Floor Statements

Mr. President, I wish to honor the service of a great Federal employee.

Human ingenuity is boundless. This is especially true in America, which has always been driven by an entrepreneurial spirit and a belief that nothing is impossible.

From Whitney's cotton gin to the first elevator, from the electric telegraph to the refrigerated rail car, our forbearers used their ingenuity to help build a nation. Such invention and perseverance closed the western frontier in the nineteenth century. In the century that followed, Americans continued to be pioneers on that frontier which has no end--the frontier of science.

Sixty-seven years ago this week, a team of American physicists led by Enrico Fermi conducted a critical experiment. On a cold winter's afternoon, they huddled under the stands of the old football stadium at the University of Chicago. Using graphite blocks, wooden rods, and uranium pellets, they initiated the first-ever controlled nuclear reaction.

That experiment, called ``Chicago Pile One,'' marked the beginning of the nuclear age.

Today all Americans know that the discovery of nuclear power was a mixed blessing. With it came the potential for a new form of energy to power our homes and businesses. For the first time, our naval ships could remain at sea--and on guard--for extended periods without refueling.

But with nuclear energy came nuclear weapons. These led to the dangerous prospect of the mass destruction of hundreds of cities within minutes. They brought us a generation of ``duck and cover'' and backyard fallout shelters.

Thankfully--though our nation and others continue to possess these weapons in our time--the Cold War is over. No longer are we minutes from ``mutually assured destruction'' the way we once were.

Today, peaceful nuclear energy provides a fifth of our electricity, and there are 104 civilian reactors in operation across the country.

Developing and enforcing the regulations that keep these reactors safe are the men and women of the U.S. Nuclear Regulatory Commission.

This week I wish to recognize the contribution of an outstanding public servant, Dr. Gareth Parry. Gareth has had a distinguished career at the Nuclear Regulatory Commission advancing our nuclear safety.

He is also a 2004 recipient of the distinguished Arthur S. Flemming Award for public service.

Gareth, who immigrated to this country from the United Kingdom, has over thirty years of experience in developing models for probabilistic risk analysis--or PRA. He retired this September after a long and distinguished career.

As senior adviser on PRA for the Commission's Office of Nuclear Reactor Regulation, Gareth became one of the leading experts on analyzing common cause failure and human reliability. His work led to the development of PRA standards and the use of PRA to support risk- informed decision-making with regard to nuclear safety.

Gareth, as a scientist and a public servant, worked hard to ensure the safety of America's civilian nuclear facilities.

The kind of work he performed is highly mathematical and complex, and it may not sound glamorous to the average American, but it is critical and contributes enormously to the security and economic well-being of our Nation.

Sixty-seven years ago, Fermi and his team first harnessed the power of the atom. Today, the men and women of the Nuclear Regulatory Commission ensure that our modern nuclear reactors continue to do so safely.

I hope my colleagues will join me in honoring the service of Dr. Gareth Parry and all who have worked--and continue to work--at the Nuclear Regulatory Commission.

Mr. President, tonight, the Strategic Arms Reduction Treaty will expire, and with it the primary framework for the reduction of nuclear weapons for the last 20 years. Today, I would like to speak a few minutes about the critical importance of an offensive strategic arms reduction, and why we must establish a follow-on treaty to START.

In September, President Obama proposed a resolution to the United Nations Security Council to eliminate nuclear weapons, ban production of the fissile material, outlaw nuclear tests,

and safeguard existing weapons stockpiles. World leaders approved the resolution, joining with the President's previous statements that ``America seeks a world with no nuclear weapons.'' This is not a vision of unilateral disarmament, but a vision for multilateral action. It is a vision of working step by step with every nation to draw down nuclear arsenals together. It is a critically important goal, and one of the best ways to ensure a safer future and a safer world.

In the past few years, we have seen a rise in clandestine nuclear programs developed by rogue states, including those which have successfully acquired a nuclear arsenal. This growing threat--primarily from North Korea and Iran--underscores the value of international strategic arms treaties. These are global challenges which require global solutions and a multilateral approach. The best way to combat proliferation is unity of the international community, and I am pleased that one of the greatest successes of President Obama's policy of engagement with Iran has been a growing convergence of views identifying Iran's nuclear program as a threat not just to one region but to the world.

While multilateralism is the best way to effectively reduce the threat posed by nuclear weapons, we must look to successful bilateral agreements as a model, including START. This historic agreement laid the groundwork for a common understanding between the United States and Russia regarding nuclear weapons, and truly symbolized the end of the Cold War. It allowed us to talk about previously taboo subjects, such as the Triad and intrusive verification, and develop a shared language of expertise and evaluation that reduced our nuclear arsenals. More importantly, it provided a process of arbitration that avoids confrontation, establishes legal mechanisms to forever avoid a nuclear war.

The stability START provided allowed both the United States and Russia to reduce our nuclear stockpiles and engage in negotiations about curbing proliferation worldwide. It also built great confidence in the other as a partner. Since its inception, START has served as an enabler of global non-proliferation efforts. Now this critical treaty is set to expire, and it is time to move to establish a follow-on which reflects the requirements of the 21st century, and allows the United States and Russia to continue this valuable partnership in nonproliferation together.

This is why I am a cosponsor of legislation which provides a legal basis for extending the START verification regime, and I strongly support the work of the Obama administration--under the leadership of Assistant Secretary of State for Verification and Compliance Rose Gottemoeller--to negotiate the follow-on treaty. We owe it to Americans to place consideration of the new treaty at the top of the agenda when it is submitted, so the United States can continue to pave the way toward a safer and more secure world.

Mr. President, a few weeks ago the Department of Education released application guidelines for the Race to the Top competitive grant program. I am very encouraged that these guidelines include a competitive preference for science, technology, engineering, and mathematics--or STEM--education. I commend the Department for its foresight.

Throughout the year, I have spoken many times about how important a focus on science and engineering is to our continued economic recovery. Engineers and scientists have always been the world's problem-solvers. They will help us to solve the challenges of clean water; lifesaving cures for cancer and disease; clean, renewable petro-free energy; affordable-health care; and environmental sustainability.

Yet, if we are to tackle these immense challenges, we can no longer wait to begin training our Nation's future STEM professionals until after they leave the K-12 education pipeline. That is why I am so pleased that the Race to the Top grant application emphasizes STEM education. This is just the kind of attention STEM education needs.

The Race to the Top fund is designed to reward States that have been successful in raising student achievement and have superior plans to accelerate education reform. State grant applications must, of course, focus on certain core education reform areas. However, an emphasis on STEM education is considered a competitive preference priority worth 3 percent of a State's application score. It is the only competitive preference in the Race to the Top application guidelines. Applicants will earn all or none of the designated points, thereby truly rewarding sound initiatives.

To meet this priority, each State must offer a rigorous course of study in STEM education. They are encouraged to collaborate with industry professionals, universities, research centers, museums, and other STEM-focused community partners. Additionally, each State must have a plan for preparing and assisting teachers in integrating STEM throughout the curriculum. This includes offering applied learning opportunities and relevant instruction for students.

There are some successful STEM education programs already in operation throughout the country. A study released by the National Academy of Engineering in September highlighted a handful of K-12 engineering curriculum projects. Other education-based initiatives are also spurring interest among our youth. For example, there is a remarkable afterschool program in Wilmington, DE, that I recently spoke about here in the Senate. It inspires high school students to pursue careers in STEM fields by teaching them how to build robots. It is a great program. All too often, though, these types of opportunities have not been available to all of our Nation's students. The Race to the Top grants will bring more opportunities to more students.

Perhaps the most important component for meeting this grant priority is that States' plans must prepare more students to pursue college majors and careers in STEM. They must also specifically address the needs of women and underrepresented minorities. The United States cannot maintain its position as a technological leader nor can we solve the problems we face without a diversity of perspectives and participation.

Women constitute about half of the students in our higher education system about half of the overall workforce, but they comprise only slightly more than 12 percent of the science and engineering workforce. African Americans hold only 4.4 percent of science and engineering jobs, Hispanics just 3.4 percent. We can, and must, do better, and the Race to the Top application guidelines are a step in the right direction.

Over $4 billion is available for competitive grants in the Race to the Top program. This is an unprecedented level of discretionary funding for the Department of Education, and States nationwide will be pulling out all the stops to earn their share of the pie. Many States working months ago to put the correct conditions in place to apply for funds.

Moreover, the ``Educate to Innovate'' campaign was recently launched by President Obama. This campaign is a nationwide effort of private companies, universities, foundations, nonprofits, and science and engineering societies--working with the Federal Government--to improve student performance in STEM subjects. As part of this effort, business leaders and nonprofits will be joining forces to identify and replicate successful STEM programs across the country. For example, Time Warner Cable and the Coalition of Science After School are creating an online directory of STEM afterschool programs. Other STEM organizations will be teaming up with local volunteers to host National Lab Days, and President Obama announced an annual science fair at the White House. This type of public-private collaboration is just the kind of action we need to bolster STEM education.

I sincerely hope the competitive preference for STEM education in the Race to the Top application, coupled with the ``Educate to Innovate'' campaign, will spur the kind of investment and attention in STEM education that I believe all of our students deserve. Our country is counting on these future scientists and engineers.

Mr. President, I am pleased to join the Chairman of the Foreign Relations Committee and my colleagues to introduce an important piece of legislation, the International Climate Change Investment Act of 2009. Climate change is a global issue and only a concerted international response can succeed. This legislation provides key elements of an international deal that will both protect our planet and meet our Nation's international responsibilities. Even more importantly in these times, it will open the door to a green economy that can create jobs here for the markets abroad for clean energy goods and services.

Successful global climate negotiations will create the opportunity for us to transform our own economy, to free ourselves from dependence on fossil fuels from foreign sources, and to create the jobs and markets for a new, sustainable economy.

This legislation establishes a new framework for a global market in clean energy technologies. A complete agenda to confront climate change will include support for our educational base and for the research, development, and deployment of clean technologies. A climate deal that moves us away from fossil fuels will create global demand for those technologies. Building capacity and encouraging dramatic change in other countries will create a pool of customers for America's innovators.

That global market offers us the best chance to create a new economy based on a growing demand for clean energy goods and services--and that will support job creation and profits here at home. Companies in my home state of Delaware and across America are ready and eager to seize this opportunity for a world's worth of new markets. Our smartest investors agree.

This legislation shows the rest of the world that we are ready to do our part to make a smart, effective, and fair international climate change agreement work. It sets us on a firm forward footing to lead the way in tomorrow's green economy.

Mr. President, I am pleased to join the Chairman of the Foreign Relations Committee and my colleagues to introduce an important piece of legislation, the International Climate Change Investment Act of 2009. Climate change is a global issue and only a concerted international response can succeed. This legislation provides key elements of an international deal that will both protect our planet and meet our Nation's international responsibilities. Even more importantly in these times, it will open the door to a green economy that can create jobs here for the markets abroad for clean energy goods and services.

Successful global climate negotiations will create the opportunity for us to transform our own economy, to free ourselves from dependence on fossil fuels from foreign sources, and to create the jobs and markets for a new, sustainable economy.

This legislation establishes a new framework for a global market in clean energy technologies. A complete agenda to confront climate change will include support for our educational base and for the research, development, and deployment of clean technologies. A climate deal that moves us away from fossil fuels will create global demand for those technologies. Building capacity and encouraging dramatic change in other countries will create a pool of customers for America's innovators.

That global market offers us the best chance to create a new economy based on a growing demand for clean energy goods and services--and that will support job creation and profits here at home. Companies in my home state of Delaware and across America are ready and eager to seize this opportunity for a world's worth of new markets. Our smartest investors agree.

This legislation shows the rest of the world that we are ready to do our part to make a smart, effective, and fair international climate change agreement work. It sets us on a firm forward footing to lead the way in tomorrow's green economy.

It is up to $220 billion.

That is absolutely right. What we are going to do is increase the number of whistleblowers, people who will see health care fraud and report it. We are going to get more prosecutors. We are going to get more FBI people. We are going to get more people to make sure we bring this health care fraud down. That is part of this bill.

But I do not understand--to follow up on what the Senator from Maryland said--how can you say you do not want to debate the bill, when you look at the fact that the alternative is our present health care system, which is totally, completely broke? How can you say you do not want to do it? You say you are fiscally responsible. How can you say you are fiscally responsible when you are not going to do anything about Medicare and Medicaid health costs and the cost of health benefits in this country?

As we have said many times before on the floor, my State is one of the worst cases; that is, in 2016, a family of four making $50,000 a year would be paying $29,000 in health care premiums. They cannot afford $29,000 in health care premiums. So what is going to happen? They are going to have the equivalent of half what they have today. If they can afford $12,000 or $13,000, they are going to have half the program.

I heard my colleagues on the other side talking about rationing. What is going to happen to these people when they are getting half as much health care from these health care companies? And the health care companies are the ones that decide what procedures you can have, when you can have them, and those kinds of decisions. When people have their health care insurance cut by this amount, you have to worry about whether they are going to be able to get the things they need.

Of course, Medicare and Medicaid prices are going through the roof. It is going to bankrupt the country. In 6 or 7 years, Medicare and Medicaid costs will cost more than everything else in the Federal Government. So how you can talk about----

Absolutely.

I think that is absolutely right. Right now, medical bankruptcies are 60 percent of U.S. personal

bankruptcies--a rate 1\1/2\ times what it was 6 years ago--because of medical bills. The thing that is striking about this is, 75 percent of the families entering bankruptcy because of medical bills actually have health insurance. Two-thirds of all Americans filing for bankruptcy because of medical bills already have health insurance. We cannot stop that unless we change the system and give people more insurance and give them better insurance and make sure you cannot be denied for preexisting conditions and make sure--the killer--once you get sick--it is bizarre. You get sick, and then the health insurance company comes in and cuts off your health insurance. No wonder so many people are going into bankruptcy.

I was presiding yesterday for I don't know how many hours. When you listen to what is said on the Senate floor by the other side, they are talking about a model where there is no competition. Any tax on an insurance company is going to be passed on to the consumer. What kind of a business--I don't know anybody in business who, if they get an increase in cost, they just pass it on to the consumer. Right? I mean, we have a law of supply and demand the last time I checked. But every single one got up and talked about the cost and said this is going to hurt the consumer. It is not going to hurt the insurance companies because they are just going to pass it on to us. The reason they are going to pass it on to us is kind of obvious.

Here is a list, a small list, that lists all the States in America and how much of their insurance is tied up in two or less companies. Do you know what you have to do? You have to get down to No. 40, Oregon, because the first 39 States on this list, two insurance companies make up over 50 percent of the market in their State. How can you have competition when you have so much of the business tied up in just one entity?

The way you can tell there is not competition? You don't have to have an advanced degree in economics to figure out there is no competition. How do you know there is no competition? Every January, my premiums go up. The only other thing I know that I get that goes up every January is my cable bill, right? There is no competition in cable. You either take cable or you don't. They say there is competition. So every year, whether it is January, February, or March my cable bill goes up. And every year, just like clockwork, my health insurance premiums go up. So clearly, there is not competition.

That is why a public option is so important. We have to have a public option so there is competition not only in the top 39 States where one firm has over 50 percent--two firms have over 50 percent of the business--but in all 50 States.

That is what this bill does. It is amazing to think on the other side, the support they have for competition, and I believe they do and I know them and I respect them and they all are concerned about competition--except every once in a while they kind of turn a blind eye to the fact of how powerful competition is. Competition is valuable and powerful in keeping costs down and increasing benefits and quality of care--only when there is actually competition. So we are going to have to have competition. This bill will actually do it.

I think the reason we use these examples so much is because certain words kind of roll off your lips; words such as ``preexisting condition.''

Here is an example involving Angela in Dover, and she is a bartender, not a waitress. Her income is from tips. She has no health insurance through her employer. She became pregnant. She tried to find private health insurance, but she was declined coverage because pregnancy was considered a preexisting condition.

Now, just do a visual for a minute. This woman has been living off of tips. She is about to have a baby, and there is nowhere she can go to get health insurance. She applied for Medicaid to find prenatal care for herself and her baby, was denied coverage because she earned $200 more than the monthly income limit. I mean, just picture this now, if you were in this situation. She called organizations and clinics and was unable to find a payment plan she could afford.

Midway through her pregnancy, Angela decided to cut back her work hours so she could qualify for Medicaid. She worked all 9 months of her pregnancy and delivered the baby on May 27. The Medicaid coverage she got was especially crucial because she had complications with hyperthyroidism and was able to get the necessary prescriptions to control her condition.

OK. Do we have the picture? How would we like to see ourselves with our spouses or our kids with this kind of a decision? The sad part of the story, as if it is not sad enough, is that Angela was so anxious to ensure that everything possible was done for a healthy baby and the system threw up roadblocks. Pregnancy should not be considered a preexisting condition.

People in this country who are pregnant should not have to worry, in addition to going through the trauma of being pregnant for 9 months and the baby being healthy and all the fears you have and on top of that fear they may go into bankruptcy because they cannot afford to pay for the doctor bills for their baby. This is real stark to me.

We are going to vote tonight on cloture so we can move to a bill that will, once and for all, make sure Angela Austin and all the women similar to her who have the ``preexisting condition'' of pregnancy will only have to worry about their baby and what is going to happen to her and not worry about what she is going to do when the child is 2 and she is in bankruptcy, because so many people are going into bankruptcy.

We are all concerned about the economy. Even with health care reform, I think for every Senator I talk to on both sides of the aisle, their biggest problem is getting people back to work again and getting the economy moving. It is truly tragic when you think so many people are losing their jobs. Under our present system, the way it is structured, when you lose your job, you not only lose the money coming in to you, you lose your health insurance. You lose your self-respect because we are all judged on where we work. That is how people judge us.

As has been said, the longest walk is the walk home to tell your spouse and your kids that you lost your job. The irony of ironies and the thing that makes this so incredible is that you don't just lose your job and self-respect, you lose your health care insurance.

We have a system, and we have to change the system so these people out their right now can maintain their health care insurance and care for their children and their families, as they and everybody in their families go through this very traumatic experience.

Madam President, I rise this afternoon to talk about the topic that is on the mind of each and every Senator today: health care reform. First off, I wish to congratulate our majority leader, Senator Reid. He has accomplished something that has not been done in years. He has the Senate on the precipice of debating a major health reform bill on the Senate floor.

I agree with the Senator from Florida. Tomorrow night at 8 o'clock we should come to the floor and we should move this bill. It is essential that we pass health care reform this year. The present system lets down all Americans and we need a new, reformed health care system. We should move this bill and then we can debate, we can amend, as the Senator from Florida said, and we can deal with this bill then. But it is essential that we move this bill.

Senator Reid has melded the good work of the Finance Committee and the Health, Education, Labor, and Pensions Committee into one bill that we stand ready to bring to the Senate floor. If people don't acknowledge that accomplishment, they are forgetting history. For all the efforts to reform our health care system back in 1994, the Senate never came close to bringing a bill to the floor to debate. Because of the searing experience the Congress went through back then, it took another 15 years to pass before Congress attempted another major reform of our present dysfunctional health care system.

I believe if we don't get it done this year, it might take another 15 years or more before we will bring it up again, and Lord only knows what will happen to the health care system in this country in the interim. But thanks to Senator Reid and Chairmen Baucus, Dodd, and Harkin, as well as the tremendous efforts of their members, the committee staffs, all the long hours, weekends in the office and time spent away from their families, we stand here this afternoon literally a day away from the first procedural vote on the Patient Protection and Affordable Care Act. Make no mistake. We cannot afford to wait another day to fix our health care system.

We need to pass health care reform because the trajectory of our national health care expenditures is out of control. In 1979 we spent approximately $220 billion as a nation on health care--

$220 billion. By 1992 we spent close to $850 billion. And in 2009 we will spend $2.5 trillion on health care--from $220 billion in 1979 to $2.5 trillion in 2009. The trajectory clearly is absolutely unsustainable.

We need to pass health care reform because premium costs for middle- class Americans are rising at an astronomical rate. Take my home State of Delaware, for example. In 2000, the average premium for family health coverage was just over $7,500. In 2008, that number had jumped to $14,900, almost doubling in just 8 years. If we do nothing and allow the current health care system to continue, the same premium for family coverage is expected to reach $29,000 in 2016, another doubling of the price. Think about it. Every 8 years, our premiums doubling in size. That is simply unaffordable.

We need to pass health care reform because failure to do so will drive more and more Americans into bankruptcy. Today, bankruptcies involving medical bills account for more than 60 percent of U.S. personal bankruptcies, a rate 1\1/2\ times that of just 6 years ago. Keep in mind, keep in mind, 75 percent of families entering bankruptcy because of health care costs actually have health insurance. To repeat: More than two-thirds of all bankruptcies due to medical expenses are of Americans who have health care insurance. That number is simply appalling.

We need to pass health care reform because small business owners and their employees are desperate for relief from the cost of health insurance. Right now small business owners and their employees pay much higher premiums than their counterparts in large corporations. In fact, during the past 5 years, one in five small businesses reported premium increases of 20 percent annually. Add that up and that is 100 percent over 5 years. Imagine paying a 100-percent increase.

Largely because of the increase in premium rates, fewer and fewer small businesses offer coverage to their employees. For example, in 2000, 68 percent of small businesses were able to offer health insurance coverage to their employees. By 2007, just 59 percent of small businesses offered health benefits. That is a reduction from 68 percent to 59 percent in just 7 years.

Small businesses are the engine of our economy and will be the catalyst to get us out of this recession. It is time to make it easier for small business owners to provide health insurance for their employees so they can retain the workers they have and hire more to help lift us out of this economic distress.

We need to pass health care reform because failure to do so could bankrupt the country. Just look at Medicare and Medicaid. One of the biggest driving forces--in fact, the biggest driving force--behind our Federal deficit is the skyrocketing cost of Medicare as well as Medicaid. In 1966, Medicare and Medicaid accounted for only 1 percent of all government expenditures. They now account for 20 percent. If we do nothing to start bending the cost curve down for health care costs for Medicare and Medicaid, we will eventually spend more on these two programs than all other Federal programs combined.

I am pleased the Patient Protection and Affordable Care Act begins to tackle these problems and begins to reform our health care system. It is passed time.

This bill is fiscally responsible. Anyone who is concerned about our budget deficits should embrace this bill. According to the Congressional Budget Office, the bill will reduce deficits by an estimated $130 billion over the first 10 years from 2010 to 2019, and by more than one-quarter percent of GDP in the decade after. This amounts to about $55 billion in 2020 and several hundred billion dollars over the next 9 years. This is not chump change. This is real, effective deficit reduction that will help our economy over the next 10 to 20 years.

In addition to reducing the deficit, the bill strengthens the Medicare Program. Contrary to claims of the bill's critics that we hear on the Senate floor, the Patient Protection and Affordable Care Act adds coverage for Medicare beneficiaries. It doesn't cut a single service. Let me repeat: It doesn't cut a single service.

For instance, the bill provides seniors with three annual wellness visits under Medicare where they can develop personalized prevention plans with their doctors to address their health conditions and other risk factors for disease, making the conditions easier and less costly to treat. The bill also eliminates out-of-pocket costs for recommended preventive care and screenings such as mammograms. In terms of restrictions on drug coverage, the bill helps seniors manage the cost of the doughnut hole in Medicare Part D coverage by giving a 50-percent discount on brand-name drugs and biologics to low- and middle-income seniors.

Most importantly, the act helps ensure the sustainability of the Medicare Program for years to come. In the past year, Medicare spending has increased by roughly 8 percent a year. According to the CBO, under this bill, the annual growth rate for Medicare dropped substantially to 6 percent for the next several decades. Adjusted for inflation, CBO estimates that Medicare spending per beneficiary under this bill will increase the annual average rate of growth of roughly 2 percent during the next two decades, much less than the roughly 4 percent annual growth rate of the past 20 years.

Right now, the Medicare Hospital Insurance Trust Fund is projected to become insolvent in 2017. But with the measures to strengthen the Medicare Program contained in this bill, the date of insolvency of the trust fund is put back by at least 4 to 5 years. Simply put, this bill is good for seniors and Medicare and good for the Federal budget.

As I mentioned earlier, small business owners struggle to provide their employees with affordable health insurance. This bill will help small business in this quest. The bill will provide a sliding scale tax credit based on the number of employees and annual average wages of these employees to help these small employers pay for health insurance for their employees. This tax credit is estimated to reach more than 3.6 million small businesses nationwide. In addition, small businesses will be able to purchase insurance through the new State-based exchanges. These exchanges would allow small businesses to expand their risk pool and thereby lower premiums. The bill is a win for small business.

The bill helps protect middle-class Americans against the worst abuses of the insurance industry. No longer will Americans be denied coverage because of preexisting conditions. Let me repeat that: No longer, if we pass this bill, will Americans be denied coverage because of preexisting conditions. No longer will insurers be able to rescind people's coverage once they get sick and they actually need the insurance they have been paying premiums on. No longer will insurers be able to charge people more based on their health status or gender.

The bill helps protect the finances of middle-class Americans and helps reduce the number of medical-related bankruptcies by placing a cap on what insurance companies can require families to pay out of pocket. It also restricts the use of annual limits and prohibits the lifetime limits on insurance benefits, which is especially important for Americans with high-cost conditions to treat. It creates a health insurance exchange that provides a public insurance option to compete with private insurers to provide consumers with more choice.

This will make a great difference in States where one or two insurance providers dominate the marketplace and where there is no true competition.

These are good, strong provisions that will help provide health security and stability to all Americans.

The bill is strong in two other areas as well: promoting prevention and wellness and cracking down on waste, fraud, and abuse. On the prevention front, the bill recognizes that we have to move away from a system that encourages people to wait until they are sick to seek treatment. Instead, it encourages prevention and early treatment of diseases which can help lower the cost of treating patients.

The bill recognizes the need to shift this emphasis by eliminating any copayments or deductibles for recommended preventive care and screenings, such as cancer screenings, colonoscopies, and mammograms. The bill would allow employers to offer premium discounts and other awards for up to 30 percent of the total premium

for individuals who quit smoking, lose weight, lower their cholesterol or blood pressure, or take other steps to improve their health status.

We have already seen how successful this type of program can work at companies such as Safeway. All of these measures will help increase the use of preventive measures and reduce the need of costly new treatments as a result of waiting too long to treat a condition or disease.

Finally, I wish to highlight the measures contained to reduce the waste, fraud, and abuse that exist in our current system. Each year, health care fraud drains between $72 billion and $220 billion from doctors, patients, private insurers, and State and Federal Government. Left unchecked, fraud drives up the cost of care while reducing public trust in our health care system. I am pleased this bill will increase the funding for the Health Care Fraud and Abuse Control Fund to fight fraud in public programs. In fact, CBO estimates that every $1 invested to fight fraud results in approximately $1.75 in savings.

In fact, CBO estimates that every $1 invested to fight fraud results in approximately $1.75 savings.

The bill will also establish new penalties for submitting false data on applications, false claims for payment, or for obstructing audit investigations related to Medicare, Medicaid and the State Children's Health Insurance Program.

By reducing the amount of waste, fraud and abuse tolerated in the health care system, we will be able to bring health care costs down for everyone.

Mr. President, this is a good bill.

I have only touched on parts of the bill, as time does not allow me to discuss every provision--including the fact that the bill will extend insurance coverage for an additional 31 million Americans.

But it is a good bill. It is fully paid for. It reduces short and long term deficits. It strengthens the Medicare program. It provides security and stability for the middle class. It provides Americans with greater insurance choices. It promotes prevention and wellness. It cracks down on waste, fraud and abuse. I applaud the hard work that went into the drafting of this bill.

As I have said many times, it is time to gather our collective will and do the right thing during this historic opportunity by passing health care reform.

We can't afford to wait another 15 years. We need to act now. We can do no less.

The American people deserve no less.

I suggest the absence of a quorum.

How can a business do this? There is a real reason why they can do it. It is because there is no competition. Other companies can't do that. They can't treat the people who are customers the way the insurance companies do. When you look at the list, you can see why they get away with it. There is no competition. In the top 39 States out of 50, over 53 percent of the market share is with 2 companies. There is no competition right now in health care. That is the big reason why we need the public option. The reason for the public option is it allows us to have competition in these States where there is no competition at the present time. You can have gigantic profits. You can have CEOs making millions of dollars. You can have all these things. You can treat your customers poorly. You can do all these things because you don't have to worry about somebody coming into the business and offering them a good or better deal. That is what the public option does.

One final point. You can tell there is no competition when every year your premiums go up. The only other business I know similar to that--and I don't mean to hurt anybody's feelings--is the cable company and my TV bill. I know every year, no matter whether the inflation rate or the cost of living is down, I will get a notice in December--don't we all--basically saying my health care premiums are going up and my cable costs are going up. The reason is because both these are essentially operating as monopolies.

Mr. President, today, I rise to recognize the inauguration of President Karzai, as he begins his second term as President of Afghanistan. This milestone presents a unique opportunity to begin a new chapter in Afghanistan's history, which I hope will be characterized by transparency, effective governance, accountability, and an even stronger partnership with America.

Our two governments share common interests in the success of Afghanistan and the stability of the region.

When I met with President Karzai during my September visit to Kabul, we discussed counterinsurgency strategy and the importance of stronger governance at all levels--national, provincial, and district. Counter- insurgency strategy has proven effective throughout the course of history, and good governance is essential for its success.

President Karzai knows that he must garner greater support among the Afghan people for his government because, ultimately, this is a battle for legitimacy between the Afghan government and the insurgents. We will continue to partner with the Afghans to defeat the Taliban, but counter-insurgency cannot succeed if the Afghan people believe their government is plagued by corruption.

I welcome President Karzai's recognition of corruption as a ``dangerous enemy of the state'' in his inaugural address earlier today.

His intention to create an anti-corruption unit is an important step to this end, but words are not enough. He must match this rhetoric with action, and immediately take steps to effectively address the problem.

No government official is above the law, and all should be held accountable for their actions. Numerous criminal cases involving government officials--such as recent allegations that the Afghan Minister of Mining accepted a $30 million bribe as part of an illicit deal with a Chinese mining firm--must be thoroughly investigated.

As President Karzai said today, government officials should register their earnings. Those who engage in corrupt behavior should face the full weight of the law and be brought to justice.

Corruption must be addressed for two primary reasons: one, to build the confidence of Afghans in their government; and two, to ensure that the government functions more effectively in providing essential services.

In order to fulfill these two goals, I urge President Karzai to appoint competent governors and cabinet members who respect the rule of law and human rights, and are unequivocally committed to the people of Afghanistan. The stakes are too high to revert to cronyism. Now is the time for President Karzai to appoint and support capable, effective, and law-abiding public servants.

The essential defense against the Taliban is an effective Afghan government. As such, I urge President Karzai to work with the United States and other international partners to produce specific and measurable guidelines for combating corruption, improving government transparency and accountability, providing essential services, strengthening rule of law tackling the drug trade, and improving the economic infrastructure.

Clear benchmarks must be set, and progress must be monitored to ensure compliance.

This plan cannot be limited to Kabul. It is critical that government officials in the provinces and districts are well qualified and empowered with the necessary authorities and budgets to improve the lives of all Afghans. We must work together to undermine the Taliban's foothold and role as the de facto provider of rule of law and basic services, especially in southern Afghanistan.

In addition to good governance and essential services a third element of success in counterinsurgency is the training and deployment of effective national security forces.

I welcome President Karzai's stated intention to assume complete Afghan control over security within 5 years. I also echo his calls for NATO partners to take more effective steps to accelerate the training of the Afghan National Army--ANA and Police--ANP.

Currently there are not enough Afghan and international forces on the ground to ``clear and hold'' against the Taliban. In fact, the number of trained Afghan security forces is less than one-third that of Iraq-- a geographically smaller country with nearly the same-sized population.

The training of the ANA and ANP must be expedited to build a stronger force of needed counterinsurgents, with the near-term goal of transferring responsibility to the Afghans.

During my two trips to Afghanistan this year, it was clear that the Afghan people identified security as a key concern, and wanted a swift transition from international to Afghan forces. Americans also hope for a swift transition, so we can eventually end our military presence and bring our brave troops home to their families.

I fundamentally disagree with accusations by some in Afghanistan-- including President Karzai--that the U.S. presence in Afghanistan is purely self-serving. We are committed to working with President Karzai to secure our shared objectives. It has been said that nations have no permanent allies, only permanent interests. As we stand on the cusp of history together, the United States and Afghanistan are allies with shared goals and coinciding interests.

As President Obama outlined in March, it is America's goal to disrupt terrorist networks in Afghanistan, to defeat al-Qaida, and to help to promote a more capable and effective Afghan government. The way to do this is to partner with the Afghan people to defend them against a resurgent Taliban. As Secretary Clinton said, these are mutually reinforcing missions.

There is an underlying urgency to this joint venture, and we cannot succeed without a true partner in the Afghan government.

In his inaugural address, President Karzai said the right things. Now is the time for implementation.

During my visits to Afghanistan, I was impressed by the resolve and vision of the brave people of Afghanistan. In the face of enormous challenges, the majority of Afghans have rejected the Taliban's oppression, and chosen to seek a better life for future generations.

Today represents an opportunity for President Karzai to fulfill the hopes and dreams of his people, and bring greater peace and prosperity to Afghanistan through good governance.

As he begins his second term, President Karzai must forge a path that will lead to a brighter future, free from corruption. We need leadership, resolve, and determination, if we are to be successful in Afghanistan.

Mr. President, I ask unanimous consent that the Senate proceed to the immediate consideration of S. Res. 355, submitted earlier today.

I ask unanimous consent that the resolution be agreed to, the preamble be agreed to, and the motions to reconsider be laid upon the table en bloc; that any statements relating to the resolution be printed in the Record without intervening action or debate.

I ask unanimous consent that amendment No. 2786 be printed.

Mr. President, I ask unanimous consent that when the Senate completes its business today, it adjourn until 9:45 a.m. tomorrow, Friday, November 20; that following the prayer and pledge, the Journal of proceedings be approved to date, the morning hour be deemed expired, the time for the two leaders be reserved for their use later in the day, and the Senate resume debate on the motion to proceed to H.R. 3590, as provided for under the previous order.

Mr. President, there will be no rollcall votes during tomorrow's session of the Senate. The next vote will occur at 8 p.m. on Saturday, November 21. That vote will be on the motion to invoke cloture on the motion to proceed to H.R. 3590.

If there is no further business to come before the Senate, I ask unanimous consent that it adjourn under the previous order, following the remarks of Senators Brownback and Hatch.

Mr. President, I ask to speak as in morning business.