Commonsense Medicare SGR Repeal and Beneficiary Access Improvement Act of 2014

Mr. President, as the new chairman of the Senate Finance Committee--16 working days on the job--it is humbling to be parachuted late into the issue of reimbursing doctors for Medicare services, and I intend to be brief here at the outset of this debate.

All sides agree that the current system for paying doctors, known as the SGR, does not work well for seniors, the many gifted physicians who serve them, or taxpayers. Devised in 1997, the SGR sets an annual cost target for Medicare physician payments, and it is honored more in the breach than in the observance. When the SGR is not met, the Congress says that is OK, we will just apply a patch and we will punt. Patch it up and let that SGR limp along, just as it has year after year after year.

Mr. President and colleagues, there have now been 16 of these patches--16--and every Senator who I talk to says that just defies common sense and it seems bizarre even by Beltway standards. The cost of the patches now resembles the cost of the full repeal.

To his great credit, the majority leader, Senator Reid, has repeatedly said his first choice for dealing with this issue is to finally repeal the SGR. Now is the ideal time for repealing SGR. The cost of full repeal is far less than anticipated. Thoughtful, bipartisan work has been done in the House and the Senate on repeal and replace, and leading advocates for seniors and their doctors want to replace the status quo with real reform.

So as an alternative to the flawed status quo--an SGR patch No. 17-- this afternoon I will make two unanimous consent requests so that the Senate is allowed to have a choice; specifically, a vote on a proposal to permanently repeal and replace the SGR and also to fund the health care extenders.

I will wrap up by briefly describing this proposal. Its essence is to close two chapters of Federal budget fiction. Since the SGR is just pretending that Congress will hold the line on Medicare spending, I believe it is time to end this fiction and wipe SGR off the books. And for balance, I am going to propose ending another piece of budget fiction, specifically the Overseas Contingency Operations, known as OCO, and the spending on wars that are winding down. This too is fiction.

As former Republican Senator Jon Kyl said--a conservative by anybody's calculation--during a previous SGR debate, let's use war savings for one last time to wipe out the debt Congress has built up by overriding reductions in payments to doctors, and from that point on war savings would only be used for defense.

So there you have my proposal: truth in budgeting all around. Wipe the slate clean on Medicare so you can support seniors and their doctors and move forward with real reforms along the bipartisan lines the House and Senate have already agreed to.

I would add that if Congress took the action I just proposed, it could go farther and address the health extenders. Unlike the SGR, these are real programs helping, for example, vulnerable low-income seniors, rural communities, and seniors who need a variety of therapies. Each one of those has strong bipartisan support.

This, too, could be addressed in a fiscally responsible manner. A big chunk of the cost of 10 years' worth of these extenders could be addressed with the savings of the 1-year patch.

So here is my closing: A lot of good work has gone into a bipartisan, bicameral reform plan that finally repeals and replaces the SGR. I would just say to my colleagues, doesn't that deserve a vote? If my unanimous consent request is accepted, we would have that vote.

At this time, Mr. President, I ask unanimous consent that notwithstanding the previous order with respect to H.R. 4302, following disposition of the Owens nomination, when the Senate resumes legislative session, the Senate proceed to the consideration of Calendar No. 336, S. 2157; that following the reporting of the bill, the bill be read a third time and the Senate proceed to vote on passage of the bill with no intervening action or debate; and that upon disposition of the bill, the Senate resume consideration of H.R. 4302, as provided under the previous order.

I object, Mr. President.

Mr. President, before my friend from Alabama leaves the floor--just to highlight where we are--I think he knows how strongly I feel about always trying to tackle these issues in a bipartisan fashion. I would just assure the Senator from Alabama, the reason we took as our underlying repeal-and-replace bill the good work that was done by Senator Hatch and Chairman Camp and Chairman Upton is I felt that extended the olive branch in trying to bring the parties together. I intend to do that consistently on the Finance Committee--pretty much just

the way I did when I supported George W. Bush on Part D of Medicare.

The challenge, of course, here is that this would be the 51st attempt to essentially try to make changes in the ACA that would end up particularly shifting costs to so many vulnerable people.

It seems to me, particularly today as we have thousands and thousands of people still trying to sign up--I noticed the Wall Street Journal, Saturday, stated that the CBO said the original target for the Affordable Care Act had been met. I think it would be particularly unfortunate to go forward with what would be the 51st effort to try the same kind of approach that particularly would cause so much cost shifting in American health care onto the books of a lot of folks who are already walking an economic tightrope.

I know a number of my colleagues want to speak. As the manager of the time, it is my intention to try to alternate with colleagues of various points of view with respect to this issue. I am sure that will be done as well on the other side.

I note my friend from Virginia on the floor. He is going to be the new chairman of the Senate Finance Subcommittee on Fiscal Responsibility. I think he brings extraordinarily important credentials to this job. His support of the kind of approach I have advocated this afternoon highlights that this will have support in both political parties from Members who have strong credentials in terms of promoting fiscal responsibility.

I would yield to him and look forward to my colleague's remarks.

Mr. President, before he yields the floor, through the Chair, I would pose a question to the distinguished Senator from Virginia.

The Senator from Virginia has, as usual, gotten right to the heart of the long-term challenge with respect to entitlements. I have always tried to describe it as the challenge of protecting the Medicare guarantee because what seniors have is a guarantee. It is not something that is up for grabs. It is a guarantee. It is inviolate. Protecting their guarantee means that in the days ahead we are going to have to figure out new ways to hold down costs.

What I have heard the Senator from Virginia talk about very eloquently is one of the key ways to do that is what the Senator from Virginia and I have sought to do, which is to start having Medicare-- start having Medicare pay for value rather than just staying with this volume-driven fee-for-service system, which largely rewards inefficiency. I think it is my sense that the Senator from Virginia believes it is very hard to start the kind of real entitlement reform we need, where we protect the Medicare guarantee and hold down costs, unless we make the kind of approach we are advocating in this repeal- and-replace strategy with SGR.

We better get to it, because until we have those changes, we cannot begin to get on with another area that the Senator from Virginia feels very strongly about; that is, chronic diseases--diabetes, cancer, heart disease, and stroke--which consume more than 80 percent of the Medicare budget. By my calculation we cannot get on that or any of the structural entitlement challenges until we do what the Senator from Virginia is talking about: Is that pretty much the way the Senator from Virginia sees it?

Before he leaves the floor, I want to say to the Senator from Oklahoma, who says--and always with a smile--that he and I certainly don't agree on everything in this debate, that the concept of what he is talking about--that physicians spend time with their patients--is certainly a concept that ought to be incorporated into how we proceed in the days ahead.

The other aspect of this that people ought to focus on, with respect to what the Senator from Oklahoma is talking about, is that time that the physician spends with the patient in the office presents a pretty good chance that some of those discussions they have there in the office are going to help keep that patient out of the hospital, and all sides ought to see that as a constructive goal.

So I want my colleague from Oklahoma to know that in the discussions he and I have had--and I appreciated the way my colleague said with a smile we don't agree on everything--the concept he is talking about with respect to doctors and time in the office--is something that ought to be incorporated into this, and it is my intention to work with my colleague on that.

Mr. President, I want to pick up on another aspect of what both

the Senator from Virginia and the Senator from Oklahoma have talked about, and that is that at this rate we have to be concerned that after patch 17 there will be patch 18, and after 18 there will be patch 19. I am sure there are some young people up in the galleries who are light years away from Medicare. In fact, the distinguished Presiding Officer of the Senate is a number of years away from the program, and I don't want to see him looking at patch 30 or 31 or 32. But the reality is if all we do is to take what we have and extend it, we are not going to turn this situation around.

My colleague from Virginia and I started talking about one of the key concepts in our repeal and replace strategy, and that is making sure we have a hard date--really, for the first time--to start paying for value in health care. Repeal and replace has that hard date. This is long, long overdo. Until then, in much of our country, we will still have volume-driven, fee-for-service medicine still driving health care in those communities from one end of the country to another.

I heard one observer say what they hoped for is that somebody in Washington would take a machete to fee-for-service. At a minimum, we ought to do what repeal and replace does, which is to reward for the first time quality, and ensure the message goes out to every corner of the country. I have heard the distinguished Presiding Officer of the Senate say with respect to his important health care reform efforts that instead of just paying for volume, we should actually pay for results, and results mean patients have a higher quality of life. What we know, in many instances, is that kind of care also costs less because we don't have people sicker and needing more expensive services and possibly institutional care.

So now, while I wait for additional colleagues to come and speak, I want to take a few minutes to describe some of the other opportunities we are missing out on by not going forward with full repeal and replace, as I and Senator Warner and others would like to see.

In particular, it is very clear that Medicare in 2014 is remarkably different than Medicare back when it began in 1965. Medicare in 2014 is now dominated by chronic disease. Cancer, diabetes, heart disease, and stroke is more than 80 percent of the Medicare spent. I believe we have some opportunities for some very important breakthroughs.

The Senator from Georgia, Mr. Isakson, has joined me in a bipartisan bill here--the Better Care, Lower Cost Act. It is bipartisan in the other body with Congressman Peter Welch and Congressman Erik Paulsen. That would give both parties an opportunity for the first time to provide the real financial incentives for the long term to reward the kind of coordinated care we are not getting in this country for seniors.

For many seniors, after the free physical they now get under Medicare, their care is so fragmented, so poorly coordinated that until they land in a hospital emergency room, perhaps with a $1,100 deductible and can't figure out all the doctors they have seen during their odyssey through chronic care treatment, we have virtually no system that responsibly manages and is accountable for that senior's care.

In repeal and replace, we take the first steps toward building a chronic care policy for our country. We take the chronic special needs plans--what are called the CSNPs--that haven't worked out as hoped and initiate reforms for those particular plans to ensure that all of the individuals who are part of that program would, for the first time, have an individual care plan. That is something many seniors--certainly a majority of seniors--lack, particularly if they are part of traditional fee-for-service medicine. They don't have an individual care plan. They might have two or more kinds of chronic conditions.

A senior might think they can manage their own medicines and manage their own nutrition, but there would be an alternative. That would be what Senator Isakson and I have talked about for the long term and what we would begin with in a true repeal and replace program for SGR. With SGR, we would start finally looking at those chronic care patients in a way that ensured they got coordinated care from the first time they saw a physician, who, under our approach for the long term, would have a pharmacist and a physician assistant and maybe a nurse. They would be able to have one person accountable for their care.

The irony is that all over the country there are programs that are now doing this and reaping dramatic savings. For example, in rural Pennsylvania there is a particularly promising program where the savings have exceeded more than 20 percent on some of the sickest patients with the kind of approach that Senator Isakson and I are advocating for the long term, and which we would at least begin with these chronic special needs patients under full repeal and replace of the SGR.

Now, I want to close with one other point before I yield the floor to colleagues. The full repeal and replace of Medicare would also contain an idea that Senator Grassley and I have worked on for over 3 years, which is to open the Medicare database. The Medicare database is really a treasure trove of the most useful information about Medicare claims and payments around this country. It holds the record of all payments from taxpayers to physicians and other providers for seniors' health care.

Right now, access to this Medicare database is very limited. If the public or seniors or others want to get access to this information, they have to wade through the bureaucracy, and there are simply very substantial obstacles. We know this kind of information can often produce better quality for lower prices because providers who do well when that information gets out will see they are rewarded for their work, and those that are not measuring up to those standards will either have to change their practices or simply find it hard to keep their doors open. The markets work best when information is transparent for all parties.

Today, most patients lack any comparative information and usually don't find out the cost of their care until after the fact, if at all. So Senator Grassley and I have proposed there be a free and searchable database, one that would allow seniors to find and choose doctors and other health care professionals enrolled in the Medicare program, adding the actual services that are performed and what price Medicare pays for those services.

Americans would finally be able to compare what Medicare pays for particular services in different parts of the country. Opening the Medicare claims database in this way would help us hold down health care costs, would also improve the quality of Medicare services, be a tool in fighting fraud, and would be useful in helping individuals with private health plans--private plans, HSAs and employer-based insurance.

What is going to happen there is, if you have an employer plan in Hartford, CT, or an HSA in Connecticut, the first thing you are going to say is, this is what Medicare pays for a particular service; why can't I, with my employer plan or my HSA have the same price? If I am not getting it, that probably means I am getting less pay, and I would rather see health care costs held down so I could get more in my paycheck.

So opening the record--from a quality standpoint--of Medicare-paid services would be a very powerful tool for measuring hospital and doctor performance. The claims data, with full protection of patient privacy, would open how doctors and hospitals are treating patients. It would also provide a full accounting of areas which lack access to doctors, specialists, treatment, and procedures. Making this information readily available would also allow doctors to collaborate on improved care management, and make sure the highest quality services are delivered to patients at lower costs.

Finally, the transparency we would get from the efforts Senator Grassley and I have teamed up on, which was part of the full repeal- and-replace strategy, would help us have a powerful new tool against fraud and waste.

We look at the Medicare Program. The Wall Street Journal and the Center for Public Integrity have been able to, even with limited access to Medicare claims data, look at that information and expose through a series of articles how doctors and medical practitioners game Medicare to increase their profits. If we made the system

more transparent, as Senator Grassley and I have sought to do and is in the full repeal-and-replace proposal, we would have a significant new tool to root out those--and they are a relatively small number, fortunately--who truly fleece seniors and taxpayers and allow us to get more value for the Medicare dollars.

In 2012 the Medicare Program cost about $580 billion. In a few years, given the demographics and technology, this bill is going to go over $1 trillion.

Often when I go to a high school and meet with young people--as I am sure does the distinguished Presiding Officer--16-, 17-, and 18-year- olds, we talk about matters which concern them, student scholarships, parks, transportation. Toward the end of the meeting I often say: So you all are 16, 17, and 18. My guess is, given your age, you probably tweet your friends when you get up in the morning about Medicare.

These students smile: Well, there is another person from Washington, DC, who doesn't get it.

I kid with them a little bit. Finally, I say: I just want you to know I am kidding, but not really. Because if we don't figure out how to protect the Medicare guarantee and hold down the costs for all you students who care about scholarships and parks and roads and the like, guess what. There is not going to be any money for the concerns which are first and foremost to you.

At this point, of course, the students jump right in, and they want to know about preventive medicine and how to root out waste and some of the things we are talking about. But we can't get to a lot of those important Medicare reform issues which Senator Warner articulated so well when he began his remarks if we can't get full repeal-and-replace of the badly flawed Medicare SGR Program.

I have spent a few minutes talking about how Senator Isakson has an approach which is bipartisan in both the Senate and the House on how to deal with chronic disease; I have talked about opening the Medicare database which is in full Medicare repeal and replace; I have talked about some broad reforms. Of course, at the center is paying for value, which is in full repeal and replace starting in 2018, and we may not get for a while if the Congress just keeps reupping from the 17th patch to 18th patch to the 19th patch.

So what we are going to have to do here in this body--and I know the distinguished Presiding Officer has a great interest in the question and the budget and the future particularly of entitlement costs, which I would say puts the Medicare guarantee and holding down costs front and center--we are going to have to speed up, we are going to have to accelerate the drive to actually get full repeal and replace, rather than patch 17, patch 18, patch 19, patch 20, and up. My view is we ought to be doing it now.

I recognize the objection from the other side. But I have talked to a lot of Senators over the last 3 days of both political parties, and I think there is a growing awareness that simply extending what we already have and punting on the need to fix the urgent structural problems with what we have--which is what some Senators and House Members sought to do--can't be ducked much longer.

Mr. President, I reserve the remainder of my time for closing.

I yield the floor and I suggest the absence of a quorum.

Mr. President, I would like to respond to the Senator from Kentucky by again making it clear that it is my interest to work very closely with colleagues on the other side of the aisle on these health care issues, and that is why we took the proposal Senator Hatch had for repeal and replace on Medicare as the base bill. It is why I spent a lot of time working with colleagues on the other side of the aisle on Medicare Part D and trying to make sure it could be implemented well.

What was striking was that a lot of the stories about Medicare Part D in the first couple of months resembled the stories we are now seeing about the Affordable Care Act. The Congressional Budget Office has made the comment that Part D has come in more than 25 percent less in terms of projected costs than what CBO saw years ago.

We are going to work in a constructive way. I hope we will not see a push, for example, to repeal the Affordable Care Act because if you do that, you will go back to the days when health care in America was for the healthy and the wealthy because you would again allow discrimination against those with a preexisting condition. The Affordable Care Act has air-tight protection for those who have a preexisting condition, and if you repeal the Affordable Care Act, you would simply go back to those days.

Working with colleagues in a bipartisan way on strengthening the health care system and our economy--absolutely. But turning back the clock on vital consumer protections, such as protecting our people from discrimination against preexisting conditions, is something that I think would be a huge mistake.

Mr. President, I ask unanimous consent to have printed in the Record an article that appeared in the Wall Street Journal last weekend. It is entitled ``Health Insurers Make Late Push to Enroll Young People'' with respect to the Affordable Care Act. The signups topped the Congressional Budget Office's target ahead of the March 31 deadline.

I was particularly pleased by the comments from insurance executives in Pennsylvania, Rhode Island, and Florida. They all talked about how more younger people are signing up, which, of course, is key to what we all want to do in terms of bipartisan approaches that strengthen the role of private health care in America.

I would like to have this article printed in the Record so my colleagues can read the remarks of Highmark, Inc., a major health plan based in Pittsburgh. Blue Cross & Blue Shield of Rhode Island said their fastest rising segment in March was people ages 22 to 40. Florida Blue senior vice president Jon Urbanek said, ``Younger people are signing up.''

I think all of this indicates--as far as private sector health care is concerned, which we all sought to promote in connection with this-- that more younger people are signing up for these plans.

Also, in response to my friend from Kentucky who asked about the jobs agenda, Senator Hatch and I have been working very constructively together on efforts to go forward in the Finance Committee--which could even begin this week--to deal with the tax extenders. Tax extenders are particularly important for the jobs Senator McConnell seeks--as he mentioned in his remarks--to get some traction. We will be talking about an extension for the research and development tax credit, which is key for innovation. We will be talking about jobs and renewable energy and jobs for veterans. This is the kind of jobs agenda we are pursuing in the Finance Committee.

I ask unanimous consent that Senator Cardin be yielded 5 minutes at this time to address the SGR.

Mr. President, pursuant to section 904 of the Congressional Budget Act of 1974, the waiver provisions of applicable budget resolutions, I move to waive all applicable sections of that act and applicable budget resolutions for purposes of the pending bill, and I ask for the yeas and nays.

Mr. President, I now ask unanimous consent to make a unanimous consent request.

Mr. President, I ask unanimous consent that notwithstanding the previous order with respect to H.R. 4302, following disposition of the Owens nomination, when the Senate resumes legislative session, the Senate proceed to the consideration of Calendar No. 336, S. 2157; that the substitute amendment, which is at the desk, be agreed to; that the bill, as amended, be read a third time and the Senate proceed to vote on passage of the bill with no intervening action or debate; and that upon disposition of the bill, the Senate resume consideration of H.R. 4302 as provided under the previous order.

I object.

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

Mr. President, I rise to mourn the passage of a friend and to pay tribute to a remarkable man. Jeremiah Denton once served his country as a pilot, a prisoner of war, a rear admiral in the Navy, and a Senator of the United States. He passed away Friday morning at the age of 89, having been active until near the end.

From time to time men and women are born into this world who are made of something special, individuals who seem to have an unlimited reservoir of strength and courage, who are made of sterner stuff. These people carry themselves with grace and dignity even as the world's weight rests upon their shoulders. Jeremiah Denton was such a man.

A proud son of Mobile, AL, he attended local Spring Hill College and the local Catholic schools and McGill-Toolen in Mobile, and he graduated later from the U.S. Naval Academy, becoming a pilot and commander. What happened next would etch his name into the annals of American history.

On July 18, 1965, Denton led a squadron of 28 jets on a bombing raid when he was shot down over North Vietnam. It was his 12th flight. Captured by the North Vietnamese, he would be a captive in prison camps for the next 7 years and 7 months. During his time as a prisoner of war, he endured virtually constant and excruciating torture. He was held captive at prisons the POWs called Hanoi Hilton, the zoo, and Alcatraz. He endured merciless beatings as well as solitary confinement for 4 years.

As a senior officer, he was a leader among the prisoners and rebelled against their brutal efforts to extract propaganda. Denton refused. Denton explained in an interview to the New York Times:

I put out the policy that they were not to succumb to

threats, but must stand up and say no. We forced them to be

brutal to us.

Denton wrote a memoir, ``When Hell Was in Session''--which is a fabulous book and too little appreciated, really--recounting his time as a POW. He describes a torture session in which his captors placed a 9-foot, cement-filled bar across his shins. He wrote that his captors ``stood on it and . . . took turns jumping up and down and rolling it across my legs. Then they lifted my arms behind my back by the cuffs, raising the top part of my body off the floor and dragging me around and around. This went on for hours . . . They were in a frenzy alternating the treatment to increase the pain until I was unable to control myself. I began crying hysterically, blood and tears mingling and running down my cheeks.''

In May 1966, Denton would defy and outsmart his Communist captors and display to the whole world the depth of American courage and ingenuity. His captors interrogated Denton for a propaganda interview. While answering their questions at this interview, filmed by a Japanese film company, Denton was simultaneously and repeatedly blinking out a message, letter by letter, in Morse code. The message was ``torture.'' It was the first official message informing Americans and the world that American POWs were being tortured by the North Vietnamese.

During the interview, he further displayed his unshakeable resolve by boldly declaring to his captors:

Whatever the position of my government is, I support it

fully . . . I am a member of that government, and it is my

job to support it, and I will as long as I live.

North Vietnam's most ruthless interrogators couldn't break the will of this rock-ribbed American and Alabama native.

More than 7 long years later, on February 12, 1973, Denton would be freed as part of ``Operation Homecoming'' following the signing of the Paris Peace Accords. He was the senior officer of the first planeload of released POWs at Clark Air Base in the Philippines. Denton brought tears to the eyes of the entire Nation at that moment as he walked from the plane. It was reported that he wasn't told to make any official remarks or make a speech, but he got off the plane and these were his powerful words:

We are honored to have had the opportunity to serve our

country under difficult circumstances. We are profoundly

grateful to our commander-in-chief and to our nation for this

day. God bless America.

Millions of Americans remember that day.

Denton earned the Navy Cross, the Defense Distinguished Service Medal, the Navy Distinguished Service Medal, three Silver Stars, the Distinguished Flying Cross, five Bronze Stars, two Air Medals, two Purple Hearts, and numerous other campaign awards. He rose to the rank of rear admiral and retired from the Navy in 1977.

In 1980 the proud and grateful State of Alabama would send our native son to the U.S. Senate. A man of deep faith, Denton believed in the dignity of public service and the selflessness required of those of us who serve. He believed that and he demonstrated it in his life.

He fought alongside Ronald Reagan to rebuild America's defenses and to fight the spread of communism and to help bring about the end of the Cold War. He was a firm believer in peace through strength. President Reagan recognized Senator Denton during his 1982 State of the Union Address. Many remember this. President Reagan said:

We don't have to turn to our history books for heroes. They

are all around us. One who sits among you here tonight

epitomizes that heroism at the end of the longest

imprisonment ever inflicted on men of our armed forces. Who

will ever forget that night when we waited for the television

to bring us the scene of that first plane landing at Clark

Field in the Philippines, bringing our POWs home? The plane

door opened and Jeremiah Denton came slowly down the ramp. He

caught sight of our flag, saluted, and said, ``God bless

America.'' Then he thanked us for bringing him home.

So said Ronald Reagan.

I had the privilege of getting to know Jeremiah Denton. He was a very special man. His word was his bond and his loyalty was unshakeable. He was modest. While he was a fierce advocate for his profound beliefs, it was never about him. In fact, he was very uncomfortable with the term ``hero'' being applied to him. His comeback was always: ``We were only doing our duty.''

They said, after his time in Communist prison, that he was out of

touch; he didn't know the 1960s had occurred. Perhaps so. In fact, it was so. In plain fact much had occurred while he was in prison and being tortured. It was, among other things, a culturally momentous time. Many of those changes he did not like. He said so in plain language. He didn't like the surge of crime and drugs. He believed in loyalty to one's spouse. He opposed abortion. He lamented the consistent weakening of family bonds, sexual promiscuity, the decline in decency. He cared enough to speak out and again give of himself for his faith and his country.

He represented the best America has to offer. His grit and bravery shined through from his dark prison cell deep in Vietnam, and it lit up the world. He loved his country. He loved his God. He loved his family.

In 1996, when I was considering running for the U.S. Senate, I sought his counsel. He graciously agreed to come by my house in Mobile. It was a very valuable discussion. Near the end, we talked of his service. He told me a story--and I think it may be appropriate to tell it now--of his time in prison that he had not put in his fine book. After President Nixon's bombing and strong military action had brought the North Vietnamese to the conference table, Denton was firmly of the belief that the Vietnamese were defeated and they knew they were defeated. Concerned over possible war crime trials, one of the prison officials demanded that Denton tell them all what he would say to the world about his treatment if he were to be released. Senator Denton sought to avoid the question, saying: Why are you asking me? I am not the senior officer in the camp.

But they pressed him again and again, and he kept saying: Why me? I am not the senior official.

Finally, the prison official looked at him and said: ``Because you are incredible, Denton.''

That is the flat truth. He was incredible.

When he told the world and his captors during that ``show'' press conference before the Japanese television where he blinked the word ``torture'' that ``whatever the position of my government is, I support it fully . . . I am a member of that government, and it is my job to support it, and I will as long as I live,'' it was a moment of great courage, historical significance, and fidelity to duty that few in this Nation would be able to match. He knew the captors would not like it, and they did not like it. They beat him brutally for the disrespect he showed by telling that truth, and they even did so before they knew he had blinked out ``torture.''

His family was his life. He was married to the late Kathryn Jane Maury for 61 years, with whom he had seven children. He is survived by his second wife Mary Belle Bordone and his children: Jeremiah, William, Donald, James, Michael, Madeleine Doak, and Mary Lewis.

The entire Senate sends our prayers to his loved ones, and we send our promise that Jeremiah Denton will not be forgotten.

Mr. President, I yield the floor.

Mr. President, reserving the right to object, I want to express my appreciation to Senator Wyden for his leadership. He is going to do a great job as chairman of the very important Finance Committee. He is active in all the issues before our Senate. But, regrettably, a number of Members on this side object to proceeding with his legislation at this point.

I would note that budget experts tell us that paying for this through OCO is the mother of all gimmicks. I just spoke about the passing of Senator Jeremiah Denton, who was a prisoner of war in Vietnam. We could use the savings from the Vietnam war that we are not spending today to pay for this bill.

So I would object, Mr. President. Hopefully, we can figure out another way to make this happen because Senator Wyden is correct, it is time to get a permanent fix of this matter done.

I would ask consent that S. 2122, Calendar No. 330, be proceeded to for immediate consideration. It would repeal the Medicare sustainable growth rate offset by repealing the ObamaCare individual mandate. I ask consent that the bill be read a third time and passed, the motion to reconsider be laid upon the table.

I did object, yes.

Mr. President, I ask unanimous consent that the Senate proceed to the immediate consideration of Calendar No. 330, S. 2122, a bill to repeal the Medicare sustainable growth rate offset by repealing the ObamaCare individual mandate. This is proposed by Senators Hatch and McConnell and Cornyn. I ask unanimous consent that the bill be read a third time and passed, the motion to reconsider be considered made and laid upon the table.

Mr. President, I thank the Senator from Oregon for his leadership and hopefully something can be worked out on this because it is important. But it is frustrating that there is no intention, it appears, to allow this provision, this fix to be brought up. Therefore, without that kind of consent, I think it is unlikely we will get a unanimous consent to move forward with Senator Wyden's fix.

Mr. President, I appreciate the work of Senator Wyden and others on this problem. It is a matter we need to fix.

The Senator from Maryland said the fix is signed off by the House too, so I guess we are supposed to know the fix is in. We are just going to take care of the doctors who need their money and we are not going to pay for it. We are not going to do it within the budget, again.

As ranking member of the Budget Committee, I feel I have a responsibility to report to this body the plain financial truth about the legislation that comes before us. The bill offered by our Democratic colleagues is worse than this one. I guess this is a Reid- Boehner bill that is before us now. But the Democrats' bill would claim to pay for it with OCO--the Overseas Contingency Operation--which couldn't be anything worse than the pay-for in this bill.

The Reid-Boehner doc fix legislation we are about to consider violates the spending limits we passed in December, the Ryan-Murray- raised spending limits--by $6 billion only 3 months after those limits were signed into law. Think about that. Bloomberg News released an analysis today concluding that:

Since December 2013, the Republican House and the

Democratic Senate have approved more than $40 billion worth

of spending ``offsets'' in the form of cuts that would take

place in 2023 at the earliest or timing shifts in policy to

bring savings into the 10-year window.

In other words, Congress has gimmicked an additional $40 billion in new spending in just a few months since Ryan-Murray was passed. That is just what it is. The Budget Committee and Chairman Murray, our Democratic chairman, has already ruled it violates the budget. It spends money we don't have. It is not a legitimate pay-for. So here we are again, proposing to bust the spending limits. This is the behavior of a profligate Congress.

How many of our Members were running for office 2 years ago, 4 years ago, 6 years ago, and they were talking to their constituents and they said that Congress is spending us into bankruptcy; they are irresponsible; they won't even write a budget; they spend, spend, spend; they don't worry about the deficit. The country is going into too much debt.

How many have said that in their campaigns--when I get there, I am going to do something about it. And what do they do when they get here? Some of our Members say, Oh, we have to take care of the doctors. And we do need to do that. But there is waste, fraud, and abuse and savings throughout this $4 trillion budget of ours that we could use to reduce that spending legitimately to pay for what we need to do for our doctors.

That is what we agreed to do when we passed the Budget Control Act. That is what the Budget Control Act did. The Budget Control Act in 2011 said this. The President signed it. It passed both Houses of Congress. It had Democratic and Republican support. The Budget Control Act says over the next 10 years we are projected to increase spending by $10 trillion; but we are going to be more frugal than that, we are only going to increase spending by $8 trillion. So spending would increase by $8 trillion.

What happens? As soon as it begins to bite a little bit, and we are challenged to make some priorities and to decide, for example, how we are going to help our doctor friends--who do need some relief--what do we do? We just violate the agreement, we spend money we do not have, and we say somehow it is paid for. That is what brought us the Ryan- Murray deal and now we are rewriting that agreement. Senator Murray agrees that this legislation currently before us violates the budget and is not paid for.

So last year we borrowed--think about this--$221 billion just to pay the interest on our debt. We have a debt of $17 trillion. We have to pay interest on it, colleagues--surely we all know that--and it was $221 billion last year.

Federal aid to education is $100 billion. The Federal highway bill is $40 billion. We spent that much on interest last year alone. But the worst news is, the Congressional Budget Office tells us that 10 years from today our interest cost will surge to $880 billion a year annually. That is more than $5,000 in interest payments for every American worker--$880 billion. Can you imagine that? That is over $400 a month for the average worker that pays taxes in America. That is how much their share is going to have to be raised in taxes to pay the interest in 1 year.

What do I say about that? This assumes, colleagues--this $880 billion in interest and the surge in our debt--this assumes that we will adhere to the Budget Control Act and the Ryan-Murray agreement, which this bill busts and violates. It is not the first time, and it will not be the last. They are going to come back again and again and again with gimmicks and violations because people in our Congress are unwilling to take the heat to find real offsets.

So we should keep that in mind as we consider this or any other legislation that will increase the amount of money we have to borrow.

I would like to call attention to three specific ways the proposed legislation violates spending and deficit limits. Each of these are points of order that lie against the bill confirmed by the majority on the Budget Committee. What I am saying is, each of these three points I am raising now represent points of order; in other words, the Budget Committee has ascertained that they violate the budget. We spend more than we are allowed to spend.

So No. 1, a $17.6 billion increase in the on-budget deficit over the 5-year period from fiscal year 2014 through 2018; and a $9.5 billion increase in the on-budget deficit over the 10-year period of 2014 through 2023--$9.5 billion.

No. 2, spending in excess of the top line total in the Ryan-Murray levels for fiscal year 2014. We just passed Ryan-Murray in December. The President signed it in January. This is going to add $6.1 billion more than we just agreed to spend in fiscal year 2014.

Oh, well, that is not a problem. I say it is a problem. I say it is the way a nation goes broke.

How about this? Spending in excess of the Finance Committee's allocation. The committees are allocated so much money. They are not entitled to spend above the allocated amount. So this spends $6.1 billion in budget authority and outlays in fiscal year 2014--this year we are in--above the Finance Committee's allocation.

Was there a time agreement, Mr. President?

Mr. President, I ask unanimous consent for 2 additional minutes, and I will wrap up.

I thank my courteous colleagues.

Maya MacGuineas, at the Committee for a Responsible Federal Budget--a well-respected group--was quoted as saying, ``We are disheartened that, even in a 12-month `doc fix,' the legislation under consideration would use a budget gimmick to offset a portion of its costs. . . . Specifically, a portion of the bill's `savings' are achieved by simply shifting sequester savings set to

occur in 2025 into 2024, within the Congressional Budget Office's scoring window, but this has zero actual impact on the debt. . . . Congress should remove the phony savings in this bill and replace them with real cuts or shorten the duration of the `doc fix.' ''

That was an objective analysis of it.

So, Mr. President, that being the case, the pending measure, H.R. 4302, the Protecting Access to Medicare Act, would violate the Senate pay-go rule and increase the deficit. Therefore, I raise a point of order against this measure pursuant to section 201(a) of S. Con. Res. 21, the concurrent resolution on the budget for fiscal year 2008.

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

Mr. President, America's top priority is the same today as it was last year, the year before that, and the year before that: unemployment, jobs, and how to get this economy growing again.

Of course, these are concerns which transcend any kind of partisan affiliation. They transcend geographic and demographic boundaries. They are shared, of course, by Republicans, Democrats, Independents-- everyone--people from all parts of our country.

But the sad fact is it has been almost 5 years since America's official economic recovery began and still too many people who want to work can't find a job. There are still 3.8 million people who have been unemployed for more than 6 months, and the labor force participation rate remains stuck at 63 percent. Of course, those are the people who don't even show up on the unemployment statistics because they have given up looking for work. This is what we talk about when we are talking about the labor participation rate--the lowest number since 30 years ago.

Since the current President took office, the average amount of time the unemployed have been without a job has almost doubled, from less than 20 weeks to more than 37 weeks. This is a shocking statistic.

So since President Obama has been in office, the average time people have been unemployed--have been out of work--went from less than 20 weeks to now 37 weeks, and the number of people on food stamps has increased from 32.2 million to nearly 46.8 million people.

As for median household income, it is now more than $2,400 lower than it was at the end of the recession in June of 2009. The President talks a lot about

income inequality, but the problem is, it has gotten worse since he has been in office, not better.

We should be focused like a laser on things we might be able to do to set the stage to help the economy start growing again, because only when the economy grows do we see the unemployment numbers go down, do we see the labor participation rate go up, and we see regular American families have the opportunity to provide for themselves and to pursue their dreams. But right now that American dream is somewhat cloudy. Many people feel as though it is starting to pass them by, and that is the American tragedy. So you would think that at a time when there is a bipartisan consensus we need to get the economy moving again, we need to get people back to work so they can provide for their families, that there would be bipartisan agreement here in the Senate that anybody with a good idea ought to step up, offer it, debate it, and let's vote on it.

Well, unfortunately, the majority leader has a different point of view. He is refusing to let anyone on this side of the aisle offer any suggestions in the form of amendments that actually might have a chance of improving the situation for people who are out of work or people looking for jobs. Not only is the majority leader blocking votes on bills that would make it easier for Americans to find work, he is also promoting and defending policies that would actually discourage work. For example, both the majority leader and President Obama are advocating a minimum wage increase of 40 percent, while the Congressional Budget Office has told us it could destroy up to 1 million jobs.

Now the majority leader and the President may not agree with that estimate, but I will remind them of what Federal Reserve Chairwoman Janet Yellin said; she is President Obama's own appointee as Chairman of the Federal Reserve Board. She said she wouldn't want to argue with the Congressional Budget Office's assessment about the number of people who would be put out of work if you raised the minimum wage by 40 percent. For that matter, the evidence suggests that any increase in the minimum wage would destroy jobs and do very little, if anything, to reduce poverty rates. The best thing we could do is to get out of the way and let the economy grow again by making the environment more conducive to the people who invest, take risks, and start businesses or grow small businesses. That is the thing we could do that would help people the most.

But in addition to the minimum wage increase, the majority leader and President Obama are pushing for yet another extension of long-term unemployment benefits, even though President Obama's own former chief White House economist has said that ``job search is inversely related to the generosity of unemployment benefits.'' So, in other words, people react in situs, and when the government continues to pay unemployment benefits for people who are out of work, human nature is such that people are disincentivized to go back to work and look for work on occasion.

We all recognize the importance of this safety net program, and the truth is under the current law 26 weeks or 6 months are available for unemployment benefits. But under this administration we have seen unemployment benefits go from 6 months to 2 years. Two years after people have been out of work and those benefits lapsed, we have done nothing to improve job training programs that would help match the skills of out-of-work Americans to the jobs that are out there which pay good money--and I have seen many of them in my State, and I am sure the Presiding Officer has as well. We have seen a lot of good jobs go wanting for lack of a skilled workforce to be able to perform those jobs. So what we ought to be doing instead of extending unemployment benefits is we ought to be focusing on how we can train workers and provide them with the skills they need in order to qualify for those good, high-paying jobs.

At a time when the American people are desperate for more jobs and more work, the majority leader is steadfastly determined to pass legislation which would disincentivize people from going back and looking for work and would in fact discourage work and discourage job creation. That is before we even get to ObamaCare, a law the Congressional Budget Office has estimated would effectively reduce the size of America's labor force by 2.5 million people over the next decade. Remarkably, I guess trying to spin it any way they could, the White House actually took the position that was actually a good thing because people would have more time off.

Perhaps we shouldn't be surprised. After all, this is the same administration that unilaterally gutted the work requirements in the 1996 welfare reform law, one of the most successful welfare reform laws ever passed. It is the same administration that refuses to approve the Keystone XL Pipeline, a project that would directly create thousands of new jobs right here in the United States, and it is the same administration that refuses to embrace progrowth tax reform.

America's corporate tax rate is the highest in the world, and yet the President said he won't enter negotiations to reduce those rates, to eliminate double taxation so people will bring the money they earn overseas back here to hire more Americans and to build their businesses here. The President won't do that without an agreement on this side of the aisle to raise taxes, to raise revenue by $1 trillion. That is not a bargain we are interested in negotiating. This is the same administration that refuses to support energy, the energy renaissance we have seen, and continues to support regulations which actually threaten jobs and hurt families in return for meager or nonexistent benefits.

As I have said before, this administration and its policies have become nothing less than a war on the American worker. I am not suggesting that is their intention, but I am suggesting that is the result.

If there is one thing we ought to all be able to agree upon it is that work is about basic human dignity. It is about self-worth and self-reliance; it is about giving people the opportunity to reach their full potential and to support their families. When the policies of the Federal Government actually discourage people from working, it makes it harder for teenagers to learn basic social skills and professional skills. It makes it harder for college graduates to utilize their education and pay off their student loan debt. It makes it harder for people of all backgrounds to start families. It makes it harder for mothers and fathers to gain the self-respect that comes from providing for your own children.

It is bad enough that the President and the majority leader have embraced an agenda that is fundamentally antiwork. What makes it even more outrageous is that this week the majority leader will deny the opportunity for anyone on this side of the aisle to offer any sort of constructive suggestions about how to deal with that problem. He is refusing to allow proposals that would actually encourage work and encourage job creation.

Here are just a few examples of the amendments and proposals that would come from this side of the aisle if the majority leader--it is his sole prerogative--would allow those amendments to be debated and voted on by the Senate:

For example, the senior Senator from Maine has a bill that would relieve the burden of ObamaCare on workers and businesses alike and restore the traditional 40-hour workweek. This has been one of the primary complaints of organized labor, some of the biggest supporters of ObamaCare. They said that in order to avoid the penalties that go along with ObamaCare, many employers are moving people from full-time work to part-time work. The amendment from the senior Senator from Maine, Senator Collins, would address that problem and fix it.

The senior Senator from Utah, Senator Hatch, has a bill that would abolish the job-killing tax on medical innovation.

The junior Senator from Missouri has a bill that would exempt military veterans from ObamaCare's employer mandate.

The junior Senator from Kentucky has a bill that would make it easier for Congress to block regulations that do not pass a simple cost- benefit test.

The junior Senator from South Carolina has a bill that would modernize

workforce training and eliminate duplicative government programs-- something I was just talking about a moment ago.

The senior Senator from North Dakota has a bill that would singlehandedly create thousands of jobs by approving the Keystone XL Pipeline.

If and when these bills are offered as amendments to the pending legislation, they deserve a vote, but if the majority leader denies them a vote, he is effectively denying us a chance to expand our economy, create more jobs, and get people back to work. I used to think this was something Republicans and Democrats both agreed was a good thing. I thought we all agreed that job creation and work promotion should be the cornerstones of our economic agenda. With an agenda such as that, perhaps we could finally have a recovery of our economy worthy of its name.

So I hope the majority leader reconsiders his decision to deny an opportunity for a full debate and vote on these constructive suggestions. None of these are nongermane. All of these are directly on point and would actually help improve the underlying legislation and actually do something about the underlying symptom that necessitates in some people's minds this long-term extension of unemployment benefits.

We are not helping people out by continuing to pay unemployment benefits for 2 years and then leaving them hanging without the skills they need in order to reestablish themselves in the workforce. Unfortunately, the only conclusion I could draw is if the majority leader is not interested in having an honest and open debate about how do we solve the problems, then something else must be driving his agenda. I think we should get back to the day when collectively we were more concerned about solving problems than trying to beat on an issue and gain political advantage, but that seems to be the road we are headed down based on the majority leader's decision not to allow any votes on amendments.

Mr. President, I yield the floor and suggest the absence of a quorum.

Mr. President, here on the Senate floor we often speak about numbers of great magnitude. Whether we are speaking of the national debt, jobs, or tax dollars, the numbers can be in the thousands, millions, or even billions. Sometimes these numbers are enough to numb even the most policy minded to the sheer volume and amount of people and resources that go into running the Nation's Capital City.

Today, as I bid farewell to Rochelle Eubanks, a diligent, beloved, and loyal staffer for 25 years, there is one number in particular I want to bring to my colleagues' attention. That number is 1,807,181.

For a quarter of a century, Rochelle has been the backbone of my office, in charge of the one critical task that all of us honored enough to be elected to Congress are charged with: to listen, to respond to, and to act on behalf of our constituents.

First as my correspondence mail system, or CMS, operator; and since 1994, as my CMS production manager, Rochelle has been at the front lines of communicating with Kentuckians. CMS is the computerized system Senate offices use to keep track of their letters to constituents. And that number--1,807,181--is the number of letters to the Bluegrass State Rochelle has sent out in her 25 years of service.

It is truly remarkable. If every letter were to go to a different person, then Rochelle has mailed a letter to nearly half the State. No one else on my staff has had more contact with the voters back home than she has. After her retirement on April 4, she will be very much missed by myself and by all of her colleagues in my office.

Rochelle started back in March of 1989. But her Senate service extends back to April of 1982, when she began work as a mail manager for the Republican Conference. She also worked with Senators John East and Jim Broyhill, both of North Carolina, before moving to the House side in 1987. I am very glad we were able to lure her back over to the Senate side to work in my office beginning in 1989.

Most staff offices have two or three staffers working on CMS. But for the majority of her tenure with my office, Rochelle has handled CMS duties on her own. How in the world does she do it? Well, ``I just do what I do,'' Rochelle says, in her usual modest fashion. Perhaps the key to how she does it

is that Rochelle is always the first to arrive in the office, often by 5:30 in the morning. I know for a fact Rochelle can be counted on as the first to arrive at work, because I can recall a time or two when she had to let me in my own office.

I knew I could always count on, as I have called her, the early bird. In fact, that is how I introduced Rochelle to my wife Elaine: This is my early bird. Rochelle could always be counted on to be there.

Because of her long tenure, Rochelle has become almost a den mother of sorts to many of the younger staff members and interns in my office. Rochelle has been with us in three different office locations, all in the Russell Building, and every time her desk has been located near the mailroom and the office interns.

When new interns or mailroom staffers start their first day, they already know who is looking out for them. ``You must be Rochelle,'' many have been heard to say. ``I've heard so much about you.''

One of my longtime staffers who worked with Rochelle for nearly 20 years remembers her fondly.

She interacted with me the same day I came as a staff

assistant, to the day I left as chief of staff. It was the

same way she treated everybody. It didn't matter if you were

a senator or an intern. She was always sweet and pleasant and

positive.

Another longtime staffer recalls:

Rochelle has long been the master of mass mail. Regardless

of how many bins I brought her, she always had a bright

smile, a kind word, a listening ear, and a delightful laugh.

All the things that make a colleague a dear friend--that's

what Rochelle is truly the master of.

Yet another former longtime time staffer says in tribute to her:

Rochelle . . . you were always the sounding board, the

moral compass and the reality check for the people you worked

with, some of whom you may have forgotten, but who will

always count you as a friend. And while your work over the

years was excellent, please know that those you have worked

with will remember you for much more.

The fidelity and loyalty Rochelle has shown to my office is exceeded only by her fidelity and loyalty to her family. Rochelle has two daughters: Rochelle and Endyia, and six granddaughters: Nyla, Jermany, Albany, Liberti, Milini, and little Marlei, who was born just this March 9.

Everyone in the office knows how cute Rochelle's granddaughters are because she proudly displays several pictures of them at her desk. Some former staffers recall years ago when Rochelle would occasionally bring her then-school-aged daughters into the office and they would show off their cartwheels. The tradition continues today with Rochelle's granddaughters. ``Granny, can we come work with you?'' they ask.

Family is also the reason that after 25 years, Rochelle is taking her well-earned retirement and moving into the next phase of her life. I was thrilled to learn Rochelle will be marrying her fiance Kevin Perry. They will soon be moving to New York. Of course, she will be missed by her family here in the District as well as by everyone in the McConnell office, but our loss is Mr. Perry's gain, and I wish the two of them great happiness in their marriage.

Kevin is a professional musician who plays the guitar, and his genre of choice is R&B and funk music. He and Rochelle have known each other since high school and after 30 years recently reconnected. Now they are back in each other's lives and looking forward to starting a new life in Queens--``not Manhattan,'' as Rochelle is quick to point out.

Rochelle is a native Washingtonian, and of course Rochelle's daughters, granddaughters, and other family here will miss her terribly, but Rochelle is reassuring. ``I'm only 4 hours away. And we'll do a lot of Skype,'' she says. ``They don't want me to stop [working] and they don't want me to leave DC. But I'm ready for a change.''

Quite a change it will be. It is hard to imagine the McConnell office without Rochelle. She is the fourth longest serving staffer in the history of my office. When she retires next Friday, she will have 9,140 days of continuous service. In fact, the three longest serving staffers still in my office are all women who have more than 25 years of service each; field assistant Sue Tharp, archivist Nan Mosher, and Rochelle.

For Rochelle it all comes down to family--her own family and the McConnell family which she has formed and grown close to in her time with us. So it is fitting that she is retiring to start a new chapter with her family.

``It's a very close-knit office,'' Rochelle says of her tenure. ``Everybody cares. Everybody helps each other out.'' I am glad Rochelle feels that way, and I couldn't agree more.

Another longtime staffer and longtime friend of Rochelle's sums up the special place she holds in our hearts this way:

For Rochelle, it comes down to family. To her, that's the

unifier. My nephew is 20 years old; she still asks what he's

up to. She's that way with everybody. She's the glue.

Now the McConnell office is going to have to soldier on without the vital glue Rochelle Eubanks has provided for 25 years. It is a great loss not only for us but for the people of Kentucky--for all of my constituents she reached out to, for the recipients of 1,807,181 letters, each letter representing a vital link between them and their elected representative.

So farewell, Rochelle, my friend, and thank you ever so much for two and one-half decades of tireless service. It is going to be a very different office without your welcoming smile and easy laugh.

Congratulations and best wishes on your marriage and the wonderful new life you will begin with your husband. You certainly deserve every happiness.

It would be such a remarkable turn of events and a genuine pleasure to receive a letter from you for a change. I would even settle for a postcard. I hope you will send us one from New York.

Ukraine

Mr. President, I wish to start by acknowledging the majority leader's decision to remove extraneous IMF provisions from the Ukraine bill. As I noted yesterday, no legislation could have passed with those provisions included. So I think it is a positive step forward. We are glad he took our advice, and now Congress will be able to pass an effective bill on Ukraine very soon.

The Economy

Mr. President, President Obama and his Washington Democratic allies are well into their sixth year of presiding over our economy. Yet the jobs recovery they keep promising us just never seems to materialize.

We have to give Washington Democrats at least some credit though. They have tried regulating, taxing, spending, stimulating, just about everything their ideology will allow. The problem is their ideology just simply doesn't work. Many of their policies just end up making things worse. Of course, the best example is ObamaCare.

They promised the Sun and the Moon to sell this thing. They said it would create jobs. They also said it would improve the economy, lower premiums, insure the uninsured, without causing Americans to lose their insurance, their doctors or their hospitals--the kind of claims which would have made Billy Mays blush.

But now Americans know better. Evidence shows that not only will ObamaCare encourage less job creation, but it is also making the economy worse, that it is driving premiums higher, and it will not come anywhere near insuring all the uninsured, while causing millions of Americans to lose the insurance and the doctors they were promised they could keep.

It is also a law which is unraveling before our very eyes. As we read this week, the administration has now handed out so many waivers, special favors, and exemptions to help out Democrats politically that the heart of the law--the individual mandate--may actually no longer even be viable. It has basically become the legal equivalent of Swiss cheese.

There is a broader point. If Washington Democrats think ObamaCare is so bad they need to exempt that many people from its mandates, then why shouldn't we remove the hardship for everyone? Doesn't the middle class deserve a break too?

Why shouldn't we repeal the 30-hour workweek created by ObamaCare, the provision which reduces take-home pay for the middle class.

Why shouldn't we do away with ObamaCare's job-killing medical device tax, something even many Democrats would vote to abolish if the majority leader would allow the vote.

What I am saying is if Washington Democrats are actually serious about

job creation, then it is time to actually show it. Work with us to eliminate the things that hurt jobs, that hold Americans back from a real recovery--such as these job-killing ObamaCare mandates--and work with us to enact things which can actually create jobs.

Approving the Keystone Pipeline would create thousands of jobs right away. Passing trade legislation--legislation President Obama has already endorsed--would help create even more, but Washington Democrats need to work collaboratively with us to make those things happen. Yet this morning's New York Times highlights their strategy for the rest of the year. Here it is summed up in three words, ``political show votes.''

Get this. Their plan is not to pass legislation but to time show votes to ``coincide with campaign-style trips by President Obama.'' Rather than take up House-passed jobs bills which would actually help middle-class Americans, they plan for yet another year of turning the Senate floor into a campaign studio.

I am asking Washington Democrats to put the ideology and political show votes aside for once and finally join us, join us to give the American people what they have been asking for all along--more jobs, more opportunity, and an economy which works for the middle class once again.

I yield the floor.

Reservation of Leader Time

I would like to spend some time talking about the bill that is on the floor.

I thank my colleagues from Oregon and Virginia. I have enjoyed working with them.

The bill we have on the floor is one of the reasons I am leaving Congress at the end of this year. This is why the American people are disgusted with us. We are going to put off until tomorrow what we should be doing today. We should be fixing this problem instead of delaying the problem. I concur a lot with what my colleague from Virginia said. But the fact is that there is no courage, there are no guts, and there are no intentioned actions to do what is the best thing in the long term for this country in this body anymore.

We have a bill that came to us--and I appreciate the fact that the chairman wants to try to fix it. But if they vote for this bill that is on the floor today, they are part of the problem. They are not part of the solution; they are part of the problem.

There are four budget points of order that lie against this bill. Why in the world would there be four points of order lying against this bill? We are only going to vote on one of them. It is because it is a sham. It is a lie. The pay-fors aren't true. They are nothing but gimmicks. It is corruptible. There is no integrity in what we are getting ready to vote on in terms of being truthful with the American public and in terms of being truthful with the people who are providing the care for Medicare patients.

I have a little bit of experience--25 years of practicing medicine. I can tell you what is wrong with the payment system. We have a payment system both from the insurance industry and from Medicare and Medicaid that says: See as many patients as you can if you want to pay your overhead because we are going to pay you based upon a code rather than how much time you spend with a patient.

The first thing a doctor is taught in medical school is sit down and listen to the patient. If we spend time with the patient, the patient will tell us what is wrong with them. We know that is true because we have two of the sets of data now--both on the concierge medicine that has come up in the past few years as well as what we have seen in one of the great HMOs on the west coast. They order 62 percent fewer tests when they are listening to the patient.

One of the biggest costs for Medicare, one of the biggest wastes for Medicare is tests. Why do doctors order tests? Because they didn't spend the time figuring out what is really wrong with the patient, so they order a bunch of tests to try to help them; whereas, if they had spent an additional 15 or 30 minutes with the patient, most of those tests--and most are not without risk--would never have been performed.

We have the Senate doing what we usually do: We are putting this off until tomorrow when we can actually fix the real problem now.

It comes to another principle of medicine. The principle of medicine is that we don't treat symptoms, we treat disease. When we treat the disease, the symptoms go away. If we just treat the symptoms, we will never find the disease. We will cover up the disease. That is exactly what we are doing.

The SGR was a great idea. It started in 1995 in the Ways and Means Committee in the House under former chairman Bill Archer. Had we followed it, we would have seen some significant reining in of the costs of care and Medicare. But what happened? We cut spending and we cut reimbursement rates one time. Instead of responding to the political clamor of the provider group, we fixed it--a short-term fix. We have been doing that ever since 1999, short-term fixes.

We are not fixing this problem today. What we are doing is taking a big old can and kicking it down the road. Worse than that, we are not even being truthful about what we are doing.

One of the little gimmicks is to shift $5 billion of sequester from 2025 to 2024 and say you saved money. But we all know this little red area on this side will go over to the other side and we will spend that money. Nobody believes it. It is kind of the wink and the nod to the American public: Oh, look at us.

There is no truth, there is no honesty about what we are doing. And that is only one. This is the other offset. The sequester was the one I just showed. Savings from future Medicare cuts: $2.3 billion. They will never occur. If you think they will occur, you obviously think--if they will occur, then we should have fixed the real problem, the real disease of Medicare today. But we didn't. So the actions will continue to be exactly the same. That $2.3 billion will never be materialized whatsoever. It is a falsehood--$4.4 billion to Medicaid. It will not ever come about. That is in the future, but we will take the money now to pay for it.

In this bill of approximately $20 billion, half of the savings we say are there aren't there. Every Member of this body knows that. So when they vote for this fix today and vote against the budget point of order, what they are saying is: I am dishonest, I am playing the game, and I will not stand up for truth so the American people actually know what we are doing. I do not believe in transparency. I do not believe that we ought to have to live within our means, that we ought to make hard choices, just as every American family out there does today.

Finally, some of this is very unfair to the very people who worked on this with the committees because they made some commitments for real cuts to them to get a long-term fix. Guess what. The real cuts--the portion that is actually paid for--pay for it for only 1 year. So not only are we dishonest with the American people, we are dishonest with the stakeholders who negotiated this for a 10-year elimination.

The budget points of order against this bill--just so we know what we are talking about, it violates pay-go. Plain and simple, it violates pay-go. This bill increases the on-budget deficit. I dare somebody to come down to the floor and tell me it does not. It does.

It violates the Ryan-Murray 2014 congressional Budget Act because it violates the top line. Nobody is going to come to the floor and say it doesn't. We won't hear one speaker come to the floor and say it doesn't violate that. It does. They know it does, but they won't speak the truth.

This bill also spends money in excess of the Finance Committee's allocation--another point of order against the Budget Act. Everybody knows that is true, but they won't come down and say it doesn't; they will just vote for it.

It also has language in it within the Budget Committee's jurisdiction that has not been reported or discharged. So we are totally ignoring the process the chairman of the Finance Committee would like to have so we can do the expedient political thing to take some pressure away, just as we did on the flood insurance bill. It got a little hot in the kitchen. Instead of actually cooking the omelet, we threw the eggs in the trash can and ran out of the room, and that is exactly what is going to happen in the Senate. We are again putting off the hard choices.

Let me tell you why this is important. The Senator from Virginia outlined this a little bit. When I came to the Senate, which was 9 years ago, the individual debt each one of us held on the national debt was under $32,000. Today it sits at 54,800-and-some-odd dollars. We can kind of get lost in that. What we have to think is this: Well, what is my family's obligation for what we haven't paid for in the Federal Government?

Let me tell you what it is. For every family in America, whose average income is $53,000 per year--the same as it was in 1988 in terms of real dollars; we have gone backward--your obligation is now $1.1 million per family.

And we are going to play this game again and we are going to add another $10 to $12 billion between now and April? We are going to say and claim it doesn't add anything, but we are going to add another $10 billion so we can get away from the heat, so we can get out of the kitchen, so we won't be responsible.

Which is more responsible--to tell the truth about where we really are or to actually profess an untruth to your constituents in this vote this evening? Because that is what it is. Mark my words: Every Senator who votes for this bill that came out of the House will be telling an untruth to the American people. They know it is not paid for. They know it violates all sorts of rules in the Senate. They even violated the House rules as they passed it--all to meet a deadline?

To give a little history, we have missed the deadline before on SGR fixes. Does it cause additional work for providers, doctors, hospitals, and doctors' offices? Yes. Does it provide additional work for CMS? Yes. Do we eventually catch up on it? Yes. So what is the hurry? Why not really treat the real disease? The real disease is that we have a payment system that is not good for patients and is not good for providers. We can't fix it over a weekend, but we can fix it. If we don't fix it, as the chairman would like to see a long-term fix--I don't necessarily agree with everything he wants to do, but I applaud his effort to get a long-term fix. If we don't fix it, we don't deserve to be in the Senate.

There will be no credibility left and there will be no legitimacy left if we pass this bill. It is all a pack of untruths--untruths to the stakeholders, untruths to the American public and, most importantly, untruths to the generation coming up that is going to pay the bill for our untruths. This isn't an unfixable problem. It is a problem that hasn't gotten the attention and the time it needs, and it reflects poor leadership of the Congress and the committees. We knew this was coming up 1 year ago. The Senator from Oregon can totally be forgiven because he wasn't in charge of the Finance Committee until 1 month ago. But there is no denying the fact this problem was there.

Doing a patch--and even doing some of what Senator Wyden wants to do--won't fix the ultimate problem. Think about the interaction you have with your caregiver. The average time in a doctor's office when you go in, before you are interrupted by your physician, is now 6 seconds. You go in, sit down, and the doctor asks: Why are you here today? You start to say something, and the first thing you know, you get interrupted. Why? Because that physician knows he needs to get to the next patient to pay the bills because we are paying bills based on CPT cuts rather than paying the physician based on the amount of time they spend with the patient, including outcome measures.

We have a system that is designed to be defrauded and creates overutilization. We designed it. We can fix it. Voting for this bill doesn't fix anything except a little heat in the kitchen. When we come back the next time, the heat is going to be hotter, and hotter, and hotter. This bill is a cowardly response to the real problem that we have. It is time we quit being cowards.

I yield the floor.

I thank the chairman.