2:15 PM EST

Chuck Grassley, R-IA

Mr. GRASSLEY. Mr. President, as I said yesterday when I spoke on this very same bill, the excesses of the Reid bill appear willfully ignorant of what is going on in the rest of the economy outside of health care.

I believe the reason people have objected to the health care bill so quickly after the summer was that there was a rude awakening on a lot of other things the Congress has done to put this country further into debt, and then they heard us talking about $1.3 trillion and $1.6 trillion for health care, and they thought Congress had gone bananas. So everything seemed to focus on health care reform at that particular time. People were concerned about the economy as a whole. I think the health care

issue in and of itself was what people came out for, but health care was kind of the straw that broke the camel's back and brought attention to everything else--the debt and things that weren't working. At the same time, they saw the auto industry going into bankruptcy and, of course, being bailed out or nationalized, as it is. They have seen banks go under. Then they wondered about health care being nationalized as well.

We have seen our Federal debt skyrocket by $1.4 trillion since this President took office. I say ``since this President took office'' because I acknowledge there was a trillion-dollar debt in last year's budget. Just with the addition, it comes out to $11,500 per household. So our Federal debt exceeds $12 trillion for the first time in history. Already, foreign holdings of U.S. Treasuries stand at nearly $3.5 trillion or 46 percent of the Federal debt held by the public. There doesn't appear

to be light at the end of the tunnel. Don't just take my word for it. We have the nonpartisan CBO and the White House Office of Management and Budget which have intellectually honest people working there who aren't politically motivated who tell us really what

is what. This is what they have to say. Both have stated that within 5 years, the Obama administration's policies will more than double the amount of debt held by the public. Both have stated that by 2019 these policies will more than triple the national debt.

In this context, you would expect Congress to be considering a bill that would create jobs and prevent the country from being burdened with a bigger and more unsustainable Federal budget. Instead of working to bring the Federal budget under control, we have in this Congress--the majority of it, by 60 being Democratic--putting forward a bill, this 2,074-page bill before us that will cost $2.5 trillion when fully implemented. Instead of addressing the budget crisis, this bill will bend the Federal

spending curve the wrong way by over $160 billion over the next 10 years.

I remember during the summer that the Gang of 6, under the leadership of Senator Baucus--I was part of that bipartisan group--said there are two things we need to accomplish: We need to make sure that what we have comes out balanced, and we also need to make sure we do not have inflation of health care continuing to go up, that we would eventually bring it down. These bills don't do either. I know people say we do have the 10-year window balance. Yes, that is technically right. But when

you have 10 years of income and 6 years of policy expenditure, it is easy to do almost anything you want to in that 10-year window. But you have to look beyond that 10-year window, and then you have questions about that.

So instead of addressing this budget crisis, this bill adds to the Federal burden with enormous costs from the biggest Medicaid expansion in history and unfunded liabilities from the new program. Instead of addressing this budget crisis, we are now considering this 2,074-page bill that cuts Medicare by $ 1/2 trillion and threatens seniors' access to care.

After the bailouts of Wall Street and Detroit, a stimulus bill that has led to the highest unemployment in 26 years, and the Federal Reserve System shoveling money out the door without any accountability--they even object to having the GAO check on them--the health care reform agenda the Democratic leadership put forward is, once again, kind of the straw that broke the camel's back.

We have the Senator from Arizona offering a motion to send this bill back to the Finance Committee with instructions to report a bill without the drastic, arbitrary Medicare cuts that are in this bill. I support the Senator's motion because it is an opportunity to fix the bill and then come back to the full Senate with a better bill. Anything that comes back to the Senate floor should not have the drastic and arbitrary Medicare cuts.

I am hearing this from seniors: I have paid into this Medicare for all these years. I am in retirement, and now Congress wants to take that money and establish a new entitlement program for somebody else other than seniors. So to a lot of seniors it just doesn't add up.

This bill, as written, now permanently cuts all annual Medicare provider payment updates in order to account for the supposed increases in productivity by health care providers. The productivity measure used to cut provider payments in this bill does not represent productivity for a specific type of provider, such as nursing homes.

You would think that if Medicare is going to reduce your payments to account for increases in productivity, it would at least measure your productivity, not an entire group of productivity or not somebody else's productivity but yours, and you would be rewarded according to that productivity or, if it wasn't productive, be harmed because of it because you are not doing the best job you can. But that is not the case. Instead, these reform bills would make the payment cuts based on measures of

productivity for the entire economy. So if the productivity of the economy grows because computer chips and other products are made more efficiently, then health care providers see their payments go down. What is the relationship? These permanent cuts threaten beneficiary access to care.

The Chief Actuary at the U.S. Department of Health and Human Services recently identified this threat to beneficiary access to care. He confirmed this in an October 21 memorandum analyzing the House of Representatives' bill and again in a November 13 memorandum. Both the House bill and the Senate bill propose the same type of permanent Medicare productivity cuts.

We have a chart here. Here is what Medicare's own Chief Actuary had to say about these productivity cuts. Referring to these cuts, he wrote:

The estimated savings ..... may be unrealistic.

In their analysis of these provisions, Medicare's own Chief Actuary said:

It is doubtful that many could improve their own productivity to the degree achieved by the economy at large.

The Actuary goes on to say:

We are not aware of any empirical evidence demonstrating the medical community's ability to achieve productivity improvements equal to those of the overall economy.

So you have a $14 trillion economy today. You have $2.3 trillion of that, or one-sixth, related to health care, and you are going to try to do something to the health care aspect, productivity measure, harm or benefit, based upon what happens to the entire $14 trillion economy? That doesn't make sense. [Page: S12034]

The Chief Actuary's conclusion is that it would be difficult for providers to even remain profitable over time as Medicare payments fail to keep up with the cost of caring for the beneficiaries.

Going back to my chart again, ultimately here is the Chief Actuary's conclusion--that providers who rely on Medicare might end their participation in Medicare, ``possibly jeopardizing access to care for beneficiaries.''

This bill also cuts $120 billion from the Medicare Advantage Program, which provides health coverage to 11 million seniors, including the 64,000 seniors in my State of Iowa. These drastic Medicare cuts would reduce Medicare payments for those 11 million beneficiaries by close to 50 percent.

Just like a lot of people, seniors are struggling financially right now, and these Medicare Advantage cuts will only make it harder for them to afford vision care, chronic-care management, dental care, and other benefits they have come to rely on, of their own choosing, because they decided to go to Medicare Advantage instead of staying in traditional Medicare. And what they are going to lose if they don't want to stay in Medicare Advantage and they are not going to get the benefits they got

out of it, they go over to traditional Medicare, are these sorts of benefits which will not be included in traditional Medicare.

During the campaign, the President said that if you like what you have, you can keep it. Well, that won't be true for Medicare Advantage people. They will either pay more, which is contrary to what the President said in his September speech to the joint session of Congress, they are going to pay more or lose benefits.

Another problem is that this bill creates a new body of unelected officials with broad authority to make even further cuts in Medicare. Ironically, this body has been renamed the ``Independent Medicare Advisory Board,'' but it is not really advisory. I would hardly describe this group that way when its so-called recommendations can automatically go into effect, even absent congressional action--absent Congress going after it.

I want to go to the chart again. The Wall Street Journal has a more appropriate name for this group. They call it the ``rationing commission.'' They described it as ``the unelected body that will dictate future medical decisions.''

These additional cuts in Medicare will be driven by arbitrary spending targets and automatic Medicare cuts written into law by this bill.

This bill, unwisely, makes this board permanent. This bill requires this board to continue making even more cuts to Medicare and to do that forever. If you want to stop it, it will take another act of Congress to do it. Of course, this kind of sounds like the sustainable growth rate, or SGR, that impacts doctors every year. We always have to correct the mistakes that were made by passing the sustainable growth rate, SGR, first set in place probably 20 years ago, because this SGR formula set arbitrary

spending targets. These targets turned out to be unrealistic. Now that flawed formula will cause an automatic 21-percent cut in Medicare physician payments on January 1 if Congress doesn't intervene by the end of the year.

We all know the challenges Congress faces every year in trying to prevent these Medicare physician cuts that are supposed to take place because spending targets have been exceeded, so automatic payment cuts are then to automatically kick in.

We have all heard from physicians in our States about the challenges in providing care to Medicare beneficiaries while these payment cuts loom above. This permanent board would cause the same problem for the entire Medicare Program, not just as SGR does for physician payments. This is a far bigger threat to the Medicare Program. It will jeopardize access to health care for our Nation's seniors on a much bigger scale.

If this bill is enacted with this permanent board, we will be hearing from other providers, in addition to doctors, about how they cannot afford to treat Medicare patients.

What is more alarming is that special back-room deals were cut to exempt some providers. This forces then, because of these special exemptions that were made, even greater cuts to fall directly on the remaining providers.

Also, the Congressional Budget Office has confirmed that the board structure requires it to take focus on its Budget Act on premiums that seniors pay for Part D prescription drug coverage and for Medicare Advantage.

I have already spoken about Medicare Advantage but just think: One of the things we hear about this time of the year all the time from seniors is prescription drug costs are going up, premiums on Part D are going up. Then you want to give this advisory commission--that is not advisory--authority to increase premiums that seniors pay for Part D prescription drug coverage? That means higher premiums for some of our most vulnerable populations.

Another issue that cannot be ignored is the pending insolvency of the Medicare Program. The Medicare hospital insurance fund started going broke last year. That means more money is going out than is coming in from the payroll tax. The Medicare trustees--you remember, they report yearly and they look ahead 75 years--the Medicare trustees have been warning all of us for years that this trust fund is in terrible trouble and, by a certain date, 2017, we bust it. But rather than work to bridge Medicare's

$37 trillion in unfunded liabilities--and that $37 trillion is that 75-year figure the trustees give us once a year, each spring, as they update it--so instead of working to bridge that $37 trillion of unfunded liabilities, this bill does what? It cuts $ 1/2 trillion from the Medicare Program to fund yet another unsustainable health care entitlement program.

Medicare has a major problem with physician payments that could cost more than $250 billion to fix, but this bill ignores the problem. Instead, the proposed legislation assumes the government would implement the 23-percent Medicare cut scheduled to go against doctors in January 2011, as well as additional cuts that are scheduled for future years under that SGR.

By pretending the physician payment issue does not exist, this bill would leave future Congresses virtually no way to restructure Medicare that would fix this problem. Instead, this bill diverts Medicare resources elsewhere and ignores major problems such as that one.

Besides ignoring major problems, such as the physician payment issue, this bill also ignores the predictions of experts that Medicare cuts, such as are in this bill, will jeopardize access to care of Medicare beneficiaries.

There are no fail-safes in this bill that would automatically kick in if these drastic cuts caused limited provider access or worsened quality of care. Instead, Congress would have to step in. Congress can always step in, but will it step in. We know how impossible it is to undo this kind of damage. By making this board a permanent program and requiring permanent productivity cuts, they become part of the baseline in the next decade. They go on cutting, cutting, cutting forever. If Congress ever

wants to shut off those cuts, then this is the problem Congress faces: We have to come up with offsets to do it. The administration can cut and cut and cut or add and add and add. They do not have to do that. But the budget laws require us to have these offsets or to do the famously impossible thing to do--get a 60-vote margin to overcome it.

The Congressional Budget Office has projected that these Medicare cuts keep increasing by 10 to 15 percent each year over the next decade. You heard me right. Medicare cuts keep growing 10 to 15 percent each year beyond the year 2019. Those are some pretty substantial cuts in a program that 43 million seniors and people with disabilities rely on for their health coverage.

Provisions, such as the productivity adjustments and the Medicare independent advisory board, would drive the increased cuts to the program. This gives us an idea of the damage these bills will do to health care. This is an example of the challenge Congress will face in the next decade if this bill--this 2,074-page bill--becomes law.

The few years of extended life this bill would give to the Medicare hospital insurance trust fund is a pyrrhic victory because the drastic and permanent Medicare cuts in this bill will worsen health care quality and access.

This bill is the wrong way to address a big and unsustainable budget. You [Page: S12035]

simply cannot slash Medicare payments, spend those funds to start up another new unsustainable government entitlement program, and then turn a blind eye toward the effect on access and quality. That is why I will support the motion of the Senator from Arizona to commit this bill and develop a bill without these Medicare cuts. I urge my colleagues to do the same.

The reason I urge my colleagues to do the same is because we have an opportunity to step back just a little ways, go back to the drawing board on bipartisanship and maybe come up with something that fits in with the health care issues affecting the lives of 306 million Americans and, secondly, restructuring one-sixth of our economy. That is something I have heard people on both sides of the aisle say ought to be done on more of a consensus basis than the partisan road this is going down. It was

a road that, for the first 6 months of this year, looked very doable, but it never turned out that way.

I get back to this bottom line: If you are having a coffee club meeting in some restaurant Saturday morning in Delaware, Illinois or Iowa, and they are talking about health care reform and I go in to explain that what we are discussing right now on the floor of the Senate is going to raise taxes, it is going to raise premiums, it is going to not do anything about the inflation of health care costs, and we are going to take almost $ 1/2 trillion out of the Medicare fund to fund a new entitlement

program, I would say that unanimously people would say: This is not health care reform. There has to be something else. But we throw away the word ``reform'' when we are not accomplishing the kind of goals we set out to accomplish the first 6 months of this year.

I yield the floor.

2:40 PM EST

Dick Durbin, D-IL

Mr. DURBIN. Mr. President, there is a saying in Iowa; that is, that any old mule can kick down a barn door, but it takes a carpenter to build one. I would modify that slightly and say any old elephant can kick down a barn door, but it takes a carpenter to build one.

We are debating health care reform. The American people are following us closely because it affects every single one of us in this room, everyone in the galleries, and everyone watching. This is one of the few issues we will debate which you can bet is going to affect you and your family personally. It is rare that an issue comes before us of this gravity and an issue that reaches every single person in America. It may be the biggest single issue we have ever tackled on the floor of the Senate

in terms of its scope and its impact on the future of every single one of us.

For more than a year, a lot of people have been working hard to come up with a piece of legislation that will have a positive impact on health care in America. It has involved lengthy committee hearings. The Presiding Officer is a member of the Senate Finance Committee. They sat in meetings hour after weary hour, day after weary day, considering amendments before they produced a bill that is part of what we have before us today.

The Senator from Iowa is part of that same committee. I understand he met personally over 60 times with Democratic Senators and a few from his own side trying to see if we could come up with some kind of bipartisan approach. I commend him for his good-faith effort in doing that.

There is another committee, the Health, Education, Labor, and Pensions Committee, that spent even more days in deliberation on a bill, considered over 100 different amendments, adopted over 100 Republican amendments to the bill, and not one single Republican Senator would then vote for the bill--not one. One Senator, Senator Snowe of Maine, voted for the Senate Finance Committee bill. One Republican Senator voted for that version of the bill.

What we have today--and I wish to slightly modify the remarks of my friend from Iowa--is a 2,074-page bill with a 1-page add. This is Senator Reid's amendment to use it as a substitute. So it is 2,075 pages, created by these two committees in the Senate and a similar endeavor taking place in the House.

For at least 10 days, this bill, in its entirety, has been available for public review. I ask anyone interested who wants to read this bill, as every Member should, to go to the Senate Democratic Web site. If you Google ``Senate Democrats,'' you will find it and you will find this bill in its entirety, every single word of it, sitting out there to be read and reviewed, as it should be.

Then I invite you, for comparison's sake, to go to the Senate Republican Web site to look at the bill produced by the Senate Republican side. Take a look at the Senate Republican health care reform bill. Take a look at what they propose to change--the health care system in America. Look at the Senate Republican proposals for making health insurance more affordable. Look at the Senate Republican proposals for dealing with health insurance companies which deny you coverage because of preexisting

conditions. Take a look at the Senate Republican approach to pass health care reform and not add to the deficit. I am afraid you will be disappointed because, as the Senator from Iowa knows, when you go to the Senate Republican Web site, there is no Senate Republican bill. In fact, what you will find on the Senate Republican Web site is the Democratic bill.

For more than a year, while we have labored to produce this monumental, historic legislation, our Republican colleagues on the other side of the aisle have not broken a sweat to produce their own answer to this challenge facing America. All they can do is come before us and criticize this bill. Any old mule can kick down a barn door, but it takes a carpenter to build one.

We have been working for over a year--almost a year--to build this health care reform package. Here is what we know. We just received a report from the Congressional Budget Office, which is akin to the referee up here. This is an agency that takes a look at what we do and tells us whether it is going to reduce the deficit, add to the deficit, reach its stated goal or fail to reach it.

It is maddening sometimes to have this separate agency kind of looking over your shoulder, but they do. They reported just yesterday that this bill will make health insurance more affordable for many Americans and will not add to the costs for many others.

I wish it would do more. I wish it would bring down costs dramatically, even more. But for weeks and months we have heard from the Republican side that our health care reform proposal would run premiums sky high. It turns out they were wrong. This bill we have produced moves us toward more affordable health insurance. Every American who pays any attention to the cost of health insurance knows that is absolutely essential. In the last 10 years, health insurance premiums have gone up 131 percent

in America. Ten years ago, a family could have bought health insurance for about $6,000 a year. Now they buy it on average for about $12,000 a year. In 7 or 8 years it will go up to $24,000 a year in premiums, projecting it will eat up 40 percent of your income for health insurance in just 8 or 10 years.

That is an impossible situation. We know it is. It is unsustainable. Businesses can't offer health insurance that expensive. Individuals can't buy health insurance that expensive. So if we do nothing we will reach a situation where the current health care system in America will start to collapse. I do not want to stand idly by and let that happen; neither does President Obama. He has challenged us to address it and address it honestly.

On the other side of the aisle, the Senate Republicans have not produced a bill, a proposal, an alternative which will make health insurance more affordable--nothing. They come before us in criticism of what we have done, and yet they cannot produce a bill.

I might also tell you the same Congressional Budget Office tells us the bill we put together will actually reduce the Federal deficit over the next 10 years by at least $130 billion. This bill, this 2,075-page bill, will cut more deficit than any piece of legislation we have ever enacted in Congress.

The Senator from Iowa is concerned about our national debt. So am I. Where is the Senate Republican proposal for health care reform that is going to reduce America's deficit? Incidentally, the same Congressional Budget Office says in the second 10 years-- [Page: S12036]

think that far in advance--this approach will reduce the Federal deficit by another $650 billion.

I ask the Senator from Iowa, with all his concern about the Federal deficit, where is the Senate Republican bill that will reduce the Federal deficit by $750 billion over 20 years?

The answer, I am sorry to tell you, is it does not exist. They either have not or cannot write a bill. They are legislators, but frankly they have come here to be critical of what we have done and will not offer a substitute or an alternative.

There is something else this bill does. It is a travesty in America today that almost 50 million people do not have health insurance. A lot of these folks are children. A lot of them are people in low-wage jobs with no benefits. A lot of them are the newly unemployed. These are 50 million of our neighbors in America who go to sleep at night without the peace of mind of having health insurance protection.

In my life it happened once: newly married, college student, baby on the way, no health insurance, and our baby had a problem. I ended up carrying, for 8 years, medical bills that I slowly paid off year after year. That goes back many years ago, as you might imagine, but it was troubling and heartbreaking to be the father of a child and not have health insurance; to sit at Children's Memorial Hospital in Washington, in the room that was set aside for people without health insurance, and wait

until my number was called to bring my wife and my baby in for a checkup. I didn't have health insurance. I never felt more helpless in my life.

Fifty million Americans go to bed each night with that feeling. They don't have health insurance. What does this bill, this 2,075-page bill, do about it? It extends the coverage of health insurance, the peace of mind and protection of health insurance to 94 percent of Americans. It is the largest extension of health insurance in our history.

Where is the Republican alternative that offers coverage for 94 percent of Americans? It doesn't exist. They have not written that bill. They don't know how to write that bill. They do know how to come and criticize this bill, but they cannot produce a bill which covers 94 percent of Americans and provides tax credits and tax assistance to help those Americans pay their premiums.

If you are making under poverty wages, let's say you are making less than $14,000 a year--and I have friends of mine in my State who are--you are covered by Medicaid. You don't pay premiums. The Federal Government compensates the States and pays the premiums. All the way up to about $80,000 for a family of four, we provide credits and help to pay the premiums, as we should, because premiums can break the bank not only for businesses but for families.

There is also something we do in this bill I never hear from the other side of the aisle--and I will tell you why in just a second. We give consumers across America a fighting chance when the health insurance company goes to war with you. Do you know what I am talking about? If somebody in your family gets sick, you know it is going to require a hospitalization or surgery and you know the cost is going to go sky high, and you say: Thank goodness, I have health insurance. You make the claim and

the health insurance company comes back and says: We dispute the claim. We are not paying. People say: Wait a minute, I have been paying health insurance premiums for years just for this day, and you are telling me I don't have coverage?

It happens thousands and thousands of times each day. Do you know why? Health insurance companies are profitable when they say no. What are the reasons for saying no? ``You failed to disclose a preexisting condition when you applied for the insurance.'' It turns out they go to ridiculous extremes to find an excuse not to provide coverage.

We also know what happens when you lose a job. You can't take your insurance with you, by and large. We know when your child reaches the age of 24 they are no longer carried on your family health insurance. Those are the realities of health insurance companies saying no. I have yet to hear the first Republican Senator come to the floor and say that is outrageous and it has to change. We have to tackle the health insurance industry because the health insurance industry opposes this bill.

The health insurance industry believes their profitability and their future depend on saying no. This bill starts saying to these companies: You can't say no based on a preexisting condition, based on lifetime limit, based on losing a job. And we cover kids through the age of 26. We extend the family coverage to children of that age, and you know that is only sensible because a lot of kids are going to college and getting out without jobs. You want them covered by your family health insurance

plan. This bill does it.

Republicans have yet to produce one bill, just one, on health care reform to take on the health insurance industry. Instead, what they have come to do, and the pending amendment by the Senator from Arizona leads with this, is to protect the health insurance companies. The first thing the motion to commit does, from the Senator from Arizona, is to instruct the committee, the Senate Finance Committee, to protect a program called Medicare Advantage.

This is a great idea for health insurance companies and not a great idea for most seniors or taxpayers in America. Allow me to explain. The health insurance companies came to us several years ago and said Medicare is a bureaucratic mess. The government cannot run these programs. We are in the private sector. We understand competition. Let us compete with Medicare.

They were given the right to do that. Private health insurance companies were given the right to write health insurance that provides Medicare benefits. They said they could do it more cheaply and, in fact, some of them did. But at the end of the day, after years of watching them, it

turned out these Medicare Advantage policies cost 14 percent more--not less, 14 percent more--than government-administered Medicare Programs. In other words, we were subsidizing health insurance companies, paying them more for the same Medicare coverage people already had received.

They loved it. Thousands and thousands of Americans are now covered by Medicare Advantage with these great subsidies coming from the Federal Government. Talk about an earmark, Senator, 14 percent--what an earmark that is, a subsidy given to the private health insurance companies.

2:55 PM EST

Dick Durbin, D-IL

Mr. DURBIN. What the basic problem with the amendment of the Senator form Arizona is--and I will yield in just a moment--what the basic problem with his amendment is, he is protecting these health insurance companies with Medicare Advantage. First thing he does. He is protecting this subsidy, this big fat earmark we put in legislation, 14 percent bump in premiums is protected by this motion to commit.

It is understandable the health insurance companies want to keep this. It is a sweet deal. They are getting paid for something they promised us would never happen. Also, there is a provision in the motion to commit of the Senator that says we should take out the conflict-of-interest sections in Medicare. Do you know what that is? That is when your doctor also owns the laboratory which does your blood test and the imaging center which does the x rays and says: I am not sure what is wrong with

you, but I know there are two things you need: You need a blood test and you need an x ray.

Maybe you do; maybe you don't. We say in this bill you have to disclose to your patient that you have a personal financial interest in this laboratory and this processing operation, and you have to give them an alternative to shop for another place if they want. Is that unreasonable? It is one of the provisions the Senator from Arizona wants to take out. It is a savings in Medicare.

That is unfortunate. We have to do our best to eliminate the waste and fraud and abuse, as terrible as that old cliche is, in Medicare. Why is it that the same medical procedure offered in Rochester, MN, to a Medicare recipient costs twice as much or more in Miami, FL? Do you think maybe we ought to take a look at that? I think we should. I think maybe there is some price gouging. I want to know. [Page: S12037]

Does that mean we are going to reduce the benefits for someone living in Miami? Not necessarily. But it means the taxpayers will not be ripped off. Medicare would not go broke. We are doing what we need to do to be responsible. So taking money out of Medicare means shutting off the subsidy to the private health insurance companies for Medicare Advantage. It means stopping the self-dealing of some doctors who are sending Medicare patients to their own labs and their own processing companies. It

means finding out where the waste is taking place.

The Senator from Arizona says we instruct the Finance Committee to take out those provisions in the bill. Keep Medicare Advantage there, with the 14 percent subsidy for private health insurance companies, don't engage these doctors when it comes to these conflicts of interest. I don't think that is right.

It was not long ago that my friend from Arizona was a candidate for another office. During the course of his campaign for President, he suggested we have a pretty substantial cut in Medicare and Medicaid. In fact, during the campaign the Senator from Arizona called for $1.3 trillion in reforms in Medicare and Medicaid, more than twice as much as we are calling for in Medicare, 2 1/2 times as much.

Douglas Holtz-Eakin, who worked for the Senator from Arizona, said the campaign planned to fund tax credits in their health care proposals with savings from Medicare and Medicaid. So the idea of saving money in Medicare is certainly not something with which the Senator is unfamiliar. We all understand there are possibilities for savings that don't jeopardize basic services for seniors. We also understand that left untouched, Medicare is going broke. Ignoring the problem will make it worse. If

we want to put Medicare on sound footing we have to tackle this issue foursquare. We cannot afford these subsidies for private health care companies for Medicare Advantage, and we cannot afford the waste that is going on in the system today.

I might also tell you the increase in payroll taxes for those individuals making over $200,000 a year and families over $250,000 a year--that is the increase in the Medicare tax--is going to be buying 5 years of solvency for Medicare. So when they talk about our raising taxes--true, at the highest income levels--what they don't tell you is the other side of the coin. The money brought in goes straight to the Medicare trust fund to keep it solid.

What else does this bill do? It starts filling the doughnut hole. You may not know what that means until you happen to be a senior or have one in your family, but Medicare prescription drug coverage stops paying at a certain point. This bill starts coverage in the doughnut hole, in the gap in coverage that currently exists in Medicare prescription Part D.

Where is the Republican bill to fill the doughnut hole? It doesn't exist--at least I have not seen it. It is not on their Web site. Here is ours. That is why AARP has endorsed this bill. The American Association of Retired Persons knows this bill is a good bill for seniors.

I urge my colleagues to oppose the McCain motion to commit.

If we take this bill off the floor, which many Republicans want us to do, it will take us days, maybe a week, to bring it back to the floor. They want to delay this as long as possible. They want us to fail. They want us to stop. They want us to adopt the Senate Republican approach to health care reform which is do nothing, leave the system the way it is. We cannot continue the system the way it is. This is a responsible bill. It makes health insurance affordable. It reduces the deficit, according

to the CBO, and covers 94 percent of Americans. It finally tackles the health insurance companies for the first time in a long time, and it buys at least 5 years more for the Medicare Program. I wish I could compare it to the Senate Republican approach, but that doesn't exist. Any mule can kick down a barn door. It takes a carpenter to build one.

I yield the floor.

3:01 PM EST

John S. McCain III, R-AZ

Mr. McCAIN. I regret that the Senator from Illinois did not observe the courtesies of the Senate, particularly when a person's name is mentioned, as he continued to mention my name throughout and totally falsifying my position both in the Presidential campaign and the position that we have on this side and this amendment. I have always extended that courtesy to the Senator from Illinois. I deeply regret that even this comity of the Senate is no longer observed.

I say to the Senator from Illinois, I regret you would not respond to a question I had posed, when you had said: I will respond in a minute. Again, even comity is not observed here.

3:02 PM EST

John S. McCain III, R-AZ

Mr. McCAIN. I will go ahead with the--the Senator did not provide me with the courtesy of allowing me to respond to a question. Now you want me to respond to a question from you? I will display more courtesy than you displayed to me. Go ahead.

3:03 PM EST

John S. McCain III, R-AZ

Mr. McCAIN. Well, I guess my questions were, one, did the Senator, who claimed that no Republican has done anything to curb the health care insurance industry, was the Senator in the Senate when Senator Kennedy and I fought for weeks and months for the Patients' Bill of Rights? Was the Senator here then? Was he engaged in that debate? Senator Kennedy and I fought for the Patients' Bill of Rights, and the majority on that side of the aisle opposed it. The fact is, there have been efforts

on my part to curb the abuses of the health insurance industry by sponsorship of the Patients' Bill of Rights.

Second, during the campaign, yes, I said that we could reduce and eliminate waste, fraud, and abuse in spending, and I said it because of Senator Coburn's Patients' Choice Act which would save $1 trillion in the States in Medicaid savings, $400 billion over the next 10 years in Medicare savings. I wish the Senator from Illinois would examine the Patients' Choice Act, as proposed by the Senator from Oklahoma. Maybe he would learn something. The Coburn bill wants to preserve the best quality

health care in America and not eliminate $12 billion in the Medicare Advantage Program, which 330,000 of my citizens who are enrollees like and want to keep, not eliminate $150 billion to providers, including hospitals, hospice, and nursing homes, $23 billion in unspecified decreases to be determined by an independent Medicare advisory board, as well as billions of additional cuts to the Medicare Program.

There is no relation between what I tried to do in my campaign and what is being done in this legislation, I tell my friend from Illinois. I would be glad to hear the Senator's response. I would be glad to extend him that courtesy.

3:05 PM EST

Dick Durbin, D-IL

Mr. DURBIN. I thank the Senator from Arizona. I commend him for his work on the Patients' Bill of Rights which I joined him in with Senator Kennedy and would do it again. The point I was making----

3:05 PM EST

Dick Durbin, D-IL

Mr. DURBIN. I ask you, do you support the health insurance reforms in this bill that give patients rights against health insurance companies; preexisting conditions, for example?

3:06 PM EST

John S. McCain III, R-AZ

Mr. McCAIN. I ask unanimous consent to yield to the Senator from Oklahoma to describe the Patients' Choice Act and the way we could truly save money and reduce fraud, abuse, and waste in the system and at the same time preserve quality health care.

3:06 PM EST

Tom Coburn, R-OK

Mr. COBURN. There needs to be some clarification. Medicare doesn't cover everything. Eighty-four percent of all [Page: S12038]

Medicare patients have to buy a supplemental policy now. Do you know what Medicare Advantage is about? Who set the prices on Medicare Advantage? The government set the prices on Medicare Advantage. The very same people you want to run it now created a 14-percent premium. The insurance industry didn't set the prices. The Center for Medicare

and Medicaid Services set the prices. The government is responsible for that differential.

Why is Medicare Advantage important? Because the vast majority of the people in my State and every State who have Medicare Advantage can't afford to buy a supplemental policy to make them whole on Medicare, because Medicare won't cover it. So Medicare Advantage for 89,000 Oklahomans is the only way they get equality with the rest of their peer group who can afford to buy a supplemental policy.

Now we are going to take that ability away from poor seniors in Oklahoma, Arizona, Iowa, and Illinois, and we are going to say: You don't get what everybody else has because you are economically disadvantaged. So we are going to give you substandard care, and we are going to take more of your income. Medicare Advantage offers the things you get with a supplemental policy when you can't afford to buy a supplemental policy. The very idea of saying we are going to take that away, when you are taking

that away from the cheapest program we have in terms of performance, because what Medicare Advantage does, which their bill and this bill purports to do, is recommends and encourages and incentivizes prevention as the Senator from Iowa wants to do for everybody. It incentivizes it. It doesn't cost to have a prevention exam

under Medicare Advantage. There is no out-of-pocket cost for our seniors who are poor who happen to have the benefit of Medicare Advantage. You are going to take that away. You are going to destroy it for 11 million seniors, the ability to get a preclearance, a screening exam, without them having to spend money on it.

Is there a way to get money out of Medicare? Yes, there is $100 billion worth of fraud a year in it. According to

Harvard, there is $150 billion worth of fraud a year in Medicare. There is $2 billion worth of fraud.

I want to address something else the Senator----

3:09 PM EST

John S. McCain III, R-AZ

Mr. McCAIN. Mr. President, I have to address the situation since I have been accused by the majority leader of changing my position. The Senate considered the Deficit Reduction Act of 2005 which called for approximately $10 billion in reduction in Medicare costs, approximately $10 billion. Senator Harry Reid, Democrat of Nevada, said:

Unfortunately, the Republican budget is an immoral document. Let's look at what is in the bill before us. The budget increases burdens on America's seniors by increasing Medicare premiums, and we have not seen what the House is going to give us. It cuts health care, both Medicare and Medicaid, by a total of $27 billion.

The majority leader was outraged in 2005 that there should be reductions in Medicare and Medicaid spending of $27 billion. Now the distinguished majority leader, with the white smoke coming out of his office, says he is for $483 billion in cuts in Medicare. That is a remarkable flip-flop.

By the way, I might add, Senator Dodd, who is here on the floor, said, concerning the Deficit Reduction Act of 2005:

For example, this bill cuts funding for Medicare and Medicaid which provide health care to poor children, working men and women, the disabled, and the elderly.

What a plea. What a plea.

Senator Barbara Boxer said:

Mr. President, I strongly oppose the reconciliation bill before the Senate. The bill would cut vital programs for the middle class, elderly, and poor. That is why I cannot believe only 2 months after Katrina we have a bill that would cut Medicare and Medicaid by $27 billion.

The list goes on and on.

Now before us we have cuts of $483 billion, including hospice, hospitals, other vital programs for our seniors. If we are going to go around and talk about flip-flops, let's look at the rhetoric that accompanied my colleagues on the other side in their opposition to $27 billion in savings which, by the way, actually only saved $2 to $3 billion over 5 years.

I ask my friend from Oklahoma, does he believe it is possible to make these cuts, including from the Medicare Advantage Program, and establish a Medicare commission that would not, over time, cut benefits that exist today for Medicare and Medicaid patients?

3:12 PM EST

Tom Coburn, R-OK

Mr. COBURN. Mr. President, I would answer my colleague by saying this bill is a government-centered approach, not a patient-centered approach. It is the very reason we are in the trouble we are in today. We have had the government making decisions rather than the patients and the physicians. It will, in fact, lessen the care for seniors.

I gave a speech earlier this morning on the floor that if you are a senior, you should be worried. Because the Medicare Advisory Commission and the cost comparative effectiveness commission will now decide ultimately what you get. We have an amendment on the floor, which in many ways I support but I would like to modify, about reinstituting what should be the standard for mammography for women. How did we get there? We have a commission that looks at cost and not patients. From a cost standpoint,

the task force on screening is absolutely right. But from the patient's standpoint, it is absolutely wrong. How do we decide the difference? Do we make the difference based on what something costs or do we make it on what my wife, who will soon be a Medicare patient, receives? The question is, will the cuts that are manifested by this bill impact seniors' care? As somebody who has practiced medicine

for 25 years and cared for seniors for longer than that, I will tell you undoubtedly they will have delay, denied care, and 80 percent of them will be fine. But 20 percent of the seniors in this country will be markedly hurt by this bill because a bureaucracy looking at numbers, not patients, never putting their hand on the patient, will make a decision about what is good for them and what is not.

Everything we know about medicine is that is exactly the wrong way to practice it. Every patient is different. Every patient's family history is different. When we talk about taking $120 billion out of the Medicare Advantage Program, what we are talking about is decreasing access to some of the most important screening capabilities that many of these people have

and making them unaffordable because they cannot afford a supplemental Medicare policy. They cannot accomplish it.

I want to address one other question. The majority whip said the Republicans have not had a bill. During the markup in the HELP Committee, I went through point by point the Patients' Choice Act. The Patients' Choice Act puts patients and doctors in charge, not the government in charge. The Patients' Choice Act neutralizes the tax effect to make everybody treated the same in this country, as far as the IRS is concerned.

Right now, if you get insurance through your insurance company, you get $2,700 worth of tax benefits. If you do not, you get $100. That is really fair. That is one of the reasons why people who do not get insurance through their employer cannot afford health insurance. It is because we do not give them the same tax benefit. It would give a tax cut to 95 percent of Americans, plus help them buy their care.

The Patients' Choice Act solves the liability problem by incentivizing States to have reforms in terms of the tort problem we have, where we know the cost is at least 6 to 7 percent more that we have spent on health care than we would if we had a realistic tort system.

Finally, we go after insurance companies because we do what is called risk readjustment. If you are dumping patients or cherry-picking--guess what--you have to pay extra; you have to pay to the very insurance companies that are covering those sick people. So we change the incentive to where an insurance company is incentivized to care for somebody rather than to dump them.

I was an advocate, when I was in the House, for the Patients' Bill of Rights. [Page: S12039]

I was defeated at every turn, trying to make this. To say we did not come with a bill, on a party-line vote in the HELP Committee 13 voted against a commonsense bill that did not increase taxes, did not increase premiums, covered more people than this bill will cover by 4 million, putting everybody in Medicaid on a private insurance policy so no longer are they discriminated

against by the doctors who will not take Medicaid, taking the Medicaid stamp off their forehead and giving them the same access to health care we have.

3:17 PM EST

John S. McCain III, R-AZ

Mr. McCAIN. So does my colleague find it entertaining that my friends and colleagues on the other side of the aisle, in 2005--as part of the Deficit Reduction Act, we had to bring in the Vice President, who I think was overseas, in order to break the tie because they were worried about what Senator Reid called an ``immoral document,'' referring to the Republican budget?

By the way, is the Senator aware that Citizens Against Government Waste has come out in favor of this amendment?

Mr. President, I ask unanimous consent that the letter from Citizens Against Government Waste be printed in the Record.

There being no objection, the material was ordered to be printed in the RECORD, as follows:

COUNCIL FOR CITIZENS

AGAINST GOVERNMENT WASTE,

Washington, DC, December 1, 2009.

U.S. SENATE,

Washington, DC.

DEAR SENATOR: You will soon vote on Senator John McCain's (R-Ariz.) motion to commit H.R. 3590 to the Senate Committee on Finance with instructions to remove the drastic cuts made to Medicare. On behalf of the more than one million members and supporters of the Council for Citizens Against Government Waste (CCAGW), I urge you to support this motion.

H.R. 3590, the Patient Protection and Affordable Care Act, would slash Medicare by $500 billion. Depriving seniors of their much-needed benefits is not a responsible way to achieve healthcare reform.

As it currently stands, the legislation calls for significant reductions including $120 billion to the highly successful Medicare Advantage program; $150 billion to providers including hospitals, hospice programs, and nursing homes; and $23 billion in unspecified decreases to be determined by an ``Independent Medicare Advisory Board.''

While CCAGW has been a long-time critic of improper payments and Medicare waste and fraud, the $500 billion in cuts in H.R. 3590 would not solve these inherent problems or help make Medicare solvent. The major reductions proposed to Medicare merely help lawmakers offset the costs of a massive new entitlement program to the detriment of the nation's senior citizens.

I urge you to support Senator McCain's motion to commit. All votes on this motion and other amendments pertaining to Medicare cuts will be among those considered in CCAGW's 2009 Congressional Ratings.

Sincerely,

Thomas Schatz,

President.

3:18 PM EST

John S. McCain III, R-AZ

Mr. McCAIN. Also, I say to the Senator, as you know, many of the seniors in my State--I would ask my colleague--have been very puzzled at the AARP's endorsement of a proposal that would cut their Medicare, where it has already been made clear that Medicare Advantage--and there are 330,000 seniors citizens in my State who are under Medicare Advantage--that it has been announced it will be slashed, and that somehow AARP is now supporting it.

All I can say is, is my friend aware there is an organization called 60 Plus that is working very hard on behalf of seniors to make sure they do not lose these benefits?

3:19 PM EST

Tom Coburn, R-OK

Mr. COBURN. I am. I would tell the Senator, again--how are we where we are? How are we where we are, when we are going to take a program that is working--granted, I think Medicare Advantage could be decreased through true competitive bidding. But CMS did not do that. We could bring the costs down and still have the same benefits. But this bill cuts the benefits in half, the extra benefits that Medicare patients have by being signed up on Medicare Advantage that everybody has who can afford a

supplemental policy.

I want to address one other thing, if the Senator would allow me. The majority whip said: Don't we want to get rid of conflicts of interest? Yes. But his argument was specious because the price is set for an X-ray or a mammogram or a CT or a blood test. They are set by Medicare now. There is no differential in the price other than what Medicare says the differential will be. There is no arbitrariness. The government sets the price for every Medicare test out there by region. So there is no way

to game it, as the Senator from Illinois said it was gamed. The best reason to have a lab in a doctor's office is so you do not have to wait and come back for another visit to the doctor who charges Medicare another $60 because you get the answer right then.

We want to eliminate that. So what will we do? There is no cost savings in that. There is a cost increase because now, instead of giving an answer to the patient, the patient is going to wait as they send it off to the lab, and have them come back in.

3:20 PM EST

John S. McCain III, R-AZ

Mr. McCAIN. Can I ask the Senator another question? How does the Senator envision that we can eliminate fraud and abuse and waste and institute significant savings? One of the ways is to retain the provisions in this amendment, this motion to commit, that uses the savings from fraud, abuse, and waste elimination to make the trust fund stronger, but at the same time preserves the benefits that our senior citizens have earned. How many times have you heard from senior citizens in your

State saying: I paid into this trust fund. I paid for my Medicare all my life. Now it is going to be cut. How is that fair? How is that fair to my generation, the greatest generation?

3:21 PM EST

Tom Coburn, R-OK

Mr. COBURN. Well, if you take $100 billion a year--and that is not an exaggeration; even HHS, this last week, said their improper payments were $92 billion; the Inspector General and the GAO both say it is higher than that; that is on Medicare alone--if we just captured $70 billion of that.

How do you do that? Do you know how Medicare pays down? They pay and then chase. So you submit an invoice. They do not know if it is accurate. They pay it, and then they go try to get the money back afterwards.

How about precertification of a payment, as everybody else does that has anything to do with the volume that Medicare has? The other way you do it is with undercover patients, where you put people actively defrauding Medicare in jail. Less than $2 billion in this whole bill goes after fraud. That is 2 percent of the fraud per year. We could cover everybody in the country or extend the life of Medicare 20 years by eliminating the fraud that is in Medicare today. What are we going to do? We are

not. We are going to create more government programs and more agencies that are going to be designed to be defrauded. So, therefore, the fraud is going to go up, not down. The fraud is going to go up, not down.

We are also going to limit the availability of prevention to seniors. I have read the prevention text in the bill. There are parts of it I absolutely agree with. We know if we manage prevention and we manage chronic diseases, we are going to save a lot of money. But we are not going to save any of it by building jungle gyms and sidewalks. What we have to do is incentivize people, both physicians and patients, to get in the preventive mode. We need accountable care organizations.

There are lots of things we can do. There are lots of things we can agree on. I know the Senator from Iowa and I agree on a lot on the prevention, but we ought to be saving that money, and we ought to eliminate the fraud. If we did nothing in this body except eliminate the fraud in Medicare, think what we would have done, think what we would have done for the kids who follow us.

Mr. President, $447 billion spent on Medicare; $100 billion in fraud. Wheelchairs that have been billed out so many times they have collected $5 million on them, doctors who submit false invoices, suppliers who submit invoices for people who are deceased. And we try to go get that after the fact? There are lots of things we could do. This bill is short on that. You all recognize it is short on it. It is the biggest savings out there. The reason there is not more in it is because CBO will not

score it because we have never demonstrated that capability.

One final point. This bill only scores the way CBO scores because it says you intend to do what no Congress has ever done. It says you intend to cut Medicare $460 billion to $480 billion. If you intend to cut Medicare, the American people ought to know where you are going to do it, how it is going to affect them. But if you are just doing it for a [Page: S12040]

scoring point, the young people in this country ought to know that too. Because where you say you are claiming

$460 billion, you are adding to the deficit if, in fact, we do not cut Medicare that much. And is it fair to the Medicare Advantage patients, who are poor--who do not qualify for dual coverage with Medicaid, who cannot afford a supplemental policy--is it fair to take away the benefits they have

today that we have given them--and it was not priced by the insurance industry; it was priced by CMS--and say because CMS, the government agency, did not price it, we are going to take away half of your benefits? It is not fair. It is not right. If there is anything immoral, that is immoral.

With that, I yield the floor.

3:26 PM EST

Tom Harkin, D-IA

Mr. HARKIN. Well, Mr. President, sitting here listening to the Senator from Arizona and the Senator from Oklahoma go on, I hardly know where to start. There have been so many accusations and so much misinformation it is hard to know where to begin.

I would begin by, first of all, saying the people who keep saying we are slashing Medicare and we are going to harm seniors are totally wrong. The fact is, the bill we have before us protects Medicare's guaranteed benefits, reduces premiums and copays for seniors, ensures that seniors can keep their own doctors, and ensures Medicare will not go broke in 8 years by stopping the waste, fraud, and abuse.

I might also say, as an aside, every time I hear the Senator from Oklahoma talking about waste and abuse and fraud in Medicare, it sounds like it is all in Medicare. The waste, fraud, and abuse we are talking about are the ripoffs of Medicare by pharmaceutical companies, many of which have been fined big fines and have settled. One of the most recent ones, I think, was almost for a billion-some dollars. It was one of the largest settlements in our history with a pharmaceutical company that was

caught ripping off Medicare. And insurance companies have ripped off Medicare, and others. It is not within Medicare; it is those who are coming at Medicare and trying to plunder it.

But that is what we do in this bill: We are stopping that kind of waste and abuse against Medicare; not in Medicare but against Medicare. We provide new preventive and wellness benefits for seniors. We lower prescription drug costs, keep seniors in their own homes, and not nursing homes, with the CLASS Act and the Community Choice Act that is also in this bill.

When they talk about going after Medicare, boy, talk about crocodile tears. Was it not Newt Gingrich, the former Speaker of the House, the leader of the Republican revolution, who said he wanted Medicare to ``wither on the vine''? Was it not Senator Bob Dole, their standard bearer for President in the 1990s, who said he had fought against Medicare and was proud he voted against it? Now, all of sudden, it seems as though Republicans are the guardians of Medicare.

People know the truth. The American people know the truth. They know it is the Democrats who fought for Medicare. Lyndon Johnson, as President, and the Democrats in the House and Senate, if it were not for them, Medicare would have never been passed. It is the Democrats who have fought to keep Medicare alive and well and healthy, and expanding it to people all over this country every step of the way--being opposed by our friends on the other side of the aisle. And now to hear them talk about

how much we are going after Medicare, boy, talk about crocodile tears.

The other thing I want to say is that I want to correct something the Senator from Oklahoma said. He talked about the recommendations that recently came out--I will have more to say about this in a minute--on mammograms. He said the U.S. Preventive Services Task Force--all they did was look at costs. That is what the Senator said. They looked at costs but they did not look at the people.

Recommendations that come from the U.S. Preventive Services Task Force cannot take into account cost. Cost cannot be a factor. They can only look at scientific evidence, safety, and efficacy. Cost cannot be taken in as any factor in their deliberations. So I wanted to set the record correct on that.

As I said, there were so many things I heard from the other side it is hard to know where to start.

I see my leader here, Senator Dodd, who did such a great job in getting our bill to the committee and getting it in the form that it is now and on the floor.

I wish to ask the Senator--I know the Senator was here listening to our friend, the Senator from Arizona, speak. Did it strike you that what he said was kind of missing the mark here a little bit and maybe not quite what we are doing in this bill?

3:31 PM EST

Chris Dodd, D-CT

Mr. DODD. I thank my colleague. Just to set the record straight, because it is amazing to me, in a very short amount of time, how people can misconstrue events. First of all, the Senator from Oklahoma was talking about the Medicare Advantage bill, and he said: Do you know who sets the rates? The government sets the rates.

That is true. That is because when that bill was passed, with very few people on this side supporting that bill--almost overwhelmingly on the other side--the requirement under the law, the requirement to pass, mandated under the law that the private plans of Medicare be overpaid, and on average those overpayments averaged 14 percent and in some States over 50 percent. The law that was passed here by the majority--and running the place at the time--insisted upon the mandates being included. So

if you wonder why that occurs today, it is because they required it in the law.

Secondly, when you talk about the Deficit Reduction Act of 2005--again, memories fade for some people. In fact, under that bill, children, working families lost the insurance they had. Cuts occurred. Women lost access to mammographies. Cervical cancer screenings were cut. Families lost benefits. There were direct cuts in them. The difference is, today, with what we are talking about, you don't cut these benefits at all--at all. In fact, we are increasing the opportunity for Medicare to be strengthened

under this bill. There is a vast difference between what happened in 2005 and what is being supported today. So, again, I just want the record to be clear. You can't make these things up as you go along. That is what happened in 2005. It was an abomination and did great damage to people in this country. People lost their insurance.

Under our bill, 31 million Americans will have coverage. We now know the premiums are going to drop for 93 percent of all Americans. Premiums will actually come down for individuals, small businesses, and large employers. For five out of six people who have their jobs, those premiums come down. Thirty-one million Americans will be covered with health insurance. Compare that, if you will, with 2005 when we actually cut mammography screening, cervical cancer research, and assistance in health care

for infants and children and women. That all got damaged in that year. Not in this bill. This is the difference.

I thank my colleague for yielding.

3:33 PM EST

Tom Harkin, D-IA

Mr. HARKIN. Mr. President, the only thing I would say to my friend from Connecticut--he said that in 2005 we had made all of these cuts in the Deficit Reduction Act. I just want to say for the record that I didn't vote for it and neither did the Senator from Connecticut.

3:33 PM EST

Tom Harkin, D-IA

Mr. HARKIN. Is this not when the Republicans were in charge and they had a Republican President and a Republican House and Senate? That is when they cut all the mammogram screenings and things such as that?

3:33 PM EST

Chris Dodd, D-CT

Mr. DODD. That is true. The record is very clear on this. People had the right to do so; that was their choice at the time. But to try to rewrite history somehow and say those cuts didn't occur--in fact, they did occur in these areas. That is why there were those of us here who objected strongly at the time. My colleague from Arizona is absolutely correct when he said that I said this was going to cut benefits for children and working families and cut screenings and tests for people. It did do

that. Those of us who made those warnings on that day were proven to be 100 percent accurate. Compare that, if [Page: S12041]

you will, with what we are talking about here today, particularly regarding reducing costs, premiums, and providing increased access for millions of Americans. That is the difference.

If you vote for the McCain amendment, we are right back where we were before--right back--which, of course, we all know means premium increases go up by literally 100 percent in the next 7 years. Tell that to a family of four in my State who is paying $12,000 right now and will go to $24,000 in 7 years, as opposed to having those premiums being reduced, depending on if you are an individual, small business, or large employer, by as much as 20 percent, 11 percent, or 3 percent, not to mention,

of course, that you will also increase the number of people who will be covered under this.

The present situation runs the risk of bringing our economy to its knees if we don't act. Recommitting this bill--going back, in a sense--would roll the clock back and do great damage to both individuals and to our country economically. That vote in 2005 set us back terribly in this country. This proposal allows us to move forward and provide the coverage a lot of people need.

I thank my colleague.

3:35 PM EST

Tom Harkin, D-IA

Mr. HARKIN. I thank my friend for pointing out those facts.

Mr. President, I have a letter dated December 1, 2009, from the National Committee to Preserve Social Security and Medicare. It says:

Dear Senator:

On behalf of the millions of members and supporters of the National Committee to Preserve Social Security and Medicare, I am writing to express our opposition to the amendment offered by Senator McCain which would recommit the bill to the Senate Finance Committee.

Much of the rhetoric from opponents of health care reform is intended to frighten our Nation's seniors by persuading them that Medicare will be cut and their benefits reduced so that they too will oppose this legislation. The fact is that H.R. 3590, the Patient Protection and Affordable Care Act--

The bill we have before us--

does not cut Medicare benefits; rather, it includes provisions to ensure that seniors receive high quality care and the best value for our Medicare dollars. This legislation makes important improvements to Medicare which are intended to manage costs by improving the delivery of care and to eliminate wasteful spending.

I won't read all of it, but it concludes:

The committee urges you to oppose the motion to recommit the bill to the Finance Committee.

Sincerely, Barbara B. Kennelly, President and CEO.

Mr. President, I ask unanimous consent to have this letter printed in the Record.

There being no objection, the material was ordered to be printed in the RECORD, as follows:

National Committee to Preserve Social Security and Medicare,

Washington, DC, December 1, 2009.

U.S. SENATE,

Washington, DC.

DEAR SENATOR: On behalf of the millions of members and supporters of the National Committee to Preserve Social Security and Medicare, I am writing to express our opposition to the amendment offered by Senator McCain which would recommit H.R. 3590, the Patient Protection and Affordable Care Act, to the Senate Finance Committee with instructions to remove important Medicare provisions.

Much of the rhetoric from opponents of health care reform is intended to frighten our nation's seniors by persuading them that Medicare will be cut and their benefits reduced so that they too will oppose this legislation. The fact is that H.R. 3590, the Patient Protection and Affordable Care Act, does not cut Medicare benefits; rather it includes provisions to ensure that seniors receive high-quality care and the best value for our Medicare dollars. This legislation makes important improvements

to Medicare which are intended to manage costs by improving the delivery of care and to eliminate wasteful spending.

The National Committee opposes any cuts to Medicare benefits. Protecting the Medicare program, along with Social Security, has been our key mission since our founding 25 years ago and remains our top priority today. In fact, these programs are critical lifelines to today's retirees, and we believe they will be even more important to future generations. But we also know that the cost of paying for seniors' health care keeps rising, even with Medicare paying a large portion of the bill. That is

why we at the National Committee support savings in the Medicare program that will help lower costs. Wringing out fraud, waste and inefficiency in Medicare is critical for both the federal government and for every Medicare beneficiary.

The Senate bill attempts to slow the rate of growth in Medicare spending by two to three percent, or not quite $500 billion, over the next 10 years. However, it is important to remember that the program will continue growing during this time. Medicare will be spending increasing amounts of money--and providers will be receiving increased reimbursements--on a per capita basis every one of those years, for a total of almost $9 trillion over the entire decade. Even with the savings in the Senate

bill, we will still be spending more money per beneficiary on Medicare in the coming decades, though not quite as much as we would be spending if the bill fails to pass.

America's seniors have a major stake in the health care reform debate as the skyrocketing costs of health care are especially challenging for those on fixed incomes. Not a single penny of the savings in the Senate bill will come out of the pockets of beneficiaries in the traditional Medicare program. The Medicare savings included in H.R. 3590, the Patient Protection and Affordable Care Act, will positively impact millions of Medicare beneficiaries by slowing the rate of increase in out-of-pocket

costs and improving benefits; and it will extend the solvency of the Medicare Trust Fund by five years. To us, this is a win-win for seniors and the Medicare program.

The National Committee with urges you to oppose the motion to recommit the bill to the Finance Committee with instructions to strike important Medicare provisions from health care reform legislation.

Cordially,

Barbara B. Kennelly,

President & CEO.

AMENDMENT NO. 2791

3:50 PM EST

Max Baucus, D-MT

Mr. BAUCUS. Mr. President, I ask unanimous consent that the next four Republican speakers to be recognized be Senators Johanns, Roberts, Hutchison, and Cornyn and for the Democrats to speak in an alternating fashion, with the next Democrats being Senators Murray and Cantwell to speak on the tragic shootings in Washington, and that following Senator Roberts, I be recognized.

3:51 PM EST

Mike Johanns, R-NE

Mr. JOHANNS. Mr. President, I rise to speak in support of the McCain amendment. I have been down here for a while, and I have listened to the debate on the Medicare cuts.

What strikes me about this debate is that reality sets in. It simply does. There will be a point at which hospitals, hospice programs, and skilled nursing facilities are going to see less money. That is simply the reality of what we are debating.

It is kind of remarkable to me that you could go from a period just a few years ago, where $10 billion over 5 years was described as immoral, and today we are talking about nearly $ 1/2 trillion in cuts. That is going to have a real impact on real programs that involve real people in our States.

From our standpoint, we try to look at this in a way that says: OK, if this were to happen, if, in fact, this gets the necessary votes, what impact will it have on real programs in Nebraska?

Let me walk down through that, if I might. For example, more than $40 billion in cuts from home health on the national level would translate back to the State I represent to the tune of $120 million in cuts. By 2016, according to our analysis back home, 68 percent of Nebraska home health agencies will be operating in the red.

In rural areas, as high as 80 percent will have negative margins. If you lose those services in rural areas, they are lost. In fact, they may be lost forever.

Skilled nursing facilities are already struggling to keep their doors open. I visit these facilities when I get back home. Many of us do that. They are already doing everything they can to make ends meet. We are already seeing them go under in community after community. I visit these facilities and they tell me: Mike, we are just holding on.

Hospice programs in Nebraska have been very well received. Years ago, I might have predicted otherwise. The reality is, hospice has worked well in my State, and I am guessing it is also in other States in the country. A survey reported that 100 percent think access to hospice services is important. This bill cuts $80 billion nationally from hospice programs.

How can we legitimately expect little or no impact, or simply attempt to argue it away, when 38 Nebraska hospice programs are already operating right at the margin? If there is any reduction, they will go out of business.

Hospitals will also see negative impacts. Let me quote, if I might, from a Nebraska Hospital Association letter:

Our 85 community hospitals have a unique stake in this debate. Not only are we providers of care to more than 10,000 patients per day, we are also one of the largest consumers of health care because we employ 42,000 people. ..... Hospitals are an economic mainstay of the community they serve and we (the NHA) are opposed to all measures that weaken our financial stability and viability.

The Nebraska Hospital Association indicates that disproportionate share hospital cuts will be $128 million. If other hospital cuts are factored in, Nebraska hospitals say they will see a total loss of $910 million.

I visit these little 25-bed hospitals. They have no room for error. There is no margin there. When they lose something such as this, they simply cease to exist. That community, then, is on its way to ceasing to exist.

Finally, it is very clear that Medicare Advantage is on the chopping block. That is 35,000 Nebraskans. No matter how hard you want to argue that, there are 35,000 Medicare Advantage beneficiaries in my State who will experience cuts in the very program that is such an important safety net to them.

CBO, the Congressional Budget Office, estimates reduced benefits from $135 to $42 a month. The so-called extra payments that would be cut are helping Medicare Advantage beneficiaries get very valuable benefits. Many who utilize Medicare Advantage are truly our most vulnerable citizens.

We cannot ignore that important fact. Seniors with a Medicare Advantage plan might receive vision or dental benefits or have their Medicare copayments reduced. In our State--I am guessing this is true of States all across the country--what you see is some of the poorest actually have Medicare Advantage.

If you don't believe me, just yesterday I received a letter from some Hispanic groups which said this:

With the growing number of Hispanic seniors, one in four of whom have Medicare Advantage, the defunding of the Medicare Advantage program and other Medicare cuts proposed would result in fewer benefits and a significant disruption in the care and coverage senior Hispanic Americans receive.

I ask unanimous consent that this letter be printed in the Record.

There being no objection, the material was ordered to be printed in the Record, as follows:

November 16, 2009.

DEAR SENATOR: As organizations that represent Hispanic Americans, we are deeply concerned with the health care reforms currently being discussed. We do not support reforms that will lead to increases in taxes for all Americans but especially for small business owners, cuts in Medicare, and mandates on families and businesses.

Hispanic small businesses are among the fastest-growing sectors in the U.S.--growing at a rate of over three times faster than the national average. We have been hit hard by this slow economy and cannot afford a greater tax burden and mandates on our families and small businesses. The result will be more Hispanics out of work and reduced wages that directly impact low-income and minority communities.

With the growing number of Hispanic seniors, one in four of whom have Medicare Advantage, the de-funding of the Medicare Advantage program and other Medicare cuts proposed would result in fewer benefits and a significant disruption in the care and coverage senior Hispanic Americans receive.

Many of our families came to the United States to escape hardship, pursue business opportunities and enjoy its economic freedoms. We deserve the right to make our own health care choices and not be subjected to costly and inefficient government mandates.

More than 30 percent of Hispanics are currently uninsured, and we want real reform that would help them. These reforms must promote real competition and choice. We want to ensure that Hispanic families have affordable health care, more choices and that their direct relationships with their doctors remain intact and uninhibited by bureaucrats.

Competition-increasing solutions include allowing businesses and individuals to purchase health insurance across state lines, which would make it easier and less costly for small businesses to provide employees with coverage. Allowing groups to join together to purchase insurance--whether they be small business or church or community groups--would also have a significant impact on the affordability of insurance for Hispanics and increase choices.

Government-focused proposals where bureaucrats and not individual business owners will decide what coverage an employer should provide will not help our families or businesses. Also, individuals will be penalized with fines and higher taxes if they do not follow the rules in Washington.

We hope that you will consider these concerns and what is in the best interest of Hispanic Americans, and all Americans, as you vote on health care reform.

Sincerely,

Hialeah Chamber of Commerce & Industries, Hispanic Alliance for Prosperity Institute, Hispanic Leadership Fund, Hispanic Professional Women Association, CAMACOL--Latin Chamber of Commerce of U.S.A.

Patients' First (Pacientes Primero), The Latino Coalition, U.S. Mexico Chamber of Commerce, Virginia Hispanic Chamber of Commerce, Voces Action.

3:58 PM EST

Mike Johanns, R-NE

Mr. JOHANNS. How could any Member go back to their State and defend these cuts to services that provide very important health care needs? Americans simply deserve better than that. If we want serious Medicare reform, we should start with true waste and fraud and concentrate on Medicare insolvency--especially when we all agree insolvency arrives in 2017.

What we are doing in these days of debate is truly robbing from Peter to pay Paul--and Peter is soon to be broke. Unfortunately, that is exactly what we are doing. Americans deserve better than the bill we are debating. I can't stand silently and accept a bill that has such dramatic cuts in the services provided to Nebraska seniors.

I will conclude by saying I support the McCain motion to commit to remedy these problems and get us back on track with commonsense reform.

I yield the floor.

4:05 PM EST

Maria Cantwell, D-WA

Ms. CANTWELL. Mr. President, I rise today to join my colleague, Senator Murray, in expressing my sorrow over the tragedy that struck Washington State and the law enforcement community. I extend the prayers and condolences of the Senate and the entire Nation to the families, loved ones, and colleagues of the four police officers who lost their lives in the line of duty Sunday in Lakewood, WA.

Those four officers, part of Washington's best, are SGT Mark Renninger, Officer Ronald Owens, Officer Tina Griswold, and Officer Greg Richards.

Collectively, they served for 47 years in the line of duty. As Lakewood Police Chief Bret Farrar describes them, they were ``outstanding individuals'' who brought a range of talents to a 5-year-old department.

These heroes, who put their lives at risk for our safety every day, will be deeply missed and never forgotten. The men and women in blue who keep our communities safe make tremendous sacrifices daily, and so do their families.

The senseless tragedy that claimed the lives of these four officers, as my colleague said, the deadliest attack in Washington State history, reminds us of the risk that police officers take every day when they put on their badges.

The risks that police take every day was driven home again today when a Seattle police officer on routine patrol confronted, shot, and killed the person believed responsible for this crime. And at a time when we are all in shock over the loss of these officers, the police remain vigilant. They did not stop doing their job, even when tragedy struck close to home.

I thank all those who participated in the law enforcement's response since this tragedy happened. I thank the Pierce County Sheriff's Office and Sheriff Paul Pastor for the investigation they have led. My heart goes out to the Lakewood Police Department and Chief Bret Farrar.

I also thank the efforts of the Seattle Police Department and the interim Chief John Diaz for his efforts and his agency's work.

In a matter of days, police and public safety officers from all around the country will converge on Puget Sound. They will form a long blue line in a show of respect for those who have fallen--Mark Renninger, Ronald Owens, Tina Griswold, and Greg Richards.

This moving ritual, which happens all too often in our country, speaks eloquently of the solidarity all of us feel with those who risk their lives to keep us safe. This tragedy also struck our State earlier in October when Officer Timothy Brenton was struck down randomly while sitting in his police car.

I hope everyone in this country will take time today and tomorrow and next week, if they see a police officer, to thank them. Thank them for their service. Express your appreciation for the job they do putting themselves at risk for all of us. We did not have enough time to thank Mark, Ronald, Tina, and Greg, but we are thanking them in our thoughts and prayers, and we are sending strength to their families with much love and appreciation for what those officers and their families have done to

serve us and their communities.

I yield the floor.

4:09 PM EST

Pat Roberts, R-KS

Mr. ROBERTS. Mr. President, I thank the distinguished Senator from Montana and my chairman of the Finance Committee. [Page: S12045]

Let me say first to the Senators from Washington State that I think all Senators appreciate both Senators bringing to the attention of the Senate the heartfelt feelings in regard to the tragedy that happened in their State. I share their dismay with regard to what has happened. I know the thoughts and prayers of all Senators are with them. I appreciate the remarks they have brought to the body at this time.

I would now like to discuss briefly the motion to commit in regard to Medicare and the tremendous cuts that are proposed in the bill--a bill I define not as the Finance Committee bill, not as the HELP Committee bill, but the bill that was done behind closed doors, which I think was most unfortunate.

This bill slashes--and I think that is the appropriate word--nearly $ 1/2 trillion from Medicare. Then it is used to establish a huge new government entitlement program.

Earlier this year during the Finance Committee markup of the health care reform legislation, I offered a nearly identical amendment to the McCain motion to commit we are now considering, which is a motion simply to send the legislation back to the Finance Committee with instructions to strike the cuts to Medicare in this bill. Unfortunately, my amendment during that time failed in committee on a party-line vote.

Let me see if I understand this correctly. Medicare is going broke. It has around $38 trillion in projected future unfunded liabilities. It is a huge, crushing entitlement program that threatens to bankrupt this country. But instead of owning up to this enormous threat and doing something about it for our financial future, instead of considering a Medicare reform bill to address this menace to future generations of Americans, instead of guaranteeing that the government-run plan we currently have

remains solvent, instead we are actually cutting some $465 billion from Medicare in order to start a brandnew, huge, crushing entitlement program that makes no sense.

If Medicare needs to be reformed--and I certainly believe it does--then we should be considering a Medicare reform bill right now. We certainly should not be cutting Medicare for the purpose of financing a huge new entitlement program.

My friends on the other side of the aisle have the temerity--that is a pretty strong word, but I think it applies--to assert these huge cuts will actually make Medicare more solvent. Nothing could be further from the truth. I have news for them. Cutting reimbursements to doctors, cutting reimbursements to hospitals and other providers--all providers--and it has been mentioned by my distinguished colleague from Nebraska--home health care providers, hospices is not reform. These cuts will hurt

Medicare beneficiaries, our seniors who have worked their entire lives with the promise that this program would support them through their older age.

Medicare already pays doctors and hospitals well below cost--70 percent approximately for hospitals, 80 percent for doctors approximately. The only saving grace is that these providers have the ability to shift their losses on to private payers to keep their doors open or their practices going. But there is a limit to their ability to cost shift. There is only so much the private sector is willing to absorb.

American families already pay--now get this--an extra $90 billion in a hidden tax to make up the Medicare and Medicaid underpayments that we in past years have provided each year. More cuts to reimbursements coupled with the massive increase to Medicaid this bill assumes will push these limits, meaning that fewer doctors will open their doors to new Medicare patients. They are doing that right now. We are rationing right now as to access to doctors who accept Medicare patients, and health care

access and quality for our seniors will be compromised.

Take the $105.5 billion cut to hospitals as an example. I know the National Hospital Organization has signed off on these cuts. I don't know why, but they have signed off on these cuts. I also know for a fact they will harm Kansas hospitals. I asked my Kansas Hospital Association--I did, at my request--to run the numbers on how this bill will affect their bottom lines. Their findings are frightening.

According to the Kansas Hospital Association's outside experts, this bill will result in nearly $1.5 billion in losses to Kansas hospitals over the next 10 years. It may be true that some urban hospitals that currently have large percentages of uninsured patients may have some of their cuts offset by the potential reduction this bill will make to the uninsured population.

But that is no consolation to a hospital in McPherson, KS, for example, that may be too large to qualify for the higher reimbursements allotted for what we call critical access hospitals, and has, unfortunately, the misfortune of serving a smaller than average uninsured base. Those hospitals will see huge cuts without seeing any of the gains. This bill's $100 billion cut will only hurt these hospitals and their ability to serve Medicare and even non-Medicare patients. Remember the cost sharing.

Medicare's own actuaries at CMS, the Center for Medical Services--sort of an oxymoron--have agreed that the Democrats' cuts to hospitals and other providers could be dangerous and could cause them to end their participation in Medicare. So why are we doing this?

Another huge cut to Medicare in this bill is that $120 billion cut to the Medicare Advantage Program. My distinguished colleague from Nebraska has already talked about that, the effects of Medicare Advantage to Nebraska. Let me talk about Kansas. Close to 11 million, or one-quarter, of Medicare beneficiaries are enrolled in Medicare Advantage; 40,000 of those beneficiaries are in Kansas. I want to read an excerpt from one letter I received from a very satisfied Medicare Advantage customer in

Shawnee, KS. Ms. Lila J. Collette is enrolled in Humana Gold Plus, a Medicare Advantage plan. She writes:

Please use everything in your power to let me and the many, many other people in Kansas who have chosen Humana Gold Plus to keep this wonderful plan.

Ms. Collette is not alone. Satisfaction rates among seniors enrolled in Medicare Advantage plans are very high. I know they are very unpopular to the other side and there are a lot of allegations made, but these people made that decision on their own, so why are we essentially gutting this program that provides quality and choice to our seniors?

I could go on about the cuts to hospice, home health care providers, nursing homes, but I think you get the point. I disagree with the failure to prioritize the solvency of Medicare over the establishment, again, of new government programs. And I certainly will never agree to financing these government expansions by bleeding the Medicare Program dry.

That is why, as I have said, I offered amendments in the Finance Committee markup that would have struck these Medicare cuts. Again, unfortunately, they were defeated on a party-line vote.

As the President is fond of saying, ``Let me be clear.'' This bill is funded on the backs of our seniors and those who provide Medicare to our seniors. This bill slashes Medicare by $ 1/2 trillion. This bill threatens access to care for seniors and health care for all Americans. I hope my colleagues will join me in opposing these cuts by voting for the McCain motion to commit.

This is the key vote. Don't kid yourselves, this is the key vote. You are either for protecting Medicare or not.

I yield the floor.

4:19 PM EST

Max Baucus, D-MT

Mr. BAUCUS. Mr. President, I wish to once and for all lay to rest this false claim that the pending bill is going to ``hurt seniors'' and is going to hurt providers; it is going to be this long parade of horribles that the other side likes to mention. It is totally, patently untrue, the claims they are making.

No. 1, all the crying allegations on the other side that the underlying legislation cuts Medicare, it cuts Medicare, it cuts Medicare--that is what they say. What they do not say is it does not cut Medicare guaranteed benefits. It doesn't cut benefits. It does reduce the rate of growth that hospitals would otherwise receive. It does reduce the rate of growth that medical device manufacturers might receive. All that is true. So it is true it is cutting the rate of growth of Medicare providers.

It is not true that this legislation cuts Medicare benefits. That is not true. The other side would like you to believe that is true by using the words [Page: S12046]

they choose. By saying ``cutting Medicare,'' they want you to think that is cutting Medicare benefits.

But it is not cutting Medicare benefits. Rather, the underlying bill reduces the rate of growth of government spending on providers, on hospitals, home health, hospice--lots of other providers. That is what is going on here. Don't let anybody fool you. This bill does not cut Medicare benefits. It does not. But it does reduce the rate of growth of providers.

Why are we doing that? First of all, most of these providers, virtually all the providers say--gee, we don't like our rate of growth, the Federal dollars coming to us, cut, but they will go along with it. They are OK with it. Why are they OK with it? Why is the American Hospital Association OK with reducing the rate of growth of hospital payments by $155 billion? Why are they OK with that? They are OK with that because they are going to make it up on volume. This legislation provides coverage

for many more Americans. They are going to have health insurance. Americans who do not have health insurance now often have to go to the emergency room of the hospital, the hospital has to provide the care, it is uncompensated care--nobody is paying for those hospital benefits--and that cost is transferred on to private health insurance premium holders. They have to pick it up. On average, that is about $1,000 per family per year.

No. 1, let me repeat, there are no cuts to Medicare benefits. There are reductions in the rate of growth to Medicare providers--which the providers agree with, by and large. I won't say totally, I wouldn't stand here and say they are jumping up and down and they are enthusiastic about it, but I am saying they realize they are not getting hurt. They are going to do OK. They are going to do OK because they are going to make up in volume what they might otherwise lose. That is a very important point

for people to understand.

Second, if you listen to the other side, what they would have us do is virtually do nothing. What does doing nothing mean? Doing nothing means the solvency of the Medicare trust fund is just over the horizon. This legislation extends the solvency of the Medicare trust fund another 4 to 5 years. Man, if I am a senior--I am about to be a senior--I would sure like the Medicare trust fund to be solvent. I would like that very much. This legislation extends the solvency of the Medicare trust fund

by another 4 to 5 years, to about the year 2017. So without this legislation, the actuaries say the Medicare trust fund is going to become insolvent 5 years earlier, 2012, somewhere there. That is not many years from now; not many years at all. So it is very important we extend the solvency of the Medicare trust fund.

You might ask why is the Medicare trust fund in a little bit of jeopardy? Why is that? The very basic reason is because health care costs are going up at such a rapid rate in America. Our health care costs are going up by 50 or 60 percent more quickly than the next most expensive country. We already are paying per capita 50 percent or 60 percent more than the next most expensive country. So there is a whole host of things we are doing in this legislation to make sure we have some limit over our

health care costs.

I realize I misspoke earlier. Currently the Medicare trust fund is due to be insolvent about the year 2017. This legislation extends the solvency of the Medicare trust fund to the year 2022. The principle is the same, just the 5 years is tacked on a little later period of time rather than upfront.

But we are doing a whole host of things in this legislation to reduce the rate of growth of health care costs to people in this country. It is health care costs which are driving up the Medicare trust fund costs so we are doing all we can to extend the solvency of the Medicare trust fund.

People are saying the Medicare trust fund is getting insolvent because baby boomers are retiring, and that will

increase the pressure on it. But the Congressional Budget Office did a study 6 or 8 months ago that said about 70 percent of the additional cost of the Medicare trust fund is due to cost increases, it is not due to more baby boomers retiring when they reach the age of 65.

What do some of the groups say about this legislation? Let me say what AARP says. We have a chart here which indicates what the American Association of Retired People says about the underlying bill. If it was cutting Medicare as the other side says, you would think they would not like this bill. You would think they would have problems with it.

AARP has not totally endorsed this bill, but they don't have problems with it because they know we are doing the right thing. What do they say? AARP says:

Opponents of health care reform won't rest. [They are] using myths and misinformation to distort the truth and wrongly suggesting that Medicare will be harmed. After a lifetime of hard work, don't seniors deserve better?

That is what the AARP says, referring to the distortions, misrepresentations, and untruths, trying to scare seniors, mentioned by opponents of this legislation.

Here is another AARP quote. This is this month:

The new Senate bill makes improvements to the Medicare program by creating a new annual wellness benefit, providing free preventive benefits, and--most notably for AARP members--reducing the drug costs for seniors who fall into the dreaded Medicare donut hole, a costly gap in prescription drug coverage.

That is a very important point. This bill not only does not cut benefits, it increases benefits for seniors. A big one is referred to right there and that is the so-called doughnut hole, the gap in coverage under the prescription drug program. This legislation in effect says that seniors now who have $500 of their drug benefit, prescription drug benefits paid for when they are in that doughnut hole period, and add to that this bill also says it is all paid for, at least for 1 year, in this doughnut

hole. We have to worry about that in subsequent years, but this bill improves the benefits that seniors will get, not take away benefits as the other side would imply.

It is true that private programs, such as Medicare Advantage, are reduced from what they otherwise would be, just as hospitals are reduced in payments from what they otherwise would get. I have a chart here. Let me point out the next chart here, if I could, which shows that the provider groups, hospitals, et cetera, are actually going to do OK under this legislation. What does this chart show? This chart shows that Medicare spending will continue to grow under this legislation. It will grow,

and grow by a lot. Here, in 2010, it is $446 billion and you see a steady growth through the 10 years of this bill.

I might say parenthetically, one of the previous speakers said rural health care is going to be hurt, rural hospitals are going to be hurt in this legislation. I do not think that is entirely true. I have a lot of hospitals in my home State of Montana, rural hospitals. They are not upset with this legislation. They say it is OK. They approve it.

In addition, there are no cuts to critical access hospitals. In rural America most of those hospitals are critical access hospitals. So they are going to be OK.

Basically, if we did not pass this legislation, these provider groups--hospitals, nursing homes, home health, hospice, Medicare Advantage, even Part B Medicare improvement--would all increase by about 6.5 percent over the decade. Under this legislation they all increase by about 5 percent over this decade, with a 1.5 percent cut which they basically agree to.

I want to make that point clearly. We are not cutting Medicare. We are not cutting Medicare benefits, but we are reducing the rate of growth of Medicare spending.

Another point I want to make, if I may, is there is nothing new here. Many of the Senators who are advocating killing this bill made the opposite statement not too many years ago. What did they say? They said: You have to reduce the rate of growth in Medicare spending in order to save Medicare benefits. That is what they said a few years ago, exactly what they said. Let me read:

We propose slower growth in Medicare. Medicare would otherwise be bankrupt.

They are standing on this floor making the opposite statement today, the exact opposite statement today, trying to scare people to kill the bill.

Here is another Senator. I will not embarrass them by giving their names, [Page: S12047]

but they are Senators who currently serve in this body.

We do heed the warning of the Medicare Board of Trustees and limit growth to more sustainable levels to prevent Medicare from going bankrupt in 2002. That is what is necessary to ensure that seniors do not lose their benefits altogether as a result of bankruptcy in 7 years.

One Senator said that. When? About 14 years ago. Exact same thing that is going on today.

We know, experts know that if we are going to save Medicare benefits, we have to stop overpaying some of the providers, hospitals and so forth. We are overpaying them.

Let me tell you one small example of how we are overpaying them. Did you know that the updates--the fancy term for paying more for hospitals and so forth--did you know they don't take productivity into account when they make these update recommendations? The recommendations are basically made by an organization called MedPAC. MedPAC is a nonpartisan organization composed of doctors and experts that advise Congress on what the payment updates--what the payment increases should be for different

groups over the years. We in Congress basically look at them. We try to decide what makes sense, what doesn't, and so forth. But MedPAC has said that this is what we have to do. We have to slow the rate of growth in some of these providers because they are getting paid too much. They are getting paid more than they need to be paid.

I repeat: We are still going to allow 5 percent growth for all the providers over the next 10 years. None of them are really crying wolf, I might say. That is the main point I wanted to make.

I mentioned what AARP is saying. Let me mention the American Medical Association:

[We are] working to put the scare tactics to bed once and for all and inform patients about the benefits of health reform.

That is the American Medical Association. They are referring to the scare tactics of the other side. The AARP and the American Medical Association and others know that no senior will see a single reduction in their guaranteed Medicare benefits under this bill, not a single one.

I might also say that this bill would reduce premiums seniors would have otherwise paid. Much of those savings to seniors comes from eliminating massive overpayments to private insurers; that is, private companies such as Medicare Advantage.

A small point here. When seniors hear the words ``Medicare Advantage,'' they tend to think that is Medicare. It is not. It is a private company. Those are private companies. They were basically enhanced. Under the 2003 Medicare Part D legislation, they were given a lot more money to encourage them to have competition in rural areas. It turns out we gave them way too much additional money. They know it. This legislation is trying to cut back on the excess they were provided back in the year 2003.

The cut is about $118 billion over 10 years. I don't have with me how much is remaining. But that 5 percent figure I gave you of growth, that includes Medicare Advantage.

I mentioned already that this legislation would reduce prescription drug costs. That doesn't sound like a benefit cut to me; that sounds like an additional benefit for seniors. We also provide for new prevention and wellness benefits in Medicare. That is an addition. That is not a cut. That is an addition. We are also helping seniors stay in their own homes, not nursing homes. That is a benefit.

It is important to point out here that the opponents of health care reform do not have a plan to protect seniors and strengthen the Medicare Program. They say don't do what they said a few years ago. They say: Commit the bill, do nothing. They say: Go back and start from scratch again. That is basically what they say. If you listen to the music as well as the words, if you read between the lines, basically they are saying: Kill it. Don't do it. That doesn't make sense.

That is what they are saying. I hate to say this because I tend to be a pretty nonpartisan kind of a guy. But these are scare tactics. They are not truths. Sometimes you have to call a spade a spade, and that is exactly what is happening here.

I might say that MedPAC, the outfit that advises us, is nonpartisan. They can't help us decide what to do here. They think Medicare Advantage plans are overpaid by 14 percent. In addition, a typical couple will pay $90 more per year in Part B premiums to pay for Medicare Advantage overpayments even if they are not enrolled in these plans. That is not right.

Medicare home health providers--I gave that list earlier. One small part of that is Medicare home health providers. They have an average margin of 17 percent. That is a little high.

If we are trying to protect Medicare benefits, we have to make sure we are not overpaying the Medicare providers. That is just common sense. It is the right thing to do. So many seniors just need help with their Medicare benefits.

Nursing homes are making profits of 15 percent off of Medicare. In my judgment, that, too, is unacceptable. We have to bring those down within reason.

We have an obligation. This is a government program. We have an obligation to taxpayers to make sure we are not overpaying hospitals and providers. We have to do right by them, make sure they are doing OK, but just not overpay. That is a tough line to draw sometimes. It is a judgment call. But that is what we are doing here.

In addition, the Office of Inspector General has found rampant fraud and waste and abuse in the Medicare Program. There is a lot of fraud and waste in the Medicare Program. The last figure I saw was about $60 billion in fraud in Medicare--providers, frankly, just ripping off taxpayers and seniors. We have added additional provisions in here to outlaw that fraud--additional screening, additional certification, additional ways to make sure that Medicare does a better job, that CMS does a better

job in knowing which payments to providers are right and which are not right.

What is the real impact of the Medicare policies here? Let's be clear: The real impact of these policies, even with the Medicare changes in the bill, overall provider payments will still go up. I don't want to beat that horse too much, but I want to make it clear. We are not cutting benefits. We are reducing the rate of growth of spending for health care providers, hospitals, and nursing homes, but we are reducing it in a moderate way. We are not reducing it by too much. As this chart shows,

those providers still get at least a 5-percent net increase in payments over the years, and the groups themselves have not really complained about them. Take the pharmaceutical companies, hospitals, nursing homes, home health, hospice--they are not crying crocodile tears because they know they are going to do better under health care reform.

Remember that famous meeting down at the White House not too long ago. The industry came in and talked to the President. Remember what they pledged, all these providers, how much they can cut reimbursements to them? This is including the insurance companies, hospitals, and everybody. They said they would cut $2 trillion over 10 years--$2 trillion. This legislation doesn't come close to cutting $2 trillion. I think the figure is about $400 billion. That is not $2 trillion, that is $400 billion.

So we are not hurting them that much. We are not hurting them, frankly. They are doing OK.

I have quotes from hospital associations. This is from Sister Carol Keehan, president of the Catholic Health Association:

Clearly, the Catholic Health Association thinks the possibility that hospitals might pull out of Medicare ..... to be very, very unfounded.

I have heard the claim over here that this legislation is going to cause providers to pull out of Medicare. That is totally untrue. I have so many quotes here from people in the hospital industry who believe this is OK. They are not going to pull out.

Chip Khan, president of the Federation of American Hospitals:

Hospitals will always stand by senior citizens.

I also know some providers are going to do very well under this reform legislation. Wall Street analysts have suggested that many providers, including hospitals, will be ``net winners,'' according to the basic feeling among Wall Street analysts. Under our bill, they estimate hospital profitability [Page: S12048]

will increase with reform because more and more hospital patients will have private health insurance.

Nobody is going to pull out. They are not going to cut Medicare benefits. It is true that there is a reduction in some of the private plan nonguaranteed benefits companies would give to seniors at the expense of private patients. That is true.

MedPAC has said it should be cut. MedPAC has said it should be cut more. We are giving these plans a break by not cutting them by what MedPAC says they should be cut.

Again, the reductions in this bill--for the providers, not beneficiaries--are far less than the health care industry itself said it could save over the next decade. A reminder: They pledged to save $2 trillion over 10 years. Under this legislation, they are going to be hit for $400 billion.

I mentioned before that the other side has often said this is exactly what we to have do, although today they say: No, no, no. I am not quite sure what the difference is between a few years ago when they said this is what we should do. Perhaps they can explain that.

I might mention, too--and this is very important, although we tend to lose sight of it--under this legislation, we provide delivery system reform.

There is a lot of waste in our health care system--estimates are 15, 20, 30 percent waste in the American system. Why is there so much waste, which means seniors are not given the benefits they should receive, which means private patients generally aren't getting the benefits they should receive because of all the waste? The waste is basically because of the way we pay for health care. We pay on the basis of quantity. We pay on the basis of volume. We do not pay on the basis of quality. To state

it differently, a hospital tries to do the right thing, doctors try to do the right thing. They are paid on the basis of how many procedures they provide, basically, not outcomes, not quality. That is the basic root that has caused a lot of the waste in the current American system.

Health care is provided for differently in different parts of the country. The fancy term is ``geographic disparity.'' Health care in one community is practiced one way. Health care in another community is practiced another way. They are very different.

Many of us have read the June 1 New Yorker article written by Dr. Gawande comparing El Paso, TX, with McAllen, TX. I see the two Senators from Texas on the floor. Perhaps they can help us elucidate what is going on in El Paso and what is going on in McAllen. In El Paso, the cost of health care is about half per person what it is McAllen, another border town. Spending per person in El Paso is about half what it is in McAllen. Yet the outcome; that is, how well the patients do, is a little bit

better in El Paso than it is in McAllen. Why? According to the author of the article, it is because of how medicine is practiced, what is the ethic, what is the sense in El Paso regarding health care and what is it in McAllen regarding health care. It may be dangerous for me to say so, but according

to the author, his conclusion is that in El Paso, it is because the care is more patient centered, it is coordinated care, it is less on making a buck; whereas in McAllen, it is less coordinated care, more specialties in hospitals, a little bit more providers wanting to go make a buck.

The main point is that medicine is practiced so differently all over the country. There are geographic disparities. In Northern High Plains States, it is less spending per person and the outcomes are terrific. In some of the Sunbelt States--and I don't want to step on the toes of any Senators from Sunbelt States--there is more spending and the outcomes are worse.

It is just because it is based on volume and quantity, not based on quality.

This legislation starts to put in place ways to move toward reimbursing based on quality, not volume. That, paradoxically, is going to result in lower costs and higher quality--lower costs but higher quality. Virtually all the folks in the health care community--the doctors, hospitals, and administrators I talk to--virtually all agree--I will be very conservative--80 percent agree, 85 percent agree, this is the direction in which we have to go.

This legislation goes in that direction. Failure to pass this legislation, which the other side wants, means we do not do any of that. It means we do not start putting in place ways to more properly reimburse doctors and hospitals and other health care providers.

This bill includes those patient-centered reforms I just mentioned. What are they? They include accountable care organizations, bundling is another concept, reducing unnecessary hospital readmissions, creating innovation centers. This bill starts to do that.

There is something else this bill does but which some on the other side get all exercised over and which I think they get exercised over improperly; that is, ways to start to compare one drug versus another, compare one procedure versus another, one medical device versus another. We have to start doing more of that with a nongovernment agency, with a private-public agency that works together so it gives good, solid information so we have more evidence-based medicine in America.

Right now, a lot of docs want to do the right thing, but what they do depends on the drug rep who comes in their office and starts peddling a certain drug. Docs feel uneasy about that, they do not like it, but they are so busy they see so many patients, it is hard to keep up to date. So we are trying to help them keep up to date with evidence-based medicine, and with a lot more health IT, health information technology, so they can get access to the best evidence through these various organizations.

There are just so many reasons this legislation is so important. I personally believe we have to move a bit toward what is called integrated systems. We hear about Geisinger, the Mayo Clinic, the Cleveland Clinic, Intermountain Healthcare. There is some home health out in Seattle where doctors and hospitals and nursing homes and pharmacists are more integrated, and that, therefore, cuts down on cost, increases quality. It is more patient centered. It is more care coordinated. This legislation

helps us move in that direction.

We are just trying to get started with this legislation, get started in doing some of the right things we know we should do. We do not have all the answers. Nobody has all the answers. But if we get this legislation passed, in the next couple, 3 or 4 or 5 years, working with the basic underpinnings of this legislation, we are going to help correct some mistakes. We are going to see some new opportunities. We are going to be working on getting health care costs down, which we have to begin doing

to help our people, help our companies.

We are going to work to get more coverage so more people have health insurance. It is an embarrassment today. It is an absolute embarrassment that the United States of America, an industrialized country, does not provide health insurance for its people. It is more than an embarrassment. It is a travesty. It is a tragedy. It is just wrong, it is morally wrong.

So this legislation gets us moving on the right track. It helps Medicare beneficiaries not hurt them, as the other side would like you to believe. It does not unnecessarily harm doctors and hospitals. They kind of go along with this. They kind of know it is the right thing to do. They are still getting big increases in payments, and there are other reforms here which I have not the time to mention tonight. But I strongly urge us to say: Hey, this is the right thing to do. Let's get started. Let's

pass this legislation and certainly trounce this committal motion to stop what we are doing. It is not right to stop this. We are getting started. Let's keep going.

I yield the floor.

4:50 PM EST

Kay Bailey Hutchison, R-TX

Mrs. HUTCHISON. Mr. President, I want to talk about health care legislation. That is what we have been talking about now on the Senate floor for the last week. I expect we will be talking about it for quite a long time.

We have just begun considering this bill, and the American people are growing in their opposition. According to a new Gallup Poll released yesterday, American independent voters now oppose this bill by an 18-point margin: 53 percent against it, 37 percent for it. This Gallup Poll states:

[Page: S12049]

Despite the considerable efforts of Congress and the President to pass health insurance reform, the public remains reluctant to endorse that goal.

But this poll is just confirming what we have really known for months; that is, the bill before us--and the one that passed the House before that--is the wrong approach.

We are not against reform of health care; we need reform of health care. People are concerned about the rise of premiums in health care. So we ought to be looking at ways to address that issue. By doing what? By cutting the costs in the system and by allowing people to have more affordable health care options, none of which is in this bill.

Americans do not support $ 1/2 trillion in Medicare cuts. They do not support $ 1/2 trillion in new taxes. They do not support mandates. They do not support our growing national debt, which has hit its ceiling at $12 trillion. They certainly do not support a government takeover of our health care system.

Let's talk about the Medicare cuts. The Americans who are most impacted are those we are usually trying to protect: our seniors. I hear others on the Senate floor saying there are no cuts to Medicare. I am looking at the language in the bill. I am looking at the description of the bill, and the fact is there is $135 billion in cuts to hospitals, $120 billion in cuts to Medicare Advantage, $15 billion in cuts to nursing homes, $8 billion in cuts to hospice care. That is nearly $ 1/2 trillion

in Medicare cuts. That is $500 billion.

In Texas, over half a million seniors are enrolled in Medicare Advantage. We know this bill will reduce their choices and the benefits they have today--benefits such as eyeglasses, hearing aids, dental benefits, preventive screenings, flu shots, home care, medical equipment, and more. So more and more seniors are not going to take the Medicare Advantage option which they now take and enjoy. This is not a solid approach.

I have heard others on the Senate floor on the other side of the aisle say it was Republicans who attempted to cut Medicare in previous years. The Republican effort to cut Medicare growth was $10 billion over 5 years. Not one Democrat voted for a $10 billion cut over 5 years. Yet today they are touting a $500 billion cut over 10 years.

Mr. President, $10 billion was out of the question, and $500 billion is now something that can be accepted? There is no reason to cut Medicare by $ 1/2 trillion. We should save Medicare. We should make it last longer and be more stable. But $500 billion in cuts is just going to make it worse. It is going to make it insupportable. Health care for our seniors will surely suffer on its face. That is a fact.

It is a fair question to ask: Well, what are Republicans for? Are you for health care reform? Well, of course we are for health care reform. Every one of us pays health insurance premiums, and we know people who are complaining about the rise in premium costs, especially small businesspeople. I sympathize with that. We all do.

So what is our approach? Step-by-step reform. What the American people are looking for is reform that does not cripple the health care industry in our country, that does not bankrupt our country, and that does not include a government takeover of the health care system.

There are commonsense, fiscally responsible reforms that Republicans have been promoting for years and would support today if we could have a bill that had any Republican input whatsoever, which this one does not--allowing small businesses to pull together and purchase insurance.

Sitting on the floor with us today is Senator Mike Enzi. Senator Enzi was the chairman, previously, of the HELP Committee. He produced a bill. He produced a bill that would have given more people coverage than the bill before us today--allowing small businesses to come together and pool their risk pool, make it larger, and give much more affordable premiums to more small businesses so they could afford to do what every small business wants to do; and that is, offer health care

coverage to their employees.

But the Democrats killed Senator Enzi's bill. That would have been the first step to health care reform. We could have passed that years ago and been on the right track increasing the number of people who have affordable options for health care.

No. 2, reducing frivolous lawsuits. Where States have taken the measure to reduce frivolous lawsuits, such as Texas and a few other States, it has been a phenomenal success. It has brought down the cost of medical malpractice premiums for doctors. It has increased the number of doctors who are willing to practice medicine again. It has increased the number of doctors who will go into rural areas that are underserved. It works.

The estimates are that if we had a part of this bill that would reduce frivolous lawsuits, it would save about $50 billion a year. If we could reduce $50 billion out of the cost in the system that is not going for anything productive, we could then put that into either helping shore up Medicare or give the Medicare reimbursements to doctors and health care providers, to hospitals. We could help the system by cutting those costs. That is something Republicans would support in a heartbeat.

How about tax incentives to people who are buying their own health care insurance? If we provided families with a tax credit worth $5,000, it would give them the ability to put that on a health care policy for their families. It would cut the cost and allow them to have an affordable option. Another is a tax deduction above the line or a tax credit, which would be a huge incentive to employers, as well as to individuals, who would be able to have that kind of help in covering the cost of health

care. We are willing to support that.

Another is allowing individuals to purchase insurance across State lines; tear down that bureaucracy that keeps people from going across State lines and getting the very best deal for themselves and their families.

Even an exchange could work. That is something that is embedded in the bill, but it is an exchange that has so many mandates that it is going to raise the cost for everyone. Just a simple exchange that has competition and transparency could actually make a difference in cutting the costs of health care.

So I think there are many things we could do to reform health care, if we could have Republican input and a bipartisan bill that would offer more affordable health care coverage to more people in our country. These are ideas that would improve competition in the marketplace, reduce costs, increase access. We do not need a government-run plan to achieve that objective.

I will be offering an amendment that will allow States to opt out, without penalties, of this plan, if it passes, not just the government part of the plan, but all of the harmful measures. We should be providing choices, not forcing people into government plans. States should not be forced to participate in the government plan. They should not be forced to subsidize it. They should not pay for a plan through increased taxes, nor mandates on businesses.

We want businesses to grow. We want businesses to hire people. We want to have jobs created. This bill is a job killer. Has anyone noticed we have one of the worst recessions since the Great Depression in this country, that over 3 million people in this country have lost their jobs this year? Mr. President, 300,000 of them live in my home State of Texas.

Yet we are talking about a bill that is going to increase mandates on businesses and surely will reduce the number of people who can be hired. There is a disconnect we need to put back together. We need to talk about options that can work, that can give more people health insurance coverage at a reasonable price and most certainly not be job killers, with mandates and taxes on small businesses that already are having a hard time staying afloat, creating jobs, and providing health care for their

employees.

The first amendment we will vote on tonight is the Mikulski amendment that has to do with breast cancer screening and other preventive services for women. Senator Mikulski and I have worked together on women's health issues for a long time in this body. Two years ago, we championed the reauthorization of the National Breast and Cervical Cancer Early Detection Program, which provides screening and diagnostic services. So we know how important it is to address women's health care issues.

I was in complete disagreement with this new task force recommendation on [Page: S12050]

mammograms and the need for mammograms for women under the age of 50. But I am very concerned that with the recent recommendations of the task force and how this health care bill that is before us relies on the task force, that the amendment is not going to do anything to solve that problem. The health care reform bill relies on the task force 14 times, and it even allocates money

to pay for advertising the task force recommendations. This amendment does not address the problem. Rather than severing the ties with that task force so it will not become the norm, the amendment now allows yet another government agency, the Health Resources and Services Administration, to interfere with the relationship between a woman and her doctor. So now coverage decisions will be dictated by both the task force and the Health Resources and Services Administration. Instead of letting doctors and their patients make the

decision about when a woman needs a mammogram, we have now not one government task force but two that we will have to intervene in that decision. Oh, my gosh, that does not make any kind of common sense. While I agree with Senator Mikulski about the great

importance of preventive care for women, I disagree with this approach because it still injects a government agency or task force into the decision that is going to determine whether women have access, easy access, full access to the health care of their choice.

The item we will be considering after the Mikulski amendment and the Murkowski amendment is the McCain motion. The McCain motion is going to strike the Medicare cuts from this bill. His motion, which I certainly endorse and support, would send the bill back for a rewrite. It would send it back to the Finance Committee with instructions to give us a new bill that does not include $ 1/2 trillion in Medicare cuts, a bill that would not be paid for on the backs of our seniors whom we should be protecting.

As I mentioned previously, the bill that is before us would cut nearly $ 1/2 trillion--$500 billion--from Medicare. It will not make it stronger; it will fund more government spending, more government takeover in our health care system. Health care reform should not mean slashing Medicare by cutting $ 1/2 trillion from seniors' care. This is not reform.

If we can support the McCain motion to go back to the drawing board and look for a way we can have a bipartisan bill that would have Republican as well as Democratic input and agree to step-by-step reforms that would increase access, reduce costs and not take away choices of seniors and certainly not have a government takeover of health care, then I think we could produce something the President would sign and the American people would embrace. Right now, everyone I talk to in Texas is scared

to death. They are scared to death of this big government takeover of our health care system because they know that when government gets involved, we are not going to have the quality we have known in the past, that the jobs are not going to be in the private sector, that we are not going to have the choice. When this bill--which relies on this task force 14

times to make the recommendations that would determine what the coverage is of the government plan--was put before us, all of a sudden people started to say women don't need mammograms before the age of 50, when we have always said it was after the age of 40; and after the age of 50, with a doctor's input, and that it would generally be on an annual basis.

The former head of the Red Cross, Bernadine Healy, and many of our health care agencies and task forces said that is going to kill women. That is going to kill women if they don't have early detection. Early detection is all we have for breast cancer right now. We don't have a cure. We only have early detection as a way to fight breast cancer. But all of a sudden, the task force that is relied on by this bill says we don't need mammograms before the age of 50; and after the age of 50, every 2

years, not every year; and after the age of 72, not at all. That is not health care reform. That is not what the President promised, and it is certainly not what Congress ought to assent to.

We can produce health care reform. We can lower the cost. We can give people access. We can give people choices. We don't have to mandate taxes and hurt businesses in this economic climate to do it. We have the capability to do something right. If we pass the McCain motion, we can go back to the drawing boards and do this right. That is the most important thing I hope we will do this week in the Senate for the American people, and they deserve it.

Thank you. I yield the floor.

5:09 PM EST

Chris Dodd, D-CT

Mr. DODD. Mr. President, I ask unanimous consent, if I may, that I be allowed to speak for 15 minutes and that that time include a colloquy with my colleague, the Senator from Minnesota.

5:09 PM EST

Chris Dodd, D-CT

Mr. DODD. Thank you, Mr. President. I wish to address a couple issues, if I may; one is this debate about Medicare cuts and savings. Let me put up one chart. I will not spend a long time on this, but I wish to make a point to my colleagues.

About a year ago, the Bush administration sent us a budget. According to the Congressional Budget Office and the Senate Budget Committee, the proposals in the Bush administration's budget in the last year alone called for $481 billion in Medicare savings and cuts. It was not in the context of a health care bill; that was part of a budget proposal. That was $481 billion, according to the CBO just last year. Literally, 12 months ago that was the proposal. In the context of the overall reform of

the health care system, in which we are trying to achieve savings to make sure the dollars are going to go further and go for the things that are needed, our proposal calls for $380 billion in savings over the coming 10 years.

I think, again, people need to understand what we are talking about and that is the difference. So a year ago, $481 billion and no health care proposal--just to get to budget proposals. Here we are in the context of over 10 years of trying to put things in this bill to ensure a more solid footing.

The National Committee to Preserve Social Security and Medicare, representing millions of our fellow citizens, wrote a letter to the Senate, every Member, dated December 1, 2009. Senator Harkin earlier put the entire letter in the Record. I am going to read just one sentence from the letter, signed by Barbara Kennelly, the President and CEO of this organization:

Not a single penny of the savings in the Senate bill

This bill we are debating--

will come out of the pockets of beneficiaries in the traditional Medicare program.

This is an organization that does not bear a political label. It doesn't represent Democrats, Republicans, Independents. It merely spends every hour of every working day assessing what happens to Social Security and Medicare. That is all they do--all they do. Believe me when I tell my colleagues this organization would not make a statement such as this if it were untrue. I know the organization. I know the people involved. They are highly critical of Democrats and have been when they think we

have gone too far in various areas. They state, categorically, what this bill does to Medicare.

I ask unanimous consent that the entire letter be printed in the Record.

There being no objection, the material was ordered to be printed in the Record, as follows:

NATIONAL COMMITTEE TO PRESERVE

SOCIAL SECURITY AND MEDICARE,

Washington, DC, December 1, 2009.

U.S. SENATE,

Washington, DC.

DEAR SENATOR: On behalf of the millions of members and supporters of the National Committee to Preserve Social Security and Medicare, I am writing to express our opposition to the amendment offered by Senator McCain which would recommit H.R. 3590, the Patient Protection and Affordable Care Act, to the Senate Finance Committee with instructions to remove important Medicare provisions.

Much of the rhetoric from opponents of health care reform is intended to frighten our nation's seniors by persuading them that Medicare will be cut and their benefits reduced so that they too will oppose this legislation. The fact is that H.R. 3590, the Patient Protection and Affordable Care Act, does not cut Medicare benefits; rather it includes provisions to ensure that seniors receive high-quality care and the best value for our Medicare dollars. This legislation makes important improvements

to Medicare which are intended to manage costs by improving the delivery of care and to eliminate wasteful spending.

The National Committee opposes any cuts to Medicare benefits. Protecting the Medicare program, along with Social Security, [Page: S12051]

has been our key mission since our founding 25 years ago and remains our top priority today. In fact, these programs are critical lifelines to today's retirees, and we believe they will be even more important to future generations. But we also know that the cost of paying for seniors' health care keeps rising, even with Medicare

paying a large portion of the bill. That is why we at the National Committee support savings in the Medicare program that will help lower costs. Wringing out fraud, waste and inefficiency in Medicare is critical for both the federal government and for every Medicare beneficiary.

The Senate bill attempts to slow the rate of growth in Medicare spending by two to three percent, or not quite $500 billion, over the next 10 years. However, it is important to remember that the program will continue growing during this time. Medicare will be spending increasing amounts of money--and providers will be receiving increased reimbursements--on a per capita basis every one of those years, for a total of almost $9 trillion over the entire decade. Even with the savings in the Senate

bill, we will still be spending more money per beneficiary on Medicare in the coming decades, though not quite as much as we would be spending if the bill fails to pass.

America's seniors have a major stake in the health care reform debate as the skyrocketing costs of health care are especially challenging for those on fixed incomes. Not a single penny of the savings in the Senate bill will come out of the pockets of beneficiaries in the traditional Medicare program. The Medicare savings inclued in H.R. 3590, the Patient Protection and Affordable Care Act, will positively impact millions of Medicare beneficiaries by slowing the rate of increase in out-of-pocket

costs and improving benefits; and it will extend the solvency of the Medicare Trust Fund by five years. To us, this is a win-win for seniors and the Medicare program.

The National Committee urges you to oppose the motion to recommit the bill to the Finance Committee with instructions to strike important Medicare provisions from health care reform legislation.

Cordially,

Barbara B. Kennelly,

President & CEO.

5:12 PM EST

Chris Dodd, D-CT

Mr. DODD. Thirdly, I wish to commend our colleague from Maryland, Senator Mikulski. Again, a lot has been said about her proposal dealing with women's health. Consider these two statistics as we try to get this right: Less than half the women in the United States have the option of obtaining health insurance through a job--less than half. They are forced either to purchase expensive insurance in the individual market or are dependent upon a spouse to provide health care.

Right now, today, whether you are a Democrat, Republican, conservative, liberal, whether you live in Connecticut, Texas or Minnesota, consider this: A healthy 22-year-old woman can be charged insurance rates 150 percent higher than a 22-year-old man in a similar condition. Our bill before us ends that--ends that. If you defeat the Mikulski amendment or recommit this bill, remember tonight or tomorrow, when the vote occurs, that 22-year-old woman and that 22-year-old man have a differential as

much as 150 percent in health care premiums. That is what happens at this very hour. The Mikulski amendment changes that as well in our bill, among other things.

Lastly--and then I wish to turn to my colleague from Minnesota--just to remind my colleagues, again, what Senator Baucus has done with his committee in the Finance Committee and what we did in the HELP Committee to provide some meaningful advantages and help to people across this country immediately. One, our bill will provide $5 billion in immediate Federal support for a new program to provide affordable coverage to uninsured Americans with preexisting conditions. Coverage under this

program will continue until the new exchanges are operating over the next few years.

Secondly, the bill creates immediate access to reinsurance for employer health care plans providing coverage for early retirees. Again, this will help protect coverage, while reducing premiums for employers and their retirees.

The bill also reduces the size of the doughnut hole immediately by raising the ceiling in initial coverage by $500 in 2010, the coming year--immediately. This will guarantee a 50-percent price discount on brand-name drugs and biologics purchased by low- and middle-income beneficiaries in the coverage gap. That is immediate.

Fourth, our bill will offer tax credits immediately to small businesses to make employee coverage more affordable. That is not a year or two or three from now, this is immediate. Tax credits of up to 50 percent of premiums will be available to firms that choose to offer the coverage as a result of the tax break.

Fifth, our bill will require insurers to permit children to stay on family policies until age 26. Right now, that ends at 23. Our bill extends it to 26 immediately, to have this benefit for people across the country who have families and children today who are staying home longer because of the absence of jobs out there for them.

Our bill will provide coverage for prevention and wellness benefits immediately and exempt these benefits from deductibles and other cost-sharing requirements in public and private insurance coverage. Not in a year, not 2 years, not 3 years but immediately when this bill becomes law.

Sixth, the bill would prohibit insurers from imposing lifetime limits on benefits and will restrict annual limits as well.

The bill also would prohibit group health plans from establishing eligibility rules of health care coverage that have the effect of discriminating in favor of higher wage employees.

In this bill, we also establish standards for insurance overhead to ensure that premiums are spent on health benefits. We also require public disclosure of overhead and benefit spending and require premium rebates from insurers that exceed established standards for overhead expenses.

Lastly, it would create new Web sites to provide information on a facilitated form of consumer choice of insurance options. And there are other immediate benefits to this legislation.

I think it is important, as we discuss the bill, that you understand there are substantial and meaningful improvements. We have debated this bill and debated these issues for months and months on end. The time has come to act. That is what we are proposing with this legislation.

With that, I appreciate the indulgence of my colleague from Minnesota. I yield to him for any additional comments he may wish to make.

5:17 PM EST

Al Franken, D-MN

Mr. FRANKEN. Mr. President, I thank Senator Dodd for his leadership on this bill. I want to talk about Senator Mikulski's amendment.

First, a little bit about some of the claims that have been made on the floor today about Medicare. Senator Dodd pointed out that in the Bush budget--the last Bush budget--there was a bigger cut to Medicare, but not in the context of any kind of health care reform. Senator Baucus said it so well about what the cuts are. They are to hospitals, and the hospitals are fine with it. They are not jumping-up-and-down excited about it, but they are fine with it because it comes in the

context of health care reform.

We are covering 30 million more people. What does that mean to hospitals? When people come into the emergency room, they have coverage. The hospitals get paid. That is the context in which we are doing this; whereas, when President Bush was proposing those kinds of cuts, they were not in the context of insuring 31 million more people. When the uninsured were going into emergency rooms for the most inefficient care possible--and won't be now--it was costing every American family $1,100 in additional

insurance costs. So they are comparing apples and oranges. We are doing so many things, and Senator Dodd talked about some of the things this bill does. I want to talk about Senator Mikulski's amendment, because women are among the most severely disadvantaged in our current health care system. Right now, health insurance companies can and do discriminate against women solely on the basis of their gender.

Right now, it is legal in many States--again, not in all States, and this is why, when you are talking about getting health insurance from another State, you have to be careful. In Minnesota, we have stronger regulations. In other States, you don't. In many States, it is legal to charge women higher premiums, or deny them coverage at all, if they have had a C-section. It is a preexisting condition. If they have been the victim of domestic violence--in many States in this country an insurance

company can deny a woman coverage because she has been the victim of domestic violence, because it is considered a preexisting condition. That is wrong.

I am immensely pleased that under this bill, for the first time, women will have access to comprehensive health [Page: S12052]

benefits, including maternity care, without having to pay more than their male counterparts. But we can do even more for women's health in this country.

Senator Mikulski's amendment improves the bill to make sure women can get the preventive screenings they need to stay healthy. Most important, the amendment will make sure that women have access to these lifesaving screenings at no cost. So it doesn't interfere with a woman and her doctor, as my distinguished colleague from Texas said a few minutes ago. It makes these screenings available at no cost. Why is this important? Because right now, women are delaying or skipping preventive

health care because they cannot afford it. That is not just bad for women's health, it is bad for our system because it drives up costs unnecessarily. Even in Minnesota, where we generally do a good job at health care, there are women right now who are not getting the care they need. They are skipping their annual exam because they are uninsured. Women who are uninsured are twice as likely not to get the care they need.

Other women in Minnesota simply cannot afford the coverage they have now. Since 2007, the number of women who have delayed or avoided preventive care because of cost has doubled. The economic crisis has only made things worse. But the economic situation is no excuse. The reality is that women are forgoing preventive services that could save their lives because of the way insurance works now.

Make no mistake what that is about. From 2000 to 2007, the health insurance companies saw their profits increase 428 percent. Women are forgoing preventive measures that could save their lives. Is this the kind of country we want to live in?

There was some good news yesterday. The CBO confirmed what many of us already knew--that with the insurance market reforms and subsidies in our bill, women will be able to purchase better coverage at a lower cost than they would be paying without the bill. That is huge. With Senator Mikulski's amendment, we will go even further, guaranteeing that women receive preventive care when they need it, without barriers. These screenings catch potential problems such as cancer as early as possible.

This saves lives and, by the way, it saves money.

For example, cervical cancer screenings every 3 to 5 years could prevent four out of every five cases of invasive cancer. Regular screenings could prevent more than half of the cases of infertility. Senator Mikulski's amendment will give women the care they need when they need it. This is a huge step forward for justice and equality in our country.

It is also a top priority for me that health reform includes another crucial women's health service, which is access to affordable family planning services. These services enable women and families to make informed decisions about when and how they become parents. Access to contraception is fundamental, a fundamental right of every adult American, and when we fulfill this right, we are able to accomplish a goal we all share--all of us on both sides of the aisle to reduce the number of unintended

pregnancies. And so I believe that affordable family planning services must be accessible to all women in our reformed health care system.

We can't wait any longer, and I urge all of my colleagues to stand up with us and support this amendment.

5:25 PM EST

Al Franken, D-MN

Mr. FRANKEN. My apologies to Senator Dodd. I guess I, as a freshman, am not necessarily familiar with all the rules. I think that means I must yield the floor, is that right?

5:25 PM EST

John Cornyn, R-TX

Mr. CORNYN. Mr. President, I want to talk principally about the Medicare cuts in this bill and make sure that people understand the context in which this takes place and what it means in terms of benefits for seniors.

There has been a lot of parsing of language here in a way that I think can perhaps obscure the real impact of these proposals.

First, let me say there is broad agreement that our health care system needs reform. But I thought the purpose of that reform was to lower costs and make it more affordable--not raise premiums, raise taxes, and cut Medicare benefits.

Again, I say to our friends across the aisle, no one wants the status quo. But it is clear that our friends across the aisle are not interested in any proposals from this side of the aisle, as demonstrated by the party-line votes in the HELP Committee and the Finance Committee, and the product coming from the House of Representatives.

This is simply too important to do on a purely partisan basis. Yet that seems to be the intention of the majority. The American people want us to get this right because they understand this impacts 17 percent of our economy, and it affects all 300 million of us. This is important to them. As they have watched these debates and proposals, as they have learned more about them, it is no mystery why public opinion for these proposals has dropped like a rock. Again, it has dropped like a rock.

First of all, on cost, they realize that the proposals as made have masked the true cost of this bill, and there was celebration when the bill came in under $900 billion. Forget the fact it doesn't actually go into effect until 4 years into the 10-year budget window, so it was only 6 years of implementation; and never mind that it didn't include reversing the 23-percent cut in physician payments that go into effect at the first part of next year, unless Congress acts. That was left out intentionally

to make this look cheaper than it is.

The Senate Budget Committee has pointed out that this bill, when fully implemented, would cost the American people $2.5 trillion. I have constituents who asked me: Do you know what a trillion dollars is? They say: I don't know. We used to talk about a million dollars being a lot of money, and then a billion dollars. Now we are into the trillions--hence, the bumper sticker ``don't tell Congress what comes after a trillion,'' for fear we will spend it.

This bill, written by the majority leader behind closed doors, increases taxes by nearly $ 1/2 trillion on American families and small businesses during the worst recession we have had since the Great Depression. Unemployment is 10.2 percent, and it is perhaps headed higher. This bill proposes to make it harder on businesses to retain employees, or perhaps maybe someday hire employees and bring down that unemployment rate.

This is a job-killing bill. That is why the American people, the more they learn about it, like it less and less. I predict that the longer this debate goes on, the more they learn about it, the less they will find to like about the bill for that and many other reasons.

This bill also, according to the CBO, increases health insurance premiums by $2,100 for American families purchasing insurance on their own. If you are fortunate and you have large group coverage, it is a little better. But for the millions who are not, it increases the cost of their insurance by $2,100 a year.

I want to focus primarily on the cuts in Medicare. When our colleagues celebrate the fact that this comes back budget neutral, let me explain that mystery. That means you have raised taxes so much and cut Medicare benefits so much, you can claim it is budget neutral. I daresay that is not cause for celebration. In order to create a $2.5 trillion new entitlement program--and that is what this is, at a time when the unfunded liabilities of our current entitlement programs go somewhere into the

$40 trillion to $60 trillion range--this bill actually cuts $465 billion in payments from Medicare. These cuts include $135 billion to hospitals; $120 billion from 11 million seniors on Medicare Advantage, including a half million--or to be more precise, 523,000 Texans who depend on Medicare Advantage will see a cut in benefits because of this proposal if it passes.

Mr. President, $15 billion will be cut from nursing homes, $40 billion will be [Page: S12053]

cut from home health agencies and $8 billion from hospice care.

You can try to parse those words and say we really are not cutting Medicare, but we are cutting Medicare Advantage. Indeed, the Obama administration's own Actuary at the Center for Medicare and Medicaid Services said Medicare cuts of this size would hurt seniors' access to care for several reasons.

First, let me start with Medicare Advantage. Medicare Advantage provides benefits over and above Medicare fee for service. But I think we need to understand that with regard to Medicare fee for service in my State, the last time I checked, 42 percent of physicians will not see a new Medicare patient because the payment rate is too low for the doctors to be able to break even or maybe perhaps earn a small profit. Again, 42 percent of Medicare patients are denied access to a doctor in my State

because Medicare payments are so low.

What we did a few years ago was pass the Medicare Advantage Program, which was created to give seniors choice. In other words, there has been so much celebration of the public option or the government-run plan. We have a government-run plan now--Medicare fee for service, which has, depending on where you read, somewhere between an 8- to 12-percent faulty payment rate. In other words, it pays somewhere around 7.8 to 12.4 percent of bills it does not owe to people who do not deserve it, diverting

that money away from payment for beneficiaries.

We decided a few years ago to give Medicare beneficiaries a choice--something I thought we all were for--a choice that provided better care coordination and better benefits. Today, 11 million seniors, including the 532,000 I mentioned in Texas, have chosen Medicare Advantage. But this bill, if passed in its current form, will take away health care benefits from those 11 million seniors on Medicare Advantage by cutting $118 billion from the program.

During the Finance Committee markup, the Congressional Budget Office acknowledged that Medicare Advantage cuts would mean fewer services, such as dental or vision.

Senator MIKE CRAPO asked this question:

So approximately half of the additional benefit would be lost to those current Medicare Advantage policyholders?

Congressional Budget Office Director Doug Elmendorf said:

For those who would be enrolled otherwise under current law, yes.

So approximately half the additional benefit would be lost to those current Medicare Advantage policyholders.

What happened to the President's promise that if you like what you have now, you can keep it? This is another example of a promise that breaks under this bill, in addition to the $2,100-per-family premium increase for those who buy their insurance on the individual market.

Despite the fact that this bill cuts $465 billion from the Medicare Program, it also fails to deal with draconian cuts that will go into effect in January, unless Congress acts, which will further ensure that seniors will be less likely to see a doctor in 2012. We all know this is sometimes called the doc fix, but this is basically a misguided decision Congress made back in the late nineties to cut provider benefits, thinking that they could do so and it would not have any impact on access to

care. But what it has done is while on one hand Congress can stand here and say: Yes, we kept our promise to seniors by providing Medicare coverage, seniors are finding it harder and harder to find a physician who will actually see them because of those low reimbursement rates. This bill does nothing to cut the 23-percent cut in those benefits in 2012 which will have an extremely negative impact on seniors' ability to see a doctor.

We know the majority leader tried, on a standalone bill, to address this issue earlier. But it was not paid for. On a bipartisan basis, Senators in this body rejected sending a bill for $200 billion more to our children. We said we need to be responsible and pay for the bill.

Then the President said health care reform would be paid for by dealing with waste, fraud, and abuse in Medicare. But that is not what this bill does. The Congressional Budget Office said the Reid bill only saves $5.9 billion from reducing waste, fraud, and abuse--$5.9 billion in a bill which over a full 10 years of implementation will cost the American taxpayers $2.5 trillion.

Instead of cutting Medicare, we should be addressing this problem. We know it is a serious problem. The Obama administration found that there was at least $47 billion in Medicare fraud, and that is a conservative estimate. According to Harvard professor Malcolm Sparrow, Medicare fraud may consume as much as 15 to 20 percent of the $454 billion Medicare budget. That means the amount lost to fraud each year in Medicare alone is $70 billion to $90 billion. As I mentioned, improper payment rates,

depending on where you look, range anywhere from 7.8 percent of all Medicare payments paid improperly to as much as 12.4 percent, depending on where you look.

Defrauding Medicare has become so lucrative that even the Mafia and other organized criminals are getting into the act. According to the Associated Press last month, members of a Russian-Armenian crime ring in Los Angeles were indicted for bilking Medicare of more than $20 million, and a week after the FBI issued search warrants for a Medicare fraud investigation in Miami, the body of a potential witness was found in the backseat of a car, riddled with bullets.

Earlier this year, I introduced a bill which I hope our colleagues on the other side of the aisle will look at as a way to change the paradigm in terms of the way we address this problem of Medicare fraud. Rather than the pay-and-pursue model, we would have a model which would actually detect potential fraud on the front end by certifying payees and otherwise making sure that money is spent properly. We need to implement commonsense solutions such as this to fix fraud in Medicare before we simply

cut in half or cut $ 1/2 trillion out of benefits in provider benefits to create a new entitlement.

We all understand Medicare is in miserable shape financially--miserable shape. If nothing is done, Medicare will go broke in 2017, according to the Medicare trustees. The Medicare part of entitlement problems has unfunded liabilities--promises Washington made but cannot keep and does not know how to pay for, nearly $38 trillion. Mr. President, $38 trillion is more than three times the current national debt of $12 trillion, and $38 trillion translated into the burden on every American family means

that each American family owes $322,000--more than most American families' homes are worth.

The bottom line is, it is simply irresponsible, without fixing Medicare, without fixing the fraud and the waste--which I know the Presiding Officer is as concerned about as I am--and without dealing with the fact that Medicare promises coverage but denies access because of low payments, to pillage nearly $ 1/2 trillion from the bankrupt Medicare program to create a new budget-busting entitlement program.

There had been some talk on the floor about earlier attempts to reduce the rate of growth of Medicare. Interestingly, back in 2005, when there were some proposals to do just that--but, frankly, the numbers paled in comparison: about $10 billion in cuts compared to $500 billion in cuts--the majority leader called those cuts immoral. I have a long list of comments made by our friends across the aisle which stand in stark contrast to the comments they are making today.

Frankly, we need to do something about the insolvency of Medicare. Even if we did not do anything else, that would be a great benefit to the seniors to whom we promised health coverage but who are currently denied coverage because of the problems I talked about.

I know the distinguished chairman of the Finance Committee talked about the sterling endorsements that come from a variety of Washington-based advocacy groups. One of them is the AARP, the American Association of Retired Persons.

Mr. President, I ask unanimous consent to have printed

in the Record an article about AARP dated October 27 at the conclusion of my comments.

5:42 PM EST

John Cornyn, R-TX

Mr. CORNYN. Mr. President, what this article demonstrates is that one reason AARP might be opposed to maintaining Medicare Advantage and [Page: S12054]

be for the cuts in benefits to current Medicare Advantage beneficiaries is because that group and its subsidiaries collected more than $650 million in royalties and other fees last year from the sale of insurance policies, some of which are designed to fill that gap between Medicare fee for service and what it actually

costs to get to see a doctor. It is a conflict of interest for this association. Frankly, I don't think its endorsement is worth the paper it is written on, just like other associations that, contrary to the best interests of their members, have made a deal that is bad for the American consumer. The American consumers know it.

They know a bad deal when they see it--a deal that includes increased premiums, higher taxes, and cuts in Medicare. Frankly, I think those people with such glaring conflicts of interest should not be in the position of trying to endorse something that is basically going to enrich them to the detriment of the American people.

I plan to offer amendments about this bill's provisions as currently proposed to cut $ 1/2 trillion from the Medicare Program. My first amendment would make Medicare play by the same financial solvency rules as private insurers.

We hear our friends on the other side of the aisle talk about insurance companies. I have no doubt that their desire is, frankly, to do away with private sector involvement in the health coverage field, which leaves, of course, only the Federal Government--ultimately a single-payer system making decisions out of Washington, DC, that affect the health care delivery of 300 million people--a bad idea.

My first amendment would make Medicare play by the same financial solvency rules as private insurers. Because private insurers are owned by their shareholders and have fiduciary responsibilities, they could not do business the way Medicare does. They could not tolerate high fraud, waste, and abuse rates. They could not function based on the same risk-based capitalization that private insurance companies do. My amendment would ensure that before we pillage $ 1/2 trillion from the Medicare Program

to pay for yet another unsustainable entitlement program, the Medicare Program should be able to meet the same solvency and risk-based capitalization requirements private insurance plans meet.

My second amendment will be to strike the unelected, unaccountable board of bureaucrats known as the Medicare advisory board.

We have heard this Medicare advisory board extolled, but this is the same kind of unelected, unaccountable board that we saw just a couple of weeks ago issued a new order or recommendation on mammograms based on cost-benefit, which would have condemned some women between the age of 40 and 49, denied them access to a mammogram and, frankly, condemned them to an early, premature death because of breast cancer. When you put all the power to determine the coverage and also payment in an unelected,

unaccountable board, such as the Medicare advisory board, then, frankly, you are going to get more of that rationing and that same sort of cost-benefit analysis which is going to consign too many Americans to a premature death because, frankly, the Federal Government doesn't care and is not going to see them get access to care.

After the Reid bill pillages $465 billion from the Medicare Program to create a new entitlement, it sets up this new Medicare advisory board, an unaccountable board of bureaucrats, to find more ways to cut billions of dollars from Medicare. Unsurprisingly, patients, providers, and even Congress don't always agree with experts, including the ones we have in place today. According to the Wall Street Journal, the Medicare Payment Advisory Commission, created by Congress in 1997, has recommended

more than $200 billion in cuts in the last year alone, which lawmakers--that means Congress--has ignored.

Artificial and arbitrary budget targets leave little room for innovation as well. What if we were to find a cure for Alzheimer's in 2020 but because it would be too expensive, the Medicare advisory board would say the Federal Government is not going to pay for it?

Some have said this independent board would be a way to insulate Medicare payment decisions from politics. But the very creation of the Board was the result of a political deal with the White House that insulated hospitals from future cuts.

I wish to close by saying I hope my colleagues will reconsider and vote for the McCain amendment, which will reverse the pillaging of $ 1/2 trillion from the Medicare Program to create a new entitlement program. We should fix Medicare's unfunded liabilities of nearly $38 trillion and not steal from Medicare to create another unsustainable entitlement program that will, of course, have to be paid for by our children and grandchildren on top of all the other debt we are piling on them. At a time

of insolvent entitlement programs, record budget deficits, and unsustainable national debt, this country simply cannot afford to spend $2.5 trillion on an ill-conceived Washington health care takeover.

I yield the floor.

Exhibit 1

5:48 PM EST

Max Baucus, D-MT

Mr. BAUCUS. Mr. President, I understand we have several Senators who wish to speak. First, the Senator from Michigan, Ms. Stabenow, then Senator Hatch; Senator Cardin would be third. I don't want to tread on any toes. I say to Senator Cardin, there is a little bit of time constraint.

We are alternating. We are respecting the alternating back and forth.

The Senator from Michigan is next, Ms. Stabenow.

5:49 PM EST

Debbie Stabenow, D-MI

Ms. STABENOW. Mr. President, I, first, thank our distinguished leader on the Finance Committee. It is my pleasure to serve on the Senate Finance Committee. We have been working on this issue for well over a year--2 years now. I very much thank the Senator from Montana and appreciate his leadership in getting us to this point because I don't think we would have been here without his leadership. I very much appreciate that, as well as our leader, Senator Reid, who has worked tirelessly,

and, of course, the Senator from Connecticut, Mr. Dodd, and Senator Harkin from Iowa as well. We certainly appreciate their leadership.

The bottom line of the legislation in front of us is very simple. On behalf of the American people, we have put forward a health care reform bill that will save lives, it will save money, and it will save Medicare. It does that in multiple ways.

I wish to spend just a few moments this evening talking about Medicare because there is a very significant amendment in front of us that would undercut what we are trying to do to save Medicare. As we go through this next debate, as I have done many times, I am going to continue to talk about the ways in which we are saving lives and saving money.

The reality is, Medicare is a sacred trust with America's seniors, with people with disabilities. Our health care reform efforts, both in the House and the Senate, will help ensure that trust is never broken. That is what this is all about. In fact, I don't think I could look my 83-year-old mother in the eye, knowing how much she has benefited from Medicare, and be doing anything that would weaken Medicare--now or on into the future.

We are going to extend Medicare solvency while providing better, more affordable care for America's seniors and people with disabilities. In fact, we are going to add 5 years to the Medicare trust fund solvency, which is extremely important. In the long run, I expect, as we go forward, as we bring down costs, as we save money, we will, in fact, be adding years to the trust fund by what we are doing.

We are going to crack down on waste, fraud, and abuse in the Medicare Program and wasteful overpayments to insurance companies through a Medicare Advantage effort that essentially was set up to privatize Medicare--turn it over to primarily for-profit insurance companies.

Reform is going to make sure we have more affordable services for seniors. We are going to begin to close that doughnut hole, a gap in prescription drug coverage, right now. It was passed a number of years ago--and I might indicate not paid for--and our effort is entirely paid for. It does not add a dime to the national debt. In fact, it brings down the deficit. But we are closing a gap in coverage on prescription drugs by 50 percent. We are going to phase that in. We are going to keep going

until we get that completely closed.

We are going to make sure preventive services do not have a cost connected with them--no deductible, no copay. We want people to be getting the cancer screenings, the mammograms, the wonderful colonoscopies, the other preventive services people need, as well as being able to have a yearly physical with their physician, without deductibles and copays. We are going to aggressively attack fraud and abuse that raises Medicare costs for seniors and for taxpayers.

Reform is also about improving quality of care. It will move Medicare toward a system of rewarding high-quality care, investing in innovations, more efforts in primary care, family doctors, better coordination of care, cutting down on duplication of tests and bureaucracy and all those things we so frequently complain about in the Senate--as we should.

It is going to make long-term care services more affordable. There is such a growing demand and need for long-term services.

It is going to eliminate the imminent physician payment cut that threatens to stop seniors from having full choice of seeing their own doctor. As my colleagues know, I am deeply committed to permanently fixing a flawed physician payment system, but in this bill we make sure the 21-percent cut that is scheduled to take place next year does not take effect, and we will continue. We are committed to working until we completely solve this problem.

It is not a surprise our Republican colleagues are opposing a plan that actually protects Medicare, it actually protects Medicare benefits for seniors, people with disabilities, and keeps Medicare finances in the black for 5 additional years. Just months, 7 months ago, nearly 80 percent of the Republican House Members voted to end Medicare as we know it by turning it into a voucher program that provides a fixed sum of money to pay to private insurance companies, which, by the way, has led--we

are now trying to fix overpayments to private for-profit

insurance companies at the expense of Medicare and services for seniors.

A top AARP policy official called this scheme that was supported by 80 percent of the House Republicans, just 7 months ago--called this scheme ``a very dangerous idea,'' saying it would raise costs for all beneficiaries and lower the quality of care for less-affluent seniors, lower income seniors.

Now faced with a plan that actually strengthens Medicare, actually saves Medicare for the future and makes sure money goes to Medicare beneficiaries rather than to insurance companies in high payments, some colleagues are pulling out all the stops to defend the health care status quo that sends hundreds of billions of dollars in overpayments to private insurance companies. That is, unfortunately, the result of the McCain amendment, which I strongly oppose. [Page: S12056]

Many Republicans are resorting to traditional scare tactics and falsehoods, myths. We have heard this over and over. You can go to the AARP Web site and see the fact that, time after time, they have put up falsehoods to try to scare seniors, which I think is outrageous. For proof of how politically motivated these attacks are on the President's proposal and our proposals to eliminate waste and insurance company overpayments in Medicare Advantage, you have to look no further than the fact that

a group of Republican Senators actually introduced a similar proposal as recently as this past May.

These kinds of distortions, the fear tactics that have been used, would be offensive under any circumstance, but they are especially disingenuous coming from a group of people who have a long history--a party that has a long history of opposing Medicare and that very recently tried to kill the program as we know it. Their most recent assault was just the latest in a war that Republicans have been waging on the program since the beginning when a majority of them voted no on even establishing Medicare.

The overwhelming majority of Republican colleagues voted no.

Last time we had a Democratic President, leading Republicans across the country launched a vicious attack on Medicare. They bragged about opposing the creation of the program in the first place. They called for huge cuts to Medicare and even the ``elimination'' of entitlement programs such as Medicare, as we know them. One even blamed seniors' greed for Medicare's budget problems.

As we now debate this issue, I find it so interesting that colleagues on the other side of the aisle are indicating that, after years of history of trying to cut, eliminate, change Medicare, Republicans having voted against even establishing Medicare, that somehow they are now the protectors of Medicare. As AARP has said, there is nothing in this proposal that is going to cut benefits or increase out-of-pocket costs for seniors. They would not be supporting the efforts we have been involved with

if, in fact, it did. I think we all know that.

President Obama and the Democratic majority in this Congress are committed to protecting and strengthening Medicare, a program we created--I should say my predecessors. I was not here. I was not fortunate enough to be here, but it was Democrats who created that program. I am very proud of it because it is one of the great American success stories, Medicare and Social Security. It is a sacred trust with our seniors, and our health insurers reform plan will ensure that trust is never broken.

Health care reform is about saving lives, saving money, and saving Medicare.

I yield the floor.