Worker, Homeownership, and Business Assistance Act of 2009

Mr. President, I yield myself 20 minutes.

Mr. President, the conference report on H.R. 2647, the National Defense Authorization Act for Fiscal Year 2010, would fully fund the fiscal year 2010 budget request of $680 billion for national security activities in the Department of Defense and the Department of Energy. This bill is the product of months of hard work by our committee, culminating in more than 6 weeks of negotiations with our House counterparts. I thank all of the members of the Senate Armed Services Committee for the commitment they have shown to the best interests of our men and women of our Armed Forces. I want to particularly thank Senator McCain, our ranking minority member, for his great work throughout the conference. It has been a real pleasure to work side-by-side with Senator McCain as we worked through issues with our counterparts from the House of Representatives.

I also want to thank the chairman of the House Armed Services Committee, Ike Skelton, and his ranking minority member, Buck McKeon, for the cooperative spirit with which they worked with us throughout the conference.

This conference report contains many important provisions that will improve the quality of life of our men and women in uniform, provide needed support and assistance to our troops on the battlefield in Iraq and Afghanistan, make the investments we need to meet the challenges of the 21st century, and require needed reforms in the management of the Department of Defense.

First and foremost, the bill before us continues the increases in compensation and quality of life that our service men and women and their families deserve as they face the hardships imposed by continuing military operations around the world. For example, the bill contains provisions that would authorize a 3.4 percent across-the-board pay raise for all uniformed military personnel--a half a percent more than the budget request and the annual rate of inflation; increase the Army's active-duty end strength by nearly 30,000, and authorize an additional

30,000 increase during fiscal years 2011 and 2012, if the Secretary of Defense deems it necessary to increase dwell time and reduce the stress created by repeated deployments; authorize payment of over 25 types of bonuses and special pays aimed at encouraging enlistment, reenlistment, and continued service by active-duty and reserve military personnel; extend the limitation on charges for inpatient care in a civilian hospital under TRICARE Standard; enhance the ability of military voters to vote by absentee ballot; increase the authorization for the Homeowners Assistance Program by almost $300 million to provide relief to homeowners in the armed forces who are required to relocate because of base closures or change of station orders; and increase the maximum amount of supplemental subsistence allowance from $500 to $1,100 per month to ensure that service members and their families do not have to be dependent on food stamps.

The conference report also includes a number of provisions to support the civilian workforce of the Department of Defense. For example, the bill contains provisions that would: provide for the application of unused sick leave toward length of service for purposes of computing a retirement annuity under the Federal Employee Retirement System; phase in locality comparability pay in place of cost of living allowances for Federal civilian employees working in Hawaii, Alaska, and other nonforeign U.S. territories, so that they are treated the same as federal employees in other States; terminate the National Security Personnel System--NSPS--and replace it with a provision that provides a series of personnel flexibilities applicable to the entire civilian workforce of the Department of Defense and an opportunity for the Secretary to propose additional flexibilities; freeze the Defense Civilian Intelligence Personnel System--DCIPS--until an independent review can be completed; and authorize the Secretary of Defense to establish a new Defense Civilian Leadership Program to help recruit, train, and retain highly qualified civilian employees to help lead the Department of Defense over the next 20 years.

The conference report also includes important funding and authorities needed to provide our troops the equipment and support that they will continue to need as long as they remain on the battlefield in Iraq and Afghanistan. For example, the bill contains provisions that would provide $6.7 billion for the Mine Resistant Ambush Protected--MRAP-- Vehicle Fund, including an increase of $1.2 billion above the President's budget request for MRAP All-Terrain Vehicles--M-ATV--which are deploying to Afghanistan; add $100 million for unfunded requirements identified by the Commander of Special Operations Command, including MC-130 airships to provide improved fire support for our ground forces in Afghanistan and Iraq; provide full funding for the Joint Improvised Explosive Device Defeat Organization--JIEDDO--to continue the development and deployment of technologies to defeat these attacks; provide nearly $7.5 billion to train and equip the Afghan National Army and the Afghan National Police, so that they can begin to carry more of the burden of defending their country against the Taliban; and authorize up to $1.3 billion for the Commanders' Emergency Response Program--CERP--in Iraq and Afghanistan for humanitarian relief and reconstruction projects that directly benefit local communities, including up to $50.0 million to support the Afghanistan National Solidarity Program to promote Afghan-led community development.

The bill would implement almost all of the budget recommendations made by the Secretary of Defense to terminate troubled programs and apply the savings to higher priority activities of the Department. For example, the bill would end production of the F-22 fighter after 187 aircraft; terminate the Air Force Combat Search and Rescue X--CSAR-X-- helicopter program; terminate the VH-71 Presidential helicopter; end production of the C-17 airlifter program; cancel the manned ground vehicle portion of the Army's Future Combat Systems program, with assurances those funds will be available for the newly designed vehicle portion--ground vehicle portion; terminate the Multiple Kill Vehicle program; cancel the Kinetic Energy Interceptor and we cancel the second Airborne Laser prototype aircraft.

Finally, the bill contains a number of provisions that will help improve the management of the Department of Defense and other Federal agencies. For example, the bill contains provisions that would enhance the ability of the DOD inspector general to conduct audits and investigations by authorizing the IG to subpoena witnesses to provide testimony; improve DOD financial management by requiring the Department to engage in business process reengineering before acquiring new information technology systems and submit regular reports on its progress toward auditable financial statements; require the Department to develop a comprehensive plan to address longstanding problems in its inventory management systems, which lead it to acquire and store hundreds of millions of dollars worth of unneeded items; place a moratorium on public-private competitions under OMB Circular A-76 until the Department complies with existing statutory planning and budget requirements relevant to such competitions; and streamline and restructure DOD management positions by eliminating 22 of the 28 current Deputy Under Secretary of Defense positions and requiring the Department to develop a new organizational plan within 6 months.

The conference report incorporates two pieces of legislation from in the Senate-passed bill: the Military Commissions Act of 2009 and the Matthew Shepard and James Byrd, Jr. Hate Crimes Prevention Act.

The Military Commissions Act of 2009 would replace, and dramatically improve, the procedures enacted in the Military Commissions Act of 2006. In its 2006 decision in the Hamdan case, the Supreme Court held that Common Article 3 of the Geneva Conventions applies to the Guantanamo detainees and requires that the trial of those detainees be conducted in a manner consistent with the procedures applicable in trials by courts-martial.

The Supreme Court concluded that this requirement ``is not an inflexible one; it does not preclude all departures from the procedures dictated for use by courts martial. But any departure must be tailored to the exigency that necessitates it.''

The Military Commissions Act of 2006 created a cloud over the use of military commissions because it failed to live up to that standard. The conference report would address this problem by, one, precluding the use of coerced testimony; two, limiting the use of hearsay testimony; three, establishing new procedures for handling classified information similar to procedures applicable in civilian courts; four, providing defendants with fairer access to witnesses and documentary evidence; and five, requiring the defendant to be provided with appropriate representation and adequate resources.

The Military Commissions Act of 2009 is intended to meet the standard imposed by the Supreme Court's ruling in Hamdan and should help ensure that convictions obtained through military commissions will hold up on appeal and will be perceived as fair by the American public and by the rest of the world.

I thank Senators McCain and Graham as well as the lawyers at the White House, the Department of Defense, and the Department of Justice, who worked with us and for the great effort they put into this provision.

The conference report incorporates the Hate Crimes Prevention Act. Similar provisions have been previously adopted by both the Senate and the House of Representatives. This legislation is intended to help deter people from being targeted for violent attacks because of race, religion, disability, gender, or sexual orientation, among other aspects. The Senate adopted the hate crimes legislation when we adopted the Defense Authorization Act, and it was kept in conference. The House of Representatives has now adopted the conference report, and so it is now hopefully going to be before us after a cloture vote.

The hate crimes legislation includes, for the first time, a provision that makes it a Federal crime to attack a member of the U.S. Armed Forces on account of his or her military service--a hate crime that is of particular interest to the armed services.

According to the FBI, the trend is up for hate crimes based on sexual orientation. There has been a 6-percent increase in such crimes in the most recent year for which statistics are available, which is the year 2006. This is a category of hate crimes that would be covered for the first time by this bill.

The language has been written to ensure it does not intrude on first amendment rights, that State and local law enforcement retain the primary jurisdiction over investigations and prosecutions.

We all know Senator Kennedy was long the Senate's leading advocate for hate crimes legislation. As he said when the Senate debated and passed this legislation in 2007:

America has taken many steps throughout our history on a

long road to becoming a more inclusive Nation, and our

diversity is one of our greatest strengths. Our tolerance for

each other's differences is part of the lamp that can help

bring light to a world which is enveloped in bigotry and

intolerance.

The enactment of the Hate Crimes Prevention Act through this, which is the last National Defense Authorization Act in which Senator Kennedy participated in his 26 years of service on the Armed Services Committee, would be a fitting tribute to one of the truly great Senators in the history of this body.

Finally, I thank Senator Leahy for the leadership role he has played on this issue in his capacity as chairman of the Senate Judiciary Committee.

As of today, we have almost 130,000 U.S. soldiers, sailors, airmen, and marines on the ground. Over the course of the next fiscal year, we will undertake the difficult task of drawing down these numbers--these are numbers in Iraq--while maintaining security and stability on the ground. At the same time, we have dramatically increased our forces in Afghanistan, with more than 60,000 engaged in increasingly active combat and combat-support operations, with more on the way.

This conference report includes numerous provisions that need to go into effect immediately to ensure that they benefit our troops immediately. These provisions cannot be implemented before this conference report is enacted but will go into effect, without the need for appropriations, immediately upon enactment.

They include the following in the area of compensation and benefits. The conference report includes provisions that would prevent the implementation of large increases in the copayments military retirees must pay for in-patient care at civilian hospitals under the TRICARE Program; provisions which would authorize new special compensation for caregivers of catastrophically injured servicemembers; and a provision which will increase the maximum amount of supplemental subsistence allowance to ensure servicemembers do not have to rely on food stamps to meet their nutritional needs. Those important provisions and others which I am going to now talk about will not go into effect until this conference report is enacted.

With regard to our efforts in Iraq and Afghanistan, the conference report includes provisions that will immediately go into effect without the need for appropriations.

For instance, there is a provision which would authorize the Secretary of Defense to transfer defense equipment that would otherwise be withdrawn from Iraq and transfer it to the security forces of Iraq and Afghanistan, their national forces. The use of that equipment by those national forces in Iraq and Afghanistan will assist in the transfer of security responsibilities to the Iraqi forces and the growth of the Afghan Army and police forces more quickly.

Another provision which will go into effect immediately upon enactment would allow the Secretary of Defense to use funds from the CERP in Afghanistan to pay for reintegration programs to separate local Taliban fighters from their leaders. This is a new program modeled on the Sons of Iraq Program which was so successful in getting large numbers of young Iraqis who had been attacking us to switch sides and support the government. These are two programs which I think people strongly support regardless of their position on the question of strategy and the troop levels. Those provisions will make it possible, immediately upon enactment, to use funds to support the reintegration of those young Afghans into their civilian life, just the way we did with the Sons of Iraq.

This provision will permit the shipping of equipment that is so important to strengthen the Afghan Army and police from Iraq instead of bringing it home. These are critically urgent provisions, particularly in Afghanistan.

Another provision, as soon as a conference report is enacted, would permit the Secretary of Defense to use up to $500 million in operations and maintenance funds to meet urgent military construction needs of the commander of the Central Command in Iraq and Afghanistan that were not previously forecast. But these new authorities are not there until the conference report is enacted.

As I mentioned earlier, this bill includes the Military Commissions Act of 2009, which is needed to make trial of detainees by military commissions a viable alternative to trial in Federal court. Until it is enacted, any conviction obtained before a military commission will be at serious risk of being overturned on appeal. For that reason, the administration has suspended all military commission trials until this language goes into effect.

We have enacted a defense authorization bill every year for almost 50 years now. We have done so because Members of Congress have understood, on a bipartisan basis, the importance of supporting our troops and making the policy decisions that are necessary to support them. This year is no different.

With almost 200,000 men and women of the Armed Forces currently serving in Iraq and Afghanistan and many more supporting them and engaging in other demanding activities on our behalf and their behalf around the world, we cannot afford not to enact this legislation.

For all these reasons, I would urge our colleagues to vote for cloture on the conference report and then to adopt the conference report itself.

I yield the floor.

Mr. President, very briefly, I yield myself just 1 minute. There is no conference to send this back to. The conference, by rules, has been disbanded.

I yield the floor.

Mr. President, how much time remains?

How much on the other side?

Mr. President, I am going to be very brief and will not use the 10 minutes, unless there is somebody else who wishes to speak in support of the motion to invoke cloture.

I yield myself, Mr. President, 6 minutes.

Just very briefly, let me say that the Senate has adopted hate crimes legislation on a defense authorization bill, I believe, three times. This is not the first time we would do this. It is not the second time we would do this. So it is not unique. It is not unusual. It is not unprecedented.

It is important that we provide the same kind of protection for the additional groups who are being protected under this legislation, including groups who would be attacked physically based on sexual orientation.

It would protect men and women in uniform for the first time from these kinds of hate crimes. That is something in which the Armed Services Committee has a special interest. The language has been written to ensure that it does not intrude on first amendment rights, that State and local law enforcement retain primary jurisdiction over investigations and prosecutions. It would punish violent acts

only, not beliefs. No Federal prosecution could take place under the provision unless the Justice Department certifies that the State in which the hate crime occurred either does not have the jurisdiction, has asked the Federal Government to assume jurisdiction, or has failed to vindicate the Federal interest against hate crime motivated violence or that a Federal prosecution is necessary to secure substantial justice. Senator Kennedy was the champion of this provision. Over and over again, he attempted successfully in the Senate to get this kind of language adopted. He pointed out, and I think with eloquence that is unmatched, that the values men and women in uniform fight for are these kinds of values: the value of diversity, the value of nondiscrimination. To say this has no place on this bill, it seems to me, is wrong for that reason as well as a number of other reasons.

We have had strong support for this provision from the Department of Justice and from law enforcement groups across the country that want this kind of support. The Senate, again, has authorized this legislation on the Defense authorization bill and has supported it twice before. This is at least the third time now that it is part of this bill. There are good reasons for it being part of Defense authorization, one of which is the values that are reflected here that when the men and women put on the uniform of our country, they fight to protect.

This would be a real tribute to Senator Kennedy for this language to be included. I remember going over with him to urge the House to adopt this language a couple years ago. The House did not do it then, although we in the Senate did do it. But now the House has adopted it. The Senate voted on this language just a few weeks ago with, I believe, 63 votes to incorporate this language into the Defense authorization bill. So we have already voted to do this. There is nothing unique or unprecedented about doing it again.

I hope we will invoke cloture. The stakes are huge. When I spoke before, I was quoting some of the things this bill will provide which are essential.

Now, some of the things in this bill required an appropriation. The Appropriations Committee hasn't acted on--excuse me--we haven't adopted an appropriations bill yet. Those things are not going to be held up if we don't pass this bill today, but there are a few things that will be held up. Our veterans are going to have to pay more for prescriptions and copays if we don't act on this bill, and acting on this bill will prevent that increase in copays without an appropriation.

We all talk about the importance of getting to Afghanistan equipment that is in Iraq. This bill has language which will permit that to happen. There is great disagreement as to what the right policy is in Afghanistan, but there seems to be no disagreement that we ought to strengthen the Afghan Army. One of the key ways to strengthen the Afghan Army is to get them equipment that is currently in Iraq which, if we don't pass this bill, is going to have to be shipped back here not only at great expense but also denying to the Afghan Army that we are trying to build up the kind of equipment that will make it possible for them to assert greater control for the security of their own country. That equipment cannot be transferred until this bill passes because that is nonexcess equipment. The moment this bill passes and is signed by the President, that equipment can be shipped to Afghanistan. That will protect our troops.

To try to pass another bill--have the House pass another bill, have another conference created if we can get one, have the conference, go through the process of conferees--is going to deny and delay an essential item going to Afghanistan to help protect our troops and our interests.

We talk a lot about: Why can't we do in Afghanistan what they did in Iraq? Why can't we have the Sons of Iraq be the Sons of Afghanistan? Why can't we put a policy in place which will attract those young Afghans who are on the payroll of the Taliban not because they believe in the extreme religious fanatic position the Taliban takes, but because it is a check or, more importantly, more accurately, cash they can put in their pockets?

With the Sons of Iraq we were able to wean away from the attackers, the people who hated us, 100,000 young Iraqis because we had a program which would help to fund that. This bill contains the authorization for our commanders to use CERP funding for that purpose. That is going to support our troops. Those funds can't be used until the President puts his name on this bill. Delaying that jeopardizes our troops, jeopardizes our interests, and it is one of the many essential provisions in this bill, and until they become law cannot be put into effect. But the moment it does become law, if and when it does, it can be placed into effect.

So the stakes on this first vote are great. If we delay adopting this bill by not adopting cloture, we are going to be taking a step backwards in terms of the support of our troops and our interests in Afghanistan and Iraq. The delay is unacceptable. I hope our colleagues will vote for cloture.

I note the absence of a quorum.

Mr. President, I ask unanimous consent that the order for the quorum call be rescinded.

Mr. President, I yield back the remainder of my time.

Cloture Motion

Mr. President, I move to reconsider the vote.

Mr. President, we have just adopted a landmark Defense authorization bill. We are sending to the President the 48th consecutive Defense authorization bill--I move to reconsider the vote on that bill and lay that motion upon the table.

The motion to lay upon the table was agreed to.

Mr. President, we have an unbroken tradition on our committee, 48 consecutive national Defense authorization bills. It is never easy to get this bill through the legislative process. But with perseverance, a lot of good-faith work has never let us down.

We maintain our focus because we are acting on behalf of our true heroes, the men and women of our Armed Forces and their families. The enactment of this conference report is going to provide the men and women of our Armed Forces, both Active and Reserve, and their families with the pay and benefits they deserve, the equipment and training they need.

The conference report includes $164 billion for military personnel, including costs of pay, allowances, bonuses, survivor benefits, and military health care. It would authorize a 3.4 percent across-the-board pay raise for our troops, a half a percent above the budget request and the annual increase in the employment cost Index.

The conference report would authorize $130 billion in funding for our ongoing military operations in Iraq and Afghanistan. It would provide more than $2.0 billion for the Joint Improvised Explosive Device Defeat Fund, to help take on the threat that has claimed so many American lives in Iraq and Afghanistan. It would fully fund the President's request for $7.5 billion to train and equip the Afghan National Army and the Afghan National Police.

This legislation sends a vital message to our men and women in uniform that we, as a nation, stand behind them and appreciate their service.

We are at this point because all our dedicated Members and all our dedicated staff members--on both sides of the Capitol--were all willing to hit on all cylinders and keep this bill rolling along.

Of course, I want to start by thanking my partner and my friend, Senator McCain, as well as all committee members, for their active roles in getting us to this point. Our counterparts on the House side, Congressmen Ike Skelton and Buck McKeon and the House Armed Services Committee staff lead by Erin Conaton and Bob Simmons, also have our gratitude. Senator McCain and I are extremely grateful to our own committee staff members who so willingly put all their legislative expertise into this bill. Not only is there a tremendous amount of legislative craftsmanship involved, but there is a mind-boggling number of administrative details that have to be meticulously tracked in this massive bill.

I again thank my partner and my friend, Senator McCain, as well as all committee members for their active roles in getting us to this very historic moment when there is much in this bill that is so important to our troops, as well as a number of other provisions which are critically important to success in Afghanistan and Iraq.

Our dedicated, hard-working staff assistants in particular deserve a special mention for their extraordinary efforts in this regard. As a visible sign of the high regard in which we hold our staff, I ask unanimous consent to have all staff members' names printed in the Record. I offer here a list of the staff of the Armed Services Committee for that purpose.

Mr. President, I thank the doctor from Oklahoma, my colleague, my friend. Let me say from the start, 3\1/2\ years ago, Tom Coburn and I sat down and realized health care was unsustainable at its current level of investment.

The American people have complained because they have seen a process that has gone too quickly. Well, in the Patients' Choice Act you find 3\1/2\ years worth of work--a bill that was designed to take 4 years before we thought we had the right information we needed to do health care reform adequately.

With the change in the administrations, the new President and his timeframe, we accelerated it. But let me say, right from the start, it is unsustainable at its current level of investment. It is 17 percent of our gross domestic product. Health care has to be reformed.

I personally believed the debate we were going to have in Washington was over what type of reform. Dr. Coburn raises a good point: cost. Where are we from the standpoint of our Nation?

I happened to gaze, as I was waiting for the last speakers to finish, on the page of this publication. It says: Baucus Bill Projected at $829 billion. In the small box down at the bottom of the page--CBO: Deficit Hits Record $1.4 trillion for Fiscal Year 2009.

Common sense would tell you that when you are in the type of financial shape the United States of America is in, not only do you stop spending, you begin to look for ways to curb spending and a way to invest to reduce the deficit. Because the deficit is what our children and our grandchildren will inherit. If you believe it is unsustainable at its current level of investment, then you sort of understand where Dr. Coburn and I are coming from.

The worst place we can start is: How much more money do we need to spend to do health care reform? But the truth is, the Baucus plan is not health care reform. It is health care expansion. The debate in Washington is not about how to reform health care. It is about how to expand health care. And once you determine the pool you are going to expand it to, the $64 million question is: How do we pay for it so the CBO says we have paid for it?

What I would like to do is spend a little bit of time exploring how the Baucus plan pays for it with the caveat up front of saying--as it relates to Dr. Coburn and myself--we don't believe we have to spend more to reform health care. I think from what he said about the Patients' Choice Act, we have made the point. We were the first two people in the Congress--House or Senate--to introduce comprehensive legislation. We cover the same amount of additional Americans that the Baucus plan covers. We do it without making additional taxpayer investments in the expansion of coverage. Why? Because in addition to expanding coverage, we reform health care. We actually bend the cost curve. We change the tax application to where it is fair and equal for all people.

What we have to realize is, the Baucus plan is a 10-year plan. We collect revenues for 10 years and we pay out for the expansion in 6\1/ 2\ years. Let me say it again. We are collecting tax revenues for 10 years, but we are only paying benefit expansions for 6\1/2\ years. We have to look at years 10 through 20 if you want to see 10 years' worth of revenue collection and 10 years' worth of expenses. As a matter of fact, if you took the first 10 years and you applied what is done in the bill and said: Well, if they started making payments in the first year, this bill would actually cost $1.8 trillion, not $829 billion but $1.8 trillion.

Incorporated in the Baucus bill are cuts to Medicare, cuts that equal $449 billion. Dr. Coburn talked about the imminent reduction to physician reimbursements: 21 percent projected. We all agree we are never going to make that. One of the attractions for health care professionals was the Baucus bill said in year one, we are not going to make those cuts. Well, they are going to cut Medicare over 10 years by $449 billion. This is giving with one hand and taking away with the other hand. Health care professionals around this country have realized that, even though their association that represents them doesn't.

The Baucus bill cuts $117.4 billion in Medicare Advantage. My colleagues are probably saying: What is Medicare Advantage? Well, it is the preferred plan of 20 percent of America's seniors. Twenty percent of our seniors on Medicare have chosen Medicare Advantage, a private sector option to traditional Medicare, where they have looked at the two and they said: I would rather have Medicare Advantage, because when I go in the hospital, Medicare is going to charge me a $750 deductible right off the bat. Medicare Advantage? Zero. For traditional Medicare, you are going to have to have Part A, Part B, Part D. Medicare Advantage, you get it all as one lump sum. You don't have to make separate selections. They provide you the doctor coverage, the hospital coverage, the drug coverage all in one plan.

Why is it under the target of some in Washington to cut $117 billion? They say it is because we pay 114 percent of Medicare per person allocations to Advantage, where we pay 100 percent in traditional fee for service. That is exactly right. I remember the debate we had in Washington when we did it. Because the objective then was: How do you get Medicare Advantage to offer this plan in rural America? To offer it in rural America meant you had to offer a greater reimbursement. This isn't reflective of a windfall for the insurance companies; it was an incentive to offer this choice not just to urban seniors but to seniors everywhere in America. In my State of North Carolina, 17 percent of all the Medicare beneficiaries are enrolled in Medicare Advantage. When anybody gets up and says pass this bill, the Baucus bill, and you can keep your health care if you like it, there is a caveat to that. Unless you are 17 percent of the seniors in North Carolina or you are 23 percent of the seniors nationally, you lose your plan. You are going to go back into traditional Medicare. You are going to go back to where, when you enter the hospital, they are going to say write me a check for $750 annually; where your Part B is a separate payment; where your Part D is something you have to figure out as to which plan you want versus something that is seamless and covers everything. I will assure everybody a $117 billion cut to Medicare Advantage will eliminate that product from the marketplace. Nobody will offer it. Twenty percent of America's seniors will lose the insurance they prefer, not keep it.

Medicaid expansion. It seems like a sensible way to go if you want to expand coverage, which is where the debate has been in Washington. Well, let's simply take a coverage tool that is out there today-- Medicaid--and let's raise the income limit so more people qualify for it. So instead of 100 percent of poverty, we raise it to 133 percent of poverty. It costs $345 billion. There is $33 billion in direct State spending. As Dr. Coburn said, four States are sort of split out of it, and they say: Well, we are not going to charge you because you are in tough economic times. Well, North Carolina is at 10.8 percent. Why aren't we included? Our cost, when the Federal Government makes North Carolina ante up, is going to be south of $1 billion a year for a State that had a $4 billion shortfall. Where is my Governor in her outrage at the proposal to expand Medicaid to 133 percent of poverty?

The tough thing is, this plan has been sold that it is not going to cost anybody anything, and the truth is it is going to cost seniors, it is going to cost taxpayers, it is going to cost the unemployed but, more importantly, it is going to cost people who have health care insurance today. People who have the money to purchase theirs and people whose employer offers them health care, their cost is going to go up because of the restrictions and the mandates that exist within the Baucus bill.

The Baucus bill would impose an annual $6.7 billion fee on insurance companies; $6.7 billion a year; over 10 years, $67 billion. So a $67 billion new fee on the insurance companies that we are trying to make the American people believe are going to reduce premiums, reduce costs, and we are sticking them with a $67 billion pricetag. There is nobody in America when they hear this who believes that health care is going to go down for the American people. For every person who currently has a plan today, I will assure my colleagues their premium will go up. They will pay more money, not less money.

We grow the IRS. There is something we haven't talked about because of the requirements in this bill to collect fees and to collect taxes. It is estimated by the Lewin Group that the IRS would need a 25-percent increase in their budget. The IRS currently gets $12 billion annually for their administrative costs. The administration costs for implementing the exchange subsidies would add nearly $40 billion from the Baucus bill. We have additional costs at the IRS because we have to increase by 25 percent the IRS requirements to go and collect and enforce this.

We tax the chronically ill. I thought this one was one of those myths that late night TV talks about. We tax the chronically ill in the Baucus bill. Let me explain what I mean. Current law says that if your health care charges exceed 7.5 percent of your annual income, then you can deduct that off your taxes. Clearly, the lower your income, the more likely you are to utilize the 7.5 percent exclusion. So what does the Baucus bill do to raise money? It raises the exclusion to 10 percent. Instead of at 7.5 percent of your adjusted gross income being able to deduct anything that exceeds that, it says you have to exceed 10 percent of your adjusted gross income. For somebody who makes $1 million a year, this is no big deal. They probably have more than enough insurance to take care of it. For somebody who is on a limited income; for somebody who maybe doesn't have all the insurance they need; for somebody who walks in and is chronically ill, has a chronic disease and they are making payments, they are covering their copays, they occasionally go to the hospital, they have that $50 charge for walking in the door, even though they have insurance. They are making it at the end of the year, even though they make $20,000 or $25,000 a year, and all of a sudden, 2\1/2\ percent of their adjusted gross income is no longer a deduction they get. What is that? That is taxing the chronically ill in this country.

Listen, I have to give them credit. They have left nobody out of this bill from taxes. They have left nobody out of this bill from instituting a new fee. As a matter of fact, some of it we are going to have to take for granted is going to be applied to us in an indirect way because incorporated in the Baucus bill we collect a new device tax. To the heart patient who goes in and gets a heart catheterization, to the senior who goes in and gets a hip replacement, it is a device. For any medical device that is used, there is a $40 billion device tax over 10 years.

What does that do for the innovation of new devices? Dr. Coburn can speak to it better than I can. When we were able to switch from open heart surgery to bypass surgery, we probably went from $40,000 or $60,000. When we were able to catheterize somebody and put a stent in, we reduced significantly the cost, we reduced significantly the invasion, we were able to raise the quality of life. We couldn't have done that if somebody hadn't innovated a cath and a stent. We would still be doing all bypass surgeries. You think through all the medical procedures we do in this country and you think about all the devices that have been created by companies and by doctors so they can be less invasive because they understand every time they go into somebody, every time they cut in, there is a fear of infection today; there is a consequence of recovery. It means a stay in the hospital is longer.

When you see a new device enter into the marketplace, you actually see a new efficiency come into health care. You see reduced health care costs because you are taking either somebody out of an inpatient setting and you are putting them in an outpatient setting, or you are taking an inpatient patient and you are getting them out of the hospital faster. Actually, you could make the case that innovation of medical devices is health care reform because it is driving down costs, because it is moving patients out, and the net result is the quality of life goes up. But, in this bill, we raise $40 billion over 10 years, or $4 billion a year on taxes on devices.

If you listen to the things I have talked about, you are probably sitting at home trying to figure this out: I am going to pay more in health care because they are taxing devices. I am going to pay more in health care if, in

fact, I have a chronic illness because I am not going to be able to deduct that out-of-pocket cost that is between 7\1/2\ percent and 10 percent of my adjusted gross income. I am going to have to cover, as a taxpayer, a 25-percent expansion in the IRS. They are going to impose a $6.7 billion so-called fee on the insurance industry, or $67 billion over 10 years, while I have an insurance policy, so that fee is going to be passed through to me as a covered life under the insurance plan.

I am going to pick up, in the State in which I live, the increase in the limitations on Medicaid when we go from 100 percent of poverty to 133 percent of poverty. How can you make a claim that this bends the cost curve? If you tried to make the claim, it bends the cost curve up not down.

Dr. Coburn and I listened very intently as the President kicked off this debate: Create a program that provides coverage for as many Americans as we possibly could. We did that. Bend the cost curve down. Well, we make a direct investment in prevention, wellness, and chronic disease management--the only three direct areas of savings in health care. We can talk all night about tort reform and about different aspects. They are indirect and there are significant savings we can achieve by incorporating those reforms into health care.

In the Patients' Choice Act, we elected to keep it narrowly targeted, and we invest in prevention, wellness, and chronic disease management. Why? Because we went to States, businesses, and self-insured companies that went 4 years and didn't have an increase in health care costs. Why? Because they changed the lifestyle of their workers. They actually paid their workers, in some cases, to quit smoking, to lose weight, to get exercise, or to take an education program on a chronic disease they had to make sure they got the treatment they needed.

The net result? In every case, the per-enrollee savings were so significant that the companies continued to try to figure out how they could spend more to reduce health care costs. The quality of life for their employees was better. The productivity of the employees was better, and they had no annual increase in their health care costs.

We are sitting here ignoring everything that has been learned in America by private self-insured companies and by some insurers who are doing creative things, targeting chronic disease, and actually paying doctors to educate. 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. President, I thank Senator Coburn for yielding. Let me just say the reason he is gray is because he cares. This is a Member of the Senate who typically on Monday morning delivers babies, and all weekend long. Before he comes back to Washington, he practices medicine.

This institution looked at what he did and said: You can't charge for what you do even though it costs you $200,000 a year to keep your practice open, your license in place, to buy your liability insurance. They said that is illegal under Senate rules.

So Tom Coburn is a unique individual. He sees women who are pregnant. He delivers babies. But he doesn't take any payment for it. He keeps his license up to date. To some degree, it is charity care because he believes it is the right thing to do. More important, he understands that what we do here affects what our children and our grandchildren get in inheritance from us--not financial inheritance, in opportunity.

Why are we passionate about the debt? Why are we passionate about trampling on the Constitution? Because every time we do it, we take an opportunity away from the next generation. We reduce their ability to be successful, whatever their definition is.

Tom Coburn covered it very well. We are somewhat impassioned about our criticism toward the bills that passed out of the HELP Committee, the Finance Committee soon, and the three bills in the House. Why? Because we introduced our bill first. We laid our cards on the table. We offered to work in a bipartisan way with anybody, and we had no takers.

I believe when you lay it out there and you come up with a successful plan, you have every right to be critical. I do question the ones who do not offer an alternative. But we have offered a solution, and that solution was based on three fundamental principles:

One, it had to cover everybody. The way our bill is structured, every American receives the same financial stipend regardless of whether they work or whether they don't, regardless of where they live. We treat everybody the same.

Two, if you are going to get cost savings, then you have to make direct investments in prevention, wellness, and chronic disease management. The Patients' Choice Act makes direct investments in prevention, wellness, and chronic disease management.

Three, is it financially sustainable into the future? We probably should have started with this one versus save it for last. Why in the world would we create a health care system in America if it is not sustainable? If it is not financially sustainable, why would we even consider that legislation in the Congress of the United States? If it did not pass the test of time, why would it even be worthy of debate?

Unless we expect people outside of America to continue to finance our urge to spend, then I have to tell you, we are not going to have any money--either that or we are going to have to tax the American people to a point where they are not going to want to be successful, they are not going to want to work overtime, they are not going to want to switch jobs because the benefit to them of being successful is to be punished by taxes.

This bill is filled with new fees, new taxes. True reform that expands coverage would pay for itself. Think about that. If you truly reformed health care, would the reforms through savings not pay for the expansion? Shouldn't this be a net sum game?

We have left out of the bill shopping across State lines for insurance. It saves money. The American people are sitting there: Why aren't you doing this? Tort reform saves money. The American people are sitting there: Why aren't you doing this?

Let me end on one that I think the American people are really plugged into. Congress, which plan are you putting yourself under? You designed this plan for everybody in America. Is it the plan you are going to have? You know what, in the Finance Committee, in the HELP Committee, in the House committees, there have been amendments that said Congress has to take the plan they create for the American people. That government option, that is what Congress has to be under. It has been rejected every time it has been offered.

But you see, Dr. Coburn and I took a different approach because in the Patients' Choice Act, we had to set what the basic minimum plan was going to be. Do you know what we put? The Federal Employees Health Benefits

Program. We didn't put them into the FEHBP, but we said it had to be equivalent to what Members of Congress had. How could we ask the American people on a plan we create to have less than we have? The American people expect us to look after them, they don't expect us to give them less than we have.

It was rejected every time that was offered to move Congress to their plan. But I think it tells you a lot about the way Tom Coburn and I approached the bill we worked on because we never thought about taking us and putting us into their plan, we thought about taking them and raising them to our plan. There is a big difference in that. There is a big difference in looking at the American people and saying, you should be here; not the American people saying, you should be where we are.

We want people to be successful in this country. Tom Coburn said this is not a bipartisan bill. He is right. But I will end with this tonight: This is also not a reform bill. If you want to talk about expanding coverage, it does an equal job to what the Coburn-Burr bill does. If you want to judge it based upon reform, it accomplishes no reform.

I encourage those who are not satisfied with the options that have been presented in the House or the Senate or that will be debated, go on Tom's Web site, go on my Web site, Google ``Patients' Choice Act.'' Read the bill. It is only 200-some pages, it is not 1,000.

The truth is, if we have a real debate--at some point, we will have one about health care reform--I could suggest to the American people one word that would drastically reform health care, that could replace all 1,000 pages of a House or Senate bill. It is called portability. It is called the ability for an individual employee to take their insurance from one employer to another, not to be construed in any way 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.

Mr. President, I listened very patiently to the last 2 hours about why we need a government-run plan. I want to concur with my colleagues about the problems in the insurance industry. There is no question they are great. But the reason the problems are great is because there is no real competition today. The rhetorical question is, you can't have it both ways. Nobody wants it both ways. The fact is, I saw this on the Internet this week. I thought it was appropriate for where we are. Here is a youngster walking on a street. She says:

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

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

the answer to that question is that we want the government involved. The Senator from Pennsylvania talked about all the government programs. Sixty-one percent of all health care today comes through the government. Every government program is over budget, associated with fraud, and ineffective in its implementation on a cost basis. That doesn't mean we want to get rid of them. It means we want to make them better. The real problem with having the government do more is, right now 43 cents out of every dollar we are spending we are borrowing. We create a government plan. We put $60 billion into it, and we can create competition. But we don't have competition now. Everybody agrees with that. Nobody denies that we don't have good competition. But we don't have good competition because we have failed to act.

The Senator from Ohio showed a chart of CEOs' pay. If they were having to compete, that pay wouldn't be there, especially not at that level. I don't disagree with that. But the way to control that is real competition. Forty-three cents of every dollar we spend this year we will borrow. And it will be worse next year. It will be 45, 46 cents next year of what we spend we will borrow.

This picture doesn't talk about what she owes. This is just what the debt is now, just the $11.8 trillion. What she owes is another $400,000, because we are paying out of Medicare what we have never created the tax base to fund. So in fact what we are doing is, we are going to charge this little girl for our Medicare. The impact of that is when she was born she owed $400,000. By the time she is 20, she will owe $800,000. What will happen to her?

There is no question we have positive benefits with Medicare. There is no question we are taking care of people who can't take care of themselves through Medicaid. There is a question of how effective we are doing with Native American tribes in terms of that. We are seeing improvements in veterans health care. We have all these different programs that are run through the government. So when you only have 39 percent of the health care in the country to put into the market, it is going to be very difficult to lower costs.

What is the problem with health care in America today? The problem is cost. It is too expensive. It is about 40 percent more expensive here than anywhere else in the world. Why is that? Well, there are a lot of reasons for it. But the first reason is, we will not allow real markets to develop in the health insurance industry. We have stopped it. And now we come and say: We are unhappy with it, so we want to create a government plan--a government plan that will compete.

I do not have any problem if you create a government plan if you fund it and make it competitive. But that is not what we are going to do. Because what we are going to do with a government plan is we are going to turn it into another Medicare. It will supply people health care. It will lower their costs. But we are going to transfer the cost to this little girl. It is just $440 billion spent on Medicare this year, of which $80 billion of it was fraud.

So the problem is, which solution do you think works better? Do you think we have the history that says government-run health care is efficient and effective and, therefore, we ought to do more of it or should we say: We know what works in the rest of the industries and markets in this country. Maybe we ought to allow markets to truly compete--which nobody wants to do--to force the insurance industry into a competitive structure where you can actually see what you are getting and you can see what you are paying.

The other problem about this little number is, not only does she have $38,000 in debt right now, and another $800,000 when she gets ready to buy her insurance, we are going to tell her what she is going to buy. We are going to take the freedom away from her to decide what is best for her and her family. Then we are going to yoke her with a whole bunch more taxes.

There is no disagreement in this body that we need to make changes in health care; and the assumption that anybody would say that is absolutely erroneous and fictitious. We recognize that. The question is, which way do you fix health care? Do you fix it with a government that is bankrupt already, that has stolen the future from the next two generations, and add more on to them or do we get common sense back in and say: Well, first of all, we can eliminate 8 percent of the cost if we have good tort reform in this country because 8 percent of the cost of health care is defensive medicine.

I read a study this week. It is interesting--and I have some passion about this because I have been on the end of those lawsuits--I would note that the vast majority of those who have been discussing health care for the last 2 years are lawyers. They are not doctors. They never laid their hands on a patient. They never stayed up 20 hours in a row to take care of somebody who needed them. They have all the answers, but they have never been in health care.

Here are what the numbers are on malpractice lawsuits in the United States: Eighty percent of all the cases that are filed are thrown out of court. Of the remaining 20 percent, 89 percent are thrown out of court. So 3 percent of the cases are legitimate in this country. What do you think that is costing us? And we ignore it? We are not even going to talk about the fact that we have an extortioned service going on in health care that does not cost the lawyers a thing? It costs everybody else in this country billions of dollars a year because we are doing tests that nobody needs, except the doctors to defend themselves. And that is $200 billion a year out of $2.4 trillion. That is what the number is.

So when less than 3 percent of the people--and I am all for compensating people who are truly injured. I have no problems with that. As a physician practicing over 25 years, there is no question I have made mistakes. There is no question. There are no doctors who are perfect, and, consequently, sometimes people are injured because of doctors' mistakes. Most of the time they are not. And it is not about not compensating the injured. It is about changing the mindset in this country that you can extort people into settling when you have no real claim, and that is what is going on with 85 to 90 percent of the cases.

So the answer for health care is: controlling costs. So how do we best do that? It is interesting, we have had the accusation that there are no other plans out there. My colleague from North Carolina and I introduced the first plan in Congress for health care.

What does it do versus what the Baucus bill or the public option bill will do, according to CBO? We cover 94 percent of Americans--identical to what the Baucus bill does. So 94 percent of all Americans will get covered under our bill. We save the Federal Government $70 billion in the first 10 years, close to $1 trillion in the second 10 years.

What does the Baucus bill do? It saves $88 billion, and nobody knows what it is going to save after that. But it costs the States billions. Our bill saves the States, in the first 10 years, $960 billion. We cover more people, with no increase in the cost to the Federal Government, versus a marked increase in the cost to the States by the Baucus bill, or by the public option plan.

It eliminates preexisting condition. We all agree we need to do that. Nobody is fighting that. The question is, how do you do it? Do you do it in a competitive model that costs insurance companies pain if they are not covering the people properly? And if, in fact, there is an incentive to cover preexisting conditions, then you have an incentive for the insurance companies to invest in the management of chronic care rather than ignore covering somebody.

I do not deny there is cherry-picking going on right now, but it is only because we allow it. We do not have to allow it. But the answer does not have to automatically be another long-term, bankrupt plan run by the government. Nobody can deny the $95 trillion, 100-year unfunded liability for Medicare. That is GAO, that is CBO, and that is the Medicare trustees. You cannot deny that.

So we have a program that seniors are fairly happy with, except the Baucus plan is going to cut a half a trillion dollars out of it. But we cannot pay for it. So we are not doing anything to drive that cost down, to drive in efficiency. What we are going to do is create more government, to have another plan that is going to get in the same shape as Medicare.

We all want the same thing. We want to get everybody covered in this country. We want the cost of health care to be affordable. And we do not want to bankrupt our children. We have already bankrupted them. So the danger of having a government-centered, government-centric, government-run, government-devised, government-managed health care program--just by history, look at what we have done.

Medicaid costs tons more than it was ever supposed to cost. SCHIP costs tons more than it was ever supposed to cost. Medicare costs tons more than it was ever supposed to cost. Indian health care--it does not cost more because we just let them suffer. We do not put the money into it. VA costs tons more than it was ever supposed to cost. TRICARE costs more than it was ever supposed to cost. They are all government programs. They are all way over budget.

So the question the American people ought to ask is: If we all want to get everybody covered, and we all want to drive down costs, does the government have a track record that says it has done that? No. As a matter of fact, it has done the opposite of that.

So it is not a matter of whether you trust in government. We have 61 percent of health care running through government. And as a physician who has practiced for over 25 years, I will tell you, it is my opinion the reason costs are out of control is not because of the insurance industry--and I am not a defender of them; as a matter of fact, I hate them about as bad as I hate anybody telling me what I am going to do to my patient--the problem is, we have directives coming from the government that have disrupted the market in health care and created this tremendous differential.

The other difference that we have in the Patients' Choice Act is that we do not put another burden on the States, which all these bills do. The States are swimming in debt. They are struggling to stay ahead, and we are transferring billions, almost--we are transferring trillions of dollars of expense to the State. We are making it nice for four States. We have picked four States and we have said: You don't have any cost the first 5 years. We just, out of the hat--because they are having a little worse economic time than others, we have said: You don't have it. But for the rest of the States, it is the mother of all mandates, and they will never be able to afford it.

There is also another little sneaky provision in the bills--both in the HELP bill, the House bill, and the Baucus bill--which is, we know we are not going to cut doctors' fees 21 percent. The Presiding Officer would agree to that, the Senator from Colorado knows we are not going to do that. But we are not going to recognize it. We are not going to recognize that cost. So we are playing games with the American people. We are saying: Here is what it costs, when we know it is going to cost a lot more than that because we know we are not about to do that. But we do not have the courage to admit that. We do not have the courage to ask for an honest score.

The other difference is, we empower patients and States, not bureaucrats. We preserve the right, the inherent individual liberty right, of an individual to decide what is best for them rather than having the government decide 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.

I thank the Senator. I am sitting here thinking, if I was sitting at home tonight listening to this, how do I hear the story that I heard for 2 hours on having a government-run plan and how bad the insurance industry is? As a physician, I don't like them a whole lot, I can tell you that. I don't like some of their tactics. I certainly don't like the way they cancel insurance policies on people. There is a lot about them I don't like. But I don't want to eliminate them. What I want to do is create a real market where they have to be savvy and compete and they have to be efficient and they have to help us help one another get well.

We are going to hear a lot over the next month on health care. We are going to hear all these claims, much like we did from Congressman Grayson, who made an outlandish claim that my side of the aisle wants people to die. That is what was said in the House of Representatives. What I want is people to live. I want this little girl in the picture to live too.

Do we have an unsolvable problem? No. Do we have ways of making health care costs much less in this country? Yes. Do we have ways of ensuring increased innovation and advanced disease prevention in this country? Yes. Do we have ways to protect this little girl in the photo? Yes. But the debate is over how we do that. One side says we do it by making the government a whole lot bigger--$1 trillion bigger, $3 trillion bigger over the next 20 years. That is one side of the debate.

Our side of the debate says this is inefficient health care. We want to cover everybody. We never want anybody to go bankrupt or to be denied care. We think you can do that without growing the government by 25 percent. We think there are other ways to do it. We are honestly worried about our track record in Washington when we have a $1.4 trillion deficit this year and a Medicare Program that is absolutely bankrupt--it will run out of money in less than 7 years from now, totally out of money--and we are going to be borrowing it all then. Is there another way to do it? So either we make a large jump in the size of the Federal Government and add to the $838,000 that this little girl is going to have, or maybe we can work together and say the insurance companies are bad, but can we keep something like that and make them efficient? Can we allow people to buy across State lines? Can we give people opportunities to buy what they want to buy rather than being limited? Do we trust people to make good enough decisions for themselves?

The Baucus plan doesn't do that. It says we have three or four plans from which you get to choose, but we are going to tell you what you have to buy. And, by the way, you have to buy insurance in this country. Think about that.

I carry with me a copy of the the U.S. Constitution all the time. Every bill out there has said you don't have liberty because the Federal Government is going to tell you where you have to spend your money. You have to buy an insurance policy. So if you make a quarter million dollars a year, it doesn't matter if you want to fund that self-insurance, it doesn't count. You still have to do that. If you don't, you are liable to a tax. If you don't pay the tax, a $25,000 fine. If you don't pay the fine, you are in jail for a year.

How do we get off telling people that and taking away that liberty, that freedom that is supposed to be guaranteed under the Constitution? The answer is, well, it is better for everybody because if we don't have everybody covered, then it is going to cost more because that is the big government answer to it. Maybe it will cost more if we force and drive competition, if we create transparent markets, where you know what something costs before you get it in health care. In fact, there is a real connection with the purchase of health care and the payment because everywhere we have tried that, it is working to control health care costs. But we refuse to do it.

Frankly, the reason our idea is rejected, which is changing the Tax Code to treat everybody the same under the Tax Code, is because the labor unions don't want that to happen. That is exactly why. Everybody knows that is the problem. Everybody in the country knows that is the problem, but we don't have the political courage to face up to how to fix the problem.

As soon as you make everybody the same under the Tax Code, you empower 35 million Americans who don't have insurance today to get it. You save the States $1 trillion over the next 10 years, and you give 95 percent of Americans a tax cut, and guys like me will pay a little bit more for my health insurance and income tax. But we will not do that because the powers that deliver politicians to Washington are more powerful than the principles and the character to follow the pursuit of the Constitution.

This little girl in the picture, and everybody like her in this country, is at risk today. We are going to have this great big debate and say how bad the insurance companies are and how bad

the government programs are. But the fact is, we don't have a bipartisan bill. Our ideas were thrown out, 13-10, at both the Finance Committee and the HELP Committee--13-10, 13-10, 13-10--because the idea is they didn't want a compromise bill. They didn't want to solve the problems. They wanted their way or the highway.

So, consequently, we are going to get a bill. I have no doubt. But my little Lucy right here and her football--she is going to lose her football. She is not going to have any little Lucys because she is not going to be able to afford them. She is going to be paying off her $800,000 worth of government obligations starting at age 20, and she will never climb out of the pit.

So when America thinks about health care, there are a lot of ways to solve it. One is to trust what makes America great--granted, with some changes--or the other is to trust the government to create more government programs.

I will just add this one point. Do you realize that in the bill that passed the HELP Committee there are 88 brandnew government programs-- 88; 219 times we have held the Secretary of HHS to write in-depth regulations. Now, 88 programs interfering in health care are going to be problem enough. But 219 new sets of regulations--oh, by the way, we created the comparative effectiveness committee with the stimulus bill, and we are going to have 26 people tell every doctor in the country how they are going to practice medicine, what is right and what is not right. And, by the way, in all the committees a prohibition on rationing was voted down.

What are we to think? We are going to create a large government program and grow the government by $1 trillion over the next 10 years, $2 billion-plus, maybe $3 trillion in the next 10 years, and we are going to have Washington tell people how the physicians and caregivers will treat, what they will use to treat, and all the time little Lucy will not matter if she gets sick. We will have already made her sick because we have stolen her future, her absolute future.

It is a cute picture, but it sends a devastating message to us as leaders in 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. President, I ask unanimous consent that the order for the quorum call be rescinded.

Mr. President, I rise to speak about one of the most significant issues we have confronting us as a nation, our rising deficits and debt. At the end of the last fiscal year, which just concluded at the beginning of October, end of September, we determined we had a $1.4 trillion deficit--$1.4 trillion.

It is projected that we will have trillion-dollar deficits for the next 10 years under the President's budgets as President Obama has brought them forward. Yesterday we had a vote not to do cloture on a bill the administration supported, and which was brought forward here, which would have put another $300 billion onto the Federal debt to pay for what is known as the doctors fix.

The doctors fix is something which should occur. We have done it around here before. We have done it every year for about 8 years; that is, reimbursing doctors at a fair rate rather than having their rates cut. But we have always paid for it.

But yesterday there was an attempt by the leadership on the other side of the aisle to pass a bill which would have not paid for the doctors fix and which would have put $300 billion of new debt onto our children's backs; so that every time somebody walked into a doctor's office and was reimbursed under Medicare, that bill, whether it was for a flu shot or whether it was for serious disease issues, would have been taken and passed directly to our children rather than paid for today, as it should have been. So it was a totally irresponsible act to try to increase the debt by $300 billion in order to take care of the doctors fix. But that was what was attempted. Fortunately that failed. At least as of yesterday it failed.

There was bipartisan appreciation in the Senate. All of the Republicans voted against doing that, and 12 Democrats and 1 Independent voted against doing it, and that was good. That was a good sign to the American people that maybe we are finally taking the deficit and the debt seriously.

The reason I wanted to speak today on this matter is because we are getting some significant warning signs, some flashing yellow lights that are moving from yellow, maybe, to red from the world community that we better do something about our debt and our deficit or the world community is going to react to it.

About 4 months ago now the Chinese, who are the primary owners of our debt--in other words, when we spend $1.4 trillion more than we have in a year like we did last year or we spend $1 trillion more than we have every year for the next 10 years as is being

proposed by the President, we have to get that money from somewhere. We have to borrow it from somebody. Someone has to be willing to lend us that money, that $1 trillion, that $1.4 trillion.

Well, the countries that have that type of money and are willing to lend it to us are countries such as China and Russia and Saudi Arabia. They have surpluses in their economies. They are not running deficits in their governments, so they have surpluses. They have, historically, at least over the last few years, been willing to buy our treasuries, our notes to finance the government operation in the United States.

About 4 months ago the leadership of the Chinese Government said: Well, we are getting a little concerned. We are still going to buy American treasuries. We are still going to help you finance your deficit. But you have to do something about this because we are concerned about the value of what we are buying. We are concerned that those IOUs we are buying from you may not be worth what we are paying for them on face value if you continue to run your deficit that you have.

That was a fairly large warning sign from a country which obviously has not historically been close to us but which is one of our largest trading partners, and which is, whether we like it or not, buying up all of this debt when we run these massive deficits, or a lot of this debt.

Another warning sign came at us when the dollar, which has historically been the reserve currency of the world--in other words, countries hold dollars in order to maintain their own structure of reserves for their countries. The dollar started to be discussed as maybe not the best reserve currency, and there have been a number of rumors and some representations by some Finance Ministers around the world that people might not want to use the dollar any longer as their reserve currency. They may want to use some other currency--maybe the euro or some basket of currencies, maybe the euro, the yen, or maybe just use commodities or maybe use IMF drawing rights, a whole series of different ideas.

What does that reflect? That reflects that people are not too confident in our future ability to maintain and defend the value of the dollar. Why are they not confident about that? Well, they are not confident about it because they are looking at the deficits we are running. They are looking at the debt we are piling up, and they are saying: Hold it. How are you going to pay all of that off? If you put $13, $14, $15, $16 trillion worth of debt on your Nation, if you take your public debt from 38 percent of GDP up to 80 percent of GDP or more, how are you going to pay that off, United States?

That is a legitimate question because there are only a few ways it can be paid off. One of them, unfortunately, is by using inflation, and that devalues the dollar and it devalues all of that debt people have bought. That is why we are hearing more and more that people, first, are worried about using the dollar as their reserve currency because they do not want to see its value drop; and, secondly, they are worried about buying our debt.

So we are getting some serious caution lights from the international community about the fact that we are running these massive deficits and this massive debt. Just yesterday, I think one of the most serious caution lights came out because there are groups in this world, small groups of people--Moody's and Standard & Poor's--who basically look at the currencies and the debt of various nations and they do that also for companies and they rate the debt. The rest of the world's financial activities look at those ratings because they are considered to be of very high caliber and very high standard. They allow people in other places to be able to assess the value of the debt they might want to buy.

So if you want to buy debt from XYZ country, you look at Moody's or Standard, that has taken a hard look at that country's debt, evaluated it, and they will tell you whether it is rated AAA, AA, A. That determines how much it is going to cost a country to lend to you. That will determine the amount of interest rate on that debt because if it is not AAA, which is the best rated debt, then people are going to be less likely to invest in it. If they do invest in it, they are going to want a higher return because they are going to be at bigger risk because they know that debt might not be paid back. If it is paid back, it might be paid back in devalued dollars or devalued currency of that country.

So, historically, American debt, the Treasury note, has been the gold standard for the world. In fact, it is technically the gold standard. Most people use it as the reserve fund. When the world went off the gold standard, the dollar basically became the way people maintained and conserved their assets. They would invest in Treasury notes and know that the treasuries were always safe. It was always determined that Treasury notes were safe because the United States always was going to pay back its debt.

So the United States has always had a AAA rating. That is hugely important to us as a nation. It is hard to appreciate as just an ordinary American going to work every day and trying to make ends meet that the AAA rating of the United States is important to them, but it is. It affects everything in this country that has to do with credit.

If the United States were to lose its AAA rating, all credit would go up, and the costs in this country. It would be much harder to buy a house because the interest rates would be higher. It would be harder to buy a car because the interest rates would be higher. It would be harder to send a child to college because the interest rates would be higher. Everything is tied to the fact that treasuries have AAA ratings. It has always been presumed that they would.

In the post-World War II period, it has always been presumed that the United States, the strongest economy in the world, the most vibrant economy in the world, would always have the gold standard for the debt it issues, that it would always be a AAA-rated event. Well, as a result of our profligate nature as a country and as a Congress, as a result of having run up these massive deficits, we are getting a very large yellow flashing light from the rating agencies.

They are saying this--this was an October 22 news report from Reuters:

The United States, which posted a record deficit in the

last fiscal year, may lose its AAA rating if it does not

reduce the gap to a manageable level in the next 3-4 years.

That is according to Moody's Investors Service.

The AAA rating of the United States is not guaranteed.

Steve Hess, Moody's lead analyst for the United States, said in an interview on Reuters Television:

So if you do not get the deficit down in the next 3-4 years

to a sustainable level, then the rating will be in jeopardy.

Those are words that should make us in the Congress pause because they are directed right at us. The most sophisticated and important evaluator of America's deficit situation and debt, Moody's ratings service, is saying if we as a Congress do not do something within the next 3 to 4 years to bring our debt under control, and our deficits down, we may jeopardize the AAA rating of the United States.

I can think of nothing that would be more irresponsible for a Congress to do to the American people than to jeopardize and put at risk the AAA rating of this country. Maybe only after disarming ourselves in the face of a potential terrorist threat or the use of a weapon of mass destruction, I can think of nothing which would have a larger impact on our populous than for the Congress to put in place fiscal policies which would jeopardize our ability to sell bonds, American debt around the world at a reasonable price, and put at risk the value of the dollar and the status of the dollar as the reserve currency of the world, as a result of putting at risk the AAA rating of our bonds.

That is exactly what we are doing. This gentleman, Mr. Hess, said we have to, within the next 3 or 4 years, put in place a manageable plan, a realistic plan, that will address the deficit and debt of the United States.

Are we doing that now? We are doing just the opposite. Just yesterday this Congress tried to pass $300 billion of new debt for ordinary expenses, for daily expenses of paying doctors. We were going to give an IOU to our children and our grandchildren 5, 10 years from now. Total irresponsibility.

Last week it was the White House suggesting we do the exact same thing in Social Security for $13 billion. A couple of months ago we did the same thing on cash for clunkers for $5 billion. A budget was passed by this Congress, which does it for the whole Nation--it creates $1 trillion of unfunded liability and deficits for the next 10 years every year.

Now we have this health care bill coming at us, which is going to increase the size of the government by $1 to $2 trillion, which is represented that it is paid for, but that is only because they phase in the expenses 4 years after they phase in the income and thus are able to match 10 years of income versus 6 years of expenses. So they claim it is paid for.

When the bill is fully phased in, it will not be paid for. It is going to be a huge cost to the Federal Government, and even if it were paid for, it would be taking massive resources in the area of Medicare by $400 billion and it is going to raise fees by $500 billion. Instead of using those resources to reduce the debt, it will use them to create a brand new major entitlement at a time when we have on the books entitlements which we can't afford today.

Medicare has a $34 trillion unfunded liability. Yet we will add a new major entitlement on top of Medicare and Medicaid, and we will pay for part of it by cutting Medicare. Still, instead of cutting Medicare for the purposes of paying for that, we should be using Medicare savings for the purposes of making Medicare solvent. We should not be growing the government. We are going to do a $1 to $2 trillion increase in the size of government. I will absolutely guarantee that that will not be fully paid for and that a large percentage of that will go to our debt.

On top of having deficits which are already projected to be a trillion dollars a year for the next 10 years, we are seeing a Congress which is being incredibly spendthrift in its approach to all sorts of areas: $300 billion to pay doctors, new debt; and who knows how much out of this health care bill. I am willing to bet the family farm that it will be well over a trillion dollars of new debt when it is fully phased in; new programs in the area of Social Security, which is already bankrupt, unpaid for, added to the debt; new programs for this favorite group, cash for clunkers or whatever the issue is of the day. We are totally out of control on the spending side of the ledger.

It is not a revenue issue. It is a spending issue. Revenues have historically been about 19 percent of GDP. Spending has been about 20 percent of GDP. But under the budget which we have been given, independent of the health care bill, spending goes from 20 percent of GDP up to 23 percent. And when we throw in this health care bill, we are heading toward 24, 25 percent of GDP. Revenues, if they maintain their historic levels once the recession is over, go back to 19 percent of GDP, but we still have a 6 to 7-percent gap because spending has gone up so much.

I appreciate the fact that this administration comes with a philosophy--and they won the election--that we create prosperity by growing the government. The President said that. People around him said that. Members on the other side of the aisle say that. We create prosperity by growing the government. But we don't create prosperity if we let the government grow so fast that it can't be paid for. Government cannot be allowed to grow any faster than it can be paid for. In my opinion, prosperity doesn't come from the government to begin with. Prosperity comes from entrepreneurs who are willing to create risks and create jobs. Independent of that philosophical debate, the simple fact is, if we allow government to grow a lot faster than we have the capacity to pay for it, we create debt. It is that debt and these independent people looking at that debt who are giving us these massive caution lights and saying: Slow down, get your house in order.

People who are buying our debt around the world are saying it. People who use the dollar as reserve currency around the world are saying it. And now Moody's, the clear, independent arbiter of what the value of debt is and what its likelihood of repayment is, is saying it in the most stark way. The AAA rating of the United States is not guaranteed, Steve Hess of Moody's, said. So if they don't get the deficit down in the next 3 to 4 years to a sustainable level, the rating will be in jeopardy.

We need to heed those words. We need to get some discipline around here, and we need to stop having proposals which dramatically increase the size of the government and continue to put us on a path where we pass debt on to our children which will cause them to have a much lower standard of living than we had and which will cause them to be unable to send their children to college, to buy their first home and afford a car, because they will be confronting a nation where the debt is absorbing so much of the productivity of the economy or where inflation has basically priced them out of the markets.

I yield the floor.

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

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.

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.

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. 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.'')

Mr. President, as you could hear from the remarks of the Senator from North Carolina and the Senator from Oklahoma, there is agreement on some issues. We know the status quo is not going to work when it comes to health care. We know our families cannot endure another decade of double-digit cost increases every single year in their health insurance premiums. We know we can do better than devoting a fifth of our GDP to health care, when every other industrialized country in the world devotes less than half that to health care. We know the biggest drivers of our outyear budget and debt--which we do need to be enormously concerned about--are rising Medicare and Medicaid costs, and the biggest drivers of those are rising health care costs.

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

So while we are disagreeing about the outcomes, I think there is a growing understanding that the current system just will not do.

Afghanistan

Mr. President, I am here to talk a little bit about Afghanistan, and just for a few minutes because yesterday we reached the 8-year anniversary of the war in Afghanistan. On this occasion, we should remember how unified our entire country was over our mission there when it began. The Nation came together after 9/11 to support our military as it bravely took the fight to the Taliban and the terrorists in Afghanistan. We had one ultimate goal: Removing al-Qaida's safe haven.

Our military succeeded in toppling the Taliban government, which had allowed al-Qaida to use Afghanistan as a staging ground and a hiding place. Once the Taliban was removed from power, an international coalition, led by U.S. forces, went about the long and difficult task of defeating al-Qaida for good.

Yet now, 8 years later and with a new administration trying to determine America's best way forward, many Americans are understandably concerned and frustrated. Afghanistan is not where any of us want it to be, and our ultimate goal has not yet been met. Al-Qaida is still there and in Pakistan as well. Afghanistan's Government has not been able to take centralized control of the country. Elections there have not added to the legitimacy of the Karzai government. We have been left to reassess our position, and we must do this reassessment together.

Policymakers are asking the important and right question: What are the proper goals for our military effort in Afghanistan? How best can we accomplish them? Are these goals purely military goals? Can they be better solved with more troops or fewer? Do we need a more complex new mission in our future, which the military aspect is only one small part?

Unless we are sure, unless all of us are sure that more troops can help us meet our goals, we should not send them. Our soldiers already have sacrificed much. This time, in particular, is a difficult one for servicemembers and their families, and it is also proving to be a difficult one for those of us making policy.

As we decide what our direction will be in Afghanistan, the fallen brave soldiers we lost from Fort Carson this week are solemn reminders of how consequential our decisions have been and 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.