Floor Statements

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 President, I ask unanimous consent that the order for the quorum call be rescinded.

Mr. President, I ask unanimous consent to speak as in morning business for up to 15 minutes.

Mr. President, I come to the floor today, as I have done each week for over a month now, to give a doctor's second opinion about the health care bill that has now been signed into law. I do this as somebody who has practiced medicine, taken care of families in Wyoming since 1983. During that time, I was medical director of something called the Wyoming Health Fairs, offering low-cost blood screening for people all around the Cowboy State, giving them an opportunity to take more personal responsibility for their own health, to learn about their health, to help get their blood pressure under control, get their cholesterol down, and get their blood sugar under control, and diagnose cancers early. All of this is aimed at early prevention, meaning better care, better survivability, which is what we need to do in this country--work on patient-centered health care.

Today, I bring to the floor of the Senate my second opinion because I think the bill that was passed into law has failed. It has failed and gotten the diagnosis and the treatment wrong.

The goal of health care reform should be to lower costs, increase quality, and increase access. I continue to believe the new health care law is bad for patients; it is bad for payers, the American taxpayers who are going to be footing the bill, and it is bad for providers, the nurses and doctors of this country who take care of those patients.

Fundamentally, I believe, unlike what the President said, this whole law is now going to increase the cost of care. The American people believe that overwhelmingly, that this is going to increase the cost of their care and it is also going to decrease the quality and availability of the care, to the point that a national poll released just this Monday shows 62 percent of Americans would like to repeal and replace the bill that has now been signed into law.

As the Speaker of the House, Nancy Pelosi, said: First you have to pass the bill to find out what is in it. As more and more Americans are finding out what is in the bill, they are finding there are more and more broken promises.

The President gave a speech, and he said: If you like your health care plan, you will be able to keep your health care plan, period.

He then went on to say: No one will take it away, period.

He said: No matter what, period.

But the Chief Actuary of Medicare and Medicaid says that 14 million Americans will lose their employer-sponsored health coverage under this law. The President is saying one thing, but the Chief Actuary for Medicare and Medicaid is saying something very different. That is why the American people do not feel this bill--now the law--was passed for them. It is for somebody else.

Most Americans have health insurance they like and are happy with, except for the cost. Unfortunately, what this body passed and what the President signed is going to increase the cost and decrease the availability. For people who like what they have, they are not going to be able to keep it.

One might say: Where do you come up with that? There was a lengthy article written called ``Documents reveal AT&T, Verizon, others thought about dropping employer-sponsored benefits.'' Why would that be? Because of a very different regime, it says, a ``radically different regime of subsidies, penalties, and taxes.'' That is so much of what is involved in this health care law--penalties, subsidies, and taxes.

``Many large companies,'' it goes on to say, ``are examining a course that was heretofore unthinkable, dumping the health care coverage they provide to their workers in exchange for just paying penalty fees to the government.''

It goes on:

In the days after President Obama signed the bill on March

24, a number of companies announced big write downs due to

the fiscal changes it ushered in. The legislation eliminated

a company's right to deduct the federal retiree drug-benefit

subsidy from their [companies].

As a result, AT&T, Verizon, and others ``took well-publicized charges of around $1 billion.'' This annoyed Henry Waxman, Democrat from California, ``who accused the companies of using the big numbers to exaggerate''--that is what he said, ``exaggerate''--``health care reform's burden on employers.'' So he summoned top executives to hearings and he requested documents.

The bottom line is, taking a look at 1,100 pages of documents from four major employers--AT&T, Verizon, Caterpillar, and John Deere--``No sooner did the Democrats on the Energy Committee read'' the documents ``than they abruptly cancelled the hearings.'' Why? Because they found out that what the companies had said was true, and it was proper in accordance with the rules and the laws within which they have to operate.

All four of these companies are taking a look at the costs and the benefits of dropping health care coverage of people who like the coverage they have. What are the alternatives if you do not want to provide health care? You pay a fine. You pay a fee.

AT&T, a major company, employs up to 300,000 people with health care coverage they like, and they are in a situation where the company is saying: If we drop their coverage and pay the fine, we as a company can save $1.8 billion.

Is that what this Congress intended? Is that what this Congress imagined? Is that what the people of this country deserve? No.

What this shows is a bill that was crammed through and down the throats of the American people by an administration desperate to have something passed into law, something that many people never even read before they voted in favor of it. And the people who read the bill carefully could see what was coming down the line, came to the floor, and pointed out these things to the American people. The American people heard, but the Members of Congress did not.

There is a new study out that was reported today in the Associated Press. It talks about what other businesses are doing. It was a poll of 650 leading corporations talking about, what do you think this is going to mean for your business? What is this going to mean for the employees? What is this going to mean in terms of health care for those folks and the cost of doing business?

Here it is. What do the employers want? They want to have three goals, and they are the goals all Americans would have. They want to bring down the cost of care, whether you are an employer or an employee. No matter who you are, they want to bring down the cost of care. Contain costs--absolutely, at a minimum. They want to contain costs. Good. They want to encourage healthier lifestyles. Good. This bill hardly does that at all. There are very few, if any, individual incentives. And they want to improve quality of life.

A mere 14 percent of all responding--650 companies--think health care reform will help contain health care costs. An overwhelming majority-- 90 percent--of employers believe health care reform will increase their organization's health care costs. Why should they be any different from what the government Actuary says? The government Actuary, who took a look at the bill, also said the cost curve is going to go up. The cost is going to go up. The amount Congress promised the American people this would cover in terms of the costs--Congress said: Oh, we are going to save money. No, that is not what the people who actually added up the figures said. They said this is going to cost money.

Yesterday, when the President visited with the Republican Members of the Senate, I specifically asked him about this point. He still takes the tact that ultimately the cost curve will go down. The American people, and certainly someone who has practiced medicine now since 1983, and the Actuary, who takes a look at these issues, who actually does the addition and puts a line and puts the total numbers at the bottom, all say: Sorry, Mr. President, that is not true. The cost is going to go up. Insurance costs are going to go up. Quality of care and availability of care will go down.

I come to the floor as a physician offering my second opinion just to tell my colleagues and to tell the American people what I have been hearing from talking with people all around the country. A majority of Americans are pleased with the health care coverage they get from their employers. But now, because of the President's new

law, companies are considering canceling employees' coverage because it would be cheaper for them to pay the government's penalty than to provide health care coverage for their employees. This is not the change Americans want. This is not the change Americans can believe in. This is the change that makes Americans lose sleep at night. In this economy, with 9.9 percent unemployment, the last thing Americans need is a new law that makes it easier for companies to pay a penalty instead of providing health coverage for their employees.

This is not the companies' fault. It is the administration's fault. It is misguided incentives, and that is why the American people are sick of Washington. What we have seen now with regard to the incentives, if you are a big company, is to drop insurance and pay the fine. If you are a small company and you want the tax relief and a tax credit that has been offered, the incentive is to actually fire workers and pay those workers who are still working with you less. That is the way to get a better tax credit.

If you are an individual with a preexisting condition and you have been living by the rules, paying those higher insurance rates through some of the State-authorized funds that have been set up, programs that have been set up to help people with preexisting conditions, to help people who need extra help, so they get their health care covered and even pay more, if you are one of those individuals, the incentive is to drop that coverage, stop paying, and basically go uninsured for 6 months. And if you take that risk of being without insurance for 6 months, only then do you qualify for what is included in this new health care law.

We need a health care law that actually lowers the cost of health care and allows Americans to keep the coverage they have. That is why I come to the floor every week to tell the American people it is time to repeal this legislation and replace it with legislation that delivers more personal responsibility and more opportunities for individual patients; that is, patient-centered care that allows Americans to buy insurance across State lines; that gives people their own health insurance and the same opportunities and the same tax relief for people who get insurance through their jobs; that provides individual incentives for people to stay healthy, exercise more, eat a little less, get their blood sugar under control and blood pressure under control and deal with health care needs as they come along; that deals with lawsuit abuse and the incredible expense of all the defensive medicine practiced in this country; and that allows small businesses to join together to provide less expensive insurance to their employees. Those are the things we need. Those are the things we need to allow us as a nation to deliver high-quality care, available care, at a more affordable cost.

This health care bill that has been crammed through the Senate with a lot of gimmicks and things such as the ``Cornhusker kickback'' and the ``Louisiana purchase'' and ``Gator aid''--those are the things that make the American people look at this city and say: We have had enough. That is why today I come to the Senate floor and offer, again, my second opinion that it is time to repeal and to replace this health care law with something that will actually work in the best interest of the American people.

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

Mr. President, I ask unanimous consent to speak as in morning business for up to 10 minutes.

Yes.

Mr. President, it is with great pride as well as regret that I rise today in the Senate to recognize a great son of the State of Wyoming. He is my chief of staff, Shawn Whitman. He joins me today on the Senate floor. Shawn is leaving the Senate this month after a consummate career working for our State and for our country.

Many in the Senate know Shawn. To know him is to like him. He was the chief of staff for our late Senator Craig Thomas. For nearly 3 years, he has continued in that role serving me. In all of that time, he has demonstrated what it means to be a loyal and trusted adviser, a superior manager, and a terrific friend.

I know that all in the Senate will want to join me in wishing Shawn well and to thank his wife Kristen and his two daughters, Lauren and Katherine, for sharing their dad with us. All of us are sorry to see him go, and we will miss him.

Shawn has actually served three different Wyoming Senators. He began in 1994 right after he graduated from the University of Wyoming. He came to work as an intern for Senator Al Simpson. Later he joined Senator Thomas's staff and filled just about every role, every position that a congressional office can have. He was actually a receptionist. He was a press intern. He was a staff assistant. He was legislative correspondent, legislative assistant, senior legislative assistant, legislative director, and finally chief of staff.

It is the example of Shawn's career path that defines the character of who he is. He completed every task, whatever was asked of him, equally well. He brought enthusiasm, smarts, and good humor to every job from the front desk to the corner office.

It is his willingness to do whatever is needed and to take on any task. That is what makes him so valuable and such a great friend.

Shawn was truly tested. In June of 2007, Wyoming lost a great friend when we lost Senator Craig Thomas. As some of my colleagues know, after Senator Thomas's passing, Shawn led the staff alone. He kept them together in serving the people of Wyoming, even while the Senate seat remained empty.

In the face of this extraordinary challenge, at a time of great sorrow for our State, Shawn continued to lead. Despite his own sorrow and his own grieving, he led others. Shawn showed grace and confidence through it all.

Perhaps it was his early years working the family ranch outside Laramie, WY, that made him so tough. It is his sense of duty, once again doing the job that needed to be done and completing the task, any task that was required.

It was my good fortune to inherit Shawn Whitman. We hardly knew each other when I was sworn into the Senate. It did not take me long to understand his value and to appreciate--fully appreciate--his indispensable leadership.

President Eisenhower once talked about the many jobs he had throughout his private career, his military career, and finally as President. He said his goal was, whenever he was leaving a job, the people there were sorry to see him go. Shawn Whitman personifies that. Everyone in our office--everyone--is sorry to see him go. All who have had the pleasure and the privilege to know Shawn Whitman in the Senate will miss him as he starts a new chapter in his life.

Shawn leaves the Senate with a wonderful reputation--a reputation for integrity and a reputation for leadership, and not just for Wyoming but for the entire Senate, as Shawn led not just my office, but he also led the organization of the Senate chiefs of staff. He was the chief of all the chiefs.

Shawn has been a trusted adviser, manager, a confidante, and a friend to me and to my wife Bobbi. His service has been invaluable.

While I am losing a very important member of my staff, I know I will not be losing his friendship, his advice, and his counsel for the future.

It is here today on the Senate floor that I say: Thank you, Shawn. Thank you for your service to the Senate, to the country and, most importantly, to the people of Wyoming. I wish you well in all you do.

Mr. President, I yield the floor.

Madam President, I come to the floor as someone who has practiced medicine in Casper, WY, since 1983, as an orthopedic surgeon taking care of many of the families in the great State of Wyoming. I come to you to talk about the health care bill that has been signed into law and to provide a doctor's second opinion about what is now the law of the land.

I come to you as someone who has worked very hard for many years, working with preventive medicine and early detection of problems as a medical director of the Wyoming Health Fairs, a program designed to give people information to stay healthy and keep down the cost of their care.

I come to you with a second opinion on what is now the health care law because I believe the goal of health care reform should be to lower costs, improve quality, and increase access to care.

Unfortunately, the new health care law, in my opinion, is going to be bad for patients, for providers--the nurses and doctors who take care of them--and for the payers, the people paying the bills--the patients as well as the American taxpayers.

I am concerned that the health care bill signed into law is going to increase the cost of care, provide less access to care, and is going to lessen the quality of the available care in this country.

I come to you with new information that has come to light on the health care bill and, specifically, an article that was in Politico this Monday, May 17, written by Kathleen Sebelius, the

Secretary of Health and Human Services. What she said in this article is:

We are collaborating with States to set up federally funded

high-risk insurance pools to make sure that the Americans

with the greatest need for health insurance will be able to

get it.

Madam President, you know as well as I that there is an old phrase in politics that goes: ``How does it play in Peoria?'' It is referring to Peoria, IL, and means what is the average American thinking about this. Regarding this health care law, it is not playing very well in Peoria. Peoria is a place that President Clinton referred to when he was running, as did George W. Bush, Ronald Reagan, and President Obama. Those Presidents went to Peoria to talk with people. Yet, when you look at what the Peoria Journal Star has reported about this health care bill, which is now law, in the President's home State, a place that is felt to be the bellwether for political thought in the country, Peoria, IL, the verdict is not good about this health care bill which is now law. I will start with an article that appeared in the Peoria Journal Star that talks about what is happening in Illinois today. It says:

For thousands of Illinois residents who pay high health

insurance premiums because of medical problems, the new

federal health care legislation won't offer relief.

It will not offer relief, this says. Continuing:

The 16,000 residents who already pay into Ilinois' high-

risk health insurance pool will keep paying high rates, while

others who enroll this summer under a new, similar program

will get coverage at lower, more reasonable prices.

What happened here? This is one of the fundamental flaws. Only the people who have been uninsured for 6 months are eligible--meaning those in the current State pool cannot switch and save money. How do the people of Illinois feel about this? How is it playing in Peoria? Quite poorly.

Julie Kramer is quoted in the article. She is 53. She said she is ``feeling a bit cheated,'' in her words, by this health care law. She has paid high premiums for nearly 7 years in the Illinois high-risk pool; she has played by the rules and has done what she needed to do. Is she being helped by the new health care law? Not at all, and she is feeling cheated.

She went on to say that:

. . . it feels very unfair. It goes against the spirit of

what health care reform was supposed to be.

Ms. Kramer is a self-employed writer and owner of Full Moon Marketing Communications in Vernon Hills. She said: ``This does seem like a low blow.''

Members of the Senate voted for the bill about which this person says she feels a bit cheated, it seems unfair, and it seems like a low blow. The existing program is called the Illinois Comprehensive Health Insurance Program. Thirty-four other States have similar programs.

People in this Illinois program pay 25 to 50 percent higher--more than standard rates. So they pay their premium; they pay every month. They continue to pay. Yet they are feeling cheated, they feel it is unfair and is a low blow.

Even the Illinois Department of Insurance--their director-- understands this lady's frustrations. To even the playing field, the director said the State legislature would have to act to reduce the premiums. You cannot rely on Washington. Illinois expects to receive money from the Federal Government to start the new high-risk pool. The insurance department says there might be enough money to cover about 5,000 people in the new plan. How does that compare? Far fewer-- according to the article in the Peoria, IL, paper, far fewer than the number of people who may qualify. A Government Accountability Office report said about 218,000 people might be eligible for a high-risk pool in Illinois.

Well, what does the Illinois high-risk pool Web site say? They sent a letter to enrollees--the people who pay their premiums month after month and play by the rules--and it says it is unlikely Federal funds will be available to reduce premiums paid by the current enrollees--the people who have played by the rules and have continued to pay the bills. They didn't actually send out this letter. They put it on their Web site. They wanted to send it out, but they didn't have the $5,000 for postage to send this letter to the people who have been sending thousands and thousands of dollars into this high-risk pool every year.

The director said: No, we have not mailed the letter because the cost of mailing was prohibitive, given that we have, at this point, not received any actual funding. He said it would be inappropriate to withdraw funds to send such a letter.

Well, Julie Kramer was shown the letter on the Web site, and she said: You know, I did feel a little flash of anger and disappointment when I read it.

I say to the Secretary of Health and Human Services--who wrote a letter to those in Washington via Politico, who said we are doing what we can to make sure we are helping these people--the people of Peoria do not agree and do not believe what she has to say.

That is why, across the board, a majority of the Americans who need health care, who are concerned about the cost of care, look at this health care law and believe, in terms of a law this Congress has passed and this President has signed, that it is going to actually make the cost of their own care go up and the quality of their own care go down. That is why, overwhelmingly, the American people have rejected this health care law.

That is why I come to the floor again with my second opinion, and my opinion is it is time to repeal this law and replace it--replace it with solid ideas that will help people lower the cost of their care, improve the quality of their care, and increase their access to care. That would be patient-centered health care, health care that allows people to buy insurance across State lines, that gives people who buy their own policies the opportunity to get the same tax relief that big companies get, to provide individuals incentives to stay healthy and get the cost of their care down by lowering their risk factors for disease because half the money we spend in health care in this country goes to 5 percent of the people--those who eat too much, exercise too little, and smoke. We need to find solutions that deal with lawsuit abuse, to get down the cost of all the defensive medicine that is practiced in this country and allow small businesses to join together to provide less expensive insurance for the people who work for those businesses.

Those are the things we know will work, the things we know will be able to allow us to deliver higher quality care, that will allow us to lower the cost of care. That is why it is my opinion, as a physician who has practiced medicine since 1983, that we need to repeal this health care law and replace it with something that will work for the people of America.

I yield the floor.

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

Mr. President, I come to the floor today--and the Republican leader has already addressed this body--to discuss the issues of health care, about new revelations, new information that has come forth in terms of the specifics of the costs of the health care bill that has been signed into law--the costs that far exceed what was ever anticipated.

I come here as somebody who has practiced medicine in Wyoming for 25 years as an orthopedic surgeon, taking care of families in Wyoming, as medical director of the Wyoming Health Fairs, a program that provided low-cost health screening in Wyoming. This gave people an opportunity to take more responsibility for their own health and keep down costs of their medical care.

I come to the floor with a second opinion, as a physician--a practicing physician, taking care of patients; it is a second opinion about the health care law.

Today, I come to the floor because the goal of the health care bill was truly to improve quality and access and get the cost of care down. Those are the things I think all of the Senate wanted to have achieved.

But having seen this bill that has been passed and signed into law, I believe the bill is going to be bad for patients, bad for our providers, the nurses and doctors who take care of them, and bad for the payers--the American people, who will foot the bill for this health care bill.

I believe this bill will fundamentally, as it has been passed into law, result in higher costs for patients and in less access to care for people all across America. It is going to result in unsustainable spending, at a time when we are running record deficits.

I think about the things the President said when he was not just running for office but as President. He said: The plan I am announcing tonight--it was a joint session--will slow the growth of health care costs for our families, for our businesses, and for our government.

But in fact, the Chief Actuary for Medicare and Medicaid has said that the President was wrong. He said the cost of care will actually go up by $311 billion through 2019. And now we heard the revelation yesterday from the Congressional Budget Office that when you look at some of the things that hadn't been scored, as they say, costed out, it will add another $115 billion on top of that. The President said if you like your health care plan, you will be able to keep it, ``period.'' He said the word ``period.'' He said nobody will take it away, ``period.'' No matter what, ``period.''

The CBO and the Chief Actuary said that 14 million Americans will lose their employer-sponsored health coverage under the new law.

Today, I come to the floor to also mention that recently the Secretary of Health and Human Services, Kathleen Sebilius, had an epiphany about the doctor shortage in America. Last week, she said a nationwide primary care physician shortage had to be addressed before over 30 million Americans get access to subsidized health insurance coverage.

This is her quote:

How are we going to be ready when we already have a

shortage in too many parts of the country?

This shortage should not have been a surprise to the Secretary of Health and Human Services. The American Association of Medical Colleges tells us that at the current graduation and training rates, we are facing a shortage of 150,000 doctors in the next 15 years. Over the past year, medical experts warned Congress--this body--and the administration that any health reform bill should tackle the issue of physician shortages. Instead of helping doctors, the new law actually discourages the next generation from becoming doctors. This new bill cuts payments for doctors and cuts patients on Medicare, and it doesn't include enough money to train new doctors.

I believe it was intentional. Maybe the Secretary, maybe the Obama administration, and maybe the Democrats in Congress should have paid attention to the experts before jamming this health care law down the throats of the American people. Maybe they should have heeded the calls I heard from medical professionals all across Wyoming and the country to slow down, let's get it right. But, no, they didn't. And now the American people are stuck with a law that costs too much, doesn't solve America's doctor shortage--doesn't even address it--and doesn't deliver good care for patients.

This should not have been a surprise to the Secretary, because the Wall Street Journal, over a month ago, said that the medical schools can't keep up. As the ranks of the insured expand, the Nation faces a shortage of 150,000 doctors. Right here, it says a shortage of primary care and other physicians could mean more limited access to health care and longer wait times--more limited access and more wait times.

What about the training of doctors? The Secretary just realized this, but it has been in print for months. Doctors' groups and medical schools had hoped the new health care law passed in March would increase the number of funded residency slots--you know, where they train family doctors--but such a provision didn't make it into the final bill. With over a trillion dollar bill, are we going to train doctors? No, they left it out.

Then what about hospitals? Here it is in the Wall Street Journal--the headline ``Hospitals Under the Knife. New York City System Aims to Cut 2,600 More Jobs as State Funding Drops.''

Not enough doctors? All you have to do is go to the New York Times, and this headline: ``More Doctors Giving Up Private Clinics.''

That is the end of it. So why would so many doctors behave this way? Let's look at Congress Daily this past week, May 4: ``Latest CBO Figures Show Higher `Doc Fix' Price Tag.''

That is to pay doctors for the doctor bill. Of course, it was left out of the health care bill. How can we have a national health care law that fails to address training doctors and paying for them? It is astonishing. It says that scheduled cuts take effect June 1, an option outlined Friday by CBO to freeze Medicare payment rates which, under the new figures, would cost $275.8 billion through 2020. That is an amazing amount, because physician payment rates for Medicare are expected to be cut 21 percent on June 1.

That is what we are looking at now. That is why, today, I come to the floor to give, as a doctor, a second opinion, because it is time to repeal this legislation and replace it with legislation that delivers more personal responsibility and more opportunities for individual patients. We need a patient-centered health care bill, one that provides individual incentives, such as premium breaks for people who behave in a way that encourages healthy behavior and gets down the risk factors that increase the cost of care; that allows people to take their health insurance with them when they switch jobs; that gives people who buy their own health insurance the same tax relief available to people who get their insurance through work; that allows Americans to buy health insurance across State lines; that deals with lawsuit abuse and that allows small businesses to join together to offer health insurance to their employees. These are the things that will work to get down the cost of care and deliver higher quality of care to the American people.

They are not in the health care bill that passed the Senate, that passed the House, and was signed into law. That is why today, once again, in light of this brandnew information on the increased costs and the final realization that the Secretary of Health and Human Services now says: Gee, we don't have enough doctors to cover the situation, it is time to repeal this bill and replace it with what we know will work for the American people.

I yield the floor.

Mr. President, I agree absolutely with my colleague because that is exactly what is happening in the British health care system. It is delayed care, and delayed care, to me, equals denied care.

This has been such a major topic for discussion among the people in Britain that it was brought up in the recent debate for the prime ministership in the election, in the first televised debate ever. One of the questions that was asked of then-Prime Minister Gordon Brown was what about the National Health Service; people have to wait too long. Here is the quote. We have a transcript because I read about this in the local papers and got the transcript. He talked about people with cancer.

Now, this is very important to me, Mr. President, because my wife Bobbi is a breast cancer survivor. She was diagnosed in her forties as a result of a screening mammogram. So we spend a lot of time thinking about, talking about cancer, as do many families in this country.

Well, this is what he said about people who have cancer. This is Gordon Brown answering the question, what about the National Health Service and the long delayed time before treatment.

He said, ``They will also be able to know that their operation will be in 18 weeks.'' Mr. President, 18 weeks, if you are a cancer patient in need of an operation--18 weeks for your cancer operation. That is what the Prime Minister of England is promising the people as an aspirational goal. It makes you wonder how long is the delay right now.

So it is no surprise that the British medical journal, the Lancet Oncology, in their August 2008 summary of statistics, says in every category Americans survive cancer at higher rates than patients in other developed countries. American cancer patients have a higher survival rate for every major form of cancer than patients in Canada and Britain. American women have a 35-percent better chance of surviving colon cancer than British women. American men have an 80- percent better survival rate for prostate cancer. I have a list, cancer by cancer--breast cancer, colon cancer, prostate cancer--and the survival rates are much better in the United States than they are in Britain. It is not that our doctors are any better, it is that the treatment is more timely.

Imagine, Mr. President, being diagnosed with cancer and being told that your operation will be coming in September. Here we are in May, so 18 weeks from now--September--is when you will have your operation. All of that time the cancer can be growing. The cancer can be spreading.

As a patient in the United States, you may say: Do I really want Dr. Berwick? Do I want somebody who favors the National Health Service of Britain, someone who says they have incredible respect for the way it works and thinks it is the right way to go? Would an American citizen want that person to be in charge of Medicare and Medicaid for this country?

So I just have to respond to my colleague that, as a physician who has practiced for 25 years, and as a husband of a wife who is a breast cancer survivor--who has had detection through a screening mammogram and then very rapid surgery, where there actually was the spread of the cancer from the breast to one of her lymph nodes--I think she is alive today because of the screening mammogram and the timeliness--the timeliness--of her surgery and treatment in the United States.

I see the minority leader, and I see he is incredulous that we would be considering that sort of a system and that sort of a director for Medicare and Medicaid in this country.

My take is that it wouldn't work for Wyoming. But this entire health care bill--law, travesty--isn't going to work for Wyoming. We look at the numbers, and the Congressional Budget Office says 15 percent of hospitals in a few years are going to

find they are losing money and they can't stay open. People are going to have to travel long distances, very long distances, to get quality care. Sometimes with weather and with winter, it is very difficult. So I have lots of concerns for all of the rural communities in this country because we have somebody from Boston, or the big city, who doesn't think the way we do in Wyoming or Kentucky or in Kansas.

The other travesty of this is that the President of the United States has been in office now for well over a year--almost a year and a half-- and it is only just now he has nominated someone to be in charge of Medicare and Medicaid. I have continued to ask on this floor why that is. Why has the President intentionally refused to send a name to the Senate to be in charge of Medicare and Medicaid at a time when this country was debating health care legislation; at a time when the President was proposing cutting $550 billion from our seniors on Medicare; at a time when the President was pushing--cramming--into Medicaid another 18 million people?

It is interesting, looking at this whole thing, because what we see happening in Britain right now--they call it NICE, but there is nothing nice about it--National Institute for Health and Clinical Excellence--what Dr. Berwick has had to say about it is very much the opposite of what doctors who practice there have said. What he has said about this system is that:

Those organizations are functioning very well and are well

respected by clinicians, and they are making their

populations healthier and better off.

But a London colon cancer specialist says:

A lot of my colleagues also face pressure from managers--

Managers in the British health system--

not to tell patients about new drugs. There is nothing in

writing, [he says] but telling patients opens a Pandora's box

for health services trying to contain costs.

So it gets down to not quality of care, not availability of care but the cost of care.

Dr. Berwick says NICE is extremely effective and a conscientious, valuable and--importantly--knowledge-building system.

This is what--someone--says:

Doctors are keeping cancer patients in the dark . . .

These are specialists, polled by Myeloma, United Kingdom:

Doctors are keeping cancer patients in the dark about

expensive new drugs that could extend their lives. . . .

So let's keep people in the dark rather than tell them what is there that can help extend or save their life. That, to me, is not a system that the American people want.

Mr. President, I first thank the chairman for the acknowledgement and thank him for the opportunity to take the floor.

I come here because of new information that has come to light about the health care bill that has been signed into law. As a physician who has practiced medicine in Wyoming for 25 years, as an orthopedic surgeon, I come to offer a second opinion on this bill and now this law. I went into this focused on the sorts of things the President had talked about--lowering the cost of care, improving the quality of care, increasing the access to care. But I come to the Senate floor today with my second opinion because I think these things have not been accomplished by the bill that has been signed into law.

For many years, I have been the medical director of the Wyoming health fairs--giving low-cost blood screening to people around the Cowboy State, giving them opportunities to learn about themselves, their health, and to focus on getting down the cost of care.

Today, when I come with my second opinion, it is that this bill--this bill now signed into law--is going to be bad for patients, bad for providers--the nurses and doctors who take care of these patients--and bad for payers, the people who are going to be paying the bill for this new law, the taxpayers of the country. I believe fundamentally that in passing this law, this is going to result in higher costs for patients, not lower costs. It will result in less access for patients, not more access. This is going to result in unsustainable spending at a time when we are looking at record unemployment and record debt.

I come today to talk about what I have seen in the new information that has been coming forth since the bill was signed into law. I have an editorial written in the Columbus Dispatch:

Almost daily the ill effects of the health care overhaul

passed by Congress are becoming apparent.

The editorial in the Columbus Dispatch goes on:

As employees and government bureaucrats analyze the law's

effects on the bottom line for the private sector and for

government, the alarm bells are ringing. The tragedy is that

these ill effects could have been and should have been

calculated before the law was passed, not after.

It goes on:

In fact, many of them were prophesied before passage of the

bill, but the prophets were ignored by President Barack Obama

and the Democratic majority in Congress. That is because

their uppermost goal was

not to pass the best health care bill possible but merely to

pass anything that could be called health care reform and

could be claimed as a political victory by a President

desperate for one.

I come today with my second opinion on the high-risk pool which has been in the headlines the last couple of days. When the President and Democratic Members of Congress were pushing the health care bill, they promised that people with preexisting conditions would receive immediate relief. The bill has been signed into law, and Americans with preexisting conditions remain as confused as ever as to how this new law will impact them, will impact their lives and will impact their pocketbooks.

Unfortunately, hundreds of thousands--that is right, hundreds of thousands--of Americans with preexisting conditions are going to end up getting the short end of the stick. In fact, even USA Today recently reported that the new law is going to trap 200,000 Americans in pricey, State-operated, high-risk plans. Here is the front page of USA Today from last Thursday: ``Health law traps some in pricey state plans; 200,000 hard to insure can't get federal option.'' Mr. President, 200,000 Americans trapped. These are the folks who have been paying for coverage through the State high-risk insurance programs that exist today.

One might say: How can that be? What is the catch? These 200,000 people are not eligible for the brandnew, low-cost, high-risk program that is created by the law. Are these not the people we were trying to help? The law requires that for people to get into this new plan, they have to have been without insurance for the last 6 months. We have 200,000 Americans with preexisting conditions who have been playing by the rules, who have been doing what is right. What happens? They are not going to have any access to the benefit the President and the Democrats in this Congress promised would be available to them.

Don't just take my word for it. Here is what the Kansas insurance commissioner had to say. She said that we have people who have struggled to stay in our existing pool and take care of their existing health needs. And then this new pool comes along, and it is more generous and they are not going to be eligible for it.

What is the difference? With the new pool, the maximum amount someone is going to have to pay for an individual is $5,950; for a family, $11,900. That is 100 percent of the standard market rate. But many of these high-risk pools across the country are at a point where they are charging twice the standard market rate because these people are an increased risk because of their preexisting conditions.

The people who have been playing by the rules, doing it right, and, as the insurance commissioner said, people who have struggled to stay in the existing pool, they are going to be left out, ignored, and rejected by this new law the President has signed into law.

This week, all 50 States were given the opportunity to tell the administration whether they wanted to run their brandnew, high-risk pool for individuals with preexisting conditions. The answer has not been positive.

Just yesterday, Tuesday, May 4, the Washington Post said: ``18 states decline to run `high-risk' insurance pools.'' Eighteen States said to Washington: No, thank you. Eighteen States have refused to participate. Why? Mainly, they do not know, if and when the Federal money runs out, how it is going to be paid for.

One may say: What do you mean, the Fed money runs out? They just passed this health care bill that is going to cost almost $1 trillion. For this high-risk pool, the amount of money that was put in, $5 billion--in the Chief Actuary report of Medicare and Medicaid, they said the money is likely to run out before 2012, even though it is supposed to last until 2014.

What is going to happen to these States? No one knows, and the administration is not saying.

The Governor of Wyoming, Dave Freudenthal, looked at this as a Governor and asked: What do I want to do? Do I want to participate or not? He is one of the Governors who looked at it very carefully, and he is one of the Governors representing the 18 States that said, ``No, thank you,'' to Washington.

This is what he said in his letter to the Secretary of Health and Human Services, Kathleen Sebelius. He said:

The State of Wyoming has operated a very successful high

risk health insurance pool for nearly 20 years, which has

served Wyoming citizens well.

And we have. I was involved with this when I was in the State senate, where I served for 5 years. As he said, a very successful, high-risk health insurance pool for nearly 20 years, which has served the citizens of Wyoming very well. Then he goes on to say:

. . . necessary requirements have not been set out and key

terms have not been defined. Without such guidance, I find it

unwise to further consume my staff and Department of

Insurance with the guesswork currently necessary to implement

this program.

Mr. President, these Governors are just guessing--guessing if it will work, guessing if it would not work--and nobody knows. That is why, in an interview with the Associated Press yesterday, the Governor of Wyoming said:

. . . the $8 million the federal government offered the

state to run the high-risk insurance program until 2014

wouldn't be enough.

He also said he's concerned the state wouldn't have been

allowed to administer the federal pool together with its

existing state program.

Sorry, States--this is what the Secretary is saying--we in Washington know better than you. You might have a program that has worked for 20 years very successfully in your home State of Wyoming, but we don't want to know about it. We want you to either set up a new program and do it our way or forget about it. And that is what the people of Wyoming have decided because the Governor said: When I looked at it, it just didn't seem to make financial sense.

So, once again, the administration is saying: Trust us. They want to act now and ask questions later. Well, Americans and Governors across our country have serious questions about this new high-risk insurance program--how much it will cost the States, how much it will cost the taxpayers, and why all American patients with preexisting conditions would not have access to the immediate benefits they were promised.

Unfortunately, Washington's lack of answers clearly demonstrates that this administration doesn't have its act together. The administration has not delivered on the President's promise to help all Americans who have preexisting conditions have access to the same affordable health insurance coverage. That is why all across this country people are saying: This bill, rammed through the Congress, with all the sweetheart deals, and signed into law, wasn't passed for somebody like me. It was passed for somebody else.

So I come to the floor of the Senate today to say it is time to repeal this legislation and replace it with legislation that delivers personal responsibility and opportunities for individual patients, that will get down the cost of care, that will improve the quality, and will improve the access to care. We need patient-centered health care-- something that will provide individual incentives, such as premium breaks for people by encouraging healthy behavior; that allows people to take their health insurance with them when they move from State to State or when they change jobs; that gives the uninsured and the self- insured the same relief when they buy insurance that the big companies get; that allows people to buy insurance across State lines; that deals with lawsuit abuse; that allows small businesses to join together to get down the cost of their care. These are the things that will work to get down the cost of care, to deliver high-quality care, and improve access to care. Those things are not in the health care bill that was signed into law. They are not in the health care bill that passed this body and passed the House.

So that is why I come to the Senate floor to once again offer my second opinion that it is time to repeal this bill and replace it-- replace it with something that will work well for the American people.

Mr. President, I yield the floor.

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

Madam President, I come to the floor as someone who practiced medicine in Casper, WY, for 25 years. I was an orthopedic surgeon for the people of Wyoming, as well as medical director of the Wyoming Health Fair Program, which reached across the State with low- cost health care screenings, aimed at giving people the opportunity to take more responsibility for their own health and essentially keep down the costs and get down the cost of their medical care.

Today, I come to the floor with a second opinion on what this Senate has passed, what the House has passed, and what has been signed into law by the President. I come today because I continue to believe that what is now the law of the land with health care reform is going to be bad for patients, bad for providers, the nurses and doctors, and those who take care of our patients, and bad for payers--the American people--who end up paying the bill for health care in this country--the taxpayers of this Nation, people who pay for their own care. I believe fundamentally, as this bill has been passed into law, it is going to result in higher costs for patients, as well as for taxpayers, less access to care for people all across America, and unsustainable spending at a time when we are running record deficits.

That is not just my opinion. If you ask what the public believes, in polling across the country the American people have overwhelmingly rejected this bill that is now signed into law by the President, because they believe the cost of their own personal care is going to go up and the quality of their own personal care is going to go down. Fundamentally, they believe this bill was not passed for them but for someone else.

The reason I come to the floor today to talk about it is because the report has just come out by the Centers for Medicare and Medicaid Services Actuary, Richard Foster, the Chief Actuary. He has come out with a report to go through methodically, page by page, what is actually in the health care bill. You will remember that when the bill was in front of the House, the Speaker of the House, Nancy Pelosi, said you will have to pass the bill before you get to find out what is in it. In a rush by this body to pass the bill--which to me was irresponsible--they have missed the things the Actuary has outlined now in a very thorough report to the American people. I want to go through that with you.

Fundamentally, this says that health care costs are going to be higher, access to care is going to go down, and the spending is unsustainable. It is fascinating, because this is in light of a speech by President Obama in June of 2009, when he said if any bill arrived from Congress to his desk that is not controlling costs, ``that is not a bill I can support.'' He said it is going to have to control costs.

Well, the Actuary tells us that the bill now signed into law by the President, as well as the additional bill, because there are actually two new laws--one the initial bill and then the fix-it bill--will increase costs, raise Federal spending, threaten access to care for seniors, and will result in higher insurance premiums.

That is not a Republican Senator saying that; that is the Chief Actuary for the United States in charge of Medicare and Medicaid in a well-documented report that came out April 22, 2010.

What is actually in the report? Let's go through it page by page. The first thing is, it says this is going to bend the spending curve--the rate at which we are spending on health care in the country. The President said we want to get the spending cost curve down. This says the opposite, that the cost curve is going to go up. That is on page 2.

Turning to page 4, What about overall national spending on health care over the next 10 years? Between 2010 and 2019, national spending on health care is going to go up by $311 billion. The President said he wanted a bill that was actually going to get the cost of care and spending down on health care.

Turn to page 7. The President said he wants to make sure if you have care you like, you can keep it--keep the care you like. We all heard that. We heard it time and time again. Yet, on page 7 in this report by the President's agency, it says about 14 million people will lose their employer coverage by 2019. Again, the President said if you like what you have, you can keep it. His Actuary, who actually did the numbers on the bill, said, sorry, 14 million people will lose their employer coverage by 2019.

Let's turn to page 8. An estimated 23 million people will remain uninsured by 2019. This is at a time when the President said he wanted to provide coverage for all these people. But even 10 years out, 23 million people will still remain uninsured in the United States. Many of them are going to have to pay a penalty because of that. They will be

fined because that is how the rule and that is how the law has been written.

I talked with a lot of seniors. I was home this past weekend in Wyoming visiting with a number of seniors around the State. I was in Torrington, WY, and Casper visiting with folks. They are concerned about their Medicare.

What does the report say about Medicare? Turn to page 9: Unsustainable. The cuts we are looking at are going to become unsustainable even within the next 10 years. With the cuts to Medicare of over $500 billion, one would think at a time when we are looking at more and more seniors coming of age to be on Medicare that we would have used that specific Medicare money to keep it in Medicare, use it to save Medicare, not to start an entirely new government program.

As you work your way through this, you say: What does this mean for seniors on Medicare? That gets us to page 9 and page 10 of the national report of the Centers for Medicare and Medicaid Services. These are the people who know. They looked into the numbers. They said they did not have time to do it while the House and the Senate were rushing to pass the bill. They said we should have given more thought and time to this bill.

What happened when they actually looked at what has been signed into law? They talk about cuts to providers, to the people who take care of the patients on Medicare. They are expecting many providers, medical professionals to ``end their participation in the program.'' This is going to jeopardize access to patient care.

The report says 15 percent of all the hospitals in this country, all the nursing homes in this country, and similar providers--we are talking about home health care agencies, that link, that lifeline to people who are at home needing care; hospice, for people who are in the final days of their lives--about 15 percent of all of them, as a result of the way this bill has been put together, are likely to be operating at a financial loss by 2019.

Are they going to be able to stay open? Are they going to be able to provide care for people? Absolutely not. Are they going to close down? Very likely. Is that going to impact a lot of rural communities across this country? Absolutely.

As we go through this actuary report, it brings to light what Nancy Pelosi meant when she said we have to pass the bill to find out what is in it. What a shame it is that the American people, although they sensed what was in it, had to wait until this point so they could continue to express their concerns to those who voted in favor of it.

Let's take a look at some other provisions. Those who supported this bill said there are other Medicare savings provisions in the bill that will help save money and that will help control future health care growth. No--the report on page 13--they said those things people in this Chamber said would help control future health care costs would have a ``negligible financial impact over the next 10 years''-- ``Negligible financial impact over the next 10 years''--even though Members of this Senate stood on the other side of the aisle and absolutely swore that this was going to improve care, as well as get down the cost of care.

Let's turn to page 15 of the report, the CLASS Act. That is the long- term care insurance program that so many in this Chamber thought was going to be a wonderful thing, and those on my side of the aisle said: This cannot work. The numbers are not going to work for our country. They are not going to work for this bill. Who are you trying to kid?

The Democrats who supported the CLASS Act were not able to kid the people at the Health and Human Services Centers for Medicare and Medicaid Services. No, they saw right through it. But, of course, the report came out after the bill had been signed into law by the President.

What the report says is that the CLASS Act faces ``a significant risk of failure''--``a significant risk of failure.'' It says there is a very serious risk that the CLASS Act program will be unsustainable. People on this side of the aisle said that. We said it before the vote. We heard from the other side of the aisle: Oh, no, you have it all wrong. People who looked at it and know--and these are the President's own people--said: Unsustainable.

What about premiums for insurance? Last year the President said he expects to lower the health care premiums for the average family in this country by $2,500. That is an incredibly admirable goal, something all Americans would support because, after all, early on the President said: My goal is to get down the cost of care, clearly something he abandoned early on.

What this says on page 17 of the report from the Actuary is that the new laws, fees, and excise taxes, higher drug prices, device prices-- this is all going to result in higher insurance premiums for American families, the exact opposite of what the President promised.

Let's go to page 16 because we have talked about funds allocated for the new high-risk insurance pools. I think it is important to have these pools. They work well in various States. A number of States have these pools. It is a commitment by the State. We want to involve the Federal Government, have people working together with folks with preexisting conditions, people who absolutely need care.

The CMS report says what this body has done is insufficient. It says the amount of money they decided to put in this program is going to be exhausted by the year 2012. Once again, this body who said they knew better than the folks who studied the bill, those who said we just have to pass it to get something done, have created a monster, and the American people are going to be paying the price for a long time.

Let's look now to page 20. So many of the people who are going to be covered under this program, how are they going to be covered? The President said: I want to cover all these people. What he decided to do and what this body decided to do is to cram another 18 million people on to Medicaid, a program we know right now is fundamentally flawed. It is broken. Half the doctors in the country do not want to see patients on Medicaid because the reimbursement to them is so low. Hospitals tell you they lose money when those patients are in the hospital. Doctors say they cannot keep their offices open if they take more and more Medicaid patients. The only way they are allowed to see them is by charging other patients more--the cost shifting that happens in health care in America.

What does this say about Medicaid? Eighteen million more people are going to be put on Medicaid by the year 2019. Is that going to be care? The President talks about coverage, but he does not talk about care. These people are very unlikely to get care.

This is what the report says on page 20: A significant portion of the increased demand for Medicaid services, because there are all these millions more people on Medicaid, the increased demand for Medicaid services could be difficult to meet. All these patients are going to be put on Medicaid, and they are not going to be able to get care.

I say it is hardly fair and it is misleading to the American people. Everybody in Canada has coverage. They have coverage but they cannot get care. Madam President, 33,000 Canadians came to the United States last year to pay for their own health care because even though they had coverage in Canada, they could not get care there. So they came to the United States and paid for care.

About a year ago when the President of the United States was talking about health care, he always held up the Mayo Clinic for excellent care in America, and it is a model for excellent care. The Mayo Clinic said: We do not want more Medicaid patients, because they lose too much money by taking those people, and they want to keep their doors open to fulfill their mission.

Here we have the Actuary who is looking at this page by page--and, obviously, the Centers for Medicare and Medicaid Services knows what they are talking about. They looked at the numbers and item after item, page by page and said: This is not working.

One of the things we talked about at the Health Care Summit was the issue of Medicare fraud. I sat at the table and discussed the issue with the President. This law does almost nothing--almost nothing--to limit actual fraud and abuse.

Last year, Medicare paid $47 billion in claims that were suspect. We know in Florida, drug dealers have been moving from dealing in drugs to Medicare

fraud. One may say: Why? Why would they do that? They are doing it for a couple of reasons: One, it is more profitable; two, it is less likely they will get caught; and, third, if they do get caught the penalty is less. They say: More profit, less chance of getting caught, less punishment. I think I ought to go into Medicare fraud. That is what they are doing.

What does the Actuary say when he looks at the new bill? He estimates the fraud provision in the law will save only about 2 percent, only $1 out of every $50 of Medicare fraud.

As we look at this, it is no surprise the American people want a second opinion about this bill. It is no surprise the American people are saying it is time to repeal and replace the bill. That is why I come to the floor of the Senate with my second opinion, with 25 years of practicing medicine.

On the way over, I picked up USA Today. It is so interesting, a big story in the paper today: ``Next Phase In Health Care War: Applying The Law.'' The subheadline is ``Cabinet''--we are talking about the President's Cabinet, the Cabinet of the United States--``Cabinet Braces For Lobbying Blitz By Industry Advocates.'' The Cabinet is bracing for a lobbying blitz. I thought the President of the United States said he did not want lobbyists in the White House, did not want lobbyists impacting on his Cabinet. They are weighing right in. Absolutely.

The President did have them in the White House, obviously behind closed doors, cutting the deals. That is the way we ended up with a health care bill that is bad for patients, bad for providers, and bad for payers, the American payers, the taxpayers of this country, and the people who are paying for their health care. That is why I come to the floor to say it is time to repeal this legislation and replace it with legislation that is actually patient centered, that gives more responsibility and opportunities for individual patients, just what I tried to do through the Wyoming health fairs where we give people more information so they can use that information to get their cholesterol down, get their blood pressure under control, find out if they are diabetic and if they are, get their blood sugar under control, give people incentives to stay healthy and keep down the cost of their care.

We need a patient-centered health care bill. We sure do not have one. We need a health care bill that allows people to buy insurance across State lines. That increased competition will drive down the cost of care.

The University of Minnesota did a study: 12 million more Americans would have insurance today without this bill if all we did was allow Americans to buy insurance across State lines and allow small groups to join together to get better opportunities to buy insurance to get the cost down.

Then, of course, we need to deal with abusive lawsuits that exist in this country which drive up the cost of care for patients because all the tests that doctors routinely order are not to help the patient get better but to make sure the doctor does not miss something.

That is why I come here today to tell you, Madam President, that there are things that will work to get down the cost of care. There are things that will work to provide additional treatment for more people in America; more patients, better care. But they are not in this health care bill that passed the House, passed the Senate, and was signed into law by the President.

That is why today I offer my second opinion that it is time to repeal this bill and replace it with what will work.

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

Mr. President, I come to the floor as a physician who has practiced orthopedic surgery in Casper, WY, for 25 years.

I come to offer a second opinion on the health care bill that was recently passed and signed into law. My opinion on this bill is very different than what I have heard from the administration, from the Speaker of the House, and from the majority leader because my opinion is that this bill--now law--is going to be bad for patients, bad for patients all around this country, bad for health care providers: The doctors, the nurses, the folks who work in our hospitals, the therapists. I believe it is going to be bad for the taxpayers--people who are going to be left with this large bill to pay for a bill that is not to save a health care system but to create new entitlements and new obligations.

As I have looked at this, it struck me last week when they were having the debate in England. They are having an election, and the candidates for Prime Minister were having a debate. It was the first nationally televised debate ever in England in an election. They compared it to the Kennedy-Nixon debate when people were up there debating and discussing.

The question presented to the Prime Minister of England was: What about the national health service? Those of us on my side of the aisle have been very concerned that with this new law we are going to be seeing a nationalization of our health care in a way like we are seeing in other countries, whether it is Canada, whether it is England--a system I think is not what the American people want.

But I wish to read to you from the transcript of the debate because they asked the Prime Minister, Gordon Brown, about the National Health Service. He said:

My priorities for the health service are that we give

people personal guarantees--

So this is what he is promising--

that every individual patient will know they will get a

cancer specialist seen within two

weeks if [they] need it. They'll get a diagnostic test within

one week, and the results to them. They will also be able to

know that their operation--

So now they know they have cancer--

will be in 18 weeks if you're any patient in need of an

operation.

So here you are, you have had your opportunity to see a cancer doctor, you have had your test, you have your diagnosis. What is the best the people of England are being promised by their Prime Minister? The best they can expect is to have an operation within 18 weeks.

The question here is, How many Americans, how many Members of this body, how many people across this country are going to see that as satisfactory? Because that is where we are heading with this health care bill that is now signed into law. How many people want that: You will have your operation in 18 weeks.

So here you are, if you are diagnosed next week in the United States--if this were the situation they have now in Britain--you would be looking at having your operation in September. See you in September. Come back for your operation. Now you can worry about it. You can worry about your diagnosis of cancer the rest of April, all of May, all of June, all of July, all of August. That is what the candidate for Prime Minister and the current Prime Minister of England is promising the people of that country with their national health system--a system that is the model of many people on the other side of the aisle of what they want American medicine to be like.

This story, once again, demonstrates that coverage does not equal care. Because everyone in Britain has coverage, but they sure cannot get care. Then you ask yourself: Does it truly matter? Does 4\1/2\ months--18 weeks--of waiting for your cancer surgery truly matter? There is not just the emotional worry of: Is that cancer spreading within my body? Should I leave the county of England and go to the United States where I can get immediate care? You have to worry because the statistics back up the fact that the care in the United States is much better than it is in England--not that the doctors are any better here than they are in England but that the timing of when you can receive the care from those qualified professionals is much better in the United States.

So if you take a look at the statistics behind this from the researchers who look at this--and I will just go through it because my wife is a breast cancer survivor. She has had a series of three operations. She has been through chemotherapy twice, and she is now surviving 6 years after her diagnosis. I am grateful she was treated in the United States, where the day after the diagnosis was made they wanted to get in immediately to do the operation.

So let me tell you, it says that today the United States leads the world in treating cancer. These are scientific studies. For breast cancer, for instance, the survival rate, after 5 years, among American woman--a woman who is diagnosed in the United States with breast cancer and is treated--83 percent are still alive 5 years later. For the women in Britain, 69 percent. Where do you want to get your care? The bigger question is, When do you want to get your care?

For men with prostate cancer, the survival rate is 92 percent in the United States; 74 percent in France; 51 percent in Britain. American men and women are more than 35 percent more likely to survive colon cancer than their British counterparts.

In an article from the August 2008 edition of Lancet Oncology, the cancer Journal there, the United States is No. 1 again. In almost every category, Americans survive cancer at higher rates than patients in other developed countries. American cancer patients have a higher survival rate for every major form of cancer than patients in Canada and Britain.

American women have a 35-percent better chance of surviving colon cancer than British women. American men have an 80-percent better survival rate for prostate cancer. American survival rates are also better than survival rates in France.

You can go on and on with this, but it is evidently clear--evidently clear--that the timing on when one gets their care is critical.

It is interesting to me that just this week--just this very week--the President made his nomination for a new Director of the portion of the Health and Human Services Department that deals with Medicare and Medicaid. The President has been in office for 15 months. We have had a debate and discussion in this body for almost all that time on health care. In this body, the Democrats have voted to cut Medicare by $500 billion from our seniors who desperately depend upon Medicare.

Why is it the President has waited 15 months to finally nominate someone to be the head of the part of government that oversees Medicare and Medicaid? The President has put 15 million to 16 million more people on Medicaid, has cut Medicare, has told us we can trust him on this. Yet he would not put somebody up to go through the confirmation process to head Medicare and Medicaid? Why? Because, in my opinion, he did not want anybody to answer the questions because they are tough questions. Why wouldn't you nominate somebody for all that time and leave the post open, essentially, and not have somebody to come to Congress and say what are the implications to the American people of dumping another 16 million people onto Medicaid, of cutting $500 billion from Medicare?

Well, because the person he has put in has a long history of a love of rationing care. It is a Dr. Donald Berwick. He has a history of support for government rationing of government health care resources on the grounds of cost--not on the grounds of quality, not on the grounds of survivability but on the grounds of cost.

He has said, as recently as last June:

The decision is not whether or not we will ration care--the

decision is whether we will ration with our eyes open.

So here we are, the newly nominated person has basically said: I am going into this to ration care. He is a big supporter of what they have going on in Britain right now. In Britain, they call it NICE. It stands for National Institute for Health and Clinical Excellence. Well, this is what Dr. Berwick has said about it. He said:

Those organizations are functioning very well and are well

respected by clinicians, and they are making their

populations healthier and better off.

Well, let me tell you what a London doctor, a colon cancer specialist, had to say. This doctor said:

A lot of my colleagues also face pressure from managers not

to tell patients about new drugs.

He said:

There is nothing in writing, but telling patients opens up

a Pandora's box for health services trying to contain costs.

He further went on--this now being again Dr. Berwick saying about this British group:

NICE is an extremely effective and conscientious, valuable

and--importantly--knowledge-building system.

What did the BBC, the British broadcast group, say? They say:

Doctors are keeping cancer patients in the dark about

expensive new drugs that could extend their lives . . . A

quarter of the specialists--

one in four specialists--

polled by Myeloma UK said they hid facts about treatments for

bone marrow cancer that may be difficult to obtain from the

National Health Service. Doctors said they did not want to

``distress, upset, or confuse'' patients if drugs had not yet

been approved by the National Health Service drugs watchdog

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

Mr. President, I ask for the yeas and nays.

Mr. President, I rise today to express our Nation's deepest thanks and gratitude to a special young man and his family. I was deeply saddened to receive word during the past recess that that on March 24, 2010, LCpl Jacob A. Ross of Gillette, WY, was killed in the line of duty while serving our country in support of Operation Enduring Freedom. Lance Corporal Ross was killed in combat in Helmand Province in southern Afghanistan.

Lance Corporal Ross was assigned to the 2nd Battalion, 2nd Marine Regiment, 2nd Marine Division, II Marine Expeditionary Force out of Camp Lejeune, NC. Lance Corporal Ross graduated from Campbell County High School in 2008. He is remembered by his friends as hard-working, intelligent and kind-hearted. He was athletic and was on the swimming and soccer teams in high school. Jacob had a passion for the outdoors and loved to hunt, fish and camp under the Wyoming skies. He always wanted to be a marine. After graduation, he followed in his father's footsteps and joined the U.S. Marine Corps.

It is because of Jacob Ross that all Americans are able to live our daily lives as free people. Freedom is not free. It carries a very high price. And that price has been paid over and over by America's men and women who answer the call to service and willingly bear the burdens of defending our Nation. They deserve our deepest respect and gratitude. They put their very lives on the line every day, and because of them and their families, our nation remains free and strong in the face of danger.

The motto of the U.S. Marine Corps is ``Semper Fidelis.'' It means ``Always Faithful.'' LCpl Jacob Ross lived up to these words with great honor. He gave his life, that last full measure of devotion, for you, me, and every single American. He gave his life serving and defending his country and its people, and we honor him for this selfless sacrifice. He was always faithful to our country and its citizens, and to his fellow marines.

Lance Corporal Ross is survived by his wife Brittney, and his parents Karen and Dennis, his sister Katie and his brother, Nathan. He is also survived by his brothers and sisters in arms of the U.S. Marine Corps. We say goodbye to a son, a husband, a brother, a friend, and a marine. The United States of America pays its deepest respect to LCpl Jacob A. Ross for his courage, his love of country and his sacrifice, so that we may remain free. He was a hero in life and he remains a hero in death. All of Wyoming, and indeed the entire Nation, is proud of him. May God bless him and his family. Lance Corporal Ross, Semper Fi.

Mr. President, it was fascinating to be here in the Senate Chamber this morning when first the Senator from Iowa made the statement, ``I'm all for paying for things.''

I am all for paying for things? But not for this. Not for that. Not for the next thing.

Watching the Senator's voting record, it seems that everything is an emergency. He certainly does not seem to want to be paying for anything, just add it to the debt.

I heard the Senator, my good friend from Michigan, a few minutes ago say it is the United States versus China. My good friend from Michigan said we are laser focused on China and that China is spending money every day to beat us.

I think the problem is the government in Washington is spending money every day--the taxpayers' money, money we do not have, and that is what is going to beat us. It is money irresponsibly being spent by this government in this city, voted on time and time again by a Washington government that doesn't live within its means, doesn't do what the States in this country do, where we do live within our means. I served in the Wyoming Senate where we did balance the budget. The Governor had a line-item veto. We had to balance our budget. It is the spending by us in the United States that is going to lead to China beating us, not money being spent in China every day.

That is why on the front page of the Wall Street Journal today, above the fold, right there, Wall Street Journal, Friday, March 26, 2010, ``Debt Fears Send Rates Up.'' The fear of the debt is sending rates up.

What it means is people do not think we are responsible in the way we are living. We are not living within our means. We are not doing what a family does in this country, where a family says we have to live within our means. When the Senator from Iowa says you can't go down and get an extended line of credit if you have already tapped your credit, this country continues to do it. Washington continues to overspend and not live within its means.

The amount of spending being done, often under the guise of saying it is an emergency, has been irresponsible, unsustainable, and my concern is it will soon be irreversible.

I believe in this country. I believe in America. We are a strong nation. We are a resilient nation. We are a proud nation. And we are a nation that has faced down some of history's most vicious tyrants, we have faced down some of the most incredible obstacles, challenging obstacles, and we have risen to the occasion time and time again.

Today, here we are, faced with many challenges, none of which is too large or too difficult for the American people to overcome. But the President of the United States has determined the people cannot be trusted to overcome the obstacles we face. Instead, here in Washington, Democrats believe the government continues to be the answer. I am here to tell you that government is not the answer. The government is the problem.

Americans have been promised transparency, accountability, hope, and change. Instead, what the American people have been given is irresponsible and unsustainable spending, along with unthinkable government intervention into nearly every aspect of our lives. This country needs an economic environment where people, where individuals, where families, where businesses can recover and thrive. What the administration has done is give us more bureaucracy and more debt and it is going to get worse now that the health care bill has been signed into law. To make matters worse, this government in Washington is sending the bill to our children and our grandchildren.

Look at the proposals that are ahead of us here--costly cap-and-trade proposals which are going to raise costs and raise energy prices for American families, government-run health care, irresponsible bailouts of every industry in sight, one takeover after another, where government says we know better than the American people.

Government is wrong. I have great concern that people here in Washington are completely out of touch with what is happening in the real world. I go home to Wyoming every weekend. I am going today. That is the best way to do it, to go home and listen to people who have to balance their checkbooks, people who have to live within their means, and then visit with State legislators who know when they go to the capitals of their respective States that the States have to live within their means, balance their budget, don't overspend, tighten the belt, cut spending if we need to.

Watching this debate in the last couple of weeks with health care, having practiced medicine for 25 years, we need to focus on the overall health of people as well as the economy, because if people cannot put food on the table or a roof over their head, no matter what additional bill is passed in Washington--which spends more money--that is not going to make it easier for the families of America. Spending billions to combat global warming--global warming--billions, it seems senseless for somebody who is retired and can't afford to heat their home in the Wyoming winter.

There was a time when our leaders recognized that America's most valuable asset was the American people. I continue to believe that. There is a reason the preamble to our Constitution begins with, ``We the people,'' not ``You, the people.'' Our forefathers created a system of government through which free Americans get to decide their own fate. Today the very fabric of America is in danger of being tattered beyond repair, and every time I go home, as I travel around the State of Wyoming, people continue to tell me we are losing our country. I am not the only one who is hearing it. When Senators, when Representatives go home--and many of us do go home every weekend--we are hearing it State by State. Those Members of Congress who choose to not go home, to not go visit with the people they represent, to not hold town meetings because they are told by leadership don't go listen to the people, listen to us--those are the kinds of people who continue to vote for irresponsible spending.

I am hoping Members go home over the upcoming Eastertime, go home and listen to people in their own home communities who will say Washington needs to live by the same rules families in America live by--live within your means. American families know what it means to live within your means.

Since the beginning of this crisis, Americans have been forced to make some very difficult choices and to tighten our belts. Financially stressed Americans balance budgets for food, for gas, for electricity, for tuition, for clothing, rent, mortgage payments, and much more. When your neighbor maxes out the limit on their credit card they are keenly aware this is a clear indication of a spending problem. They cannot call the credit card company and simply say increase the credit limit. Unfortunately, we know Washington is not your average consumer. President Obama said it best. He said:

In the long run we can't continue to spend as if deficits

don't have consequences, as if waste does not matter, as

if the hard earned tax dollars of the American people can

be treated like monopoly money.

Let me repeat that. This is President Obama who said last year, right before Christmas, ``We can't continue to spend as if the hard earned tax dollars of the American people can be treated like monopoly money. That's what we have seen time and time again.'' He said ``Washington has become more concerned about the next election than the next generation.''

Those on this side of the aisle are most concerned about our economy, our Nation, jobs, growth, opportunity, the families of this country. This is a long-term problem and it must be addressed in the short term. We cannot afford to wait. We cannot continue to call everything emergency spending without paying for it.

The American people are demanding action. Time and again Washington's insatiable appetite for spending is met with more of the same. Only in Washington can you max out the country's credit card at $14 trillion and simply keep on spending. Unlike your average American, Washington has refused to make the tough choices needed to rein in unsustainable deficits we are now facing. Since we are not making the tough choices, the cost of handling the debt is continuing to go up. Interest rates are rising which means the amount of money that is going to go to pay that debt will continue to rise. Yet we are looking at a deficit that continues to rise, $1 trillion a year, all the way through 2020, and a Presidential budget that will double the national debt in 5 years and triple it in 10.

The current national deficit for this fiscal year is $1.4 trillion. That is three times the previous record high. As I said, according to the budget projections, the deficit is going to be close to $1 trillion a year through 2020. This budget deficit is simply appalling. All you need to do is go home, have a townhall meeting, listen to people. People around the country are incensed with this sort of reckless, wasteful Washington spending.

The worst part is people do not believe they are getting value for their money. In a recent poll, of every $1 you send to Washington in taxes, how much do you think is being wasted? The American public said 50 cents on every dollar sent to Washington in taxes is being wasted. That is an all-time record high number. People are not seeing that Washington is being responsible in how taxpayer dollars are being used and the American people simply do not believe they are getting value for their money.

I agree, the people are not getting value for their money. All you need to do is look at the Washington wasteful spending and it is no surprise that the American people are incredibly upset. Year after year, monstrous deficits are leading us to a national debt crisis. In 2009 alone, the public debt grew 31 percent. It now is almost half of the gross domestic product. By 2020 it is expected to balloon to over 70 percent of the gross domestic product.

So when I look at this and I talk to people at home and I think about this and I look at the great threats, the great threats to our Nation, to me the debt is the threat. As a result, I take a look at this major spending bill, the so-called stimulus package--which was supposed to keep unemployment down below 9 percent and said if you didn't pass it, it might go to 9 percent--they passed it, and it still went to 10 percent. Do you know only 1 in 16 Americans believes it actually created jobs.

The President is out there saying it created jobs, traveling around the country, and only 1 in 16 Americans believes it. That is how severe this problem is.

With that, I see my part of the time has expired and I wish to turn the remainder of this time over to Senator Coburn.

Mr. President, my amendment protects families and protects small businesses from dramatic increases in insurance premiums. My amendment directs the Department of Health and Human Services to certify that insurance premiums will not rise faster under the new health care law than they would have if the law had not been passed. If they find that premiums are higher, then the new law would sunset.

This month in Pennsylvania, the President said the Senate bill would reduce most people's premiums. I say to my friends on the other side of the aisle, if you believe the President and you believe that this bill lowers premiums, prove it. Vote for this amendment.

This is a reasonable, straightforward amendment. It holds the President and it holds the Members of Congress accountable to the American people for promises made.

Thank you, Mr. President.

I am not aware of that article, but I look forward to hearing about it from my colleague from Arizona.

My colleague is absolutely correct. That is exactly what is happening. They call this a health

care bill. It doesn't seem to address the major issues that patients across the country are concerned about. My colleague is absolutely right, we need a patient-centered approach. It doesn't address the issue that doctors are concerned about, which is the issue of making sure a doctor and a patient can work together toward the best health for that patient.

Doctors and patients alike are very much opposed to this bill. When Senator McCain talks about the doctor fix to make this bill work, they say they are going to cut doctors across the country 21 percent in what they get paid for taking care of patients who depend upon Medicare for their health care, and then keep that price frozen for the next 10 years. That is the only way the Democrats can say, well, this actually saves money. In reality, in terms of health care in the country, it does not.

This bill, if it passes, is going to end up costing patients more. It is going to interfere with the doctor-patient relationship. It is going to result in an America where people truly believe their personal care--and that is what people care about: What is in it for me? How will this bill affect me and my life and my children? If they are providing for adult care, how is it going to affect their parents? They believe the care they receive, in terms of the quality of care and the available care they receive, it is going to be worse. They believe it is going to end up costing more. That is why, in a recent poll this week, 57 percent of Americans say this plan, if it passes, will hurt the economy. We are at a time where we are at 9.7 percent unemployment in this country. People are looking for work, and the place people find jobs in this economy right now seems to be working for the government.

For decades and decades, the engine that drives the economy of our Nation has been small businesses. That is who we rely upon to stimulate the economy and get job growth. That is who we should be relying on, not Washington, not the Federal Government. That is why 57 percent of Americans who are focused on the economy say we believe this economy will be hurt if this bill passes.

People are focused on the debt and the cost, and 81 percent of Americans say it is going to cost more than estimated because of the fact, as Senator McCain has said, that doctors are going to be cut 21 percent across the board and continue for the next 10 years with their Medicare fees. The people of America realize that is not going to work for health care. People are going to say how am I going to get to see a doctor? I am on Medicare. I want to see a doctor. That is why people believe Medicare in their own personal care is going to get worse if this bill passes.

Then the President promised we are not going to raise taxes on anyone. Seventy-eight percent of Americans believe there will be middle-class tax hikes if this passes. That is why people are opposed to a bill that cuts $500 billion from Medicare for our seniors who depend on Medicare for their health care. It is not just cutting payments to doctors; it is to hospitals, to nursing homes where we have so many seniors across the country. It affects home health agencies, which is a lifeline for people who are at home, and keeps them out of the hospitals. They are even going to cut payments for people who are in hospice care, who are at the terminal point, who are in the final days of their life. They are cutting that out.

All of these are reasons the American people say I am not for this bill and it is time to stop. Half of America says stop and start over. One in four says stop completely. Only one in four actually believes this is going to help. That is not a way to pass legislation in this country. That is not a way to find something the American people agree with. That is not the way to get successful implementation of a program. I spent 5 years in the Wyoming State Senate. On major pieces of legislation, we always sought broad bipartisan support because if you have broad bipartisan support, then people all around the community and the country would say this must be the right solution to a significant problem we are facing.

We are facing a problem with health care in this country and we need health care reform. We just do not need this bill that cuts Medicare, raises taxes, and for the most part most Americans will tell you they believe their own personal care will suffer as a result of this bill becoming law. For whatever means or mechanism or parliamentary tricks are used to try to cram this bill through and cram it down the throats of the American people, the American people want to say no, thank you. They are saying it in a less polite way than just saying no, thank you. They are calling, they are showing up, they are turning out to tell their elected representatives that we do not want this bill under any circumstances. Let's get to the things we can agree upon and isolate those and pass those immediately, not an over-2,000-page bill that is loaded with new government rules and new government regulations and new government agencies and new government employees at a time when 10 percent of Americans are unemployed and people are looking for work in communities around the country.

One of the things I found so interesting and also distressing when the President says everyone will have coverage is he wants to do it by putting 15 million Americans on Medicaid. Having practiced medicine for 25 years and seen all patients, regardless of ability to pay, I can tell you there are many doctors across the country who do not see Medicaid patients because what they receive in payment from the Government for seeing those patients is so little. Even the people at the Congressional Budget Office--who look at this health care bill with the cuts in Medicare and with so many people put on Medicaid--say one in five hospitals is going to be unable to stay open 10 years from now if this gets passed because they are not going to be able to even cover the expenses of staying open. The same applies to doctors' offices and to nursing homes.

We need a program approach that is sustainable, not something like this, that we know is irresponsible and unsustainable. That is what we are going to do if we put 15 million more people on Medicaid by sending them a Medicaid card. But, as Senator Alexander has said, that is like giving somebody a bus ticket when a bus is not coming--because coverage does not always equal care.

As a surgeon in Wyoming, I took care of people who came from Canada. They came to Wyoming from Canada for health care. They had coverage in Canada because Canada covers all the people, but they do not get care in Canada. That is why 33,000 Canadians last year came to the United States for surgery. Why? Because the waiting lines were so long in Canada. Even a Member of Parliament had cancer--and my wife is a breast cancer survivor--a Member of Parliament in Canada came to the United States for her cancer care because the survival rates for people treated in the United States are so much better. Why are they better? It is more timely care.

People come for artificial hip replacements because they do not want to wait in Canada. In Canada, come Halloween--it is called trick-or- treat medicine--they have spent the amount of money they are going to spend on a procedure, whether it is cataract surgery or total joint replacement, and they say: OK, we are done. Wait until next year. Go get in line again.

I hear it time and time again in patients who come from Canada to the United States because they have coverage but they do not have care.

Then we look at Medicaid and Medicare and we look at the model the President has lifted up as the one that is a good model for health care in America, and he pointed to the Mayo Clinic, which is a wonderful place with wonderful care. Yet the Mayo Clinic in Arizona said we can't take more Medicare patients. They said we have to limit the number of Medicaid patients we take. Why? Because, by taking care are of those patients in the past, the Mayo Clinic has said they have lost hundreds and hundreds of millions of dollars because Washington is the biggest deadbeat payer of all for health care.

When it comes to actually rejecting patients' claims, the No. 1 rejecter of claims in this country is Medicare. The highest percentage of claims rejected is Medicare, over other insurance companies. Having practiced medicine for 25 years, I have fought with Medicare and I fought with insurance companies, all on behalf of patients. When you are

fighting with an insurance company you can always actually appeal that if they reject it. It is very hard to fight with Washington.

This health care bill we have been debating in the Senate and is now before the House is the one where the American people say don't make me live under this. Don't cut my Medicare. Don't raise my taxes. Don't interfere with my relationship with my doctor. Don't make it tougher for me to get care. Don't lessen the quality of that care.

I ask how much time I have remaining.

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

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

Madam President, I ask unanimous consent to have printed in the Record the letter that Senator McCain referenced from the 85,000 doctors across the country opposing the bill.

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

Well, Mr. President, that is exactly what I am hearing at home from Wyoming's voters and from my patients. I was in Wyoming this past weekend. I have had the privilege of practicing medicine there for 25 years, taking care of families in Wyoming. When I talk to people, their concerns are the national concerns the Senator from Kansas has just mentioned--the debt and what our Nation is facing long term. But they are also very focused on their own personal care. If you have a town meeting or just talk to people at the coffee shop, the people of America believe that if this bill passes, the quality of their own personal health care will go down; that their opportunity to go to the doctor they have enjoyed a relationship with for years, where they know them and they know their family, may be gone.

We are also seeing that health care providers all across the country--even the Mayo Clinic--are saying this bill is a huge lost opportunity. It was supposed to be designed to help get the cost of care down, and it is not doing that. It is going to raise the cost of care. It was designed to improve the quality of care, but it is going to cost people the quality of their own health care. That is why Americans don't like this bill. They do not like anything about it.

The Mayo Clinic was used early on by the President in this debate as the model for how we should have health care in this country. The Mayo Clinic has said ``no thank you'' to patients on Medicare in Arizona, ``no thank you'' to patients on Medicaid. Yet the President plans to push this program through. He says he is going to provide coverage for more Americans, and he is going to do it by putting 15 million more people on Medicaid--a program that many doctors won't see because the reimbursement is so low. If all a provider saw were Medicare patients, they couldn't afford to keep their doors open--not at the hospital or the clinic. And we are hearing that from hospitals and doctors across the country. That is why the Mayo Clinic said: No thank you, Mr. President. We can't take those patients, whether it is Medicare or Medicaid.

This bill will cut Medicare--the program our seniors depend upon--by $500 billion for patients who depend on Medicare. It cuts Medicare Advantage, and that program is an advantage, and the reason people signed up for it is because it provides preventive care and coordinated care. But it is not just that; there will be $135 billion in cuts to hospitals in all our States and communities, $42 billion to home health agencies. These are the folks who help provide a lifeline for people who are at home, and it saves money by keeping them out of the hospital. There are cuts to nursing homes, to hospice providers-- providing services to people in the final days of their lives. That is why the American people are offended that this bill is being crammed through.

I see we have the former Governor of Nebraska here on the floor, who has experienced these issues with Medicaid, with Medicare, and with nursing homes. So I would ask my friend and colleague whether this the same thing he is hearing at home in Nebraska.

I heard that just this morning. We had a number of county commissioners from Wyoming here in Washington. They were at a speech yesterday given by Speaker of the House Nancy Pelosi, and she told these county commissioners, this group from all around the country, we

need to first pass the bill so then later the American people will know what is in it. She said this to them and they laughed. They laughed at the Speaker of the House at this meeting yesterday because these are county commissioners. They know they are not going to vote on something the people in the community don't know about. The people in the community come, they want to know what is going to be discussed and then voted on.

The people of America do not know what is in this bill. They know this bill is going to raise taxes by $500 billion. They know this bill is going to cut Medicare for our seniors who depend upon Medicare by another $500 billion. They know they are going to be paying for this thing for 10 years, but there are only 6 years of services. It is amazing how much the people of America know about the gimmicks of this bill that, in fact, those who are pushing the bill wish they didn't know.

That is why three out of four Americans say stop. A quarter of them say stop, a quarter of them say stop and start over, and only a quarter of them support what is happening here.

Mr. President, I just heard the Republican leader talk about the issue of health care in America and the goal which we heard so much about of getting the cost of care under control.

I have practiced medicine for 25 years in Casper, WY. I was in Wyoming yesterday visiting with physicians, visiting with nurses, visiting with those who are patients, as well as those who are providers, and talking with them about what is happening in this country and in this body with the discussion about health care in America and the legislation. No matter whom I talk with in Wyoming, when they look at this massive, 2,000-page bill and they think about it and then they ask questions about it, they say: How in the world is this actually going to get the cost of care down? How is this going to help them save money? Because as they read it and as they look at the rules and the regulations and the new mandates for more bureaucracies-- they say it is going to be more government employees at a time when there is 10 percent unemployment in the country--they say: It is going to likely cause my own cost of health care to go up, my own insurance coverage to go up. They have great concerns that the quality of their own care will go down--go down. Americans, and certainly the people in Wyoming, are very worried that if this bill becomes law, the cost of their care is going to go up and the quality and availability of their care is going to go down. That is not what they want.

The President was speaking in Philadelphia yesterday. The front page of one of the papers this morning says: ``[The President] Turns Up the Volume in Bid for His Health Measure.'' And he said, as a challenge to Democrats, ``If not us, who?''

Mr. President, it should be all of us. This should not be something that is being rammed through the House and the Senate and force-fed to the American people at a time when 75 percent of them want nothing to do with this bill. Three out of four Americans say: Stop, we don't want this, because they are worried about the cost of their own care and the availability and the quality of the care they are receiving.

So when the President gives his speeches, as he did yesterday, I would say: Involve all of us. Involve all of us in the discussion, which is what we should have been doing for over a year.

I look at what he said in his speech, and he talked about an insurance broker who apparently told some others there was so little competition--this is the President now talking, saying there is so little competition in insurance, that allows people to drive up the cost. The solution to that is the Republican solution that says: Increase the competition, increase the competition. That is what we need. Patients, people, citizens of this country want to be able to shop around, buy insurance across State lines, look for what is best for them and best for their families. If we did that, if we did that today, there would be 12 million more Americans with insurance by merely being allowed to have more competition, to be able to shop across State lines and to look around for something that is best for them and for their families--not the limited choices they may have in the State in which they happen to live.

So I look at this from the standpoint of practicing medicine for 25 years, visiting with patients, visiting with providers, talking with nurses, talking with doctors, saying there are things we can do to get down the cost of care. Unfortunately, they are not included in this 2,000-page bill that is now sitting over in the House, with all of these different approaches to force this through in a way that undermines what the American people want, what the American people are asking for--the opinions of the American people--by a group of people in this body who say: We know better than the American people.

This body does not know better than the American people. The House does not know better than the American people. It is time to listen to the American people, which is why I go home every weekend to visit with those folks in my State, in my home State of Wyoming, to visit with them about their needs, their concerns. And they have great concerns about this bill.

It is not just people in my home communities. Warren Buffett, the great investor, says Washington should scrap this health care bill and start over. He said they should focus, as our Republican leader said a few minutes ago, on the costs. He said we should say we are going to focus on the costs and not dream up 2,000 pages of other things. Warren Buffett says get rid of the nonsense, and this bill is loaded with nonsense. This bill is loaded with nonsense--nonsense that is going to drive up the cost of care and decrease the quality of care in this country.

So we have now been going through this for a year. The President is out trying to make an appeal to the Nation to say: Yes, buy this package I am trying to sell. The American people are too smart for that. They realize this package cuts $500 billion from Medicare patients who depend on Medicare for their health care--$500 billion in Medicare cuts. Part of it is to hospitals and part of it is to a program called Medicare Advantage. There are 10 million Americans on Medicare Advantage. The reason they signed up for this, they choose this, is because there is an advantage for them as seniors to participate in this program because this is a program that actually works with preventive care, with coordinating care, things that regular Medicare does not do. They are going to cut over $100 billion from our nursing homes and money from home health, which is a lifeline for people at home. They are going to cut money from hospice for people in their final days of life. That is part of this big bill the President is supporting and that he is asking the House to vote for. It is a bill that raises taxes by another $500 billion. It is a bill the House is going to be asked to pass that includes every one of the sweetheart deals because their first act in the House is going to have to be to pass the bill the Senate passed on Christmas Eve and that includes all the sweetheart deals, whether it is to Nebraska or Louisiana or Florida. Thirteen different Senators had sweetheart deals put into that bill the Democrats are going to be asked to vote for because the Republicans see through this whole thing.

So the opposition to this is bipartisan. It is bipartisan opposition. Those who support it is one party only.

We are looking now at a mandate where every American is going to be forced--forced--to buy a product, to buy insurance--forced under this-- or they will either have to pay special taxes, have their wages garnished or pay a fine or a penalty under this plan

that the American people, three out of four, have absolutely rejected.

I see my colleague from Arizona has taken to the floor, and I would ask him if he is hearing similar things when he goes home to Arizona to visit with the people and what concerns he is hearing because there are certainly many seniors in the fine State of Arizona.

Mr. President, I would say to my colleague from Arizona--and there is actually a Mayo Clinic in Arizona, as there is in Florida and as there is in Rochester, MN, which is the home of the Mayo Clinic--one would think, since the President early on talked so much about the Mayo Clinic being a model for health care in the country, the Mayo Clinic might agree with what the President had to say. But if you go to the Mayo Clinic's blogs, they say:

The proposed legislation misses the opportunity--

We have an opportunity now--

to help create high-quality, more affordable health care for

patients. In fact, it will do the opposite.

So here you are. The proposed legislation misses the opportunity to help create higher quality, more affordable health care for patients. In fact, it will do the opposite.

Absolutely.

I thank the Senator very much.

I agree exactly with what the Senator has said because my experience has been very similar. I served 5 years in the State senate in Wyoming, and before that I was a physician practicing in Wyoming, taking care of so many families.

Just this Monday I was at the Wyoming Medical Center, the largest hospital in our State. It is a hospital where I have previously been chief of staff. What I hear from the people of Wyoming is, I am sure, what the Senator has heard from the people at home in Mississippi.

They say: Why don't you just stop and start over? It is not just the people from our States. In a recent CNN poll, 50 percent of all Americans say it is time to stop and start over. We do need health care reform, but we don't need this 2,700-page bill with all of the unintended consequences that may come with it, all of the new government boards and commissions, a program that cuts $500 billion from our seniors who depend upon Medicare for their health care, and raises taxes by another $500 billion.

The American people are saying stop and start over. They know we have good ideas. They listened to that summit last week that I was able to attend at the White House, and they have heard Republicans say to let people buy insurance across State lines. That will help 12 million more people get insurance today. They say let's deal with lawsuit abuse. That will help cut down the cost of these unnecessary tests which are done as defensive medicine.

The American people understand the value of allowing small businesses to join to help more effectively get down the cost of care. That is why half of all Americans say stop and start over. One in four say just stop. Only one in four Americans say, yes; pass the bill. So three and four do not want what the President seems to be wanting to shove through Congress and shove down the throats of the American people. The American people are incensed. That is what I heard in Wyoming this weekend, and I am sure that is what my colleague from Mississippi heard as well.

So the President made his speech yesterday, which seemed to be a new sales pitch, but it is for the same bill. It is why so many folks have said stop, start over, focus on ideas that we know will work. Give individuals as patients, as citizens, rights to make more choices that affect their own lives. Give them those opportunities. We don't need a government bureaucrat standing between the doctor and a patient. We don't need a government bureaucrat. We don't need an insurance bureaucrat.

I see my colleague, Senator Coburn, is on the Senate floor, another physician who has, as have I, fought against government bureaucrats and insurance company bureaucrats all for our patients because we need a patient-centered health care program, and we need health care reform, but we do not need this massive bill.

I also see my colleague from Florida has joined us. He knows we have positive ideas that will make a difference because we need to be focused also on the cost of care. People like the quality of care they are getting. They like the fact it is available. But the cost is what is affecting us. That is why Warren Buffett just on Monday has said we need to focus on cost. They need to take 2,000 pages of nonsense out of the bill and focus on getting the costs under control. And so many of the ideas that the Republicans have brought forth have focused specifically on that.

So I would ask my colleague from Florida, are there things he has heard as he has visited with his constituents and the people in his State that he might wish to add to this discussion right now?

If I may, one of the phrases the Senator used about using reconciliation was ``hijacking,'' hijacking the system, hijacking the way this works. That specific word was used by then-Senator Barack Obama when he was a Senator and very much opposed to this approach.

One of the other things he has said, when we talk about the $500 billion being cut from our seniors on Medicare, he talks about a program called Medicare Advantage. That is only a part of the area that is involved. For people on Medicare Advantage--and there are about 10 million of them--they know they are on it, and they like the program. There are some advantages. One is it actually works to help coordinate care. It works with preventive care. Those are things that are very important. But there are also cuts in Medicare for nursing homes, for payments to doctors, for home health care, which is a lifeline for people, for hospice care, for care at the end of someone's life. That is all going to get cut under these $500 billion of Medicare cuts.

Absolutely.

Well, it would have affected me in several ways. It would have affected my life in that my wife Bobbi is a breast cancer survivor. She had a screening mammogram when she was in her forties-- something this Task Force on Preventive Services says was unnecessary. If it hadn't been for that screening mammogram, her cancer would not have been detected. And by having the screening mammogram, which the American Cancer Society and others recommend for women in this country, and following the guidelines of the cancer society as opposed to this new government-mandated guideline, her cancer was detected. She has had three operations, several bouts of chemotherapy, and is alive today, a breast cancer survivor, 6 years later, because she did what scientists and what those who know what is best for patients recommended as opposed to what a government panel might have recommended trying to focus on their cost-effectiveness.

It puts the government between you and your patient, which is what you never want to have happen. As Dr. Coburn said, that is the wrong approach. It is not the way medicine has ever been practiced in America. It is not the way patients want it; it is not the way doctors want it. We don't want bureaucrats, whether government or insurance company bureaucrats, between doctors and patients.

As we saw at the health care summit on Thursday of last week, the President kept talking about covering people, health coverage, but he wants to put 15 million more people on Medicaid--a program where half the doctors don't see them because the government pays so little; a program where the Mayo Clinic, which the President has held up as a model for health care in America, says: We can't continue to see Medicaid patients from a number of States because we lose too much money. And now they have said the same with regard to Medicare. So when they are talking about $500 billion of cuts to Medicare, the Mayo Clinic, on January 1, said they can't handle additional Medicare patients because last year they lost, they said, $800 million by taking care of Medicare patients because the government pays so little.

Madam President, I ask unanimous consent to continue for an additional 5 minutes.

Madam President, if I could, several things. There is a wonderful Paul Ryan op-ed in today's Wall Street Journal, and I would recommend it to anyone to look at that because he specifically points out that the President's own chief Medicare actuary says the Senate and House bills are bending the cost curve up, making the costs go up, which is what you hear if you go to a town meeting in Arizona or in Wyoming. When you ask people: If this bill passes, will the cost of your own care go up, the hands go up. When you say: Well, how about the quality; will the quality of your care go down? Again, the hands go up. So that is a

continual concern of people all across America, which is why three- quarters of Americans have told CNN it is time to either just completely stop or stop and start over and only one-quarter of Americans support this proposal, because they realize this is going to do that.

The Senator from Arizona mentioned, and it was interesting, the 11 pages from the President. The gimmicks are still there. They may have taken out one of the gimmicks, but the spending gimmicks are there, plus the Louisiana purchase, the special carve-out for 800,000 people in Florida who are on Medicare Advantage. They are protected, but there are another 10 million Americans who will lose their Medicare Advantage.

Then the question came up of what we refer to as the ``doc fix.'' The way the numbers are moved around----

Right now--and we just passed a 1-month extension the other night--Medicare is supposed to cut the fees for all doctors across the country by 21 percent. Seniors know Medicare underpays right now. As one of my colleagues in the State senate in Wyoming used to say, government is the biggest deadbeat payer because they do not even pay enough to cover the cost of the care that is delivered in our hospitals. With ambulances, they do not cover enough to pay for the gas to fill up the ambulances to go the long distances we have in Arizona or in Wyoming.

But right now, to deal with some promises that were made years ago, the fees for physicians should be cut 21 percent, according to Medicare. A number of years ago, they were supposed to cut it by 1 or 2 percent, and they said: Well, we will not cut it, but next year we will cut it by 4 percent and then next year 8 percent and then 10 percent. Well, now they have continued to kick the can down the road enough so that this year they are supposed to cut the fees for physicians by 21 percent.

It could not. According to the President's budget numbers and the way this bill is written and the financial gimmickry, they want to cut physician fees for Medicare by 21 percent and keep them frozen for the next 10 years. So it is cut and freeze for 10 years, and they use that as one of the additional financial gimmicks.

Well, if you do that to the doctors in the country, who are already reluctant to see Medicare patients because the payment is so low--the Mayo Clinic said they are not going to see new Medicare patients because the reimbursement at today's rates is so low--if you drop them 21 percent additionally at a time when the Congressional Budget Office says one-fifth of the hospitals and one-fifth of the doctors' offices in this country will be unable to continue to be solvent 10 years from now if this bill goes into place--we know without a question that we cannot allow that to happen. Congress knows that, the doctors know that, the American people know it. Everybody knows it except, apparently, the people writing the health care bill, who say: Oh, this is actually going to save money in the long run. When people look at this in an honest way, they know this is going to drive up the cost of care and make the quality of care for our American citizens go down.

We are going to see that. We will see that across the board. I was at our hospital in Wyoming on Monday talking to physicians who take care of everyone, and they have great concerns because they say at that rate they can't afford to keep the doors open, if the Medicare cuts go through, the cuts the President says will have to go through if, in fact, he wants to hold up the numbers he continues to talk about.

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

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

Mr. President, I rise today because the Senate Committee on Environment and Public Works will soon be meeting to discuss the nomination of Mr. Arthur Elkins to be the inspector general at the Environmental Protection Agency. I support Mr. Elkins moving out of committee, and to date he has truthfully answered all the questions I posed to him. Before the full Senate votes, I do have some additional questions based on a report I am releasing today.

As ranking member of the Subcommittee on Oversight in the Senate Environment and Public Works Committee, I care a great deal about ensuring oversight over the agencies within our jurisdiction, the most important of which is the EPA. Over the last few months, the minority on the subcommittee has compiled a report. The report is entitled ``The Status of Oversight: A Year of Lost Oversight.'' This report details the severe lack of oversight by the majority of the committee and the administration.

When the majority created the Subcommittee on Oversight, it was stated that they planned ``to use the subcommittee to explore ways to restore scientific integrity in the EPA, and other Federal agencies focused on the environment, and to strengthen environmental protections by once again making the regulatory process more transparent.'' I agree. One year later, as my report details, there have only been two subcommittee hearings, and, as the report concludes, ``The result of this is that the majority has let a year go by where they have failed to pursue their stated goals.''

Over the last year, my colleagues and I have requested a series of investigations and hearings into key matters related to whistleblowers being silenced, data being manipulated, and shadow czars holding meetings where nothing is put into writing to avoid Freedom of Information Act requests. We have asked for these hearings and investigations because we believe the public needs to have trust in their government.

At the beginning of this administration, Environmental Protection Agency Administrator Lisa Jackson herself stated unequivocally: ``The success of our environmental efforts depends on our earning and maintaining the trust of the public we serve.''

As this report demonstrates, this administration and the majority have shown little interest in pursuing these matters. Let me read to you the findings and recommendations of the report: In 2009, the Senate Environment and Public Works Committee majority chose not to conduct oversight over the relevant agencies within the executive branch. The lack of any oversight over the activities of the Federal agencies weakens the system of checks and balances and invites the potential for larger abuses. Action must be taken to investigate oversight issues from the last year, and further coordination within the committee regarding the oversight jurisdiction and responsibility is needed.

I believe that finally receiving a nominee for inspector general at EPA gives the public another opportunity to get to the truth about the issues raised in this report.

In his answers to my questions to date, Mr. Elkins has signaled that he is absolutely willing to chart a new course from where this administration and the majority have taken us.

When I asked: Do you believe it is the responsibility of the EPA inspector general to investigate instances where whistleblowers are silenced by their superiors at the Agency, he said yes.

When I asked: Will you pursue those instances, he said yes.

When I asked: Do you believe it is the responsibility of the EPA inspector general to investigate and report instances where scientific procedures at EPA are circumvented, he said yes.

When I asked: Will you investigate instances where agency employees are smeared publicly in the press by higher-ups in an agency or in the administration simply for providing their best advice and counsel, he said yes.

All of these things are not hypotheticals; they all occurred over the last year. My colleagues and I in the minority have asked for investigations into each of these instances by the majority and the administration. The response we have received each time has been a resounding no.

If the administration and the majority refuse to provide proper oversight, then someone else has to. That is why I plan to share this oversight report with Mr. Elkins, the nominee to be inspector general at the EPA. Before a floor vote, I will seek confirmation that he will give the matters I raise in this report due consideration. I am confident based on his response so far that he will answer in the affirmative. If so, we will have the sea change at the EPA that will restore the public's confidence in that Agency.

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

I will.

Amendment No. 3382