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

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

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

Motion to Recommit

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

[Rollcall Vote No. 319 Leg.]

YEAS--33

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

NAYS--65

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

NOT VOTING--2

Byrd
Kerry

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

Unanimous Consent Request--H.R. 3548

Mr. REID. Madam President, I ask unanimous consent that the Senate
proceed to the immediate consideration of H.R. 3548, which was received
from the House. I further ask unanimous consent that a Reid substitute
amendment which is at the desk be agreed to; the bill, as amended, be
read a third time and passed; the motion to reconsider be laid upon the
table, with no intervening action or debate, and that any statements
relating to the bill be printed in the Record.
The PRESIDING OFFICER. Is there objection?
Mr. KYL. Reserving the right to object.
The PRESIDING OFFICER. The Senator from Arizona.
Mr. KYL. Madam President, it is my understanding that we received
this an hour and a half ago. I have no doubt at the appropriate time we
will be able to work out some kind of agreement. But our side is going
to need some time to look at it. We will need some Republican ideas or
amendments as well, and we will need a CBO score.
At this time, I will have to, on behalf of Members on our side, pose
an objection.
The PRESIDING OFFICER. Objection is heard.
Mr. REID. Madam President, if I can just say--and I know others wish
to speak on this issue--we have found a new stalling tactic. It is
pretty new. It is CBO. Now I am sure everything is going to be ``CBO.''
I am sorry the consent request was not granted.
The PRESIDING OFFICER. The Senator from Vermont.
Mr. LEAHY. Madam President, I was going to call up an amendment, but
I think the Senator from New Hampshire wishes to speak. I ask unanimous
consent that the Senator from New Hampshire be recognized and I be
recognized after her.
Mr. REID. Madam President, if I may ask my friend, the chairman of
the Finance Committee, does he wish to speak?
Mr. BAUCUS. That is correct, 2 minutes.
Mr. REID. Why don't we let the chairman of the Judiciary Committee go
for 30 seconds to offer an amendment.

[[Page S10285]]

I ask unanimous consent that Senator Baucus be recognized following
Senator Leahy and then Senator Jack Reed.
Mr. REID. And then Senator Shaheen.
The PRESIDING OFFICER. Is there objection to the leader's request?
Mr. GRAHAM. Reserving my right to object, and I don't intend to, I
would advise my colleagues that somewhere in this line, I need a minute
to call up an amendment I wish to have pending.
Mr. REID. Why don't you do that--you will have a minute following
Senator Leahy.
The PRESIDING OFFICER. Without objection, the Senator from Vermont is
recognized for 30 seconds.

Amendment No. 2642

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

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

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

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

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

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

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

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

Amendment No. 2669

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

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

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

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

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

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

[[Page S10286]]

As with the other seven bills that have come before the Senate for
consideration to date, the committee supported their recommendations
unanimously, and the bill was reported out of the Appropriations
Committee on June 25 by a recorded vote of 30 to 0.
This bill has been available for review by members for more than 3
months, so if a Member has an amendment, they should be willing to come
to the floor today and offer it. At this point, it makes no sense for
Members to delay.
Vice Chairman Cochran and I, along with the other subcommittee chair
and ranking members have worked diligently to restore regular order to
the appropriations process. We have come a long way in responding to
what was asked of us at the beginning of the year.
But for us to succeed, it takes the cooperation of all Members of the
Senate. Therefore, I strongly encourage my colleagues not to delay
action on this bill.
Mr. LEAHY. Mr. President, I am pleased to cosponsor today an
amendment to require the antitrust division of the Department of
Justice to carry out oversight, information-sharing, and joint
activities concerning competition in the agriculture sector. Our
Nation's antitrust laws exist to promote competition, which ensures
that consumers will pay lower prices, and receive more choices of
higher quality products. The Department of Justice is charged with
enforcing these antitrust laws. Yet there are few industries in which
there are more serious concerns about the state of competition than the
agriculture sector. Small farmers are suffering because the prices they
can charge for many of their products continues to decline, and the
level of concentration throughout the industry could have a negative
long-term impact on the prices that consumers pay and the choices they
have.
Since first coming to Washington, I have fought to help our family
farmers by ensuring a level playing field in American agriculture. The
consolidation in recent years throughout the agriculture sector has had
a tremendous impact on the lives and livelihoods of American farmers.
It affects producers of most commodities in virtually every region of
the country, and in my home State of Vermont, it affects dairy farmers.
Farmers need a fair opportunity to compete in the marketplace and we
must prevent giants in corporate agriculture from repeatedly hurting
them with unfair, discriminatory, deceptive, and anticompetitive
practices.
I held a field hearing last month in Vermont to assess competitive
issues in the dairy industry. During that hearing, we heard from
officials from the Department of Justice and the United States
Department of Agriculture. We also received first hand testimony from
farmers whose businesses are suffering at the hands of large
distributors. This crisis is real, and the Department of Justice has
pledged to take a renewed look at competitive issues in the agriculture
sector as a whole. This amendment is another step to help ensure that
competition exists in the agriculture sector.
Mr. GRAHAM. Madam President, this amendment is simple, direct, and to
the point. It would prohibit the use of funds for the Department of
Justice to prosecute the perpetrators of 9/11 in article III courts.
What does that mean? That means that Khalid Shaikh Mohammed, and
people like him, who organized the attacks against our Nation on
September 11, 2001, would be tried by military commissions, not Federal
courts. They are not common criminals, they are war criminals. They
should be tried in a military setting, like other people throughout the
200-year history of this country have been tried regarding acts of war
against the United States.
The military commissions have been reformed. Thanks to Senator Levin
and others, we have a great process that I would not mind our own
soldiers being tried in. At the end of the day, we need not criminalize
this war. There is a law of armed conflict awaiting the defendants that
is fair and it is robust. It has adequate due process, but it
recognizes we are at war. And military commissions have been used
throughout the history of this country. They are better able to protect
classified information.
We need to be consistent. The people who planned the attacks of 9/11
are not common criminals. They are people who have taken up arms
against the Untied States, and they should be adjudged accordingly in a
military tribunal, which I think we have now designed as the best in
the world.
There will be more to follow in this important debate.
With that, I yield the floor.
The PRESIDING OFFICER. The Senator from Montana.
Mr. BAUCUS. Madam President, what is the parliamentary situation?
What is pending?
The PRESIDING OFFICER. The Graham amendment is pending to the CJS
appropriations bill.

Unemployment Insurance Extension

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

[[Page S10287]]

gets spent immediately on necessities. People who are out of work need
this money to help pay the rent, pay their mortgages, buy food, pay for
gas. Extending unemployment benefits is one of the most effective
actions we can take to help get this economy moving again, and I urge
my colleagues to support this important extension and to quickly pass
this critical legislation.
Madam President, I yield the floor.
The PRESIDING OFFICER. The Senator from Rhode Island.
Mr. REED. Madam President, I commend Leader Reid and Chairman Baucus
for the work they have done to get this bill to the floor. I also
commend Senator Shaheen for her valuable contribution to moving this
forward.
I am disappointed, to say the least, that we cannot move this
legislation quickly. There are millions of Americans who are looking at
the prospect of losing their unemployment compensation, others who have
already lost it and, frankly, millions who may be working but, sadly,
may qualify shortly for unemployment compensation.
As my colleagues have pointed out, there are six job seekers for
every job. This unemployment crisis will continue, and the least we can
do is to provide people with some support while they look for jobs and
try to maintain their families.
One point I wish to make--which should be very clear--is that this
legislation is fully paid for. This is not something that requires a
CBO score in order to determine how it is used and what the cost will
be and how it will be paid for. It is paid for by a continued extension
of the FUTA surtax for a year and a half--through 2010 and the first
six months of 2011. So this is responsible legislation as well as
critically important legislation.
Again, as my colleagues indicated, this legislation will provide an
additional 14 weeks of unemployment insurance benefits throughout the
country. But as we have done on numerous past occurrences, it will
recognize that even though there is pain everywhere, the pain is not
distributed equally. There are States, such as my home State, where the
unemployment rate is extraordinarily high. It is a critical need in
Rhode Island where the unemployment rate is nearly 13 percent. So for
those States, there will be an additional 6 weeks, for a total of 20
weeks, for all States with an unemployment rate of 8.5 percent or
above.
This has to be done quickly, because as we speak there are 5.4
million Americans who have been unemployed for 6 months or more. There
are signs that the economy may be recovering--credit markets, equity
markets--but the unemployment markets still remain, unfortunately, in a
deep decline. We are trying all we can do to reverse that, but in the
interim we have to be able to give people a chance to simply get by,
and that is what this does.
We are poised to pass this, and this unnecessary delay is not only
inappropriate but inexcusable. This is something that affects every
State in the country and it affects people who have worked hard all
their working lives and now face unemployment, many for the first time.
The psychological shock is great. Add to that the financial reality
that they can't pay their bills, they can't pay the mortgage, and that
adds another problem which I think cries out for immediate action, not
waiting for a score from CBO, not waiting to see if there is something
ancillary to this that could be attached. This is a time and a moment
to meet the needs of the American public, to do so responsibly--and we
have because it is fully offset--and not to delay. I urge the speedy
passage of this critical legislation. I hope Leader Reid will be
prepared to make a UC the next time we are convened and that at that
time this measure can be passed unanimously.
Madam President, I yield the floor, and I suggest the absence of a
quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The legislative clerk proceeded to call the roll.
Mr. SCHUMER. Madam President, I ask unanimous consent that the order
for the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. SCHUMER. Madam President, I want to support the words of the
Senator from New Hampshire and the Senator from Rhode Island about
moving the unemployment insurance extension forward.
We all know that joblessness is a tremendous problem in this country.
We can argue about which States should get the unemployment benefits
and for how much time, but if you are unemployed, your household is 100
percent unemployed. It doesn't matter to you whether you are in a State
where it is a 6-percent or a 9-percent or a 12-percent rate. If you
have been looking for a job for 26 weeks, you are in trouble and your
family is in trouble.
It is hard to believe on an issue such as this, where you would think
there would be some comity--you know, I was on one of the TV shows with
the Senator from Texas and he agreed unemployment benefits should be
extended. We talked about it on that show. Yet we are now holding
things up. But people can't wait. They have food to put on the table;
they have families to keep together. They have a work ethic. When you
can't find a job, try as you might, it eats at you. It is one of the
great things about Americans.
I hope my colleagues will reconsider. I hope they will reconsider--
yes, because the politics is not on their side here, but more
important, because of the substance. We have the worst unemployment we
have had over a period of time since World War II, since the Great
Depression. We can debate what we should ultimately do. We have to do
more, in my opinion, to get this country out of the economic problems
in terms of jobs. We do not want to wait 2 or 3 or 4 years for
unemployment to gradually come down. We can debate all that. Should
there be a second stimulus? Should we do other things? What should we
do about highway building? Should we extend the home credit? These are
all legitimate considerations we should debate. There will probably be
some differences. But in terms of helping those unemployed, the vast
majority of whom are unemployed through no fault of their own, I don't
think there can be much of a debate. I don't think there will be much
of a debate. When it comes to the floor through the good efforts of the
Senator from Montana and the Senator from New Hampshire, my guess is it
will be overwhelmingly voted on.
Let's not delay. Let's move forward as quickly as we can to help
those who, through no fault of their own right now, cannot find a job,
try as they might themselves.
I yield the floor and suggest the absence of a quorum.
The PRESIDING OFFICER (Mrs. Shaheen). The clerk will call the roll.
The legislative clerk proceeded to call the roll.
Mr. DURBIN. I ask unanimous consent that the order for the quorum
call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. DURBIN. Is there a pending order of business before the Senate?
The PRESIDING OFFICER. The appropriations act is pending, and there
is an amendment pending to that.
Mr. DURBIN. Madam President, I rise to discuss an amendment I filed
that takes an important step to address the disturbing level of youth
violence in the city of Chicago. My amendment would allow the Attorney
General to dedicate up to $5 million from the Office of Juvenile
Justice and Delinquency Prevention to community-based, street-level
violence prevention efforts.
It breaks my heart to read the Chicago newspapers and see the stories
of senseless violence that occurs on a regular basis. Stories such as
that of Chastity Turner, a 9-year-old girl who was shot and killed last
June while she washed her pet dogs outside her home in Englewood. Or
Simeon Sanders, an Army soldier who was on furlough back home in the
south suburbs when he was fatally shot in front of a community center
this past July. Or 17-year-old Corey McClaurin, a high school senior
shot and killed by a gunman while sitting in his car just a few weeks
ago. Many of us have seen the shocking, startling videotape of the
beating death of 16-year-old Derrion Albert, buried in Chicago last
Saturday.
These stories simply overwhelm us. My heart goes out to the families
and all the loved ones grieving for their loss. No one ever should have
to face the tragedy of losing a child to such senseless violence.

[[Page S10288]]

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

Health care reform

Mr. BROWN. Madam President, I take the floor tonight with my
colleagues Senators Merkley, Stabenow, Udall of New Mexico, Casey, and
Whitehouse to talk about the public option and why the public option is
so important to our Nation and to improving our health care system. I
will speak for the first 10 minutes. Then I will turn to Senator
Merkley, who serves with me on the HELP Committee and has done such a
terrific job helping to write the health care bill. I wished to start
with something I have done for several weeks and that is to share
letters from people in Ohio who, by and large, have health insurance
they were satisfied with.
They thought they had a good health insurance policy. In these
letters, typically, people tell me when they get sick, they have very
costly health problems, long hospital visits, doctor visits, tests.
They end up losing their health insurance. The insurance company cuts
them off because they have become too expensive, which is not even
insurance. That has happened too many times. That is one of the reasons
this is so very important.
I know Senator Stabenow gets letters from Lansing and Detroit. I know
Senator Merkley gets the same kind of letters from Eugene and Portland,
from all over his State.
Joyce from Ottawa County, west of where I live on Lake Erie, writes:

I am a 77-year-old great-grandmother who knows how the
expenses of health care create a constant worry for families.
My oldest

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

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

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

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

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

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

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

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

FDR said:

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

It is time to try something different. The insurance industry has had
nearly a century to provide coverage to all Americans. It is safe to
say, if we rely on that industry to cover all Americans now, we will be
disappointed. If we rely on them to take charge of our health insurance
system, as they have now--if we rely exclusively on them, we will be
disappointed again.
We need a public insurance option, one that is designed to compete
fairly with private insurers but differs from them in two crucial
aspects. No. 1, the public plan will not pick and choose where to
locate. Instead, it will offer coverage in every corner of this
country--from the Presiding Officer's State of New Hampshire, to
Senator Merkley's Oregon, to Senator Stabenow's Michigan, to Ohio, and
to Florida--it will offer coverage in every corner of the country that
is affordable, continuous, and patient-focused. You do not see Medicare
turning down somebody for a preexisting condition like the insurance
industry habitually does in the country.
Second, if the public plan takes in more premiums than it needs, it
will return those dollars to enrollees. Not a dollar will go to Wall
Street, not another dollar will go to huge CEO salaries--more on that
in a moment--and not another dollar will go to massive ad campaigns.
For these and many other reasons, we need a public option. The public
option will protect the public from price gouging. It will protect the
public from rescission tactics. That is an insurance company word--
``rescission''--that disqualifies people who have insurance from
keeping their insurance. It will protect the public from insurance
loopholes that deny you coverage, deny you care, and deny you financial
protection. The public option will protect the public from premium
markups that pay for outrageous CEO salaries and sales trips to Tahiti.
I want to show, just for a moment, some of these CEO salaries for
2008. This is in millions, in case you cannot see that directly on the
chart: Aetna's CEO's salary, $24 million; CEO of CIGNA, $12 million;
CEO of Well Point, $9.8 million; CEO of Coventry--it is not even an
insurance company I am particularly familiar with--$9 million; CEO of
Centene, $8.8 million; CEO of AmeriGroup, $5.3 million; CEO of Humana,
$4.8 million; CEO of HealthNet, $4.4 million; CEO of Universal
American, $3.5 million; and the poor man or woman at UnitedHealth
Group, that CEO is only bringing in $3.2 million.
The point is, these CEO salaries are from these same companies that
turned down somebody in Findlay, OH, or denied care to somebody in
Warren, OH, because of a preexisting condition, or they take a patient
in Springfield, OH, who has been a little bit too expensive for their
company, and they have this cap on their insurance costs, this annual
cap, and they disqualify them from further care. They practice their
rescission in order to pay these kinds of CEO salaries.
The public option will also protect the public from insurance that is
unaffordable, unresponsive, and unreliable.
Our Nation should try something new when it comes to health reform,
something that gives Americans more options and the insurance industry
a reason to cut out the fat from health insurance premiums.
Some of my colleagues in Congress believe a public insurance option
will harm the private insurance industry. That industry, however, has
profited from competing with Medicare. Taxpayers did not profit from
that deal, but that is a story for another day.
The insurance industry profited from competing with Medicare, and it
will profit from competing with the public option. There is simply no
reason, when we have this competition, that the insurance companies
will not continue to make money. They are going to have 40 million new
customers--40 million new customers. Several million will join the
public option, to be sure. But these insurance companies will continue
to find a way to make money because they are competing. They will be
competing on a level playing field with the public option.
The insurance industry claims to be infinitely more cost-efficient
and capable than a public plan could ever hope to be. The same
industry, though, on the other hand, insists it will go under if forced
to compete--level playing field or not--against a public option.
So think of it this way: On the one hand, the insurance industry
tells us: We are going to be put out of business. The first thing the
insurance companies say is, the government cannot do anything right.
The government is bloated. The government is bureaucratic. The
government is inefficient. They just cannot do anything right.

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

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of Members who have joined us who are going to help us get health care
reform done, as well as tackle energy and a number of different issues.
So it is a pleasure and honor to work with you.
As I speak about health care and the importance of having a public
insurance option, I first want to take just a moment to note another
issue that is very much tied to health care but an action that was
taken a while ago--a very concerning action, again, where the Senate
Republican leadership chose to block us moving forward on the extension
of unemployment insurance.
As our Presiding Officer from New Hampshire knows, having been a
leader in bringing us together and putting forth a plan to be voted on,
it was incredibly concerning to me that, in fact, the effort and the
proposal to extend 14 weeks of benefits for all of the people in all of
our States who are currently unemployed or who will soon be unemployed,
with an additional 6 weeks for States such as mine with the very
highest of unemployment levels, was blocked one more time on the Senate
floor. This is not what we ought to be doing.

When we look at what is happening in our State with about 15 percent
unemployment, everyone understands the challenges we are going through.
We have people who want to work. They want to work. They are looking
for work. They may be piecing together income in a variety of ways. The
difference between their being able to keep a roof over their heads for
their families and food on their tables right now has been the efforts
of extending unemployment that we did with our great new President,
President Obama, coming into office and making that a priority. We made
it a priority in the Recovery Act. Now we are at a point where we need
to extend that.
We expect in Michigan alone that 99,000 people will exhaust their
unemployment benefits by the end of this year; tens of thousands of
people coming to the unemployment offices. So this is critical for us.
We are not going to go away. We are going to keep right back at it
until we get this done.
The same thing is true with health care reform because there is a
direct relationship. As I start to speak about health care, I wish to
say one of the very positive things of the many positive things about
the legislation we will be voting on is that we want to strengthen it
with a strong public option. One of the very important pieces of this
legislation we worked on in the Finance Committee, and supported by the
HELP Committee as well, creates a real safety net so if you lose your
job, you don't lose your insurance. This is absolutely critical.
We are talking about extending unemployment benefits for people who
have been trying to find work and can't find work. Well, what we all
know is that when you lose that job, too many people also lose their
insurance. Then they lose the house. Then they lose whatever comes
next--the car or the kids can't go back to school. So it is all
related. In our health care bill, we make sure there is a real safety
net and that people who lose their jobs know they will be able to have
insurance, and that is very important.
It is also critical, for people who are looking to purchase
insurance, that they can get the very best price. It is important that
people who have insurance can keep it; that they know what they are
paying for they actually get, by the way, which is why the insurance
reforms are so important; so you are not dropped right when you get
sick or blocked from getting coverage. We know in order to create this
new pool for individuals and small businesses that can't find or afford
insurance that it is absolutely critical, if we are going to say
everybody in the United States of America needs to have insurance, that
it be affordable, that it be competitive in the marketplace, and that
people be able to have every choice possible available to them. That is
what we are talking about tonight because, ultimately, this is about
providing real stability and security for American families.
I received a letter from a constituent of mine, Lynn, in Marshall,
MI. She wrote:

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

Every parent's worst nightmare.

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

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

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

Haven't we all been through that?

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

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

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

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and moral things to do. I didn't create this mess, but I am
sure paying for it.

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

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

In America, we are supposed to prize competition. It is the lack of
competition that drives inefficiency in our health care system.
It has become clear that health insurers are either incapable or
unwilling to reform themselves and control costs. Among the many
reforms our system desperately needs, we need a public option to
promote competition and keep private insurers honest.
We, your constituents, need help; we need you to represent us, not
the insurance companies. As consumers, the more choices we have, the
better off we will be.
Phil understands this from his mother, who was pleading with the
insurance company to be fair and to live up to their side of the
agreement. His father paid for insurance for years. He suffered a
debilitating stroke, and she had to push and push and push. With the
competition that a public option would bring, those kinds of things
won't happen.
A moment ago, I was speaking with Senator Udall. We were talking
about competition. In my State, Ohio, one health insurer, WellPoint,
controls 41 percent of the market. WellPoint and one other insurer
control nearly 60 percent of the market. We were looking at this map.
On this map, the dark purple illustrates those States where more than
80 percent of the market is controlled by 2 companies. I am not a
lawyer--and I am sure not an antitrust lawyer--but I know if 2
companies have 80 percent of the market, there are a lot of games being
played.
When two companies have that percent of the market, you can see why
those CEO salaries I put up earlier are so high. Look at these
salaries. You can see what the CEO of Aetna makes, $24 million; Cigna,
$12 million; and WellPoint, almost $10 million, in my State. In
Montana, 2 companies have more than 80 percent of the market; North
Dakota, more than 80 percent of the market; Minnesota, more than 80
percent of the market. Two companies. In Iowa, 2 companies have more
than 80 percent of the market. The same is true in Arkansas, Alabama,
Alaska, Hawaii, and Maine, 2 companies have more than 80 percent of the
market. The lighter color on the chart--the medium color is where 2
companies have 70 to 80 percent of the market. No wonder these
companies charge so much. No wonder insurance company salaries are so
high. No wonder people are denied care and have nowhere to turn,
because there isn't any real competition when you have 2 companies that
have 70, 75, 80, 90, or maybe 100 percent of the market.
In Senator Udall's State, which is not quite like mine, 2 companies
have only 50 to 70 percent. In Maine, it is 58 percent. I am not sure
exactly what his State is. Even then, two companies have more than half
the market. Insurance prices in Santa Fe, Albuquerque, and Truth or
Consequences--my favorite name of a town in New Mexico--are too high,
just as they are in Lima, Findlay, Zanesville, and Cleveland, in Ohio;
and the service those companies bring to customers isn't particularly
high quality. Those customers are denied care because of preexisting
conditions, because of discrimination, and because of annual caps and
lifetime caps.
Again, I thank the Senator from New Mexico, Mr. Udall, for joining us
to discuss some of these issues about his support for the public
option.
Mr. UDALL of New Mexico. Mr. President, I ask unanimous consent for
those of us on the floor to be able to carry on a colloquy about a
public option.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. UDALL of New Mexico. Mr. President, I say to Senator Brown that
the number in New Mexico--the Senator from Ohio has a range on his
chart, but the number in New Mexico is actually 2 companies controlling
65 percent of the market. So we are talking about a situation that
isn't very competitive. I think that is the bottom line of what we have
been hearing.
We have had our colleague from Oregon, Senator Merkley, and we have
had Debbie Stabenow from Michigan, and other colleagues are here on the
floor, speaking to that situation in their States, and why we should
proceed with a public option.
Let me first say to the Senator from Ohio, I appreciate his
leadership. I know he was on the HELP Committee, which is the one that
wrote the public option we have the opportunity to put in the final
legislation. He was on the committee. Some of us are getting into
writing the legislation now. But one of the best public options out
there is the one that came out of Senator Kennedy's committee. It has
been passed for a couple of months. It is sitting right there ready to
go, if we just put it in.
When we talk about a public option, what exactly are we talking
about? I think people have a right to know a little bit about what we
are talking about when we say public option. I think if I outline that
a little bit, people will see

[[Page S10293]]

why it is so important to have a public option, so let me give a little
bit of an outline.
First, it would be voluntary. We are not forcing anybody to get into
it. We are talking about a voluntary system. So you would have a choice
to get into it, based on whether it would fit your particular
circumstances.
The public option would not be subsidized by the government. It would
be fully financed by premiums. So this would be something where people
would be paying premiums, the premiums would come in, and we wouldn't
be adding to the deficit. We would be creating a good, solid insurance
situation and insuring people.
We have heard, as Senator Brown has talked about here--he put up a
chart about these incredible salaries. One of the things a public
option would do is you won't make profit for the shareholders. You have
the opportunity to take those premiums and put them all back into
health care. So that, once again, is something that is very important.
Let's look here at this chart Senator Brown has loaned me. Look at
the total compensation for CEOs of major health insurance companies in
2008: Aetna, $24.3 million; Cigna; WellPoint; Coventry--look at these
salaries. There is a total, for these 8 or 10 companies, of $85 million
in salaries.
What we are talking about is money being spent on health care for
people through a public option. One of the other things that I think
would be a hallmark of a public option would be having low
administrative costs, since it operates on a nonprofit basis. One of
the things you should know about these insurance companies where you
have these CEOs working is that they have administrative costs in the
range we have heard about, 30 percent administrative costs. So what
happens here is that the money comes in on the premiums, but they spend
an incredible amount of time going back and forth denying claims,
telling doctors they should not put that in, they are not going to
cover it, and it builds up into a big administrative cost.
The great thing about a public option is you don't have high
administrative costs. One of the comparisons there, as Senator Brown
and Senator Sanders know, is that I think Medicare has 3 percent
administrative costs. Here you have a comparison of 30 percent to 3
percent.

One of the other parts of a public option I think makes a difference
is exerting bargaining power to obtain discounts from providers. That
could make a big difference with the public option operating out there.
We would offer savings to subscribers with lower premiums. We should
follow the same insurance requirements as private plans. What we would
offer, through a public option, would be low cost and high value.
Basically, what we are talking about here is keeping insurance
companies honest, driving the costs down, and having a competitive
market.
Senator Sanders well knows that the situation right now isn't serving
the American people. I know he wants to comment on his situation in
Vermont and what's going on there.
Mr. SANDERS. I do. I thank the Senator from New Mexico for his
remarks and Senator Brown for his leadership efforts here. I will say a
few words.
If anyone in America does not understand what the function of a
health insurance company is, let me give you the bad news. If you think
the function is to provide health insurance for people, sorry, you are
wrong. The function of a health insurance company is to make as much
money as it possibly can. Do you know what. They do that very well. We
have to acknowledge that. Insurers have increased premiums 87 percent
over the past 6 years. Premiums have doubled in the last 9 years,
increasing four times faster than wages.
Profit at 10 of the country's largest publicly traded health
insurance companies in 2007 rose 428 percent from the year 2000 to
2007, from $2.4 billion to $12.9 billion, according to the U.S.
Securities and Exchange Commission.
What we are seeing is that people are thrown off of health insurance
because they committed the crime of getting sick, and they cannot get
health insurance because of preexisting conditions. Well, that is the
bad news. The good news is that CEO salaries are very high, and profits
are doing very well.
At the very least--and I speak as somebody who believes in a
Medicare-for-all, single-payer system--this country deserves a strong
public option to give people the choice about whether they want a
private insurance company.
With that, I yield back my time.
Mr. UDALL of New Mexico. Mr. President, I thank the Senator from
Vermont.
I want to also yield to a Senator here and give him the floor--with
Senator Brown's permission. Sheldon Whitehouse, from the great State of
Rhode Island, I believe was also on the committee and was intimately
working through the bill. It is wonderful to have him here with our
colleagues talking about the idea that we have to have a public option.
Mr. WHITEHOUSE. I thank the Senator. I had the real pleasure and
honor, along with Senator Brown, of being among the principal draftsmen
of the public option in the HELP Committee. When I think back on the
effort we put into it, and the plan we came up with, it is astonishing
to me that it is now the public option that appears to be the most
contentious part of the American health care debate right now, because
the bill we passed out of the HELP Committee in July was very
thoughtful. It includes a community health insurance option--a national
plan, administered by the Secretary of the Department of Health and
Human Services. It will be available in every State and territory. It
would offer benefits that are as good as those available through the
private insurance plans, or better. The Secretary would negotiate
provider payment rates to encourage doctors and hospitals to
participate. Americans who need financial help to participate in the
public option would get it. And local advisory councils would assure
that the public option was sensitive to local conditions and local
needs.
To be clear, this plan includes no mandate for doctors to
participate, no rate setting by the Secretary, no requirement that any
American buy a public option policy, and absolutely no direct link to
the Federal Treasury. Other than the initial capitalization, this plan
would operate solely on premium revenue--a completely self-sufficient
financial model. It would have absolutely no baseline advantage over
private insurance companies. The HELP Committee got here by approving a
number of amendments by our friend from North Carolina, Senator Burr,
to make sure of this.
Because this version of the public option was so sensitive to these
concerns from across the ideological spectrum, the House Blue Dogs,
moderates in the House, used a number of our provisions in the House
bill to gain moderate support. In fact, the community health insurance
option makes so much sense that Republicans have had to resort to
illogical arguments to justify their opposition.
For example, they argue that the government should not be in the
business of providing health insurance, that it is a slippery slope to
socialized medicine. Well, hello, government-sponsored health insurance
serves nearly half of Americans--78 million Americans--who are enrolled
in Medicare, Medicaid, TRICARE, VA, and they get benefits from the
Federal Employee Health Benefits Program, and so forth. We don't hear
our colleagues on the other side talking about ending Medicare, closing
up the trust fund, throwing our parents and grandparents out to the
tender mercies of the private insurance companies. We don't hear that.
I have not heard one Republican say they want to deny our Iraq and
Afghanistan veterans all the Federal medical care they need when they
come home. I don't see Republican Members of Congress opting out in
droves or criticizing the Federal Employee Health Benefits Program.
Why? Because these programs work, because Americans rely on them,
because they provide dignity and stability in the lives of millions of
American families and they have not led to a government takeover of our
entire health care system. Indeed, ironically, the very best program is
probably the VA program where the level of government involvement is
the highest, where they own the hospitals and where they employ the
doctors.
Republicans have also been arguing that government involvement in the

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private health insurance market will be uncompetitive and will push
private companies out of business. We see the government competing
competitively in a variety of markets in this country--private versus
public universities, private versus government student loans, workers'
compensation insurance, the Postal Service versus UPS and FedEx. The
existence of public options in these markets has not swallowed up
private industry. What it has done is broadened the market and enhanced
the variety of competition consumers enjoy. Think how many people in
America right now have a higher education because a State university
was there as an affordable option, an alternative to private colleges.
Similarly, a public insurance option adds choice for consumers and
adds competition in the market, and it gives private insurers a strong
incentive to behave fairly and to keep their costs down. In fact, if
one thinks about it, there is hardly an industry in this country where
the big players are so far from being pushed out of the market. In
fact, if you ask me, the for-profit health insurance industry has been
doing the pushing--pushing the American people around--for far too
long.
Let me give one example from my home State of Rhode Island. Two years
ago, United Health Care of Rhode Island proposed to send $37 million in
excess profits to its parent company, United Health Group, hundreds of
miles away instead of investing that $37 million back into the system.
That is $37 million in 1 year out of a State of only 1 million people
in which this company only had a 16-percent market share. With a public
option, that $37 million would have gone back into improving the health
care infrastructure in Rhode Island, into lowering premiums, into
increasing provider payments, into investing in our health information
and chronic care sustainability projects and helping doctors buy
electronic health records and supporting our Rhode Island Quality
Institute. But no. And this after United had already sent $16.5 million
out of our State in 2004, $13.4 million out of our State in 2005, and
$17.1 million out of our State in 2006.
Competition is supposed to lower prices for consumers, create demand
for a better product, and push bad actors out of the marketplace. I
don't see that in the health insurance market. I see 10 States with the
two largest health insurance companies controlling over 80 percent of
the market. I see a 120-percent increase in premiums from 1999 to 2007,
while wages only went up 29 percent. I see a 109-percent increase in
administrative costs from 2000 to 2006--a 109-percent increase--as
insurers increasingly game the system rather than competing on better
quality of care, better health, and lower cost.
As I have traveled around Rhode Island, I have seen how these
circumstances work out for individual Rhode Islanders.
David, a self-employed resident in Central Falls, described the
astronomical rise in the cost of health insurance for him and his wife.
Years ago, he paid $85 a month for his plan. Today, it is $19,000 for
their annual health insurance. Despite the dramatic jump in price, the
health insurance does not cover as much as it used to. David has been
forced to drop dental coverage and increase the out-of-pocket expenses
he and his wife pay on their plan.
He wrote to me:

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

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

Let me make one last point. My Republican colleagues have argued that
a public option would drown out private competition and amount to a
government takeover. In many places from which they made that argument,
the facts at home disprove that contention. Twenty-five States actually
provide health insurance benefits through public plans. They actually
provide health insurance benefits through public plans in their
workers' compensation systems.
For example, Kentucky, represented so ably by our distinguished
minority leader, is home to Kentucky Employers Mutual Insurance, a
State-run public fund which has operated in the State since 1995 and
now provides health insurance benefits to 24 percent of the workers'
compensation market in a competitive market.
In Wyoming, the home State of the ranking member of the HELP
Committee, Wyoming's Worker Safety and Compensation Division delivers
all the health care in the workers' compensation system. They have a
single-payer public plan. There has been concern expressed that a
government plan will give terrible customer service. I doubt that the
Wyoming plan would last very long if it gave terrible customer service.
In Arizona, so ably represented in this Chamber by Senators McCain
and Kyl, since 1925 SCF Arizona has provided health insurance benefits
through the workers' compensation system, and it now has a 56-percent
market share in a competitive market environment. To those who have
said you cannot have a government plan because it will necessarily
crowd out private insurance by virtue of an unfair competitive
advantage, Arizona belies that argument. It has been that way for 80
years, since 1925.
To my knowledge, those who criticize the idea of a Federal public
option for health insurance have not criticized the role--often a
decades-old one--of public insurance plans in their own States'
workers' compensation insurance markets.
We have in front of us an opportunity for a new day in the American
health care system where affordable, quality health care is available
for everyone; where doctors and hospitals are paid for value, not
volume; where you cannot lose coverage because of an illness

[[Page S10295]]

or preexisting condition; where insurance company bureaucrats do not
come between you and your doctor; where care is not rationed by your
family's ability to pay; where every American gets the best health care
the country's medical system has to offer.
I support the public option because I see that vision for the future,
and I think a public option can get us there. I also see this lesson of
the past: that an industry--the private insurance industry--that has
put its own financial welfare in front of the physical and mental
health of its customers for years, over and over again, cannot now be
trusted on its own to lead us into that future, not without a push in
the marketplace, not without the kind of push in the marketplace a
public option will give.
Mr. BROWN. Mr. President, I thank the Senator. I was intrigued by
much of what he said.
We are also joined on the floor now by Senator Bennet from Colorado,
and Senator Casey and Senator Udall are still with us.
When the Senator from Rhode Island talked about the Rhode Island
experience, I remember while we were drafting the public option
language in the Health, Education, Labor, and Pensions Committee, on
which Senator Casey and now Senator Bennet sit, the Senator talked
about what a disaster Rhode Island's workers' compensation system was
because of the corruption in private insurance and the high costs and
that the Senator from Rhode Island introduced a public option into
private insurance there. Many States--I believe roughly half the
States--have a public option as Rhode Island does and the experience of
the Senator from Rhode Island with bringing in this competition.
My understanding--and correct me if I am wrong--is that the public
option not only made private insurance operate more efficiently and
made private insurance more honest, if you will, and helped to sort of
flush the corruption out, but I would guess competition from the
private insurance industry made the public system a little bit more
nimble, too, right?
Mr. WHITEHOUSE. We actually pretty much had a complete meltdown in
the private insurance market, so we had to put in a public option to
provide any workers' compensation insurance. But the private insurance
companies had written off our marketplace because their business model
was impossible to maintain for any reasonable cost. We knew that with
good reform in the system and with a public option to implement that
reform, we could reduce those costs.
What has happened is two things. It used to cost $3.93 for 100 hours
of payroll for workers' compensation, the year after this went through
and got stood up. Today, it is $1.74. It is more than 50 percent
cheaper in Rhode Island. The model that was set by the public option, a
new business model that focused on prevention, on getting people back
to work, on better quality medical care, has actually attracted the
private industry back into the market.
Mr. BROWN. So the private companies are making money.
Mr. WHITEHOUSE. They are back in and making more with the leadership
of the public option.
Mr. BROWN. A lot more honest and a lot more efficient.
Mr. WHITEHOUSE. And they improved their business model, so they are
now delivering better quality care, getting people back to work sooner,
reducing medical costs by getting people back to work, and providing
better quality care. It has been a very successful story from a cost
point of view.
It used to be the worst issue for the Rhode Island business
community. They were nuts about workers' compensation. We literally had
torch-lit parades, and nobody has heard about the issue in a decade
because the public option has led the way.
If you think the business community is scared about a public option,
go to a State where there is a workers' compensation public option. I
think you will find they support it.
Mr. BROWN. I think we can safely predict that 10 years after the
President signs a good health care reform bill in November or December
which has a strong public option similar to the language our Health,
Education, Labor, and Pensions Committee drafted and the House Energy
and Commerce Committee passed, we will see the same kind of thing; we
will see a more efficient but still profitable health insurance
industry, with a public option disciplining the market and keeping
prices in check. We no longer will have people denied care because they
have a preexisting condition or denied care because of an annual limit
or a lifetime limit on coverage. We will no longer see the kind of
discrimination in the marketplace we have seen from all of these
private companies.
Before turning to Senator Casey, who has brought the bill to the
floor with him tonight to talk about the legislation itself which he
helped draft in the Health, Education, Labor, and Pensions Committee, I
want to mention that today we submitted a letter to Majority Leader
Reid that pretty much all of us on the floor signed. Some 30 Senators
signed a letter to him today calling on him to support the public
option and putting that on the bill when we bring the bill to the floor
in the next couple of weeks.
Again, before turning to Senator Casey, I wanted to read another
brief letter I received from Ohio--Kathy from Medina. Kathy writes:

I own a small business with three employees. With the
current economy, I can no longer make payments on our health
plan. We were paying $2,000 a month for our plans and were
told we needed at least 10 workers to negotiate a more
affordable plan. After dropping our plan, I had to see a
doctor because I had difficulty breathing. I now have to see
a cardiologist and endocrinologist. I am still in shock at
how quickly my health turned into a serious condition. In
just a month's time, I have almost $7,000 in medical bills
and I still have further tests and treatment ahead. Unless
there is health reform, I will be just another 55 and over
American not taking my meds or seeing a specialist when I
should because of the high medical bills. It's been upsetting
just being seriously ill, let alone facing financial
hardship.

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

Without a not-for-profit public insurance alternative that
competes with these insurers based upon premium rates and
quality,

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insurers will have free rein to increase insurance premiums
and drive up the cost of Federal subsidies tied to those
premiums.

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

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

Very simple. Part of this legislation has features to it that are
very similar to Medicare--a public insurance program that has worked
real well for generations of Americans. But it will also have some of
the requirements that insurance companies have to live by. Let me go
through a couple of those.
First of all, a public option, in terms of the process starting,
would have to get government funding to start. In the way of resources,
the government would pay for the first 3 months of claims as a way to
capitalize it initially, but then it has to pay back any kind of
capitalization over a 10-year time period.
What we are talking about is a program, State by State, that would be
self-sufficient. It is very important for people to understand that.
This would be self-sufficient. Senator Whitehouse talked about this a
moment ago, and it needs repetition and reiteration. It would follow
the same rules as private plans by defining benefits, by protecting
consumers--we hope any entity would do that--finally, by setting
premiums that are fair based upon local costs.
So this isn't some theory. This isn't some idea we don't know how it
will work. We know exactly, and the American people know exactly, how
this will work because we understand what it is like to deal with a
system where the insurance companies have virtually unlimited power to
deny you coverage if you have a preexisting condition, for example. The
bill also makes that illegal under the bill we passed in the HELP
Committee this summer. But also, insurance companies right now have
free rein to jack up their prices.
I know there are some State-by-State limitations on that, but mostly
free rein exists to do whatever they want. Without a public option,
that is what we will have going forward. So if you like costs going up,
then you should be against our proposal because costs going up is what
we are going to have more and more of if we don't have a public option.
One of the important features is that there be State advisory
councils--councils set up in each State, made up of providers and
consumers to recommend strategies for quality improvement. So this
isn't going to be some Washington control here. You are going to have
lots and lots of accountability at the State level, and States would
share in the savings that result from that kind of accountability.

Finally, the notion it is a voluntary program. The providers would
have a choice of participating in the public option and there would be
no obligation to do so. I point to the bill for this reason. When we
were in our States this summer, I remember going back to Pennsylvania
and reading about Senator Brown's public forum in the State of Ohio and
I was reading about others as well and learning about what was
happening in other States. We had our public forums. I spoke to
thousands of people over the course of a couple weeks.
One of the things I would say to the audience when we had our public
forums is, Look, if you walked in here today and you don't support the
public option, I ask you to do one thing: Read the bill. Well, the
final version of the HELP Committee bill that I am holding right here
was 839 pages. I wasn't asking them to read every page, but what I said
to them was: If you don't support the public option, just read that
section, which is right now 19 pages in the bill. Section 3106,
Community Health Insurance Option. In the bill, it is from page 110 to
129. So it is 19 pages in the bill. I said: Look, spend some time
taking a look at it.
I remember at the one public forum, someone who disagreed with my
point of view on the public option went at me verbally and said: You
are going to force people to go into these public options. I said: That
is not true. Of course, saying it doesn't always end the argument. So,
then, I would hold up the bill and I would say: Let's go to section
3106, and I would read from section 3106--I know the camera can't see
this--subsection (a). The first two words of this section--other than
the heading of it--are ``voluntary nature.'' That is the subheading. So
I would read part of that section and say: This is voluntary. Voluntary
for any American who goes into the exchange and may decide they want to
stay with their own private insurance coverage or may want another--a
different--choice. So they can choose this.
It was important for people to understand that in a long bill we at
least spent 19 pages to get this right.
There is a solvency standard in here, for example. This isn't some
theory we dreamed up in Washington. We know solvency is important; that
a program such as this, in an option such as this, has to meet basic
solvency standards. Senator Whitehouse spent some time talking about
that and helping Senator Brown and others craft that, along with
Senator Udall, who is with us here tonight. It is voluntary. It has to
be self-sufficient.
There is even an audit section. If you want to get into the detail,
there is even an audit section. So that when you have administrators,
there is a measure of accountability, in terms of auditing.
There are a lot of parts to this that we could go through. The
important point, though, is that unless we inject some choice into this
and some competition, I am not sure the American people will believe we
have done our job. We have said over and over again that among the
basic elements of any final health care bill is that we have to have a
total commitment to prevention, so we can prevent disease and
conditions from leading to bad results for an individual and their
family, and prevention will also help us save money at the same time;
that any health care bill would have to have choices. If someone wanted
to stay with their private coverage, they could do that, but if they
wanted other options, we are trying to give them a public option; that
any kind of health care reform would have to have quality standards.
This will help ensure more quality standards in our system. So I don't
believe we can get to where we want to get to in the end unless we have
a public option.
Let me make two or three more points, and then I wish to have my
colleagues rejoin this discussion and also talk about what we are
trying to do. There are a lot of discussions--and I know my colleagues
saw these in these public forums where we would have someone stand and
say: I don't like a government program or I don't like government in
our health care, as if we have a system now that is 99 to 1--99 percent
private and 1 percent public. I would remind them--and these are some
overall numbers, but it is important to remember--that we have a
Medicaid Program right now that at last count had over 60 million
people in it--60 million Americans. We have a Medicare Program with
about 45 million Americans. Then you go to VA health care, and at last
count it has 7.8 million Americans.
So when you go down the list of programs right now that are
government-run programs for health care, you get a large number of
Americans--well over 100 million Americans--and their families who
benefit from those programs, and you get a commitment from the Federal
Government year in and year out to make sure we have that kind of
coverage for those who happen to be poor, those who happen to have
particular health care challenges, those who happen to be over the age
of 65, those who happen to be veterans and who need health care
coverage. So we have an American system right now that has a lot of
private coverage, but there is a lot of coverage through government
programs that even people who oppose some parts of this bill, the last
time I checked, don't want to repeal. I haven't found anyone who wants

[[Page S10297]]

to repeal VA health care or who wants to repeal Medicare.
I think we have a system right now that is not working in large
measure, but there are some things that are working well. We are trying
to improve both ends of this, the public health care end of this and
the private health care part of our system.
Mr. WHITEHOUSE. Will the Senator yield for a question?
Mr. CASEY. Sure.
Mr. WHITEHOUSE. With respect to your observation that we don't see a
lot of outcry about ending Medicare, about ending VA health care, and
other government programs, Senator Brown has been remarkable about
coming to the floor regularly to read the true-life horror stories that
our present health care system inflicts on Americans and American
families across the board. I have brought a great many Rhode Island
stories to the floor. We all have this experience.
I am interested in the evaluation the Senator from Pennsylvania might
make in terms of his own experience and his own constituent contacts in
terms of those heartbreaking stories you get. Do you hear a lot of
heartbreaking stories from people in Medicare; people being thrown off
for preexisting conditions? Where in your experience have the real
heartbreaking stories come from in Pennsylvania?
Mr. CASEY. I will give you an example. In our State, just in terms of
age categories, we have, in terms of children up to the age of 18--we
have a 5-percent uninsured rate. It is still too high. Until it gets to
zero, we have not done enough, but that number is way down. So we have
a diminishing number of children who are uninsured largely because of
efforts and initiatives such as the Children's Health Insurance
Program. Then, on the other end, those who are over the age of 65, they
have Medicare.
Where I am getting the real-life stories from people, people who send
e-mails to our office just like to Senator Whitehouse, or people who do
it the old-fashioned way, who actually write a letter or people you see
in a public forum or on the street--they are coming to us in that age
category, 19 to 64. In our State, that number of uninsured is 12
percent, more than double the number of uninsured children.
For example, I got a letter in February from Trisha Urban from the
eastern end of our State near Reading in Berks County. Here was her
story in summary.
She was working; her husband was working. But he was trying to
advance, as we always tell people we want them to get more education.
So he was trying to finish his doctorate. In order to finish that he
had to take an internship. The internship did not have health insurance
coverage. The coverage they had, ultimately they lost.
Here is Trisha Urban who was working, and her husband was working as
well. She was working four different jobs. They lost coverage and then
they started to run up bills. Then she became pregnant. While she was
pregnant, her husband, who had a heart problem, missed an appointment
because they were worried about paying for the doctor visit for her
pregnancy and also worried about the doctor visit for his heart
ailment. So he skipped his appointment because of his heart problems.
Time goes by, a couple of weeks go by, and all of a sudden her water
broke. She was preparing to go to the hospital in a couple of hours,
her husband went out and did a few errands, came back to the house, and
as she was walking out of the house to go into the driveway to join him
in the car to go to the hospital to deliver her baby, she looked in the
driveway, and her husband is on the pavement of the driveway dead
because of his heart condition, a preexisting condition which, thank
God, in our bill, in the first section of our bill, we make illegal. It
should have been illegal a long time ago. I still find it hard to
believe that we live in a country where we have allowed insurance
companies to do that to people.
She went out and found her husband dead. An ambulance came to take
her to the hospital to deliver her baby, and the other ambulance came
to pick up her husband.
That is the kind of story we hear in Pennsylvania and across the
country because of our system. There is no reason we should tolerate
this and let it go on any longer. We have a chance to change it.
One of the ways to move it forward is by making sure we have choices
and competition in a public option.
Mr. BROWN. Could I ask Senator Casey a question? I thank him for that
story. Of these stories of people in private insurance, that is as
tragic a story as you will ever hear. We have these letters I have read
and these stories from Senator Whitehouse, Senator Bennet, Senator
Udall, who have come to the floor and read these letters from people
who thought they had pretty good insurance and something happened and
they lost it because they have gotten too sick or they lost their job
and they can't afford COBRA and all that.
I want to ask the Senator a question. You mentioned early in your
comments about the costs going up. I want to put this chart up and ask
about this. Senator Bennet from Colorado will speak in a moment. These
are costs under Medicare Advantage. The government, as you know,
provides, in large part because of insurance company lobbying, plain
and simple--the government provides all kinds of subsidies to Medicare
Advantage plans.
These are not most of the Medicare beneficiaries. Most Medicare
beneficiaries, 75 to 80 percent of them, are in what is called regular
fee-for-service Medicare. Some are in a more privatized Medicare. The
government writes checks to insurance companies. You can see how
insurance companies have extracted more and more taxpayer dollars as
their salaries have jumped and jumped. The poster that Senator Udall
was showing, that I showed earlier, the executive salaries of Cigna and
Aetna and these companies have gone into the tens of millions of
dollars, in some cases. These subsidies--in 2004 they got $4 billion;
by 2005, $5 billion. Now the insurance companies basically get a check
from the Federal Government for $11 billion.
Talk for a moment, if you would, Senator Casey, about what if the
public option is competing with these insurance companies. What will it
do to these costs as these insurance companies continue to extract more
and more money, with their lobbyists, from the government, as they have
tried to privatize Medicare?
The public option, talk about what it would do about cutting costs so
people like your friend in eastern Pennsylvania--those kinds of things
don't happen to them.
Mr. CASEY. I think it stands to reason if you have, as we do in a lot
of States, one or two or a very small number of insurance companies
that dominate the marketplace, sometimes a lot more than 50 percent of
the marketplace but in other cases--in our State we have two that have
control over at least half of the marketplace. That alone is bad
enough.
Mr. BROWN. In this poster--we talked about it earlier; Senator Udall
mentioned it too--some States, yours and mine are a little bit better.
In some States--Montana, Alaska, Hawaii--lets go down to Minnesota,
Iowa, Arkansas, Alabama, Maine--two companies have more than 80 percent
of the market. Two companies control 80 percent of the market, which
means there is no price competition. In some States it is 70 to 80
percent, in Ohio, Pennsylvania, Rhode Island--I am sorry Rhode Island
has two companies more than 80 percent also. In all, about almost 10
States.
But in our States--Pennsylvania, Ohio--large States, States with
populations over 10 million people, each of those has more than 50
percent. In my State one company has 41 percent; the two largest
companies have 58 percent. In Pennsylvania, two companies also have
more than 50 percent.
Mr. CASEY. It just stands to reason. If you don't have competition,
you have no incentive, no pressure to keep your rates at an affordable
level. I do not understand why anyone, in the midst of this debate, is
against choice and competition. Both are the central pillars of why we
need a public option. What do we do for our health care system? I don't
understand the logic.
One point we should make, and we address it in the bill--we will not
spend a lot of time on it--we should all remember, you look around, we
have 100 Senators. Everyone in the Senate, and all of our families,
everybody in the House, and then you add other millions

[[Page S10298]]

of Federal employees, we have a pretty good deal because we have a
system where, as I look at some of the features of the public option,
we have a pooled purchasing power.
If you have millions of Federal employees and their families who are
in the same pool, that brings costs down. We are trying to get more and
more Americans the same opportunities we have, to be in a pool that big
and to keep costs down. For the life of me I cannot understand why
someone would not like that, especially people who benefit from it and
their families who benefit from what the Senate gets.
I have been blessed to have that kind of coverage because I happen to
be in the Senate. But every seat here, and then add millions more
Federal employees, gets this opportunity because we are in a large
purchasing pool. I don't know why a small business owner should not get
the same opportunity, a business owner paying through the nose.
I know Senator Brown has seen this in the State of Ohio. You have
heard from small business owners, time and again, haven't you, about
what they are paying every day? What we are saying is, if it works for
and if it is good enough for Federal employees to get the lower cost/
benefit of a large and open purchasing pool, why isn't it good enough
for the rest of America?
I say it is not only good enough for them, but we should make sure
they have the same opportunities as small business owners or as part of
a family. That is one of the reasons the public option makes lots of
sense.
Mr. BROWN. Let me read a note from a small business person. I get so
many letters from small businesses. You know, like most Americans, they
care enough about their employees, their fellow employees, their
friends, they want to provide insurance. Almost every small business
person I have talked to who is struggling with health insurance wants
to find a way to pay for insurance for her or his employees, and so
often they can't.
Let me read a letter, Kathy from Crawford County, which is Bucyrus,
Gallion, Crestline, just west of where I grew up. She says:

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

This happens too often. That is why in the legislation we wrote in
the Health, Education, Labor, and Pensions Committee, we made special
provisions for small businesses. If you have 20 people or you have 5
people, if 1 of them gets very sick and costs the pool of 15 or 20
people exorbitant amounts of money, the insurance company either raises
premiums so high--increases, as Cathy said, 37 or 24 percent--or the
insurance company sometimes cancels the insurance. Either way, it is a
terrible hardship and a tragedy for the small business and a tragedy
for so many employees.
If we do this right, we enlarge the pool by allowing these insurance
companies to go into the insurance exchange or the public option, if
they choose--an option. They also get a tax credit. They get a break
that way and they are much more likely to be able to afford their
insurance.
Let me turn to Senator Bennet, who is a new member of the Health,
Education, Labor, and Pensions Committee. He has been outspoken for the
public option. Senator Bennet?
Mr. BENNET. Mr. President, I actually am here to talk about something
else, but I was so inspired by what the Senator from Pennsylvania and
the Senator from Ohio and the others have said, I want to spend a few
minutes on this issue. Part of it is I just don't understand what
Washington doesn't understand about what our working families and small
businesses are going through.
In my State over the last 10 years, median family income has actually
gone down by $800 in real dollars. The cost of health insurance
premiums have gone up 97 percent during the same period of time.
There are people who want to leave the system just the way it is, but
the result of having flat income for our working families and small
businesses, and for those costs going up 97 percent--by the way, in my
State the cost of higher education has gone up 50 percent at the same
time. The cost of health insurance, up 97 percent; the cost of higher
education up by 50 percent--this is tough on the middle class. It is
tough on small business owners in my State.
The result is, if we keep the status quo--there is a great irony of
the arguments to keep the status quo--by default, we are putting more
and more people off private insurance and more and more people either
on public insurance or having the benefit of uncompensated care.
We have seen in my State, you can see it on this chart--probably not
all that well--small business spends 18 percent more for insurance than
large business just because they are small, and fewer and fewer people
in Colorado are able to get coverage at work. Before this recession
started it had already dropped roughly 10 percentage points; the
percentage of folks who were getting insurance from their employer,
from our employer-based system. You can see, the Senator from Ohio
certainly can see, the percentage of small businesses in my State able
to offer health insurance has declined dramatically.
Where do these people go? They either end up on Medicaid or they end
up showing up in the emergency room where they are treated with
uncompensated care, the most expensive way we can deliver health care
in the United States of America.
We have a wonderful public hospital in Denver called Denver Health,
where they do an amazing job at a much lower cost than a lot of other
hospitals.
I was told by the woman who runs the hospital--her name is Patty
Gabow, a gifted administrator--that they had done a study and they
discovered they had spent $180 million in 1 year on uncompensated care
for people who were employed by small businesses. These were not
unemployed people, these were not people who could have had access to
Medicaid, but people employed by small businesses who could not afford
health insurance.
So I think one of the ironic things about the debate we are having is
the failure to recognize that the status quo is creating a situation
where fewer and fewer people have private insurance and more and more
people are moving into public insurance. But it is not being done in a
thoughtful way. It has not been constructed that way. So I think that
is one of the reasons it is very important that we are having this
debate.
I tell the Senator from Ohio, I am sure he had this reaction when he
was on recess. I certainly did. I had townhalls all over the State.
What I kept hearing from people is this, and this is the reason I
support a public option. They would say to me: Michael, we paid every
single year, year after year after year, into private insurance. Every
year, we did what we were supposed to do, and then when we needed it,
it was not there for whatever reason. Because somebody on the other end
of the telephone told them: You are not covered, or the fine print did
not cover you for that problem or your child for that problem. They
deeply resented the fact, as I would, that someone earned a profit off
that commercial transaction.
That is the thing about insurance. It is not like going to the store
and buying a loaf of bread or a gallon of milk where you know what you
are getting in return. Many people who buy private insurance year after
year don't know what they have until they need it and they don't know
what they have lost until they lose it.
Having a choice, just another option that is out there, not a
government takeover of health care but a choice that empowers working
families in my State to make the decisions that are in the best
interests of their family or their children--as a father of three
little girls under the age of 10, I can understand why people would
want that choice. I am not scared by the choice. We have to design it
properly, and the HELP Committee did a very good job

[[Page S10299]]

designing it, in answering a number of the charges that have been made
against it. We may be able to do a better job in the final legislation.
The final thing I am hearing from people in Colorado is: If you are
going to mandate that we have insurance, if you are going to require
that we have insurance, you better make it affordable. You better not
tell me I have to have insurance and make it unaffordable. You better
not tell me I have to have insurance and I have to change the plans I
have for my family.
The public option provides one more choice for people, an affordable
choice for people. We have to do a lot more to drive down costs, as I
and others have talked about on this floor. But we need to do this
right.
I understand, I come from a State where we have a lot of diversity of
opinion on a lot of things, and there is a lot of concern about the way
the system works today, and there is a lot of concern that we are going
to make it even worse. I think we need to elevate the standard of the
discussion we are having to the standard that we had, that the people
of Colorado had in townhall after townhall, which, by the way, no one
would ever have any interest in putting on TV, I am proud to say. We
need to elevate the standard of the discussion in Washington so that we
can produce a result that has something other than double-digit cost
increases year after year for working families.
Mr. BROWN. Will the Senator yield for a question? I heard what you
said about buying a loaf of bread and how buying insurance is
different. Before you were in the Senate, you were the superintendent
of the Denver public schools and were very successful in business
before that. When you talk about how insurance companies deny care and
insurance executives get paid well, talk for a moment about the
business plan. When you were an entrepreneur and you were a
businessperson, you obviously had a business plan. Talk to us. Share
with Senator Udall and me and others what the business plan of a health
insurance company is in particular.
Mr. BENNET. I appreciate the question. I will say that I used to make
my living buying bankrupt companies. So these were companies that were
actually fairly well managed but capitalized really poorly, and our
opportunity was to buy them, capitalize them properly, produce a
business plan, as you are describing, and make sure the people who
worked for them, the people who benefited from them continued to be
able to do that.
You know, as a capitalist, I look at the state of our health
insurance industry and our health delivery system and I can almost not
believe what I see. We have 44 counties in Colorado. Every one of those
counties has a convenience store, at least one, some many more than one
but at least one. With the exception of the loose beef jerky that is on
the counter, there isn't anything in there that doesn't have a barcode
on it. It is 1970s technology that our small business owners in
Colorado know is critical to managing their inventory, critical to
allowing them to be competitive and giving their customers what they
need.
Only 3 percent of hospitals in this country have that technology. One
out of every 25 doctors has that technology, which is a really simple
thing. And it is the reason why--as a parent of three little girls or
if you are caring for a parent of your own, it is so frustrating when
you go in and you have to explain over and over again what the last
person just told you simply because we don't have a system of
electronic medical records.
Then, on top of that is a business model where, unlike everything
else in our society, every year the cost goes up and the quality to the
customer goes down, which is what we see with insurance. We don't see
that in other parts of our private marketplace. We don't see that in
other parts of our private marketplace where people are incentivized to
compete on price, on quality, on customer service. And it is why it is
not just enough to have a public option. We need a public option, but
we also need commonsense regulation of insurance so that we start
driving a marketplace that actually makes sense.
Mr. UDALL of New Mexico. Senator Bennet, one of the things that is
happening--and your chart there really explains it, and I wanted to get
you to talk about this a little bit--your chart says: Rising health
care costs are hitting small businesses the hardest and forcing all
Colorado businesses to make tough choices.
That is exactly what is happening in New Mexico, exactly what is
happening in Ohio. And really what we have going on here is very hard-
working, good small businesspeople who want to give their employees
insurance. I hear that. I know the Senator from Ohio said that a number
of times when he read letters. They want to give that insurance, but
they can't. They search around, they can't find policies they can
afford, and so they are really stuck. And I can give you a list of
examples in New Mexico.
One of the things you pointed out on your chart is that even before
the recession--even before the recession--fewer Colorado small
businesses could offer coverage. I was wondering if you could talk a
little bit about the small business situation because most of these
people are working without insurance.
Mr. BENNET. I appreciate the Senator from New Mexico raising that. I
remember a florist I talked to, a family-owned business since 1972 in
my State, and he is now down to no employees, just his wife and
himself. They are running the shop. They had health insurance for many
years, and they took it, as so many small businesses do, as an article
of faith that part of their job was to offer insurance to their
employees, to make sure their employees had the benefit of insurance.
Now they are the only two employees. There is no one working for them.
They do not have health insurance themselves.
Their daughter has been admitted to the University of Colorado. He
said to me last week: Michael, what was she supposed to do when she got
to the box that said check the box if you have health insurance? If you
don't, you have to pay this terrible fee.
So, first of all, people are having to make choices they should not
have to make and they would not have to make in a rational private
market that was working well. That is one of the issues.
The second thing is, as you know--I am sure it is true in New Mexico,
and it is certainly true in Ohio--most of our jobs are created by small
businesses. Depending on the numbers you look at, roughly 70 percent of
our jobs are created by small businesses. And a higher percentage of
those jobs are going to be responsible for the recovery that hopefully
we are about to have in this country. It is harder and harder to do
that if you are carrying the freight of double-digit cost increases in
insurance every single year.
The last point I want to make--every small business owner understands
this--as small business owners try to hang on to insurance for their
employees and the price of that goes up and up, what that leads to is a
choice between holding on to the insurance and compressing the wages of
the employees because you can't do both. You can't give people the
increases they deserve in their compensation and at the same time hold
on to health insurance. So that is a reason we have seen all across
this country, actually, a decline in median family income. It has gone
down by $300 over the last decade in the country, $800 in my State,
while the cost of insurance has gone up by 97 percent. That wage
compression is directly linked to the problems people have holding on
to insurance.
I appreciate the question. I yield.
Mr. BROWN. I thank the Senator from Colorado for his good work and
his very good description particularly of how the cost of health care
affects small businesses in such a negative way.
We will wrap up in the next 10 or 15 minutes.
Earlier today, a group of Democratic women Senators came to the
Senate floor to talk about health care. And some of the things that
amaze a lot of us as we work through this, some of the things we hear--
in several States in this country, being a victim of domestic violence
is considered a preexisting condition. There are women in this country,
believe it or not, who have been victims of domestic violence.
Insurance companies have said: You cannot get insurance because of that
because, presumably, you might be abused again, you might be hit again,

[[Page S10300]]

and it would cost us, the insurance company, far too much money. So,
believe it or not, they actually can't get insurance because of that.
Obviously, this legislation makes that--as Senator Casey says, there
will be no more preexisting condition denials of care, no more
discrimination based on gender, based on geography, based on
disability, based on age.
One of the other things the bill does that is important is it will
eliminate copays for things such as mammograms. We want people,
particularly when they get to be my age, when they are in their
fifties, we want people to go in and get the right kind of preventive
care and get the right kinds of tests. People should have a colonoscopy
when they are 50, and people should be tested by mammography and should
have mammograms and all of that. I mean, none of us probably goes in as
often as we should for the preventive care and the tests, but an awful
lot of people would like to do that and simply can't because of the
cost.
This legislation would say: If you are going in for something like a
mammograms or for something like a colonoscopy, there will be no
copays. It will encourage people to get into the system. Then, if they
are diagnosed with cancer, they are diagnosed typically in the early
stages, and it is certainly more likely to save their lives, and it is
much less expensive as a result of going into the system earlier. So it
ultimately saves us money by telling insurance companies: You are not
going to do that anymore.
That is so clear to me, that if we are going to do this right, we
need to make sure women are treated better by this system, no longer
preexisting conditions and all that.
I will close and then turn to Senator Udall or Senator Bennet, if
they would like.
I have another letter I got--exactly what I was talking about.
Darlene from Mahoning County:

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

She is not yet eligible for Medicare.
So many of these letters just cry out: I am trying to get through the
next year or the next 3 years, the next 6 years, whatever, until I am
eligible for Medicare, I am just trying to get through. And it really
is a call for help, and it really is a plea from people in my State,
people in Warren and people in Bellaire and people in Gallipolis and
people in Crestline: Please help us in these years when we are in our
late fifties, early sixties. We are going to be in Medicare pretty
soon. We know Medicare works for us. We know this government program
works, a program that doesn't look much different from the public
option. But I need just a few more years. It is a time in my life when
I am starting to get more aches and pains or worse. It is a time in my
life when I am much more likely to get sick, to get an expensive
illness, when I am 56, 58, or 63.
These are people who know they will be embraced with a decent health
care system. They know they will be in a decent health care system when
they get to Medicare age, when they get to be 65.
They have friends who are in Medicare, and they know Medicare works
for them. That is as good a testament to the public option as there is.
Those are the kind of letters I am getting from people saying: Please
include a public option. I am 58 years old. I am not yet eligible for
Medicare. I was diagnosed with diabetes. I need to do this; I need to
do that. That is what is so very important about the public option.
I yield to Senator Udall.
Mr. UDALL of New Mexico. One of those charts you put up over there
emphasized the point of competition in the marketplace and how much we
need competition. We joined together with the majority of our
colleagues in the caucus to sign a letter to our leadership. I think
one of the paragraphs in this letter is particularly persuasive. The
Senator's signature is the No. 1 signature on this letter, but we
wrote:

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

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

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

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

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

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

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

Everybody agrees we have a too costly health care system. Everybody
agrees we need to fix that. What we don't agree on is how to fix it. We
have heard 2 hours of what is wrong with the private insurance industry
that has not been allowed to be competitive, has not been forced to be
competitive. And yet

[[Page S10301]]

the answer to that question is that we want the government involved.
The Senator from Pennsylvania talked about all the government programs.
Sixty-one percent of all health care today comes through the
government. Every government program is over budget, associated with
fraud, and ineffective in its implementation on a cost basis. That
doesn't mean we want to get rid of them. It means we want to make them
better. The real problem with having the government do more is, right
now 43 cents out of every dollar we are spending we are borrowing. We
create a government plan. We put $60 billion into it, and we can create
competition. But we don't have competition now. Everybody agrees with
that. Nobody denies that we don't have good competition. But we don't
have good competition because we have failed to act.
The Senator from Ohio showed a chart of CEOs' pay. If they were
having to compete, that pay wouldn't be there, especially not at that
level. I don't disagree with that. But the way to control that is real
competition. Forty-three cents of every dollar we spend this year we
will borrow. And it will be worse next year. It will be 45, 46 cents
next year of what we spend we will borrow.
This picture doesn't talk about what she owes. This is just what the
debt is now, just the $11.8 trillion. What she owes is another
$400,000, because we are paying out of Medicare what we have never
created the tax base to fund. So in fact what we are doing is, we are
going to charge this little girl for our Medicare. The impact of that
is when she was born she owed $400,000. By the time she is 20, she will
owe $800,000. What will happen to her?
There is no question we have positive benefits with Medicare. There
is no question we are taking care of people who can't take care of
themselves through Medicaid. There is a question of how effective we
are doing with Native American tribes in terms of that. We are seeing
improvements in veterans health care. We have all these different
programs that are run through the government. So when you only have 39
percent of the health care in the country to put into the market, it is
going to be very difficult to lower costs.

What is the problem with health care in America today? The problem is
cost. It is too expensive. It is about 40 percent more expensive here
than anywhere else in the world. Why is that? Well, there are a lot of
reasons for it. But the first reason is, we will not allow real markets
to develop in the health insurance industry. We have stopped it. And
now we come and say: We are unhappy with it, so we want to create a
government plan--a government plan that will compete.
I do not have any problem if you create a government plan if you fund
it and make it competitive. But that is not what we are going to do.
Because what we are going to do with a government plan is we are going
to turn it into another Medicare. It will supply people health care. It
will lower their costs. But we are going to transfer the cost to this
little girl. It is just $440 billion spent on Medicare this year, of
which $80 billion of it was fraud.
So the problem is, which solution do you think works better? Do you
think we have the history that says government-run health care is
efficient and effective and, therefore, we ought to do more of it or
should we say: We know what works in the rest of the industries and
markets in this country. Maybe we ought to allow markets to truly
compete--which nobody wants to do--to force the insurance industry into
a competitive structure where you can actually see what you are getting
and you can see what you are paying.
The other problem about this little number is, not only does she have
$38,000 in debt right now, and another $800,000 when she gets ready to
buy her insurance, we are going to tell her what she is going to buy.
We are going to take the freedom away from her to decide what is best
for her and her family. Then we are going to yoke her with a whole
bunch more taxes.
There is no disagreement in this body that we need to make changes in
health care; and the assumption that anybody would say that is
absolutely erroneous and fictitious. We recognize that. The question
is, which way do you fix health care? Do you fix it with a government
that is bankrupt already, that has stolen the future from the next two
generations, and add more on to them or do we get common sense back in
and say: Well, first of all, we can eliminate 8 percent of the cost if
we have good tort reform in this country because 8 percent of the cost
of health care is defensive medicine.
I read a study this week. It is interesting--and I have some passion
about this because I have been on the end of those lawsuits--I would
note that the vast majority of those who have been discussing health
care for the last 2 years are lawyers. They are not doctors. They never
laid their hands on a patient. They never stayed up 20 hours in a row
to take care of somebody who needed them. They have all the answers,
but they have never been in health care.
Here are what the numbers are on malpractice lawsuits in the United
States: Eighty percent of all the cases that are filed are thrown out
of court. Of the remaining 20 percent, 89 percent are thrown out of
court. So 3 percent of the cases are legitimate in this country. What
do you think that is costing us? And we ignore it? We are not even
going to talk about the fact that we have an extortioned service going
on in health care that does not cost the lawyers a thing? It costs
everybody else in this country billions of dollars a year because we
are doing tests that nobody needs, except the doctors to defend
themselves. And that is $200 billion a year out of $2.4 trillion. That
is what the number is.
So when less than 3 percent of the people--and I am all for
compensating people who are truly injured. I have no problems with
that. As a physician practicing over 25 years, there is no question I
have made mistakes. There is no question. There are no doctors who are
perfect, and, consequently, sometimes people are injured because of
doctors' mistakes. Most of the time they are not. And it is not about
not compensating the injured. It is about changing the mindset in this
country that you can extort people into settling when you have no real
claim, and that is what is going on with 85 to 90 percent of the cases.
So the answer for health care is: controlling costs. So how do we
best do that? It is interesting, we have had the accusation that there
are no other plans out there. My colleague from North Carolina and I
introduced the first plan in Congress for health care.
What does it do versus what the Baucus bill or the public option bill
will do, according to CBO? We cover 94 percent of Americans--identical
to what the Baucus bill does. So 94 percent of all Americans will get
covered under our bill. We save the Federal Government $70 billion in
the first 10 years, close to $1 trillion in the second 10 years.
What does the Baucus bill do? It saves $88 billion, and nobody knows
what it is going to save after that. But it costs the States billions.
Our bill saves the States, in the first 10 years, $960 billion. We
cover more people, with no increase in the cost to the Federal
Government, versus a marked increase in the cost to the States by the
Baucus bill, or by the public option plan.
It eliminates preexisting condition. We all agree we need to do that.
Nobody is fighting that. The question is, how do you do it? Do you do
it in a competitive model that costs insurance companies pain if they
are not covering the people properly? And if, in fact, there is an
incentive to cover preexisting conditions, then you have an incentive
for the insurance companies to invest in the management of chronic care
rather than ignore covering somebody.
I do not deny there is cherry-picking going on right now, but it is
only because we allow it. We do not have to allow it. But the answer
does not have to automatically be another long-term, bankrupt plan run
by the government. Nobody can deny the $95 trillion, 100-year unfunded
liability for Medicare. That is GAO, that is CBO, and that is the
Medicare trustees. You cannot deny that.
So we have a program that seniors are fairly happy with, except the
Baucus plan is going to cut a half a trillion dollars out of it. But we
cannot pay for it. So we are not doing anything to drive that cost
down, to drive in efficiency. What we are going to do is create more
government, to have another plan that is going to get in the same shape
as Medicare.

[[Page S10302]]

We all want the same thing. We want to get everybody covered in this
country. We want the cost of health care to be affordable. And we do
not want to bankrupt our children. We have already bankrupted them. So
the danger of having a government-centered, government-centric,
government-run, government-devised, government-managed health care
program--just by history, look at what we have done.
Medicaid costs tons more than it was ever supposed to cost. SCHIP
costs tons more than it was ever supposed to cost. Medicare costs tons
more than it was ever supposed to cost. Indian health care--it does not
cost more because we just let them suffer. We do not put the money into
it. VA costs tons more than it was ever supposed to cost. TRICARE costs
more than it was ever supposed to cost. They are all government
programs. They are all way over budget.
So the question the American people ought to ask is: If we all want
to get everybody covered, and we all want to drive down costs, does the
government have a track record that says it has done that? No. As a
matter of fact, it has done the opposite of that.
So it is not a matter of whether you trust in government. We have 61
percent of health care running through government. And as a physician
who has practiced for over 25 years, I will tell you, it is my opinion
the reason costs are out of control is not because of the insurance
industry--and I am not a defender of them; as a matter of fact, I hate
them about as bad as I hate anybody telling me what I am going to do to
my patient--the problem is, we have directives coming from the
government that have disrupted the market in health care and created
this tremendous differential.
The other difference that we have in the Patients' Choice Act is that
we do not put another burden on the States, which all these bills do.
The States are swimming in debt. They are struggling to stay ahead, and
we are transferring billions, almost--we are transferring trillions of
dollars of expense to the State. We are making it nice for four States.
We have picked four States and we have said: You don't have any cost
the first 5 years. We just, out of the hat--because they are having a
little worse economic time than others, we have said: You don't have
it. But for the rest of the States, it is the mother of all mandates,
and they will never be able to afford it.
There is also another little sneaky provision in the bills--both in
the HELP bill, the House bill, and the Baucus bill--which is, we know
we are not going to cut doctors' fees 21 percent. The Presiding Officer
would agree to that, the Senator from Colorado knows we are not going
to do that. But we are not going to recognize it. We are not going to
recognize that cost. So we are playing games with the American people.
We are saying: Here is what it costs, when we know it is going to cost
a lot more than that because we know we are not about to do that. But
we do not have the courage to admit that. We do not have the courage to
ask for an honest score.
The other difference is, we empower patients and States, not
bureaucrats. We preserve the right, the inherent individual liberty
right, of an individual to decide what is best for them rather than
having the government decide what is best for them. In our bill, 9 out
of 10 Americans get a tax cut.
So let me draw the parallel again. We do not have a government-run
program. We save the Federal Government money. We save the States $1
trillion. We get more people covered than any other plan that is out
there. Nine out of 10 Americans get a tax cut. We eliminate preexisting
illness. And we bend the cost curve down considerably.
And, oh, by the way, we do not destroy innovation in health care,
which is 75 percent of the innovation in the world, which will go away
if any of these other plans are instituted--the incentive to put
capital at risk to create opportunity for medical innovation.
There is a lot I could say, but I think what I would like to do is
yield to my colleague from North Carolina in terms of someone who has
been with me, who knows health care, who has been from the start
working with us to try to put forward a plan that says we can
accomplish this same thing and save tons of money.
Mr. President, I yield to my colleague from North Carolina.
The PRESIDING OFFICER. The Senator from North Carolina.
Mr. BURR. Mr. President, I thank the doctor from Oklahoma, my
colleague, my friend. Let me say from the start, 3\1/2\ years ago, Tom
Coburn and I sat down and realized health care was unsustainable at its
current level of investment.
The American people have complained because they have seen a process
that has gone too quickly. Well, in the Patients' Choice Act you find
3\1/2\ years worth of work--a bill that was designed to take 4 years
before we thought we had the right information we needed to do health
care reform adequately.
With the change in the administrations, the new President and his
timeframe, we accelerated it. But let me say, right from the start, it
is unsustainable at its current level of investment. It is 17 percent
of our gross domestic product. Health care has to be reformed.
I personally believed the debate we were going to have in Washington
was over what type of reform. Dr. Coburn raises a good point: cost.
Where are we from the standpoint of our Nation?
I happened to gaze, as I was waiting for the last speakers to finish,
on the page of this publication. It says: Baucus Bill Projected at $829
billion. In the small box down at the bottom of the page--CBO: Deficit
Hits Record $1.4 trillion for Fiscal Year 2009.
Common sense would tell you that when you are in the type of
financial shape the United States of America is in, not only do you
stop spending, you begin to look for ways to curb spending and a way to
invest to reduce the deficit. Because the deficit is what our children
and our grandchildren will inherit. If you believe it is unsustainable
at its current level of investment, then you sort of understand where
Dr. Coburn and I are coming from.
The worst place we can start is: How much more money do we need to
spend to do health care reform? But the truth is, the Baucus plan is
not health care reform. It is health care expansion. The debate in
Washington is not about how to reform health care. It is about how to
expand health care. And once you determine the pool you are going to
expand it to, the $64 million question is: How do we pay for it so the
CBO says we have paid for it?
What I would like to do is spend a little bit of time exploring how
the Baucus plan pays for it with the caveat up front of saying--as it
relates to Dr. Coburn and myself--we don't believe we have to spend
more to reform health care. I think from what he said about the
Patients' Choice Act, we have made the point. We were the first two
people in the Congress--House or Senate--to introduce comprehensive
legislation. We cover the same amount of additional Americans that the
Baucus plan covers. We do it without making additional taxpayer
investments in the expansion of coverage. Why? Because in addition to
expanding coverage, we reform health care. We actually bend the cost
curve. We change the tax application to where it is fair and equal for
all people.
What we have to realize is, the Baucus plan is a 10-year plan. We
collect revenues for 10 years and we pay out for the expansion in 6\1/
2\ years. Let me say it again. We are collecting tax revenues for 10
years, but we are only paying benefit expansions for 6\1/2\ years. We
have to look at years 10 through 20 if you want to see 10 years' worth
of revenue collection and 10 years' worth of expenses. As a matter of
fact, if you took the first 10 years and you applied what is done in
the bill and said: Well, if they started making payments in the first
year, this bill would actually cost $1.8 trillion, not $829 billion but
$1.8 trillion.
Incorporated in the Baucus bill are cuts to Medicare, cuts that equal
$449 billion. Dr. Coburn talked about the imminent reduction to
physician reimbursements: 21 percent projected. We all agree we are
never going to make that. One of the attractions for health care
professionals was the Baucus bill said in year one, we are not going to
make those cuts. Well, they are going to cut Medicare over 10 years by
$449 billion. This is giving with one hand and taking away with the
other hand. Health care professionals around this country have realized
that, even though their association that represents them doesn't.

[[Page S10303]]

The Baucus bill cuts $117.4 billion in Medicare Advantage. My
colleagues are probably saying: What is Medicare Advantage? Well, it is
the preferred plan of 20 percent of America's seniors. Twenty percent
of our seniors on Medicare have chosen Medicare Advantage, a private
sector option to traditional Medicare, where they have looked at the
two and they said: I would rather have Medicare Advantage, because when
I go in the hospital, Medicare is going to charge me a $750 deductible
right off the bat. Medicare Advantage? Zero. For traditional Medicare,
you are going to have to have Part A, Part B, Part D. Medicare
Advantage, you get it all as one lump sum. You don't have to make
separate selections. They provide you the doctor coverage, the hospital
coverage, the drug coverage all in one plan.
Why is it under the target of some in Washington to cut $117 billion?
They say it is because we pay 114 percent of Medicare per person
allocations to Advantage, where we pay 100 percent in traditional fee
for service. That is exactly right. I remember the debate we had in
Washington when we did it. Because the objective then was: How do you
get Medicare Advantage to offer this plan in rural America? To offer it
in rural America meant you had to offer a greater reimbursement. This
isn't reflective of a windfall for the insurance companies; it was an
incentive to offer this choice not just to urban seniors but to seniors
everywhere in America. In my State of North Carolina, 17 percent of all
the Medicare beneficiaries are enrolled in Medicare Advantage. When
anybody gets up and says pass this bill, the Baucus bill, and you can
keep your health care if you like it, there is a caveat to that. Unless
you are 17 percent of the seniors in North Carolina or you are 23
percent of the seniors nationally, you lose your plan. You are going to
go back into traditional Medicare. You are going to go back to where,
when you enter the hospital, they are going to say write me a check for
$750 annually; where your Part B is a separate payment; where your Part
D is something you have to figure out as to which plan you want versus
something that is seamless and covers everything. I will assure
everybody a $117 billion cut to Medicare Advantage will eliminate that
product from the marketplace. Nobody will offer it. Twenty percent of
America's seniors will lose the insurance they prefer, not keep it.
Medicaid expansion. It seems like a sensible way to go if you want to
expand coverage, which is where the debate has been in Washington.
Well, let's simply take a coverage tool that is out there today--
Medicaid--and let's raise the income limit so more people qualify for
it. So instead of 100 percent of poverty, we raise it to 133 percent of
poverty. It costs $345 billion. There is $33 billion in direct State
spending. As Dr. Coburn said, four States are sort of split out of it,
and they say: Well, we are not going to charge you because you are in
tough economic times. Well, North Carolina is at 10.8 percent. Why
aren't we included? Our cost, when the Federal Government makes North
Carolina ante up, is going to be south of $1 billion a year for a State
that had a $4 billion shortfall. Where is my Governor in her outrage at
the proposal to expand Medicaid to 133 percent of poverty?
The tough thing is, this plan has been sold that it is not going to
cost anybody anything, and the truth is it is going to cost seniors, it
is going to cost taxpayers, it is going to cost the unemployed but,
more importantly, it is going to cost people who have health care
insurance today. People who have the money to purchase theirs and
people whose employer offers them health care, their cost is going to
go up because of the restrictions and the mandates that exist within
the Baucus bill.
The Baucus bill would impose an annual $6.7 billion fee on insurance
companies; $6.7 billion a year; over 10 years, $67 billion. So a $67
billion new fee on the insurance companies that we are trying to make
the American people believe are going to reduce premiums, reduce costs,
and we are sticking them with a $67 billion pricetag. There is nobody
in America when they hear this who believes that health care is going
to go down for the American people. For every person who currently has
a plan today, I will assure my colleagues their premium will go up.
They will pay more money, not less money.
We grow the IRS. There is something we haven't talked about because
of the requirements in this bill to collect fees and to collect taxes.
It is estimated by the Lewin Group that the IRS would need a 25-percent
increase in their budget. The IRS currently gets $12 billion annually
for their administrative costs. The administration costs for
implementing the exchange subsidies would add nearly $40 billion from
the Baucus bill. We have additional costs at the IRS because we have to
increase by 25 percent the IRS requirements to go and collect and
enforce this.
We tax the chronically ill. I thought this one was one of those myths
that late night TV talks about. We tax the chronically ill in the
Baucus bill. Let me explain what I mean. Current law says that if your
health care charges exceed 7.5 percent of your annual income, then you
can deduct that off your taxes. Clearly, the lower your income, the
more likely you are to utilize the 7.5 percent exclusion. So what does
the Baucus bill do to raise money? It raises the exclusion to 10
percent. Instead of at 7.5 percent of your adjusted gross income being
able to deduct anything that exceeds that, it says you have to exceed
10 percent of your adjusted gross income. For somebody who makes $1
million a year, this is no big deal. They probably have more than
enough insurance to take care of it. For somebody who is on a limited
income; for somebody who maybe doesn't have all the insurance they
need; for somebody who walks in and is chronically ill, has a chronic
disease and they are making payments, they are covering their copays,
they occasionally go to the hospital, they have that $50 charge for
walking in the door, even though they have insurance. They are making
it at the end of the year, even though they make $20,000 or $25,000 a
year, and all of a sudden, 2\1/2\ percent of their adjusted gross
income is no longer a deduction they get. What is that? That is taxing
the chronically ill in this country.
Listen, I have to give them credit. They have left nobody out of this
bill from taxes. They have left nobody out of this bill from
instituting a new fee. As a matter of fact, some of it we are going to
have to take for granted is going to be applied to us in an indirect
way because incorporated in the Baucus bill we collect a new device
tax. To the heart patient who goes in and gets a heart catheterization,
to the senior who goes in and gets a hip replacement, it is a device.
For any medical device that is used, there is a $40 billion device tax
over 10 years.
What does that do for the innovation of new devices? Dr. Coburn can
speak to it better than I can. When we were able to switch from open
heart surgery to bypass surgery, we probably went from $40,000 or
$60,000. When we were able to catheterize somebody and put a stent in,
we reduced significantly the cost, we reduced significantly the
invasion, we were able to raise the quality of life. We couldn't have
done that if somebody hadn't innovated a cath and a stent. We would
still be doing all bypass surgeries. You think through all the medical
procedures we do in this country and you think about all the devices
that have been created by companies and by doctors so they can be less
invasive because they understand every time they go into somebody,
every time they cut in, there is a fear of infection today; there is a
consequence of recovery. It means a stay in the hospital is longer.
When you see a new device enter into the marketplace, you actually
see a new efficiency come into health care. You see reduced health care
costs because you are taking either somebody out of an inpatient
setting and you are putting them in an outpatient setting, or you are
taking an inpatient patient and you are getting them out of the
hospital faster. Actually, you could make the case that innovation of
medical devices is health care reform because it is driving down costs,
because it is moving patients out, and the net result is the quality of
life goes up. But, in this bill, we raise $40 billion over 10 years, or
$4 billion a year on taxes on devices.
If you listen to the things I have talked about, you are probably
sitting at home trying to figure this out: I am going to pay more in
health care because they are taxing devices. I am going to pay more in
health care if, in

[[Page S10304]]

fact, I have a chronic illness because I am not going to be able to
deduct that out-of-pocket cost that is between 7\1/2\ percent and 10
percent of my adjusted gross income. I am going to have to cover, as a
taxpayer, a 25-percent expansion in the IRS. They are going to impose a
$6.7 billion so-called fee on the insurance industry, or $67 billion
over 10 years, while I have an insurance policy, so that fee is going
to be passed through to me as a covered life under the insurance plan.
I am going to pick up, in the State in which I live, the increase in
the limitations on Medicaid when we go from 100 percent of poverty to
133 percent of poverty. How can you make a claim that this bends the
cost curve? If you tried to make the claim, it bends the cost curve up
not down.
Dr. Coburn and I listened very intently as the President kicked off
this debate: Create a program that provides coverage for as many
Americans as we possibly could. We did that. Bend the cost curve down.
Well, we make a direct investment in prevention, wellness, and chronic
disease management--the only three direct areas of savings in health
care. We can talk all night about tort reform and about different
aspects. They are indirect and there are significant savings we can
achieve by incorporating those reforms into health care.
In the Patients' Choice Act, we elected to keep it narrowly targeted,
and we invest in prevention, wellness, and chronic disease management.
Why? Because we went to States, businesses, and self-insured companies
that went 4 years and didn't have an increase in health care costs.
Why? Because they changed the lifestyle of their workers. They actually
paid their workers, in some cases, to quit smoking, to lose weight, to
get exercise, or to take an education program on a chronic disease they
had to make sure they got the treatment they needed.
The net result? In every case, the per-enrollee savings were so
significant that the companies continued to try to figure out how they
could spend more to reduce health care costs. The quality of life for
their employees was better. The productivity of the employees was
better, and they had no annual increase in their health care costs.
We are sitting here ignoring everything that has been learned in
America by private self-insured companies and by some insurers who are
doing creative things, targeting chronic disease, and actually paying
doctors to educate. We have ignored all of this. Why? Because we are
having a debate in Washington with the Baucus bill about coverage
expansion, not about health care reform.
Coverage expansion costs a lot of money--$829 billion. We are having
that debate and telling the American people this is about reform. If
you read the fine print, the bottom of the page, and if you read the
part they don't want you to remember, it says this year alone there is
a $1.4 trillion deficit. That is $1.4 trillion we didn't have that we
had to borrow.
The last thing we need is more money in health care. It is 16 percent
of our GDP, and we cannot maintain that level of investment. The
challenge is on us to come up with the reforms that continue to invest
and promote innovation, that expand coverage and, more important,
reduce costs.
What do the American people want? They want health care costs to go
down, and they want quality to go up. We don't accomplish that in the
Baucus bill, but you do in the Coburn-Burr bill. It is not perfect, but
it heads in the right direction.
I yield to my good friend from Oklahoma.
Mr. COBURN. I thank the Senator. I am sitting here thinking, if I was
sitting at home tonight listening to this, how do I hear the story that
I heard for 2 hours on having a government-run plan and how bad the
insurance industry is? As a physician, I don't like them a whole lot, I
can tell you that. I don't like some of their tactics. I certainly
don't like the way they cancel insurance policies on people. There is a
lot about them I don't like. But I don't want to eliminate them. What I
want to do is create a real market where they have to be savvy and
compete and they have to be efficient and they have to help us help one
another get well.
We are going to hear a lot over the next month on health care. We are
going to hear all these claims, much like we did from Congressman
Grayson, who made an outlandish claim that my side of the aisle wants
people to die. That is what was said in the House of Representatives.
What I want is people to live. I want this little girl in the picture
to live too.
Do we have an unsolvable problem? No. Do we have ways of making
health care costs much less in this country? Yes. Do we have ways of
ensuring increased innovation and advanced disease prevention in this
country? Yes. Do we have ways to protect this little girl in the photo?
Yes. But the debate is over how we do that. One side says we do it by
making the government a whole lot bigger--$1 trillion bigger, $3
trillion bigger over the next 20 years. That is one side of the debate.
Our side of the debate says this is inefficient health care. We want
to cover everybody. We never want anybody to go bankrupt or to be
denied care. We think you can do that without growing the government by
25 percent. We think there are other ways to do it. We are honestly
worried about our track record in Washington when we have a $1.4
trillion deficit this year and a Medicare Program that is absolutely
bankrupt--it will run out of money in less than 7 years from now,
totally out of money--and we are going to be borrowing it all then. Is
there another way to do it? So either we make a large jump in the size
of the Federal Government and add to the $838,000 that this little girl
is going to have, or maybe we can work together and say the insurance
companies are bad, but can we keep something like that and make them
efficient? Can we allow people to buy across State lines? Can we give
people opportunities to buy what they want to buy rather than being
limited? Do we trust people to make good enough decisions for
themselves?
The Baucus plan doesn't do that. It says we have three or four plans
from which you get to choose, but we are going to tell you what you
have to buy. And, by the way, you have to buy insurance in this
country. Think about that.
I carry with me a copy of the the U.S. Constitution all the time.
Every bill out there has said you don't have liberty because the
Federal Government is going to tell you where you have to spend your
money. You have to buy an insurance policy. So if you make a quarter
million dollars a year, it doesn't matter if you want to fund that
self-insurance, it doesn't count. You still have to do that. If you
don't, you are liable to a tax. If you don't pay the tax, a $25,000
fine. If you don't pay the fine, you are in jail for a year.
How do we get off telling people that and taking away that liberty,
that freedom that is supposed to be guaranteed under the Constitution?
The answer is, well, it is better for everybody because if we don't
have everybody covered, then it is going to cost more because that is
the big government answer to it. Maybe it will cost more if we force
and drive competition, if we create transparent markets, where you know
what something costs before you get it in health care. In fact, there
is a real connection with the purchase of health care and the payment
because everywhere we have tried that, it is working to control health
care costs. But we refuse to do it.
Frankly, the reason our idea is rejected, which is changing the Tax
Code to treat everybody the same under the Tax Code, is because the
labor unions don't want that to happen. That is exactly why. Everybody
knows that is the problem. Everybody in the country knows that is the
problem, but we don't have the political courage to face up to how to
fix the problem.
As soon as you make everybody the same under the Tax Code, you
empower 35 million Americans who don't have insurance today to get it.
You save the States $1 trillion over the next 10 years, and you give 95
percent of Americans a tax cut, and guys like me will pay a little bit
more for my health insurance and income tax. But we will not do that
because the powers that deliver politicians to Washington are more
powerful than the principles and the character to follow the pursuit of
the Constitution.
This little girl in the picture, and everybody like her in this
country, is at risk today. We are going to have this great big debate
and say how bad the insurance companies are and how bad

[[Page S10305]]

the government programs are. But the fact is, we don't have a
bipartisan bill. Our ideas were thrown out, 13-10, at both the Finance
Committee and the HELP Committee--13-10, 13-10, 13-10--because the idea
is they didn't want a compromise bill. They didn't want to solve the
problems. They wanted their way or the highway.
So, consequently, we are going to get a bill. I have no doubt. But my
little Lucy right here and her football--she is going to lose her
football. She is not going to have any little Lucys because she is not
going to be able to afford them. She is going to be paying off her
$800,000 worth of government obligations starting at age 20, and she
will never climb out of the pit.
So when America thinks about health care, there are a lot of ways to
solve it. One is to trust what makes America great--granted, with some
changes--or the other is to trust the government to create more
government programs.
I will just add this one point. Do you realize that in the bill that
passed the HELP Committee there are 88 brandnew government programs--
88; 219 times we have held the Secretary of HHS to write in-depth
regulations. Now, 88 programs interfering in health care are going to
be problem enough. But 219 new sets of regulations--oh, by the way, we
created the comparative effectiveness committee with the stimulus bill,
and we are going to have 26 people tell every doctor in the country how
they are going to practice medicine, what is right and what is not
right. And, by the way, in all the committees a prohibition on
rationing was voted down.
What are we to think? We are going to create a large government
program and grow the government by $1 trillion over the next 10 years,
$2 billion-plus, maybe $3 trillion in the next 10 years, and we are
going to have Washington tell people how the physicians and caregivers
will treat, what they will use to treat, and all the time little Lucy
will not matter if she gets sick. We will have already made her sick
because we have stolen her future, her absolute future.
It is a cute picture, but it sends a devastating message to us as
leaders in this country. How dare we do that. I wanted to bring out my
other charts tonight, but I didn't want to bore everybody. The fact is,
the appropriations bills that were passed--if we keep doing what we are
doing--America, hear this--we are going to double the size of the
Federal Government in 3\1/2\ years.
We passed the Agriculture bill today, which is 22 percent bigger, and
it was 15 percent last year, and that doesn't count any of the
supplemental and the stimulus money. It doesn't take long, if you are
growing something at 22 percent, for it to double.
My gray hair comes from the fact that I think we are missing a great
opportunity to work together. I think we can solve the health care
problem. I think we can do it without enlarging the Federal Government.
Especially when we pay 40 percent more than anybody in the world, there
ought to be savings that we can get to make health care cost less and
to cover everybody else. I know we have seen the studies that show
that.
So why isn't it going to happen? Why isn't there going to be a
bipartisan bill? It is all political. It is not about the people in
this country, it is about the political power structure in this
country.
Problems can be solved, common sense applied to limited government
and restoring freedom to individuals.
There are going to be so many lawsuits in this country, most of them
legitimate, over the health care bill. You will not be able to uphold a
challenge to the Constitution of forcing me to pay, take my money that
I earn privately and spend it on what you say I have to spend it on. It
is one of the greatest denials of liberty I ever heard of, and it is
going to get challenged. It is going to go through the courts fast, and
I suspect the courts are going to uphold the citizens of this country
rather than the power center.
I yield the floor or I yield back to my colleague from North
Carolina.
Mr. BURR. Mr. President, I thank Senator Coburn for yielding. Let me
just say the reason he is gray is because he cares. This is a Member of
the Senate who typically on Monday morning delivers babies, and all
weekend long. Before he comes back to Washington, he practices
medicine.
This institution looked at what he did and said: You can't charge for
what you do even though it costs you $200,000 a year to keep your
practice open, your license in place, to buy your liability insurance.
They said that is illegal under Senate rules.
So Tom Coburn is a unique individual. He sees women who are pregnant.
He delivers babies. But he doesn't take any payment for it. He keeps
his license up to date. To some degree, it is charity care because he
believes it is the right thing to do. More important, he understands
that what we do here affects what our children and our grandchildren
get in inheritance from us--not financial inheritance, in opportunity.
Why are we passionate about the debt? Why are we passionate about
trampling on the Constitution? Because every time we do it, we take an
opportunity away from the next generation. We reduce their ability to
be successful, whatever their definition is.
Tom Coburn covered it very well. We are somewhat impassioned about
our criticism toward the bills that passed out of the HELP Committee,
the Finance Committee soon, and the three bills in the House. Why?
Because we introduced our bill first. We laid our cards on the table.
We offered to work in a bipartisan way with anybody, and we had no
takers.
I believe when you lay it out there and you come up with a successful
plan, you have every right to be critical. I do question the ones who
do not offer an alternative. But we have offered a solution, and that
solution was based on three fundamental principles:
One, it had to cover everybody. The way our bill is structured, every
American receives the same financial stipend regardless of whether they
work or whether they don't, regardless of where they live. We treat
everybody the same.
Two, if you are going to get cost savings, then you have to make
direct investments in prevention, wellness, and chronic disease
management. The Patients' Choice Act makes direct investments in
prevention, wellness, and chronic disease management.
Three, is it financially sustainable into the future? We probably
should have started with this one versus save it for last. Why in the
world would we create a health care system in America if it is not
sustainable? If it is not financially sustainable, why would we even
consider that legislation in the Congress of the United States? If it
did not pass the test of time, why would it even be worthy of debate?
Unless we expect people outside of America to continue to finance our
urge to spend, then I have to tell you, we are not going to have any
money--either that or we are going to have to tax the American people
to a point where they are not going to want to be successful, they are
not going to want to work overtime, they are not going to want to
switch jobs because the benefit to them of being successful is to be
punished by taxes.
This bill is filled with new fees, new taxes. True reform that
expands coverage would pay for itself. Think about that. If you truly
reformed health care, would the reforms through savings not pay for the
expansion? Shouldn't this be a net sum game?
We have left out of the bill shopping across State lines for
insurance. It saves money. The American people are sitting there: Why
aren't you doing this? Tort reform saves money. The American people are
sitting there: Why aren't you doing this?
Let me end on one that I think the American people are really plugged
into. Congress, which plan are you putting yourself under? You designed
this plan for everybody in America. Is it the plan you are going to
have? You know what, in the Finance Committee, in the HELP Committee,
in the House committees, there have been amendments that said Congress
has to take the plan they create for the American people. That
government option, that is what Congress has to be under. It has been
rejected every time it has been offered.
But you see, Dr. Coburn and I took a different approach because in
the Patients' Choice Act, we had to set what the basic minimum plan was
going to be. Do you know what we put? The Federal Employees Health
Benefits

[[Page S10306]]

Program. We didn't put them into the FEHBP, but we said it had to be
equivalent to what Members of Congress had. How could we ask the
American people on a plan we create to have less than we have? The
American people expect us to look after them, they don't expect us to
give them less than we have.
It was rejected every time that was offered to move Congress to their
plan. But I think it tells you a lot about the way Tom Coburn and I
approached the bill we worked on because we never thought about taking
us and putting us into their plan, we thought about taking them and
raising them to our plan. There is a big difference in that. There is a
big difference in looking at the American people and saying, you should
be here; not the American people saying, you should be where we are.

We want people to be successful in this country. Tom Coburn said this
is not a bipartisan bill. He is right. But I will end with this
tonight: This is also not a reform bill. If you want to talk about
expanding coverage, it does an equal job to what the Coburn-Burr bill
does. If you want to judge it based upon reform, it accomplishes no
reform.
I encourage those who are not satisfied with the options that have
been presented in the House or the Senate or that will be debated, go
on Tom's Web site, go on my Web site, Google ``Patients' Choice Act.''
Read the bill. It is only 200-some pages, it is not 1,000.
The truth is, if we have a real debate--at some point, we will have
one about health care reform--I could suggest to the American people
one word that would drastically reform health care, that could replace
all 1,000 pages of a House or Senate bill. It is called portability. It
is called the ability for an individual employee to take their
insurance from one employer to another, not to be construed in any way
because they have a preexisting condition, but also to recognize the
fact that when you do portability, you change drastically the way
insurers look at covered lives.
I think the American people would be shocked to know the average
person is under a health care plan for an average of 4\1/2\ years right
now. Ask yourself: If I am an insurer and I am going to invest in
somebody's lifestyle changes and I am only going to have them 4\1/2\
years--how much are you going to invest? The answer is, probably very
little. By the time they lose weight or quit smoking, you haven't
reaped the benefits of those savings, and all of a sudden you create
portability. That means a 24-year-old covered by an insurance company--
that insurance company has an opportunity to keep him until he is 64
years old, 40 years. How much are you going to invest in that insured
if you are going to have them for 40 years? You are going to invest a
heck of a lot because you will want to keep him well as long as you
can. You are going to reimburse doctors to do the education; you are
going to make sure you keep them out of the hospital; you are going to
make sure that if they go into the hospital you get them the treatment
they need to get them out as quickly as you can. You are not going to
deny a prescription a doctor wrote for them. You are not going to
question a treatment a doctor chose because all of a sudden the doctor
is a partner to the insurance versus just a cost to the insurance.
You see, true reform has to change health care across the board. It
has to change the relationship between patients and insurers, between
doctors and insurers, between hospitals and insurers.
Ask yourself: Does the Baucus plan accomplish any of it? The simple
answer is no, it does not. That is why it costs $829 billion, and that
is why to pay for it you don't get it through savings, you get it
through taxing and fees. You get it through the insurance costs of
everybody who has it. You achieve the costs by cutting Medicare, by
knocking seniors off the health care plan they prefer. You get there by
increasing the income limitations on Medicaid, making States actually
pay for the expansion of 11 million Americans who are going to be
covered under the most inefficient health care system in the country,
Medicaid, where only 60 percent of the health care professionals will
even see Medicaid beneficiaries because the reimbursements are so low.
But we are going to grow that population by 11 million people.
We are doing an injustice to these people to put them in a plan where
only 60 percent of the health care professionals will see them. They
will not get the education they need for chronic disease management.
They will not make the lifestyle changes because Medicaid does not pay
for prevention, wellness, or chronic disease management, nor does
Medicare, nor does the VA, nor does Indian Health. Show me a government
plan that pays for prevention, wellness, and chronic disease
management, and I will quit coming to the floor and quit talking about
the lack of reform.
The truth is, the Baucus plan tries to replicate what the Federal
Government has, and it does not have prevention, wellness, and chronic
disease management today. It will not have it tomorrow, and it will not
have it next year.
Mr. President, I thank you for your patience. I assure you and our
other colleagues that Dr. Coburn and I will be frequent visitors here
as we get ready for this debate, as we have this debate, and probably
after this debate is over, depending upon the outcome of it.
But let me make it perfectly clear, if any Member in this debate is
looking to try to achieve a bipartisan solution to health care, you can
sign Tom Coburn and Richard Burr up today to sit at the table with you,
to forget about who is the author of legislation, to talk about real
solutions to real problems that deal with health care. I am committed
to doing it, but I am not committed to rolling over and just accepting
another expansion of the Federal Government and Federal Government
spending.
Mr. President, I yield the floor.
The PRESIDING OFFICER. The Senator from Colorado.
Mr. BENNET. Mr. President, as you could hear from the remarks of the
Senator from North Carolina and the Senator from Oklahoma, there is
agreement on some issues. We know the status quo is not going to work
when it comes to health care. We know our families cannot endure
another decade of double-digit cost increases every single year in
their health insurance premiums. We know we can do better than devoting
a fifth of our GDP to health care, when every other industrialized
country in the world devotes less than half that to health care. We
know the biggest drivers of our outyear budget and debt--which we do
need to be enormously concerned about--are rising Medicare and Medicaid
costs, and the biggest drivers of those are rising health care costs.

I would say, again, as I have said before, I hope we can start on
where the areas of agreement are and try to work from there. Because
our small businesses and working families all across this country,
including in my State of Colorado, cannot endure another 10 years like
the 10 years they have endured. We will not be able to compete
effectively in this global economy, where we are devoting more than
twice what any other industrialized country in the world is devoting to
just one sector of our economy--health care--and we are not going to
keep the kind of commitment the Senator from Oklahoma was talking about
to the young girl in the photograph or, for that matter, to my three
daughters at home, who are 10, 8, and 5. I am deeply concerned about
where we are with respect to our deficits and our debt.
So while we are disagreeing about the outcomes, I think there is a
growing understanding that the current system just will not do.

Afghanistan

Mr. President, I am here to talk a little bit about Afghanistan, and
just for a few minutes because yesterday we reached the 8-year
anniversary of the war in Afghanistan. On this occasion, we should
remember how unified our entire country was over our mission there when
it began. The Nation came together after 9/11 to support our military
as it bravely took the fight to the Taliban and the terrorists in
Afghanistan. We had one ultimate goal: Removing al-Qaida's safe haven.
Our military succeeded in toppling the Taliban government, which had
allowed al-Qaida to use Afghanistan as a staging ground and a hiding
place. Once the Taliban was removed from power, an international
coalition, led by U.S. forces, went about the long and difficult task
of defeating al-Qaida for good.

[[Page S10307]]

Yet now, 8 years later and with a new administration trying to
determine America's best way forward, many Americans are understandably
concerned and frustrated. Afghanistan is not where any of us want it to
be, and our ultimate goal has not yet been met. Al-Qaida is still there
and in Pakistan as well. Afghanistan's Government has not been able to
take centralized control of the country. Elections there have not added
to the legitimacy of the Karzai government. We have been left to
reassess our position, and we must do this reassessment together.
Policymakers are asking the important and right question: What are
the proper goals for our military effort in Afghanistan? How best can
we accomplish them? Are these goals purely military goals? Can they be
better solved with more troops or fewer? Do we need a more complex new
mission in our future, which the military aspect is only one small
part?
Unless we are sure, unless all of us are sure that more troops can
help us meet our goals, we should not send them. Our soldiers already
have sacrificed much. This time, in particular, is a difficult one for
servicemembers and their families, and it is also proving to be a
difficult one for those of us making policy.
As we decide what our direction will be in Afghanistan, the fallen
brave soldiers we lost from Fort Carson this week are solemn reminders
of how consequential our decisions have been and will be. Those of us
who opposed going to war in Iraq, including President Obama, believed
then it was the wrong war at the wrong time. We believed that
Washington's focus on Iraq was diverting precious resources from our
efforts in Afghanistan. We are still dealing with the consequences of
the decision to focus on Iraq, both in Iraq and in Afghanistan.
Recalling recent history is so important because now we have to find
new wisdom on Afghanistan. At the same time, all 100 Members of this
body know we must take great care as we make decisions that will affect
the lives of our men and women in uniform and their families. For every
soldier who answers our Nation's call to serve in combat, a new
deployment is akin to a new decision to go to war. That is why our
national purpose and their mission must be absolutely clear.
That is also why, as Members of this body, we must be willing to ask
hard questions. The country will be counting on the Senate to
scrutinize and understand the purpose of any decision to deploy
additional troops. As we, together, debate a new approach to
Afghanistan, I will be motivated by the memory of the Fort Carson
soldiers who died this past week, as well as all those who have fallen
in rank and Afghanistan. I know all of us feel the same way. They
served honorably. So must we.
Mr. President, I yield the floor.
Mr. BEGICH. Mr. President, I suggest the absence of a quorum.
The PRESIDING OFFICER (Mr. Bennet). The clerk will call the roll.
The assistant legislative clerk proceeded to call the roll.
Mr. BEGICH. Mr. President, I ask unanimous consent that the order for
the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.

____________________