 hours as well and 
that it ought to be on the Internet and that everybody in America, if 
we are going to take one-sixth of our economy, ought to have the time 
to truly read--we are going to have a managers' amendment, and that is 
actually what mine is focused on.
  Mr. BAUCUS. Sure.
  Mr. COBURN. But to be able to truly not just read the managers' 
amendment but then go into the bill where it is going to fix the bill.
  Mr. BAUCUS. I think that is a good idea. I think it is going to 
happen.
  Mr. COBURN. But the Senator will not agree to it by unanimous 
consent?
  Mr. BAUCUS. I cannot at this time but, again, saying it is my 
expectation it will be available for more than 72 hours.
  Mr. COBURN. I appreciate the sincerity of the chairman's remarks.
  Mr. BAUCUS. I thank the Senator. I object.
  The PRESIDING OFFICER. Objection is heard.
  Mr. COBURN. Mr. President, I have another unanimous consent request. 
The following consent request would be associated with a Coburn 
amendment that would certify that every Member of the Senate has read 
the bill and understands it before they vote on the bill. The reason I 
ask unanimous consent that amendment be agreed to and accepted is that 
is exactly what the American people expect us to be doing.
  So we do not have a bill right now. We do not know what is going to 
be in the bill. The chairman has a good idea what is going to be in the 
bill, but he does not know for sure. Only two sets of people--Senator 
Reid and his staff and CBO--know what is going to be in the bill. I 
suspect somebody at the White House might.
  But we ought to take and embrace the idea of transparency and 
responsibility, that the American people can expect every one of us to 
have read this bill, plus the amended bill, and certify that we have an 
understanding for what we are doing to health care in America with this 
bill.
  I ask unanimous consent that be accepted.
  The PRESIDING OFFICER. Is there objection?
  The Senator from Montana.
  Mr. BAUCUS. Mr. President, reserving the right to object, I certainly 
agree with the basic underlying import that we should know what we are 
voting on here. But I must say to my good friend from Oklahoma, I 
cannot certify that Members of the Senate will understand what they are 
reading. That presumes a certain level of perception on my part in 
understanding and delving into the minds of Senators that not only have 
they read but they have taken the time to understand. And what does 
``understand'' mean? Understand the second and third levels, the

[[Page 31974]]

fourth level of questions? I think it is a practical impossibility for 
anybody to certify that any other Senator has fully understood. They 
may read, but they may not fully understand for a whole variety of 
reasons. So I cannot certify that.
  Mr. COBURN. Could I clarify my request?
  Mr. BAUCUS. I have to object.
  The PRESIDING OFFICER. Objection is heard.
  Mr. COBURN. Let me clarify my request that the individual certify 
themselves. I am not asking some group of Senators to certify some 
other Senator. I am saying that Tom Coburn tells his constituency: I 
have read this puppy. I have spent the time on it. I have read the 
managers' amendment, and I, in fact, certify to the people of Oklahoma 
that I know how terrible it is going to be for their health care.
  Mr. BAUCUS. The Senator is always free to make any representations he 
wants. If he wants to certify he has read it and certify that he has 
understood it, that is the Senator's privilege.
  Mr. COBURN. But the Senator won't accept that we as a body, on one-
sixth of the economy, ought to say we know what we are doing?
  Mr. BAUCUS. I can't certify that every Member of the Senate has done 
anything around here. Neither can the Senator from Oklahoma. That is an 
impossibility. But if the Senator wants to certify he has read it, that 
is great, and understands it fully, that is great, on any measure--not 
just this measure but any measure. But I can't certify that for 100 
different Senators, on any measure. That is up to the individual 
Senators and that is up to their mental capacities and up to their 
initiatives and imaginations and conscientiousness and so forth. I 
can't certify to that.
  Mr. COBURN. I thank the chairman.
  Mr. BAUCUS. Mr. President, I ask unanimous consent that the Senator 
from Vermont be recognized to proceed for at least a half hour.
  The PRESIDING OFFICER. The Senator from Vermont is recognized.


                Amendment No. 2837 to Amendment No. 2786

  Mr. SANDERS. Madam President, I call up my amendment per the order.
  The PRESIDING OFFICER (Mrs. Hagan). The clerk will report the 
amendment.
  The assistant legislative clerk read as follows:

       The Senator from Vermont [Mr. Sanders], for himself, Mr. 
     Burris, and Mr. Brown, proposes an amendment numbered 2837 to 
     amendment No. 2786.

  Mr. SANDERS. Madam President, I ask unanimous consent that the 
reading of the amendment be dispensed with.
  The PRESIDING OFFICER. Is there objection?
  Mr. COBURN. Madam President, I object.
  The PRESIDING OFFICER. Objection is heard.
  The assistant legislative clerk continued with the reading of the 
amendment.
  Mr. SANDERS. Madam President, I ask unanimous consent that the 
amendment be considered as read.
  The PRESIDING OFFICER. Is there objection?
  Mr. COBURN. There is objection.
  The PRESIDING OFFICER. Objection is heard.
  Mr. SANDERS. Madam President, may I ask my friend from Oklahoma why 
he is objecting?
  Mr. COBURN. Regular order, Madam President.
  The PRESIDING OFFICER. Regular order is the reading of the amendment.
  The assistant legislative clerk continued with the reading of the 
amendment.
  (The amendment (No. 2837) is printed in the Record of Wednesday, 
December 2, 2009, under ``Text of Amendments.'')
  The PRESIDING OFFICER (Mr. Cardin). The Senator from Vermont is 
recognized.


                      Amendment No. 2837 withdrawn

  Mr. SANDERS. Mr. President, I withdraw my amendment.
  Mr. COBURN. Regular order, Mr. President.
  The PRESIDING OFFICER. The Senator has that right. The amendment is 
withdrawn.
  Mr. SANDERS. Pursuant to the 30 minutes that I----
  The PRESIDING OFFICER (Mrs. Shaheen). Under the previous order, the 
Senator from Vermont is recognized for 30 minutes.
  Mr. SANDERS. Madam President, let me begin not by talking about my 
amendment but by talking about the Republican action that we have seen 
right here on the floor of the Senate. Everybody in this country 
understands that our Nation faces a significant number of major 
crises--whether it is the disintegration of our health care system, the 
fact that 17 percent of our people are unemployed or underemployed, or 
the fact that one out of four of our children is living on food stamps. 
We have two wars, we have global warming, we have a $12 trillion 
national debt, and the best the Republicans can do is try to bring the 
U.S. Government to a halt by forcing a reading of a 700-page amendment. 
That is an outrage. People can have honest disagreements, but in this 
moment of crisis it is wrong to bring the U.S. Government to a halt.
  I am very disturbed that I am unable to bring the amendment that I 
wanted to bring to the floor of the Senate. I thank Senator Reid for 
allowing me to try to bring it up before it was obstructed and delayed 
and prevented by the Republican leadership. My amendment, which was 
cosponsored by Senators Sherrod Brown and Roland Burris, would have 
instituted a Medicare-for-all single-payer program. I was more than 
aware and very proud that, were it not for the Republican's 
obstructionist tactics, this would have been the first time in American 
history that a Medicare-for-all single-payer bill was brought to a vote 
before the floor of the Senate. I was more than aware that this 
amendment would not win. I knew that. But I am absolutely convinced 
that this legislation or legislation like it will eventually become the 
law of the land.
  The reason for my optimism that a Medicare-for-all single-payer bill 
will eventually prevail is that this type of system is and will be the 
only mechanism we have to provide comprehensive high-quality health 
care to all of our people in a cost-effective way. It is the only 
approach that eliminates the hundreds of billions of dollars in waste, 
administrative costs, bureaucracy, and profiteering by the private 
insurance companies, and we are not going to provide comprehensive, 
universal, cost-effective health care to all of our people without 
eliminating that waste. That is the simple truth.
  The day will come, although I recognize it is not today, when the 
Congress will have the courage to stand up to the private insurance 
companies and the drug companies and the medical equipment suppliers 
and all of those who profit and make billions of dollars every single 
year off of human sickness. On that day, when it comes--and it will 
come--the U.S. Congress will finally proclaim that health care is a 
right of all people and not just a privilege. And that day will come, 
as surely as I stand here today.
  There are those who think that Medicare-for-all is some kind of a 
fringe idea--that there are just a few leftwing folks out there who 
think this is the way to go. But let me assure you that this is 
absolutely not the case. The single-payer concept has widespread 
support from diverse groups from diverse regions throughout the United 
States. In fact, in a 2007 AP/Yahoo poll, 65 percent of respondents 
said that the United States should adopt a universal health insurance 
program in which everyone is covered under a program like Medicare that 
is run by the Government and financed by taxpayers.
  There is also widespread support for a Medicare-for-all approach 
among those people who understand this issue the most, and that is the 
medical community. That support goes well beyond the 17,000 doctors in 
the Physicians for National Health Care Program, who are fighting every 
day for a single-payer system. It goes beyond the California Nurses 
Association, the largest nurses union in the country, who are also 
fighting for a Medicare-for-all, single-payer health care. In March of 
2008,

[[Page 31975]]

 a survey of 2,000 American doctors published in the Annals of Internal 
Medicine concluded that 59 percent of physicians ``supported 
legislation to establish national health insurance.''
  Madam President, you might be particularly interested to know that 
the New Hampshire Medical Society surveyed New Hampshire physicians and 
found that two-thirds of New Hampshire physicians, including 81 percent 
of primary care clinicians, indicated that they would favor a 
simplified payer system in which public funds, collected through taxes, 
were used to pay directly for services to meet the basic health care 
needs of all citizens. That is New Hampshire.
  In 2007, Minnesota Medicine Magazine surveyed Minnesota physicians 
and found that 64 percent favored a single-payer system; 86 percent of 
physicians also agreed that it is the responsibility of society, 
through the Government, to ensure that everyone has access to good 
medical care.
  But it is not just doctors, it is not just nurses, it is not just 
millions of ordinary Americans. What we are seeing now is that 
national, State, and local organizations representing a wide variety of 
interests and regions support single payer. These include the U.S. 
Conference of Mayors, the American Medical Students Association, the 
AFL/CIO, the United Church of Christ, the UAW, the International 
Association of Machinists, the United Steelworkers, the United 
Electrical Workers, the Older Women's League, and so many others that I 
do not have the time to list them.
  I ask unanimous consent to insert a list in the Record of all the 
organizations representing millions and millions of Americans who are 
sick and tired of the current system and want to move toward a 
Medicare-for-all single-payer system.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

              National Organizations Support Single Payer

       American Federation of Musicians of the United States and 
     Canada, American Medical Students Association, Americans for 
     Democratic Action, American Patients United, All Unions 
     Committee for Single Payer Health Care, Alliance for 
     Democracy, Business Coalition for Single Payer Health Care, 
     California Nurses Association/National Nurse Organizing 
     Committee, Coalition of Black Trade Unionists, Coalition of 
     Labor Union Women, Committee of Presidents, National 
     Association of Letter Carriers, Committees of Correspondence, 
     Earthly Energy Werx, Electrical Workers Minority Caucus, 
     Fellowship of Reconciliation, Feminist Caucus of the 
     American, Humanist Association, and Global Kids Inc.
       Global Security Institute, Health Plan Navigator, 
     Healthcare NOW!, Hip Hop Caucus, House of Peace, Institute 
     for Policy Studies, Cities for Progress, Inter-religious 
     Foundation for Community Organization, International 
     Association of Machinists and Aerospace Workers, League of 
     Independent Voters, National Association for the Advancement 
     of Colored People, National Association of Letter Carriers, 
     National Council on Healthcare for the Homeless, National 
     Economic and Social Rights Initiative, National Education 
     Association, National Organization of Women, National Student 
     Nurses Association, Needed Now, and Older Women's League.
       PACE International Union, Peoples' Health Movement--US 
     Circle, Physicians for a National Health Program, Progressive 
     Christians Uniting, Progressive Democrats of America, The 
     United Church of Christ, United Association of Journeymen & 
     Apprentices of the Plumbing & Pipe Fitting Industry of the 
     United States & Canada, United Automobile Workers, United 
     Automobile Workers, International Union Convention, United 
     Electric Workers, United Federation of Teachers, United 
     Methodist Global Board of Church and Society, United 
     Steelworkers of America, Up for Democracy, Women's Division 
     of The United Methodist Church, Women's Universal Health 
     Initiative, and Young Democrats.

                State Organizations Support Single Payer

       1199SEIU United Healthcare Workers East, MD, DC, NY, MA; 
     1199SEIU Retired Division of New York; American Guild of 
     Musical Artists: Chicago/Midwest Region; American Postal 
     Workers Union (APWU), Michigan State; Arizona AFL-CIO; 
     Arkansas AFL-CIO; California State Pipe Trades Council, 
     United Association; California School Employees Association; 
     Connecticut State Council of Machinists of the IAMAW; 
     Connecticut Medicare for All; Delaware State AFL-CIO; Florida 
     CHAIN; Florida State AFL-CIO; Florida State Alliance for 
     Retired Americans; Health Action New Mexico; Health Care for 
     All California; Health Care for All Colorado; Health Care for 
     All New Jersey; Health Care for All Texas; Health Care for 
     All Washington; Hoosiers for a Common Sense Health Plan; and 
     Iowa Federation of Labor; AFL-CIO.
       Kentucky House of Representatives; Kentucky Jobs with 
     Justice; Kentucky State AFL-CIO; Maine Council of United 
     Steelworkers; Maine State AFL-CIO; Maine State Building & 
     Construction Trades Council; Maryland State and District of 
     Columbia AFL-CIO; Massachusetts Nurses Association; 
     Massachusetts State United Auto Workers; Michigan State AFL-
     CIO Women's Council; Michigan State Association of Letter 
     Carriers; Minnesota DFL Progressive Caucus; Minnesota State 
     AFL-CIO; Missouri State AFL-CIO; New Jersey Media Corps; New 
     Jersey State Industrial Union Council; New York Professional 
     Nurses Union; New York State Nurses Association; North 
     Carolina Fair Share; North Carolina State AFL-CIO; North 
     Dakota State AFL-CIO; Ohio Alliance for Retired Americans.
       Ohio State AFL-CIO; Ohio Steelworkers Organization of 
     Active Retirees; Oregon United Methodist Church; Pennsylvania 
     Association of Staff Nurses and Allied Professionals; 
     Pennsylvania State AFL-CIO; SCFL of Wisconsin; SEIU--United 
     Healthcare Workers West; South Carolina State AFL-CIO; South 
     Dakota AFL-CIO; Texas AFL-CIO; Texas Alliance for Retired 
     Americans; Texas Building & Construction Trades Council; The 
     Tennessee Tribune Newspaper; Utah Jobs with Justice; Vermont 
     State Labor Council AFLCIO; Washington State Alliance for 
     Retired Americans; Washington State Building and Construction 
     Trades Council; Washington State Labor Council; West Virginia 
     State AFL-CIO; Wisconsin Clean Elections Campaign; Wisconsin 
     State AFL-CIO; Wyoming State AFL-CIO.

  Mr. SANDERS. There is also significant support in the House of 
Representatives for a single-payer system. Together, H.R. 676 and H.R. 
1200, two different single-payer proposals, have 94 cosponsors.
  And let me say a word about State legislatures that have moved 
forward aggressively toward a single-payer system. In California, our 
largest State, the State legislature there has on two occasions passed 
a single-payer program. The largest State in America passed a single-
payer program, and on both occasions it was vetoed by the Governor. In 
New York State, the State Assembly passed a single-payer system. Among 
other States where single payer has been proposed and seriously 
discussed are Ohio, Massachusetts, Georgia, Colorado, Maine, Vermont, 
Illinois, Wisconsin, Oregon, Washington, New Mexico, Minnesota, 
Indiana, and New Hampshire.
  Why is it that we need an entirely new approach for health care in 
this country? The answer is pretty obvious. Our current system, 
dominated by profit-making insurance companies, simply does not work. 
Yes, we have to confess, it does work for the insurance companies that 
make huge profits and provide their CEOs with extravagant compensation 
packages. Yes, it does work--and we saw how well it worked right here 
on the floor yesterday--for the pharmaceutical industry which year 
after year leads almost every other industry in profit while charging 
the American people by far--not even close--the highest prices in the 
world for prescription drugs.
  So it works for the insurance companies. It works for the drug 
companies. It works for the medical equipment suppliers and the many 
other companies who are making billions of dollars off of our health 
care system. But it is not working for--in fact, it is a disaster for--
ordinary Americans.
  Today, 46 million people in our country have no health insurance and 
an even higher number of people are underinsured, with high deductibles 
or copayments. Today, as our primary health care system collapses, tens 
of millions of Americans do not have access to a doctor on a regular 
basis and, tragically, some 45,000 of our fellow Americans who do not 
have access to a doctor on a regular basis die every single year. That 
is 15 times more Americans who die of preventable diseases than were 
murdered in the horrific 9/11 attack against our country. That takes 
place every year: the preventable deaths of 45,000 people.
  This is not acceptable. These horrific deaths are a manifestation of 
a collapsing system that needs fundamental change.
  A number of months ago I took to the floor to relate stories that I 
heard

[[Page 31976]]

from people throughout the State of Vermont regarding the health care 
crisis, stories which I published in a small pamphlet and placed on my 
Web site. Let me tell you one story.
  A man from Swanton, VT, in the northern part of our State, wrote to 
me to tell me the story of his younger brother, a Vietnam veteran, who 
died 3 weeks after being diagnosed with colon cancer. At the time he 
was diagnosed, he had been laid off from his job and could not afford 
COBRA coverage. This is what his brother said:

       When he was in enough pain to see a doctor it was too late. 
     He left a wife and two teenage sons in the prime of his life 
     at 50 years old. The attending physician said that, if he had 
     only sought treatment earlier, he would still be alive.

  Horrifically, tragically, that same story is being told in every 
State in this country over and over again. If only he had gone to the 
doctor in time he could have lived, but he didn't have any health 
insurance. That should not be taking place in the United States of 
America in the year 2009.
  Our health care disaster extends beyond even the thousands who die 
needlessly every single year. Many others suffer unnecessary 
disability--strokes that leave them paralyzed because they couldn't 
afford treatment for their high blood pressure, or amputations, 
blindness, or kidney failure from untreated diabetes. Infants are born 
disabled because their mothers couldn't get the kind of prenatal care 
that every mother should have, and millions with mental illness go 
without care every single day.
  In a town in northern Vermont not far from where I live, a physician 
told me that one-third of the patients she treats are unable to pay for 
the prescription drugs she prescribes. Think about the insanity of 
that. We ask doctors to diagnose our illness, to help us out, she 
writes the prescription for the drug, and one-third of her patients 
cannot afford to fill that prescription. That is insane. That is a 
crumbling health care system. The reason people cannot afford to fill 
their prescription drugs is that our people, because of pharmaceutical 
industry greed, are forced to pay by far the highest prices in the 
world for prescription drugs. This is indefensible. There is nobody who 
can come to the floor of this Senate and tell me that makes one shred 
of sense.
  The disintegration of our health care system causes not only 
unnecessary human pain, suffering, and death, but it is also an 
economic disaster. Talk to small businesses in Vermont, New Hampshire, 
any place in this country, and they tell you they cannot afford to 
invest in their companies and create new jobs because all of their 
profits are going to soaring health care costs--10, 15, 20 percent a 
year. Talk to the recently bankrupt General Motors and they will tell 
you that they spend more money per automobile on health care than they 
do on steel. GM is forced to pay $1,500 per car on health care while 
Mercedes in Germany spends $419, and Toyota in Japan spends $97. Try to 
compete against that.
  From an individual economic perspective, it is literally beyond 
comprehension that of the nearly 1 million people who will file for 
bankruptcy this year, the vast majority are filing for bankruptcy 
because of medically related illnesses. Let's take a deep breath and 
think about this from an emotional point of view. Let's think about the 
millions of people who are today struggling with cancer, struggling 
with heart disease, struggling with diabetes or other chronic 
illnesses. They are not even able to focus on their disease and trying 
to get well. They are summoning half their energy to fight with the 
insurance companies to make sure they get the coverage they need. That 
is not civilized. That is not worthy of the United States of America.
  In my State of Vermont--and I suspect it is similar in New Hampshire 
and every other State--I have many times walked into small mom-and-pop 
stores and seen those little donation jars that say: Help out this or 
that family because the breadwinner is struggling with cancer and does 
not have any health insurance or little Sally needs some kind of 
operation and she doesn't have any health insurance, put in a buck or 
five bucks to help that family get the health care they need. This is 
the United States of America. This should and cannot be allowed to 
continue.
  One of the unfortunate things that has occurred during the entire 
health care debate is that we have largely ignored what is happening in 
terms of health care around the rest of the world. I have heard some of 
my Republican colleagues get up and say: We have the best health care 
system in the world. Yes, we do, if you are a millionaire or a 
billionaire, but we do not if you are in the middle class, not if you 
are a working-class person, certainly not if you are low income. It is 
just not true.
  Today, the United States spends almost twice as much per person on 
health care as any other country. Despite that, we have 46 million 
uninsured and many more underinsured and our health care outcomes are, 
in many respects--not all but in many respects--worse than other 
countries. Other countries, for example, have longer life expectancies 
than we do. They are better on infant mortality, and they do a lot 
better job in terms of preventable deaths. At the very beginning of 
this debate, we should have asked a very simple question: Why is it we 
are spending almost twice as much per person on health care as any 
other country with outcomes that, in many respects, are not as good?
  According to an OECD report in 2007, the United States spent $7,290, 
over $7,000 per person on health care. Canada spent $3,895, almost half 
what we spent. France spent $3,601, less than half what we spent. The 
United Kingdom spent less than $3,000, and Italy spent $2,600 compared 
to the more than $7,000 we spent. Don't you think that maybe the first 
question we might have asked is: Why is it we spend so much and yet our 
health care outcomes, in many respects, are worse than other countries? 
Why is it that that happens?
  Let me tell you what other people will not tell you. One key issue 
that needed to be debated in this health care discussion has not been 
discussed. The simple reason as to why we spend so much more than any 
other country with outcomes that are not as good as many other 
countries is that this legislation, from the very beginning, started 
with the assumption that we need to maintain the private for-profit 
health insurance companies. That basic reality that we cannot touch 
private insurance companies, in fact that we have to dump millions more 
people into private health insurance companies, that was an issue that 
could not even be discussed. And as a result, despite all the money we 
spend, we get poor value for our investment.
  According to the World Health Organization, the United States ranks 
37th in terms of health system performance compared with five other 
countries: Australia, Canada, Germany, New Zealand, and the United 
Kingdom. The U.S. health system ranks less or less than half.
  Sometimes these groups poll people. They go around the world and they 
poll people and they ask: How do you feel about your own health care 
system? We end up way down below other countries. Recently, while the 
Canadian health care system was being attacked every single day, they 
did a poll in Canada. They said to the Canadian people: What do you 
think about your health care system? People in America say you have a 
terrible system. Do you want to junk your system and adopt the American 
system? By overwhelming numbers, the people of Canada said: Thank you, 
no thank you. We know the American system. We will stay with our 
system.
  I was in the United Kingdom a couple months ago. I had an interesting 
experience. It was a Parliamentarian meeting. I met with a number of 
people in the Conservative Party--not the liberal Democratic Party, not 
the Labour Party, the Conservative Party, the party which likely will 
become the government of that country. The Conservatives were outraged 
by the kind of attacks being leveled against the national health system 
in their country, the lies we are being told about their system. In 
fact, the leader of the Conservative Party got up to defend the

[[Page 31977]]

national health system in the United Kingdom and said: If we come to 
power, we will defend the national health system. Those were the 
conservatives.
  What is the problem with our system which makes it radically 
different than systems in any other industrialized country? It is that 
we have allowed for-profit private corporations to develop and run our 
health care system, and the system that these companies have developed 
is the most costly, wasteful, complicated, and bureaucratic in the 
entire world. Everybody knows that. With 1,300 private insurance 
companies and thousands and thousands of different health benefit 
programs all designed to maximize profits, private health insurance 
companies spend an incredible 30 percent of every health care dollar on 
administration and billing, on exorbitant CEO compensation packages, on 
advertising, lobbying, and campaign contributions. This amounts to some 
$350 billion every single year that is not spent on health care but is 
spent on wasteful bureaucracy.
  It is spent on bureaucrats and on an insurance company telling us why 
we can't get the insurance we pay for. How many people today are on the 
phone today arguing with those bureaucrats to try to get the benefits 
they paid for? It is spent on staff in a physician's office who spend 
all their time submitting claims. They are not treating people; they 
are submitting claims. It is spent on hundreds of people working in the 
basement of hospitals who are not delivering babies, not treating 
people with cancer. They are not making people well. They are sending 
out bills. That is the system we have decided to have. We send out 
bills, and we spend hundreds of billions of dollars doing that rather 
than bringing primary health care physicians into rural areas, rather 
than getting the doctors, dentists, and nurses we need.
  Let me give a few outrageous examples. Everyone knows this country is 
in the midst of a major crisis in primary health care. We lack doctors. 
We lack nurses. We lack dentists--a major crisis getting worse every 
single day. Yet while we are unable to produce those desperately needed 
doctors and nurses and dentists, we are producing legions of insurance 
company bureaucrats.
  Here is a chart which deals with that issue. What this chart shows is 
that over the last three decades, the number of administrative 
personnel, bureaucrats who do nothing to cure our illnesses or keep us 
well, the number of bureaucrats has grown by 25 times the number of 
physicians. This is growth in the number of doctors--nonexistent. This 
is growth in the number of health care bureaucrats on the phone today 
telling you why you can't get the health care coverage you paid for or 
telling you that you have a preexisting condition and throwing you off 
health care because you committed the crime last year of getting sick. 
That growth is through the roof. This is where our health care dollars 
are going. This is why we need a single-payer system.
  According to Dr. Uwe Reinhardt in testimony before Congress, Duke 
University Hospital, a very fine hospital, has almost 900 billing 
clerks to deal with hundreds of distinct managed care contracts. Do you 
know how many beds they have in that hospital? They have 900 beds. They 
have 900 bureaucrats involved in billing for 900 beds. Tell me that 
makes sense.
  At a time when the middle class is collapsing and when millions of 
Americans are unable to afford health insurance, the profits of health 
insurance companies are soaring. From 2003 to 2007, the combined 
profits of the Nation's major health insurance companies increased by 
170 percent. While more and more Americans are losing their jobs, the 
top executives of the industry are receiving lavish compensation 
packages. In 2007, despite plans to cut 3 to 4 percent of its 
workforce, Johnson & Johnson found the cash to pay its CEO Weldon $31.4 
million. Ron Williams of Aetna took home over $38 million, and the head 
of CIGNA, Edward Hanway, took away $120 million over 5 years on, and on 
and on it goes.
  So what is the alternative? Let me briefly describe the main features 
of a Medicare-for-all single-payer system. In terms of access, people 
getting into health care, this legislation would provide for all 
necessary medical care without cost sharing or other barriers to 
treatment. Every American--not 94 percent but 100 percent of America's 
citizens--would be entitled to care. In terms of choice, the issue is 
not choice of insurance companies that our Republican friends talk 
about. The question is choice of doctors, choice of hospitals, choice 
of therapeutic treatments. Our single-payer legislation would provide 
full choice of physicians and other licensed providers and hospitals. 
Importantly--and I know there is some confusion--a single-payer program 
is a national health insurance program which utilizes a nonprofit, 
private delivery system. It is not a government-run health care system. 
It is a government-run insurance program. In other words, people would 
still be going to the same doctors, still going to the same hospitals 
and other medical providers.
  The only difference is, instead of thousands of separately 
administered programs run with outrageous waste, there would be one 
health insurance program in America for Members of Congress, for the 
poorest people in our country, for all of us. In that process, we would 
save hundreds of billions of dollars in bureaucratic waste. In terms of 
benefits, what would you get? A single-payer program covers all 
medically necessary care, including primary care, emergency care, 
hospital services, mental health services, prescriptions, eye care, 
dental care, rehabilitation services, and nursing home care as well. In 
terms of medical decisions, those decisions under a single-payer 
program would be made by the doctors and the patients, not by 
bureaucrats in insurance companies.
  If we move toward a single-payer program, we could save $350 billion 
a year in administrative simplification, bulk purchasing, improved 
access with greater use of preventative services, and earlier diagnosis 
of illness.
  People will be able to get to the doctor when they need to rather 
than waiting until they are sick and ending up in a hospital.
  Further, and importantly, like other countries with a national health 
care program, we would be able to negotiate drug prices with the 
pharmaceutical industry, and we would end the absurdity of Americans 
being forced to pay two, three, five times more for certain drugs than 
people around the rest of the world.
  Every other industrialized country on Earth primarily funds health 
care from broad-based taxes in the same way we fund the Defense 
Department, Social Security, and other agencies of government, and that 
is how we would fund a national health care program.
  Let me be specific about how we would pay for this. What this 
legislation would do is, No. 1, eliminate--underline ``eliminate''--all 
payments to private insurance companies. So people would not be paying 
premiums to UnitedHealth, WellPoint, Blue Cross Blue Shield, and other 
private industry companies--not one penny. The reason for that is that 
private for-profit health insurance companies in this country would no 
longer exist.
  Instead, this legislation would maintain all of the tax revenue that 
currently flows into public health programs like Medicare, Medicaid, 
and CHIP, and it would add to that an income tax increase of 2.2 
percent and a payroll tax of 8.7 percent. This payroll tax would 
replace all other employer expenses for employee health care. In other 
words, employers in this country, from General Motors to a mom-and-pop 
store in rural America, would no longer be paying one penny toward 
private insurance revenue.
  The income tax would take the place of all current insurance 
premiums, copays, deductibles, and all other out-of-pocket payments 
made by individuals. For the vast majority of people, a 2.2-percent 
income tax is way less than what they now pay for all of those other 
things. In other words, yes, you would be paying more in taxes. That is 
true. But you would no longer have to pay for private health insurance, 
and, at the end of the day, from both a financial perspective and a 
health security perspective, we would be better off as individuals and 
as a nation.

[[Page 31978]]

  What remains in existence--I should add here--is the Veterans' 
Administration. I believe, and most of us believe, they have a separate 
set of issues, and the VA would remain as it is.
  Let me bring my remarks to a close by giving you an example of where 
I think we should be going as a country in terms of health care. Oddly 
enough, the process that I think we should be using is what a small 
country of 23 million people--the country of Taiwan--did in 1995. In 
1995, Taiwan was where we are right now--massive dissatisfaction with a 
dysfunctional health care system--and they did what we did not do. They 
said: Let's put together the best commission we can, the smartest 
people we know. Let's go all over the world. Let's take the best ideas 
from countries all over the world.
  As Dr. Michael Chen, vice president and CFO of Taiwan's National 
Health Insurance Bureau, explained in an interview earlier this year, 
the Taiwanese ultimately chose to model their system--after a worldwide 
search--on our Medicare Program. That is where they went, except that 
they chose to insure the entire population rather than just the 
elderly. After searching the globe, the Taiwanese realized what many 
Americans already know: a Medicare-for-all, single-payer system is the 
most effective way to offer quality coverage at a reasonable price.
  Taiwan now offers comprehensive health care to all of its people, and 
it is spending 6 percent of its GDP to do that while we spend 16 
percent of our GDP. But, unfortunately, the single-payer model was not 
ever put on the table here. Maybe we should learn something from our 
friends in Taiwan.
  Let me end by saying this: This country is in the midst of a 
horrendous health care crisis. We all know that. We can tinker with the 
system. We can come up with a 2,000-page bill which does this, that, 
and the other thing. But at the end of the day, if we are going to do 
what virtually every other country on Earth does--provide 
comprehensive, universal health care in a cost-effective way, one that 
does not bankrupt our government or bankrupt individuals--if we are 
going to do that, we are going to have to take on the private insurance 
companies and tell them very clearly that they are no longer needed. 
Thanks for your service. We don't need you anymore.
  A Medicare-for-all program is the way to go. I know it is not going 
to pass today. I know we do not have the votes. I know the insurance 
company and the drug lobbyists will fight us to the death. But, mark my 
words, Madam President, the day will come when this country will do the 
right thing. On that day, we will pass a Medicare-for-all single-payer 
system.
  Mr. LUGAR. Mr. President, I take this opportunity to share with my 
colleagues a statement I have prepared regarding the health care reform 
debate in which the Senate is currently engaged.
  A majority of the Members of Congress share President Obama's humane 
goal that millions more Americans might enjoy health insurance coverage 
and that medical care to all Americans might be substantially improved. 
For the moment, however, President Obama and the Congress must 
recognize that the overwhelming demand of most Americans is that 
presidential and congressional leadership should focus each day on 
restoration of jobs, strengthening of housing opportunities, new growth 
in small business and large industries, and banks that are not only 
solvent but confident of normal lending. In essence, the task facing 
national leadership is truly monumental. A national and international 
recession has not ended and many economists predict that unemployment, 
which has exceeded 10 percent in the United States, will continue to 
grow in coming months.
  The President and the current Congress have realized a final deficit 
for fiscal year 2009 of $1.4 trillion, with the total national debt now 
at $12 trillion. The appropriation bills that Congress has passed and 
that will make up the next fiscal year's expenditures are predicted to 
result in another annual deficit of more than $1 trillion. In fiscal 
year 2009, Medicaid spending increased by 24.6 percent to $251 billion. 
Spending on Food Stamps increased 41 percent to $56 billion. 
Unemployment benefits increased almost 155 percent to $120 billion.
  Republicans and Democrats may feel that passing comprehensive health 
legislation before the end of the year is crucial to the success or 
failure of the Obama administration and/or party leadership in the 
Congress.
  But I would suggest that successful leadership will be defined, now 
and historically, by success in bringing a horrendous economic 
recession to an end, bringing new strength to our economy, and 
providing vital leadership in international relations as we hope to 
bring conflicts under control and in some cases, to conclusion.
  I appreciate that President Obama has strongly argued that 
comprehensive health care legislation is an important component to 
reducing federal deficit spending. He has contended that failure to 
pass this legislation will increase deficits now and for many years to 
come. I disagree with the President.
  After the economic recession in our country comes to a conclusion, a 
high priority may be extension of health insurance coverage and reform 
of many health care practices. When such changes occur, they are likely 
to be expensive and Americans will need to debate, even then, their 
priority in comparison to many other national goals. One reason why 
health care is likely to remain expensive is that major advances in 
surgical procedures, prescription drugs, and other health care 
practices have prolonged the lives of tens of millions of Americans and 
improved the quality of those additional years. The Washington Post, in 
a front-page story on July 26, 2009, mentioned that ``the fight against 
heart disease has been slow and incremental. It's also been extremely 
expensive and wildly successful.'' Americans should not take for 
granted all of the advances in health care that have enriched our 
lives, but we sometimes forget that we require and even pray for much 
more medical progress in years to come, which is likely to be 
expensive.
  In order to pay for the cost of the nearly $1 trillion health care 
legislation, several Members of Congress are suggesting new forms of 
taxation, reduction of payments to doctors and hospitals, and 
curtailment of certain types of insurance coverage. These and other 
suggestions may temporarily bring about cost reduction but will also 
have some after-effects in the overall economy. In fact, strong 
financial incentives may be needed to enlist men and women to enter the 
medical field. Failure to enlist a sufficient number of doctors could 
lead to rationing of service and longer lines to find someone who will 
give humane attention.
  In the meanwhile, it is possible that the President and Members of 
Congress might find some inexpensive, incremental improvements that 
could result in a greater number of Americans being served through 
health insurance and more efficiently operating health care 
institutions. The strong desire that most of us have to continue 
discussing these issues and make improvements need not be postponed 
even as President Obama and the Congress strive for victory over a 
devastating national economic recession.
  Because our Federal spending deficits have risen so much and are 
predicted to rise even more, all substantive discussions on health care 
and other important issues will be conducted during many years of 
planning and, finally, decisive action to reduce deficit spending and 
preserve the value and integrity of the dollar as we continue to borrow 
hundreds of billions of dollars in the form of U.S. Treasury bonds sold 
to governments and citizens of other countries. They, too, are counting 
on the integrity of our dollar and our financial system to preserve the 
value of their financial reserves.
  Starting with President Obama and extending to all Members of 
Congress, we wish that we had inherited a neutral, peaceful playing 
field. We have not been so fortunate. Our responsibility now is to 
recognize the extraordinary financial tragedy that has befallen our 
country and to recognize the unprecedented opportunity that we have to 
stop the momentum of that

[[Page 31979]]

tragedy. We must provide valid hope of constructive vision, idealism, 
and change in the future. I look forward to working with the President 
and my colleagues to tackle first things first.
  Ms. COLLINS. Madam President, I rise today to speak in favor of the 
motion to commit offered by Senators Hutchison and Thune.
  The Hutchison-Thune motion to commit would send the health care bill 
to the Senate Finance Committee with instructions to revise the bill in 
a revenue-neutral manner, to prevent taxes in the bill from going into 
effect before the exchanges are set up in 2014.
  The bill makes Americans wait until 2014 to get insurance through the 
new ``exchanges,'' but it rolls out new tax hikes starting right away. 
Unless we take action to change this, Americans will see 4 years of tax 
increases before the chief benefits of this bill become available.
  In the 4 years between now and the time the exchanges come online, 
Americans will face at least a dozen new or increased taxes and fees 
costing $73 billion.
  Some of these taxes start in 2 weeks. For example, a new tax on 
pharmaceutical manufacturers, which will raise an average of $2.2 
billion per year; a new tax on health insurance providers, which will 
raise $6.7 billion per year; a new tax on medical device manufacturers, 
which will raise $2 billion per year.
  Other taxes kick in 1 year from now. These include an increased 
penalty on withdrawals from Health Savings Accounts and a new $2,500 
cap on FLEX spending accounts.
  These new limits and penalties make no sense to me. Why would we want 
to impose a penalty on Americans who use money from their FLEX spending 
accounts to buy over-the-counter medicine? How is that going to help 
make health care more affordable?
  But that is not all the bill does with respect to taxes. In 2013, the 
bill imposes several more taxes, including a reduction in the tax 
deductibility of medical expenses, a new high cost insurance excise 
Tax--the so-called Cadillac tax, and an increase in the Medicare 
payroll tax for high earners.
  These tax increases total $73 billion before 2014, before anyone gets 
a dollar of subsidy to purchase health insurance in the new exchanges.
  These taxes will be paid right away by Americans in the form of 
higher health insurance premiums. This is not just my opinion; this is 
what the Congressional Budget concludes too. Here is what the CBO said 
about the $6.7 billion annual fee on health insurance providers, which 
is scheduled to begin next year:

       We expect a very large portion of [the] proposed insurance 
     industry fee to be borne by purchasers of insurance in the 
     form of higher premiums.

  It is not just taxes on insurance that will be passed on to 
consumers. Taxes on pharmaceutical manufacturers and medical devices 
makers will also be passed on.
  This means that American consumers will see price increases for 
everything from insulin pumps, to pacemakers, to power wheelchairs and 
drugs like Prilosec.
  As the CBO Director has said:

       Those fees would increase costs for the affected firms, 
     which would be passed on to purchasers and would ultimately 
     raise insurance premiums by a corresponding amount.

  The Joint Committee on Taxation shares the CBO's view these tax hikes 
will be passed along to consumers.
  Once again, I do not see how imposing these new taxes now--before the 
exchanges are set up and the chief benefits of the bill are supposed to 
become available--makes health care more affordable.
  For all of these reasons, I will be voting in favor of the Hutchison-
Thune motion to recommit, and I would urge my colleagues to do the 
same.


                            Motion To Commit

  Mr. SANDERS. Madam President, I now move to table Senator Hutchison's 
motion to commit, and I ask for the yeas and nays.
  The PRESIDING OFFICER. Is there a sufficient second?
  There appears to be a sufficient second.
  The question is on agreeing to the motion.
  The clerk will call the roll.
  The assistant legislative clerk called the roll.
  Mr. DURBIN. I announce that the Senator from West Virginia (Mr. Byrd) 
and the Senator from Massachusetts (Mr. Kerry) are necessarily absent.
  Mr. KYL. The following Senator is necessarily absent: the Senator 
from Oklahoma (Mr. Inhofe).
  The PRESIDING OFFICER. Are there any other Senators in the Chamber 
desiring to vote?
  The result was announced--yeas 56, nays 41, as follows:

                      [Rollcall Vote No. 379 Leg.]

                                YEAS--56

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

                                NAYS--41

     Alexander
     Barrasso
     Bayh
     Bennett
     Bond
     Brownback
     Bunning
     Burr
     Chambliss
     Coburn
     Cochran
     Collins
     Corker
     Cornyn
     Crapo
     DeMint
     Ensign
     Enzi
     Graham
     Grassley
     Gregg
     Hatch
     Hutchison
     Isakson
     Johanns
     Kyl
     LeMieux
     Lugar
     McCain
     McConnell
     Murkowski
     Nelson (NE)
     Risch
     Roberts
     Sessions
     Shelby
     Snowe
     Thune
     Vitter
     Voinovich
     Wicker

                             NOT VOTING--3

     Byrd
     Inhofe
     Kerry
  The motion was agreed to.
  Mr. REID. Madam President, I move to reconsider the vote, and I move 
to lay that motion on the table.
  The motion to lay on the table was agreed to.
  (At the request of Mr. Reid, the following statement was ordered to 
be printed in the Record.)


                            vote explanation

 Mr. KERRY. Madam President, I was necessarily absent for the 
vote on the motion to table the Hutchison motion to commit to the 
health care bill, H.R. 3590. If I were able to attend today's session, 
I would have voted to table the Hutchison motion to commit.

                          ____________________