Floor Statements

Mr. President, I ask unanimous consent that at the conclusion of my remarks, the Senator from Michigan, Senator Stabenow, be recognized.

Mr. President, we now have a draft of the Senate majority's health care reform bill, after spending several weeks behind closed doors producing that bill. Some of the details are starting to emerge.

I think it is critical that all Members in the Senate have an opportunity to look very closely at what is in the bill. It should come as no surprise that it is a 2,000-plus page bill. Much was made of the bill in the House of Representatives being a 2,200-page bill when it was all said and done. This one is 2,074 pages. It hasn't been amended yet, so that will probably expand it as this bill comes to the floor.

I think we at least now have something we can look at and review. There was a lot made last night by the majority when they rolled this bill out--how fiscally responsible this bill is and how much of an improvement it is over recent drafts of this legislation. I wish to point out a couple things that I think, perhaps, put into perspective what this bill would do, what it entails, and how, with all the rhetoric about how it differs and improves upon previous drafts of the bill, it comes down to basically the same elements that have been in all the bills we have seen.

First is with respect to the costs. It is very clear the cost of this bill--which was stated last night as $849 billion--is dramatically understated relative to its true cost when fully implemented. There are several reasons. One, they push back the effective implementation date to 2014 for many of the provisions to take effect. So you will not see the actual spending in the bill start to kick in until January 1 of 2014.

However, many of the revenue components in the bill begin to kick in next year, on January 1, 2010. So the tax increases, which are multiple and hundreds of billions of dollars, would begin to take effect immediately, starting January 1, 2010, while much of the spending in the bill would be deferred until much later in the budget window--not taking effect until January 1, 2014.

That distorts the true picture of what this legislation would cost and distorts it substantially.

The other point I will make is that there are a couple other provisions in the bill that, by its absence in one case and its inclusion in the other, understate the cost of the bill. One is the absence of the sustainable growth rate formula, or the so-called physician fee fix, the reimbursement form, that is a $247 billion hole--$247 billion in additional spending that is not included in the bill. That, obviously, understates the overall cost.

There is also a $72 billion assumption in there for a program called the CLASS Act. I wish to read for you something that one of my colleagues on the Democratic side said about the CLASS Act. This was the Senator from North Dakota, chairman of the Budget

Committee in the Senate. He called the CLASS Act ``a ponzi scheme of the first order, the kind of thing that Bernie Madoff would be proud of.'' That is how he refers to this CLASS Act included in the bill and the savings that are associated with it. In fact, the $72 billion it shows as revenue in the first 10 years turns into a deficit in the second 10 years. So when you back out the $72 billion that, it is assumed, would add to the revenues in the bill and you add to the cost of the bill the $247 billion that would be required to fund the physician fee formula over a 10-year period, the so-called surplus that this bill generates actually turns into a deficit. It goes from a surplus of $130 billion to a deficit of $189 billion.

Again, a lot of gimmicks are being used to understate the true cost of the bill to the American people. All that being said, if you look at the overall cost, when fully implemented over 10 years, you come up with this: Remember, when the HELP Committee passed its version of this bill out of committee, the 10-year, fully-implemented cost was $2.2 trillion.

When the Finance Committee passed its version of the health care reform bill out of the committee, the 10-year, fully-implemented cost of that bill was $1.8 trillion. So that is $1.8 trillion for the Finance Committee bill and $2.2 trillion for the Health, Education, Labor, and Pensions Committee bill. Guess what the pricetag is on the bill that was merged together and has now been unveiled for all the world to see. It is $2.5 trillion in overall cost--10-year, fully- implemented cost. That is a $2.5 trillion expansion of the Federal Government in Washington, DC, associated with the fully implemented cost of the bill.

The point I am trying to make is this: The cost of the bill is being dramatically understated by the authors of the bill to make it look like it comes in under $1 trillion, when, in fact, when you back out the two components I mentioned, it is over $1 trillion in the first 10 years, and that is because they delay implementation of many provisions until January 1, 2014--a budgetary gimmick designed to understate the true cost of the bill.

When you look at the fully implemented, 10-year cost of the legislation, without the gimmick of the delayed implementation date and the other gimmicks in here, it is $2.5 trillion in additional costs to the taxpayers of this country. Of course, that $2.5 trillion has to be paid for somehow. The way it is paid for isn't any different than in any of the other bills we have seen so far. It is paid for with higher taxes on small businesses and higher taxes on individuals. It is paid for with cuts to Medicare Programs that would impact senior citizens in this country, as well as medical providers, from hospitals to home health agencies, to hospice--you name it--and medical device manufacturers get hit hard in this legislation. Everybody gets hit when it comes to the reimbursement side to pay for this.

Of course, the American taxpayer gets hit hard when it comes to the tax increases included in there--$\1/2\ trillion in tax increases and $\1/2\ trillion in Medicare cuts to finance this $2.5 trillion expansion of the Federal Government to create a new entitlement program.

The other thing this bill does, which wasn't included in a previous version, it has an increase in the payroll tax on Medicare. The argument is, it only applies to people in the higher income categories. They tried to carve out people under $200,000 a year. Remember, the Medicare tax--and the payroll tax that every employee in this country pays, which is 1.45 percent on their income, matched by their employer, for a total of 2.9 percent--is increased. It gets increased to pay for not reforming or making Medicare more sustainable, a program we all know is destined to be bankrupt by 2017.

The increase in the Medicare tax will fund a whole new entitlement program unrelated to Medicare. The argument will be it is a health care program. But the fact is, the Medicare payroll tax was put into place to fund Medicare, a program people would pay into so that when they retire, they would have the security of health care coverage.

The payroll tax included in this bill, first off, will hit a lot of people. If you are a couple who both make a couple hundred--or $100,000 a year, you are already into the category where you are going to be hit by the tax. One of my main objections--and I am not for this tax increase--one of my main objections is the majority has chosen to use that tax increase not to make Medicare more sustainable but to create a whole new entitlement program with this bill.

The other thing I wish to point out, because it has come up in the last day or two, is there has been all this discussion about mammograms, this U.S. Preventive Services Task Force that came out with a recommendation that women under 40 should not go through mammogram screening; and, of course, a few years ago they made the opposite recommendation--back in 2002--when the U.S. Preventive Services Task Force made the recommendation that women 40 and older should undergo annual mammogram checks for breast cancer. That recommendation was completely reversed earlier this week. The 16-member task force ruled that patients under 50 or over 75, without special risk factors, no longer need annual screening. What is being said about that? They are backing away from that in a hurry. The HHS Secretary, Kathleen Sebelius, said: No, no, no, nothing will change. This is just a recommendation. It is not binding.

That may be true today. Here is the problem with government-run health care, the problem with the direction we are heading with this legislation: A greater level of government involvement and intervention and more requirements imposed on those who offer insurance products, particularly those who contract with the government. I think it is safe to assume that. There are many new creations in this legislation, and there is a new Medicare advisory board. They will have recommendations that are not just recommendations and advisory but, in fact, binding.

This is exactly the point many colleagues have been making about government-run health care. When you start down that path--and we have seen the model in Europe and Canada--where the government imposes cost control measures, that leads to rationing. Pretty soon, people are denied care, and care is delayed when people want to get a particular procedure. It has been concluded that this is not cost-effective, and some of these decisions that have traditionally been made between patients and doctors are made by the government.

I will read for you something that was in an editorial in the Wall Street Journal today. It gets at the very heart of what I am talking about. It says:

More important for the future, every Democratic version of

ObamaCare makes this task force an arbiter of the benefits

that private insurers are required to cover as they are

converted into government contractors. What are now merely

recommendations will become de facto rules, and under

national health care these kinds of cost analyses will

inevitably become more common as government decides where

finite tax dollars are allowed to go.

In a rational system, the responsibility for health care

ought to reside with patients and their doctors. James Thral,

a Harvard medical professor and chairman of the American

College of Radiology, tells us that the breast cancer

decision shows the dangers of medicine being reduced to

``accounting exercises subject to interpretations and

underlying assumptions,'' and based on costs and large group

averages, not individuals.

He goes on to say:

I fear that we are entering an era of deliberate decisions

where we choose to trade people's lives for money.

What is important about that observation is that he is pointing out what a lot of people will be very concerned about. If you are a woman in my home State of South Dakota, and let's say you are 42 years old, the recommendation made by this task force, which everybody is now dismissing and saying don't worry about it, it is not binding--under legislation such as this, where you create a board that actually does have statutory powers and is enabled to make many of these decisions based on what is cost-effective, you could have someone in a State such as mine, or any woman in any State in this country who is in their forties--because they said 50 should be the baseline now, the age at which you get mammograms or breast cancer screening done--that you could actually have women in this country who would be denied the opportunity to do that.

Of course, we all know and everybody can relate to people in this country

who, by virtue of that screening process and that test, have been detected early and able to beat breast cancer, which is something that afflicts a great number of women across this country.

That is one example. I use that as an example of how this new type of government-run program might work. But there are countless other examples of the very same thing.

As we head into this debate, again I remind my colleagues this type of undertaking--reforming health care--ought to be about driving down costs, it ought to be about providing more access to Americans, it ought to be about maintaining that important relationship between a physician and their patient and not getting to where we have the government making those decisions, where we are actually bending the cost curve up rather than driving it down.

By the way, the CBO said in response to the majority's bill that was unveiled yesterday that it actually increases costs by $160 billion. To me, the fundamental goal of health care reform for most Americans, the key concern they have about health care today, is its costs. Everything we have seen so far, including this most recent version which we are going to have at some point on the floor of the Senate, probably sometime after the Thanksgiving holiday, increases costs, drives the cost curve up.

How can you be for something that cuts Medicare to providers and seniors across this country, that raises taxes on small businesses, the economic engine that creates jobs in this country, raises taxes on middle-income Americans and which also, ironically, raises the cost of health care, increases the cost of health care? I am not saying this is the CBO. That has been consistent through all the bills that have been produced. It is consistent with this one as well that the proposals and all the new provisions that will be included--again, $2.5 trillion, 10- year fully implemented costs paid for by Medicare cuts, $\1/2\ trillion in Medicare cuts, $\1/2\ trillion in tax increases, and obviously much more than that when you get into the fully implemented time period, all that--all that--to raise health care costs for people in this country. How can we label that reform?

I hope the American people, as they listen to this debate, will engage, will take a hard look at this 2,074-page bill. It is going to be a lot of legislative, arcane language. We are all going to do our best to make sense out of it. But it is a massive bill, just in terms of its volume. It also includes a massive expansion of the Federal Government in Washington, DC, at tremendous cost to the taxpayers, to Medicare beneficiaries and, in the end, doesn't do anything to drive down the cost of health care. It simply increases it and puts at risk, I would argue, many of the types of things I talked about with regard to breast cancer screening. When government is making decisions rather than patients and doctors, that is a world in which I don't think I want to enter, and certainly I think most Americans don't either.

Mr. President, I ask unanimous consent to have printed in the Record a Wall Street Journal editorial.

Mr. President, I yield the floor.

Mr. President, how much time remains on our side?

Mr. President, I wish to say to my colleague from Nebraska, former Governor and now Senator from that State, that I am one of the signatories on the letter he has sent requesting we get cost data before we move forward with this and what the impact is going to be, because that is the issue.

I have listened to some of the discussion that has occurred on the floor this morning. The Senator from Illinois was down here earlier, Mr. Durbin, saying that the Republicans are attacking the House bill. Why are they attacking the House bill? Why aren't they talking about the Senate bill? Well, it is very simple. There is no Senate bill. It is being written behind closed doors. We have not been included in any of that. We have not been privy to any of the discussions that are occurring behind closed doors. So when we come down here and talk about health care reform, we are confined to talking about the House-passed bill because there isn't a Senate bill.

There are two Senate versions that have passed Senate committees. The Finance Committee has passed a bill. The Health, Education, Labor and Pensions Committee has passed a bill. But the merger of those bills is occurring behind closed doors in direct contradiction of what was promised earlier about health care reform. President Obama said when we do health care reform, it is going to be an open, transparent process. The American people are going to be able to observe this. In fact, it is going to be done on C-SPAN. Well, nothing could be further from the truth, because it is all happening behind closed doors.

So when we come out here and talk about health care reform, we are left with talking about a House bill because there is no Senate bill. We are told that this week we are going to see it, and I hope that is the case, because we would love to be able to react to the Senate bill and we would love to know what it is going to cost, and the American people would love to know what it is going to cost. We would also love to have some time to look at it before we start voting on it in the Senate.

My understanding is this is going to be a compressed schedule. They are going to try to get a vote this week on a motion to proceed to this bill, and come back after Thanksgiving and try to rush this through the Senate before the Christmas holiday, a bill that represents one-sixth of the American economy. The House bill was 2,200 pages long and the Republicans were allowed 1 amendment, 1 amendment in the House. I think we are going to have to make sure, in the Senate, this gets done right. That will take some time.

When the No Child Left Behind legislation was debated in the Senate, it took 7 weeks on the floor. We had a comprehensive energy bill a few years ago that took 8 weeks on the floor of the Senate. The farm bill that passed in the last session took 4 weeks on the floor of the Senate. We need to make sure this gets done in the right way for the American people. We don't even have a bill yet. That is why we are down here talking about the bills that were so far out there.

The Senator from Illinois also said the main concern the American people have is cost--costs keep going up. I had a roundtable in my State, in Sioux Falls, last week. The Governor, Governor Rounds, participated, as did several small business owners, including a restaurant owner, a retail pharmacy, a chain drugstore manager, and a small business owner who manufactures wood products.

They were all concerned about the same thing--costs. They said: How are we going to provide good coverage to our employees? What are we going to do if this massive expansion of the Federal Government--$3 trillion, when it is fully implemented--passes and when all the costs are going to be passed on to business? How are we going to be able to continue to cover our employees? What will that mean for people in terms of coverage?

I agree with the Senator from Illinois, who said cost is the issue. That is what I care about, and that is what the people in South Dakota care about. How do we get the cost for health care and health care coverage down?

The ironic thing we have seen about all these bills so far is none of them does anything to get costs down. All of them increase costs. So the so-called curve we talk about--bending the cost curve down--isn't happening under any of these bills. We have not seen the Senate bill because it is still being written behind closed doors. The House-passed bill--the 2,200-page monstrosity that passed the House of Representatives earlier--and the Senate bills we have seen so far that have been produced by committees all have the same basic characteristics about them. The first one is, they raise taxes substantially. They raise taxes--in a contradiction of promises made by the President--on people making less than $200,000 and those making less than $100,000. In fact, because of the individual mandate in the House-passed bill, people making $22,800 a year and up to $68,400 a year will see a huge tax increase that will hit them. Small businesses, because of the pay-or-play mandate, which under the House bill supposedly raises $135 billion, are going to see their taxes go up. The high-income earners making $500,000 and above will see their taxes go up because there will be a surtax applied to the high-income earners.

The problem with that is, this doesn't just hit high-income earners, it hits small businesses because of the way they are organized, as subchapter S corporations or LLCs, to file on their individual tax returns. CBO has said one-third of the tax increases targeted at the so-called rich will hit small businesses, which are the job creators in our economy, the engine of economic recovery in America. They say three-quarters to two-thirds of our jobs are created by small businesses. We are going to raise taxes on them. In fact, the highest marginal income tax rate, if this passes, next year, with the expiration of tax cuts that were enacted in 2001 and 2003, will go from 35 percent to 46.4 percent. That is the highest marginal income tax rate we have seen in 25 years. It is going to hit squarely small businesses that we are relying on to try to get us out of this recession and create jobs. This health care reform is all financed with higher taxes, with Medicare cuts.

I talked about the characteristics consistent with regard to all these proposals: You have higher taxes, and you have Medicare cuts to the tune of one-half trillion dollars a year, which, as my colleagues already pointed out this morning, are going to hit not only providers but also seniors. Medicare Advantage Program seniors will see benefits cut. So you have the individuals impacted, the providers impacted, and, of course, you have most Americans impacted in one way or another by the tax increases.

The final point is the most important; that is, the other characteristics these plans have in common, in addition to higher taxes and Medicare cuts, are higher health care costs and higher premiums. The CMS actuary came out last week with a report describing the House- passed bill, and it says it is going to increase the cost of health care in this country by $289 billion. We spend 17 percent of our GDP on health care today. Under that bill, it would go up to 21.1 percent, if we did nothing. We would be better off in terms of the costs that will be passed on to people in the form of higher health care expenses. It said we are going to see increased costs and that we are going to

see, the chief actuary concluded, 12 million people lose their employer-sponsored coverage because small employers would be inclined to terminate coverage so workers would qualify for heavy subsidies through the exchange.

The biggest number of people who will be covered will be those who are pushed into Medicaid, which, under this proposal, does expand significantly. The problem with that is, it passes on enormous costs to the States. You heard the former Governor of Nebraska and the former Governor of Tennessee talk about that. My Governor, Governor Rounds, in South Dakota, said we are going to be faced with $134 million in increased costs to the States to pay for this because Medicare is a partnership between the States and the Federal Government. So any benefit we get--about 60 percent of the people who will get coverage because of the bill will get it through Medicaid at an enormous additional cost to the States, which will be passed on to the taxpayers in the individual States.

So you will have higher taxes on small businesses, higher taxes on individuals, and you will have Medicare cuts that will impact seniors and providers. The amazing thing about all this is you are going to have higher health care costs when it is all said and done. It is remarkable that anything could be called health care reform that raises costs the way these proposals would do.

Finally, in response to what the other side has said, which is that Republicans don't have alternatives, that is wrong again. Republicans have proposed step-by-step solutions that would do this right, so it would drive down the costs, such as interstate competition, allowing people to buy insurance across State lines; small business group health plans, which would give businesses the advantage of group purchasing power, tort reform. We have a range of things we hope we have an opportunity to get to. We have to defeat this $3 trillion monstrosity.

I yield the floor.

Mr. President, today I wish to honor the life of Gordon J. Jones of the Flandreau Santee Sioux Tribe, who passed away on October 6. He was a man of great faith in God and had a strong conviction to serve his country, State, city, and Santee Sioux tribal community in many generous and selfless capacities.

After graduating from Oglala Community High School in Pine Ridge, SD, Gordon joined the Armed Forces and served in the Air Force until his discharge in 1954. Eventually, he returned home to Pine Ridge to work as a police officer.

Gordon went on to serve the Flandreau Santee Sioux Tribe in a number of leadership positions, including tribal chairman, treasurer, trustee, and judge. His knowledgeable and competent abilities remained evident throughout his service in each of these official tribal roles. Gordon also fought for the interests of Indian Country during his time with the Bureau of Indian Affairs and as the executive director of the Flandreau Santee Sioux Gaming Commission. His leadership and guidance while with the Commission resulted in greater accountability within Indian gaming in the form of the National Indian Gaming Regulations, which he was instrumental in developing.

Gordon's lifelong service to veterans and citizens of South Dakota is reflected in his membership in the American Indian Veteran Lodge, the American Legion, the Flandreau Bible Church, the Kiwanis, the Shriners, and the VFW. Gordon was the longest serving member of the South Dakota Human Rights Commission which he served on from 1985 and resigned in 2001 due to health issues. He was the legion chaplain for South Dakota from 1997-1998. This type of active and continuous involvement stands as a testament to Gordon's commitment to his community and his fellow South Dakotans. It is this type of selfless volunteerism which makes South Dakota truly great.

Gordon's opinions and actions influenced policies and decisions at all levels of government. His involvement within his local community, his service to his tribe and State, his time in the Armed Forces and his testimony before U.S. congressional leaders all speak to the great devotion and passion which Gordon demonstrated throughout his life. His many accomplishments show the enormous difference a single life can have on so many others. South Dakota is better because of the life and efforts of Gordon. This life of active service and involved citizenship provides an example for each of us to follow.

Mr. President, I want to commend the Senator from Tennessee. I totally support his approach. I think handling health care reform in a way that reflects a more thoughtful step-by-step approach is the correct way to proceed.

The leadership, the Democratic leadership in the House of Representatives, wanted to pass a health care reform bill in the worst possible way. They succeeded on Saturday, passing it in the worse possible way. It is a 2,000-page bill which was debated for about 4 hours and passed on a party-line vote. It was a partisan bill, very limited amount of debate, very few number of amendments that were offered. I think the Republicans were able to offer one substitute during that entire debate.

They passed out a 2,000-page bill that expands the Federal Government by $3 trillion over 10 years when it is fully implemented. So you have a 2,000-page bill coming out of the House of Representatives, a $3 trillion expansion of the Federal Government, and I think what the American people are probably asking in observing this process is, What does it all mean for me?

Well, let me tell you what it means. If you are a taxpayer in this country, if you are someone who currently does not have insurance in this country, you are going to pay higher taxes. If you are somebody who has insurance, you are going to pay higher taxes. If you are a medical device manufacturer, you are going to pay higher takes. If you are a small business, you are going to pay higher taxes. If you are someone who has a flexible spending account, you are going to pay higher taxes. If you are someone who has a health savings account, you are going to pay higher taxes. If you are someone who itemizes on your tax return and deducts your medical expenses, you are going to pay higher taxes.

So pretty much that kind of covers the gamut. Everybody in this country is going to be hit with higher taxes to pay for this monstrosity, this 2,000-page bill, which, according to the CBO, raises taxes in the first 10 years by three-quarters of $1 trillion.

What is interesting about that, when I mention that people who do not have insurance are going to pay higher taxes, there is, in this bill, what is called an ``individual mandate.'' Those who would pay the higher tax under the individual mandate--it would raise taxes by about $33 billion--are people who currently do not have health insurance coverage. What is interesting about that is that the CBO has looked at who would be impacted by the individual mandate and found that almost half of that tax burden would fall on taxpayers who are making between $22,800 a year and $68,400 a year. So about half of the individual mandate, about half of that $33 billion tax increase, would fall on individuals who, in their incomes, fall into the middle of that category, $22,800 a year to $68,400 a year. That is according to the Congressional Budget Office.

Now, it raises taxes by $135 billion on businesses through what is called a

``pay-or-play mandate.'' In other words, if you do not offer health insurance, you do not offer insurance that meets the government requirement, then you pay a payroll tax starting at 2 percent, up to 8 percent of payroll. That raises $135 billion in this bill in additional taxes and taxes that are going to hit small businesses.

There are also taxes on what they call ``high-income earners.'' That raises about $460 billion in the bill. It is designed to hit people who make between $500,000 and up to $1 million a year, which is sort of the traditional ``tax the rich and pay for this thing.''

The dirty little secret in all of that is that tax hits a lot of small businesses. In fact, about one-third of that tax is going to fall on small businesses that file or are organized as subchapter S corporations or LLCs and therefore file on the individual tax return.

So we are going to be faced with a situation where next year a small business--when the tax cuts that were enacted in 2001 and 2003, the top marginal income tax rate--goes from 35 percent to up to 39.6 percent. You will add in this health care, this 2,000-page bill, a 5.4-percent surtax on those high-income earners. So if you can believe this, the top marginal income tax, Federal income tax rate in this country, will go up to 45 percent--45 percent.

That is the highest rate we have seen in 25 years. As I said, it would be one thing if it were just hitting high-income individuals who were making more than $\1/2\ million a year, but it does not. It hits small businesses, small businesses that are organized as partnerships, subchapter S corporations, LLCs, and, therefore, file an individual tax return.

So they have $460 billion of tax increases there, $135 billion in the pay-or-play mandate, $33 billion in tax increases through the individual mandate--all totaled, $752 billion in new taxes in this 2,000-page bill that are going to be passed on and paid for by the American public.

The Joint Tax Committee said of the Senate bill--by the way, this is the Senate version of the bill. This is only 1,500 pages. We do not know--as the Senator from Tennessee pointed out--what the final Senate bill is going to look like.

All we know is that this is the version that was reported out of the Finance Committee, 1,500 pages also filled with higher taxes on individuals and small businesses.

The argument was made that we will make the people who are wealthy, the affluent, pay for this. What the Joint Tax Committee found was that 87 percent of the tax burden in the Senate Finance Committee bill would be paid by wage earners making less than $200,000 a year and a little over 50 percent would be paid by those making under $100,000 a year. If one fits into those categories, there are 46 million Americans who will be hit with higher taxes under the 1,500-page Senate Finance Committee bill as opposed to the 2,000-page House bill that passed on Saturday.

I remind my colleagues that when we talk about a massive $3 trillion expansion of the Federal Government, it has to be paid for somehow. Of course in this case, it is paid for in the form of higher taxes and by way of Medicare cuts that will hit very hard on seniors, $170 billion in cuts to Medicare Advantage, cuts to providers such as hospitals, home health agencies, hospices. Everybody gets to have their reimbursements cut in order to finance this $3 trillion monstrosity of an expansion of the Federal Government.

Having said that, it would be one thing if, in fact, the goal was accomplished, which is to reduce health care costs. Ironically, after a $3 trillion expansion of the Federal Government and three-quarter trillion dollars in additional taxes in the first 10 years, we don't see any impact on insurance premiums. In fact, they will not go down; they will actually go up.

I want to read what the Congressional Budget Office said about that:

On balance, during the decade following the 10-year budget

window, the bill would increase both federal outlays for

health care and the federal budgetary commitment to health

care, relative to the amounts under current law.

That is consistent with everything we have heard so far from the Congressional Budget Office about the impact this bill would have on overall health care costs and on the premiums average Americans would end up having to pay.

With respect to State governments, because something has been said in this bill about the expansion of Medicaid, in fact, there is a massive expansion of the Medicaid Program, to the point that a decade from now one-quarter of the entire population would be on Medicaid. This was a program that at one time was designed to assist poor, disabled people who really need assistance with health care. A decade from now, with this expansion of Medicaid, we would see one-quarter of the population on Medicaid.

The other component of that, the element I think should be so disturbing to States--as we all know, Medicaid is a State-Federal shared responsibility. I see the Senator from Nebraska, Mr. Johanns, a former Governor, who knows full well about the cost of Medicaid to State budgets. What this bill would do is increase the amount of cost passed on to States by $34 billion. States are going to have to look at how they are going to finance this thing, probably in the form of additional and higher taxes.

We have a $3 trillion expansion of the Federal Government, cuts to Medicare that will affect not only seniors but also most providers, and massive increases in taxes which will hit squarely small businesses and individuals, in particular individuals who make less than $100,000 a year. We need to do what the Senator from Tennessee suggested; that is, start over and do this step by step rather than a massive expansion of the government that raises taxes and increase health care costs.

I yield the floor.

Madam President, that is exactly the point. Why would we pass on $34 billion in additional cost to States when, as my colleague suggested, in States such as Nebraska and South Dakota, it is on the front page every day about decisions made at the State level, about cuts that will have to occur, looking at revenue increases, with the economy in the difficult situation it is in? I can't imagine complicating that by passing on an additional $34 billion in cost that every Governor and every State legislature will have to deal with.

Mr. President, I wish to join my colleague from Virginia in support of this legislation and I thank him for his leadership on this and on so many of the other issues and initiatives that recognize the service and sacrifice of America's veterans. He has been a leader on that, and I appreciate his leadership on this issue because I think, as we prepare to observe Veterans Day tomorrow, it is important to recognize those veterans who served throughout our Nation's history. Along with Senator Rockefeller, Senator Webb and I have introduced legislation that is known as the Frank Buckles World War I Memorial Act, which recognizes, once and for all, those veterans who served their country during World War I.

Frank Buckles's World War I Memorial Act would rededicate the existing District of Columbia War Memorial as the National and District of Columbia World War I Memorial on The National Mall in Washington, DC. The act is named for Frank Buckles of West Virginia who, at 108 years of age, is the last surviving American World War I veteran.

I appreciate the strong support of Senator Rockefeller who, of course, has Frank Buckles as a constituent, and I appreciate also the strong support of Senator Webb for this bill. Senator Burr, the ranking member of the Committee on Veterans' Affairs, is also a cosponsor, so it has strong and meaningful support on both sides of the aisle.

As I said, I think it is very fitting to speak on a bill seeking to establish a national World War I memorial because, as many know, Veterans Day was initially known as Armistice Day, which marked the end of World War I on November 11 of 1918.

After America's role in World War II and the Korean war, Congress passed legislation changing Armistice Day to Veterans Day, and President Eisenhower signed the change into law on June 1, 1954. From initially being a day to honor World War I veterans, November 11 became a day to honor all veterans.

We are rapidly nearing a century since the beginning of World War I, which began for most of the world in July of 1914. While World War I has become a distant, fading memory of another era, it still profoundly shapes the world in which we live.

As Oxford historian Hew Strachan concludes in his history of the first World War, the war ``forced a reluctant United States onto the world stage'' and began to ``lay the seeds for the conflict in the Middle East. In short, it shaped not just Europe but the world in the 20th century.''

World War I began for the United States when it entered the war in April of 1917 on the western front because of German submarine attacks on United States shipping and because President Woodrow Wilson concluded that the United States had to wage war if it was to shape the future of international relations, as Hew Strachan states in his history of World War I.

The United States was in World War I for only 18 months. Its Army grew from only 100,000 men to 4 million, with 2 million men sent overseas, 1\1/2\ million of whom arrived in Europe in the last 6 months of the war. Forty-two American divisions were in the field by November 11 in 1918, and 29 of them had

seen action. Over 100,000 American soldiers died in World War I.

Frank Buckles is the last surviving American World War I veteran. He was born in Missouri and currently lives in West Virginia. He joined the Army at 16 and went to Europe to fight in 1917, driving ambulances and motorcycles for a casualty detachment. He was discharged from the Army in 1919. Mr. Buckles also was extraordinarily affected by World War II. He was in Manila as a civilian on business in December of 1941, when the Japanese attacked, and was captured by the Japanese and spent 4 years in a Japanese prison camp in the Philippines. I strongly urge everyone to track down his interview, where he talks about his war experiences in both World War I and World War II. Transcripts and videos of Frank Buckles' interview can be found on the Library of Congress's Veterans History Project Web site. The Veterans History Project is a great initiative. I have taken advantage of the Veterans History Project myself, to interview my dad about his experiences as a pilot in World War II.

Mr. Buckles is also the honorary chairman of the World War I Memorial Foundation, which is seeking refurbishment of the District of Columbia War Memorial and its establishment as the National World War I Memorial on The National Mall. The Frank Buckles World War I Memorial Act will help to make this vision a reality.

I had the opportunity to meet Mr. Buckles last year. He is certainly an extraordinary individual. Mr. Buckles also traveled to South Dakota in July of 2008 to be honored at Mount Rushmore during their magnificent Fourth of July celebration. It is a great honor for me to support this bill that carries his name.

I wish to briefly describe what the bill does. In 1924, Congress authorized the construction of a war memorial on The National Mall near the Lincoln Memorial to honor the 499 District of Columbia residents who died in World War I. Funded by private donations from organizations and individuals, the memorial was dedicated by President Herbert Hoover on November 11, 1931. The Frank Buckles World War I Memorial Act would rededicate the District of Columbia Memorial as the National and District of Columbia World War I Memorial. The legislation would also authorize the nonprofit World War I Memorial Foundation to make repairs and improvements to the existing memorial, as well as install new sculptures to underscore the sacrifice of over 4 million Americans who served in World War I.

The bill would not require any taxpayer dollars because the World War I Memorial Foundation would raise the necessary funds through private donations.

All the major wars our Nation has fought in the 20th century are memorialized on The National Mall. Rededicating the District of Columbia World War I Memorial as the National and District of Columbia World War I Memorial fits the narrative of The Mall, with its wonderful memorials to World War II, the Korean war, and the Vietnam war. I think it only makes sense to rededicate a memorial to this 20th century war that established our Nation's path to superpower status among the community of nations.

This Veterans Day will mark the 91st anniversary of the end of World War I. I can think of no better way to honor Mr. Buckles and his departed comrades than by quickly passing this bill to establish a national World War I memorial. This bill would provide timely but long overdue recognition of all World War I veterans in our Nation's capital. I look forward to working with my colleagues to pass this bill as soon as possible.

I yield the floor.

Mr. President, a few moments ago, the Senator from Illinois was on the Senate floor essentially responding to comments that had been made by the Senator from Iowa, Mr. Grassley, regarding the health care debate and the legislation that has been reported out of the House and that is going to be voted on this week--legislation which is 1,990 pages long.

The Senator from Illinois asked: Where is the Republican bill, if they do not like the Democratic bill? Well, there are a number of Republican bills out there, but I would say to the Senator from Illinois or anybody on the Democratic side who is waiting for Republicans to produce a 2,000-page bill, it is not likely to happen. We don't believe legislating with 2,000-page bills makes a lot of sense when we are talking about one-sixth of the American economy. We believe it makes a lot more sense to approach that in a way that fixes and addresses the problems that exist with the health care economy in this country today in a step-by-step way, not with a huge, massive expansion of the Federal Government in Washington, DC.

The bill that came out of the House last week--at least according to the CBO--was a $1 trillion increase in spending. But that is before it is fully implemented. When it is fully implemented, it will be $2 trillion in additional spending--a massive expansion of the Federal Government in Washington, DC, with massive tax increases on small businesses and working families in this country, massive cuts to Medicare Programs upon which seniors across this country rely and depend. And that doesn't even include what happens if those cuts in Medicare don't happen. And we have reason to believe based on historical patterns they would not happen. Then it probably gets borrowed, and we add more trillions of dollars to the Federal debt--a debt which is already growing at $1 trillion a year every year for the next 10 years.

So we have a massive expansion of government--a $2 trillion expansion of government, massive tax increases, massive cuts to Medicare, and perhaps massive borrowing and additions to the Federal debt. That is what happens with the 2,000-page bill which is being proposed by the Democratic leadership in the House of Representatives.

So if the Senator from Illinois or anybody on the other side is waiting for Republicans to produce a 2,000-page bill that expands the government by $2 trillion and raises taxes on small businesses--which are the economic engine of our economy and that will create the jobs and get us back on a path toward recovery--I would suggest they are going to be waiting a very long time.

That isn't to say for 1 minute that there aren't lots of ideas that Republicans are putting forward that will help drive the cost of health care down--contrary to the big government schemes put forward by the other side which, in addition to raising taxes, cutting Medicare, and borrowing more--if you can believe this--increases the cost of health care by raising premiums for everybody who currently has health insurance in this country.

So the 2,000-page bill isn't coming from us. We have a lot of great ideas that we will have an opportunity to debate and amendments we can offer, if and when we get on this bill. But the 2,000-page bills--the massive expansion of the Federal Government in Washington, DC--is not the way we believe we should fix and address the health care economy.

That brings me to my point because in contrast to a 1,990-page bill some are calling reform--which doesn't reform but certainly wrecks one- sixth of the American economy--I have a simple one-page amendment. It is four lines long. I would like to have the opportunity to offer it to the underlying legislation that is a matter of debate on the unemployment insurance extension, which I think most people on both sides of this aisle support. I think both Republicans and Democrats in the Senate believe it makes sense for us to extend unemployment benefits coverage to people who are losing it, and the underlying bill would do that by 14 weeks.

We also believe when a bill comes before the Senate, under the historical practices of the Senate, typically it is

open to amendment. That is what makes the Senate different from the House of Representatives. Our Founders, in their infinite wisdom, conceived of two institutions--one, the House of Representatives; two, the Senate. The Senate has a more deliberative role. In doing so, it allows for open consideration and debate and votes on amendments.

What has happened today is that the majority leader has decided to fill the tree; in other words, not to allow votes on any amendments. So my one-page amendment, which is very simple and straightforward, isn't going to get voted on.

Mr. President, all my amendment does is end, on December 31 of this year, TARP. If the Congress doesn't take action, the Treasury Secretary can extend TARP. What is important to note about that is TARP has over $200 billion that hasn't been spent, and with payments that have come back into that fund, over $300 billion in funds that are unexpended. If we don't spend those--and it doesn't become a political slush fund to be spent on other priorities the Federal Government in Washington comes up with--that goes to pay down the Federal debt.

I can't think of anything more important now than trying to pay down the Federal debt. If we are worrying about trying to help the economy recover and helping taxpayers, let's take the unobligated balance in the TARP fund, end that program at the end of the year, and use those proceeds to apply to the Federal debt so we can start making a dent in these massive deficits and this massive debt building in Washington,

Mr. President, today I recognize Anna ``Ann'' Ross Kary Anderson who served honorably during World War II as a member of the Women Airforce Service Pilots, WASP.

More than 1,000 women answered the call and served as pilots during World War II. However, because WASP records were classified and archived for over 30 years, WASPs have been left out of much of the documented history of World War II.

On July 1, 2009, legislation was signed into law that honors the service of these women with the Congressional Gold Medal, which is given in honor of outstanding service to the United States and is one of the Nation's highest civilian awards. This Congressional Gold Medal finally gives Anna ``Ann'' Ross Kary Anderson and the rest of these brave women the honor and recognition they deserve.

Between 1942 and 1944, the 1,102 women of WASP were trained in Texas, and then went on to fly noncombat domestic military missions so all their male counterparts could be deployed to combat. WASPs were required to complete the same primary, basic, and advanced training courses as male Army Air Corps pilots, and many went on to specialized flight training. By the conclusion of the war, WASPs logged 60 million miles of flying in every kind of military aircraft.

Following the war, the WASPs were disbanded and the women pilots paid their own way home without pomp or circumstance. Even during the war, the families of the 38 women who died in the line of duty were responsible for the costs to transport their bodies and arrange burials. It was not until 1977 that the WASPs were granted veterans status.

Anna ``Ann'' Ross Kary Anderson was born in 1920 on her family's homestead in Mellette County in South Dakota. Following high school, she attended the University of South Dakota. After her military service ``Kary,'' as she was known to her students, went on to instruct hundreds of future pilots and was one of the first female FAA inspectors. By the time she retired she had logged over 20,000 flight hours. She still has family living in South Dakota.

While many of the South Dakota WASPs are no longer with us, I would like to recognize all of the women who joined from South Dakota in addition to Anna ``Ann'' Ross Kary Anderson: Helen (Anderson) Severson of Summit, SD. who was killed in service during a flight training accident in 1943; Marjorie (Redding) Christiansen of Mystic, SD; Loes (Monk) MacKenzie of Salem, SD; Laurine Nielsen of Deadwood, SD; Maxine (Nolt) Wright DeHaven of Sioux Falls, SD. I would also like to honor Violet (Thurn) Cowden formerly of Bowdle, SD, who now lives in California, and Ola Mildred ``Millie'' Rexroat, who currently resides in Edgemont, SD.

The WASPs served our country with extraordinary bravery, even in the face of discrimination. Their service was essential to the war effort, and this recognition of their heroics is long overdue and rightfully deserved. Though the pages of history have thus far overlooked the accomplishments and even the existence of this group, which served its country so well, this bill ensures forever their rightful place in history.

Mr. President, today I recognize Rapid City, SD, resident Bill Groethe on the occasion of his 86th birthday.

Bill has dedicated most of his life to preserving and capturing the history and heritage of Native Americans and South Dakota through his photographs. This means of documentation, which Bill has so aptly and skillfully employed, has allowed for the preservation and study of many of our region's most significant events.

Bill's photographic experiences and services extend beyond the scenery and history of the South Dakota. During World War II, he served his country as a photo reconnaissance technician for the Army Air Force.

Throughout his career, the photographs Bill has taken have not only been masterpieces of great artistic achievement but have also contributed, in a unique way, to memorializing great events of the past and, oftentimes, the people whom these events affected. Examples of this include photographs of Gutzon Borglum and his crew during the carving of Mount Rushmore, the dedication of the Crazy Horse monument, survivors of the 1890 Wounded Knee Massacre, the Rapid City flood of 1972, and, most notably, 1948 photos of the last nine Native American survivors from the Battle of the Little Big Horn. Each of these photographs captures a pivotal and monumental event in our history.

Thanks to the efforts, talents, and generous donations of Bill Groethe, generations to come will have the opportunity to look upon and more fully appreciate the events of the past.

Mr. President, today I recognize the life and accomplishments of June Culp Zeitner, the ``First Lady of Gems,'' who passed away on October 11, 2009.

June, a longtime South Dakota resident and world-renowned mineralogist, contributed greatly to the study and knowledge of minerals and fossils through her research and published writings. Her written works include 12 books and more than 1,000 scholarly and magazine articles on subjects such as natural history, cutting and polishing techniques, and collection methods.

In 1976, June acquired the nickname of the ``First Lady of Gems'' during a ceremony honoring the 25th anniversary of the American Federation of Mineralogical Societies. Those in attendance that day in the White House's Rose Garden to honor and thank June Culp Zeitner included First Lady Betty Ford and Mayor of Washington, DC, Walter Edward Washington.

As the founder of the State Stone Program, June encouraged each State to select an official stone, mineral, and fossil. It is thanks to June's initiative in founding the State Stone Program that South Dakota's official gem is the Fairburn Agate, our mineral is Rose Quartz, and our fossil is the Triceratops.

June's activities extended beyond the purely scientific to include education and journalism, serving as a teacher and, for 38 years, a member of the editorial staff of Lapidary Journal. She also founded the National Rockhound and Lapidary Hall of Fame in my hometown of Murdo, SD. Her other accomplishments include creating a display collection for the Smithsonian Institution and receiving various State and national awards.

The passion and dedication June displayed for mineralogy has done much to influence professionals and hobbyists alike. The people of South Dakota and our Nation are grateful for the contributions and life of June Culp Zeitner.

Mr. President, I appreciate the comments of my colleague from Arizona and before him my colleague from New Hampshire in pointing out what happens when you deal with a Federal Government insurance company. If you want to call it Federal Government, Inc., whatever you want to call it, what you are essentially talking about when the Federal Government takes greater control of any part of our economy but certainly one-sixth of our economy with health care, which is what health care represents--$1 in every $6 of our economy is spent on health care in this country--what you typically get is fewer choices and higher costs. That is certainly the case here because you are going to see fewer choices.

I think most Americans realize that if the Federal Government has more control, more intervention, more involvement in health care in this country, it is going to ratchet down the availability of choice and there will be fewer freedoms for people in this country because the Federal Government is going to start saying what has to be in a certain health care policy. It is going to start getting in the way of that fundamental relationship between physicians and their patients. You are going to have more and more governmental intervention, and that ultimately is something I think most Americans have great reservations and great apprehension about.

In fact, if you look at the bills, the various bills that are before the Congress today--and there are three that have been reported out in the House, two now in the Senate--they vary a little bit in terms of particulars, but they are consistent in terms of their overall themes. They are all going to raise taxes. They are going to raise taxes not just on the rich, not just on people with high incomes, they are going to raise taxes on ordinary Americans. All the studies bear that out. The Congressional Budget Office says that. The Joint Tax Committee says that. They are going to cut Medicare for seniors, particularly those who have Medicare Advantage. So Medicare benefits are going to be slashed if this bill becomes law. And they are going to all lead to higher premiums. That is the remarkable thing about this legislation. All these bills that are before Congress right now, which propose to control costs and to lower costs for people in this country, all lead to the same result; that is, higher costs for health care in the form of higher premiums.

I want to point out something in the bill the Finance Committee produced.

By the way, they are still merging these bills behind closed doors. There are a handful of people who are writing this bill. Contrary to the assertions of the President last year when he was campaigning that this was going to be on C-SPAN, it was going to be a wide-open process, and the American public was going to be able to participate and engage in this, this is all occurring behind closed doors. The specifics of this legislation are being written right now and probably will end up being hundreds of pages, perhaps even thousands of pages. But they all come back to the basic characteristics I mentioned earlier: higher taxes, Medicare cuts, and higher premiums for Americans.

What is interesting about this chart I have in the Chamber is there are Americans who will be put into an exchange who would be able to get some subsidies to help purchase insurance. Obviously, there are a lot of people in this country who do not have access to insurance today, and that is what we all--Members on both sides in the Senate--want to address: How do we provide more Americans access to affordable health care in this country? So there are some who get subsidies and who would be able to buy insurance through an exchange. That is about 18 million Americans. But if you are among the 185 million Americans who currently have health insurance, you will pay higher taxes and your premiums will end up going up.

What is ironic about this is 18 million Americans will get subsidies through these exchanges, but there are still 25 million Americans under the Finance Committee bill who will not have insurance when this is all said and done. So you actually have more people without insurance than would actually get subsidies under this plan that is being proposed by the Finance Committee, financed by the 185 million people who are going to pay higher taxes and also who are going to see their premiums go up. Now, I am not saying that. That is what the Congressional Budget Office and the Joint Tax Committee have said. That is what every independent study that has looked at this has said.

By the way, last week there was an analysis that came out, done by the Actuary at the Department of Health and Human Services here in Washington, DC, that said overall spending on health care under this proposal--and when I say ``this,'' I am talking about the House proposal. Again, they are very similar in their characteristics, and in some of the particulars they differ. But in the House proposal, it would go up by 2.1 percent. If you remember, today we spend about $1 in every $6 in our economy on health care. At the end of the 10-year period, according to the Actuary at the Department of Health and Human Services, we are going to be spending more than $1 in every $5. So 21.3 percent of every $1 in our economy is going to go to health care because under these proposals, health care costs are going to go up over and above the rate of inflation. In other words, if we do nothing today, you are going to have normal inflationary health care costs, which are going to increase the cost of health care. Enacting this legislation would increase the cost of health care 2.1 percent above that, or $750 billion over 10 years. That is what the Actuary at the Health and Human Services Department said--$750 billion in spending on health care above and beyond what would be normal if we did nothing with health care inflation in this country. So it would add 2.1 percent to the

amount we spend as a percentage of our GDP, to where 21.3 percent of our entire economy would be spent on health care.

So you have health care costs going up, you have taxes going up, according to the Congressional Budget Office and the Joint Tax Committee, on people who are making less than $200,000 a year. And even half of the tax burden, over 50 percent, according to the Joint Committee on Taxation, would be borne by those who make less than $100,000 a year.

The amazing thing about this, from the analysis that has been done, is that someone who is making 150 percent of the poverty level, which is $32,200 a year, because of the way the provisions in this bill would interact, would actually end up with an effective marginal tax rate of 59 percent--a 59-percent tax rate--because they would lose subsidies as they make more money. So the incentive for someone in a lower income category to make more money is going to go away because with every dollar they make, their effective marginal tax rate is going to go up. It would be 59 percent for someone making $32,200 in this country today. That is for people whose income is 150 percent of the poverty level.

So to suggest for a minute these tax increases and these tax policies and the way this bill is financed are not going to impact average Americans, working-class Americans, is absolutely wrong. It is false. That is what the Joint Tax Committee and the Congressional Budget Office have said.

But probably the worst thing: If you are one of these 185 million Americans, as shown right here, who are paying the burden in the form of higher taxes, you are going to see, at the end of all this, that after all the promises that we are going to get costs under control, your health care costs are going to go up and your taxes are going to go up. If you are a senior citizen, your Medicare benefits go down. And guess what. Your health care costs, your insurance premiums are going to go up. That is what has been said consistently.

Doug Elmendorf, the Director of the Congressional Budget Office, said:

Our judgment is that piece of the legislation would raise

insurance premiums.

He goes on to say:

Those projected premium amounts include the effect of the

fees that would be imposed under the proposal on

manufacturers and importers of brand name drugs and medical

devices, on health insurance providers, and on clinical

laboratories. Those fees would increase costs for the

affected firms, which would be passed on to purchasers and

ultimately would raise insurance fees by a corresponding

amount.

That is a direct quote from the Congressional Budget Officer Director, Doug Elmendorf.

He also said, when asked the question about, Would these taxes be passed on in the form of higher premium, that roughly dollar for dollar they would be passed on in the form of higher premiums.

Some of the independent studies that have been done out there suggest that if you are buying in the individual market as an individual, you are going to see up to a 73-percent increase in your health insurance premiums; if you are a small business, up to a 20-percent increase. The studies vary. I have looked at my State. They break it down, some of these analyses, State by State. In my State of South Dakota, if you are buying in the individual marketplace as an individual, you would see a 49-percent increase. If you are buying in the individual marketplace as a family, you would see a 50-percent increase. If you are someone who is in a small group market, you would see smaller increases but still double-digit increases--14 percent, 15 percent above the normal rate of inflation. In other words, if we do nothing, if we do absolutely nothing, you are going to have normal inflationary increases in health care costs, which I think are hurting a lot of small businesses. But if we do what is being proposed here, it is going to be way worse because the overall cost of health care, according to the Actuary at the Department of Health and Human Services, the overall cost of health care above and beyond the rate of inflation is going to be $750 billion over 10 years or a 2.1-percent increase in overall health care costs. It translates, as I said earlier, into individuals, small businesses, and families paying higher health insurance premiums, higher costs for their health care, higher taxes.

If you are among the 185 million Americans, again, who are not in the exchange, who do not get subsidies, you are going to pay higher taxes and you are going to see your health insurance premiums go up.

There are a lot of people--a total of 282 million people--who are not going to be in the exchange. There are a lot of people who derive their health care through the government: Medicare and Medicaid. So there are a total of about 282 million people in this country who are not going to get subsidies and 18 million who will.

By the way, again, 25 million Americans will still not be covered. There will be more not covered than would be able to get subsidies through these exchanges to buy insurance.

The Democrats are saying: Trust us. They said that on the stimulus. They said unemployment would not go above 8 percent.

I will wrap up with this, Mr. President. ``Trust us'' is not enough for the American people. The American people need real, meaningful health care reform that will drive costs down, not up. These proposals drive it up.

I yield the floor.

Mr. President, I want to speak to the bill before the Senate right now and also to an amendment I would like to have voted on as a part of the underlying legislation. But I do want to also react to some of the remarks made by my colleague from Vermont.

When it comes to some of the legislation some are trying to jam through the Congress this year, we believe it is OK to say no to some things. We think it is OK to say no, for example, to 1,500-page bills written behind closed doors, in secret. We think it is OK to say no to higher health care premiums for our constituents in our home States and most Americans in this country who currently have health insurance. It is OK to say no to trillion-dollar spending bills that don't do anything to create jobs. We think it is OK to say no to higher taxes for small businesses and working families who are going to get hit by many of the proposals in front of the Congress, including the health care bill which, according to the Congressional Budget Office, more than half the tax burden is going to fall on families making under $100,000 a year.

We think it is OK to say no to energy taxes that will kill jobs and wreck the economy. We think it is OK to say no to a $2 trillion expansion of the Federal Government in Washington to create a new health care entitlement that will be financed with higher taxes, Medicare cuts, and borrowing from future generations. We think it is OK to say no to a $\1/2\ trillion in Medicare cuts that are going to impact senior citizens across this country. It is also OK to say no to the extension of what has become a TARP slush fund, what has become a political slush fund that is now being used for lots of things for which it was not intended.

I do not apologize for saying no to bad policies that are going to wreck the economy, cost Americans jobs, and put more and more of our future generations at risk because we are saddling them with a burden of debt that they will be carrying forever into the future. I think it is OK for people in this Chamber to stand up to bad policies and to say no.

I am going to continue to defend the right of my colleagues in the Senate, whether I agree with them or not. A lot of my colleagues on the other side, they have things they want to do. Some of them I do not agree with. That is why we have the Senate. It is to come here and resolve our differences and try to reach common ground if that is possible. But if there are bad things being proposed, I don't think there is anything wrong with saying no--to higher taxes, higher health care premiums, more borrowing, and more debt we are putting on future generations. I don't particularly have a problem with that.

I do think it is important, however, that we act on legislation that will create jobs, that will provide a better, stronger economic future for people in this country, and that will address the needs of the people who are hurting because of this economic downturn. The legislation we have before us will do just that, and I voted to proceed to that legislation last night so we could have this debate, so we could get on this bill, so we could provide an additional 14 weeks of assistance to people who need unemployment benefits because of what is happening in our economy and this country.

I do not think we will find a lot of disagreement that we need to take those steps that are necessary. I will say the amendment offered by the Senator from Nebraska, Mr. Johanns, is a germane, legitimate amendment that ought to be voted on. All he is saying is, if we are going to do this, we ought to figure out a way to pay for it that doesn't lead to higher taxes on small businesses.

I think that is a fair vote to have. It is totally related to the underlying bill. But the underlying bill that would provide and extend unemployment insurance benefits to people in this country who are suffering as a result of the economic downturn, we are not objecting to that. Nobody here is. In fact, we could finish that in the next hour or two if the majority would agree to allow a couple of amendments to be voted on.

Having said that, I do have an amendment on which I think it is important to get a vote, and the reason it is important to get a vote on it now is because we are not going to get many opportunities. The TARP program expires at the end of this year. If Congress doesn't take steps to end it, the Treasury Department can extend it. The reason that is important is because the TARP program has gotten far afield from anything it was designed to do. It was designed to stabilize the economy last year at a very difficult time. So we voted to extend $700 billion in this authority for the Federal Reserve to go out, to buy some of these troubled assets in various financial firms. They decided to take equity positions.

I think it is a very different use of the funds than what many of us intended when we voted for it, but that having been said, it was done to stabilize the financial system in the country. That was a year ago. I think it is fair to say it is not an emergency anymore. In fact, many of the TARP funds that have been extended are now being extended to other types of industries. We have seen the auto industry, to the tune of about $80 billion, come in and get TARP assistance. We have seen insurance companies get TARP assistance. We have even seen TARP assistance made available to help modified home mortgages in this country to the tune of $50 billion, on which the Congressional Budget Office says we will never see any return.

The TARP has become--I hate to call it a political slush fund. I hate to refer to it that way, but at a minimum it has become a revolving fund that can

now be used by the Treasury for all kinds of purposes. In fact, I think from statements that have been made by the Treasury Secretary, the indications are they expect to reuse a lot of those funds even after they are paid back by some of the institutions that have gotten assistance.

So we have the $700 billion TARP authority out there. With payments that have been paid back, there is now over $300 billion that is unused. This is about $213 billion that was never used. And with payments that have now come back from some of the institutions that received assistance, there is a little over $300 billion of unobligated funds in the TARP account. Why is that significant? It is significant because if we do not use those funds for some other purpose than for which they were intended, those funds will be to retire the Federal debt. To me, that is probably as good a use of funds as we could possibly find right now.

We had a deficit last year of $1.4 trillion. We are looking at trillion-dollar deficits as far as the eye can see. If the predictions of the Congressional Budget Office are accurate, in the next 5 years we will double the Federal debt. In the next 10 years we will triple the Federal debt to the point where every American, every household in this country is going to owe $188,000 of debt.

So as a young couple gets married and starts out in their life together, they are going to get a wedding gift from the Federal Government, a big fat IOU for $188,000. The best thing we can do in addition to extending unemployment benefits to people who have lost their jobs and whose coverage is running out is to try to get this debt under control so we are not passing on this enormous liability to future generations.

I would argue if we allow this situation to go unabated, if we continue to borrow money at the rate we are borrowing it today, and we continue racking up debt at the rate we are today, it is going to create all kinds of economic consequences down the road in the form of, perhaps, higher interest rates; we could see inflation pick up down the road. Nobody sees that in the near term, but in the long term, when we start having to print money to monetize our debt, and we are paying back our debt with cheaper dollars, the people who are buying our debt are going to start saying: Wait a minute. I want a better return on my investment.

So the interest rates start to pick up, and that could have some very disastrous consequences for our economy when it comes to homeowners and small business owners and people who are trying to get student loans. There are all kinds of consequences from this incredible binge of borrowing that we are on as a country.

I think the best we can do if we have got unobligated funds in the TARP authority right now is use those funds to pay down that Federal debt. That is what my amendment does. I am coauthoring it with the Senator from Utah, Mr. Bennett. But we believe we ought to end the TARP authority this year when it is set to expire. If Congress is not heard on this, then the Treasury has the authority to extend it.

I wish to at least have Congress heard. Congress, after all, created the TARP fund. It seems to me that if it is going to be extended, Congress ought to have a vote on that. As I said, that extension or that expiration date is looming. It is December, the end of December of this year. So if Congress is going to be heard, that is going to have to happen in the very near future.

So I wish to see a vote by the Senate on whether we believe that TARP ought to be extended, ought to continue to be used for all of these other ancillary purposes I mentioned that are unrelated to the underlying purpose for TARP when it was created a year ago, and whether we are going to say we think it is a priority that we start paying down this gargantuan Federal debt that is growing by the day, and the interest payments are growing with it.

I wish to see, on this opportunity, this legislation that is moving through here, a vote on whether we can extend TARP. My amendment is one page. In fact, it is only four lines long. It is very simple. It is here for everyone to take a look at. It will not take very long to figure out what it does. I cannot imagine why the majority would not want to have a vote on whether we are going to allow a $700 billion authority of the Federal Government to continue to use these funds, why Congress would not want to be heard when, in fact, it was the Congress that created this program in the first place.

My amendment is very simple. All it says is when TARP expires at the end of the year, it ends. That does not mean that the Treasury does not have the authority to wind down some of the assets in some of the places where it has already invested those TARP dollars. Not at all. All it simply says is the moneys that are not expended out of that account will be used to pay down the Federal debt and no additional moneys will be extended to other programs or other uses.

Some people might say: Well, what if we have another emergency? If we have another emergency, Congress can act again. That is what we do. We are the legislative branch of the government. We have the power of the purse. There is not any reason to think that if for some reason it became clear that a TARP-like authority was necessary down the road that the Congress would not take the necessary steps to address that emergency.

But in the meantime, we have a $700 billion out there which, as people are making payments back in, are now going back out. We have got about $300 billion right now of head room in that fund. It seems to me we ought to take that $300 billion and apply it to paying down the Federal debt, so that future generations of Americans are not having their future mortgaged because we have not been able to live within our means.

It is a one-page amendment, four lines long. The bill that I am told is being written on health care, which is 1,500 pages, the last version of it that I heard or saw--we have not seen the current version of it. But that 1,500-page bill is being written behind closed doors.

This, on the other hand, is one page, four lines long--a very simple, straightforward amendment. It would not take us probably but a half an hour to debate it and vote on it. If the majority does not want to have a vote on this amendment, I am not sure why, because it would seem to me that the Senate would want to weigh in on one of the most important issues of the day, and that is whether we are going to take some of these unexpended funds and use them, apply them to paying down the Federal debt.

With regard to the debate before us on unemployment insurance, it needs to be extended. There is no debate about that. In fact, I think there will be a big bipartisan vote when it happens.

But why wouldn't we, in the interest of having a vote, a fair debate and a vote on amendments, allow amendments such as this which, as I said, because of the expiration date being December 31, it is unlikely, in my view, that Congress is going to get an opportunity, if we do not vote on this now, to vote on whether a $700 billion expenditure of taxpayer dollars is going to be extended. And, if in fact, it has served its purpose--and it has not--then why would we not use that unexpended authority, that unobligated balance to pay down the Federal debt which, I would argue, I think most Americans would agree is one of the most difficult and protracted problems that is going to face the country going forward.

I guess I would simply say that this, in my view, is related to the debate we are having. Because the debate we are having is about the economy. It is about people who have been displaced and who have lost jobs and extending assistance to them, which they need and which we are all supportive of doing.

But if you are talking about things we can do to bring greater stability to the American economy, to provide a better and a brighter and more secure future for future generations, and to try and get this economy back on track, I think it would be a great message to send to the American people that the TARP, which was created for a specific purpose for a specific time, has accomplished that purpose. We do not believe it ought to become a slush fund for other activities. The unexpended balances in that fund ought to be used to pay down the Federal debt

and to provide a better and a brighter future for the taxpayers of tomorrow, unencumbered by a huge mountain of debt that is going to be passed down to them if we are not able to get our fiscal house in order.

I hope the majority will come around to the view that let's have a vote, let's have a 30-minute or hour debate on a couple of these amendments. Let's pass this bill and be done with it. But it seems to me, at least, for some reason--I am not sure what that is--the majority does not want to have a vote on what I think is a very consequential issue of our time, and a very consequential issue for the future of this country.

I yield the floor.

The PRESIDING OFFICER (Ms. Stabenow.) The Senator from Texas is recognized.

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

Mr. President, I ask unanimous consent that when I am finished speaking the Senator from Illinois be recognized.

Mr. President, last week, something remarkable happened on the floor of the U.S. Senate--bipartisanship broke out. We had a vote where 40 Republicans were joined by 12 Democrats and 1 Independent to vote down a piece of legislation that would have added $250 billion-- $\1/4\ trillion--to the Federal debt. That $\1/4\ trillion, with interest, was $300 billion.

It was highly anticipated, as we were heading toward that vote, that there would be enough support to pass it. But I think it tells Members in the Senate, and probably people around the country, that there is a certain amount of discomfort among Senators when it comes to spending, borrowing, and adding to the debt $\1/4\ trillion. I think that is good. That is the kind of bipartisanship I wish we had more of in the Senate: bipartisanship in the interest of fiscal discipline. Fiscal sanity in this country would be a welcome prize for most Americans.

As we draw nearer to the next stage of the debate on health care--and I would argue that was sort of the first vote on health care reform because it was a health care-related vote and, frankly, something many of us believe needs to be addressed. The physician reimbursement issue is an issue Congress deals with on a year-to-year basis. This would have put a 10-year solution in place, but, again, at a cost of $250 billion--$300 billion with interest--and not paid for, borrowed, put on the Federal debt, a Federal debt which is already growing at a record pace.

Last year, the deficit was $1.4 trillion. The deficit this year is expected to be at a comparable range, and every single year, as we spend more than we are taking in, we borrow more and more from future generations. In fact, last year, in fiscal year 2009, which was just concluded, 43 cents out of every dollar that was spent by the Federal Government was borrowed. Yet we were talking about putting another $\1/ 4\ trillion--$300 billion with interest--on that Federal debt with the vote that was held last week.

So I was very pleased that bipartisanship did break out on the floor of the Senate and that we were able to defeat a piece of legislation that, frankly, would have saddled future generations with even more debt than they are already facing.

I think the next big issue in the debate over health care, Mr. President, has to do with whether--in the legislation that is being written behind closed doors--there is going to be a so-called public option, which is the phraseology that has now been adopted to describe what I would characterize as a government plan, and whether that government plan is going to have an opt-in for States, an opt-out for States, or whether it will have a trigger that will take effect somewhere down the road. All these questions, in my mind, belie the basic fundamental fact that what we are talking about is government-run health care.

Whether we have a State opt-in or a State opt-out or some sort of trigger, the conclusion is still the same: we are going to have a government plan that will compete with the private health care market and the opportunities that are available to most Americans. When you do that, of course, I think you put the competitive marketplace at an unfair disadvantage because the government, obviously, will have huge advantages, and eventually over time you will see more and more people pushed into that government plan, more and more employers will drop their coverage as people gravitate toward the government plan.

My point simply is this: Whether you call it a State opt-in or a State opt-out or a trigger, a government plan by any other name is still a government plan. What we are talking about is creating a mechanism whereby the Federal Government can enter into the marketplace and compete against the private sector when it comes to offering health care insurance to people in this country. That, to me, is an unacceptable outcome and I hope one that will be defeated.

It seems to me at least that the vote last week perhaps is an indication that there already is some discomfort developing among Members here, in a bipartisan way, on the direction in which this health care debate is headed.

I think the No. 1 concern most Americans have when it comes to health care reform is the issue of cost. It really is. How are my day-to-day costs for health care going to be impacted by the debate occurring in Washington, DC? Is health care reform going to drive that cost down or is it going to increase it?

What we have questioned consistently with respect to all the proposals out there, including the more recent version released by the Senate Finance Committee of which we finally got a written copy last week, over 1,500 pages, currently being merged with the Senate HELP Committee legislation--again in a process which is very closed to most Members of the Senate where a handful of people in a room are developing this--we hope to see that merged version at some point here in the not too distant future and know what it is going to cost because I think that is a consideration all of us are going to be following very closely: What is this latest version going to cost?

For most Americans, the issue is going to come back to how it impacts my premiums. We have now seen the Congressional Budget Office, we have seen the Actuary at the Department of Health and Human Services, we have seen a number of independent studies that have said this is going to bend the cost curve up, not down. In other words, you are going to see overall health care costs increase, you are going to see premium costs increase for most Americans.

In fact, if you are one of the 185 million Americans who derive their health insurance through their employer, you are going to see higher premiums. There are those who are going to get their insurance through an exchange--18 million Americans--for whom subsidies are available. But if you are one of the 185 million Americans who get their health care insurance through their employer, you are not going to be eligible for a subsidy. You are, however, going to be paying the higher taxes that are associated with this and you are going to see your premiums go up.

The most recent, I guess, analysis of this, which was released last week by the Department of Health and Human Services, by the Chief Actuary there, suggested that overall spending for health care at the end of the 10-year period would be up 2.1 percent. In other words, today we spend about $1 in every $6 of our entire economy--one-sixth of our GDP is spent on health care. In 2019, we will be spending 21.3 percent or over one-fifth of our entire economy on health care. So $1 out of $5 in our economy is going to pay for health care at the end of that period. What does that mean? It means health care spending is going to increase by about $750 billion over that period of time. That is the wrong direction to go if you are talking about reform.

As I said before, most Americans, when they look at how this impacts them, want to know whether health care reform that is being acted on by Congress is actually doing something to impact the cost of their health care in a positive way--in other words, that the cost for their premiums, their health care premiums, is going down.

I say again, based upon all the analysis that has been done with respect to my State of South Dakota, I have seen several studies which suggest that if you buy your insurance in the individual marketplace, you could see your

premiums go up as much as 47 percent. If you are a family buying in the individual marketplace, you could see your premiums go up as much as 50 percent. In fact, there have been some analyses done that suggested premiums could go up as much as 73 percent for some people.

What does that mean to the average American who is observing this debate? It means not only are you going to see taxes go up--according to the Congressional Budget Office and the Joint Tax Committee, the tax increases in the bill are going to hit the middle-income classes the hardest. In fact, about 90 percent of the tax burden will be borne by those making less than $200,000 a year. According to the Joint Committee on Taxation, over 50 percent of the tax burden will be borne by those making less than $100,000 a year. The taxes are clearly going to hit right at middle-class Americans. If you are a senior over 65, you are going to see significant cuts in Medicare because that is one of the ways the new expansion of this program, this new entitlement program, is financed and paid for. So you are going to see higher taxes, you are going to see cuts to Medicare, and then ironically, as I said earlier, you are going to see your premiums go up. The average American has to be sitting out there asking: What is the whole purpose of this exercise?

One of the things that has been advocated in the debate over health care reform is we have to cover the people who are not covered. There are a lot of Americans who do not have access to health care coverage today. That could be addressed. There are lots of ways that could be addressed, but the way it is proposed to be addressed here actually leaves 25 million Americans uncovered. So not only have you raised taxes, cut Medicare, and increased premiums for people who already have insurance, you leave 25 million Americans without health care coverage. How can you, in any stretch of the word, characterize or define that as health care reform?

As the debate gets underway, I hope last week's vote was an indication, at least, of the initial stages of this debate; that there is some bipartisan support for constraining spending, for fiscal responsibility, and for fiscal discipline; and that as we get into this, we can move away from this discussion about a $2 trillion expansion of the Federal Government financed with tax increases and Medicare cuts and premium increases for 185 million Americans who get their insurance through their employer and start focusing on things that actually would provide greater competition and would bend the cost curve down, would drive costs down for most Americans. We believe that is a fair place to start.

We think there are things that could be done that would accomplish that, one of which is allowing people to buy insurance across State lines, creating a bigger market, a more expansive market for people in this country. Another is to allow people to join larger groups and get the benefit of group purchasing power, small business health plans-- legislation voted on a number of times here and always been defeated. We ought to address the issue of medical malpractice reform and defensive medicine, which costs, some estimates are, $100 billion a year in terms of additional spending.

There are many solutions that we think make sense that actually do get at the issue of cost, which, as I said, is where I think most Americans are concerned about health care reform and where all the bills we have seen so far, including the one that was released by the Senate Finance Committee, fall short. It doesn't do anything to impact premiums, the health care costs for most Americans, at least those Americans who have health insurance; it raises them at the same time it raises taxes on working families in this country and cuts Medicare for senior citizens to the tune of $\1/2\ trillion.

If you take a fully implemented 10-year time period for this--bear in mind that many of the tax increases in this bill are implemented immediately and the actual other provisions in the bill are implemented later on down the road in 2013. So you see a distorted view of what this bill really costs. The 10-year fully implemented cost is $1.8 trillion, almost $2 trillion. That amount, of course, is financed evenly between cuts in Medicare Programs and tax increases on people in this country.

I do not think that is what we want to see in terms of reform. It certainly is not what I think the American people are expecting Congress to do. They are expecting health care reform that does do something about getting their costs under control. This bill, the last bill we have seen--of course, we have a bill that is being merged now behind these closed doors which we hopefully will see in the near future--falls short on that account, and that is why I hope there will be strong bipartisan opposition to this legislation, allowing us to start over and in a step-by-step process work in a way that will actually impact, in a positive way, the costs most people are paying for insurance in this country by driving the overall cost of health care down rather than up.

I yield the floor.

Mr. President, I thank my colleague for yielding the floor, and I appreciate listening to his observations about the current state of the health care debate.

Mr. President, I ask unanimous consent that I be allowed to speak for up to 20 minutes.

Mr. President, as my friend from Arizona noted, there are many things about the current debate that I think raise questions with the American people. He was discussing what he had heard back in his State of Arizona regarding the current debate that is before the Congress and the concerns people have, the anxiety, the frustration, and, frankly, the fear that I think a lot of Americans have about what happens and what the ultimate result may be. For instance, will this health care reform effort lead to higher costs for them? Will it lead to questions about whether they will be able to retain that fundamental, essential relationship between the patient and the doctor?

Those are, I think, very valid questions. Frankly, we don't have answers to them because, one, we don't have a bill. We haven't seen a bill. That bill is being written, we are told, in the majority leader's office. There will be a handful of people in that room. There will not be input from our side, let alone from many Democrats in the Senate. It is going to be basically cranked out and at some point we will have a bill that will be put on the floor before the entire Senate. Having said that, it is interesting to me that this week we are going to have a vote in the Senate on an issue which, frankly, is very much a part of the debate over

health care reform and yet that vote is being separated out. I think there is a reason for that, which I will come back to in a moment.

I think it is important and telling that the first vote on health care reform here in the Senate is going to be to add a quarter of a trillion dollars to the Federal debt. That is right, $250 billion--or $247 billion, to be precise--is going to be added to the Federal debt because what the majority leader has decided to do is to bring legislation to the floor this week that would address the physician reimbursement issue. We all believe that needs to be addressed. There is no one on our side of the aisle who doesn't believe we need to address the challenge that we will face in January of this coming year. Physicians across this country, if we don't take steps, are going to be subjected to a 21\1/2\ percent pay cut. That is not something anybody I know of in this Chamber is willing to abide.

But we have a fundamental difference about whether that ought to be addressed in a way that is paid for, that actually doesn't borrow $250 billion from future generations. The reason I say it should have been in the health care reform bill, but wasn't, is because it is a part of that debate. In fact, the House of Representatives included the physician reimbursement issue in their version of health care reform and put it out of balance, but at least they were honest. They dealt with it in the context of health care reform, because it is fundamental to addressing the health care issues we have in this country. The reason I think it was left out of the Finance Committee bill, the Baucus bill, is because they knew if they put that in the bill, it would put their bill out of balance, and we had the big proclamation that had come out about how this is deficit neutral, that it is going to add $81 billion in surplus, that it is actually going to save money in the long run.

Obviously, if you back out $250 billion, you can make your books balance in the near term. But what you are doing is adding a quarter of a trillion dollars to the debt, which this year was $1.4 trillion-- three times what we have ever seen here in the last 40 years or so. The last time we have seen debt of this magnitude in terms of a percentage of our gross domestic product was right after World War II. But the debt this year is three times what we have seen in recent history--at least in this last decade.

I think the first point I would make is that the first vote out of the gate on health care reform should not be to add a quarter of a trillion dollars to the Federal debt and to pile this burden on future generations of Americans. In fact, there is a bumper sticker going around right now, which I think is perhaps pretty descriptive of what is happening in Washington, and it says something to the effect: ``Don't tell those people out in Washington, DC what comes after a trillion dollars.'' I think the American people are sitting out there wondering, when we talk about billions and billions and billions, and now we are talking trillions and trillions and trillions, what comes after that? And yet we continue to spend and borrow as if there is no tomorrow. I think the American people are picking up on that, and obviously they want to see a government that lives within its means just as they have to every single day in their personal lives, in their businesses, and most people who have to live within balanced budgets.

It is a lesson I think Washington could learn. It is essential that we don't continue to pile this burden of debt on future generations of Americans. The deficit last year was $1.4 trillion. It is estimated if we stay on the current trajectory that we will double the Federal debt in 5 years, triple it in 10 years, and at the end of the 10-year period, the average part that each household in this country will own of that entire Federal debt obligation is $188,000. So if you are a family in America today or say you are a young couple who has just gotten married, and looking at your life ahead of you and planning for your future, you are going to get a wedding gift from the Federal Government--a big old IOU for $188,000. That will be everyone's share of the Federal debt.

What we do here with the first vote out of the gate on health care reform is add a quarter of a trillion dollars to that Federal debt. A quarter of a trillion dollars used to be a lot of money in this town. When you start talking about $1.4 trillion deficits, maybe it doesn't seem like that anymore. I think that is why the American people are asking, and probably fairly so, what comes after a trillion dollars. When you add a quarter of a trillion dollars to the debt, the total interest payment on that amount over the 10-year period, if you can believe this, is $136 billion. So we are adding $136 billion in additional interest payments that we are going to have to make over the course of the next 10 years by borrowing an additional quarter of a trillion dollars to address the physician reimbursement issue.

I say all that because I think it bears on the bigger question of health care reform and the fact that right now we have competing bills: One in the House, called the tricommittee bill, if you will, which does spend, over a 10-year period, about $2.4 trillion; the Senate HELP Committee bill, which over a 10-year period spends $2.2 trillion; and the Senate Finance Committee bill, which over a 10-year time period spends $1.8 trillion--until now. When we add in this $250 billion for physician reimbursements, that now pushes the number on that particular bill up to about $2 trillion as well.

So what we have is a whole new expansion, a whole bunch of new spending on health care by the taxpayers in this country. Obviously, it has to be paid for somehow. Most of it is paid for by cuts to Medicare reimbursements that providers in this country would receive, paid for in the form of higher taxes that would be borne by small businesses, by individuals, and would ultimately lead to the final outcome of this big debate, which is higher premiums. The whole purpose of this was to reduce the cost of health care for people in this country by reducing and driving down what they paid for health insurance. But as has been pointed out, I think over and over now in response to questions posed by members of the Senate Finance Committee in answers from the CBO Director, these tax increases--roughly dollar for dollar--will be passed on in the form of higher taxes. In fact, some of the taxes in the House bill hit squarely at small businesses and hit squarely at individuals. The CBO and the Joint Tax Committee, which looked at the Finance Committee bill, concluded that 90 percent--87 percent, I should say, as far as the Joint Tax Committee and 89 percent was the CBO estimate--of the tax burden would fall on taxpayers--on wage earners-- making less than $250,000 a year. In fact, the Joint Tax Committee went so far as to say a little over 50 percent of that tax burden would fall on wage earners making less than $100,000 a year.

So the tax burden is going to be borne by people who were promised they wouldn't pay higher taxes in the health care reform proposals, and it was stated by the President and others that we wouldn't tax people who make less than $250,000 a year. That is clearly not the case. There is a 5.4 percent surcharge on high-income earners in the House bill which would be borne largely by small businesses, many of whom file, because of the way they are organized, on their individual tax returns. So you are going to have higher taxes on small businesses, higher taxes on middle-class Americans, and this explosion and expansion of Federal Government here in Washington to the tune of $2 trillion.

You would hope then that you would see that would have some positive impact on health insurance premiums. The reality is, as I said earlier, it does not. I think as the debate broadens and we become engaged on health care reform, the American people are going to come to that conclusion, which is why I think they are very concerned about what is happening here in Washington.

The other point I will make is that one of the objectives of health care reform--in fact, to me, health care reform ought to be about driving health care costs down, not increasing them, which is what all these bills do--was that it was designed to cover people who aren't currently covered, to provide access to more Americans. What we are seeing now with all these various bills is there are lots of people who get left out. Under what they call the House bill--the tricommittee bill--17 million Americans still would not have

health insurance. Under the Senate HELP Committee bill, that number is much higher. It is 34 million who would still not be covered. But there is an assumption there, although it wasn't included in the bill, that Medicaid would be expanded. That would cover more people. So that number may be overstated. But the Senate Finance Committee assumes 25 million people will be without health insurance.

So you will have higher taxes, a tremendous amount of higher spending--up to about $2 trillion under any of these bills--and an expansion of government here in Washington, DC, cuts to Medicare reimbursements--to seniors--across this country, and all for what? Higher premiums for most Americans, for people who currently have insurance, to hopefully cover some Americans. When you are spending $2 trillion, there ought to be some advantage to that, but clearly a lot of Americans are still going to be without health insurance when this is all said and done.

I am concerned. I think a lot of our colleagues here in the Senate-- and not just on our side of the aisle, but I think a number on the other side too--have expressed concerns about starting the debate a quarter of a trillion dollars in the hole by putting a bill on the floor that is going to spend a quarter of a trillion dollars--$250 billion--over the next 10 years that is not paid for. That puts any bill that is considered later completely out of balance, and it is a gimmick that is designed to allow the President and the Democratic majority to say our health care reform bill is deficit neutral. Well, sure, if you take the $250 billion and back it out, it is easy to say it is deficit neutral, when in fact now it is going to be $200 billion. They have about an $80 billion overage on the bill in the Finance Committee, but it is still going to be $200 billion out of balance when you do this, again, to be financed with more debt and more borrowing, which is exactly what I think we want to avoid, and particularly when you are running deficits as far the eye can see.

This last year, about 43 cents out of every dollar that was spent here at the Federal level--in Washington, DC--was borrowed. There isn't anyplace in America where you can function like that and still be in business. If you are a person doing that in your personal household finances, you would be forced into bankruptcy. If you were a small business, you would be forced into bankruptcy. Frankly, were it not for the fact that other countries around the world are financing America's debt, we would be in bankruptcy. Because you can't borrow 43 cents of everything you spend, as we are doing here in Washington, DC. In fact, to put it in perspective--and a lot of Americans understand this--if you are a family with an annual income of $62,000, it would be the equivalent of spending $108,000. That is what we are doing here in Washington, DC. Of all the money we spend in a given year, 43 percent of that is borrowed. We cannot continue to sustain that.

I hope that before this bill comes to the floor, we can reach an agreement about amendments that might be offered. I would say our side, the Republican side, has amendments it would like to offer to this bill that would help pay for it, help reduce the amount or perhaps entirely reduce the amount that would be borrowed in order to finance the physician reimbursement fix, on which we all agree. As I said, there is not anybody on this side who does not agree that needs to be done. In fact, Senator Cornyn offered an amendment to the bill that would provide a 2-year fix, a 2-year solution to the problem for physician reimbursement. It was voted down. It was defeated, that amendment, in the Senate Finance Committee.

We are looking. We are proactive. We have to address this issue. This issue was created by the Balanced Budget Act back in 1987. I was a Member of the House of Representatives at the time. I voted for that balanced budget agreement, but it included what was called a sustainable growth rate formula by which physicians are reimbursed. As I said earlier, in January of this year, based upon that formula, physicians would receive a 21.5-percent reduction in their fees, in their reimbursements.

Everybody here--I should not say everybody. I can't speak for everybody. But I think most Senators on both sides of the aisle acknowledge that issue has to be addressed. We need to fix that, but we have to do it in a way that is fiscally responsible. We want an opportunity to offer amendments that would allow us to do that.

As of last week, that request was being rejected. There was going to be a cloture vote today, which I understand now has been vitiated, which means perhaps the leaders are working together on an agreement that would allow Senators on both sides to offer amendments to this legislation that would help pay for it.

I think it is telling that there are Democrats who are uncomfortable with the idea of adding $\1/4\ trillion to the Federal debt with the very first vote we will cast on health care in the Senate Chamber.

I hope we can reach an agreement. I hope the leaders will be able to do that and this will be an open process, that we debate, and there will not be any mad rush to try to cut off debate. Rather, Senators on our side would have an opportunity to fix the issue that is going to put a lot of physicians in a very uncomfortable position if we do not address it but do it in a way that also is fair to the American taxpayer and make sure we, as a nation, are honoring the responsibility we have, not just to fix this issue for today but to provide a better and brighter and more secure future for future generations of Americans. It is a future which, I would add, is very much in jeopardy and in peril if we continue to spend and borrow and tax at the rate that is contemplated in the health care reform bill but, more important, with the very first vote on that health care proposal, which is to add $250 billion to the Federal debt.

I yield the floor.

I suggest the absence of a quorum.