Floor Statements

Will the Senator yield for a question? Since the Senator mentioned my name, will he yield for a question?

I regret that the Senator from Illinois did not observe the courtesies of the Senate, particularly when a person's name is mentioned, as he continued to mention my name throughout and totally falsifying my position both in the Presidential campaign and the position that we have on this side and this amendment. I have always extended that courtesy to the Senator from Illinois. I deeply regret that even this comity of the Senate is no longer observed.

I say to the Senator from Illinois, I regret you would not respond to a question I had posed, when you had said: I will respond in a minute. Again, even comity is not observed here.

I will go ahead with the--the Senator did not provide me with the courtesy of allowing me to respond to a question. Now you want me to respond to a question from you? I will display more courtesy than you displayed to me. Go ahead.

Well, I guess my questions were, one, did the Senator, who claimed that no Republican has done anything to curb the health care insurance industry, was the Senator in the Senate when Senator Kennedy and I fought for weeks and months for the Patients' Bill of Rights? Was the Senator here then? Was he engaged in that debate? Senator Kennedy and I fought for the Patients' Bill of Rights, and the majority on that side of the aisle opposed it. The fact is, there have been efforts on my part to curb the abuses of the health insurance industry by sponsorship of the Patients' Bill of Rights.

Second, during the campaign, yes, I said that we could reduce and eliminate waste, fraud, and abuse in spending, and I said it because of Senator Coburn's Patients' Choice Act which would save $1 trillion in the States in Medicaid savings, $400 billion over the next 10 years in Medicare savings. I wish the Senator from Illinois would examine the Patients' Choice Act, as proposed by the Senator from Oklahoma. Maybe he would learn something. The Coburn bill wants to preserve the best quality health care in America and not eliminate $12 billion in the Medicare Advantage Program, which 330,000 of my citizens who are enrollees like and want to keep, not eliminate $150 billion to providers, including hospitals, hospice, and nursing homes, $23 billion in unspecified decreases to be determined by an independent Medicare advisory board, as well as billions of additional cuts to the Medicare Program.

There is no relation between what I tried to do in my campaign and what is being done in this legislation, I tell my friend from Illinois. I would be glad to hear the Senator's response. I would be glad to extend him that courtesy.

Your statement was that no Republican had done anything. You just said no Republican had done anything to curb the health insurance industry. The Patients' Bill of Rights certainly would have done it.

That is not what you said.

My record is very clear of advocating for patients and against the abuses of insurance companies across the board.

I ask unanimous consent to yield to the Senator from Oklahoma to describe the Patients' Choice Act and the way we could truly save money and reduce fraud, abuse, and waste in the system and at the same time preserve quality health care.

Before the Senator continues, I ask unanimous consent to regain the floor and then yield to the Senator from Oklahoma.

I ask unanimous consent to engage in a colloquy with the Senator from Oklahoma.

Mr. President, I have to address the situation since I have been accused by the majority leader of changing my position. The Senate considered the Deficit Reduction Act of 2005 which called for approximately $10 billion in reduction in Medicare costs, approximately $10 billion. Senator Harry Reid, Democrat of Nevada, said:

Unfortunately, the Republican budget is an immoral

document. Let's look at what is in the bill before us. The

budget increases burdens on America's seniors by increasing

Medicare premiums, and we have not seen what the House is

going to give us. It cuts health care, both Medicare and

Medicaid, by a total of $27 billion.

The majority leader was outraged in 2005 that there should be reductions in Medicare and Medicaid spending of $27 billion. Now the distinguished majority leader, with the white smoke coming out of his office, says he is for $483 billion in cuts in Medicare. That is a remarkable flip-flop.

By the way, I might add, Senator Dodd, who is here on the floor, said, concerning the Deficit Reduction Act of 2005:

For example, this bill cuts funding for Medicare and

Medicaid which provide health care to poor children, working

men and women, the disabled, and the elderly.

What a plea. What a plea.

Senator Barbara Boxer said:

Mr. President, I strongly oppose the reconciliation bill

before the Senate. The bill would cut vital programs for the

middle class, elderly, and poor. That is why I cannot believe

only 2 months after Katrina we have a bill that would cut

Medicare and Medicaid by $27 billion.

The list goes on and on.

Now before us we have cuts of $483 billion, including hospice, hospitals, other vital programs for our seniors. If we are going to go around and talk about flip-flops, let's look at the rhetoric that accompanied my colleagues on the other side in their opposition to $27 billion in savings which, by the way, actually only saved $2 to $3 billion over 5 years.

I ask my friend from Oklahoma, does he believe it is possible to make these cuts, including from the Medicare Advantage Program, and establish a Medicare commission that would not, over time, cut benefits that exist today for Medicare and Medicaid patients?

So does my colleague find it entertaining that my friends and colleagues on the other side of the aisle, in 2005--as part of the Deficit Reduction Act, we had to bring in the Vice President, who I think was overseas, in order to break the tie because they were worried about what Senator Reid called an ``immoral document,'' referring to the Republican budget?

By the way, is the Senator aware that Citizens Against Government Waste has come out in favor of this amendment?

Mr. President, I ask unanimous consent that the letter from Citizens Against Government Waste be printed in the Record.

Also, I say to the Senator, as you know, many of the seniors in my State--I would ask my colleague--have been very puzzled at the AARP's endorsement of a proposal that would cut their Medicare, where it has already been made clear that Medicare Advantage--and there are 330,000 seniors citizens in my State who are under Medicare Advantage--that it has been announced it will be slashed, and that somehow AARP is now supporting it.

All I can say is, is my friend aware there is an organization called 60 Plus that is working very hard on behalf of seniors to make sure they do not lose these benefits?

Can I ask the Senator another question? How does the Senator envision that we can eliminate fraud and abuse and waste and institute significant savings? One of the ways is to retain the provisions in this amendment, this motion to commit, that uses the savings from fraud, abuse, and waste elimination to make the trust fund stronger, but at the same time preserves the benefits that our senior citizens have earned. How many times have you heard from senior citizens in your State saying: I paid into this trust fund. I paid for my Medicare all my life. Now it is going to be cut. How is that fair? How is that fair to my generation, the greatest generation?

Madam President, I ask unanimous consent to send to the desk at this time a motion to commit with instructions.

Madam President, simply put, this motion to commit would be a requirement that we eliminate the one-half trillion dollars in Medicare cuts that are envisioned by this bill--one-half trillion dollars in cuts that are unspecified as to how, and one-half trillion dollars in cuts that would directly impact the health care of citizens in this country--Medicare Advantage cuts totaling $118 billion; an independent Medicare advisory board that would cost $23 billion; an expansion of Medicare hospital penalties totaling $7.1 billion; home health care cuts totaling $42.1 billion; and hospice--of all the things--payment changes. The list goes on and on.

All of these are cuts in the obligations we have assumed and that are the rightful benefits people have earned--particularly our senior citizens--across this Nation. This eliminates one-half trillion dollars in cuts to Medicare that are cuts that are unspecified.

I eagerly look forward to hearing from the authors of this legislation as to how they can possibly achieve one-half trillion dollars in cuts without impacting existing Medicare programs negatively and eventually lead to rationing of health care in this country.

That is what this motion is all about. This motion is to eliminate those unwarranted cuts. All of us know there are enormous savings in fraud, abuse, and waste that can be identified. No expert I know of believes that would come up to one-half trillion dollars. Hospitals are cut by $105 billion. Nursing homes are cut by $14.6 billion. Hospices are cut by $7.6 billion.

These are not attainable cuts, without eventually rationing health care in America and rationing health care for our senior citizens, who have earned these benefits, and we have guaranteed them these benefits.

For the life of me, how the AARP can support this 2,000-page legislation is beyond my imagination. Seniors all over America, including Arizona, including the 330,000 senior citizens in my State who are under the Medicare Advantage Program, which will be drastically cut by some $120 billion, are outraged. The more they find out about it, the more angry they are becoming.

Here we are, as my colleague from the great State of Iowa, a leader on health care, articulated, with a totally partisan measure before the Senate, in which no Member on this side of the aisle has been consulted in any way. I point out that, historically, there has never been a major reform implemented by the Congress of the United States unless it is bipartisan in nature, and I don't believe the American people want this 2,000-some-page monstrosity, which is full of all kinds of provisions that they are either unaware of, or even in the study of this legislation, many of us have also become unaware of. But fundamentally, the Bernie Madoff/Enron accounting that has been going on with this bill is dependent upon envisioning one-half trillion dollars in cuts that are not attainable. If they are attainable, it would mean a direct curtailment and reduction of the benefits we have promised the senior citizens of this country. That is not acceptable.

What this motion to commit does is send it back to the Finance Committee: Come back with another bill. Only this time, don't put the cost of it on the backs of senior citizens of this country. Don't do it. It was back last summer, 3 months before he was elected President, on a campaign stop not far from Washington, DC, now-President Obama vowed not only to reform health care but to do it in a new way. He said:

I am going to have all the negotiations around a big table,

televised on C-SPAN, so that people can see who is making

arguments on behalf of their constituents and who are making

arguments on behalf of the drug companies or the insurance

companies.

Americans wanted to believe this would be true. Republicans offered to work with the majority on our ideas. But that was rejected. So what has happened? Business as usual. Let me read from a report of this past weekend about business as usual:

The Associated Press has moved a story saying that health

care lobbyists and other interests have made 575 visits to

the White House between January and August. The report is

based on records released by the White House on Wednesday.

The timing of the release smells of a classic Washington

tactic--dumping bad news on the getaway day before a long

weekend. Clearly, the White House, which prides itself as

being the most transparent administration in the history of

the world, hopes this nugget gets lost over the four-day

Thanksgiving weekend.

AP's Sharon Theimer:

Top aides to President Barack Obama have met early and

often with lobbyists, Democratic political strategists and

other interests with a stake in the administration's national

health care overhaul, White House visitors records obtained

Wednesday by the Associated Press show.

All of my fellow citizens watching, I urge you to call the White House and say you want to have an appointment to meet with the President or members of the administration in the White House. Five- hundred-seventy-five special interests were able to get in. Why can't you? Give them a call. Tell them you want to meet with the members of the administration. That is what 575 lobbyists have been able to do. Give them a call.

Continuing to quote:

The records show a broad cross-section of the people most

heavily involved in the health care debate [except for

average citizens] weighted heavily with those who want to

overhaul the system.

It talks about who were among them.

The list also includes George Halvorson, chairman and CEO

of Kaiser Health Plans; Scott Serota, president and CEO of

Blue Cross and Blue Shield Association; Kenneth Kies, a

Washington lobbyist who represents Blue Cross/Blue Shield,

among other clients; Billy Tauzin, head of PHARMA, the drug

industry lobby; and Richard Umbdenstock, chief of the

American Hospital Associations.

Several lobbyists for powerful health care interests,

including insurers, drug companies, and large employers also

visited the White House complex, the records show.

Again, citizens, why don't you call the White House and ask for an appointment? The lobbyists and special interests--big donors--get it. They are not ambassadors. They are lobbying the White House on this issue.

Health care reform should have been about both sides sitting down together and fixing what is broken, reducing health care costs, while preserving the highest quality health care in the world.

Somewhere in the course of this debate, in the process of this legislation, we have lost sight of the fundamental problem with health care in America, and that is the cost of health care in America, not the quality. This legislation will destroy the quality and the availability, if the cuts envisioned in this legislation--this Enron accounting measure, where the first 4 years after this legislation-- suppose this legislation were signed on the 1st of January by the President of the United States. Immediately benefits will begin being cut. Immediately taxes will go up. Guess what. None of the benefits will be given to any American citizen for 4 years. That is how you get deficit neutrality. That is how you get deficit neutrality.

If you started giving the benefits at the same time you raise the taxes, you have got about $1.3 trillion in deficit in a $2.5 trillion bill--a $2.5 trillion piece of legislation. Here we are with the highest deficits in history, with deficits and debt as far as the eye can see, with a stimulus package that has done so well that we now have 10.2 percent unemployment, and many predict it will go even higher. Wall Street is doing fine, and lobbyists are doing fine. Mr. Tauzin, the PhRMA lobbyist, is doing fine. I understand his salary is a couple million dollars a year, not to mention all the other perks. But the average citizen, including the 330,000 citizens of my State, who have the Medicare Advantage Program, are going to see it cut and cut over and over again--about $120 billion worth.

So what happened? The White House engaged in the tradition of handing out favors to special interests, including PhRMA, AARP, and AMA. Shame on AARP and shame on the AMA. We know there are many commonsense reforms that Americans want.

By the way, in this monstrosity, find me any significant, real medical malpractice reform. The threat of medical malpractice causes physicians to practice defensive medicine. The CBO estimates it would be roughly a savings of $54 billion over 10 years. That does not take into consideration the cost of defensive medicine that doctors have to practice because of fear of being sued.

I ask the distinguished chairman of the committee: Where is any meaningful medical malpractice reform in this 2,000-page bill? Where is it?

I had a townhall meeting the other day in Arizona, as I do quite frequently. There were a lot of doctors, nurses, and caregivers who came. I asked them: What do you do about medical malpractice reform? Every one of them said: We practice defensive medicine. We prescribe additional tests and procedures. We have to do it because we will find ourselves in court by the trial lawyers.

Do not underestimate, I say to my friends, the many special interests and their influence in this legislation, but do not underestimate the stunning success of the American Trial Lawyers Association that has made sure there is no provision in this bill that has to do with medical malpractice reform.

By the way, if there is an example, it is called the State of Texas. The State of Texas enacted meaningful and yet not draconian medical malpractice reform. Premiums have gone down. Cases have gone down. Doctors are flooding back into the State of Texas. It has worked.

We are going to hear from the other side that there may be demonstration projects, there may be this, there may be that. The demonstration project is the State of Texas. That is all we have to do. It has already been proven.

Instead of a reform which could save tens if not a couple hundred billion dollars, what are we going to do? We are going to cut hospitals by $505 billion, nursing homes by $14.6 billion, hospices by $7.6 billion, and the list goes on and on, up to one-half trillion dollars. My motion will send it back to the Finance Committee and tell them to remove these unnecessary, unneeded, unwanted, harmful cuts in the Medicare system, which will not allow us to fulfill our obligation to the senior citizens of this country.

Buried in this partisan legislation, as I mentioned, are 10 years of tax increases and Medicare cuts, a total over $1 trillion. Using CBO numbers, this stack of partisan legislation costs $2.5 trillion over its 10-year implementation.

Let me put this in different terms for you. Suppose you want to buy a house. You go and buy the house, but the terms of the contract of purchasing the house say you have to make payments on the house for the first 4 years and then after 4 years you can move in. That is why this is Bernie Madoff accounting. It is a sham. It is a sham. It is a sham to make people pay taxes and have their benefits cut for 4 years and then only after 4 years do the benefits kick in. That is the way, with this kind of accounting, they get to deficit neutral. It is crazy. It is crazy.

The increased taxes and Medicare cuts begin impacting Americans and our economy in 32 days, if this is passed. Let me repeat this. Starting in January 2010, just 1 month from now, the majority begins tax increases and Medicare cuts, starting in January, and incredibly delays implementation of this bill for 4 years. That is 1,460 days and 208 weeks of new taxes and Medicare cuts before implementation. That is playing games with the American people.

If they were not playing games by delaying implementation of the bill 4 years after the tax increases and Medicare cuts, we would not even be discussing this pile of legislation because it would be scored as adding over $1 trillion to our deficit.

If the other side wanted to be honest and reject the Madoff-Enron accounting, they would be talking about the first 10 years of real costs and the first 10 years of their tax increases and Medicare cuts.

The respected dean of the Washington press corps, David Broder, pointed this out just last week in his column in the Washington Post entitled ``A Budget-Buster in the Making.'' By the way, the majority leader then felt compelled to come down and trash one of the most respected columnists in America whom I don't need to take the time to defend; he can defend himself and so will many others who have great respect for David Broder.

David Broder's column said:

It's simply not true that America is ambivalent about

everything when it comes to the Obama health plan.

The day after the Congressional Budget Office gave its

qualified blessing to the version of health reform produced

by Senate Majority Leader Harry Reid, a Quinnipiac University

poll of a national cross section of voters reported its

latest results.

. . . by a 16-point margin, the majority in this poll said

they oppose the legislation moving through Congress.

Broder went on to say:

I have been writing for months that the acid test for this

effort lies less in the publicized fight over the public

option or the issue of abortion coverage than the

plausibility of its claim to be fiscally responsible.

This is obviously turning out to be the case. While the CBO

said that both the House-passed bill and the one Reid has

drafted meet Obama's test by being budget-neutral, every

expert I have talked to says that the public has it right.

These bills, as they stand, are budget-busters.

Here, for example, is what Robert Bixby, the executive

director of the Concord Coalition, a bipartisan group of

budget watchdogs, told me: ``The Senate bill is better than

the House version, but there's not much reform in this bill.

As of now, it's basically a big entitlement expansion, plus

tax increases.''

These are nonpartisan sources, but Republican budget

experts such as former CBO director Douglas Holtz-Eakin

amplify the point with specific examples and biting language.

Holtz-Eakin cites a long list of Democratic-sponsored

``budget gimmicks'' that made it possible for the CBO to

estimate that Reid's bill would reduce federal deficits by

$130 billion by 2019.

Perhaps the biggest of these maneuvers was Reid's decision

to postpone the start of subsidies to help the uninsured buy

policies from mid-2013 to January 2014--long after taxes and

fees levied by the bill would have begun.

Even with that change, there is plenty in the CBO report to

suggest that the promised budget savings may not materialize.

If you read deep enough, you will find that under the Senate

bill, ``federal outlays for health care would increase during

the 2010-2019 period''--not decline. The gross increase would

be almost $1 trillion--$848 billion, to be exact, mainly to

subsidize the uninsured. The net increase would be $160

billion.

But this depends on two big gambles. Will future Congresses

actually impose the assumed $420 billion in cuts to Medicare,

Medicaid and other federal programs? They never have.

Why don't we tell the truth to the American people and take these supposed cuts out of this bill? Tell them the truth about what it costs and tell them the truth that this is a dramatic expansion of entitlements, but at the same time those presently eligible, those senior citizens, such as the 330,000 who are under the Medicare Advantage Program in my home State of Arizona, will not see that program maintained. You cannot reach these kinds of savings, these kinds of reductions, these kinds of cuts without impacting existing programs. I know of no expert who says it will who is an objective observer. I believe Dr. Coburn, Dr. Barrasso, and others in the medical profession will say the same thing. Every time Congress has enacted so- called cuts in Medicare or contemplated it, they have never taken place.

That doctor fix? We took care of that problem. We just took it out of the bill. But you know what we are going to do about the doctor fix. Every year we are going to delay it, delay it and delay it and it will never happen. That has been the history of the so-called doctor fix since its beginning.

And will this Congress enact the excise tax on high-premium

insurance policies (the so-called Cadillac plans) in Reid's

bill? Obama has never endorsed them, and House Democrats--

reacting to union pressure--turned them down in favor of a

surtax on millionaires' income.

The challenge to Congress--and to Obama--remains the same:

Make the promised savings real, and don't pass along unfunded

programs to our children and our grandchildren.

That means taking this legislation back, taking out these cuts in Medicare and programs that are vital to the citizens of this country and come back with a realistic--a realistic--piece of legislation that has malpractice reform, the ability to go across State lines to get the health insurance policy of your choice, rewards for wellness and fitness, expansion of health savings accounts, and medical malpractice reform.

There are many cost-saving measures we can enact to bring the cost of health care in America under control and preserve quality. Instead, we are doing the opposite.

If you are going to make these kinds of cuts--the $420 billion in cuts to Medicare and Medicaid and other Federal health programs--then you are going to impact the provision of health care in America.

Americans have been clear overspending has to stop, nor do the American people believe empowering Washington bureaucrats in a new Federal health care entitlement is health care reform. The other side disregards the message from the American people all across the country, and the bill does the opposite.

I wish to talk just for a minute about a provision in this bill that is very important; that is, the transfer of power, the massive transfer of power in this bill to the Secretary of Health and Human Services. This is a huge transfer. ``HHS would become federal giant under Senate plan'' by Susan Ferrechio:

A quick search of the Senate health bill will bring up

``secretary'' 2,500 times.

That's because Health and Human Services Secretary Kathleen

Sebelius would be awarded unprecedented new powers under the

proposal, including the authority to decide what medical care

should be covered by insurers as well as the terms and

conditions of coverage and who should receive it.

I wish to repeat that. In this bill, the Secretary has the ``authority to decide what medical care should be covered by insurers as well as the terms and conditions of coverage and who should receive it.''

We saw a little precursor of that the other day with, for example, recommendations concerning mammograms. A board recommended that women under 50 should not get routine

mammograms. Of course, the response was incredible and justified. Women all over America are now alive today because they had mammograms prior to the age of 50. The Secretary of Health and Human Services said that would not be carried out, et cetera. We are creating a situation where the Secretary of Health and Human Services and a board would decide that.

``The legislation lists 1,697 times where the Secretary of

Health and Human Services is given the authority to create,

determine or define things in the bill,'' said Devon Herrick,

a health care expert at the National Center for Policy

Analysis.

For instance, on Page 122 of this 2,079-page bill, the

secretary is given the power to establish ``the basic per

enrollee, per month cost, determined on average actuarial

basis, for including coverage under a qualified health care

plan.''

The HHS secretary would also have the power to decide where

abortion is allowed under a government-run plan, which has

drawn opposition from Republicans and some moderate

Democrats.

And the bill even empowers the department to establish a

Center for Medicare and Medicaid Innovation that would have

the authority to make cost-saving cuts without having to get

the approval of Congress first.

``It's a huge amount of power being shifted to HHS, and

much of it is highly discretionary,'' said Edmund Haislmaier,

an expert in health care policy and insurance markets at the

Heritage Foundation, a conservative think tank.

Haislmaier said one of the greatest powers HHS would gain

from the bill is the authority to regulate insurance. States

currently hold this power, and under the Senate bill, the

federal government would usurp it from them. This could lead

to the federal government putting restrictions and changes in

place that destabilize the private insurance market by

forcing companies to lower premiums and other charges, he

said.

``Health and Human Services doesn't have any experience

with this,'' Haislmaier said. ``I'm looking at the potential

for this whole thing to just blow up on people because they

have no idea what they are doing. Who in the Federal

Government regulates insurance today? Nobody.''

``The health care reform legislation would rely on the U.S.

Preventive Services Task Force for recommendations as to what

kind of screening and preventive care should be covered. Last

week, the group, which operates under HHS, drew sharp

criticism for advising that mammograms should begin at age

50, a decade later than the current standard.''

``Critics of the bill said this was an example of how the

new bill could empower HHS to alter health care delivery, but

Democrats argue they would rather have the government making

these decisions.''

That is the key to it. They would rather have the government making these decisions. If you like the way the post office is run, you will love the way HHS runs health care in America.

I understand the amendment of the other side may address some of this, but under the Reid bill the Senate moved to consider, beginning in 32 days, the language from the bill on page 1,189 authorizes the Secretary to modify benefits under Medicare pursuant to task force recommendations. As I mentioned, how many women would have died if the coverage provisions guiding the new Federal plan under mammograms had been implemented? Then, on the following page, 1,190, the Secretary is authorized to deny payment for prevention services that the task force recommends against. So if this unelected panel changes the preventive recommendation for some other type of cancer, the Federal Government plan would not cover it. I don't think the American people want their health coverage decisions coming from a panel in Washington.

The Reid bill drives up costs and premiums. Just today the CBO released its assessment of what will happen to health insurance premiums under the new entitlement compared with premiums today. The CBO dealt a blow to claims the health care bill introduced by Senator Reid will lower premiums when they released an analysis showing that premiums will go up significantly in the individual market. Premiums for individuals without employer-sponsored coverage would increase 10 to 13 percent or $2,100 per family in 2016. The Democrats' bill therefore requires individuals to purchase insurance that is more expensive than would be available under current law. For small businesses and employers, the bill largely preserves the status quo and does little if anything to lower the cost. In fact, CBO estimates that under the Reid bill the average family with employer-sponsored coverage will soon pay more than $20,000 per year for health insurance.

President Obama said the following during the campaign:

I have made a solemn pledge that I will sign a universal

health care bill into law by the end of my first term as

President that will cover every American and cut the cost of

a typical family's premium by up to $2,500 a year.

Well, CBO's analysis shows that the President is breaking that pledge by both failing to achieve universal coverage and raising premiums, just as it contradicts an analysis by MIT economist John Gruber released by the White House this weekend claiming that individual premiums would go down. In fact, even with the generous assumptions made by CBO in a number of areas, premiums will either go up or remain unchanged.

From the CBO report just today, CBO says premiums in the individual market would be 10 percent to 13 percent higher in 2016 than under the current law. Average premiums would increase by $300 for an individual policy and by $2,100 for a family policy. The new benefit and coverage mandates actually drive up premiums by 27 to 30 percent, and this increase is offset by other factors, such as new administrative efficiencies.

CBO says that little more than half of enrollees in the individual market would receive a government subsidy. However, the bill before us would still require nearly 14 million Americans to purchase unsubsidized insurance that is more expensive than they have today.

President Obama has promised that seniors will not see a reduction in benefits. In fact, he said recently:

People currently signed up for Medicare Advantage are going

to have Medicare and the same level of benefits.

How did he get there? How do you get there when you are cutting Medicare Advantage by $120 billion? There is no math--old or new--that gets you to no change in the benefits that they have under Medicare Advantage and yet cutting $120 billion. Traditional Medicare doesn't offer coordinated benefits that can improve the quality of care. Traditional Medicare doesn't have many of the aids or benefits for our seniors.

President Obama has also promised several times, ``If you like what you have, you can keep it.'' The American people took those words as a promise that if they had a health benefit they were happy with, they could keep it. I want to make sure we are helping the President keep his promise. I want to help him keep his promise by sending this bill back, taking out the cuts that are in it on Medicare, on the $105 billion cuts to hospitals, nursing homes by $14.6 billion, hospices cut by $7.6 billion, Medicare Advantage by $120 billion. I want to send it back to the Finance Committee and come back with a bill that the American people can believe in that will preserve the solemn obligations we have made to our senior citizens.

Medicare Advantage provides the only choice in the Medicare Program allowing an option for seniors who want additional benefits or a better option. Medicare Advantage is working for nearly 11 million seniors to give them a choice about their health care and better benefits. As I mentioned, 330,000 beneficiaries in my State of Arizona are in Medicare Advantage, and they will see benefit reductions or their plan disappear. Eighty-nine percent of seniors need and have some form of supplemental coverage on top of Medicare to provide protections against out-of-pocket costs or additional benefits. Many low-income Americans and minorities rely on Medicare Advantage as their supplemental coverage.

Some have claimed that cutting the ``extra payments'' to Medicare Advantage plans reduces insurance company profits. Under Federal law, that is simply not the case. The fact is, 75 percent of those ``extra payments'' go directly to better benefits for seniors under current law. The other 25 percent goes back to the Federal Government. Unfortunately, those extra benefits will be taken from seniors who are enrolled in Medicare Advantage.

This bill contains $120 billion in direct cuts to private Medicare plans. Common sense says you can't do that without affecting benefits. The Congressional Budget Office thinks so as well. CBO assumes the Reid bill will cut benefits by more than half, from an average of $98 in additional benefits to $41 a month.

I see one of my colleagues is waiting to speak, but I hope the American people will understand what we are trying to do. All we are trying to do is send this back to be reworked, to be fixed on a bipartisan basis, and not to force $400-some billion in cuts and benefits that we have promised the American people. We want to send it back and come out with a bipartisan approach. Sit down, for the first time, Republicans and Democrats, have the C-SPAN cameras rolling--the way the President promised he would a year ago last October.

Let's sit down together and figure out how we can fix this.

The best way to fix it is to preserve the quality of health care in America and bring down the cost, not to pass a 2,074-page monstrosity that is full of the measures that would impair the ability, particularly of our senior citizens, to keep the benefits they have earned and we have promised them.

Madam President, I yield the floor.

Mr. President, I say to my colleague, not only is David Broder's column this morning important, but he is probably the most respected columnist in America. He talks about it in far more eloquent terms than I can.

I ask my friend from Arizona--a very unusual event happened today. The majority leader, I guess proceeding on the concept, the age-old tried tactic of ``shoot the messenger,'' came to the floor of the Senate and excoriated David Broder, of all people, probably the most respected columnist. I might say, Mr. Broder from time to time has written an article or two or more that has been critical of me, but he always had my respect. For the majority leader, who cannot rebut the facts in David Broder's column, to come to the floor and excoriate one of the most respected columnists in America is remarkable.

One of the things, I say to my friend from Utah, is that I do not think Americans really understand the scam that is going on here of beginning to collect taxes. Tax increases and Medicare cuts of approximately $1 trillion begin 40 days from now. In other words, on the first of January, according to this plan, Americans will begin experiencing cuts in Medicare and increases in taxes, 40 days from now. But then it will be 208 weeks and 1,460 days before any benefits from the legislation come about.

Tell me, isn't that like a couple goes to buy a house and they say: OK, you can have the house for X amount. And by the way, you have to start making the payments now and for the next 4 years before you can move into the house. Is there anybody who would agree that is nothing but a scam on the American people? I do not think the American people truly understand the reason why--and why would they do that? To disguise the real cost of this $2.5 trillion bill. That is why they do it. I think Bernie Madoff went to jail for this kind of behavior.

Again, it is so important that we read this hernia- inducing bill, that we understand the details of it. Specifically in these cuts, which are going to take place in 40 days--40 days from now; Happy New Year, America--in 40 days, it will cut $135 billion from hospitals, it will cut $120 billion from 11 million seniors on Medicare Advantage.

I would like to pause there for a moment. Senator Kyl and I represent the State of Arizona. We have thousands and thousands--and I am going to get the number before this debate is over--of seniors who are on Medicare Advantage. They are going to cut out the Medicare Advantage Program and tell the American people that if you like your insurance policy you have, you can keep it? How does that work? Then

there is $15 billion going to be cut from nursing homes, $40 billion from home health agencies, and $8 billion is going to be cut from hospice care--my God, hospice care, $8 billion.

Here we are telling the American people that we are going to fix health care in America, and the way we are going to pay for the massive government takeover of health care is through cuts. It is terrible on its face, but does anybody really believe these cuts are going to take place? Does anybody really believe the doctors are going to be cut $247 billion in the next 10 years? Does anybody believe we are going to cut $247 billion--or whatever it is--from Medicare? We are not. Why are we not? Because we are a loving, caring nation. We are not going to tell our seniors that they are not going to receive a high quality of Medicare.

Of course, this latest mammogram incident where a board, not unlike the one that is envisioned in this bill, said that women over 40 should not have mammograms--by the way, I have a close friend, Carly Fiorina, who has just recovered from chemotherapy. What would her situation be today if she had not had a mammogram? Women all over America are rising up about it. If you think that is bad, wait until you get this legislation.

By the way, while my friends are standing, I would like to say please sit down, I have shocking news. The three Senators we were worried about--the Senator from Louisiana, the Senator from Arkansas, and the Senator from Nebraska--shocking news. They are going to vote for this bill to move forward. That was an issue of tremendous speculation with the media. I certainly did not know that with all the protestations we had from those three Senators that, by golly, they were thinking long and hard. Guess what. So, OK.

Did the majority leader happen to notice that the AARP has now endorsed this bill? It has endorsed a bill that will cut people, 300,000 of them in my State, from their Medicare Advantage Program, that would cut $15 billion from nursing homes, that would cut $8 billion from hospices, and that AARP, which, by the way, I understand gets some $60-some million out of this deal--I say to the senior citizens in my State: Take your AARP membership card, cut it in half, and send it back to AARP because they have betrayed you.

Also, I would like to follow up on what the Senator from Tennessee has said because, particularly from some quarters on the other side of the aisle, we have been attacked: Where is the Republican plan?

A very important article was written by Robert Samuelson in the Washington Post on November 16--again, one of the most respected economists in America.

I don't lay off these opinions of my own on them, but the fact is, when you have highly respected people like Robert Samuelson, one of the most respected economists in America, I quote from his column--the title is ``Obama Care, Buy Now, Pay Later.'' That is the title of it. He says--which I think is directly in consonance with what the Senator from Tennessee said:

[A] prudent society would embark on long-term policies to

control health costs, reduce government spending and curb

massive future deficits.

Then he goes on to say:

So what do they do? Just the opposite. Their far-reaching

overhaul of the health care system--which Congress is halfway

toward enacting--would almost certainly make matters worse.

It would create new, open-ended medical entitlements that

threaten higher deficits and do little to suppress surging

health costs. The disconnect between what President Obama

says and what he's doing is so glaring that most people could

not abide it.

That is strong language from an economist. I think what the Senator from Tennessee is saying, and what we are trying to say is, let's go forward. Let's have malpractice reform. That is nowhere in this monstrosity. Why don't we encourage health savings accounts and expand them? Why don't we let people go across State lines to get health insurance policies of their choice? Why don't we reward wellness and fitness? There is a long list of amendments, of fixes to the long-term costs of health care that we could control, that we could enact tomorrow on a bipartisan basis. They do not add to the deficit. In fact, what they do is control health care costs, which is what is wrong with health care in America.

The quality of health care in America is outstanding. It is the cost. We could be working together step by step, as the Senator from Tennessee says, with a long list. I am sure he will add to them the ones I just gave out to control health care costs in America. We stand willing to do it.

After this bill fails, because the American people overwhelmingly are beginning--it may pass the Senate. It may pass the House. It will not pass.

Then why don't we sit down together for a change, Republicans and Democrats, and move step by step to fix the health care problems in America?

Along those lines, again, about this Madoff-type budgetary procedure, I am not that good at math. I am sure the Senator from Tennessee is. Help me out.

We have $1 trillion that they want to make in offsets, right, in this 10-year plan. If you started the program at the same time that you enacted the savings, that would be $1 trillion, right? That would be $2.5 trillion. So the deficit, if you used correct accounting procedures--in other words, you bring in the benefits at the same time you start paying for it--you would end up with a $1.5 trillion deficit to the budget? Does that make sense?

If the benefits kicked in at the same time the taxes did, you would be talking about a $2.5 trillion cost.

Could I bring up another issue to the Senator from Tennessee and the Senator from Arizona and Utah. A New York Times article this week stated: ``Drug Makers Raise Prices in Face of Health Care Reform.''

Even as drugmakers promise to support Washington's health

care overhaul by shaving $8 billion a year off the Nation's

drug costs after the legislation takes effect, the industry

has been raising its prices at the fastest rate in years.

In the last year, the industry has raised the wholesale

price of brand-name prescription drugs by about 9 percent,

according to industry analysts. That would add more than $10

billion to the nation's drug bill, which is on track to

exceed $300 billion this year. By at least one analysis, it

is the highest annual rate of inflation for drug prices since

1992.

So the moral of the story is, you lie down with dogs and you get fleas. So they cut a deal with the administration to cut drug costs, and guess what. With inflation zero, no inflation, they have decided to raise costs by more than 8 percent. Oh, the Consumer Price Index has fallen by 1.3 percent. The Consumer Price Index has fallen by 1.3 percent, and the prescription drugs have increased in cost by 9 percent.

What does this do to seniors? Seniors are not going to get a COLA in Social Security this year because the consumer price index has fallen-- which is the indicator as to whether cost of living adjustments are given to Social Security recipients. So what does the drug industry do? Without inflation, they raise the cost of prescription drugs by some 9 percent at a time when Americans are hurting more than ever. Shame on the drug industry. Shame on those people, and shame on the administration for cutting a deal with them.

Mr. President, I thank both Senators from Utah for their thoughtful comments and significant involvement. I wish to return to the issue of what we need to do. I say that because criticism has been leveled at this side of the aisle that we have no plan; therefore, since we have no plan, we should embrace this. The fact is, we have had plans. We have had proposals. We have tried to get them listened to. They range from medical malpractice reform to other free market cost reduction measures that add competition

and quality to the health care system. Our objective is affordability and availability.

I want to talk with the Senator from Tennessee about the issue of medical malpractice reform. Here is a huge piece of legislation. Yet I ask my friend from Tennessee, is there any measure in this bill we have been able to detect so far--we have been able to detect $100 million in additional Medicaid benefits for the State of Louisiana, but we haven't been able to determine all of the aspects of this bill. On the issue of medical malpractice reform, physician after physician in America says they have to practice defensive medicine for fear of finding themselves in court. Why is it that we have literally no addressing of an issue that could significantly reduce cost?

As I recall, the CBO said that medical malpractice reform could reduce direct medical costs by some $54 billion over 10 years. There are other estimates that say if we added in the cost of the practice of defensive medicine over prescription medicines and drugs because of fear of finding themselves in court, this could be as much as $200 billion. Yet there is not one significant addressing of the issue of medical malpractice in this legislation. I think that is a testimony to the influence of the American trial lawyers association.

Could I add, the mirror opposite of that is the State of Texas which was hemorrhaging medical doctors and care providers and then, after they enacted a very modest malpractice reform, there was a flood of physicians returning to the State of Texas. Isn't that the case?

Could I revisit with the Senator an issue we talked about a little earlier and with my friend from Utah as well. This is the recent spate of publicity concerning a recommendation that women wait until 50 years of age before--I see our physician Dr. Barrasso is here also--getting routine mammograms. That ignited a firestorm throughout America and story after story of women who have experienced breast cancer who state categorically that if they hadn't gotten the mammogram when they did, it is possible they would not be alive today.

Now that is a nice academic discussion. But I would ask--maybe Dr. Barrasso would answer it--isn't that the kind of advisory board this legislation could put into law; that those kinds of mandates could come down, which could literally jeopardize the health and lives of Americans?

I say to the Senator, you would not describe that as a ``penal panel''?

Mr. President, I thank the Senator.

Could I go back, again, and reemphasize with my colleagues and the American people what is very odious about the bill that is before us; that is, the Madoff-style budget gimmickry associated with this legislation. In 40 days--in 40 days--tax increases and Medicare cuts of approximately $1 trillion will begin--in 40 days. That is 6 weeks from now. But any benefits that would accrue from this legislation would begin in 208 weeks--1,460 days.

So why in the world would we approve--and, obviously, we know why it is done. It is to make the budget look better, when it is deception being perpetrated on the American people because we are not telling them the true cost. We are not telling the truth because, if the benefits started at the same time the taxes started, it would be a $2.5 trillion deficit over 10 years.

It is unfair to the American people, who are going to have to foot the bill for this massive piece of legislation--it is unfair to them to tell them they are going to have to start paying the taxes and footing the bill for it and only 4 years later would any benefits come to them. I think that is a really wrong thing to do to the American people.

Do you know what. The American people are beginning to figure it out. Mr. President, 51 to 35, the American people do not want this. The American people do not want an increase in the deficit. They want the spending stopped, and they are figuring it out. I am afraid my friends on the other side of the aisle may have underestimated the intelligence of the American people.

Mr. President, from media reports, certainly not because Members on this side of the aisle have been told about it, I understand the majority leader is now corralling the final three Democrats, which I am sure he will succeed in doing, in order to secure 60 votes to move forward with the greatest takeover of the private sector in health care by legislation perhaps in the history of this country. Of course, I would not know that myself, nor would any Member on this side of the aisle, because of the fact that there is no communication between the majority leader and Republicans. I understand they have 60 votes. I understand they will get 60 votes. I understand that they may likely be able to railroad this through the Senate. Then, again, they will gather in a small room, and they will come out with significant changes and revisions in the form of a conference report.

I have been having townhall meetings around my State of Arizona, the

second hardest-hit State in America because of the economic downturn. I assure my colleagues on the other side of the aisle, there is a revolution going on out there. It is a peaceful revolution. They do not want increased costs of a reform commitment that would be up to $3 trillion, that would cut Medicare by $500 billion and tax Americans across the entire income spectrum by an additional $500 billion. My friends across the aisle may not have gotten the message from the elections in New Jersey and Virginia not that long ago. Americans want cost control, and they want affordable and available health care. They don't want increases in taxes. They don't want the government taking over the health care system. Yet that is what is going to be delivered.

A lot of people, may I say, may not trust the word of some of us on this side of the aisle and may think we are uninformed or we are just politicians. Maybe we ought to listen to Dr. Jeffrey Flier, dean of the Harvard Medical School. I have never been that great of an admirer of Harvard, but the dean of the Harvard Medical School states in today's Wall Street Journal, entitled ``Health Debate Deserves a Failing Grade''--and he has some criticism for this side of the aisle that perhaps is deserved--

As the dean of the Harvard Medical School, I am frequently

asked to comment on the health-reform debate. I'd give it a

failing grade.

Instead of forthrightly dealing with the fundamental

problems, discussion is dominated by rival factions

struggling to enact or defeat President Barack Obama's

agenda. The rhetoric on both sides is exaggerated and often

deceptive. Those of us for whom the central issue is health--

not politics--have been left in the lurch. And as the

controversy heads towards a conclusion in Washington, it

appears that the people who favor the legislation are engaged

in collective denial.

Our health-care system suffers from problems of cost,

access and quality, and needs major reform. Tax policy drives

employment-based insurance; this begets overinsurance and

drives costs upward while creating inequities for the

unemployed and self-employed. A regulatory morass limits

innovation. And deep flaws in Medicare and Medicaid drive

spending without optimizing care.

During the last campaign, I proposed addressing the issue of employer-provided health benefits, doing away with it in return for a $5,000 refundable tax credit. Tens of millions of dollars in attack ads were leveled against it. I proposed it not because it was easy, not because I didn't think the American people didn't need straight talk. I did it because it is one of the fundamental problems with the cost of health care in America. If someone gets something for free, they are not going to be careful about the money that is spent.

Ronald Reagan once said: Nobody ever washed a rental car. He is right. So when people receive free medical care that they don't have to pay for and that they don't have to have accountability for, it is obvious that that is misused.

Again, there is the story this morning about some $49 billion in wasteful spending in Medicare. The numbers go on and on.

Why is it that the dean of the Harvard Medical School says ``the rhetoric on both sides is exaggerated and often deceptive''? Maybe it is. But the rhetoric on both sides becomes more intense because of a failure to sit down and try to work something out together. At no time during this entire, long, drawn-out process have there been serious negotiations between Republicans and Democrats. Not once. Of course, the rhetoric gets exaggerated on both sides and even deceptive. We are not doing what the American people expect us to do, and that is sit down together and work these things out on one of the greatest financial crises this Nation faces.

Dr. Flier goes on to say:

Speeches and news reports can lead you to believe that

proposed congressional legislation would tackle the

problems of cost, access and quality. But that's not true.

The various bills do deal with access by expanding

Medicaid and mandating subsidized insurance at substantial

cost--and thus addresses an important social goal.

However, there are no provisions to substantively control

the growth of costs or raise the quality of care. So the

overall effort will fail to qualify as reform.

Dr. Flier is alleging that there is no control of the growth of costs or rise in the quality of care. We all know that the cost of health care is unsustainable. The Medicare trustees have said in 7 years it will go broke. I believe forcing more Americans into Medicaid, a public program that gets failing grades for access to care and the quality of care, is not the right approach to covering millions more Americans.

Dean Flier goes on:

In discussions with dozens of health-care leaders and

economists, I find near unanimity of opinion that, whatever

its shape, the final legislation that will emerge from

Congress will markedly accelerate national health-care

spending rather than restrain it.

The whole problem with health care in America is not the quality of health care, it is the accessibility and affordability. Dr. Flier says ``the final legislation that will emerge will markedly accelerate national health care spending rather than restrain it.''

Dr. Flier continues:

Likewise, nearly all agree that the legislation would do

little or nothing to improve quality or change health-care's

dysfunctional delivery system.

This isn't just Dr. Flier's opinion. Look at Samuelson's article the other day about the effects of what has been passed by the House and will apparently be before us. Democrats are proposing a $3 trillion expansion of government health care, including $1 trillion in Medicare cuts and tax increases. But experts tell us the legislation would do little or nothing to improve quality or change health care's dysfunctional delivery system. Senate committees have spent months writing bills and spinning the benefits of legislation, and experts tell us the efforts fail the basic test.

On March 5 of this year, the President is quoted as saying:

If people think we can simply take everybody who's not

insured and load them up in a system where costs are out of

control, it is not going to happen. We will run out of money.

The federal government will be bankrupt; state governments

will be bankrupt.

The President is right. But the Democratic leadership writing these bills is not listening. Partisan reform designed behind closed doors will bankrupt this country, in effect committing generational theft. The majority leader continues to put his bill together in a secret committee of one with a deaf ear to what experts tell us is needed. And we wait. We wait with great anticipation to see how high taxes and fees will be increased. We wait with great anticipation to finally understand how Senate Democrats will force a government health insurance entitlement into our health care market. We will wait to see how much they will cut Medicare. And these are Medicare cuts, my friends, have no doubt about it. We will wait to see the new mandates on individuals and employers to buy government-designed insurance.

We already know that the Senate Finance Committee bill includes roughly $508 billion in new taxes on individuals and businesses.

Beginning in January of 2010, health insurers would also be required to pay annual nondeductible fees totaling $60.4 billion over 10 years.

Beginning in January of 2010, medical device manufacturers are required to pay $40 billion in new nondeductible fees.

Beginning in January 2010, prescription drug manufacturers are required to pay $22 billion in new nondeductible fees.

By the way, in case my colleagues missed it, surprise, surprise, the pharmaceutical industry has now dramatically increased their prices, while the cost of living has gone down. What a shocker. Those great people from the pharmaceutical lobby who have been willing to make such ``sacrifices'' for the American people are raising their prices in an unprecedented fashion, totally disconnected to the absolutely nonexistent increase in the cost of living. And the administration continues to oppose drug reimportation from Canada, where seniors could get prescription drugs for about half of what it is now costing them.

Beginning in 2013, Democrats raise taxes by $201 billion by increasing taxes by 40 percent on certain family health care plans with higher coverage values, payable by insurance companies or employers.

Beginning in 2013, taxpayers who deduct medical expenses on their tax returns will pay $15 billion more in taxes.

Taxes on individuals who fail to maintain government-approved health insurance coverage will pay $4 billion in new penalties, breaking President Obama's promise that no one with income under $250,000 would pay higher taxes.

Businesses that are struggling to keep the doors open and keep workers employed in this recession will see higher taxes of $23 billion in the form of mandates and penalties for failing to offer government- approved health insurance.

Again, I urge my colleagues to read the article in the New York Post entitled ``Obamacare: Buy now, pay later'' by the well-respected economist Robert Samuelson. He writes:

There is an air of absurdity to what is mistakenly called

``health-care reform.'' Everyone knows that the United States

faces massive governmental budget deficits as far as

calculators can project, driven heavily by an aging

population and uncontrolled health costs. As we recover

slowly from a devastating recession, it's widely agreed that,

though deficits should not be cut abruptly (lest the economy

resume its slump), a prudent society would embark on long-

term policies to control health costs, reduce government

spending and curb massive future deficits. The administration

estimates these (deficits) at $9 trillion from 2010 to 2019.

The president and all his top economic advisers proclaim the

same cautionary message.

So what do they do? Just the opposite. Their far-reaching

overhaul of the health-care system--which Congress is halfway

toward enacting--would almost certainly make matters worse.

It would create new, open-ended medical entitlements that

threaten higher deficits and would do little to suppress

surging health costs. The disconnect between what President

Obama says and what he's doing is so glaring that most people

could not abide it. The president, his advisers and allies

have no trouble. But reconciling blatantly contradictory

objectives requires them to engage in willful self-deception,

public dishonesty, or both.

Those are not my comments, Mr. President. Those are the comments of Robert Samuelson, one of the most respected economists in America.

I want to take another minute to talk about how the influence of special interests--I mentioned the pharmaceutical companies and the deal they cut so the administration would oppose drug importation from Canada, that there would not be competition for Medicare patients. But let me talk about probably the most powerful force in this whole discussion of legislation, and that is the trial lawyers of America.

There is no provision for medical liability or medical malpractice reform in this legislation. In fact, it was passed by the House that if States have enacted reforms, they will not be eligible for any additional funding to try and fund demonstration projects to reduce the cost of medical malpractice.

Everybody knows, ask any physician, they will tell you, they practice defensive medicine. They do so because of their fear of finding themselves in court and being wiped out. Sometimes these additional procedures and tests are not so comfortable for the patient, but, most importantly, they dramatically increase costs. Time after time after time, any effort we have made to put in medical malpractice reform--and we will do it again when the majority leader gives birth to whatever you want to call this--then, the fact is, they are not seriously interested in reducing costs, but they are seriously dependent on the largesse and generosity of the trial lawyers of America, and it is an outrage. It is an absolute outrage.

I would point out, when the President talks about, ``demonstration projects,'' there is a demonstration; it is called Texas. The State of Texas was hemorrhaging doctors and physicians and medical care practitioners. They reformed the medical malpractice. There have now been reductions in premiums. There have been reductions in lawsuits. There have been doctors and physicians and medical care providers flowing back into the State of Texas. It is proven. It is not everything we want. But it shows that medical malpractice reform can reduce health care costs.

And what have my friends on the other side and a couple on this side done? They have refused to consider in any significant way what everyone agrees could reduce health care costs in America. Outrageous. So do not be surprised when our approval rating is 18 percent. The approval rating of Congress: 18 percent. And in the townhall meetings I have been having, I have not met anybody in that 18 percent.

We need truth and honesty in our national discussion on health care reform, not spin, not budget gimmicks, not cuts to Medicare, not higher taxes, not government takeover, and not trillions in new health care spending.

We have $12 trillion in debt, 10 percent unemployment--17 percent real unemployment in my State--and an economy that is still struggling. Meanwhile, Wall Street makes obscene profits and bonuses that are unbelievable. We cannot afford another $3 trillion open-ended health entitlement. Americans deserve an honest discussion of ideas without artificial deadlines, and real solutions that will bring our skyrocketing health care costs under control.

Finally, I guess we are told that maybe this evening there may be something that will emerge with white smoke from the majority leader's office and we will be given the manifesto that he will call health care reform, and that will begin a great debate. I believe the question will be: Will the special interests and the big spenders and those who are in favor of government control of health care in America win or will the American people win?

That is why the American people are aroused. If they stay aroused, and if we continue to see the tea parties and the townhall meetings and the expressions of anger and frustration the American people feel, we will beat this back and we will go back to the bargaining table--for the first time we will go to the bargaining table and sit down, Republicans and Democrats, together.

History shows there has been no successful reform in America without bipartisanship, and I do not believe this will be the first one. I hope--I hope and pray--it will not be.

Mr. President, I yield the floor.

Mr. President, I thank my friend and colleague, Senator Lieberman. Along with Senator Graham and Senator Webb, we are strongly supporting this amendment.

Senator Lieberman made reference to a letter that has currently been signed by 214 9/11 family members. Mr. President, I ask unanimous consent that this letter be printed in the Record, along with an article from the Wall Street Journal dated October 19, 2009, entitled ``Civilian Courts Are No Place To Try Terrorists'' by Michael B. Mukasey, the former Attorney General of the United States of America.

Mr. President, I urge my colleagues, who will be made aware of a letter from Mr. Holder and Secretary Gates, who are urging defeat of this amendment, to look at the views of the previous Attorney General of the United States, which are diametrically opposed.

The 9/11 families say--and I am sure they represent all of the 9/11 families--

We adamantly oppose prosecuting the 9/11 conspirators in

Article III courts, which would provide them with the very

rights that may make it possible for them to escape the

justice which they so richly deserve. We believe that

military commissions, which have a long and honorable history

in this country dating back to the Revolutionary War, are the

appropriate legal forum for the individuals who declared war

on America. With utter disdain for all norms of decency and

humanity, and in defiance of the laws of warfare accepted by

all civilized nations, these individuals targeted tens of

thousands of civilian non-combatants, brutally killing 3,000

men, women and children, injuring thousands more, and

terrorizing millions.

I would be glad to respond to a question from the Senator from Illinois.

Mr. President, I ask unanimous consent that the Senator from Illinois follow me.

Mr. President, these are the 9/11 families. All Americans were impacted by 9/11, the 9/11 families in the most tragic fashion. This is a very strong letter from them concerning the strong desire that these 9/11 conspirators not be tried in article III courts but be tried according to the military commissions.

The 9/11 victims experienced an act of war against the United States, carried out not on some distant shore but in our communities on the very symbols of our national power. Because it involved attacks on innocent civilians and innocent civilian targets, it is a war crime. It is a war crime that was committed by the 9/11 terrorists. It is important that we call things what they are and not gloss over the essence of these events, even though they occurred 8 years ago.

In response to the attacks, the Congress quickly and overwhelmingly passed the Authorization for Use of

Military Force giving the President the authority to ``use all necessary and appropriate force against those nations, organizations, or persons he determines planned, authorized, committed, or aided the terrorist attacks that occurred on September 11, 2001. . . .'' The Senate passed this legislation unanimously.

The Authorization for Use of Military Force recognized the true nature of these attacks and committed the entire resources of the United States to our self-defense in light of the grave threat to our national security and foreign policy. The United States does not go to war over a domestic criminal act, nor should it. It was clearly understood at that time that far more was at stake. We sent our sons and daughters off to war, where they have been bravely risking their lives and futures on our behalf for the last 8 years.

Given the facts and history of the 9/11 attacks, we should not deal with the treachery and barbarism of the slaughter of thousands of innocent civilians as a matter of law enforcement in the ordinary sense. To do so would belittle the events that transpired, the symbolism and purpose of the attacks, the huge number of lives that were lost, and the threat posed to the United States--which continues in the caves and sanctuaries of al-Qaida to this day.

During my life, I have been a warrior, although that seems a long time ago now. I have some experience in the reality of combat and the suffering it brings. I know something of the law of war, having fought constrained by it and having lived through it, with the help of my comrades and my faith, times when my former enemy felt unconstrained by it.

No, the attacks of 9/11 were not a crime; they were a war crime. Together with my colleagues in Congress, I have worked closely with the President to provide a means to address war crimes committed against this country in a war crimes tribunal--the Military Commissions Act of 2009. It was designed specifically for this purpose. It should be used not to mete out a guilty verdict and sentence that could not be achieved in Federal criminal court but to call things what they are, to be unshakable in our resolve to respond to the unprecedented attacks of 9/11 consistent with the Authorization for Use of Military Force and to tell this and any future enemy that when they attack our innocent civilians at home, we will not be sending the police after them to make an arrest.

By denying funds to the Department of Justice to prosecute these horrendous crimes in article III courts, I do not mean these outrages against our country and its citizens should go unpunished. In fact, I have long argued that justice in these cases was long overdue and that prosecutions should be pursued as expeditiously as possible. Rather, my support for this amendment is based on my unshakable view that these events were acts of war and war crimes and that the proper forum for bringing the war criminals to justice is a military tribunal consistent with longstanding traditions in this country that date back to George Washington's Continental Army during the founding of the Republic.

For that reason, I urge my colleagues to support this amendment so that the prosecution of war crimes will take place in the traditional and long-accepted forum of a military tribunal, as the Congress overwhelmingly enacted in 2006 and which the National Defense Authorization Act for 2010 amended and improved in a statute that was enacted into law by President Obama just days ago.

Again, I hope we will, as we have in the past, listen to the families of 9/11. From the trauma and sorrow of the tragedy they experienced in the loss of their families, they became a force. They became a force that without them we would have never had the 9/11 Commission, we would have never been able to make the reforms that arguably have made our Nation much safer.

Now, today, the families are standing up and saying: Try these war criminals according to war crimes which they committed--the heinous acts of 9/11, which I know Americans will never forget.

Mr. President, I hope we will vote in favor of the amendment.

I yield the floor.

Mr. President, I always enjoy hearing the words of wisdom of my friend and colleague from Delaware.

30TH ANNIVERSARY OF THE HOSTAGE CRISIS IN IRAN

Mr. President, today we mark a painful anniversary for our country--the day, 30 years ago, when America's Embassy in Iran was violently seized and an institution of diplomacy became a prison for dozens of peaceful servants of this Nation. For 444 days, the United States and the world watched and feared for the safety of our citizens. Eight brave Americans lost their lives trying to rescue our diplomats. And after so many days of dread, anguish, and heartbreak, we all felt a great weight lifted when our fellow citizens were returned home safely to their friends and families.

Today we express our deepest gratitude to those Americans taken hostage in Iran 30 years ago and to those who died to save them. They all gave more for our country than should be asked of any public servant, and we thank them for it.

Today, however, we are also mindful that the pain and suffering that began on November 4, 1979, did not end after only 444 days. For the people of Iran, that hardship continued for 30 more years, and it continues to this day.

Iran is a great nation, and the Iranian people are the stewards of a proud and accomplished civilization.

Throughout their nation's history, Iranians have made spectacular contributions to the arts and sciences, to literature and learning. These achievements have not only benefited Iran, they have added to the development and enrichment of all mankind. So it is with profound sadness that we think today of all the potential of the Iranian people that has been suppressed and squandered over the past 30 years by the rulers in Tehran.

I know that the Iranian Government is singing the praises of their revolution today. But Iranians are not fools. They know what the real legacy of the past 30 years is. Iranians know that the government in Tehran has ruined their nation's economy and kept them isolated from the promise of trading and engaging with the world.

Iranians are right to ask how much better off they would be if all of the money--the billions and billions of dollars--that Iran's rulers have spent sponsoring terrorist groups, tyrannizing their people, and building weapons to threaten the world were instead devoted to creating jobs, educating young people, and caring for the sick.

Iranians are right to wonder why a country so blessed with natural resources cannot meet the basic needs of so many of its own citizens. And yet corrupt members of the ruling elite are stuffing the wealth of their nation into their own pockets.

The rulers in Iran seized power 30 years ago, promising justice and better lives for all. But now they throw innocent Iranians in prison without proper trials. They mistreat and torture Iranians in jail. They beat and murder Iranians in the streets for trying to speak freely and exercise their basic human rights.

The world watched in horror as Iran's rulers inflicted all of this abuse and more upon peaceful Iranian protesters after the flawed elections last June. But the world also watched in awe as courageous Iranians risked everything for freedom and justice.

We Americans reflect with sympathy on Iran's continuing struggle for human dignity and human rights. Our country seeks a relationship of peace and prosperity with Iran, and it is incredibly unfortunate that the Iranian Government seems determined to keep the relationship between our two countries mired in the past by funding and arming violent groups that threaten our citizens and our allies, by building a nuclear weapons program in violation of Iran's own agreements and multiple U.N. Security Council resolutions, and by spurning repeated American efforts to reach out respectfully to resolve our differences in peace. The United States of America has no eternal enemies. We can overcome even the most painful parts of our own history, as we are doing now with countries such as Vietnam.

So today, on this solemn anniversary of the hostage crisis in Iran, we honor our fellow Americans whose lives were forever altered by that tragic day. But we also look forward to a new day, a better day when the long nightmare of the Iranian people is over and when our two nations share a relationship of mutual security, mutual respect, and mutual advantage.

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

Mr. President, I understand the Senate is proceeding to the consideration of the nomination of Dr. Tara O'Toole to serve as Under Secretary for the Science and Technology Directorate at the Department of Homeland Security. This nomination has not been available for consideration until now because I was waiting for Dr. O'Toole to answer the nearly two dozen questions I submitted to her during the past month. As of Monday, she has answered each question.

While I continue to have concerns about this nominee failing to disclose her activities as strategic director for the Alliance for Biosecurity, I will not hold up consideration of her nomination. A September 8, 2009 article in the Washington Times referred to the Alliance as a ``lobbying group funded by the pharmaceutical industry.''

Specifically, the article stated, ``The alliance has spent more than $500,000 lobbying Congress and federal agencies--including Homeland Security--since 2005, congressional records show. However, Homeland Security officials said Dr. O'Toole need not disclose her ties to the group on her government ethics form because the alliance is not incorporated . . . Analysts say the lack of disclosure reflects a potential loophole in the policies for the Obama administration, which has boasted about its efforts to make government more transparent.''

The article continued:

They also question lobbying laws that allow such a group to

spend hundreds of thousands of dollars without the public

knowing exactly how much money each of the companies that

belongs to the group contributes, though such arrangements

are permitted under the law . . . Ethics rules require

nominees to report any paid or unpaid positions held outside

of government, including but not limited to those of

``officer, trustee, general partner, representative, employee

or any consultant of any corporation, firm, partnership or

other business enterprise.'' Dr. O'Toole signed a letter on

behalf of the group sent to the White House as recently as

March.

I put forward numerous questions to Dr. O'Toole about her ``stealth lobbying'' on behalf of the Alliance. She repeatedly answered that her ``activities did not constitute lobbying.''' I also asked numerous questions about her involvement in securing an earmark for the Center for BioSecurity at the University of Pittsburgh Medical Center. She provided answers to the questions and stated that although she provided a statement for the media in support of the earmark, she did not provide any assistance in lobbying Congress for the earmark.

Elections have consequences, and while she would not have been the nominee I would have chosen for this position, she is the President's choice.

I ask unanimous consent that the September 8, 2009, Washington Times article be printed in the Record.

Will the Senator yield for a question?

Will the Senator yield for an additional question?

Does the Senator recall--and perhaps the Senator from Illinois recalls--does the Senator recall, during the last Presidential campaign, when the President of the United States said there will be Republicans and Democrats sitting down together and there will be C- SPAN cameras? I wonder if the Senator knows the C-SPAN cameras are still waiting outside this room over there. Does the Senator recall that commitment? I wonder--I wonder--whatever happened to that campaign promise that the American people would know who is on the side of the pharmaceutical companies and who is on the side of the American people. If they came in now, it would be too late because they already cut a deal with the pharmaceutical companies in return for $80 billion. They got $100 million in positive ads for reform.

I wonder if the Senator from Tennessee recalls that commitment on the part of the President of the United States. I wonder if he might urge his colleague, the other Senator from Illinois, to get the C-SPAN cameras in there while these negotiations are going on.

Madam President, what little time remains to this side of the debate?

Forty-one minutes?

I thank my friend from Tennessee, and I thank you, Madam Chairman.

As we know, we are considering the conference agreement for the fiscal year 2010 Interior, Environment and Related Agencies appropriations bill. I was deeply touched and moved by both the manager of the bill and the ranking minority member's lamentations about the budgetary constraints in which we are suffering--deeply moved, almost to tears, until I saw that this bill provides approximately $32.2 billion, a 17-percent increase over last year's levels, and $4.66 billion more.

You know, the bill comes after we already gave $10.95 billion in the stimulus bill. It is remarkable, remarkable.

When the distinguished manager talked about how the budgetary constraints did not allow for us to have the necessary water infrastructure projects which are so vital, particularly to those of us in the West, we somehow found room for 542 earmarks totaling $341.3 million.

I believe we might be able to find some more projects that are very badly needed for water infrastructure and even for firefighting if maybe we shifted those 542 earmarks totaling $341.3 million over to the needed projects. As far as I know, not one of these earmarks was requested by the administration, authorized, or competitively bid in any way. No hearing was held to judge whether these were national priorities worthy of scarce taxpayers' dollars.

When I read some of these, I think it would be hard to argue that they would withstand any scrutiny, any competition. For example, $500,000 for a tropical botanical garden in Hawaii. Not in Arizona, not in California--Hawaii--$500,000 for a tropical botanical garden in Hawaii.

There is $150,00 to renovate an opera house in Connecticut--renovate an opera house. The real unemployment in my State is now 17 percent. It is listed as less than 10 percent, but including those who have given up looking for work--17 percent of the people in my State are without a job, and we are going to spend $150,000 to renovate an opera house in Connecticut.

We are going to spend $500,000 for a native Hawaiian arts program in Hawaii.

We are going to spend $1 million for improvements in the Sewall- Belmont House in Washington, DC. That is what I call a cozy relationship. The Sewall-Belmont House is next to the Hart Building--$1 million. Couldn't this museum raise private money for these improvements?

There is $2 million for an interpretive center at the California National Historic Trail in Nevada and another $100,000 for the Tahoe Rim Trail in Nevada to build a 15-mile hiking trail from Reno, NV, to the Mount Rose Ski Resort near Lake Tahoe.

I get favorites every once in a while, but this is probably one of my favorites recently. If we Twitter the top 10, I guarantee you this will make the top 10: $1.2 million for rat eradication at the Palmyra Atoll National Wildlife Refuge; $1.2 million worth of rat traps. This $1.2 million in rat traps is for a 5-square-mile island, U.S. territory that is not occupied except for a few scientists from the Nature Conserve studying the island's coral reef, according to the Interior Department.

There is $750,000 for a conservation training center in West Virginia. I am sure over the years my colleagues have gotten to hear certain States named--Hawaii, West Virginia, Nevada, California. I am sure all of those are strictly coincidental.

There is $200,000 for historic preservation of the Richardson- Olmstead Complex in Buffalo, NY. I am not making this up. The Richardson-Olmstead Complex is actually the former Buffalo State Insane Asylum which was decommissioned in the 1970s. According to Richardson Center Corporation, which is a nonprofit managing the complex for historic preservation, this funding would go toward maintaining the former hospital as ``an example of the humane treatment of the mentally ill.''

There is $750,000 for the Hudson Quadricentennial Commission in New York to celebrate the 400th anniversary of the Dutch explorer Henry Hudson sailing the Hudson River; $500,000 to the Vermont Wood Products Collaborative, which provides grants to promote the development and marketing of wood products businesses in the State of Vermont. According to the Office of Management and Budget, Vermont Woods Products Collaborative is a continuing earmark that has received over $780,000 from Congress over the past 4 years.

That is for the Vermont Wood Products Collaborative when my State has a 17-percent unemployment rate.

Some of these that I just described may have merit. There are 542 of them. Some of them may have merit, but we will not know that. We will not know whether or not they have merit. They have never been authorized, never been subjected to competition, they have never been scrutinized. But what has been done is they have been put in because of the relative power of certain Members of Congress.

I had intended today to bring over recent articles concerning the investigations that are being conducted on Members of Congress because of this practice of earmarking and porkbarrel spending.

One more example of this is the Environmental Protection Agency State and Tribal Assistance Grants Program, which funds wastewater and drinking water infrastructure projects throughout the country. Local communities that request assistance under this program have to do so under Federal and State systems for prioritizing the most important projects from a health and environmental standpoint.

But all it takes to sidestep the entire process is for a Member to slip an earmark into an appropriations bill that benefits a special interest in their home State. Inevitably, communities that are worthy of EPA's help are left empty handed because they were not connected well enough in Washington.

The President's 2010 budget calls for terminating all of these earmarks. The President's budget asks that they should be eliminated. The administration says, the President says, these earmarks are ``duplicative'' and ``not subject to the State priority-setting process which typically funds cost-effective and higher priority activities first.''

Moreover, the administration points out these earmarks ``single out projects and communities for a greater subsidy than otherwise available through existing programs,'' and ``that these types of projects require more oversight and assistance than standard grants because many of the recipients are unprepared to spend or manage such funds.'' In other words, some communities are receiving earmarks so large that they do not know how to handle them.

Let's look at a few of these infrastructure earmarks. For the town of Moorefield, WY, $2.5 million is earmarked for a wastewater treatment plant. The town of Moorefield has a population of 2,375. That is a subsidy of over $1,000 per person.

Six million dollars goes to construct a drinking water reservoir in Fayette County, AL. Estimated population of Fayette County: 18,000.

There is $1.2 million for sewer improvements in Plattsmouth, NE; population: 6,900. Finally, $15 million for water infrastructure in remote Alaska Native villages, which exceeds the administration's request by $5 million. In its budget submission, the administration proposed reducing spending for Alaska Native villages to $10 million because:

Audits conducted by the EPA Office of the Inspector General

identified several financial management problems, including

improperly charging labor costs to grants and disbursing

funds that were not tied to the actual project costs.

I am for helping our neediest and most rural communities. Some of these projects may be truly needed. But it is disregard for the procedure that should be followed that concerns me.

Last month the House and the Senate Democratic leadership airdropped a continuing resolution into the legislative branch appropriations bill to keep the government running until this Sunday. It is not the way to do business. There is nothing that prohibits the majority leader from calling up a continuing resolution as a stand-alone piece of legislation.

I want to say that I intend to raise a point of order. But, more importantly, if this bill passes the Senate, as it did the House earlier today, the President of the United States, if he is serious about eliminating waste and unnecessary spending, should eliminate a bill

that has a 17-percent increase over last year's levels, which is $4.66 billion more, in addition to the $10.95 billion that was appropriated to these accounts in the stimulus bill, and contains 542 earmarks totaling $341.3 million. If that is not enough to earn the President's veto, I do not know what is.

I raise a point of order that the conference report violates the provisions of rule XXVIII, and I ask for the yeas and nays.

Mr. President, I wish to say that the presentation by the Senator from South Dakota, Mr. Thune, is a strong one and a compelling one. I am also very impressed with his knowledge of the facts and his in-depth analysis of what we are apparently facing. I say ``apparently'' because so far, as has unfortunately been the case, the majority leader has not shared with at least this side of the aisle or anyone I know of on this side of the aisle any of the specifics of the latest proposal. That is very unfortunate.

As the Senator from South Dakota mentioned, the President of the United States, when campaigning, stated categorically that there would be C-SPAN cameras, that there would be Republicans, there would be an open process, and he was specifically addressing the issue of health care reform.

Americans grow cynical from time to time about the things we say during political campaigns. I can only conclude that the statement made by the President during the campaign contributes mightily to not only the issue of health care reform but also the cynicism about real change in Washington. Change has not taken place; the majority rules.

I certainly agree those abuses were committed when Republicans were in the majority in this body, and I saw it, and I fought against it. But it was stated just a little over a year ago that when health care reform came to its period of consideration by the Senate, when the negotiations went on, C-SPAN cameras and Republicans would be present so the American people would be able to see, in the President's words, ``who is there representing the pharmaceutical companies and who is representing the American people.''

Well, if we open it up now, if we opened the doors not far from here, we would see that already a deal has been cut with the pharmaceutical companies. It is an $80 billion deal done in return for $100 million or so in positive ads and in return for punishment to average American citizens because the administration agreed to a prohibition of importation of prescription drugs from Canada that could sometimes save as much as 60 percent on lifesaving pharmaceutical drugs; as well as the elimination of or opposition to competition amongst drug companies to provide prescription drugs to Medicare recipients.

So what they have done by buying off the pharmaceutical companies--by the way, according to the latest reports I read this morning, the head of the pharmaceutical lobby makes over $2 million a year--we have now penalized the American people by preventing them from having choice, as well as seeing the influence of special interests in this country and in our deliberations. It is very unfortunate.

There is a great deal of cynicism out there amongst the American people. It is manifest through tea parties and in other ways. Polling data shows the great dissatisfaction the American people have about the way we do business.

That cynicism has been authenticated by the process we are going through.

I would again urge the majority leader to invite us in to sit down. We have some constructive ideas. We have some thoughts as to how we can reform health care in America. We know there needs to be reform. We have people such as my colleagues, two doctors--Dr. Coburn and Dr. Barrasso--on our side of the aisle, who have extensive hands-on experience with these issues. Why can't we at least at some point-- which we should have done a long time ago--be allowed to have input into the behind-closed-doors process that is taking place as we speak?

H1N1 Preparedness

Mr. President, I wish to also say a few words this morning about an issue that is of great concern to me and is of greater concern throughout the country; that is, the availability of vaccines in order to combat swine flu, known as H1N1. There are long lines around the country. There is scarcity. There is great concern amongst the American people about this problem. Unfortunately, just last week, in a hearing before the Homeland Security Committee, the Secretary of Health and Human Services assured us that it was no problem and that there would be plenty of supplies on hand.

The previous administration conducted the initial analysis, as we know, and worked with the World Health Organization to estimate the magnitude of this worldwide pandemic. A plan was put in place and stakeholders began executing their roles in protecting the public health.

In the fall of 2005, in response to the government's lessons from combating avian flu, Congress provided $6.1 billion in the 2006 supplemental appropriations for pandemic planning across several Federal departments and agencies. Since then, annual funding has been provided to the Centers for Disease Control and the FDA and activities in Health and Human Services to continue work on vaccine development, stockpiling of countermeasures, and assistance to States.

In late April of this year, Margaret Chan, the World Health Organization's Director General, declared ``a public health emergency of international concern'' when the first cases of the H1N1 virus were reported in the United States. National and State plans were in place and orders for vaccines were processed. Among other actions, officials released antiviral drugs from the national stockpile, developed and released diagnostic tests for the H1N1 virus, and developed guidance for the clinical management of patients and the management of community and school outbreaks. The administration requested $9 billion in emergency supplemental appropriations to address the situation.

On June 26 the President signed an appropriations bill which provided $1.9 billion immediately and an additional $5.8 billion contingent upon a Presidential request documenting the need for and proposed use of the additional funds. In total, from 2004 through 2009, Health and Human Services alone has received almost $9 billion for pandemic flu preparedness. Again, this doesn't account for the other billions to other agencies.

However, for the $9 billion and counting the government has spent on preparing for pandemic outbreaks, Americans have only experienced frustration at vaccine shortages and the long lines for the limited supply of H1N1 vaccines that are available. This should make all Americans extremely nervous about the government possibly taking control of our health care system.

Three months ago we were told--this is important. Three months ago we were told the CDC expected 120 million to 160 million doses by the end of October. Two months ago the administration's estimate of vaccine availability dropped to 40 million by mid October, with 20 million additional doses rolling out every week. Last week, the estimate dropped again. Now only about 28 million doses are expected to be available by the end of October. Yet the CDC estimates there are at least 45 million high-risk Americans, including pregnant women and children, in need of the vaccine. So according to my math, we are about 20 million doses short.

Unfortunately, the outbreak of the flu is widespread and deaths are accumulating. The Washington Post reported yesterday:

As of October 17, 46 States were reporting ``widespread''

influenza activity and many doctors' offices have been

swamped with swine flu patients . . . The U.S. Government has

ordered enough vaccine to make up to 251 million doses if

needed, but production has been slower than originally

anticipated. A total of 11.3 million doses of vaccine have

been shipped to U.S. doctors and hospitals and clinics as of

Wednesday, according to the CDC, out of a total of 14.1

million doses that manufacturers had shipped to warehouses by

that time. By Friday, 16.1 million doses of vaccine had been

shipped to warehouses.

In Arizona, State officials estimated a need of 900,000 to 1 million vaccines for my State's 6.5 million residents.

I ask unanimous consent for 2 additional minutes.

However, Arizona has only received 263,000 vaccines as of yesterday. According to the Arizona Republic, the swine flu vaccine was only available at 35 of the 113 planned clinics in Maricopa County. The article quoted the county's director of public health as stating:

It's a very frustrating situation where we are just not

getting what we need. Right now, it is completely out of

everyone's control.

On October 24, the Arizona Republic reported:

The lines were long, but the desire intense Saturday as

hundreds, possibly thousands, of people waited up to three

hours to get in one of today's rarest experiences: a swine-

flu shot.

The doses available represented a little more than 1 percent of Maricopa County's population. People were turned away if they did not fall into the high-risk group.

Congress needs to know more information. Obviously, the hearing we had in the Homeland Security Committee last week was, at best, misleading as to the magnitude of this problem. We need more information from the government, and we need to act now and find out how we are going to get enough swine flu vaccine to take care of the citizens of this country. We have already invested $9 billion. I don't think we have a lot to show for it.

Mr. President, I yield the floor.

Mr. President, today I am pleased to be joined by Senator Michael Bennet in introducing the Post-9/11 Troops to Teachers Enhancement Act. This legislation would allow more veterans and school districts to participate in the Troops to Teachers program. In addition to expanding the program, the proposed bill would create an advisory board that would be charged with improving awareness and participation of the program, ensuring that the program meets the needs of our schools and veterans. I hope that my colleagues in the Senate will also support this important piece of legislation.

In 1994, Congress authorized the Department of Defense, DOD, to oversee a new national program, Troops to Teachers, which was designed as a Transition assistance program for retiring or separating members of the military to obtain their teaching credentials and place these teachers in schools throughout the country. The program was reauthorized by Congress in 1999. That reauthorization transferred responsibility for oversight and funding from the DOD to the Department of Education and authorized $10,000 bonuses to participants who agreed to teach in ``high-need'' schools. Troops to Teachers was later incorporated and reauthorized under the No Child Left Behind Act of 2001. Since its inception, over 11,000 teachers have been hired by school districts across the Nation, of which many are nontraditional first-time teachers.

Teaching is among the most honorable professions in our society. I believe we should encourage military veterans to enter the teaching profession and that this bipartisan bill would further enhance the Troops-to-Teachers program. Simply put, the proposed legislation would reduce the years of military service requirements from 6 to 4, extend the eligibility to all schools that receive Title I funds, and create an advisory board that would coordinate and make recommendations to Congress in regards to the program.

Current eligibility guidelines for the Troops to Teachers require that members of the military have 6 years of service and that members of the guard and reserve have 10 years of service with a commitment to serve an additional 3 years. The requirement of 6 years active duty is leaving many single enlistment contract 4 year veterans and/or Guard members out of consideration. Lowering the required years of service would expand eligibility and create a larger pool of potential teachers for this program.

Under the current Troops to Teachers program, participants who agree to teach for 3 years in a ``high need'' schools are eligible to receive a $5000 stipend to offset the cost of teacher certification. The proposed legislation would extend the eligibility for the stipend to any eligible teacher who agrees to teach 3 years in a school that is in a district receiving Title I funds. The proposed bill would retain the optional bonus of $10,000 which is available to individuals who take jobs in low-income schools. This legislation would result in a 49 percent in the number of eligible schools for the program. For my home State of Arizona, over 600 additional schools would become eligible to participate in the program.

A recent GAO Report revealed that although Troops to Teachers is a successful program, it suffers from a lack of coordination and oversight. To remedy this concern, the proposed legislation would create an advisory board that consists of a representative from the Department of Defense, the Department of Education, and representatives from state offices and veteran's service organizations to make recommendations on ways to improve and expand the program.

Our veterans make excellent candidates to impart the virtues of serving to a cause to the next generation and instill the value of learning as a means to self-improvement and much nobler ends. Their unique experiences bring a more diverse teaching environment to our children and grandchildren.

Mr. President, today I am pleased to be joined by Senator Michael Bennet in introducing the Post-9/11 Troops to Teachers Enhancement Act. This legislation would allow more veterans and school districts to participate in the Troops to Teachers program. In addition to expanding the program, the proposed bill would create an advisory board that would be charged with improving awareness and participation of the program, ensuring that the program meets the needs of our schools and veterans. I hope that my colleagues in the Senate will also support this important piece of legislation.

In 1994, Congress authorized the Department of Defense, DOD, to oversee a new national program, Troops to Teachers, which was designed as a Transition assistance program for retiring or separating members of the military to obtain their teaching credentials and place these teachers in schools throughout the country. The program was reauthorized by Congress in 1999. That reauthorization transferred responsibility for oversight and funding from the DOD to the Department of Education and authorized $10,000 bonuses to participants who agreed to teach in ``high-need'' schools. Troops to Teachers was later incorporated and reauthorized under the No Child Left Behind Act of 2001. Since its inception, over 11,000 teachers have been hired by school districts across the Nation, of which many are nontraditional first-time teachers.

Teaching is among the most honorable professions in our society. I believe we should encourage military veterans to enter the teaching profession and that this bipartisan bill would further enhance the Troops-to-Teachers program. Simply put, the proposed legislation would reduce the years of military service requirements from 6 to 4, extend the eligibility to all schools that receive Title I funds, and create an advisory board that would coordinate and make recommendations to Congress in regards to the program.

Current eligibility guidelines for the Troops to Teachers require that members of the military have 6 years of service and that members of the guard and reserve have 10 years of service with a commitment to serve an additional 3 years. The requirement of 6 years active duty is leaving many single enlistment contract 4 year veterans and/or Guard members out of consideration. Lowering the required years of service would expand eligibility and create a larger pool of potential teachers for this program.

Under the current Troops to Teachers program, participants who agree to teach for 3 years in a ``high need'' schools are eligible to receive a $5000 stipend to offset the cost of teacher certification. The proposed legislation would extend the eligibility for the stipend to any eligible teacher who agrees to teach 3 years in a school that is in a district receiving Title I funds. The proposed bill would retain the optional bonus of $10,000 which is available to individuals who take jobs in low-income schools. This legislation would result in a 49 percent in the number of eligible schools for the program. For my home State of Arizona, over 600 additional schools would become eligible to participate in the program.

A recent GAO Report revealed that although Troops to Teachers is a successful program, it suffers from a lack of coordination and oversight. To remedy this concern, the proposed legislation would create an advisory board that consists of a representative from the Department of Defense, the Department of Education, and representatives from state offices and veteran's service organizations to make recommendations on ways to improve and expand the program.

Our veterans make excellent candidates to impart the virtues of serving to a cause to the next generation and instill the value of learning as a means to self-improvement and much nobler ends. Their unique experiences bring a more diverse teaching environment to our children and grandchildren.

Mr. President, I want to thank again my colleague from Tennessee for the great work he has been doing on the issue of health care and the many other leadership issues. There are a lot of things going on. There are a lot of moving parts in the health care reform debate situation.

I would like for us, however, to maybe pause and look back for a second as to what we heard and what has actually been going on. First, we heard the President say that if you like the insurance you have, you can keep it, period. Increasing mandates on employers, who today have difficulty affording health care coverage, and cutting Medicare by $500 billion will ensure that millions of Americans will not be able to keep the coverage they have today. CBO and common sense tell us this. According to CBO, 3 million fewer Americans will be covered under employer health plans; and further, millions of seniors may lose the Medicare plan they have and that they want to keep. That is called Medicare Advantage.

We also heard the President say that he won't support legislation that increases the deficit one dime. We now know that is not true. We saw yesterday an attempt at incredible gimmickry to do away with $247 billion worth of debt that would have been associated with health care. Obviously, it is a way to get around the $\1/4\ trillion increase in the cost of health care that would have accrued if we had kept doing what we are doing. We all know that the true implementation cost of

the proposal in the Senate Finance Committee is $1.8 trillion, once you look at the real numbers.

One of the more entertaining aspects of the protestations of cost savings is the approach that all of these bills take to medical malpractice reform. There is none. There is none. Before the joint session of Congress several weeks ago the President even referenced a grand initiative, that he was going to support medical malpractice reform. Consequently, we found out the announcement was that the administration was going to--get this; I am not making it up--the President was going to accept grant applications for demonstration programs. I say to the President and to my colleagues, there are already demonstration programs: One is called Texas and the other is called California. They have enacted medical malpractice reform and it has saved incredible amounts of money. CBO now estimates that real medical malpractice reforms can save the health care system $54 billion over the next 10 years. Real medical malpractice reform can save as much as $200 billion.

My favorite example so far--and then we politicians wonder sometimes why the American people are a little cynical about the things we promise and the things we commit to during political campaigns; that we are going to do A, B and C and you can count on it, et cetera. My favorite so far is when the President was running for office. Three months before he was elected, President Obama vowed not only to reform health care but also to pass the legislation in an unprecedented way. He said:

I'm going to have all the negotiations around a big table.

He said that at an appearance in Chester, VA, repeating an assertion he had made many times. In referring to the debate on health care, he said the discussions would be--

. . . televised on C-SPAN, so that people can see who is

making arguments on behalf of their constituents and who are

making arguments on behalf of the drug companies or the

insurance companies.

Well, maybe the administration and the majority leader don't know where the C-SPAN cameras are. I can get them outside of Senator Reid's office at a moment's notice. In fact, they are televising this. I want to repeat what the President of the United States promised the American people specifically on health care reform. He said the discussions would be--

. . . televised on C-SPAN, so that people can see who is

making the arguments on behalf of their constituents and who

are making arguments on behalf of the drug companies or the

insurance companies.

It might be a little late for the drug companies. They have already cut a sweetheart deal with the drug companies. They have agreed to oppose importation of drugs from Canada and oppose competition amongst drug companies for Medicare patient recipients in return for some $80 billion in supposed savings over 10 years, and $100-some million worth of advertising by the drug companies in favor of health care reform. I am not making it up.

President Obama also said he didn't want to be--

. . . negotiating behind closed doors but bringing all

parties together and broadcasting those negotiations on C-

SPAN so the American people can see what the choices are.

Because, part of what we have to do is enlist the American

people in this process.

The last I saw, they were trying to enlist the AMA by doing a $247 billion unpaid for deal so that they could buy their support. They bought the drug companies. They couldn't buy the health insurance companies, so now they are going to retaliate against them by removing their antitrust exemptions.

One thing I have to say for this administration, they know how to play hardball. They know how to play hardball. But they also don't seem to care about the commitments that the President made during his campaign for the Presidency.

I see my colleague is here--Senator Barrasso--and he wants to speak also, but I say to my colleagues on the other side of the aisle, the American people are tired of this behind-closed-doors dealmaking, deal cutting, which none of us on this side of the aisle have had anything to do with and very few on the other side of the aisle. They are doing a multi-trillion-dollar deal which will affect the future and the lives of 300 million Americans eventually. It is not right. This process is not right.

The process they should be going through is exactly the one that the President promised the American people when he was running for President of the United States.

Mr. President, I yield the floor.

Mr. President, I yield myself such time as I may consume.

Today, the Senate begins consideration of the conference report to accompany this year's national defense authorization bill providing our soldiers, sailors, airmen, marines, and their families with the support they need and deserve. This is a responsibility I do not take lightly, especially during a time of war. It is a responsibility my good friend and colleague Senator Levin understands very well. I thank and commend Senator Levin for his skill in shepherding this bill through the conference process in a bipartisan fashion. I thank Senator Levin for his leadership. I thank him for his commitment to the men and women who are serving in the military and the long relationship we have enjoyed working together as colleagues in that effort.

The conference report largely supports the defense priorities laid out by Secretary Gates and authorizes over $550 billion in base program funding for the Department of Defense and the national security programs of the Department of Energy.

Additionally, the legislation authorizes over $129 billion in overseas contingency operations funding for ongoing activities in Iraq, Afghanistan, Pakistan, and other regional operations and support of the war on terrorism.

The conference report demonstrates our bipartisan support for the men and women of the Armed Forces and their families and provides them with the pay, benefits, equipment, and training they need and deserve.

The report increases benefits for our wounded warriors and provides an across-the-board pay raise for our military.

The report terminates production of the F-22 aircraft, contains no funding for additional C-17 cargo aircraft, provides full funding for procurement of 30 Joint Strike Fighters, and fully authorizes funding to train and equip the Afghan National Army and police forces.

I am disappointed that we are unable to eliminate funding for the continued development of the alternative engine for the Joint Strike Fighter. As Secretary Gates said, ``This program is unnecessary and could disrupt the overall

JSF Program by diverting resources away from efforts needed for the continuation of that program.''

During the more than 20 years Senator Levin and I have worked together, we have had our share of respectful disagreements, and this year is no exception. I strongly disagree with the majority's decision to include hate crimes legislation in the national defense authorization bill. I have consistently opposed attaching hate crimes legislation to the national defense authorization bill in years past. This year, I again objected to the inclusion of this nongermane, nonrelevant language as an amendment to the defense authorization bill when the bill was being considered on the floor of the Senate. Today, I remain strongly opposed to its inclusion in the conference report. The defense authorization bill is not the appropriate vehicle for consideration of hate crimes legislation. It is not germane to the work of the Armed Services Committee. The stand-alone legislation, S. 909, has not even been considered by the Senate Judiciary Committee, where it could have been debated, modified, improved, and brought to the floor of the Senate. What we are doing here is an abuse of the Senate process.

I also object to the language itself because it would create a new Federal crime for willfully causing bodily injury to any person due to the actual or perceived race, national origin, religion, or gender identity, sexual orientation, or disability of any person.

I do not believe an expansion of the Federal criminal code is necessary to cover a certain class of citizens from ``perceived injustices.''

Let me tell you one of the biggest problems I have here. We have now seen a virtual disappearance of authorization bills for various functions of government from Senate consideration. We have done that because extraneous and nongermane issues have been raised on those authorization bills. I don't remember the last time we had authorization bills for foreign operations out of the Foreign Relations Committee. I don't know when we have had authorization for other branches of government. The reason is because they always get bogged down in extraneous amendments on both sides. I am not placing the blame on the other side. I am placing the blame on both sides. This then bogs down the legislation which then, because of the exigencies of time, means we are not able to address the proper authorizing process for many functions of government. That, then, throws it all into the appropriations process. Of course, that is now an enormous shift of power and authority and responsibility from the authorizing committees, in whom the responsibility should lie, to the appropriating committees which are simply only supposed to appropriate money for previously authorized functions of government. I worry a great deal about that.

The only bill that has been consistently passed for many years through the Senate and into law is the Defense authorization bill. The Defense authorization bill is vital. We are now starting a very dangerous precedent by adding a very large and controversial provision, which is nongermane and nonrelated to defense, to a Defense authorization bill.

As my friend Senator Levin will point out, there have been other times where provisions have been added to this bill which were nongermane. Nothing of this magnitude, nothing of the controversy that is associated with the hate crimes legislation which was tacked on to this bill without any consideration in the committee itself. There was no committee consideration. When the bill came to the floor, bang, the first amendment out of the box was the hate crimes legislation which, of course, tied up the legislation for some days.

I understand the realities around here. I know what majority votes are. I know what majority membership in this body means. It was jammed through. I want to tell my colleagues, if we allow hate crimes to be added to this Defense authorization bill, what is next? What pet project or legislation on the part of the majority leader or the majority will be included in the next authorization bill?

If this legislation is signed into law, it will force police and prosecutors to treat identical crimes differently depending on a police officer or prosecutor's determination of the political, gender, philosophical, or even religious beliefs of the offender. Our legal system is based on identifying, capturing, and punishing criminals, not on using the power of government to divine biases. Crimes motivated by hate deserve vigorous prosecution, and I strongly support punishing those who commit such heinous acts under existing laws. Moreover, I am committed to a full and transparent debate on the issue. But I strongly oppose using the men and women of the military as the vehicle to pass this controversial and partisan legislation.

The Detroit News editorialized:

Certainly, threats of violence or violence against

individuals for any reason should be prosecuted to the full

extent of the law. Not, however, because the victims are

members of a particular race or sex, adherents of a

particular religion or are gay. These crimes should be

punished because the victims are uniquely valuable

individuals who deserve the protection of the law solely on

that basis. The idea of special prosecutions for ``hate

crimes'' is inherently divisive.

I am pleased the conference report does retain some legislative language offered by Senator Brownback during Senate debate on the bill. The Brownback language clarifies that nothing in the hate crimes legislation language shall be construed as an infringement on Americans' first amendment rights. Additionally, his amendment ensures that nothing in the hate crimes language should be construed to overturn ``the Religious Freedom Restoration Act of 1993'' that ensures our laws do not substantially burden Americans' free exercise of their religion.

The majority had the votes in July to add hate crimes to the Senate bill, and I am sure the majority will again have the votes today to invoke cloture on the conference report containing hate crimes language. It is indeed, unfortunate, that we are using the brave men and women in uniform as leverage to pass hate crimes legislation.

This legislation should have gone through the Judiciary Committee. That is the oversight committee. That is the committee of jurisdiction. I know my colleagues who are here on the floor will be justifying this legislation on the grounds of how badly it is needed. I say to the majority, who controls the legislative schedule here, they could have had this bill through the Judiciary Committee and on the floor of the Senate and passed in the Senate in the proper fashion and not put hate crimes on a bill that cares for the men and women serving in the military today. I worry a great deal about the precedent we will be setting by including an incredibly controversial piece of legislation in the Defense authorization bill which provides for our first and foremost obligation, and that is to secure the safety and welfare of our fellow citizens.

Finally, I believe it is important to note that the Defense authorization bill has been the only authorization bill that the U.S. Congress has consistently passed every year. Other authorization bills have often fallen under the weight of provisions inserted into must- pass bills that are not relevant to the legislation and highly controversial. The lives of our men and men serving abroad literally depend on our ability to consistently and reliably pass this authorization bill every year. I am not willing to take a gamble with our troops. For these reasons I cannot in good conscience vote to support the motion to invoke cloture on this bill, and I encourage my colleagues to do the same.

Prior to the final vote on passage of the conference report, I plan to speak in more detail about the overall bill and the commitment we have made in this conference report to do everything possible to ensure our soldiers, sailors, airmen, and marines receive the support they deserve and need, as well as a message we need to send those brave men and women and their families whom we support and stand behind.

I will vote against cloture. I will vote for final passage of the legislation in deference to our need to care for the men and women who are serving. I also would point out that if cloture is not invoked, we could immediately pass a resolution reconvening the conference and get this bill done today. But that is not going to happen, unfortunately.

I yield the floor.

Mr. President, today I am pleased to introduce legislation that would prohibit the Federal Communications Commission from enacting rules that would seek to regulate the Internet. Today the commission will meet to determine whether the historically open architecture and free flow of the Internet should be subject to onerous Federal regulation. Specifically, the commission will seek to impose ``net neutrality'' rules that would reign in the network management practices of all Internet service providers, including wireless phone companies.

Skeptical consumers should rightly view these new rules as yet another government power grab over a private service provided by a private company in a competitive marketplace. Earlier this year the administration moved to control much of the auto industry and the banking industry and now the administration is trying to control the technology industry by regulating its very core: the Internet.

This government takeover of the Internet will stifle innovation, in turn slowing our economic turnaround and further depressing an already anemic job market. Outside of health care, the technology industry is the nation's fastest growing job market. Innovation and job growth in this sector of our economy is the key to America's future prosperity. In 2008, while most industries were slashing jobs in the worst economy in nearly 30 years, high tech industries actually added over 77,000 good high-paying jobs. Just this month, Google and Yahoo both released positive earnings reports.

According to a report released last week by the Recovery Accountability and Transparency Board, which oversees the stimulus plan, 30,000 jobs have been directly created or saved by contractors who received money from the $787 billion stimulus package for infrastructure and social programs. This pales in comparison to the fact that the high tech industry produced more than double the number of jobs so far ``created or saved'' by the so-called ``stimulus legislation.'' It did so without the assistance of $787 billion from the wallets of taxpayers. Maybe a better stimulus package for this economy would be an administration decision to keep the Internet free of government control and regulation.

Unfortunately, the administration seems oblivious to the fact that their stated opposition to the supposed excesses of capitalism is at odds with a new regulatory regime being lobbied for by the most powerful businesses. As the Chairman of the Federal Communications Commission has recognized, Americans have benefitted enormously from the Internet's ``fundamental architecture of openness.'' The light touch regulatory approach toward the Internet that was advanced by previous administrations has brought Americans social networking, low cost long distance calling, texting, telemedicine and over 85,000 ``apps'' for the iPhone. It also brought us Twitter, You Tube, Hulu, Kindle, the Blackberry and the Palm. It has allowed the Internet to change our lives forever.

The wireless industry exploded over the past twenty years due to limited government regulation. Wireless carriers invested $100 billion in infrastructure and development over the past three years which has led to faster networks, more competitors in the marketplace and lower prices compared to

any other country. Meanwhile, wired telephones and networks have become a slow dying breed as they are mired in state and Federal regulations, universal service contribution requirements and limitations on use.

It is for these reasons that today I introduce The Internet Freedom Act of 2009 that will keep the Internet free from government control and regulation. This will allow for continued innovation that will in turn create more high-paying jobs for the millions of Americans who are out of work or seeking new employment. Keeping businesses free from oppressive regulations is the best stimulus for the current economy.

Mr. President, today I am pleased to introduce legislation that would prohibit the Federal Communications Commission from enacting rules that would seek to regulate the Internet. Today the commission will meet to determine whether the historically open architecture and free flow of the Internet should be subject to onerous Federal regulation. Specifically, the commission will seek to impose ``net neutrality'' rules that would reign in the network management practices of all Internet service providers, including wireless phone companies.

Skeptical consumers should rightly view these new rules as yet another government power grab over a private service provided by a private company in a competitive marketplace. Earlier this year the administration moved to control much of the auto industry and the banking industry and now the administration is trying to control the technology industry by regulating its very core: the Internet.

This government takeover of the Internet will stifle innovation, in turn slowing our economic turnaround and further depressing an already anemic job market. Outside of health care, the technology industry is the nation's fastest growing job market. Innovation and job growth in this sector of our economy is the key to America's future prosperity. In 2008, while most industries were slashing jobs in the worst economy in nearly 30 years, high tech industries actually added over 77,000 good high-paying jobs. Just this month, Google and Yahoo both released positive earnings reports.

According to a report released last week by the Recovery Accountability and Transparency Board, which oversees the stimulus plan, 30,000 jobs have been directly created or saved by contractors who received money from the $787 billion stimulus package for infrastructure and social programs. This pales in comparison to the fact that the high tech industry produced more than double the number of jobs so far ``created or saved'' by the so-called ``stimulus legislation.'' It did so without the assistance of $787 billion from the wallets of taxpayers. Maybe a better stimulus package for this economy would be an administration decision to keep the Internet free of government control and regulation.

Unfortunately, the administration seems oblivious to the fact that their stated opposition to the supposed excesses of capitalism is at odds with a new regulatory regime being lobbied for by the most powerful businesses. As the Chairman of the Federal Communications Commission has recognized, Americans have benefitted enormously from the Internet's ``fundamental architecture of openness.'' The light touch regulatory approach toward the Internet that was advanced by previous administrations has brought Americans social networking, low cost long distance calling, texting, telemedicine and over 85,000 ``apps'' for the iPhone. It also brought us Twitter, You Tube, Hulu, Kindle, the Blackberry and the Palm. It has allowed the Internet to change our lives forever.

The wireless industry exploded over the past twenty years due to limited government regulation. Wireless carriers invested $100 billion in infrastructure and development over the past three years which has led to faster networks, more competitors in the marketplace and lower prices compared to

any other country. Meanwhile, wired telephones and networks have become a slow dying breed as they are mired in state and Federal regulations, universal service contribution requirements and limitations on use.

It is for these reasons that today I introduce The Internet Freedom Act of 2009 that will keep the Internet free from government control and regulation. This will allow for continued innovation that will in turn create more high-paying jobs for the millions of Americans who are out of work or seeking new employment. Keeping businesses free from oppressive regulations is the best stimulus for the current economy.