A joint resolution proposing an amendment to the Constitution of the UnitedStates which requires (except during time of war and subject to suspension by Congress) that the total amount of money expended by the United States during any fiscal year not exceed the amount of certain revenue received by the United States during such fiscal year and not to exceed 20 per cent of the gross national product of the United States during the previous calendar year.

Madam President, I ask unanimous consent that the order for the quorum call be rescinded.

Madam President, I ask unanimous consent that the Senate proceed to a period of debate only on the FAA authorization bill for the purposes of opening remarks from the chairman--that being me-- and ranking member--that being Senator Hutchison--of the Commerce Committee.

Madam President, I wish to thank the majority leader for bringing this bill to the floor so promptly--the first bill of this year, the 112th Congress. The Air Transportation Modernization and Safety Improvement Act reauthorizes the Federal Aviation Administration. It has been postponed 17 times over the last 4 years, to the consternation of all of us who care about this subject. There are three Commerce Committee members in the Chamber right now, and we are all frustrated about getting it done. So it is the first piece of legislation.

The bill which I introduced and which we are considering is the text of the FAA reauthorization bill that was approved by the whole Senate last year by a vote of 93 to nothing. All of the matters of safety and air traffic control systems and all the rest of it that we talk about are all incorporated already in this bill. Although the Senate and the House of Representatives informally conferenced, it was not productive, and we were unable to come to a final resolution, so here we are once again. I thought that beginning this year's consideration of the FAA reauthorization bill with the legislation that did pass unanimously last year would signal a commitment to bringing forward a bill that had broad bipartisan support--at least last year. It wasn't that long ago. There are some new Members, and some issues still stand out. We didn't resolve all of them.

I wish to say at the beginning that this is a monumentally important bill. I would also say that I recognize without rancor that there are a lot of Members of the Congress who don't really keep up with aviation because they kind of take it for granted. It is highly technical and not always interesting but always important--always important. It employs 11 million people, just for a start. It is a vastly important bill, and we are vastly behind where we should be, and this bill will help us move forward.

I wish to thank particularly Senator Hutchison, the ranking member of the Commerce Committee and my able partner, for her efforts on this bill last year. I look forward to working with her again this year in passing this bill, as I know she wants to have it happen, and get it enacted into law. She and I can't sign it into law, but we want to have a good bill signed into law. I believe this bill reflects a shared vision and our mutual goal of making sure the United States continues to have the safest, most efficient, and most modern aviation system possible.

Given the importance of the airline industry to our Nation's economy--again, many people take this for granted, but it is a vast industry--I can't think of a more important piece of legislation to our Nation's long-term economic competitiveness. It is the right bill to start with. We know this legislation will create and support good- paying American jobs. It already does--11 million is a lot of jobs. That is slightly more than the population of West Virginia. The bill improves the safety and efficiency of our Nation's aviation system by preventing something called runway incursions, which people often aren't aware of unless their plane runs into another on the tarmac, which happens infrequently but does happen. People would be shocked to know how often and how many times incursions are just about to happen until they are rescued by an understaffed control tower which says: Hey, head right, head left, stop--whatever. It also modernizes our air traffic control system. That is an easy phrase--``modernizes our air traffic control system.'' It is a vast, new concept. We are living in an age when everybody else is GPS and digitalized, and I include Mongolia. I would like to include Mongolia because it does have a GPS system, and the thought of Mongolia being ahead of us is deeply disturbing to me, and it is a way of making a point, I think one would agree. I wish to reduce delays that frustrate fliers, and we do that. It opens the door to better economic development, especially in rural and underserved areas. It makes a very big point of that, with essential air service, airport improvement programs, and other programs.

Simply put, this bill helps protect our position as the global leader in aviation. Now, I said ``global leader.'' We are. We are. The aviation needs and goals of Texas and West Virginia are the same. People might not believe it, but they are. My good friend Senator Hutchison represents some of the largest airports in the country. I represent some of the finest smaller airports in the Nation. All of our airports are critical economic engines to their respective communities. Senator Hutchison may have more flights in and out of Texas than we have in West Virginia--in fact, I guarantee she does--but we both know the importance of air service to economic growth and global competitiveness.

Every one of our constituents wants the safest aviation system possible. Before assuming our current roles, Senator Hutchison and I rotated being chairman and ranking member of the aviation subcommittee. We did that for 10 years, so we are pretty heavily into the subject, and we agree on virtually everything--virtually everything. But we share a passion for aviation because we know how critical this industry is to our economy, to the comfort and mobility of our people, and to our Nation's future. We both share a strong desire to get this legislation enacted into law. I have already said that. It has been far too long--4 years--since the last FAA reauthorization bill was enacted. Our Nation cannot afford to wait one second longer.

Sadly, when many people think of flying, their first reaction is often negative, and that is usually what we hear--people complaining about TSA lines, about delays, about weather; airlines are meant to control weather. Actually, they don't, statutorily or otherwise. But people are not happy, so there is sort of a grumpiness about this subject, which we don't address, but we try to take away the causes of grumpiness.

I will be the first to admit from my own point of view that travel is not always enjoyable. That is a symptom of a number of expectations we have somehow developed over the years. Air travel has changed with deregulation. Oh, how well I remember regulation. American Airlines, big jets in Charleston, WV; United Airlines, big jets in Charleston, WV; Eastern Airlines, big jets in Charleston, WV; deregulation, and one month later, no more jets, and we now subsist basically on prop planes with two propellers. If you are my height, it takes an hour or so to restore your blood flow after you get out of one of those--if you are lucky enough to get an exit seat. If you are not, it may take 2 or 3 hours. Anyway, some of the changes with deregulation have been for the better. Not all of those changes have been for the best. There have been frustrating changes for travelers as the industry has adapted to this new reality. There have been many other benefits, primarily cheaper tickets to more places for the average flier.

We must also remember that aviation is more than just a commercial air travel service. Aviation accounts for $1 trillion-plus worth of economic activity for the country and, again, supports more than 11 million jobs. It is a critical sector of our economy. Boeing is the Nation's largest exporter, and aerospace sales from large and small producers provide billions of dollars toward balanced trade for the United States with international buyers. This is a great success story, but we haven't been tending to it. That is why we are doing this bill now.

In 2010, the United States did not have a single commercial aviation fatality. That is a truly remarkable statistic. It is one we should not only be thankful for but very proud of. Safety is the No. 1 priority of the Federal Aviation Administration, the airline industry, and the people who work for both, and it is the No. 1 priority of Senator Hutchison and myself, and well as the Commerce Committee as a whole. It always is and has to be. It is through the hard and dedicated work of the thousands of FAA and airline industry employees that we do, in fact, have the safest aviation system in the world. Improving the safety of our aviation system has been a huge priority for all of us. You can't rest on your laurels in aviation in any respect. The industry is always shaky. The public is always a little bit shaky. Times are shaky--bad times, fewer passengers; better times, more passengers. That sounds like good news--more passengers--but I am copping to that. It isn't necessarily good news that there will be more passengers in the future.

I strongly believe this bill is fundamentally about the future of aviation, and it is vastly important. This bill is about making sure we have the most technologically advanced satellite-based air traffic control system in the world. This bill is about catapulting our air traffic control system out of the 19th century and into the 21st century with every other industrialized country in the world. We do not share that with them now. More people drive rented cars with GPS systems than airplanes have. It sort of doesn't make sense, but that is a fact. Today, as I said, we are behind Europe and even Mongolia. We have to remedy that fact, and we have to do it quickly.

This bill is about making sure we continue to have the most dynamic aviation industry in the world. I will say it again. The U.S. civil aviation sector generates $1 trillion a year in economic activity and employs 11 million people. All of that activity creates jobs in every sector of our economy, including airport construction jobs and building airplanes, from the smallest general aviation planes to Boeing's state- of-the-art 787 Dreamliner. All this activity creates jobs--jobs in airlines, jobs in general aviation, such as the small airports that dot both Senator Hutchison's State and mine, the rural parts thereof, as well as the Presiding Officer's. Airports and the aviation industry support millions of indirect jobs. That makes sense. One need only look--and this is sort of the most obvious presentation of it--at the growth around Dulles, Dallas/Fort Worth, and Denver International. Denver International was built out in the middle of the desert. Not anymore. I don't think Dallas/Fort Worth was ever out in the middle of the desert, but the growth is extraordinary. It attracts jobs. People don't want to bicycle to Dallas or Charleston or anywhere else; they want to go by air. Business decisions are made by air. So that point speaks for itself.

In Beckley, WV, which is not huge but has a wonderful airport, what is interesting is that it also has an enormously successful business park at that facility. Our major airports in Charleston and Huntington have direct flights to the major headquarters of chemical and energy companies that allow businesses to grow in West Virginia.

I believe the future of the U.S. aviation system has unlimited potential. We face serious challenges in making sure we reach that potential, but I know we are up to it. To make it work, we have to upgrade our 1950s-era, antiquated air traffic control system. Investing in technology and infrastructure is a very good place to start. It is embarrassing that some of our newer cars have more sophisticated global positioning systems than many of our aircraft in the skies. That has to change, and it costs money. It has everything to do with lives and safety. It is going to get much bigger, with many more passengers. We have about 750 million people flying every year now. In another decade it will be nearly 1 billion. So it is almost like a 50-percent increase in the number of people flying. Everything gets more complicated and crowded.

It is eye-opening to see the speed with which China and other developing nations are investing in their air traffic control systems and their airports. They know what they are doing. They take nothing for granted. Growth is on their minds. Again, we have to make the effort to get ahead or we will be left far behind. I am sorry, but that is the way it works. It is not a sentimental industry. It is one that needs to be treated well, nurtured, and supported.

If we don't act quickly, we are at risk for falling behind our global competitors. We will lose the cargo hubs, the aircraft manufacturing plants, and the economic development that aviation causes. I cannot understate the importance of a vibrant and strong aviation system. I have made no attempt to be shy on that account. I cannot be. It is fundamental to our Nation's long-term economic growth and to my State's ability to attract new investment.

When choosing to invest in an area, the quality of air service is the prime consideration. I say ``the''; you could say ``a.'' You can have a great quality of life, but it doesn't give you a factory. Quality of life is good, but it isn't preemptive. The ability to fly from West Virginia to almost any corner of the world, which we now have, is critical for our ability to attract new businesses and jobs.

Why do we have 20 Japanese companies in West Virginia? That is actually a cerebrally interesting question. The reason is, because we have good air service and good workers. But if we had good workers and no particularly good air service, we would not have them. You have a lot more of that in Texas, but for West Virginia that is a phenomenal statistic. All of our futures are tied to modern aviation systems.

Over the last several years, we have focused more on the inconveniences of air travel, rather than trying to solve the underlying problems that make air travel so challenging.

Most Americans do not understand how fragile our air transportation system is. The economic downturn of the last several years masked this fragility because fewer people flew, so there was less pressure on the system.

As our economy recovers, I am afraid the inherent weakness of our system will loom larger than ever in years to come as we get to 1 billion passengers a year.

The possibility of a meltdown of the air traffic control system may become reality, unless we modernize it. This will create more than inconvenience; it will put passenger safety at a very substantial and unnecessary risk.

These are not the only troubling signs, as I noted. There were no commercial aviation fatalities in 2010, but that doesn't mean the system is working to perfection. We were lucky and people worked hard. Over the last few years, the FAA and the industry have faced serious questions over their commitment to safety. That commitment has been called into question.

The grounding of thousands of aircraft throughout the system in 2008 raised questions about the quality of airline maintenance practices and the FAA's ability to provide sufficient oversight of air carriers and their maintenance, not just domestic but also overseas, which is another subject.

The tragic accident, the downing of flight 3407 on that snowy night in Buffalo, exposed problems with pilot training, flight crew fatigue, particularly pilot fatigue, and the ability of the industry to assure the traveling public that there is one level of safety throughout the entire system. This bill addresses that through a number of stipulations, but we are making it a rule. We have to get this into law. The FAA is putting some of this into practice, but we have to make it into law. People have to get enough sleep. Above 10,000 feet, they can talk about something other than aviation, but below 10,000 feet, where the crowd gathers and aviation is being scrutinized by air- traffic control folks, you have to have what is called a sterile cockpit, where nobody talks about anything but landing. So I am deeply proud of the reforms we have put into place in the area of safety, and they offer even more incentive to pass the bill quickly.

Before I close, I wish to recognize the efforts of former Senator Byron Dorgan and I think Senator Hutchison would join me in saying this--for his hard work on behalf of the safety issue. I am pleased to say the FAA is currently working on implementing the two dozen provisions of the law that he helped, with others, to create.

I feel very strongly that improving our aviation system is a national priority. My passion comes from a deep belief that our future is tied to a healthy aviation industry. America is the cradle of aviation. I don't want to see that change.

Since 1988, I have worked diligently, as the chairman of the Aviation Subcommittee and now as chairman of the Commerce Committee, to support our aviation system and to address its challenges; to wit, inadequate funding for the FAA, a chronically unprofitable commercial aviation industry, and minimal investment in aerospace research.

Nobody moves forward in industry without doing research, and we will not pay for it. So a lot of it is not done.

In some areas, we have made progress. We have increased our investment in airport infrastructure, we have opened new markets for U.S. air carriers and, thanks to the Obama administration, we have finally begun to make serious investments in modernizing our air traffic control system. It is a multi-year process, highly expensive.

I know many of my colleagues will say we cannot afford to make those investments in aviation at this time. But now, it seems to me, it is the precise time to make them.

The recession has prevented widespread delays from occurring. So we were lulled into thinking everything was going well. Over the last decade, airlines dramatically cut capacity and parked hundreds of planes in the desert. We don't have them in West Virginia, and I don't know where they are parked--somewhere in the desert. They were taken offline because of a lack of passenger demand. Anyway, we cannot make shortsighted budget decisions. The cost of inaction will be far greater.

I ask my colleague from Texas, I am proceeding well, but I am not finished; is that acceptable?

I thank the Senator. Our economy has begun to slowly turn around, and the demand for air travel has slowly begun to grow. Airlines have cautiously increased capacity. If we act now, we can be prepared to meet the challenges of adding millions of passengers to the system in the next decade. If we fail to act, congestion will plague the system again, delays will be a fact of life, and today will look like the golden age of travel.

The benefits of investing in air traffic control modernization extend far beyond the ability to handle more passengers. Most important, the Next Generation Air Transportation System, what we call NextGen, will dramatically improve the safety of our air transportation system by providing pilots and air traffic controllers with better situational awareness. Now you can't tell if there is a mountain in front of you, you can't tell about the ground situation, and you can't tell very well about separation. It is inefficient. Planes land, but they could land

more quickly. You cannot read the distance and altitude between one plane flying in for a landing or one taking off. It is inefficient-- dangerous, in fact. So we have to do this. We have to be able to see other aircraft and detailed weather maps in real time and to be able to go from one place to another in a straight shot. That is what NextGen will do for us. Now planes are going all over the place, avoiding this and that, as they go from one TRACON to another TRACON, a weather system or an unexpected flight. GPS NextGen will allow for straight flights. That saves a lot of fuel and a lot of time, and delays cost the American economy over $30 billion a year.

So, again, we have to provide our pilots and air traffic controllers with better situational awareness. They will be able to see other aircraft and detailed weather maps, and that becomes important.

A new satellite-based ATC system will allow airplanes to move more efficiently by taking more direct routes, which saves our economy billions of dollars on an annual basis.

Greater operational efficiency will also create substantial environmental benefits. Drastic reductions in fuel consumption means not only that we will achieve lower carbon emissions--less of them will be spewed out--but almost every community near an airport will benefit greatly from this effort. Also, planes are becoming quieter. In all ways they are getting better. We still have to guide them correctly.

As I noted, the President clearly recognizes the value of investing in our air transportation system, and this was reflected in his budget request. The administration proposed a total of over $1 billion in fiscal year 2011 for NextGen programs, which is more than a 30-percent increase from the fiscal year 2010 budget. Is that bad in this time and age of skepticism about budgets? I hope we can continue this level of budget, even in lean budget years.

Modernizing the ATC system will require a sustained focus and substantial resources. This legislation takes concrete steps to make sure the FAA accelerates and achieves key NextGen programs and that the agency implements modernization efforts in an effective and efficient manner in the long run. How many airports can be done by 2014 and by 2018? It is laid out in the bill.

Let me discuss a few key measures in S. 223 that further address modernization. To improve accountability, this bill establishes an air traffic modernization board, and it designates a chief NextGen officer to provide specific oversight of the FAA's modernization activities. Oversight is what Congress is for, and we don't do it well enough because we are all on too many committees and have too much work to do. Putting somebody in who is responsible for overseeing NextGen within the FAA is a good idea, not a silly one.

The bill also establishes specific deadlines for the implementation of the key NextGen programs. It has fancy names for them. Area Navigation, or RNAV, and Required Navigation Performance, or RNP, procedures must be developed at the Nation's largest 30 airports by 2014. Where these technologies are already in place, we are seeing dramatic benefits in reduced fuel consumption and many other benefits.

All aircraft are required to be equipped with Automatic Dependent Surveillance-Broadcast. I will not bore you with what that is about. It is called ADS-B, and it is the cornerstone of the FAA's traffic control modernization effort. It provides controllers and pilots with an aircraft's immediate position. Pilots will be able to see the real-time position of other aircraft in their vicinity and receive the same information the controllers are seeing in their towers. They will see them in their cockpit.

The FAA estimates that NextGen will cost probably about $20 billion through 2025 and the airlines another $20 billion in aircraft equipage. In other words, they have to match--the airlines--to a certain extent what the Federal Government is doing. They will do that. Again, some will argue we cannot afford this investment. I say it is the other way around.

This bill is paid for. It makes a substantial commitment to providing the FAA with the resources it needs. I have worked with Senators Inouye and Baucus to reach an agreement that moves us in the right direction. S. 223 will create a new subaccount with the aviation trust fund to fund FAA's modernization efforts. This modernization subaccount will dedicate $400 annually to NextGen efforts and to nothing else. So it is boxed right in. Our colleagues have worked hard on this issue.

A word on small community air service. That is another core challenge. Every part of my State of West Virginia is basically rural, and every State has some rural parts. Everybody thinks of LaGuardia and JFK, but try upstate New York, try around the Saranac or west of that into Buffalo. They deal with small aircraft. That is where the small aircraft crash took place, in Buffalo. The pilot was drowsy.

The continuing economic crisis has hit the U.S. airline industry very hard. Rural communities are at the end of the food chain. If something bad happens at the top of the food chain, there will be some suffering. But the real suffering takes place at the bottom of the food chain. That is where the flights get cut off, that is where they get limited, that is where some flights suddenly stop going to places. There is hope for better times, but we do not have them yet. We are in crisis.

The reduction or elimination of air service has a devastating effect on the economy of the community nearby. I stipulate that with the previous sentence. Having adequate air service is not just a matter of convenience but also a matter of economic survival. Without access to reliable air service, no business is going to locate their operations there. I already talked about that issue. Small airlines and small airports are important.

When Congress deregulated the airline industry in 1978, we made a promise to small communities--an official promise--that they would continue to have access to the Nation's air transportation system. I believe that the Federal Government needs to provide additional resources and tools for small communities to help them attract adequate air service. This legislation does this by building on existing programs.

Authorized funding for the Essential Air Service program is increased to $200 million annually. The EAS program is critical to dozens of communities throughout this country. I made that point. It is needed. It also provides a lot of flexibility to EAS, and what small airports can do with EAS. Someone may be phasing out being a commercial EAS airport and headed to being a general aviation airport. This allows that transition to move forward.

I am almost at the end. Consumer protection is key. We are about protecting lives, protecting people, protecting passengers. The bill strengthens passenger protections by incorporating elements of the passenger bill of rights which came right out of the Commerce Committee to deal with the most egregious flight delays and cancellations.

Talk about angry travelers. This is where you run into them. The industry would be required to take basic steps to improve the passenger experience. To wit, passengers must be provided with information regarding on-time arrivals and chronically delayed flights when they purchase tickets. Most of them will do that online so the airlines have to publish what is their record for on-time takeoffs or on-time landings, what is their delay, what is their cancellation. That has to be posted so that fliers who want to purchase tickets can compare and go elsewhere if they want.

Air carriers are also required to permit passengers to deplane after 3 hours have elapsed. We all heard about 9-hour waits on the tarmac. It is usually not as dramatic as that. If you are a mother and have three children, 3 hours not moving is a long time. Three hours moving is a long time, but not moving is a very long time. They would have, after 3 hours, the right to deplane. It is their right to deplane. Airlines cannot stop that unless the pilot has a certain belief that they are just about to take off. They have to be given water and medical attention, if they need it, bathroom facilities, and the rest of it.

The Department of Transportation has taken steps to improve customer protections, and I applaud their actions. But I for one believe statutory protections are better than when a government agency decides to do it.

In conclusion, when we began work on this bill, I at least had four simple goals: One, take steps to address critical safety concerns; two, establish a

roadmap for the implementation of NextGen and accelerate the FAA's key modernization programs; three, make sure we adequately invest in airport infrastructure; and four, continue to improve small communities' access to the Nation's aviation system. This bill takes those steps.

I feel very strongly about the bill. The Airport Improvement Program, which is part of this bill, is estimated to support 120,000 jobs annually. This bill authorizes a total of $8.1 billion for this account. Moving forward with NextGen will certainly help us keep our position as a global leader. This is the culmination of more than 4 years of work with Senator Hutchison and myself and the hard-working members of the Commerce Committee.

Again, this language passed 93 to 0 less than 12 months ago. It is an important bill--important for the safety of the traveling public, important to our ability to create jobs, important to sustaining an aerospace industry, important to having healthy airlines, important to general aviation's future, and important to our future competitiveness.

I urge my colleagues to support this bill, and I welcome ideas on how we might improve it. I ask my colleagues to join me in our determination to complete our work and reauthorize FAA.

Madam President, I don't see any other folks who want to speak on the FAA bill for the moment or on much else for the moment. I will suggest the absence of a quorum but not yet. I am hoping Senator Baucus and Senator Hatch will come down to oversee the 1099 argument and repeal of the health care bill, which is about the worst idea I have ever heard. I think it will be voted down, and I believe the minority knows that. I don't know who they are trying to speak to. When I think of the health care bill and all the work that went into it--the work that went into it is not that important, it is the product that came out. When he says the American people are against it, that was actually quite true for a year and a half, maybe almost 2 years, because we were in the process of making the bill and it was kind of like making sausage, and people turned against it. But now it is going in quite the opposite direction. Now as people begin to get some of the benefits, they understand some of the conditions they will be unbonded from, that they won't be slaves anymore to costs determined by others who don't care about their health care, I think the momentum is swinging.

What we would be condemned to, if the amendment were to pass and health care were to be repealed, in that there aren't any particular ideas of note which were put forward by the other party about what we should do to make it better other than to repeal it, is another 2 or 3 years trying to write a bill and not having a bill. We would be in a situation as follows: I recall in the year 2008--and I just happen to recall this because we worked on this in the Commerce Committee--the five largest health insurance companies in America made profits of $12.4 billion. I don't have a problem with that. What I do have a problem with is what they were doing and what will continue to happen if we repeal the health care bill; that is, while they were making all that money, they were, through the process of rescission--and that means a unilateral decision that because somebody has acne or has been through a C-section or asthma or any number of things--they actually insured 3 million fewer people while they were making that $12.4 billion by the sole act, which is their right under previous law, which we corrected, to do rescission. That is, by their own decision to simply remove health care from people who made an agreement with them, signed up, had been sending in premiums and all the rest of it.

I also think about a young 8-year-old I met in Charleston at a town meeting. He had had leukemia for a while. Without this health care bill, there are lifetime limits and annual limits on what one can get in the way of health insurance. And when you have leukemia, the lid is lifted off. The boy died. He died because he couldn't get insurance. His family obviously couldn't afford to pay for it, and he couldn't get it so he died. People say that is kind of an extra dramatic example. Unfortunately, it is not. It is very common.

Something else that would disappear, if the health care bill were repealed, is something which nobody ever talks about but which is sort of the philosophical basis for a lot of this, and it is called the fee- for-service system which we now have in America on medical care, particularly with Medicare, but generally. That is the person who provides the service or the medical equipment person who provides the medical equipment or the hospital which provides the service, they provide the service, and they bill Medicare. Medicare doesn't ask any questions. Medicare just pays the bill. That is one of the reasons, of many, if the bill is repealed, we will go into hock $1.3 trillion more on our deficit, because our bill saves that kind of money. Their bill would vitiate that savings. Fee-for-service is not the way health care ought to work. The way it ought to work is that like anything else, this very bill, there is no tree on this bill. What happened in the Senate? It was an epiphany of some sort. We decided to be transparent and accountable. So anybody can offer amendments on anything. And indeed, they are and will. But accountability causes efficiency and makes better results. Under the bill that has been passed, people are held accountable for what they do. Hospitals, for example, or doctors or medical equipment people, are measured by their outcomes. In other words, it is evidence-based outcomes. What are the results of what you have been doing in health care? Are they better? Are they worse? Did fewer people die? MRSA is a reason hundreds of thousands of people in this country die. Basically that comes from relatively unclean bathrooms in hospitals that don't pay attention to that and accreditation folks who don't pay enough attention to that either. That is a disease which is easily cured, one, by cleaning up

bathrooms and, secondly, it is just automatically a part of the expense part of health care and it should not be. Evidence-based outcomes, you prove to me that you are doing a better job this year than you were in the last 2 or 3 years, or whatever the range might be. So it is not fee-for-service. It is fee after the explanation of the efficacy and the lifesaving quality of the service.

That is the direction health care has to go. That isn't discussed but if this whole bill is repealed, that is exactly what will happen. Everybody is held accountable. We are being held more accountable. The big three automobile companies were held more accountable. They were embarrassed, but they have come back pretty nicely. The way we make our progress in America now is to make sure that people do what they are meant to be doing, and they do it well, and they can show it. Actually some of the paperwork is you have to convince the folks from Medicaid and Medicare, whatever else it is, that you are doing a better job. If half of all Medicare is spent, as it is, in the last 6 months of life, that bears analysis. Why is that so? What are we doing? What are we not doing? Don't just pay the bill because it is sent to you. You look at it and you ask questions. That is the direction of the new health care. I think it is a fair direction. It is one which I am sure the Mayo Clinic does routinely. But it is not a good idea.

I will speak on this more later. I am now waiting for Senators Baucus and Hatch to handle both matters since it is within their jurisdiction. I am on the Finance Committee. I am close to Senator Baucus, but I am not Senator Baucus. He needs to be down here to do that. I hope he will be down shortly.

Pending that situation, I suggest the absence of a quorum.

Madam President, after that last sentence, I had to drink a little water to sort of balance myself out. To be praised at such length by Senator Schumer--one can't take it lightly.

I wish to make a few comments on the health care bill, which, in and of itself, interests me because we are here doing FAA. If I remember correctly, I stood here at excessive length and gave a speech about the importance of the FAA bill. Kay Bailey Hutchison did the same. Then, all of a sudden, here we are on health. That is very interesting because we have sort of made ourselves entirely transparent. Anybody can offer amendments. The leader doesn't fill up the tree, so it is open. And what happens is, immediately everybody pops in with their favorite amendment. I don't resent that; I just say it is an interesting phenomenon which is showing itself on the very first day. Whether that will last, I don't know.

In any event, I think they are still working--Senators Baucus and Hatch and others--on the FAA stuff and the 1099 matter, so I wish to talk about a couple of things on health care.

I think it is very important--and I mentioned this in my earlier comments--when you say the American people don't want this bill, there was a period of time when that was correct because the bill was made in front of everybody on C-SPAN--whoever watches it, but enough people did because a lot of people were interested in what was happening--and it wasn't a very pretty process.

The public option, for example--Al Franken and I put a public option bill on the floor and thought it would save the world. Then all the talk shows took it up, either blasting it or loving it--in excess in both cases. There was one problem with the public option: It didn't have any votes in the Finance Committee, which means it couldn't have gotten far. That was based on a $50 billion Medicare benchmark. So it was a real cost saver and a very good--obviously, to get a nonprofit option as you buy your health care is very appealing--all of which is true but all of which was unpersuasive because it sounded like too much government. Maybe if we had called it the freedom option, it would have been different. That doesn't matter. It didn't get the votes. My version got 10 votes, and Chuck Schumer got 8 votes on his--or maybe it was the opposite. We then came up with a medical loss ratio, which nobody understood because of the ridiculous wording, except that it works.

I want to talk about a couple of things like that until somebody comes, and then I will humbly and gladly yield the floor.

Does the Senator wish to speak?

I will not be too long.

As it happens, on the poll, over a period of months and months, people saw this thing happening, and they didn't like it. People lined up on one side or the other--mostly one side--and they didn't like it. It turns out that the New York Times and CBS did a poll--I don't necessarily have to trust them because they took a poll; I don't trust polls--that says 80 percent of Americans oppose repeal. I found that in the cloakroom. I don't live by polls. But that is based on January 20 of this year. Let's suppose it is off by 10 percent or 15 percent. One thing that becomes clear from the generalization of that number-- certainly it could go lower--is that people don't want repeal.

Then that takes you to, well, what if we do have repeal? Does the repeal then lead you to a thought-out process

that would then be substituted for what we created and the President signed? And then very quickly one comes to the realization that there isn't an alternative from the other side. There never has been. From that, it quickly follows that the deduction is what they want is the present system. If that is not true, then they can come down and tell me about that. That is what I have to believe because I haven't heard the new ideas or the alternatives to what it was we worked on and accomplished over a very difficult period of many months and much angst, agony, and screaming at townhalls and all the rest of it, which was worth it.

The bill, although not perfect, was a real step forward. It looks at the fee-for-service system, which has always been a fallacy in the American health care system, that you automatically get paid for whatever you do if you are a doctor, a hospital, or you sell medical equipment, no questions asked. You don't save money, you don't improve health care by doing that. Productivity, efficiency, and excellence are done by oversight, by accountability, by asking questions, asking people to show, through the evidence of what they have done for a particular service, that it is better than it was the year before.

I will mention--unpleasant probably and not fit for this floor--that one of the biggest problems we have in health care today is something called MRSA. MRSA is in almost every hospital in the country. Unfortunately, it emanates from bathrooms that are not kept that clean. So if we don't do our bill and it is repealed and hospitals then are not judged on MRSA and many other things, such as too many MRIs in one hospital, too many MRIs in one town that can only support two but has seven because you have to make money off of them but they are not used very much--all of these have to be checked and looked at carefully before people are paid. That is the way you save money, and that is the reason the health care bill that was finally signed saves $1.3 trillion over 20 years and $240 million or $280 million in the very first year. It is a cost saver.

So, by definition, if we went back to the present system, you would have to start with the fact that we would be losing those savings and therefore adding it onto our deficit. So we would have $1.3 trillion more in deficit over 20 years, et cetera, et cetera. It is unwise. But then cost isn't absolutely everything. We understand that. The Senator from New Hampshire understands that. We have to use good judgment.

Then you look at the public option, which didn't work, and then you look at the medical loss ratio. Folks don't know what that is--even some in this body. It is a simple system where you simply say--and it will disappear if Senator McConnell's amendment passes--that health insurance companies are required to spend 80 percent of all--85 percent if it is a large institution or, if it is a small business or an individual, 80 percent--they have to spend that percentage of their premiums they collect on health care, and then they have to show to HHS that it is being spent on health care that makes Americans better or at least keeps them where they are. The bathrooms get cleaner, to be crude about it but actually quite accurate about it.

That is a very good system because it is not sort of mandating; it is called oversight. The American people should want to do oversight over their health care dollars because it is so much of their income they have to spend on health care. The medical loss ratio--a strange name but a sound principle--is where 85 or 80 percent of all premium dollars have to be spent on health care, and health care cannot just be health care but better than it was in the previous year or 2 or 3 years. Obviously, we are not into that system entirely yet and won't be until 2014.

Is it possible for me to explain that I am very disturbed that this bill we are now wanting to repeal will insure 32 million people who don't have health insurance, and then I am saying to myself that there are a lot more than that who are uninsured in this country, but that is all we could afford to do because we didn't have enough money. So let's say it is really 45 million and then decide there are many millions more than that who are underinsured. You may be dealing with 50 million people, and all of a sudden, their prospects for getting health insurance disappear. They simply disappear because we repeal the bill.

Now, truth in telling, the 32 million people--we weren't going to be able to get that all done until 2020 because of the lack of funds. We had to do as much as we could as soon as we could, but we couldn't do more than that because we didn't have the money. Everything was scored by CBO, which is very tough. But I am astounded by the prospect of the excellent people who are on that side of the aisle--they are like us; a different party, but so what--saying that 32 million would lose their health insurance--or they were going to get health insurance, but now they will not, so they are on their own.

What happens then? Well, they take up the practice, which I saw first when I was chairman of the Children's Commission for 4 years in the early 1980s or the late 1980s--we went out to Chicago in one visit, to Cabrini-Green, and Chicago was a robust health care city, and the folks out there told me that in that particular year, eight emergency rooms in hospitals had closed down. Why? Because they were being overwhelmed even then.

Secondly, they are by far the most expensive part of the hospital. They cost the most. They drain health care because of all the emergency service. People wait 5, 6 hours--we have all been through it--and they get their health care, maybe. It is so inefficient, so brutal, such an awful system where more attention, because of health insurance, would allow more cautious, attentive, logical work to be done on patients. That is gone. That is simply gone.

Emergency rooms are important, but a lot of them are going out of business because they still cannot afford to stay open. They are too expensive for the hospital corporation that makes that decision. I do not blame them for that.

I know my colleague wants to speak. I think of when I was a VISTA volunteer--I sometimes talk about that on the floor--a long time ago. There were no jobs, no health care. Nobody went to school because the schoolbus did not come to pick up any of the kids because we were considered too far away. It was kind of a bad community. I latched on to that community. It is the reason I went to West Virginia and then stayed in West Virginia.

They depended on a rural community center. It was right next door, the Lincoln County Community Health Center. It was not a hospital so they did not have to worry about going up in an elevator because many of them in very rural parts of the State have not been in an elevator before, have not crossed a traffic light, red or green. That is new to them. They live in rural places. They deal with it that way. I suspect it is true in parts of New Hampshire, although New Hampshire has gotten sophisticated.

People trust rural health centers. Why? Because they are not hospitals. They are on the first floor. They are an old Kroger store, an old Safeway store, an old hardware store. But inside are doctors, nurses, and now health IT, which is in this bill and heavily promoted, which may be coming on its own, but I doubt it.

This bill is really important to health IT. They could communicate with any university, any medical center, not just in West Virginia but in the world. They can get experts to look at, let's say, a mole on a 14-year-old's arm. Is that just a mole or is that cancer? I have seen that done. A doctor at West Virginia University--this was 20 years ago--I can't believe that--looking at a kid in Moscow with a physician assistant attending. They put the then-technology on that mole. The doctor in West Virginia was able to analyze it and say it is not cancerous. That was a wonderful event.

People gravitate to community centers. Poor people gravitate to them. Rural people gravitate to them. They are easily accessible. They have very good doctors. There is a lot in the bill to help with those kinds of doctors, those kinds of nurses, the staff, those kinds of places and the whole health IT issue which makes the work they do there checkable, accessible anywhere else in the State, the country, or in the world. Those would be gone.

We have $10 billion in our bill for 1,000 new community health centers all across America. I am excited about

that. I think that is great for rural America, and a lot of America is rural. Most of America is rural. That goes.

Then I think about subsidies for small business. I spoke to a Chamber of Commerce in a rural part of West Virginia, a conservative part of West Virginia. They did not like the bill. That is why I went there. They were all small business people. There are no big businesses down there. I spent 3 hours with them. I went through the whole health care bill.

What was unusual to them is I stayed around and answered all their questions. That was interesting. In other words, you do not just say this is good, this is bad, here I am. You say: Have at me and I will answer you as best as I can. Where you do not agree with me, you tell me that.

They had no idea that they get a 35-percent tax reduction, a tax credit for giving health insurance. They cannot afford to give health insurance. Maybe 35 percent is not enough, but they get that, and they get that until 2014. And then after 2014, it goes up to 50 percent. They did not know that. All of a sudden the possibility of keeping their employees and doing the right thing by their employees--people in New Hampshire, people in Wyoming, and people in West Virginia care about each other. That is one of the beauties of small States. People really care. They want to do the right thing because they all live together. They do not commute out to the suburbs. There are not a lot of suburbs around. That was impressive to me.

When I left, I got a standing ovation. I am going to put that aside because I cannot believe that standing ovation, but what I do believe is that they were interested. They at that point did not know it was in the bill and there is no reason they should have known it was in the bill. Then someone who had been a major part in writing that bill talks to them and answers all their questions, the end point of which is 3 hours, and I get up and leave. That perplexes me.

If the minority leader's amendment prevails in that I do not think there is an alternative coming, we go back to the present system. That all goes. The Senator from Wyoming, when he speaks, may say, yes, there is an alternative, and we will have to listen to that. If we do an alternative, that whole negotiation may be 2 to 3 more years. I do not think people can wait that long.

In any event, I worry about the doughnut hole. Madam President, you know that. It is so unfair that seniors pay up to a certain amount, they get their prescription drugs, and they keep paying the premiums. But then from $2,000 something to $5,000 something, they have to keep paying their premiums but they do not get any prescription drugs. That is the doughnut hole which we close, again not until the year 2020, but they know it is going to close. That is gone. They have to work the system as best they can, pay their premiums if they can, and if they cannot they are out of luck. They will get cut off.

To me it would be brutally devastating if preexisting conditions, for children in particular, which starts right away, which is in effect now, disappears. I was speaking about a 9-year-old kid who had cancer. He was killed by the fact that he could not get any treatment because of annual limits. That is in effect now, and no lifetime limits is in effect now. Annual comes into effect in 2014. He died. I was a friend of that kid. I met with that kid. I met with his parents. I keep in touch with them. He died. He could not get health care under the present system. Under our bill, he would have gotten health care. One can say maybe it was too late, but that does not matter in the sense that he is just an example of somebody who is sick, who could get health care, and who otherwise could not get health care and he died.

I am haunted by that because I remember his face. His name was Sam. He was a lovely kid. He is not around any longer because of the old health care system.

Health care is a very hard subject. It uses all kinds of words and acronyms. It is true in the Federal aviation bill, too, if we ever get back to that. Acronyms are not bad, they are just not friendly. They still mean something, and because something is complicated it does not mean it is bad or wrong, it means it is complicated.

Health care by definition has to be complicated. People have to understand how the parts work together. It is very hard to do. I plead with my colleagues to be cautious about repealing something which is in place which appears people do not want to see repealed. They certainly want to give it a chance. They certainly are seeing the benefits from it. We are already reading about those things, and it has just literally started. It is a month-and-a-half old or a month old. We need to be cautious about that, particularly on repeal if it means going back to our present system or any substantial part of our present system. That would be a tragedy.

I thank the Presiding Officer and yield the floor.

Mr. President, that was a magnificent speech.

For the information of all Senators, there will be no rollcall votes this evening. I will continue to work with my ranking member, Senator Hutchison, and the leadership on both sides of the aisle on an agreement to dispose of the pending amendments tomorrow. Actually, it is on the FAA bill. Remember that? We sort of started out the day doing that. That is a very important bill, as the Senator from Maryland pointed out.

I ask unanimous consent that there be debate only on the FAA authorization bill for the remainder of the evening.

Mr. President, I suggest the absence of a quorum.

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

Mr. President, I have come to the floor today to talk about the amendment Senator McConnell brought forward in terms of repealing the health care bill. I am probably going to approach this differently than a lot of my colleagues have. I do not doubt that the intent of what was passed a year ago last December was well intentioned, with the thought of solving health care problems in this country.

My experiences, as a physician for 25 years, and as a manufacturer in the medical device field for the 10 years before that, gives me a little bit different take on what the consequences are associated with this bill.

During that hardy debate we all had, I made some claims that people doubted in this Chamber which have become absolutely apparent and true. Costs are going through the roof, faster than we thought; portions of people cannot tolerate the plans, so we are giving them exemptions because it will not work in the business model to keep people covered but, most importantly, what is getting ready to happen is what happens between a patient and their access and their care and their provider. As well meaning as the bill was, the destruction of that aspect of health care will cause us to rue the day we put into motion what we are putting into motion.

Let me explain. Most of the doctors in this country became very interested in this health care bill, and rightly so. They are the ones who are going to be impacted, along with their patients, because they are the ones delivering the care. When you poll those doctors, what do you find, now that they actually know what this bill is going to do?

Well, some pretty significant statistics have come out--one by Thomson Reuters--where two-thirds of the doctors in this country absolutely believe the care of their patients is going to suffer as a consequence of this legislation.

Think for a minute if you are an individual needing to access care and we are in 2014, 2015, and the Advisory Payment Board of Medicare is intact. We also know what the Medicare trustees have said about that, that when this is fully impacted, the payment under Medicare--this is a very important point--the payment under Medicare will be less than the reimbursement for Medicaid.

So all of a sudden who was your family physician or who was your surgeon is no longer there. You see, this bill is about whether you can walk in and have the attention and care of somebody dedicated to you, who has your best interests at heart in terms of your health. What we are moving to is somebody who is going to have their best interests of survival at heart and your interests second.

That is the real tragedy of what is happening with this bill and the implementation of it. Not only are we going to have payments reduced in Medicare--that is the only way the bill works, by the way; it is the only way we can ever get out of the jam until we address fixing Medicare--but 55 percent of the specialists in this country today will not see Medicaid patients at the reimbursement rate we have, and we are going to have a reimbursement rate for Medicare lower than Medicaid.

Let me give you another example. What we know on Medicaid is, if you have no insurance and you go to an emergency room with a significant illness versus if you have Medicaid and you go to an emergency room with the same illness, the outcome for you with no insurance is better than the outcome for you with Medicaid. That has been repeated in four different studies now, and we are putting 18 million people into a system who are not going to have access to the best doctors because the payment is so low that there is a loss every time you see a patient.

So describe to yourself for a minute what happens to the mother who has three young children and has their 4-year-old all of a sudden sick with a fever, and there is no primary care doctor available under the 18 million new people who are going into Medicaid, and this child does not get seen for 72 hours. The mother thinks: Well, I will wait the fever out. I don't have a doctor I can call. I will wait the fever out.

When the child gets to the emergency room, because there was not a primary care doctor for that Medicaid patient to call, what do they find? They find the 4-year-old not with otitis media any longer, but with the early stages of meningitis. What was a simple, treatable disease--because access, even though guaranteed, was denied because there are not the available resources to care for that child--the child ends up with a very complicated hospital stay and potentially the loss of hearing or brain damage. Those are the real consequences of what we are talking about as we put 18 million people into a Medicaid system.

We have had several Senators today talk about the cost and the gimmicks. I am not going to do that. But I want to talk about the real issues. The one place we failed in health care is we did not fix the real problem. The real problem is, everybody's health care costs too much. We did not ask the right question: How do you drive costs down? Even when you go through all the numbers that have been given by CBO, Medicare trustees, Medicaid trustees, and outside studies, what we know is, what we did not do is drive any costs down. In fact, in the short term we have actually driven costs up.

So how do we do that? The way we do that is put some responsibility on both the physician and the purchaser of health care for the cost. It is human nature. If I gave you an insurance card for your groceries, and once your deductible was met all you had to pay was 20 percent of that cost from then

on out, your diet would significantly improve in terms of the quality and price of the products you buy. That is all in our human nature.

What we have failed to do is to address the real cost drivers. That cost driver is: There is no connection with my purchasing of health care with the actual payment of health care. How do we know if we connect it, it works?

Go to any place in the country that has Amish folks. They do not have health insurance--none of them. They do not buy health insurance. What do they do? They are grand consumers and very discretionary consumers of health care because they come forward and they want to know what they are getting and what it costs before they buy it, every time. I have delivered over 500 Amish babies, and there was not one time I wasn't asked at the time the patient came to see me: What is the price for this? Will you take a cash payment up front so I can buy for cheaper? Are there some other places where I can get the tests done? Every test I ordered, I would be questioned on whether they absolutely needed the test. They were discretionary purchasers and very sharp in their discretion on how they wanted to pay for health care. Consequently, their cost for the same thing was 40 percent less than anybody who walked in with insurance.

So we have totally missed this connection of market forces allocating scarce resources by making discerning consumers out of the purchasers of health care. We have gone exactly the other way. We have taken people who are at 133 percent of poverty and said: You are going into Medicaid, and by the way, you can't buy private insurance even if you want to. You have to be in Medicaid--a far substandard health care system. All the studies show the outcomes are poor, even after you equate for social disparities. We are going to put 18 million into that program, and we are going to have a shortage of over 100,000 primary care doctors in this country in the next 10 years. So who is going to see them?

Let me give another example. It happened this weekend. A patient--90 years of age--severely bent over from kyphoscoliosis, bad aging and kyphoscoliosis, is running a fever and can't breathe well. She goes to the ER. She had seen a physician on Friday. She had a chest x ray, and no pneumonia showed. She goes to the ER that night. She has a pulse ox of 81 percent. Normal is 93, 94 percent. They put her on oxygen, change her antibiotics, and send her home.

Well, what happened? Had we not interceded--I personally as a physician making a call to another physician--she would be dead by now because what she had was a full-blown, raging pneumonia and restrictive lung disease, but she was sent home from the ER because a physician-- not a doctor--a physician did not see her. So consequently she goes back to the ER the same night and is admitted to the hospital. They take a chest x ray, and all of a sudden they see this full-blown pneumonia. She had all the symptoms, but the person seeing her in the ER didn't have the experience to make the judgment. So is that really what we want? We want substandard care, so somebody can go home and die versus coming to the hospital? Today, she is 200 percent better. She is eating. Her pulse ox, now on room air, is 91 percent.

We actually saved her life because a real physician put hands on a patient and made the right diagnosis. But we are going to put people into a system where that doesn't happen because we are going to use physician extenders. That doesn't mean they are bad; they just don't have the same experience, and people die when they don't have the same experience. But we are going to inflate the utilization of less than a physician to care for the vast majority of these people who are going into Medicaid.

These are real examples of what the consequences are of what we have done.

As I started, I said I don't doubt the intent of my colleagues in terms of what they were trying to get to, but the biggest disease Washington has is fixing the wrong problem. We have expanded health care access under this bill, but access doesn't mean you are going to get care. And when you add 18 million people to the Medicaid rolls, let alone what is going to happen to the States, ultimately, with the cost on the maintenance of effort where they have Medicaid now and we are going to go to 133 percent, what you have done is put the States in a pinch, and they are in a pinch already.

So my question to my colleagues is, Where are the things that drive the costs down? Where is the discerning consumerism that allocates scarce resources in the most effective way? In this bill, it is not there. Nowhere is it there.

Now, what is there? What is there is a tremendous amount of new taxes. There is $52 billion over 10 years on employers who fail to comply with the insurance mandate; 40 percent excise tax on high-cost health plans, $32 billion; ban on purchase of over-the-counter drugs from somebody's health savings account, $5 billion; increased Medicare tax on wages of small businesses, nine-tenths of 1 percent; a 3.8- percent surtax on investment income, and that is $210 billion; increase from 7.5 percent to 10 percent of income the threshold after which you can make a medical deduction; $2,500 annual cap on flexible spending account contributions--and I could go through this and through this. The point is, we are increasing spending on health care by $2.6 trillion after this is truly in play. Also, the gimmickry in terms of accounting and the problems associated with that have been discussed on the floor.

One of the things that is there that concerns me as a physician, getting back to talking about patients, is cost comparative effectiveness. It was really cheap to send that 90-year-old person home. There was an ER visit, a little bit of oxygen, a change in antibiotics. That was really cheap. Comparative effectiveness would have said: Oh, that is OK--except she would have been dead in 24 hours.

Every physician who is maintaining their license or their specialty certification studies comparative effectiveness every day. They read it in the journals. They do it to get recertified. They know the comparative effectiveness. What they don't know is that we are going to mandate what they will do, what is the cheapest--not what is the best, what is the cheapest.

Well, I will tell my colleagues, if you look at heart disease in our country, if you look at cancer cure rates in our country, if you look at recovery rates from massively serious illnesses in our country from both trauma and otherwise, what you will see is the highest rate of recovery in the world. We have the highest 5-year survival rate on almost every cancer by 20 or 30 percent over every other system in the world. Do we really want to take that away?

In 2003, I was diagnosed with colon cancer. I had metastatic colon cancer. I am so thankful for the health care system we had that generated new devices, that incentivized great care, and after a major surgery where half of my colon was taken out, radical lymphadenectomy was carried out, and 6 months of chemotherapy, I stand before you today, 7 years after that. I want to tell you, had I been in England or Canada, my cure rate would have been about 35 percent. Do we know what it is in this country for somebody with metastatic colon cancer? It is nearly 70 percent. Now, what created that? What gave us the technology to do that? It is because we looked at the best clinical effectiveness, not the best price. We said: How do we best and most effectively get an outcome of cure?

This bill goes the other way. This bill is going to be a mandate from Washington on what your doctor can do for you, and it is also going to mandate from Washington what price should be paid. There is no question that, according to the trustees for Medicare, for us to maintain what has been put in this bill, Medicare reimbursement rates will fall below Medicaid rates. Do we really want that to happen? I will tell my colleagues, for those in my condition, those people who are diagnosed today with colon cancer, you don't want that to happen.

Now, how do we get the cost down? There is no question that there is tons of waste in our health care system. We have not attacked in the way we should attack--and I can say as a practicing physician that I wasted money caring for people because I didn't concentrate on that individual because that individual wasn't paying the bill. Some nebulous insurance company was paying the bill. Some government program was paying the bill. But when

somebody such as an Amish patient looks you in the face and you know that what you spend of their hard-earned money is going to come directly out of their pocket, all of a sudden the other obligation of a physician jumps up: How do I do this in the most efficient and effective way that still gives the best outcome? And we have totally missed that.

The most personal of all interchanges between humans besides those within a family are between patients and their physicians, and we are going to interrupt that. We are going to undermine it, and we are going to undermine it because somebody from Washington is going to be looking and saying: Did you do it the way we said to do it, Doctor?

Now, what is the doctor's oath? Is it to do what Medicare says or is it to do what is in the best interests of the patient? So that is the rub. That is where we are going with this program. So what we are going to have is, first of all, we are going to have tens of thousands of physicians retire over age 55--our best, most experienced physicians. They are leaving. They are not going to play this game. And then we are going to give physician extenders the role as primary care. They are very good in what their limited knowledge will give them but not anywhere compared to a full 8 years of medical training, including residency. They have 2 years. And then we are going to treat all of these people. What do we think the cost of that is going to be in terms of lost lives, in terms of delayed diagnosis? Delayed care is denied care. What good is it if I have Medicaid and I can't see a doctor?

So the problems are very real with this bill, and I don't say that as a fiscal hawk. I want to fix health care, and I want to drive the costs down. And we can drive the costs down $300 billion or $400 billion a year.

Thomson Reuters did a study. I talked about it in our debate last year. The fact is, we know that over $580 billion a year is blown in health care. That is enough to cut everybody's health care costs 20 percent. But we didn't address any of those issues. Not one of the issues that Thomson Reuters has brought up that said, here is what is wrong, here is why health care is more expensive--we didn't address those in the health care bill that was passed. Yet we wonder why we are out here wanting to change this bill. It is not so we can say: You did it wrong; it is because we really care, as you do, that we have to fix the real problem, and this bill didn't fix the real problem.

So I hope my colleagues will take in the spirit that it is intended-- that we don't believe we have done anything except expand coverage under a very broken system that is highly inefficient, that tells people they are going to have care, but they are not going to have care, and those who have a doctor are going to be told by the Federal Government what care they are going to have. It is exactly the opposite of what we should have done, and we did it in haste.

We know there are 1,600 new sets of rules coming, of which about 100 are through. We have another 1,500 to go.

CBO says that is $100 billion in costs just to implement all this, which was never even considered in the cost of this bill. That doesn't consider the cost of complying with all of the new rules and regulations.

My time is up. I will be back to talk on this again. My hope is that--now we have three physicians in the Senate and we have all seen the same thing. I am a primary care OB, one is an ophthalmologist, and one is an orthopedist. We pretty well have it covered.

What we have done is not going to work. We are going to be sorry we did it. But do you know who will be the most unfortunate receivers? It is the people who think they have care but don't, the people who get seen by less than qualified individuals for the care they need, and we are going to pay twice what it should cost.

I yield the floor.

Mr. President, I wish to add to the comments made by my colleague from Wyoming, who in his former life was a physician, and so he understands this issue probably better than any of us here in the Chamber. I think he very eloquently pointed out why this amendment we are hopefully going to be voting on, which will repeal the health care law, is so important.

Obviously, there is a big debate that has been raging in the country over the past year about this legislation as it was being considered here in the Congress, and I think the one thing that is clear about the public's view of this is that they think it was a bad idea. And that hasn't changed. That was true a year ago, that was true 6 months ago, and that is still true today.

I think the administration had tried to argue they had merely done a poor job of communicating to the American people how great this health care reform idea was. But that excuse misses the point entirely. The American people are not clueless. They know a bad idea when they see one, and they understand that the Democratic health care plan was a bad idea. So despite the administration's full court PR press in trying to reverse the public opinion, the health spending law remains unpopular in the polls.

In fact, as was quoted by my colleague from Wyoming, there was a poll that came out today where 58 percent of likely voters in a recent Rasmussen poll favor repeal. In fact, if you drill down a little further into that survey, it says 47 percent strongly favor repeal, 38 percent oppose repeal, and 29 percent strongly oppose repeal. But you have a decisive majority in this country--58 percent of the population--saying they wish to see this repealed, and nearly half are strongly committed to that position.

So notwithstanding efforts by the administration to reverse the public's view, the American people still get it. I think the administration had hoped this would get behind them, that people would, once they were educated about the benefits, come to a different conclusion, but I think they see clearly now that hasn't happened. That hasn't been the case.

This whole health care law has failed the test of being something the American people think is important and something they want to see done. I don't doubt for a minute they want to see the issue of health care addressed in this country--health care reform. Unfortunately, this particular proposal didn't do anything to reform health care. It expanded health care dramatically and expanded the cost most people are going to bear when it comes to paying for their health insurance premiums. So it failed the test of public support of the people in this country who have been following this debate very carefully, because it affects them in a very personal and profound way. Health care is something every American understands. It is something they get, and it is regrettable we passed it. I think the American people have turned a thumbs down on it, and that should speak to the importance of this amendment and our trying to go back and do this the right way.

The other test it failed--which everybody here talks about, and there is a great deal of lip service and a great deal of rhetoric paid to it--is the issue of jobs. Honestly, I think if there was a message coming out of November's election it was this: The American people want us focused on three things. They want us focused on jobs, they want us focused on spending, and they want us focused on the debt.

On the issue of jobs, this also fails the test. Why? Because it raises taxes so dramatically. If you look at the tax increases in the bill--$569 billion in taxes on virtually every sector of the American economy. For instance, the measure penalizes employers for hiring more workers by raising the Medicare payroll tax by $210 billion, levying new taxes on many small businesses that will serve as the engine of economic growth and job creation.

If we want to get this economy recovering again and creating jobs, the one thing you don't want to do is to impose new mandates, new burdens, new taxes, new regulations on the economic engine, the job creators in America today, and that is our small businesses. So if we are serious about the issue of jobs, this certainly didn't do anything to create jobs.

I think the American people made it plain, and it is clear, they want us focused on jobs. They want us exclusively focused on getting this economy back on track, creating jobs and getting the American people back to work. So it failed on that test.

How about on the test of spending? I think the American people understand that very basic sort of adage--if you want to call it that-- which says when you are in a hole, you don't keep digging. What we have done is we have dramatically expanded the size of government at a time when we are running year-over-year trillion-dollar deficits. So what did this do? When it is fully implemented, it will increase spending by $2.6 trillion. That is the 10-year score between 2014 and 2023. That is a massive expansion--the most dramatic

expansion we have seen in government, literally, since the 1960s.

So this doesn't do anything to address the issue that the American people spoke loudly about, and that is getting Washington spending under control.

Arguably, as I said before, I think they care deeply about the issue of health care and getting health care costs under control. As I will get to in a minute, this does little, if anything, to address health care costs. But it certainly increases Federal spending and increases the role and the size of government at a time when most Americans are saying we want the government reined in. We want less government. We want the government to start living within its means. Instead, we have increased and expanded the size of government dramatically.

How about the issue of debt? A lot has been made by our colleagues on the other side that if we were to repeal this, it is going to add to the deficit. Let's go back to the reason why they can make that argument. The reason they can make that argument is because of all the gimmicks, all the phony accounting that was included when this bill was passed in the first place.

We have all referenced and talked about the double counting of Medicare savings, to the tune of about $400 billion, new payroll taxes, savings that are supposed to be achieved by reductions in Medicare spending double counted, counted both as a ``paid for,'' an offset to pay for the new health care entitlement program, and as a credit to the Medicare trust fund. You cannot double count. You cannot score these things in a way that dips into the same revenues twice. That was one of the great ironies of this legislation, when it was being debated here, that issue did not become more fully discussed, the way this thing was accounted for and the way in which the trust funds were credited with saving or extending the lifespan of Medicare at the same time the same dollars were being used to pay for this new health care entitlement. You cannot spend the same money twice and that is exactly what happened.

The American people get that. I cannot feature any other place in America where you could get away with what happened here during the health care debate. So you had the $400 billion--$398 billion, to be exact--that was double counted on Medicare. You also had $29 billion in Social Security revenues that was double counted as well. The Social Security trust fund was credited with $29 billion at the same time the revenue that was coming in from higher Social Security payroll taxes because some changes that were made in the legislation were counted to pay for the new health care entitlement. So you had Social Security and Medicare payroll taxes that were double counted, that were essentially scored twice, to credit the Social Security trust fund and the Medicare trust fund, at the same time they were being used to finance the new health care entitlement.

Add in the $70 billion that was listed as revenues to pay for this from yet another new entitlement program called the CLASS Act, which is a long-term care entitlement program. As was described by my colleague from Wyoming, even the Senate Budget Committee chairman, the Senator from North Dakota, described the CLASS Act as a Ponzi scheme of the highest order, something Bernie Madoff would be proud of. Yet $70 billion was scored as being a revenue raiser to pay for the new health care entitlement program, knowing that full well, at some point in the future, the people who paid premiums into this new program were going to demand some sort of payment when it came time to stake a claim against that, against that trust fund, those benefits were going to have to be paid out. So in the outyears it dramatically expands and explodes the deficit, even though in the near term it was counted as revenue that was used to shield the true cost of the health care bill.

If you add in the cost of implementation, which turned out to be $115 billion, something that was not discussed nor included in the debate nor was it included in the initial CBO score, you have about a $208 billion cost to do the doctors fix, to take care of the physician fee issue, which will be coming to us, which was left out of this bill to understate the true cost of this bill to put it into balance, my point simply is, by any objective measure, if you look at the games that were played, the gimmicks that were used, the phony accounting that was used to claim that somehow this was going to be a positive impact on the deficit, it does not pass the smell test. No rational American would look at this and say this makes any sense at all.

In fact, if you add up everything I just said, if you take all these accounting gimmicks, all the phony accounting that was used, and you offset that against what is claimed as a budget savings, you actually get not a $143 billion savings, you get about a $700 billion deficit. That is what we would be looking at over the 10 years.

Remember also that you have the 6 years of spending in this bill in the first 10-year window, which is what the CBO used to score this, and about 10 years of revenues. So the tax increases start right away, the revenues are counted immediately, but the spending doesn't come until later. You front-load the revenue, you back-end load the spending in that decade and try to claim that somehow this thing balances out. Again, the American people see through this. They get it, which is why they have taken the position they have on the health care bill in the first place. On the test of debt, on the test of how does this impact the deficit, how does this impact America's long-term fiscal standing, this bill is a failure.

One other point I would like to make--I wanted to come back to it earlier--I think a lot of Americans were hoping that when Congress took on this issue of health care, it actually would be with an eye toward reducing the cost of health care insurance premiums for most Americans. What we are seeing is the contrary. Actually, what we predicted would happen is coming true. Many of us who were involved in that debate said, at the time, this was going to lead to higher health care costs for most Americans, and it is actually true. Actually, the CBO said the same thing. They said the individual health insurance premiums would increase by about $2,100 per family as a result of the new law and that some consumers would face total premium increases of more than 20 percent. Those are things we are seeing come to fruition now. A lot of people are seeing their health insurance premiums go up. That is a fact. It is a reality. It is a complete contradiction of what was promised when this bill was being debated.

You have not only higher taxes on small businesses that are costing us jobs, that are destroying jobs, you have this massive expansion of spending, you have the debt and the deficit which, in the outyears, are going to explode because of all these accounting gimmicks, and then when all is said and done, you still have not done anything that lowers health care costs for most Americans. I believe, for most Americans, that is what they wanted to see come out of the health care debate in the Congress. They wanted to see reforms passed that put downward pressure on health care costs to them and their families rather than increase it. In fact, what we have seen is the opposite. It has not decreased cost; it has increased costs. I think we are going to continue to see costs go up because as these tax increases kick in, a lot of businesses around the country obviously are going to pass these costs on to the American consumer. So it fails the test of doing anything to lower costs for most Americans.

Finally, it is also now failing the legality test, as we are seeing these courts coming out and determining that this whole exercise was unconstitutional. That triggers a whole other debate in this country, a debate that I think we are going to watch probably for a while, but I hope, as this moves through the courts, it does engage the American public about what is the role of the government and how intrusive should it be and what kind of mandates can it impose on the American people. There was a very well-reasoned decision that came out of the Florida court yesterday which says this legislation is unconstitutional. Again, that makes the argument that many of us were making as this was being debated last year.

The bottom line is, we are in a position to do something about it. This is not the end. This should not be the end

of the debate. We should look at this as an opportunity. If the amendment that was offered by the Senator from Kentucky, Mr. McConnell, actually were to pass and we were to repeal this, we could start over. We could go about this in a way that actually does reform health care in this country in a way that lowers costs rather than raises costs for most Americans. I think that would be a welcome thing for the American people.

The other side is going to argue we do not need to do this. We do not need to repeal this. We just need to ``repair'' it. We can make these little modifications to it. But the fundamental fact is, this was a mistake in the first place and we should acknowledge it. I think, again, the fact that it passed last year on a total party-line vote, a total partisan vote--there was not a single Republican in the Senate who voted for this. Usually, when you are doing big, bold things, when you look historically in the country, it is done in a bipartisan way. It is done in a way that incorporates the best thoughts, best ideas, best inputs from both sides, and you generally get a bipartisan vote in support of something such as that. This was passed on a party-line vote. It is now facing a challenge--and I think a very direct challenge--in the courts, which is going to play out in the course of the next several months. But we in the Senate could do something by repealing this law and starting over and going about this the right way. That is not to say for a moment there are not issues that need to be addressed with regard to health care in this country. Many of them have been touched upon by speakers who have come down here before me. But there is a better way to do it. There is a way to do this that does not dramatically expand, increase the size of our Federal Government, that does not add and explode the debt in the outyears, that does not raise taxes on our small businesses when we are asking them to create jobs, that actually does lower the cost of health care insurance for most people in this country rather than increasing it and is done in a way consistent with what our Framers intended, in terms of the basic parameters that are allowed by our Constitution.

I hope the McConnell amendment will be voted on. I think it is important for all of us, obviously, to be on record. But I hope my colleagues on the other side may reconsider the position they took when this was voted last year and conclude with many of us that this was a failure and that starting over is the very best solution for the American people, if we are serious about giving them a health care system in this country that is affordable, that delivers the high quality they expect, and enables them to have the maximum amount of choice and decisionmaking authority when it comes to something that is so personal and so important to them; that is, their health.

I yield the remainder of my time.

Mr. President, I listened to my friend from South Dakota. I was thinking about how long we have been debating health care reform. If we were to repeal the bill we enacted last year, how long would it be before we would be able to get back to serious health care changes?

It took us 1 year to debate and pass the bill that was ultimately signed by the President, but it took us 30 years to get to this subject and several administrations, both Democratic and Republican, that offered proposals where we could bring down the cost of health care and make it more available to the people of this country.

We brag, and rightly so, that we have the highest quality, most technologically advanced health care in the world in the United States. I look at my own State of Maryland, and I know people come from all over the world to get their health care needs met and get their doctors trained, whether it is at Johns Hopkins University or the University of Maryland Medical Center or what is happening at NIH. I know the Presiding Officer can tell us about the great institutions in the State of Pennsylvania, and that is true.

The problem is, it is out of the reach for too many Americans. It is too expensive. We don't have access to care in too many communities in America. The Congress last year did something about that. We took major steps forward to help the people of our Nation.

I have gotten hundreds of letters and phone calls from people in Maryland who told me their stories about fighting health insurance companies or their stories about trying to get access to preventive health care and how they were denied under our current system. I have talked to seniors in Maryland. I know how expensive health care is to them.

Seniors are very fortunate in that they have Medicare. But seniors, as an age group, have the highest out-of-pocket costs of any group of Americans. There are too many gaps in the system. We have to improve the system.

The problem I have with the amendment of Senator McConnell is, if we repeal what we did last year, we have to understand what consequences that will mean. We are not sure when Congress will be able to deal with this subject again. It might be 30 years from now. If we just repeal the bill, as suggested by Senator McConnell, the consequences of that action will be very damaging to the seniors in Maryland and around the Nation.

Let me tell you why. The bill we enacted last year started to deal with the gap in coverage for prescription drugs. Seniors last year received $250. This gap--after you spend a couple thousand dollars on prescription medicines, you then have to pay 100 percent of the costs of your prescription medicines under current law, until you spend another couple thousand. For many seniors, they cannot afford that. That means doing without prescriptions, cutting pills in half, compromising their own health care.

I have received many letters from seniors in Maryland telling me: I had to leave a prescription on the counter because I couldn't afford it and I have Medicare and I have coverage under Medicare D, but I could not afford it because I fell within the coverage gap. Do something about it.

It is not fair. Taking medicine to keep me healthier--I should be able to get that coverage here in the wealthiest Nation in the world. We did something about it last year, and repeal would eliminate that protection. We are going to close totally that coverage gap, that so- called doughnut hole. This year, the benefits are going to be worth about $500 to seniors who fall within that coverage gap. That would be lost if the McConnell amendment were adopted and became law. We can't let that happen. Next year, it will even be a better benefit because it gets up to about $2,400. That would be lost if we were to repeal the legislation.

It goes beyond that. We are now providing a wellness exam every year to seniors. They will be able to get covered for their preventive health care. They don't have that today. We expand their benefits. We guarantee their benefits will be provided, but we go beyond that. We eliminate a lot of the copayments on preventive health care. We make the program stronger, increasing the benefits for seniors.

At the same time, we do something which is extremely important: We make the program safer for tomorrow. We extend the solvency of the Medicare trust fund for a decade. That is what we did last year.

If we repeal the bill, if the McConnell amendment becomes law, the Medicare system will be on much weaker ground, making it much more vulnerable to the types of attacks some of my Republican colleagues have been talking about, much more likely that would become a reality. That is what this bill means for the seniors of Maryland and the seniors of West Virginia and the seniors of Pennsylvania.

That is what we did. We strengthened the program. That would be lost if the McConnell amendment were to become law.

It goes beyond seniors. It goes to all families. I can't tell my colleagues how many families I have run into who have said to me: Senator Cardin, we want to cover our children, but under the old law, once they became 21 or 22, they lost coverage, even though they still needed insurance coverage.

We changed that to the age of 26. Under this law, one is allowed to be on their parents' policy until age 26. That is the law of the land right now. The McConnell amendment will repeal that. It will tell these young people who perhaps have graduated from college, who may be in their first job but

they don't have insurance available, that they will not have an affordable option for health coverage. They can't be on their parents' policy. Do we want to do that? That doesn't help American families. That moves us in the wrong direction.

We have told the private insurance marketplace that your premium that you pay, whether you do it through work and your employer and your own contributions or the premium you pay, that most of that premium should go for health benefits. It should not go for bonuses for insurance company executives. It should not go for nonmedical expenses. Most of it should go for benefits. The bill we passed last year says that now 80 to 85 percent of the premium you pay for your health insurance must go for benefits. If it doesn't, you will get a rebate. The money will actually come back to you in your pocket. That is taking on the private insurance companies, telling them they have to work within at least acceptable ranges. That is going to provide real benefits, improved coverage for the people. If the McConnell amendment were to become law, that would be lost. We would be at the mercy of private insurance companies.

How many constituents have we heard from who have told us examples of insurance companies using preexisting conditions to block their coverage? I could tell you about a family in Montgomery County. A husband and wife with two children had to take out two insurance policies because the insurance company said that one of their children had a preexisting condition. They had to take out two insurance plans, paying two premiums and two deductibles. That is outrageous. We have done away with preexisting conditions for children.

We are going to do away with preexisting conditions for all Americans, as we should. You buy insurance to protect you. I was surprised to learn how many Americans, if they try to buy insurance today without government protection, would run into an insurance company that tells them they have a preexisting condition. If you have high blood pressure, even if it is under control--preexisting condition. God forbid you should need to see a cardiologist--not covered. If you have high cholesterol, take a pill, it is under control. You think you are in good shape. Your cholesterol numbers are still good. Not for the insurance company; that has been considered a preexisting condition. If you are a victim of domestic violence, that is considered a preexisting condition. Quite frankly, some insurance companies consider women to be a preexisting condition, the way they write their policies. We do away with that. If the McConnell amendment were to become law, all that protection is gone.

If you think we will be able to pass it again quickly in this Congress, come down here and watch the way Congress works. Thirty years it took us to bring this bill up and get it passed. These are protections that are critically important to families. We need to make sure these are protected.

Caps. You buy an insurance plan and find out you have annual caps and lifetime caps which you thought you were buying protection against in a catastrophe. It is not there. We have done away with the caps to protect American families. That would be gone if the McConnell amendment were to become law.

I have heard a lot of discussion about small businesses. One of the reasons I worked so hard for passage of the Affordable Care Act is to help small businesses. They are discriminated against. It costs a small business owner more for the same coverage for its employees than a large company. On average, it is about 20 percent higher for smaller companies to insure their employees. That is just wrong. We take steps to correct that immediately by giving small businesses a credit. We help them by making it more affordable for them to cover their employees.

I heard my colleagues complain that premiums are going up. Yes, they are, because of the current system, the one we have changed or are in the process of changing. It is going to take some time for us to get full implementation of that law. That is understandable. It is wrong. I wish we could do more to bring it down quicker. But for this bill the premiums would be even higher. We know that.

This bill helps us to start to get a handle on helping small businesses have affordable coverage for their employees. Once again, if the McConnell amendment were adopted and became law, that protection, that help for small businesses would be lost.

Let me talk about taxpayers for a moment. There is a lot of discussion on both sides of the aisle--and I hope we are able to reach agreement--about bringing down the deficit. We need to do that for the sake of our economy and for our children and grandchildren. It is wrong for us to pass on our debt to future generations. We need to be serious about deficit reduction. I hope we do come up with a game plan in order to bring that about, but you don't do that by repealing the health reform bill.

Our own Congressional Budget Office, our independent evaluators, tells us that repealing this bill will add about $1.5 trillion to the national deficit over the next 20 years. I know people who are listening to me may not believe what I say. I understand that. I understand there has been a lot of misinformation given out. My colleagues on both sides of the aisle have tried to oversell this.

The Congressional Budget Office is our independent evaluator.

I remember when Senator Rockefeller was working on this bill, and we thought we had a pretty good understanding on how to bring the bill out. But, unfortunately, the CBO said: We can't give you all the savings you think you are going to get by keeping people healthy. Senator Rockefeller and the Finance Committee had to go back and find some additional savings in order to meet the CBO's requirement so that we made sure we didn't add to the deficit. In fact, we reduced the deficit with this bill.

So what do my colleagues in the House do? They say the CBO doesn't mean anything. If we do that with every bill we pass here, we will never attack the deficit. We have to have objective rules for evaluating what we do and its impact on the deficit.

One thing is clear by the objective scorekeepers: The McConnell amendment will add $1.5 trillion to the national debt because of what we were able to do in the Affordable Care Act.

We could argue this from many different sides. I am always amazed that my friends on the other side of the aisle say this is what the American people want us to do. I have looked at the polls. They go back and forth. Americans are divided on this issue, but most Americans want us to move forward. They want us to deal with job creation and job growth.

The bill my friend from West Virginia has brought forward, the FAA bill, is a very important bill for the American people. It is going to make our air traffic safer, but it will also create more jobs in communities--the exact type of bill we should be bringing forward. We should be working today to create more jobs and keep more jobs. That is what this underlying bill does, not the McConnell amendment. That won't help us create jobs. That will add to the deficit and make it more difficult for Americans to keep and get affordable health care. That is not what we should be doing.

I invite my Republican friends, we should be working together on this bill. We should be looking at ways to improve health care. We never said, when we completed our work last year, that we know there is no more work to be done. We know there are ways we can improve health care. Let's work today to do that, but let's not go backward. Let's move forward for the American people. Let's create the jobs we need for our economy. Let's continue to make health care accessible to more and more Americans and affordable to more and more Americans. Let's provide the quality of care that is befitting of this great Nation to all of our citizens.

In my State of Maryland, we have a person whom we will never forget-- Diamante Driver, a 12-year-old who lived in Prince George's County. In the wealthiest Nation in the world, in 2007, he needed to see a dentist but had no health insurance. So his mom tried to get him to a dentist. No dentist would treat him because he had no money. So he went to a social worker. His mom took him there. They made a lot of calls. No one would treat him. His condition got worse. He went to an emergency room, which is what happens

with a lot of people who have no health insurance. Talk about saving money. One of the ways we save money under the Affordable Care Act is to bring people out of the emergency rooms and into our clinics and get them the health care they need. Diamante Driver went to an emergency room months after he should have seen the dentist. Because his tooth had become abscessed and had gone into his brain, he had severe headaches. He went to the emergency room because of his headaches. They found that the only way they had a chance to save his life was through emergency surgery.

Two surgeries later, $\1/4\ million spent, where it would have cost $80 to take care of his need, Diamante Driver lost his life in 2007 in the wealthiest Nation in the world.

I understand that health care is personal to every person. Everyone looks at how they are going to be taken care of in this health care bill. That is what they should do. We think the overwhelming majority of Americans benefit by the bill we passed last year. But I would hope every American wants to make sure we have no more Diamante Drivers, that every person has access to affordable quality care. That was the signature accomplishment in the last Congress. We did it in a way that helped seniors, that helped families, that helped small businesses, that helped taxpayers and helped America to become at long last a Nation that said health care is a right, not a privilege. All that is lost if the McConnell amendment were to become law.

I urge my colleagues to think before they vote on this amendment as to whether they want to be on the right side of an issue that has helped define the Nation. I urge my colleagues to reject the McConnell amendment.

I yield the floor.

Mr. President, I have an amendment at the desk, amendment No. 9, and I ask for its immediate consideration.

I ask unanimous consent that the reading of the amendment be dispensed with.

Mr. President, first, I want to congratulate Senator Rockefeller and Senator Hutchison for their leadership in putting together what is such an important bill for 280,000 jobs that are saved or created as a result of this bill, and focusing on our ability to out-innovate and out-build in a global economy. We can't do that without a 21st century FAA system--airports, air traffic control, and so on. So I join with Senator Hutchison in hoping that--and I am sure it will be true--at the end of the day we will have a strong bipartisan vote, because they are moving forward in the spirit in which we have all come together in saying we want to move forward; that is, working hard and focusing on jobs. That is what the American people want us to do, focus on jobs, and find common ground, working across the aisle. That is evident from this bill.

I am very appreciative of the fact they are focusing, and I want to thank our leader for making sure that the first bill we are bringing up is about jobs. We understand that too many families--certainly in my State--are still looking for work. They have worked hard all their lives, and they never thought in a million years they would find themselves in the situation they are now facing. They want us to be laser-focused on jobs and the economy and outcompeting in the global economy, as the President said. This bill is exactly the kind of policy on which we should be focused. What is concerning to me is that while we are doing that, we are now going to have a debate that is very divisive, really looking backward rather than looking forward.

One of the things the President talked about--again, which I agree with strongly--is that in the area of health care, what we passed last year, we know there are measures we can fix to make our system more competitive, to make it better for families, to put families back in control rather than insurance companies. We know we can make it better. Certainly no one has been more of a champion than our leader on this legislation, now the chairman of the Commerce Committee but one of the leaders, the No. 2 on the Finance Committee, who brought his passion to the issue of health care as well. We know this can be fixed, and we want to work together to make it better but not fight old fights, create old political fights and division, and certainly not roll back the clock where we put all the control in the insurance companies and we see our families losing the freedom and security to make sure their children, their families have the health care they need.

Let me first talk about my amendment and then why I believe we should be focused on this kind of amendment to fix the bill that passed last year, the new law, to make it better rather than rolling the clock back. Certainly we have heard now, if you follow the polls, that four out of five Americans are saying: Don't go back and just repeal what was done; fix it. So the majority of people are not supporting going back to old political fights or going back, frankly, to a system that is an uncontrolled system where insurances companies can raise rates 20, 30, 40 percent

every year without some plan, some focus to be able to lower costs, to be able to get people out of emergency rooms and into the doctors' offices, and, frankly, for people who have insurance not to be placed into a situation where they continually see their rates go up to pay for people who do not, which is what we have put in place.

There is a provision that has been a concern of mine and many others. We have debated it on the floor. We have attempted to get it fixed several different times. I hope today, I hope tomorrow--whenever we vote--that we will actually be able to get this fixed. This has been supported on both sides of the aisle, and it deals with eliminating redtape and burdensome IRS reporting requirements for our businesses, particularly small businesses.

We are particularly concerned about what this means for small businesses. The provision that was placed into the bill that now, as we look at how the IRS would implement it, is clearly too burdensome--my amendment would repeal that. It would allow business owners to spend their time growing their companies and creating jobs instead of filling out paperwork from the IRS. We want them creating jobs. It is a commonsense solution to an issue that has come up. Basically, it would make sure that the provision that would require a 1099 form for every vendor when a company has a purchase of $600 or more for goods would no longer be in place. This is a provision that actually does not take effect until next year, but we want to send a very clear message to businesses that have expressed great concern about this, about what is coming for them at the end of the year. We want to let them know that we will not continue the new provision. We would allow small businesses that already create 64 percent of the jobs to be able to keep creating those jobs, and we would make sure we are not putting in place additional paperwork for them.

It is important to note that, according to the IRS, the provision we want to repeal if left unchecked would impact about 40 million American businesses and 26 million of them are sole proprietorships--our smallest businesses. They would be overwhelmed with the paperwork that is involved. It does not make any sense.

We passed a great small business jobs bill last fall that created eight different tax cuts and focused on making capital loans more available for small businesses. We don't want to now go in the other direction and see a mountain of paperwork added to the small businesses we have been very committed to fighting for and supporting. Unfortunately, if this provision were allowed to stand, it would require a 2000-percent increase in 1099 filings. Frankly, that does not make sense.

This particular provision would repeal what was placed into the new health care law. We pay for the repeal by cutting $44 billion in unobligated spending. We do make it clear that certainly this does not affect Medicare or Social Security benefits in any way. I would not support that. I know colleagues on the floor would not as well. It makes it clear that the Departments of Defense and Veterans Affairs and the Social Security Administration are not included. But it would give the Office of Management and Budget the ability to look at the possibility in areas for cuts, and they would then report back to us in 60 days after enactment--to the Secretary of Treasury and the Congress--concerning the amounts and the accounts they would be using in order to cut back, in order to save this particular provision.

This is an area where we can come together, where Democrats and Republicans--both sides of the aisle--who care passionately about small businesses can come together and eliminate redtape and burdensome IRS reporting provisions. We would get that off the table and make it clear to small businesses that there is no intent or actuality that this is going to happen. We can do that together.

But what we should not be doing is what the next amendment, the Republican leader's amendment, would do because his amendment would take us back to the time of uncontrolled insurance company increases, of no accountability, and it would put the control of health care coverage and costs back in the hands of insurance companies. What I support and what the new law allows is the freedom and security for families to make sure they can get the medical care they need when they need it.

I have two beautiful grandchildren, a granddaughter age 3 and a grandson age 1, and they are the most beautiful children in the world, just for the record. I want my son and daughter-in-law picking up the phone and calling the doctor when they get sick, not fighting with the insurance company. If this is repealed, they go back to fighting with the insurance company. I want to ensure that my children, as well as my grandchildren, my mom, everyone else in my family, as well as everyone in Michigan and the country, is getting the medical care they need, not fighting with the insurance companies, not worrying that because their child has juvenile diabetes or leukemia or some other disease or condition, the insurance company is going to say: Tough luck, we are not going to cover your child even though your child needs care or you suddenly get sick and they say: You know, there is some fine print over here, and we know you are sick, but we are going to cancel your coverage or we have 10 treatments we will provide even though the doctor says you need 20.

Right now, because of what we have done in the Patients' Bill of Rights that was put into place, we put those decisions in the hands of families and doctors instead of insurance companies. I certainly am not going to vote to taking it back to putting it in the hands of insurance companies.

Frankly, I have had many families approach me to say ``thank you'' who now have the ability, the freedom, the security to put their child--this 22-, 23-, 25-year-old--on their insurance. They get that first job, and it doesn't have health insurance, but they can go out, get started, and know they have the peace of mind that they have health insurance. That would be taken away under what the Republican leader is proposing. We would see young people going back to no insurance as a result of that.

Right now, we have seniors who know they are going to have their freedom and security to be able to get the cancer screening they need, the wellness visits, even if they do not have the out-of-pocket--the copay and deductible they were used to being charged in the past because there is no co-pay and deductible now. They will be able to get what they need in preventive care.

They will have the peace of mind, the security to know that if they use a lot of medicine and they fall in a gap in coverage, the cost in that gap is going to be cut in half for any brand-named drugs--cut in half. What does that do? It means my mom, who is 84, has the security to know that her great-grandchildren are going to have her around longer--a lot longer, I hope--because she is going to be able to play with those kids. Every older person is going to know they have a better chance to be around for their grandkids because they are going to be able to afford the medicine that will help them get healthy. That is taken away with the Republican leader's amendment, the freedom and security for seniors to know they can stay healthy, they can stay in their homes, they can have the medicine they need or the doctors' visits they need to be able to stay healthy and live a long, healthier life. That is taken away.

There will be the freedom and security for women to know that we are not going to pay twice as much as men for insurance--which, by the way, in the majority of policies prior to passing this legislation, if women went out to buy an insurance policy, in over half the policies, women paid as much as twice as much. We changed that.

We have also said that things such as maternity care ought to be a basic part of a health insurance policy. Maybe we will not be 39th in the world in the number of babies who live through the first year in their lives if moms are able to get the prenatal care they need and babies are able to get it through the first year of their lives. This gives women the freedom and security of knowing they are going to get what they need to have healthy babies. Isn't that what we all want? That is taken away with the amendment of the Republican leader.

Among many other things, I will just mention two others. For the first time, we are putting accountability on the

insurance industry--again, our chairman of the Commerce Committee led this effort and the Finance Committee--to say that you know that if you pay a hard-earned dollar out of your pocket for health insurance, and it is tough and the rates are high--and unfortunately, until we get this implemented, they keep going up, they keep having it go up until they have to stop--the majority of that is going to go for medical care. So, depending upon the size of your policy, either 80 or 85 percent that you pay out has to go into medical care, not executive compensation or bureaucracy but medical care. What does that mean? It means it will limit the rate increases over time and put more accountability on the company. The amendment of the Republican leader rolls that back. We have companies now that spend 60 percent of every dollar you give on medical care or 70 percent. This would say that 80 or 85 percent, the majority of your hard-earned dollars--they are hard to come by in this economy--if it is for health care, then it should be used on health care. That is what is repealed in this--accountability on insurance companies.

Finally, what is also repealed is a major focus in this bill on supporting small businesses to be able to get a better deal on health insurance, and this takes away the freedom and security for a small business to get the leverage they need, like a big business, to get a better deal on rates. This was something that took effect. If we were going to change something, I wish we could speed that up. That needs to be faster, in my judgment, and not having to wait for the next 3 years because we have all kinds of small businesses that are going to be able to band together and be able to get a better rate like a big business through competition in the marketplace--not government control, private sector competition.

I had an opportunity to talk to a gentleman who runs a program for our automakers and other manufacturers for retirees. It is a health exchange, exactly like we passed in the new law. He said to me: I don't think, Senator, even you guys realize how good it is, in terms of what we have done in creating a marketplace and bringing rates down.

He said: We bring rates down about 30 percent for the auto companies, for retirees, about 30 percent, because of competition in this bill, leveraged for small businesses, and tax cuts to help small businesses pay for it in the new law, taken away by the McConnell amendment.

I hope in the spirit of the underlying bill, which is a great jobs bill, a great bill for innovation--it is about rebuilding our infrastructure; it is about competing in a global economy; it is about being the best we can be--I would hope in the spirit of the FAA bill, we would not succumb to this backward, divisive, political debate on repeal. If we want to join on something on health care, I strongly urge a 100-percent vote on eliminating the burdensome provision for small businesses, eliminate the redtape, eliminate this IRS provision on 1099. Let's do something together that both sides agree should be done. Let's fix the things that need to be fixed, but let's not roll back the clock and put insurance companies in charge of everything, every medical decision, every rate increase as they were in the past.

I urge adoption of the Stabenow amendment.

We will have a number of colleagues in the process of joining. I don't have a whole list. We have a number of colleagues who will be cosponsors. I thank Senator Baucus for his leadership, his ongoing leadership on this amendment as well. I urge adoption of this amendment to fix what we know needs to be fixed, and then let us go on to jobs.