Floor Statements

Mr. President, I ask unanimous consent to engage in a colloquy with my colleagues to discuss the issues at hand.

I thank the Presiding Officer.

Mr. President, I have been looking at the bill, which, to me, is going to hurt the health care system of our country. I am a physician. I have taken care of families in Wyoming for 25 years, and I think if we want to get costs under control, if we want to help families all across America who are struggling with their health care needs, we need to focus on an amendment that is before us today, brought forward by the Senator from New Hampshire.

I ask my friend and colleague from New Hampshire, is it not true that the numbers we are looking at are underreported? It is going to be much more expensive and the cuts are going to come from our seniors, those who are vulnerable, those who depend on Medicare for their health care, and we need to make sure and promise the American people we will be protecting those folks who depend on Medicare for their health care?

If I could follow up with a question for my colleague from New Hampshire, because as I read the Sunday New York Times, it said the Bennet amendment was completely meaningless--the Bennet amendment was meaningless. It also goes on to say, Senator McCain is trying to keep that $500 billion in Medicare, but the Democrats are trying to take that money out of Medicare and, as the article says, the editorial says: to finance coverage for uninsured Americans but not people on Medicare.

So it does seem the New York Times, at least in this segment, got it right: that the Bennet amendment that our colleague from Georgia referred to is meaningless, that the cuts are going to come out of people who depend upon Medicare for their health care to pay for a whole new government program and not to focus on Medicare.

Well, don't we owe it to these seniors who have paid into the program and who have been promised the program to save that program first?

I have a question for my Senate colleague from South Dakota who is here. We heard the majority leader, Senator Reid, come to the floor a few minutes ago and talk about how this bill is going to get premiums under control, keep the cost--for people who have insurance, keep their premiums under control. I saw a chart from the Senator from South Dakota yesterday that said for 90 percent of Americans, those who have insurance now, if we did nothing and did not pass this bill, the premiums would be lower than if we do pass this bill; that passing this bill actually will raise premiums, in spite of the fact the President of the United States promised, while campaigning, that he would lower the cost of premiums for American families by $2,500.

I would ask my colleague from South Dakota, isn't it true that if this bill passes, Americans wanting--feeling they have been promised that premiums would be reduced, are they not doomed to disappointment?

As my colleague from Georgia knows, there is no way you can save Medicare when you cut that kind of money out of it. How, when they cut physicians' payments by 23 percent, are we going to have physicians going to any of our small communities in South Dakota, in Georgia, in Wyoming, where we have many people

who depend on Medicare for their health care? I worry about access to care.

Our colleague, Senator Isakson, yesterday talked about home health care and how, for pennies on the dollar, you can help people. It provides a lifeline for people who are homebound. It keeps them out of the hospital, out of the nursing homes. Instead, this Senate, the Democratically led Senate, yesterday voted to cut $42 billion out of home health care, which people in our small communities and in the rural areas of our State depend upon. So there is no way this program can stay solvent.

It is hard for me to fathom and, clearly, hard for the people of Wyoming to fathom, how with all this budget trickery it is going to work for people who need to go to see a doctor or to have a home health care provider in many of our rural communities.

We all have townhall meetings, and when I go to townhall meetings, people say: Don't cut my Medicare, don't raise my taxes, and don't make things worse for me than they are now.

Mr. President, I appreciate the comments from my colleagues. I think we are hearing around the country that we do need health care reform. We need to get costs under control. We need to have patient-centered reform, not government-centered reform, not insurance- centered reform. We need to not cut Medicare. We need to not raise taxes. We need to not make things worse for the American people.

From what I have seen of this bill--and I worked my way all the way through it--it makes things worse for the American people, not better. This is not the right prescription for health care in America.

With that, I yield the floor.

No objection.

I agree with the Senator from Arizona. I looked at another one of his favorite newspapers, the New York Times, today because we--

On this floor have said the Democratic proposal is cutting the Medicare the seniors of this country depend on for their health care. We pointed out that they have taken $120 billion away from Medicare Advantage. Mr. President, 11 million seniors use Medicare Advantage. One out of four seniors is on Medicare. The reason they signed up for Medicare Advantage is because there is an advantage for the seniors--preventive care, coordinated care, things we know are important.

Yesterday on this floor, the Democrats voted to cut away from home health care. This is a lifeline for homebound patients. It helps keep them out of the hospital and out of the nursing homes. Yet in spite of all the letters we have read from patients, as well as home health care communities in all of our States, they have cut back.

Yet the majority whip came to the floor at the opening of the session today and said: Oh, we have handled all of that. He said: We have handled all of that with a wonderful resolution of the Senate by Senator Michael Bennet.

The New York Times today, about that resolution, said:

Democrats decided to respond to the Republicans saying: Hey, you are cutting Medicare for our seniors. ``Democrats decided to respond . . . with a meaningless amendment.'' The New York Times editorial today, ``a meaningless amendment.'' We knew it was meaningless, and we know they are cutting Medicare from the seniors who depend on it--Medicare Advantage from hospitals, from nursing homes, from hospice, from home health care. This is robbing the people who need this care, deserve the care.

If you said maybe we should take a look at Medicare, then do it, Mr. President, to save Medicare, to save Medicare that we know is going broke.

I see the Senator from New Hampshire is here. He has been an expert on this topic of the budget and ways we can save Medicare. I say to my friend from New Hampshire, is this not true that Democrats have proposed a meaningless amendment but they are cutting the guts out of the Medicare Program on which the seniors of this country are dependent?

When I talk to other doctors, they tell me, across the board they order a number of tests, expensive tests--call it defensive medicine--tests that do not necessarily help a patient get better, get well, but just to make sure they get covered in case they are sued. It is not unusual, when

you look at the numbers, that we are talking $100 billion a year in tests that are done that do not necessarily help somebody get better, but they are doing it because of the legal atmosphere in this country.

Here we are on the Senate floor on a Sunday afternoon. The President is less than 100 yards away, a former Member of this body. He ought to be involving all Senators. He is meeting behind closed doors, possibly cutting deals, trying to come to arrangements, twisting arms, asking people to march, follow his marching orders right off a cliff that I think is going to be coming for health care in America. I think he ought to be involving all Americans. We are talking to the Americans in this country. We are not hiding behind closed doors. People who aren't part of those discussions are completely cut out.

I know my colleague from Tennessee has been outstanding and outspoken on these very issues, but we are here, and we want to visit with people because we do have solutions that work; that will not increase the cost of care, which is what we are seeing now; that are not going to cut Medicare, which is what the Democrats are proposing; that are not going to increase taxes, which the Democrats are proposing; and they are not going to drive up the premiums.

The whole idea behind this was to get the costs under control. Senator Ensign's amendment does that by taking a look at the lawsuit abuse that we look at in this country. But I want to turn to my colleague from Tennessee, who I know has some more points he wants to make.

Standing on the Senate floor, looking at so many colleagues from States with a lot of rural areas, it is a challenge to have people who can provide these excellent services, who are very well trained, know how to do it, how they can provide the services in these small communities. We have dealt with that in Wheatland, WY, and New Castle, WY, where the expense for the malpractice insurance for those physicians was so high that even though they didn't deliver that many babies in these small communities, they could not afford and the hospital could not afford to allow them to continue to deliver any babies. The amount of money they would receive from delivering babies was not enough to cover the insurance. In New Castle, WY, there were three physicians qualified to deliver, but the number of deliveries was such they ended up with no one delivering because they wanted to take one night and the next and the next. So you have communities all across our country that are losing highly qualified medical practitioners-- whether it is cardiologists, surgeons, trauma surgeons, whether it is obstetricians, gynecologist. We are seeing this all over our communities.

The Senator from Tennessee is here. There are a lot of small communities where they are going to lose those. We are seeing it in the cuts yesterday for home health. Those people are not going to be available to deliver small community care, lifeline, homebound, keeping them out of nursing homes, keeping them out of hospitals.

There are real consequences of this bill, not just with the junk lawsuits--that is a big part of it--but also with the Medicare cuts, also with the increased taxes we are seeing in this bill and how that is going to affect small businesses, which are the engines that drive the economy of this country--and profoundly.

We heard the Senator from South Dakota show the premiums families are going to have to pay for insurance are going to climb faster if this bill becomes law than if nothing were passed. Even though the President promised that families in this country on average would see a $2,500- per-year decline in premiums, the President's own numbers people say: Sorry, it is going to go up $2,100. That is a $4,600 shift for every family who tries to buy their own health insurance. That is what we are seeing in Wyoming.

I ask my colleague from Tennessee if he is seeing the same things at home.

Well, as the Senator from Arizona knows, I have treated patients in Wyoming, families in Wyoming, for 25 years. The story in the New York Times has a wonderful picture of Bertha Milliard, a 94- year-old lady, who is very similar to many of the patients I have taken care of in families in Wyoming who depend on this care. There is a picture of Bertha dealing with her nurse. Bertha greets the nurse who has come to check her condition and review the medications she takes for chronic pain, for heart failure, and for stroke. Ms. Milliard says those visits have been highly effective, she says, in keeping her out of the hospital.

That is the whole idea: Keep them out of the hospital so they can lower the cost of care. But the home care that she receives could be altered, according to the front page of the New York Times, under the legislation passed by the House and pending on the Senate floor today. The legislation

would reduce Medicare spending on home health services, which is a lifeline for homebound Medicare beneficiaries which keeps them out of hospitals as well as out of nursing homes.

So there you have it. What could be better for our seniors than to have the dignity of being in their own homes, to have someone coming into their homes to help them, to make their lives better, and that is going to include skilled nursing care, physical therapy, occupational therapy, sometimes speech and language therapy, and different medical and social services? That is where the care ought to be given, in the home. That is what we want for our seniors: the dignity at home, opportunities at home, to stay in their surroundings. That is what we want for not just all seniors such as Bertha, we want that for our Nation because that will help keep down the cost of care.

This bill does the exact opposite. That is why we have to have this amendment that says don't cut Medicare for our seniors and certainly not to start a whole new program.

In the Wall Street Journal today is an editorial by the dean of Johns Hopkins Medical Center, a wonderful, world class center: ``Health Reform Could Harm Medicaid Patients.''

So we are taking the money from Medicare, hurting Medicare patients, and they are using it in a way that is actually going to make it worse for patients on Medicaid, as they have dumped 15 million people into this program that is absolutely broken.

I will yield to the Senator from Arizona.

I agree with the Senator. It is astonishing that the Senator from Montana would read a national organization's letter instead of one from his home State.

In Wyoming, we have 43 different home health care agencies, and some of them are in communities that don't even have hospitals. Therapists drive long distances. We have colleagues from rural States here, and Montana is certainly one of them. Those home health care agencies know they are not even going to get paid enough from Medicare to put gas in the car to drive out to the ranches and the farms where people are who are staying at home, trying to stay out of the hospitals and nursing homes. We have home health agencies throughout the States, and they drive tens of thousands of miles every year, with therapists and nurses and home care aides going out to help people stay at home and therefore give them dignity and allow them to keep down the cost of care for everybody.

This proposal is going to hurt patients in a lot of ways. It is going to hurt patients psychologically. They are in a hospital when they want to be at home. It is going to hurt patients in terms of their health. The better place to be is at home, as long as somebody is coming around to check on them. That is why for so many reasons, doctors have for decades said: Try to help patients get home as quickly as they can. That is the best place for them to heal.

We have heard from the Senator from Georgia a remarkable story about pennies on the dollar, the effectiveness of this program. It is good for folks, and it is good for the whole health care of our Nation if we have people healing at home, not in the hospital.

It has been a privilege to take care of patients in Wyoming for the last 25 years. This bill is going to hurt them. It is going to hurt the future of care. It is going to hurt the future of Medicare in America. You cannot take $464 billion away from Medicare, a program on which the seniors of this country depend, and say it will not affect their care. It will affect them in the hospitals, it will affect them in the doctors' offices, it will affect them in the home, it will affect them in the final days of their lives in the hospices. That is what I hear about across Wyoming.

I have not met doctors who support this--not at all. I have not met very many patients who support it, and they are also told by others: We don't want this. The townhall meetings have been overwhelming in opposition.

This is a bill that will be bad for our small businesses and bad for people who want to get insurance. It will be bad for people who have insurance because they know their premiums are going to go up. It will be bad for people who pay taxes because those are going to go up. But specifically for home health care, this will be awful. It will affect small communities--in all of the small communities of America, not just in Wyoming. I can't imagine anyone in a small community being for this.

Madam President, how much time remains?

Madam President, you know as well as I that the President promised the American seniors that if they liked the care they had, they could keep it. Nothing could be further from the truth.

Looking through this bill we are debating, there is an incredible amount of cuts to Medicare, which is a program seniors rely upon for their health care: $120 billion of cuts to Medicare Advantage. One in four people in America who depend on Medicare for their health care--11 million Americans--are on Medicare Advantage. The reason they chose it is because it is an advantage. It helps with coordinated care and preventive care. Having practiced medicine for 25 years, I know the people at home get it. That is why they chose that program. It also cuts $135 billion from hospitals and $115 billion from nursing homes.

I want to focus a little bit on the $42 billion cut from our home health agencies. I don't know how anybody on the other side of the aisle can say with a straight face that the legislation before us doesn't cut Medicare and doesn't hurt our seniors because it does.

I will tell you, having taken care of people in hospitals, the services that are provided through home health care is what helps get people out of the hospital sooner, gets them home faster, gets them out of nursing homes, and helps keep down their costs. These services include skilled nursing care, physical therapy, occupational therapy, speech and language therapy, and medical social services.

I have a letter from the director of home health services of Wyoming, the Home Health Care Alliance.

I ask unanimous consent that it be printed in the Record.

This letter talks about the devastating impact of the cuts proposed in this bill we are considering today. There are 43 home health agencies in Wyoming and a number of them are in communities--the occupant of the chair is from a State where there are a lot of rural areas. A number of our agencies are in communities that don't even have hospitals. So it helps people stay in their homes, in their home communities, stay out of the hospital, out of the nursing home, and it gives them the dignity and the opportunity and the independence they need to stay at home.

Yet this bill, according to the folks in Wyoming and the folks nationally, is going to make it that much harder for our seniors to stay at home.

Taking $42 billion from home health care, raiding that program to start another program, to spend it on a new government program is going to absolutely impact the ability of home health care providers in this country to offer services. These nurses, therapists, and home care aides all drive hundreds of miles on a daily basis in Wyoming, going from ranch to farm, to help care for people and to help them stay at home. It is all around the country.

There is a front-page story in the New York Times today, a wonderful story of a delightful 94-year-old lady, Bertha Milliard. She lives in Maine. There is a picture of her with her nurse during a home health care visit. Bertha is very worried that they are going to lose this service, which is the service that keeps her out of the hospital.

It just seems, as we look at this, that there is no way home health care agencies around the country are going to be able to sustain these kinds of cuts and continue to remain available to the Medicare patients who depend on home health care.

Even the National Association for Home Care & Hospice said that in a few short years, Medicare will be paying home health agencies less than it costs to even provide the services. We are talking about less than the gas in the cars and the salaries of the folks who drive around. We are not talking about profit. We are talking just about keeping doors open.

As I think about the patients in Wyoming whom I have taken care of over the years who have benefited from home health services, who have been able to receive care from nurses, therapists, home care aides and allow them to stay at home, to be more independent--not totally independent but more independent--I think anything that cuts into this is not good for America.

I yield the floor.

I agree with the Senator from Arizona that people choose to be on Medicare Advantage. Mr. President, 11 million people have chosen to be on Medicare Advantage because it is a wise choice to make because they get better benefits. They get dental care, they get the vision care, they get the hearing aids, they get the fitness thing.

Just as we do. It works in preventive care and coordinated care.

It is also no surprise when people read about this and learn about it that they would want to be on Medicare Advantage. What the Senator from Utah has said, the sponsor of this motion, is that the money that goes into this program is for the benefit of the seniors. It is for services for the seniors on Medicare. To me, this whole bill basically guts Medicare, raids Medicare to start a whole new program.

Today, as the Senator from Arizona has mentioned in these articles, the Associated Press and USA Today said:

Senate Democrats closed ranks Thursday behind $460 billion

in politically risky Medicare cuts at the heart of health

care legislation. . . .

It goes on to say:

Approval would have stripped out money to pay for expanding

coverage to tens of millions of uninsured Americans.

So they are going to take $460 billion, it says, away from our seniors who depend on it for their Medicare and start a whole new government program. The Washington Times, front-page story headline, reads: ``Democrats Win $400B in Medicare Cuts. McCain Pushed for Another Way to Pay for It.''

I look at this and say this is not fair to our seniors, not fair to the patients I have taken care of for 25 years in Wyoming, taken care of folks--taken care of folks--when grandmom breaks her hip, what we need to do for our patients. These are choices people have made.

Mr. President, 11 million Americans have chosen Medicare Advantage because there is an advantage to them for the health care they get--the additional services, the coordinated care, the preventive care. Anyone who looks at this and studies it says: I want to sign up.

It has been wonderful in rural areas and big cities. This has helped a lot of people in the country. It is not surprising that one out of four people in the country on Medicare have chosen Medicare Advantage, but yet what we are seeing here is Democrats want to get rid of Medicare Advantage.

We are taking it away from seniors and using all that money to start a new government program when we know Medicare is going to go broke by 2017.

Mr. President, I ask my colleague from Wyoming, with whom I have the privilege of serving, I saw a large story in USA Today. This story says ``Senate Keeps Medicare Cuts in the Bill.''

What it says is:

Senate Democrats closed ranks Thursday behind $460 billion

in politically risky Medicare cuts at the heart of health

care legislation.

It goes on to say:

Approval would have stripped out money to pay for expanded

coverage to tens of millions of uninsured Americans.

As I read this, it says the Republicans tried to keep the Medicare money for people on Medicare, but the Democrats want to take $460 billion away from seniors who depended upon Medicare and use it to start a whole new government program. Am I reading this correctly?

Mr. President, I would say when my colleague from Wyoming and I held townhall meetings around the State of Wyoming, people have said don't cut our Medicare. Yet what I see this bill doing is cutting our Medicare and specifically, right now, there are thousands of people in Wyoming who are on a program called Medicare Advantage. There is an advantage to this program. That is why so many Americans have signed up for the program.

As a matter of fact, about one in four Americans who depend upon Medicare for their health care in this country has chosen Medicare Advantage, because there are some advantages being in this program called Medicare Advantage: dental, vision, hearing, fitness. Also, as a practicing doctor for 25 years, taking care of families in Wyoming, what I saw, the reason they liked this, if they were on Medicare, is because it dealt with prevention and it actually helped coordinate care.

One of the things Medicare does not do as well is coordinate care and work with prevention. We know how important prevention is in helping people keep down the cost of their care--how good it is in terms of giving people opportunities to stay healthy. That is why they call it prevention.

The bill in front of us, as I see it--I ask the Senator from Wyoming--is a bill that is going to cut $120 billion from Medicare Advantage, the program the people in our State like?

I actually heard somebody say Medicare Advantage is not Medicare. But if you turn to the Centers for Medicare Services' 2010 Official Government Handbook--we are going to go into 2010 next month. If you go to the official handbook for 2010, and the handbook is called ``Medicare And You,'' it says a Medicare Advantage plan is ``another health coverage choice you may have as part of Medicare.'' People who actually look at this choose this. They make the choice because they say this is a good deal for me. That is what Americans want. They want to get value for their money.

A recent poll said, in terms of Americans, when they send money to Congress, how much of that do they get back in value? They think about 50 cents on the dollar. That is a national Gallop Poll. They have been polling on this for a long time and it is the highest number ever of what Americans think, in terms of the fact that they are getting very little value for their tax dollars. They see games being played. That is what I hear when I have telephone townhall meetings in Wyoming. They know Senator Reid's bill steals $464 billion from Medicare. They know it raids the health care program they depend upon, not to make Medicare stronger, not to make Medicare more solvent, but as my colleague from Wyoming tells me, to create a brandnew entitlement program. They are raiding Medicare to start another government program that is itself going to be insolvent.

I ask my colleague from Wyoming, are you seeing what I am seeing?

Mr. President, an article in Bloomberg yesterday said the Kaiser Family Foundation poll released this past month found that 60 percent of seniors said they would be better off if Congress did not change the health care system.

We know we need to do some changes. But this massive bill, this 2,000-page bill that weighs 20 pounds, is not the right change we need. For our seniors, people who rely on Medicare for their health care, to absolutely raid $464 billion from Medicare, almost $\1/2\ trillion, there is a point where more people--the baby boomers, more and more people are added to the rolls every day. To raid this program to start a whole new government program is not the right prescription for America. It is not what our seniors want. It is not what they signed up for. It is not why they are choosing Medicare Advantage. It is because it is a choice they make and that is why we right now have 11 million Americans who are on Medicare Advantage. We have 11 million seniors-- that represents almost one-quarter of all Medicare patients in this country.

Yes.

Mr. President, to correct something I heard on the floor today, when the senior Senator from Connecticut had some concerns about this, he said how private health plans deny claims. He said Medicare doesn't deny claims.

In the United States of America, the No. 1 denier of claims for health care is Medicare. The study that is out from a full year, from March 2007 to March 2008, Medicare rejected 475,000 claims of its 6.9 million claims filed, at the rate of 6.85 percent. When you compare that to private insurance companies, the industry average for the claims that are rejected is about 4.05 percent.

So Medicare rejects, by number, 10 times more than the largest private insurance company. A lot of these claims--I have followed this closely because I have been the medical director of something called the Wyoming Health Fairs, where people can get their blood tested at a low cost. It is a preventive or prevention-designed program. Yet Medicare refuses to pay for prevention. It refuses to pay for these blood tests because they are preventive as opposed to diagnosing a specific problem in a specific patient with a specific symptom.

What do our seniors in America do? They turn to a program called Medicare Advantage because it gives them the advantage to choose this program. It is one of the choices they have under Medicare. At this point, 11 million Americans have chosen to participate in Medicare Advantage and receive their health care through Medicare Advantage. We are talking about seniors who depend on Medicare for their health care.

The number of people signing up for Medicare Advantage has continued to increase, and now there are 11 million people--or one out of every four seniors--on Medicare in this country. They know who they are and they like the program. The reason they like the program is because they get additional services--services beyond what someone on the traditional Medicare Program receives, such as dental care, hearing care, eye care, preventive care, and coordinated care.

We hear a lot about the failings of the health care system, and there are many in this country, and one of them is that care is not coordinated. People go from specialist to specialist. We need coordinated care. Medicare Advantage does a much better job at coordinating care than traditional Medicare.

It is baffling to me that the plan in front of us in the Senate today is trying to eliminate Medicare Advantage to the tune of over $100 billion. When one looks at the cuts that are in this plan--it is $464 billion in Medicare cuts, $135 billion for hospitals, $42 billion for home health agencies, $15 billion for nursing homes, and $8 billion for hospice providers. But it is $120 billion for Medicare Advantage--the program that more seniors, as they learn about it, want to sign up for, because it is an advantage to them to have their health care through a program which focuses on preventive care, coordinated care, and helps them stay healthy and live longer. Yet this Senate and this bill that Senator Reid has brought to the floor is trying to completely gut that program and deny our seniors who rely upon it from receiving the care they have earned.

I yield the floor.

Mr. President, my wife Bobbi was diagnosed with breast cancer by a screening mammogram in her forties. It is that screening mammogram that has saved her life. By the time of the mammogram, the tumor had spread and she has had two operations and two full bouts of chemotherapy. I do not want a government bureaucrat making a decision for the women of America if they should be allowed to have screening mammograms. It saves lives--1 in 1900, for women in their 40s.

The Reid bill empowers bureaucrats to decide what preventive benefits will be allowed for American women. The amendment from the Senator from Maryland does the same--bureaucrats, not the physicians who are doing the treating. That is why I support the amendment of the Senator from Alaska, because that amendment says the Federal Government cannot use recommendations of the U.S. Preventive Services Task Force, recommendations from bureaucrats, to deny care to anyone including seniors on Medicare--anyone in America. That is how this decision should be made, not by government bureaucrats.

I yield the floor.

Mr. President, I come to the floor also to talk about Medicare and what I see to be significant cuts in the Medicare Program. I practiced medicine in Wyoming for 25 years, taking care of families from across the State and many of these wonderful folks who are on Medicare. They depend on Medicare for their health care. They depend on Medicare. Patients depend on it, the hospitals depend upon it, the physicians, the nursing homes, the home health care agencies--all of them depend on Medicare for their health care.

I listened to my close friends from across the aisle come to the floor as well, and they seem to be trying to convince the American public that the 2,074-page bill which weighs over 20 pounds actually does not cut Medicare. I heard the chairman of the Finance Committee talk about it on the floor; I have heard it from the majority leader.

The health care reform plan we are looking at on this floor cuts $464 billion from Medicare, and I have a list of all the Medicare cuts in this bill, page after page, column after column. When you add them all up, it cuts $135 billion from our hospitals--from our hospitals--that are providing the care. We have heard about some of the cost shifting from the Senator from Rhode Island. Cost shifting occurs. Medicare is one of the biggest deadbeats when it comes to paying for hospital services, and it is why hospitals end up shifting more costs to people who have health insurance, and why, for those people, their premiums will go up if this bill becomes law. So $135 billion cut from hospitals.

The bill cuts $120 billion from a program called Medicare Advantage. There are 11 million Americans in this country who are on Medicare Advantage. They know who they are. They know it is a program that has worked well for them. People ask me what the difference is. Why would somebody want to be on a program called Medicare Advantage? Well, there is an advantage to those seniors who depend upon Medicare for their health care if they are on Medicare Advantage. The No. 1 advantage is, it actually helps coordinate care.

We know one of the best ways to help people keep down the cost of their medical care is to find problems early and to get early treatment. So find the problem and treat it before it gets too bad. Well, Medicare Advantage does both preventive care as well as coordinated care. One of the big problems with Medicare is, it will pay a lot for doing something to someone, but it will not pay much for helping someone stay healthy. But now all of a sudden we are going to cut $120 billion from Medicare Advantage, which actually works on prevention and on coordinated care.

Then there is $42 billion from home health care agencies that will be cut. Those are the folks who come into someone's home and help them stay out of the hospital. The advantage of home health care is to allow people to get care at home and not need to be in the hospital, but suddenly we are looking at $42 billion in cuts on Medicare for home health care agencies.

Then let's take a look at nursing homes: $15 billion in cuts for nursing homes--those facilities taking care of people on Medicare-- which, to me, means they are actually cutting it from the people who depend on Medicare for their nursing home needs.

As an orthopedic surgeon, I have taken care of many people, such as a grandmother who breaks her hip. She doesn't need to go into a nursing home permanently, but what she needs to do is to go there for a short period of time for rehabilitation, where she can get better and get stronger. She is not ready to go home, and she does not need to stay in a hospital, but she needs to be in a nursing home for a period of time to get rehabilitated and then to get ready to go home and go back to an independent life. There is a gap in time, and nursing homes help with that. They are wonderful as a way to give somebody an opportunity to gain their strength. In our country, such as it is now, so many grandparents are living in communities where, perhaps, their children or grandchildren are no longer living or they can't go and live with a son or daughter, but they need additional help and so they go to a nursing home.

So for that patient who has broken a hip--the type of patient I have taken care of in the hospital--this bill is going to end up cutting from the hospital $135 billion from Medicare for that patient. It will end up cutting nursing homes by $15 billion, for patients who rely on nursing homes as they recover from their hip surgery. Then once they get home and get ready for an independent life, a lot of times they can benefit from home health care--someone coming into the home and checking on them, giving them medications, making sure they are doing all right, checking their wound, and a number of different things--this bill will cut $42 billion from home health care agencies; again, cutting the services to people who depend upon those services for their health care needs.

Then there is an $8 billion cut from hospice providers, people who take care of our patients--my patients--in the final stages of their life. At a time in their life when their body may be riddled with cancer or they just need a place to go and be treated with respect and to be cared for, we are cutting $8 billion in this bill from the hospice providers--people who are there and helping people in the final stages of their life.

When I look at this, I say: How in the world can my colleagues on the other side say they are not cutting Medicare for our seniors? I read through the bill and there is $135 billion from hospitals, $120 billion from Medicare Advantage, $40 billion from home health care agencies, almost $15 billion from nursing homes, and $8 billion from hospice providers, for a total of $464 billion for this country's seniors. I don't think we should pass this bill. Of course, there is another $500 billion in taxes. It is a huge and hugely expensive bill.

To me, this is absolutely nothing but robbing our folks who are on Medicare to start a whole new government program. I am worried seniors all around the country are going to have less access to doctors, especially in rural and in frontier States, such as Wyoming. I am concerned they are going to see community hospitals and home health care agencies and nursing homes--skilled nursing facilities--struggling to keep their doors open.

It is time for this Congress, for this Senate to listen to America's seniors. Let's listen to the administration's own chief actuary. Richard Foster, the chief actuary for the Centers for Medicare and Medicaid Services, said if these Medicare cuts take effect, then many providers ``could find it difficult to remain profitable and might end their participation in the program.'' They may say: I don't want anything else to do with Medicare. I am closing my doors to Medicare patients.

We cannot have that in this country, but I believe that is what this bill does. Even the nonpartisan Congressional Budget Office said these Medicare cuts could ``reduce access to care or diminish the quality of care.'' Is that what this Senate wants, to reduce access to care or diminish the quality of care?

How many experts does it take to convince the majority party that cutting Medicare to pay for a brandnew government program is irresponsible? We all agree Medicare is going broke. The trust fund will run out of money in the year 2017. It has more than $37 trillion in unfunded liabilities. The Presiding Officer knows that in his State, as well as in mine, Medicare's physician payment formula, which calls for doctors to face a more than 40-percent cut over the next 10 years, is a system that is broken. The Reid bill does nothing to fix this problem. Instead, it takes $\1/2\ trillion from Medicare to create a brandnew entitlement program. It punishes a group of people in order to benefit another. To me, that is not reform. It will only make the system worse.

That is why I support the motion we will be voting on today, the McCain motion. It says we are not going to finance a new government program on the backs of our Medicare patients, on the people who depend upon Medicare for their health care. It instructs the Finance Committee to write a bill that doesn't cut hospitals, that doesn't cut home health care, that doesn't cut Medicare Advantage, and that doesn't cut hospice for our seniors who depend upon those services. A vote for the McCain motion gives us a chance to get this right.

I do want health care reform. I just don't want this bill. This is the wrong prescription for our country. I don't believe we have to take the money out of Medicare and then spend it on a brandnew entitlement program. I go home to Wyoming every weekend--and I know other Members go home and listen to their constituents--and what I hear from the people in Wyoming is: Don't cut my Medicare. Don't raise my taxes. Don't make things worse for me in this economy. I certainly can't afford it. The people of Wyoming want practical, commonsense health care reform; reform that drives down the cost of medical care, improves access to providers and creates more choices.

It is clear this bill has a very different plan in mind. It is not too late to work together for meaningful reform. We do not have to dismantle the current health care system and build it up in the image of big government and then try to say this is reform. The American people are telling us what kind of changes they want, and that is why I will be voting for the McCain motion.

I yield the floor.

I will, Mr. President.

I don't have that letter with me, but everything I look at says this will gut Medicare, make it go broke sooner, and it will be bad for seniors.

The Senator absolutely believes we need to find a way to make sure all the citizens of this country have insurance, and there are ways to do it: allowing people to buy insurance across State lines. That doesn't take a 2,000-page bill. There are ways to do it to help get down the cost of care that give individuals incentives to buy their own insurance, giving tax breaks to those individuals. We could do things with tort reform, such as the loser pays rule. We could allow small groups to join together to have a better ability to bargain and get the cost of insurance down.

So this Senator absolutely believes we need to find a way to get everyone insured. There are people who need help who don't have help, and we need to find a way to do that, but it is not this 2,000-page bill.

The current system is broken, Mr. President. The reimbursement system focuses more on doing things than on helping patients stay healthy and get better. Medicare has done a terrible job of that over the years, in terms of giving incentives for people or even for paying for preventive services. They have not done that over the years.

This is an illustration of how the system is broken. It is now December--the end of the year--and it is the busiest time of year for me as a physician in Wyoming because people have met their deductibles--those who have insurance have met their deductibles for the year--and they come into the office and say: Is it now time for my operation? I have to get it done before the 1st of the year because my deductible has been used up, and I want to have my operation so I am not going to have to pay for it.

In this country, we have the incentives all wrong in terms of health care. We do need health care reform.

I don't think this bill is the way to do it, which is a government takeover of the health care system.

Twenty-five years taking care of families and the people of Wyoming. I have taken care of people on Medicaid and Medicare. We heard from Senator Burr about North Carolina and Medicaid as well as Medicare and I have concerns about both. I take care of all patients, regardless of their ability to pay. So what we know right now is that the Mayo Clinic--and the Mayo Clinic in Rochester, MN, has been held up in the Senate by our colleagues. It has been held up by the President of the United States as the model for what we should try to get to do in America for health care. The Mayo Clinic has now told Medicare and Medicaid patients they are not welcome. It has put out the sign: No vacancies for you. It is astonishing. It is hard to believe the Mayo Clinic would say: No thank you, we don't want you, but they have done that.

As the senior Senator from Tennessee said, it is like having a bus ticket when no bus is coming. Others commented in the paper that it is like putting more people into a sinking ship.

Why would the renowned Mayo Clinic not want to see these patients? They are sending out letters saying if you are from these surrounding States--Wyoming and others in the Midwest and the Rocky Mountain West send many patients there--you cannot do it. The Mayo Clinic is able to provide the kind of care they do because they take very few Medicaid patients, they take very few Medicare patients, and they take people who have insurance. That is why we know premiums go up when more people are on Medicaid. There are actually two hospitals in Rochester, MN-- Mayo Clinic, where 5 percent of their patients are on Medicaid. At the neighbor hospital in the same community, it is 29 percent of their patients.

The hospitals in Tennessee cannot take everybody out of town. We have to take care of those people. When reimbursement is so low by the Federal Government, which is the biggest deadbeat payer in the world when it comes to health care--the deadbeat Federal Government pays so little, the Mayo Clinic wants nothing to do with them. That is why they came out against these proposals.

Harvard Medical School gave these proposals a failing grade and said people who support these are collectively in denial, because they know we are looking at a health care bill that will raise the cost of care, to be paid for by raising taxes and cutting Medicare for seniors. Our seniors on Medicare cannot even get into the Mayo Clinic. It is fascinating. Mayo set up a branch in Arizona. They say they will no longer accept Medicare for patients seeking primary care at its facility in Arizona: We don't want them. No vacancies for you. If you want to come in, you have to pay additional fees--a $250 annual fee plus anywhere from $174 to $400 a visit if you are on Medicare.

It will absolutely prevent new Medicare and Medicaid patients from getting in. The Medicare cuts will prevent doctors from taking new patients and may cause them to drop others. The concerns are so large, and the concerns aren't just for the doctors. I am concerned for the people in Wyoming, who depend upon Medicare for health care. I know the Senator is concerned for them in Tennessee. How will they get the care they need? More people are coming of Medicare age every day.

This big bill, this monstrosity, will cut close to $500 billion from people who depend on Medicare for their care. The American people-- those watching--need this care. But this takes it away to start a whole new government program. It is not fixing the program that is going broke already.

So the hard reality is--and I think the spokesperson for the Mayo Clinic said it well. She said that ``it simply is the reality of the health care business and how we are going to be able to continue our mission when these payments are so far below what it costs to provide the care.''

You are not even talking about staying open, keeping the doors open, breaking even. The reimbursements are so far below what it even costs the Mayo Clinic--the model being held up by Senators on the other side of the aisle--so far below what it costs them to provide care. So as we look at this and say how can we take care of and help the people of America get health care, quality care, what we need to do is be aimed at driving down the cost of care. This means an increase of the cost of care and premiums. They are going to do it by raising taxes, and everybody will be affected. The Senator from North Carolina, a State with an incredible background in technology and advances in medical devices--anything that taxes them will be passed on to everybody, regardless of income level. Every patient in America will suffer. The Mayo Clinic--the world-renowned Mayo Clinic, where anybody in America would like to go for their care--I heard the Senator from Tennessee say, in addition to what the Senator from North Carolina said, that people in his State want to have the same level of care you would have. We would all want that. The Mayo Clinic says if you are on Medicare or Medicaid, like many of the other States, don't come here, because we cannot afford to have you, because Washington--the biggest deadbeat payer of all time--isn't paying enough to keep our doors open.

Mr. President, I would say to my colleague and friend from Arizona, this type of legislation would have cost my wife her life. She is a breast cancer survivor, diagnosed by a routine screening mammogram. She was in her forties when that mammogram was performed. She went through the testing and had the operation. In that age, in her forties, she already had the breast cancer spread from her breast to one of the lymph nodes. It was a screening mammogram that saved her life. She has had three operations, two bouts of chemotherapy. As a result, she is a survivor--6 years later.

But this piece of legislation says: No, no, do not worry about it. There is not going to be any denial of care. There is not going to be anything like that. But if you turn to page 1,150, it talks specifically about this preventative task force, specifically saying when they make their recommendations there is going to be money that taxpayers are going to pay to tell people what those recommendations are. Then, if you go to page 1,190, it says that if it is not approved, they will deny payment for that service--deny payment. It does not say they might.

Some people might.

The reasons for that are they are not doing early enough screening, and even once they are able to find the cancer in Great Britain, how long do they have to wait in line until they actually receive the surgery? The delay of care is the denial of care, and that is what is going to happen under this bill.

I see my colleague from Idaho standing as well because he is familiar with this situation. But I look at this and see the numbers. They said: Well, we don't want to cover this service because it would only save 1 life out of 1,900 women in their forties. Well, in my case, that 1 life out of 1,900 was my wife Bobbi.

I know the Senator from Idaho wants to get involved in this discussion.

Senator Risch.

Mr. President, in joining my colleague from Wyoming, he and I had a townhall meeting together in Gillette, WY, his hometown, a wonderful community. I was just there last week for a Veterans Day parade. What Senator Enzi knows and I know is when we talk to the people of Wyoming, they want commonsense solutions.

As I am here with the House-passed bill and the Senate bill we are now looking at, people of Wyoming are astonished at the amount of pages in this sort of thing, how to deal with this, how to comprehend it. What does it mean? What if I like something on page 208 but don't like something on page 1,200?

We ought to be using a step-by-step process. My colleague has a wonderful program, a 10-point plan to improve our health care, and any one of those would be a positive step to actually helping American families, helping them get the health care they would like and they need. But not these bills--one through the House, one through the Senate.

I don't know if my colleague wants to join me in discussing the townhall meetings, where people said: We want health care reform; we want things that are going to make life better but to help keep down our premiums, help keep down the cost of our care. Eighty-five percent of Americans have health care coverage. They are just not happy with the cost. What I heard for the last hour from my colleagues on the other side of the aisle is we need to cover more people; we need to cover more people. That is only part of it. We need to keep down the cost of care for the 85 percent of people who like the care they have.

That is what happens when we get together with groups of people from around the State of Wyoming who come out for our townhall meetings to discuss the issues, to listen. We are there mostly to listen; they are there mostly to talk.

I ask my colleague, is that not exactly what we heard: We need changes but not this?

Mr. President, there are a lot of flaws in these bills because what Senator Enzi and I both hear when we go to townhall meetings--but also I had a telephone townhall meeting the other day-- is: Don't cut my Medicare. Yet when we take a look at the details of these bills, it is going to cut $500 billion--$500 billion--from our seniors who depend on Medicare for their health care.

They also say: Don't raise my taxes. But taxes are going to go up across the board. Every family is going to notice an increase in their costs, whether through taxes, premiums, an increase in the cost of their lives in terms of how it is going to impact the care they are going to receive. They say: Don't make my family pay more for health care. But across the board, people look at this and say they are going to end up having to pay more.

When Senator Reid brought this bill out, he said: Of all the bills I have seen, it is the best. To me, it is the best of the worst bills I could ever see. It raises taxes. It is not just me speaking. If you read what the people who had a chance to read the bill say--the Associated Press, the Washington Post, the New York Times, others throughout the country, our e-mails from home--there are higher payroll taxes, companies would pay a fee, rely primarily on new taxes, new fees, and then cuts in Medicare. It is beyond me that this Senate--that this Senate, the Senate of the United States--is ready to tell the seniors of this country they are going to cut $500 billion from the care these seniors get from Medicare. That is a growing number of people. Year after year, more people are on Medicare but yet the cuts are going to be there.

The gimmicks, the budget gimmicks are astonishing. The advertised pricetag is an astonishingly large number, over $800 billion. To get down to that astonishingly high number, they have used quite a few gimmicks. You get taxes, you get Medicare cuts, and then you get the gimmicks.

I visited with Senator Gregg from the Budget Committee earlier today. He is going to be on the floor to discuss the gimmicks. One of the things they have done is basically hidden the true cost of the bill. The true cost of the bill is going to be close to $2.5 trillion over a 10-year span. They have done it by putting in a whole new program called the Community Living Assistant Services and Support Act. It is a new Federal long-term care program.

What happens in these long-term care programs? They take in the money early on and then they do not spend it until many years later. But in the way they count money around here--they do kind of a 10-year score, they call it. For the first 10 years they are going to be taking in all of this money, and then when it is time to pay the money out, that money is not going to be there anymore because they will have spent it on the increased cost of medical care because these bills do nothing to get the cost of care down.

Kent Conrad, Democratic Senator from North Dakota, do you know what he called this part of the bill, the Democratic bill on which we are going to be asked to vote? He called it a Ponzi scheme of the first order. He said it is the kind of thing that Bernie Madoff would be proud of. That is a Democrat talking about what is in this bill.

What has the Washington Post said? ``It's a gimmick. These are not savings that can honestly be counted on the balance sheet of reform.''

Do we need reform? Yes. Do we need health care reform? Do we need to change the system? Absolutely. But this is not the way to go.

Senator Enzi is here. He has done a remarkable job as a member of both the Finance Committee and the HELP committee, and he has been part of the markups for both of the bills. He has focused relentlessly on trying to get the costs down so the premiums for the American people will not go up, and he has offered amendment after amendment, and they have been rejected time and time again.

Then Senator Reid gets these two bills--one from the HELP committee, one from the Finance Committee--tries to stitch them together behind closed doors, and there is an amendment that Senator Enzi had put into the bill, one of the bills--it was voted on and approved--and then it magically disappeared without the knowledge of any members of the committee. It was something intended to help the American people, but that got taken out and thrown away in the dead of night.

I don't know if Senator Enzi would like to comment on that, but this is a Senator who was working to improve the lives and health and pocketbooks of the American people, and his great idea is thrown away.

Mr. President, that is exactly what is going to happen. No. 1, we will get this huge push of an unfunded government mandate onto the States, a mandate that both Republican and Democratic Governors have called the mother of unfunded mandates, and they are across the board opposed. This is the way that Washington, with its wisdom, will say: We keep the price down, but what we will do is make the American people pay for it in a roundabout way. The more people you have on Medicaid, the program to aid the poor--and we have seen this in Massachusetts with their health care plan; there are not enough doctors to take care of everyone so the system is swamped, which is why it is taking now up to 9 weeks to get an appointment to see a doctor in Massachusetts, but also about 40 percent of doctors do not see Medicaid patients because the reimbursement rate is so low.

What you said, 60 percent of the cost, that is exactly right. It doesn't cover the cost of seeing the patient. We are talking about hiring a nurse, turning the lights on, paying the rent on the office, doing all of those things, the medical charts, the liability insurance, the whole list of the costs of having an

office opened. You cannot keep the office open if all of your patients are Medicaid patients. As a result, physicians--and I saw every Medicaid patient who wanted to see me. My partners and I have the same program where anyone can call and get an appointment, regardless of the ability to pay. But we know 40 percent of the doctors don't see patients on Medicaid.

The answer is no. Doctors' offices cannot stay open at the rate that Medicaid reimburses, and no hospital in the country can stay open if they are getting paid across the board at Medicaid rates. You have to have other people who are paying more to make up for the underpayment by the government on Medicaid.

The people who have private insurance end up paying more for their insurance premiums to help make up the difference because the government has across the board been the greatest deadbeat payer. Washington is a deadbeat when it comes to paying for health care costs, both for Medicare as well as Medicaid across the board. That has been the long tradition of Washington and health care. The other people who are penalized under this situation are people who have no health insurance, because they are being charged at a higher rate. The person who works hard and says, I will kind of self-insure in case something happens, I get sick and I have to pay the full bill, they pay the full bill to cover themselves as well as more to help for the underpayment done by Washington.

That is how, when you have more and more people on the Medicaid rolls, more and more people forced onto that through Washington's wisdom, it is going to be harder on people who have insurance through their jobs. Insurance premiums, for people who have insurance and like their insurance, those rates are going to go up. It is going to make it harder for American families and for small businesses that want to hire someone, because the rates of insurance will go higher. It will make it harder for small businesses to provide health insurance for their workers, and those who continue to provide health insurance will not be able to give raises because the costs are going to go up.

This whole approach to health care reform was supposed to be designed to help keep the cost of care down. That is what the President and the Senate promised all through the year. But it does not. It drives prices up.

When I hear my colleague from New Hampshire talk about all of the gimmicks being used in an effort to claim this is a good bill, I refer to this morning's column ``Health Bill Hoax.'' Only Bernie Madoff could believe the Senate's health care bill will expand coverage to 31 million while cutting the deficit by $127 billion over 10 years. It would be the first profitable entitlement. Kind of like when the President of the Senate, at an AARP townhall meeting this year, said: We have to spend money to keep from going bankrupt. On its face, we know how absolutely ridiculous that sounds. You can't do that. This is an incredible expense: taxes galore, all over the place. The word ``tax'' is used in the Senate bill 183 times; ``taxable,'' 164 times; ``taxes,'' 17 times; ``fee,'' 152 times; ``penalty,'' 115 times.

For people who believe this will keep down the cost of care, it will not. As my colleague from Wyoming said earlier, I advise Members to take a look at an editorial by the dean of Harvard Medical School, living in a State where they have the Massachusetts health care plan, which is government-forced insurance, government-mandated care, government-run care. According to the dean of Harvard Medical School in an editorial this week, the health debate deserves a failing grade. The plan is wrong and those who support it are living in collective denial. This is what is wrong with this. This will markedly accelerate national health care spending rather than restrain it. It will do nothing or little to improve the quality of care.

That is what we started with at the beginning--to improve quality, improve access, and lessen the cost. What we have is a bill which, if passed into law and signed by the President, will decrease quality, increase cost, and lessen the access of Americans to health care providers.

I appreciate my colleague's comments. The numbers are so high. These are staggering figures. How do you communicate to the folks back home how astonishingly large these numbers are? Because people say: We do want you to fix things, but don't cut Medicare, don't raise our taxes. Drive down the cost of medical care. Improve access to providers. Create more choices. As I look at this, to me this is going to mean higher health insurance costs, higher taxes, Medicare cuts and then, unfortunately, more government control over health care decisions.

I have 24 years practicing orthopedic surgery, taking care of the families of Wyoming.

The Senator from North Carolina, who has been a champion of early detection, early treatment, and prevention of disease, did see a preview of rationing this past week when this Preventive Services Task Force made a decision and recommendation about breast cancer.

The Senator talked about our seniors. I worry about rationing of care, delaying care, denying care. They said for women under 50 they should not have mammograms anymore. They should not do a breast self- exam. They said for women over 75, they should not have a mammogram anymore.

I will tell you that my wife is a breast cancer survivor, and she was diagnosed by a mammogram under the age of 50. And they cannot say that mammograms are not helpful. What they are saying is that the number of mammograms done per life saved is not cost effective.

I know both of the Senators who are on the floor, from New Hampshire as well as from North Carolina, have talked about early detection, early treatment, not using cost as the issue on comparative effectiveness research. We say let's use some clinical judgment. Let's see what we can learn. But, no, because for women under 50, they have to do 1,900 mammograms to save a life. For women over 50, it drops down to 1,300 mammograms to save a life. So that is what they are putting the cost of a life at: a 600-mammogram difference.

But for my wife--who is alive today, after three operations, and two full bouts of chemotherapy, and is now 6 years cancer free--having that mammogram under the age of 50 meant the difference between life and death.

That is what this bill has to do with. It is the difference between life and death for people. If you get into rationing care, delayed care--that is why people come to the United States for their care. It is the best care in the world. That is why Canadians and Europeans come here, because they have to wait too long. That is why our techniques and our treatments and our survival for cancer is so much better in the United States than these other countries. Because the Senator from North Carolina knows it is that early treatment that makes a big difference.

Mr. President, there are improvements that need to be done to the system. There are simple things we can do to keep down the cost of care, such as allowing people to buy insurance across State lines as well as giving individuals the same tax breaks big companies get, ending lawsuit abuse and dealing with what is needed to be done in terms of incentives to help people stay healthy so they have opportunities to save money themselves, and allowing small businesses to join together.

The bill we are looking at here is going to raise premiums for people who already have insurance. It is going to raise taxes on all Americans. It is going to cut Medicare--cut Medicare--for our seniors who depend upon Medicare for their health care needs. And while they are doing it, they are going to fund a whole new program rather than save Medicare--a system we know is going to go bankrupt.

Thank you, Mr. President. I yield the floor and note the absence of a quorum.

Mr. President, I find it fascinating, listening to the comments from the Senator from Maine. Maine and Wyoming are similar in a number of ways. One is that the engine that drives our economy is small businesses. What we heard is that this bill right here, this large bill which is the bill the Senate is considering right now, over 2,000 pages--underneath it is the bill that passed the House--I hear these are actually going to penalize the small businesses of Maine and the small businesses of Wyoming when those businesses try to hire another employee.

We are looking at 10.2 percent unemployment right now. People in our States are well aware of those numbers. I don't know if that number is being neglected by others, but for small businesses trying to hire people, this health care bill makes it much tougher. It will certainly make it tougher for them to provide insurance, and it will make it tougher for those small businesses to give raises to people.

It is, indeed, unfortunate that we are here in the Senate Chamber looking at a bill that is going to raise premiums for the American people who have insurance and who like the insurance they have. Their big concern isn't cost. We are looking at a bill that is going to cut Medicare for seniors who depend on Medicare, and the numbers are huge, almost $500 billion. And we are looking at a bill that is going to raise taxes on the American people.

I heard the Senator from Maine, and she can jump in and correct me if I am wrong. What I heard her say is that it is not just a tax on the rich; it is a tax on people all across the board because the taxes are going to be passed on. I see the Senator nodding her head in the affirmative. When taxes are raised on medical devices or on medication, on one thing after another after another, those are costs that will get passed on to all the consumers of health care.

Right before this party took the floor, we had the senior Senator from Minnesota talking about the Mayo Clinic and the wonderful care that is given there. It is wonderful care. But the Mayo Clinic has also said they don't want any part of this bill, nothing to do with it, to the point that they have sent doctors in my home State and States surrounding the Mayo Clinic who refer patients--and I practiced medicine in Wyoming for 25 years, have taken care of families there as a physician, and we sent patients to the Mayo Clinic--they just said: Stop sending patients on Medicare or Medicaid. We want nothing to do with it because the government is the biggest deadbeat payer. The Mayo Clinic said: Every time we get one of those patients, we have to charge the people who pay their own way, the people who have insurance. We have to charge them more. We don't want to take any more patients on Medicare and Medicaid. Hospitals and the communities in Maine, South Dakota, and Nevada, hospitals in those States have to take all those patients.

So what happens to people who pay their own way because they buy insurance themselves or they get it through work is the hospitals have to charge them more to make up for the biggest deadbeat payer of all time--the Federal Government.

I see the Senator from Nevada rising to his feet. I imagine the exact same thing is happening to hospitals in Nevada. Premiums are going up on the 85 percent of the people who have insurance they like. Yet we in the Senate tomorrow night are going to vote on a bill which, to me, the people of America don't like. Do you know who doesn't like it the most? Seniors. They are concerned. They know Medicare is going broke. And by the year 2017, there will be $500 billion of cuts in Medicare. Yet the money that is being cut from Medicare isn't being used to save Medicare; it is to start a whole new program that will cause Americans who have insurance to pay more. It will cause people who don't have any insurance to make it harder to get or if they go to an emergency room and have to pay a bill, that bill will be higher, all because of what I believe is an irresponsible piece of legislation that is going to be a huge weight on the American economy at a time when we have 10.2 percent unemployment.

I see the Senator from Nevada. He has a similar copy of the bills next to him. He may want to chime in on what he sees in his home State and what he is hearing from people who live in Nevada, from small businesses as well as hospitals and providers.

Plus, when you read this bill, one of their so-called solutions is they will put more people on the Medicaid rolls.

It is millions and millions of people, with the cost to the States. You say we will take it out of here. You won't see it in this bill because they are going to make the States pay over $20 billion in money because it is a matching program, so they get it off the Washington books. But it is still the taxpayers and the States, and we all come from States. That is going to drive up the cost for individuals as well as increase taxes around the country.

Those costs will have to go up. Premiums will go up for all people who have insurance, private insurance. The Senator from Nevada is correct. Some people think the number is 15 million more who will go onto the Medicaid rolls because there is a difference between the Senate bill and the House bill as to how many more folks they move onto the Medicaid rolls. But either way, we are talking tens and tens of billions of dollars that will come out of the taxpayers' pockets around the States. But that is still for a government-run program that doesn't reimburse, doesn't pay the hospitals, doesn't pay the doctors even what the cost of delivering the care is.

Across the board, hospitals will tell you they cannot keep their doors open if everyone is paid at Medicaid or Medicare rates. The only way they can pay the nurses, keep the lights on, take the food in the trays around to the patients, do all the things a hospital has to do, or keep a doctor's office open, the only way they can do it is because they charge more to people who have private insurance than they get paid for people on Medicare or Medicaid. And Medicaid is worse than Medicare in terms of the payment.

So it is this cost shifting that occurs. Who pays that? The people who have regular insurance. It is the hard-working men and women of America through their jobs who pay for that. We just heard from the Senator from Maine. Anytime we try to help that individual--I see the Senator from South Dakota is in the Chamber as well, and he may want to jump in as well because South Dakota is a State like mine where we have lots of small businesses that are going to be hit specifically hard as they try to continue to provide insurance. This does not even allow small businesses to group together to get better deals.

The Senator from Nevada talked about buying insurance across State lines to help people get the costs down. This bill prevents that. It also prevents small business groups from getting together, which would be a great help.

I know the Senator from South Dakota is interested in getting into the discussion. I invite him to discuss this very aspect and the impact of all these increasing premiums on the folks in his State.

Mr. President, if you do a poll of doctors, with the question: Have you ever ordered a test that was not going to help that person get better, that patient get better, but you were doing it because you did not want to miss something for fear of a malpractice suit, every hand will go up of

every physician. The Massachusetts Medical Society did a poll and 87 percent of doctors said that. Massachusetts has their new health care plan.

As an aside, the dean of the Harvard Medical School had an editorial in one of the major national publications this week, and he gave this whole thing--he said: I give this whole thing a failing grade. He said people who support this--the legislation that is being proposed--are engaged in collective denial. We need to do some things that will help with cost, with access, with quality. All this bill is going to do is drive up the cost, with no improvement at all in quality.

So there are step-by-step things we can do: letting people buy insurance across State lines, getting the same tax breaks as others. The Senator talked about helping people stay healthy--exercising, getting down the cost of their care by getting their cholesterol down.

But also you have to deal with lawsuit abuse. It is out there. You could do a thing as easy as loser pays. Obviously, there are great objections to trying to do that. There are people who would oppose that all the way. But it would help eliminate--eliminate--a lot of the unnecessary tests and certainly a lot of the costs of the system. Because two-thirds of the cost of that whole liability system goes to the system, it does not even go to the injured person. If somebody is injured, you want to take care of them. But this does not do it at all.

One of the things the Senator from South Dakota mentioned, fairly quickly in passing, was age band ratings, which flies in the face of the things we have been talking about: individual responsibility, opportunities for people to stay healthy. The big problem is that we know 50 percent of all the money we spend on health care on this country is on 5 percent of the people--the people who eat too much, exercise too little, and smoke. But yet under this government-forced insurance, where people are going to be forced to buy insurance--and if young people do not buy it, they are going to be listed as either tax cheats or criminals because they are going to get fined or they are going to get taxed an amount for not buying the insurance--they are going to have to buy insurance.

As the Senator from South Dakota talked about a 3-to-1 ratio--and the Senator from Maine mentioned the same thing--what that means is for the youngest, healthiest person buying insurance--that kid out of college who is staying healthy or might be working construction, who is in good shape, going to the gym--what they are doing on a 3-to-1 ratio is that person has to pay a lot of insurance compared to the person who does eat too much, exercises too little, and smokes. The ratio of their insurance premiums--this person can pay no less than one-third of what this person pays, when you might have 100 young people where their total health care bills for a year would be equal to that one person who exercises too little, eats too much, and smokes.

So these young people are going to end up paying the cost. And it is their premiums--and I think we heard that from the Senator from South Dakota--their premiums are going to go up--did I hear 69 percent?

It is the wrong prescription for America.

I am going to continue to speak on the floor about the things that I think are problems with this bill. I think it is the wrong approach. I think it costs way too much. I think it raises taxes on all Americans. It cuts Medicare. What we have heard now, and what we know for sure, is it is going to raise premiums for people who have insurance, who like the insurance they have, who want to keep the insurance they have; and their costs are going to continue to go up if this becomes law, at a rate faster than, as we saw from the graph, if nothing was passed at all.

Mr. President, I rise today to express our Nation's deepest thanks and gratitude to a special young man and his family. I was saddened to receive word that on November 16, 2009, SSG Ryan Zorn of Wright, WY, was killed in the line of duty while serving our country in support of Operation Iraqi Freedom. Staff Sergeant Zorn died near the town of Talifar in northwestern Iraq from injuries sustained when his armored vehicle overturned.

Staff Sergeant Zorn was assigned to the 1st Battalion, 34th Armor Regiment, 1st Brigade, 1st Infantry Division, out of Fort Riley, KS. Staff Sergeant Zorn grew up in Upton, WY, and joined the Army following his graduation from Upton High School. He loved his country, and loved serving his country. His mother JoAnn says this is what he lived for. He was on his third tour of duty in Iraq. His family and his faith were very important to him. Friends and neighbors remember him as always open and friendly, with a broad smile and a wonderful sense of humor. He was dependable and generous, always willing to help others without hesitation.

It is because of Ryan Zorn that we are allowed to go about our daily lives as free people. America's men and women who answer the call to service and willingly bear the burdens of defending our Nation deserve the deepest respect and gratitude of all Americans. 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.

Jesus says in the Book of John that, ``Greater love has no man than this, that he lay his life down for his friend.'' SSG Ryan Zorn 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.

Staff Sergeant Zorn is survived by his mother JoAnn, his father Myron, and his brother Todd. He is also survived by his brothers and sisters in arms of the U.S. Army. We say goodbye to a son, a brother, a friend, and an American soldier. The United States of America pays its deepest respect to SSG Ryan L. Zorn 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 and welcome him with open arms.

Mr. President, continuing along this line--because both of us have practiced medicine--I took care of families in Wyoming as an orthopedic surgeon for the last 25 years; Dr. Coburn in Oklahoma for longer than that. We know there are things that need to be corrected. There are improvements that need to be made. We need to fix what is wrong with the system, and that is what I hear every weekend when I go home. It is what I have talked about in the surgeons' lounge in the hospital. That is what I have talked about in the office with my patients. So we need to fix what is wrong with the health care system. But whatever we do, we have to make sure we do not make matters worse. So I say to my friend from Oklahoma, absolutely, my concerns are that this absolutely is going to make matters worse. It is going to increase premiums for families who have insurance. It is going to take almost $500 billion away from our seniors who depend upon Medicare for their health care. It is going to raise taxes on everyone in America--not just on people above a certain income level, on everyone.

They all are going to be impacted when you look at all the taxes that are going to be thrown on this. It is going to be passed along. People in America understand that. People know exactly what is happening here. That is why when I had a telephone townhall meeting earlier this week and asked: ``Is this the right way or the wrong way? Do you think you are going to pay more?'' Everybody thinks they are going to pay more. When asked: Do you think your system is going to get better or worse? They think it is going to get worse. Americans do not want to pay more and get less. That is not the value we as Americans want. It is not what we expect.

People say: Don't cut my Medicare. Especially, if you are going to try to do anything with Medicare, do it to save Medicare, which is already going to go broke in the year 2017. Don't do it to start some whole new, big government program. They say: Don't raise my taxes. People want to know what is going to happen to them, what is going to happen to their family.

What happens if they get sick? Well, they look at this and they say: We want practical, commonsense health solutions, not higher insurance premiums, not higher taxes, not Medicare cuts, not more government control over health care decisions. We want to have lower costs, improved access to providers, more choices. That is the whole crux of why we are doing health care reform, at least that is what I was told 9 or 10 months ago. When they said: We need health care reform. I said: Yes, we do.

I served 5 years in the Wyoming State Senate. We did major pieces of legislation, always in a bipartisan manner, as the senior Senator from Maine has said. Now we are trying to find a way where somebody is trying to get just the minimum number of votes to pass this--not because they want to say, let's see what we have that will work for people.

As doctors, we try to find solutions that work for people. We do not say: What is the very minimum we can do? That is what we are seeing here. We are saying: What can we do to get it right? What this bill is saying is: What can we do to get 60 votes, the minimum we can do to get this, to drag it over the next step along the line--not to solve the health care issue that faces our country.

We know we need to deal with access to care, quality of care, and the cost of care. As my colleague from Oklahoma said earlier, it is the cost of care that needs the attention right now. Eighty-five percent of people like the care they have but they do not like the cost of that care. So what can we do to help get that cost down?

Everything I read and everything I know and everything I study and everything I believe from my years of practicing medicine and taking care of patients tells me this is going to drive the cost up for everyone in the country. And that is not just me.

The dean of Harvard Medical School said it just the other day. He gave the whole thing a failing grade. He said those ``people who favor the legislation are engaged in collective denial.'' And he went on to say that when you talk about the problems of cost and access and quality--with the cost, he said, this ``will markedly accelerate national health-care spending rather than restrain it'' and will ``do little or nothing to improve quality.''

Well, if you are going to spend much more money, you ought to get increased quality. But the problem is not that we are not spending enough money. We are spending enough money in the system. Half of all the money we spend in this country for health care goes for just 5 percent of the people--people who eat too much, exercise too little, and smoke. But there is nothing in this bill anywhere that gives an incentive to those individuals, to that one person to say: Hey, look, we want you to quit smoking. We want to help you lose weight. We want to help you get your cholesterol under control, through exercise get your diabetes under control, get your blood sugar down. There is nothing that gives an incentive to any one individual.

Now, there is a lot of money in here for roadways and streetlights and jungle gyms to encourage community health. But that does not work. What works better is an individual incentive to some person to say you are going to save this much money, get this much money, if you take responsibility for your own health. A lot of people try to do that on their own. But those are the 95 percent, not the 5 percent who are costing this country 50 percent of its health care dollars.

But I will ask my colleague from Oklahoma, do you see anything in here that focuses on that individual patient, a patient-centered approach, as opposed to a government-centered approach or an insurance company-centered approach? I see nothing here that is really focused on the individual patient, giving them incentives, giving them opportunities, giving that individual, American citizen more control, more freedom of choice, to help stay healthy and keep down the cost of their care.

Mr. President, here you have it, what we have been waiting for for weeks and weeks, what has been put together behind closed doors. People all across the country have seen the doors behind which people, in secret, have been writing this bill. It is 2,074 pages. Some people call it remarkable; I call it a monstrosity.

The leader of the majority, Senator Reid, has said that of all the bills we have seen, it will be the best. Mr. President, it is the best of the worst. It just looks like more of the same. All of the things I have been talking about--it still does those sorts of things. It still raises taxes on Americans, higher payroll taxes--and this is the Associated Press talking, not just me. Companies will pay a fee. That is from the Associated Press as well. It adds an array of tax increases, a rise in payroll taxes. That is from the Washington Post. It relies primarily on a new tax. That comes from the Washington Post as well. Then the New York Times says: New taxes and new fees. It is more of the same. It is the best of the worst.

What about Medicare cuts? Oh, they are in here, too, you better believe it. It is relying on cuts in future Medicare spending to cover costs. That is from the Associated Press. It is financed through billions of dollars in Medicare cuts. That is from the Washington Post. There will be reductions in Medicare. It is all in here--taking away the

health care of the seniors of this country, who have relied on Medicare and have been promised Medicare, to start a brandnew program which is in these 2,074 pages. It is just wrong.

Then look at the budget gimmicks. The costs of this legislation--and the CBO came up with some number, but it is not what the real cost is. This thing is going to cost $2.5 trillion over a 10-year period. They try to get the number down. How do they do it? They start collecting taxes on day one, but until they actually implement the program--the things that are supposed to help Americans, they have delayed those things through 2014. Here we are in 2009, and the people who are watching at home and saying: This is going to help me next week, forget it, wait another 5 years. That is the way they maneuver and manipulate the numbers.

Here we have it--a bill that still raises taxes, still cuts Medicare, uses lots of budget gimmicks, and will cost the American people trillions and trillions of dollars.

Mr. President, obviously health care is one of the most important issues Congress is going to take up this year and maybe in our careers in the Senate. This may be the most important issue and bill we are ever asked to vote upon.

I travel home to Wyoming every weekend. I talk to people. I was there for 5 days over Veterans Day.

I say to them: What do you need? What do you think? What are your thoughts on this?

They say: Deliver to Washington a clear and simple message: Fix what is wrong with the health care system. Whatever you do, don't make things worse for me.

I have town meetings and ask people: Do you think it is going to cost more or less if this is passed? And I have had telephone townhall meetings with folks around Wyoming, and there is a way you can poll and ask people their ideas. People believe it is going to cost them more. I ask: Is your care going to be better or worse? People believe it is going to be worse, that they are going to pay more and get less.

That is not the kind of value the people of Wyoming or anywhere in America want. It is not the kind of work they expect out of Congress. They want us to fix what is wrong with the health care system. As Senator Alexander said earlier, we need a step-by-step approach in the right direction, dealing with the things we can do to improve the system. Whatever you do, they say, don't make matters worse for me. That is what people care about. That is what they care about in the telephone townhall meetings and the meetings we have in person.

They say: What does this mean for me and my family? What will it mean to our health care? What happens if I get sick? That is what people care about. None of them want to read this bill, and probably none of them will read the bill. It is on the Internet, after weeks behind closed doors. I hope the people in Wyoming and around America read it so that they know about the travesties in the bill and the impact it will have on them personally. It is the wrong prescription for America. And it is not just me saying that.

Yesterday, there was an article in the Wall Street Journal, and the dean of Harvard Medical School--it is in Boston, which is where they have this whole Massachusetts health care plan. He said that it is not working in Massachusetts and that this is not going to work for America. He gave the health care bill we are looking at in this Congress a failing grade. It doesn't do a good job in dealing with costs, access, or quality. It misses the boat on all of them.

The people who believe this is going to be helpful collectively are delusional, absolutely wrong. They have no idea how this will be for the health of our Nation. Yet this is what we are looking at. As Senator Reid says, what we have seen, of all the bills he has seen, it is the best. It may be, but it is the best of the worst. It looks like more of the same.

Some people in Wyoming in townhall meetings say: Don't take away my freedom to choose the plan I want. Well, this bill sort of does that. If they have something they like, this has a lot of numbers and mandatory sets in there--the sorts of things that will take away freedoms of the people to choose specifically what they want because of all of the mandates this has to cover, and it has to cover this, that, and the next thing. A lot of people don't want that.

People also say: Don't cut my Medicare. I hear that all around Wyoming and around the country. There are 11 million people on Medicare Advantage. That Medicare Advantage Program is actually the only Medicare Program that does a good job of working on preventive care and coordinating care, and that is going to be slashed under this program. So we are going to take away prevention and the things that have to do with coordinated care. Just take a look at this monstrosity of over 2,000 pages.

People say: Don't cut my Medicare or raise my taxes. We are looking at 10.2 percent unemployment right now. This is not the time to raise taxes. It is just not the time. We need to focus on getting jobs moving in the economy and helping people hire new people. With that 10.2 percent unemployment, the last thing you want to do is raise taxes, but that is what this bill will do. That is not just me saying that; it is also the AP, the Washington Post, and the New York Times. All along the way, it is higher payroll taxes, companies paying fees, raising payroll taxes, primarily new taxes and fees--one after another--to pay for something the American people do not want.

The people say: Don't make me pay more for my family's health care. But that is what is going to happen across the board. Premiums are going to increase, the premiums for people who have insurance--the premiums people pay who have insurance. For the 85 percent of Americans who have insurance, those costs will go up. This plan was designed, theoretically, when it was announced a year ago, to get costs down, to get premium costs down. This raises the premiums for the American people.

We are living in a time and in an economy when people say they can't afford this sort of a bill. The American people don't want it.

I travel around the State and visit with people. I visited with a young lady from Cody, WY, who has health insurance through her job, and she likes it. She takes care of her family. She found out that because of increasing premiums--which will get worse if this bill passes--the raises people think they are going to get will not be coming to them. In some places, they have had their pay cut a little bit so they can continue with the health care they have. They like the care, but they don't like the cost of their care. Again, this doesn't get the costs down for American families. Premiums will go up.

This is what we have been seeing all across the country. Whether it is independent people, whether it is people who work for government, whether it is people who sell insurance or those who buy insurance or people who need insurance, across the board, people say these atrocious health care proposals will make matters worse for the families, for the men and women of this country. They are going to be paid for not just by them but also by the young people, as the debt continues to accumulate in our Nation and goes on to impact the young people of this Nation.

The people of Wyoming want practical, commonsense health care reform--the kinds of reforms that will drive down the cost of medical care, that will improve access to providers, that will create more choices. They don't want things that will increase the costs or things that will limit access or things that will take away their choices.

Obviously, the majority leader and the Democrats in Congress have a very different plan in mind. Their legislation is going to force upon Americans higher health insurance costs through higher premiums, higher taxes, Medicare cuts, and more government control over health care decisions. That is not reform.

There are only two physicians in the Senate. The two of us bring a unique perspective to the health care debate. I practice medicine, taking care of families from all across the great State of Wyoming. I have dedicated my life's work to helping patients live longer, live healthier, and stay well. I can say, without reservation, in this Nation, we do offer some of the finest medical care

in the world. I am not blind to the fact that our health care system has failings. I have seen them firsthand. We can fix a broken system in a way that actually works to get costs down, to get more people covered, to give people more choices, not in this plan, not in this atrocious plan which raises taxes, cuts Medicare, and takes away choices from the American people.

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

Madam President, I ask unanimous consent to be allowed to speak as in morning business for up to 5 minutes.

Madam President, today I rise to recognize the 30th anniversary of Public Law 96-114, which is the Congressional Award Act. My predecessor, Senator Malcolm Wallop of Wyoming, was a champion of this program.

In 1979, the late Congressman James Howard of New Jersey and Senator Wallop introduced the Congressional Award Act legislation.

Thirty years ago, as you recall, America was still living with the Cold War. The country was in the middle of a serious national conversation, one that would require America's young people to participate in a period of national service. It was a controversial concept, in part because the country had eliminated the armed services draft. Legislation to establish the congressional award had been introduced in Congress for several sessions, but no action had yet been taken. When Senator Wallop was approached as someone who might have an interest, he quickly understood and embraced the core of the program.

Our Nation's young people have worthy contributions to make to the world around it, he thought and he said, and the process required to earn an award was a productive path to determine their future. Senator Wallop felt that if America was thinking about requiring national service, then Congress should recognize and thank America's youth for their positive contributions made through the course of their own lives. He saw the congressional award as the perfect opportunity to do this.

When Senator Wallop agreed to serve as a sponsor of the congressional award, he made it a full commitment. The legislation quickly moved through

Congress, and it became law in his very first term of the three terms he spent in the Senate.

The congressional award is available to any young person in our country aged 14 to 23, no matter their life circumstances or their current abilities. Through goal setting, participants move from where they are to where they can be, providing service to others and exploring their own interest in the process.

Recipients of the award are not selected for it. The recipients of the award earn it. It has been my privilege to witness the success of this program both in my home State of Wyoming and around the country. I thank all of the Members of Congress who are involved in the congressional award in their own States and districts. I encourage those who have not yet done so to bring this program to their young constituents. And most of all today, I thank our former colleague, Senator Malcolm Wallop, for his gift--a gift of opportunity for America's young people through the creation of a congressional award, an award that was signed into law 30 years ago today.

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

Madam President, I wish to recognize the Wyoming Farm Bureau Federation's 90 years of service. Since its first meeting, the Wyoming Farm Bureau Federation has advocated for Wyoming farm and ranch families in local, State and Federal policy. The organization has been a leader in advocating for low taxes, less government, multiple use, and most of all private property rights for generations. The Wyoming Farm Bureau Federation provides organization, resources, and service to our agriculture community.

Among the strengths of the Wyoming Farm Bureau Federation is the organization of the Farm Bureau Young Farmers & Ranchers Program. This program provides resources and leadership for men and women beginning their careers in agriculture. The program is laying the foundation for future leaders in Wyoming agriculture and our rural communities.

Wyoming Farm Bureau Federation serves as a reliable source of agriculture and business information in Wyoming. Many in Wyoming turn to Wyoming Farm Bureau Federation as the source for up-to-date agricultural news. The organization provides timely information and valuable insight into current issues facing Wyoming and America.

Wyoming Farm Bureau Federation members will celebrate 90 years of service at their annual meeting this week in Casper, WY. They will remember the pioneer spirit that brought together farmers and ranchers from Wyoming's counties 90 years ago. The foresight of those early members has allowed the Wyoming Farm Bureau Federation to be the leading agriculture organization that it is today.

Wyoming Farm Bureau Federation has led the way to preserve individual

freedoms and expand opportunities in agriculture for 90 years. I recognize this important milestone, and I wish the organization and all of its members future success.

Madam President, any day now the Senate will begin to debate a single bill affecting the lives, the wallets, and the health of all Americans. Three Senators from the other side of the aisle have been working behind closed doors, trying to stitch together yet another health reform bill--a bill that will restructure 17 percent of the American economy. It is unclear when the other 97 Senators will get to see the majority leader's bill.

As we wait for the opportunity to read the bill, to examine the bill, to see what is in it--and the American people are waiting as well--I am reminded of a book that I believe still has much to teach us, ``The Federalist Papers,'' particularly Federalist 62 authored by James Madison. He says this:

The internal effects of a mutable policy are still more

calamitous. It poisons the blessings of liberty. It will be

of little avail to the people that the laws are made by men

of their own choice--

Let's get that over again.

It will be of little avail to the people that the laws are

made by men of their own choice if the laws be so

voluminous--

You have seen this 1900-page House bill--

That they cannot be read, or so incoherent that they cannot

be understood; if they be repealed or revised before they are

promulgated, or undergo such incessant changes that no man

knows what the law is today, can guess what it will be

tomorrow.

That is what we are looking at. The quote strikes a chord with everyone who hears it because it summarizes so very well what we are facing today in the Congress--in the Senate, in the House--as we are dealing with health care and health reform. The House health reform bill is nearly 2,000 pages long. The Finance Committee bill is over 1,500 pages. The HELP Committee bill is over 1,000 pages.

Some in Washington may believe that drafting a bill in secret and then rushing to enact it into law with little debate is the perfect way to avoid tough questions and public scrutiny. That plan has not gone as intended. The American people are much too smart. As the American people began to understand the details, they began to ask the tough questions. They know what the Democrats in Congress and the administration are trying to do. The American people are not buying it. They are not convinced that we should turn over the Nation's private health care system to Washington, to bureaucrats, and to the Federal Government.

Of course the American people want reasonable, commonsense health insurance reform. We need that. But the American people do not want a bill that limits their freedom and bankrupts the country. Fortunately, the American people see that the numbers simply do not add up. They know that if the reform bills we are debating become law, the health care costs are going to go up.

I go home to Wyoming every weekend. I was there yesterday. People continue to ask me: How will all of these health care bills affect me and affect my family? Inevitably, the question is followed by a statement. It says: Tell those people back in Washington that I want them to fix what is wrong with our health care system, but whatever they do, that should not make things worse for me and worse for my family. I can't afford to pay more for my family's health care.

I agree completely with the people of Wyoming. Health care costs today are rising three times faster than inflation. Especially during these economic times, rising health care costs stretch family budgets to the limit. It also makes it harder for employers to keep offering health benefits to their employees.

Now the Congressional Budget Office, the Joint Committee on Taxation, and the Health and Human Services Office of the Actuary are all telling us what the American people already know. They are telling us that if we pass the health reform bill that is coming before us, we are going to make things worse.

What exactly did all of these nonpartisan organizations say? On September 22 of this year, the Congressional Budget Office sent a letter to the Finance Committee chairman, to Chairman Baucus. In the letter, the CBO said two important things. No. 1, premiums in the new insurance exchanges would tend to be higher than the average premiums in the current individual market. This was a bill that was supposed to lower costs. No. 2, people with low expected costs for health care would generally end up paying higher premiums. Again, that is not where we are supposed to be heading. According to the Congressional Budget Office, the Baucus bill actually causes many individuals and families struggling today to afford health insurance to end up paying more.

In the same letter, the CBO also indicated that tax increases in the Baucus bill will make monthly health insurance bills go up, not down.

During the Finance Committee debate, my friend from Texas, Senator Cornyn, asked CBO Director Doug Elmendorf a specific question. He said: ``Would the new fees on health insurers be passed along to health consumers?''

Dr. Elmendorf responded. ``Our judgment,'' he said, ``is that the new fees would raise insurance premiums''--make them go up.

The Joint Committee on Taxation confirmed exactly what the CBO Director had said because during the same Finance Committee debate, the Joint Committee on Taxation Chief of Staff said:

Basic economics is that the fee will be reflected in higher

premium costs.

Who pays the premiums? Obviously the people who are being insured or their employees.

I wish to point out that, like many things in this Baucus bill, this new insurance tax system, the new taxes begin in the year 2010--next year--a full 3 years before Americans see any benefits, any coverage benefits. So they are going to start paying for this years before the benefits actually arrive. I thought the goal of health reform was to lower the cost for hard-working Americans, not to raise the costs. Instead, the respected economists who looked at this are telling us that monthly health insurance costs will go up for every single American starting next year.

Next, the Health and Human Services Office of the Actuary, which is another nonpartisan, highly respected scorekeeper, took a look at this Democratic health reform bill. On October 21, they released a memo analyzing the House bill, at the time H.R. 3200. Unfortunately for the Democratic leadership and the White House, the news was not good. The House bill bends the cost curve up. The expenses go up. According to their memo, health care spending will increase if the House bill becomes law.

Here is what they said:

In aggregate, we estimate that for calendar years 2010-

2019, National Health Expenditures would increase by $750

billion or 2.1 percent over the updated baseline projection.

Often the government uses fancy, complex language, so let me be very clear about this. They are saying that as national spending on health care increases, American families will see their monthly health insurance premiums go up.

My friends on the other side of the aisle will try to tell you the data is meaningless. They will try to tell you the taxpayer-funded subsidies included in the bill will make the health care premiums more affordable. It is fascinating to me that the Democrats do not even try to deny that premiums will go up. They admit it. Instead, they tell us not to worry about it.

We should worry about it. The people of Wyoming worry about it. The people of America are worried about it. Why? Because hard-working American taxpayers and the generations to follow will be forced to pick up the tab. I want everyone who is listening to know that the American people are not being fooled. They understand that subsidizing something does not make it cheaper.

Not only do the proposals in front of us raise taxes, they slash nearly $500 billion from Medicare, from the hard-working Americans who have given and sacrificed and who rely on Medicare for their health care, and they raise premiums, they raise the cost for people who have insurance. They are doing it not to save Medicare but to create an entirely new entitlement program.

Again, my friends on the other side never seem to mention that most Americans will not even qualify for these subsidies that are being promised. About 160 million Americans get their health insurance through an employer. Under the Democratic health reform plans, they will not qualify for a Federal Government subsidy. You have to take the health insurance your employer gives or buy a policy on your own, whether you can afford it or not. That is going to be the law. Either way, it will cost you more if this bill becomes law.

We have not even gotten into the issue of the quality of the care you will receive under this new government-run system. The Congressional Budget Office also confirmed that almost 5 million American people who buy insurance through this new government exchange will not receive any help to pay for their insurance. What good are taxpayer-funded subsidies to help pay for premium increases when most people don't actually qualify for the promised help?

It sounds to me as if the Baucus bill will stick people with higher taxes, will take away their choices, will remove personal freedom, and will implement changes that increase their monthly health care costs. This is not reform; it is a blatant effort by Washington to take over health care in America.

It is important that Members of Congress and the American people fully understand how the Democratic health bills will increase costs, so let's go through the list one by one.

We have already talked about the new tax on health insurance providers. Experts tell us this tax will be passed on to patients. BlueCross BlueShield of Wyoming tells me this tax will raise monthly premiums of families in my State by $500 a year.

Then there are the new requirements. The Democratic bills all have the Federal Government defining what kind of insurance can be sold and must be purchased. Well, this makes it illegal for insurers to sell certain policies that many people have today, that many people like, and that many people want to keep.

How do they accomplish this? The Democratic bills require most health plans to offer products that meet new, higher, specified what are called actuarial values and cover an exhaustive list of mandated benefits. If you do not know what the term ``actuarial values'' means, you are not alone. I have been in the practice of medicine for 25 years taking care of families all across Wyoming. I had never heard of it.

``Actuarial values'' is a technical term. It stands for the total amount of health spending paid for by an insurance plan. In other words, the actuarial value of a health plan depends on all of the benefits, on any cost sharing that the health plan covers. Actuarial values are represented by a percentage. In insurance plans, they can range anywhere from 55 percent to 90 percent. Typically, as these values increase, the cost increases.

Well, the health care bill raised this so called actuarial value minimum to a standard of 65 percent, which actually is much higher than many policies that are sold on the market today. As a result, experts tell us that people who buy insurance will pay at least 10 percent more just to meet the new standard.

I am sure the other side of the aisle will try to say: Do not worry. We will protect you.

You know, the idea was that you should be able to keep the insurance you have so that your premiums will not go up. But what they do not tell you is that you are out of luck if your insurer stops offering coverage or if you want to change your policy in any way.

How might you change your policy? Well, you might add dental care or vision benefits. If you want to do any of those changes, you are out of luck. Any change to your current insurance policy and the promise that ``you get to keep what you have if you like it,'' well, that promise will not come true.

Finally, there are some new rules called age rating. They are going to drive up the premiums specifically for younger folks. The age rating rules limit the amount premiums can vary between healthy younger Americans and older individuals. Experts tell us that the Finance Committee bill, for example, will cause monthly insurance premiums for younger, healthier people who are then going to be subsidizing older folks who are sicker--to drive up the premiums of younger folks by 69 percent. These extreme price increases will force young healthy people out of the market. A young person will see that it is cheaper to pay a $750 fine annually, what they call a tax penalty, and forget about having health insurance than it is to pay $5,000 a year for health insurance when, as many young people believe, they will never need it. Besides, if this young person does get sick, he or she can always buy health insurance later without facing a penalty.

That is exactly how this bill is written. Without a doubt, the policies I have described will cause health insurance costs to go up for millions and millions of Americans, and specifically so very much for young Americans.

Plans that the President promised the American people that they could keep if they liked, well, we all know the President cannot and will not keep that promise. I will give a specific example. In Wyoming, a healthy 35-year-old man can go out today and buy a high-deductible health insurance policy for about $90 a month.

Scorekeepers at the Congressional Budget Office estimate this level plan in the Finance Committee bill will cost $392 a month. That is a huge increase because that is what they are going to be mandated to buy. Not one of my constituents can afford to pay 329 percent more for their health insurance than they can pay today.

We can solve the problem of rising medical costs without a government takeover of health care. I struggle with the assumption that people generally can be trusted to do the right thing and society prospers when government has less to say about how people run their lives. Others start by assuming that Washington knows best and should take more authority over all of us.

There are better ideas that improve our Nation's health care system, commonsense reforms on which all of us can agree. Having practiced medicine, taken care of families in Wyoming for 25 years, I would prefer a step-by-step approach to reform--simple, commonsense, affordable changes that we can implement right away. And all of those ought to be centered on the patient, patient centered, not government centered: Giving people incentives such as lower costs when they engage in healthy behaviors; prohibiting the use of preexisting condition clauses; allowing people to take their health insurance with them if they change jobs; allowing Americans to buy insurance across State lines, to shop for a policy that is best for them, best for their family; giving people the same tax breaks that big companies get when

people buy their insurance policies individually; dealing with abusive lawsuits and the situation there that involves doctors ordering many tests that do not necessarily help the patient stay healthy but help protect the doctor in case of a suit; and allowing small businesses to pool together in order to offer health insurance to their employees at a more reasonable cost to the employees as well as to the business.

The time has come to work together for meaningful reform. I think most Americans would prefer that we get these reforms right than pass a 2,000-page bill--a bill that raises taxes, a bill that cuts Medicare, a bill that costs $1 trillion, and a bill that represents a Washington takeover of health care.

The American people want better. The American people deserve better. The American people deserve nothing less.

I yield the floor.

Mr. President, I join Senator Enzi today to introduce the Heart Mountain Relocation Center Study Act. This legislation will authorize the National Park Service to conduct a special resource study of the site of Heart Mountain Relocation Center near Powell, Wyoming. The site is an important part of our national history and of the history of our communities in western Wyoming.

This legislation is truly a credit to the individuals, local communities and grassroots organizations supporting recognition of the Heart Mountain site. Many of these individuals readily share their experience of the years between 1942 and 1945, when Japanese American families from the West Coast were forcibly moved to Park County, Wyoming and interned at the site near Heart Mountain. During those years, the Heart Mountain site was the third-

largest community in Wyoming, housing nearly 11,000 Japanese Americans. The experience during those years shaped internees and local residents alike. It represents an important chapter in American history.

The legislation introduced today will authorize study of the Heart Mountain site and its significance to the mission of the National Park Service. The study will involve participation by the public and evaluate options for future management of the Heart Mountain site.

I want to thank the Heart Mountain Wyoming Foundation, along with other supporting organizations, for championing this cause. It is because of their efforts that this important historical site has been preserved and presented to the public.

The internment of Japanese Americans during World War II is a part of America's history. The special resource study of Heart Mountain Relocation Center will lay groundwork for protecting this history for future generations. I urge Senators to support the Heart Mountain Relocation Center Study Act.

Mr. President, I join Senator Enzi today to introduce the Heart Mountain Relocation Center Study Act. This legislation will authorize the National Park Service to conduct a special resource study of the site of Heart Mountain Relocation Center near Powell, Wyoming. The site is an important part of our national history and of the history of our communities in western Wyoming.

This legislation is truly a credit to the individuals, local communities and grassroots organizations supporting recognition of the Heart Mountain site. Many of these individuals readily share their experience of the years between 1942 and 1945, when Japanese American families from the West Coast were forcibly moved to Park County, Wyoming and interned at the site near Heart Mountain. During those years, the Heart Mountain site was the third-

largest community in Wyoming, housing nearly 11,000 Japanese Americans. The experience during those years shaped internees and local residents alike. It represents an important chapter in American history.

The legislation introduced today will authorize study of the Heart Mountain site and its significance to the mission of the National Park Service. The study will involve participation by the public and evaluate options for future management of the Heart Mountain site.

I want to thank the Heart Mountain Wyoming Foundation, along with other supporting organizations, for championing this cause. It is because of their efforts that this important historical site has been preserved and presented to the public.

The internment of Japanese Americans during World War II is a part of America's history. The special resource study of Heart Mountain Relocation Center will lay groundwork for protecting this history for future generations. I urge Senators to support the Heart Mountain Relocation Center Study Act.