Floor Statements

Mr. President, could I just interrupt?

Thank you.

To answer my colleague quickly, I think the vote was 87 to 13, or in that general range. Almost all Republicans voted to conclude the unemployment compensation legislation by getting to the process where we could offer amendments and then have a vote on the final passage.

But I would ask my colleague from Tennessee, have Republicans been afforded the opportunity to offer five amendments? How about four amendments, three, two, one? Obviously not. Have Republicans been afforded the opportunity to offer any amendments, I would ask my colleague? Then I have a follow-up question.

Mr. President, if I could further inquire of my colleague, is it not the Senator's understanding that of all of the issues the American people are concerned about today, the No. 1 issue is jobs and economic recovery--how do they get back to work?

When our friends from the Democratic side say: We need to hurry up and extend unemployment compensation, my guess is the vote on that will be overwhelming. I will support it. I am sure my colleague will support it. That is not the question. The question is, Instead of just continuing to extend unemployment compensation for all of the increased number of Americans who are out of work, what are we going to do to put people back to work?

Then I have one other question to ask my colleague. I may not be correct that it is the No. 1 issue in public opinion surveys, but I recall it is pretty high on the list.

Mr. President, if I could further inquire, the first thing we want to do is find out how much this unemployment extension is going to cost. I think the number is about $2.4 billion. The second thing we want to find out is, how is it going to be paid for? I understand it is proposed to be paid for by a continuation of a tax on payroll; that is to say, employers and employees will have to pay a certain percentage of the employee's wage to the Federal Government in order to provide funds to those who are unemployed.

Some of us are concerned if our goal is to put people back to work, to allow

companies to hire more people, that the worst thing we would want to do is impose another tax on hiring, another tax on employees or, to be totally accurate, to extend the existing tax on workers, on payroll, as a way of paying for the extension of unemployment benefits. Perhaps a better way to pay for that would be, for example, to take the $2.4 billion out of unspent and unobligated stimulus funds, which was $780- some billion, half of which is not going to be spent for the next 8 years--or over the period of the next 8 years.

One of the amendments we wanted to offer was not just to extend unemployment benefits but to pay for it in a way that would not harm job creation, as is contemplated under the bill. Am I correct in that?

I know my colleague wanted to talk about student loans, so I will close my point here.

The whole point, when colleagues and friends of ours on the other side of the aisle say: Well, Republicans are just trying to slow this down; the answer is: No, we could have been done with this bill 24 hours ago. All that was necessary was a simple agreement between the majority leader and the minority leader that the minority would get a couple of amendments. One of them is an amendment to say, Let's pay for this worthy cause of extending unemployment benefits in a more sensible way with respect to job creation; at least in a way that isn't going to cost us jobs, to prevent employers from hiring more people. Let's pay for it by taking some of the unobligated stimulus funds that won't be spent for another 6 or 7 years and achieve our goal in that way. But no, no agreement to do that. The majority says no amendments, take it or leave it.

If you ask for amendments, then you are slowing the process down and somehow standing in the way of those who are unemployed. The benefits haven't run out yet. We are going to pass this before the benefits run out. That is not the question. You can either come down here and make a pitch to people to make it sound as though you are trying to help them and the other side is not or you can try to do things the right way. I submit that on this, the right way is to pay for it in a way that doesn't cost jobs because our goal here ought to be to put people back to work.

I would also say that if the majority were serious about getting this legislation completed, they would not in the middle of the process have parachuted onto the floor a bill that around here was called the ``doc fix''--a most unfortunate term--a bill that was going to add $250 billion to our debt in relationship to the reimbursement of physicians who provide Medicare benefits. The minority didn't do that. Republicans didn't do that.

My point is that a week ago we could have had an agreement to conclude work on the extension of unemployment benefits that would have taken maybe 24 hours, maybe 48 at the most. We would have had the benefit of voting on a couple of amendments, which I think are very well taken, directly relating to the subject, germane amendments, but for some reason the majority has not seen fit to permit that to happen.

So as friends around the country consider what is the reason for this being slowed down, I hope there would be a better appreciation of the reason why this has been delayed. A, we didn't ask for the delay. The delay was occasioned by action by the majority leader by, first, going to another bill and, secondly, by filing cloture and, third, by not agreeing to allow the minority to have a couple of amendments.

Finally, I would say I wish we did have that opportunity because I think when we do support this, it will be a better bill by not only taking care of those who find themselves without a job today but helping to find a way to get them back to work, and that ought to be our primary goal.

I thank my colleague for yielding.

Mr. President, if I could comment on that, that is another very important point. I think Americans very much want to engage in a debate about health care reform. I think Republicans are anxious to engage in that debate here on the Senate floor. But, first you have to have a bill. You can't just have a debate on the floor; you have to have a bill you are debating.

We are told there is a bill. It was written in the majority leader's office with some people from the White House and a couple of other Democratic Senators, and then the bill was sent to the Congressional Budget Office to be scored, for a cost estimate to be developed. I know several people have said, Could we see the bill? Could you share that bill so the American people can see what we are talking about here? So far, no luck. No bill. If we are talking about getting this debate going on health care, one would think that we would get the bill written, we would get it out there, we would all get a chance to read it, our constituents would have a chance to understand what is in it and, by the way, know how much it costs.

I ask my colleague from Tennessee, are Republicans doing anything to slow down the bill or making it public or understanding it?

Mr. President, I would say to my colleague, the minority leader yesterday in a press conference talked about this bill that has been written. I am not actually even sure it has been written. Obviously, we have never seen it. All the majority leader has chosen to talk about publicly is the so-called public option. So maybe that one feature of it has been written.

My point is it isn't Republicans who are slowing anything down. As far as this health care debate is concerned, I think we are very anxious to engage in that debate now. As my colleague from Tennessee pointed out, we are not going to be in debate on a bill which is going to raise taxes, raise premiums,

cut benefits under Medicare, increase the deficit, reduce the quality of our health care, and I am not going to vote to begin work on that kind of a bill, but I certainly will vote to begin work on a bill which meets the primary objective.

There are two primary things we need to try to resolve. One is to make sure we could get insurance to about 18 million Americans who can't afford it and don't have it, and the other is to keep premiums from going up. As the Senator from Tennessee pointed out, under the legislation that came out of the Finance Committee and out of the House of Representatives, insurance premiums go up more than they otherwise would have--according to who? The Congressional Budget Office, the nonpartisan entity that we all ask to analyze these things. There are many other studies that came to the same conclusion.

So I am not anxious to begin working on a bill that does those things, but so far we haven't seen any bill.

Well, I would say to my colleague, something happened to it on the way to the Senate, I guess. Because, first, the bill is going to cost somewhere between $800 billion and $1 trillion. That is obviously money that isn't being spent today that will be spent tomorrow. I don't know of any American who believes you can have a $1 trillion new government program and not add to the debt, but we are told: Wait for the details; we will show you.

There is only one way to make sure it doesn't add to the debt: Raise taxes so much that you cover the costs of it. Then that gets to the other half of the equation. What about for the American people? Are we going to be better off? No. It turns out we are going to have our taxes increased by $400 billion, Medicare cut by almost $500 billion--by the way, if it is ever cut. There is a question about whether we will ever achieve those savings; we never have in the past--in which case the bill is then out of balance by $500 billion; $500 billion in debt. So either there is going to be a big debt there or seniors are going to see their benefits lost.

But I wandered off the point. My colleague was asking, Wasn't the exercise here to reduce costs. Yes. And what will the bills do? It will increase costs for the Federal Government so, therefore, the taxpayers. It will increase costs for all Americans in the form of higher taxes, some imposed directly on us. For example, if we don't comply with the government forcing us to buy insurance, the Congressional Budget Office says other taxes will be passed directly through to us. For example, there is a tax on the manufacturers of medical devices. If you have an angioplasty or some kind of heart problem and they put a little stint in there, one of those very high tech items, that is going to get taxed. Why should you be taxed on something that makes you well? I can't understand that. But in any event, the tax is first on the manufacturer and it will be passed on to the consumer, so increased taxes.

Finally, my colleague asked about premiums. According to CBO, the premiums will go up over what they otherwise would have been. The Oliver Wyman study that I think is very credible on this said the average would be $3,300 per year per person. In my State of Arizona, it was over $7,000, an increase in insurance premiums over what it otherwise would be. When Americans see that, they are going to say, Where is the reform? This is a lot worse than it was before.

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

Madam President, I wish to talk for a moment about health care

since, hopefully, one of these days we will be able to begin a debate on a piece of national health care legislation. I wish to make it clear that Republicans support sensible health care reform, but we believe the bill the majority will bring to the floor could create a whole new set of health care problems. We don't have the specifics yet, but I think we can be sure that certain things are true.

First, the bill is a Washington takeover of health care that will raise taxes, cut Medicare by nearly $\1/2\ trillion or more, and increase premiums as new taxes on the insurance industry and medical device manufacturers are passed on to consumers. This much we know. Before any bill is considered and as we debate the legislation, we think it is important to remember Americans have some rights in this process.

They have the right, for example, to have access to all the specifics of the bill and to have time to weigh it and to give us their reactions, their concerns. Let's not forget we function as a result of their consent, the consent of the governed.

Americans also have the right to know what the legislation is going to cost them and their families, including what it will cost their children and grandchildren 10 or 20 or 30 years from now. They have a right to know what it will cost the Treasury and how much debt will have accrued. By the way, if Medicare is a model for the new Washington-run health care program, how can anyone believe it is going to be deficit neutral? In fact, I asked people at a townhall meeting: How many people here believe you can have a $1 trillion health care bill and not add to the national debt? Not a single hand, of course, was raised.

We also have the right to know about the unintended consequences of the bill. A lot of my constituents are concerned because of a Lewin Group prediction that 119 million people will end up on the Washington- run insurance plan. That is of great concern to them, among other things. They also are concerned this will interfere with their sacred doctor-patient relationship. They have a right to have their concerns taken seriously.

I think one of the guarantees we need to give to our constituents is that the President can keep his pledge not to raise taxes on the American people, as he pledged not to increase taxes by one single dime on middle-income Americans. Yet as we read the legislation that has come out of the various committees, taxes are raised on Americans.

Republicans will insist on these protections, these guarantees for our constituents: protections from increased premiums, from Medicare cuts and from increased taxes and, perhaps most importantly, protection from rationing of health care, the delay and denial of care that comes from things such as Medicare cuts of $\1/2\ trillion.

We support legislation that features cost-saving measures Americans can support, things such as medical liability reform. But what we want to ensure is that our constituents do not have to suffer high taxes, high premiums, a bill that cuts Medicare and ends up rationing their health care. Americans deserve better.

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

Mr. President, I thank him for his courtesy in allowing me to precede his remarks this evening.

Health Care Reform

A little more than a year ago, President Obama said:

I can make a firm pledge. Under my plan, no family making

less than $250,000 a year will see any form of tax increase.

Not your income tax, not your payroll tax, not your capital

gains taxes, not any of your taxes.

We have not seen the bill yet--the bill written in the majority leader's office--but it is probably fair to assume that the Finance Committee bill will cover most of the tax provisions.

So how does the President's commitment fare under the Finance Committee bill? It turns out that the bill will raise your taxes. In fact, it will raise them in several ways.

First, the Finance Committee bill would levy a host of new taxes on millions of Americans--and I am not just talking about the wealthy--in fact, primarily on middle-income Americans who I think will tell you they already have enough taxes to worry about.

Let me discuss the specific elements of this bill. The first one is on taxing flexible savings accounts. Under current law, employees can make contributions to flexible spending accounts. Many middle-income families enjoy the benefits of these accounts which allow them to set aside tax-free

income for their medical expenses. In fact, the Employers Council on Flexible Compensation estimates that the median income for those 35 million Americans who have an FSA is $55,000. The bill would limit their contributions to $2,500. So the less they can contribute, the more their taxable income rises. The total cost for taxpayers? It is $15 billion over 10 years.

The Finance bill would also tax many Americans through their insurance plan by imposing a 40-percent excise tax on certain high-cost plans. So while another part of the bill taxes you if you don't buy insurance, this provision will tax you if you buy too much. So tax No. 2, if you don't buy insurance; tax No. 3, if you buy more than Washington thinks you should.

Tax No. 4, Americans who suffer catastrophic illnesses and the chronically ill would face a harmful change in the IRS Code, the Tax Code. Currently, catastrophic medical expenses are deductible if they exceed 7.5 percent of income. The bill would raise that threshold to 10 percent. Mr. President, 87 percent of Americans who would be hit by this tax earn less than $100,000 a year. Seniors, who already face hardships through Medicare cuts, would be exempt from this tax for only 4 years.

In addition to raising these four taxes, the bill taxes insurance which would be passed on to everyone who buys health insurance. Specifically, the bill would impose an annual $6.7 billion so-called fee on the insurance industry. The entire amount collected by this tax: $67 billion over 10 years would be passed on to patients in the form of higher premiums, according to the Congressional Budget Office. That is tax No. 5.

The bill would also impose a new tax on medical devices, $40 billion over 10 years. The entire cost of this tax, too, would be passed on to patients in the form of higher premiums, according to the CBO.

The medical device tax will be assessed against thousands of products such as contact lenses, stethoscopes, hospital beds, artificial heart valves, and advanced diagnostic equipment, thereby increasing costs for consumers, physician practices, hospitals, and the sickest patients who require the most care.

There is serious, bipartisan concern over this provision. But the last time we looked, it is still in the bill.

So here are six ways Americans earning less than $250,000 will be taxed, contrary to the President's promise. Some are direct taxes, such as the IRS tax if you don't buy the exact insurance policy Washington says you must. Others are indirect but a tax nonetheless because the first target, be it the device manufacturer or the insurance company, will, according to the CBO, pass it on directly to you.

The bottom line, Mr. President, is that the tax provisions in the bill will, in fact, violate a fundamental promise President Obama has made about health care--not to raise taxes on middle-income Americans. The American people have a right to expect some guarantees from Washington. Keeping the President's promise on tax increases is one of them. But that is not the direction in which this bill is moving. This bill would increase taxes on working families, seniors, and the chronically ill by more than one-half trillion dollars over 10 years. Republicans have better ideas, starting with protection from taxes and premium increases. The whole point of health care reform is to make things better for American families. These taxes only make things worse.

The following Senator is necessarily absent: the Senator from South Carolina (Mr. DeMint).

Further, if present and voting, the Senator from South Carolina (Mr. DeMint) would have voted ``yea.''

Mr. President, I believe it is now time for President Obama to move forward with General McChrystal's plan for executing the war in Afghanistan and to fully support his troop request.

The President has correctly called Afghanistan a ``war of necessity.'' The counterinsurgency strategy that he announced last March is a good one, and it has been widely accepted. Having read General McChrystal's August report, I believe it may represent our only chance to successfully implement

the March strategy, and it will require the forces that General McChrystal has recommended.

There is no reason to delay the decision regarding a troop increase until after the Afghan election, a point that I will talk about in a moment. Our national security is at stake regardless of the government in Kabul. The outcome of the Afghan runoff election on November 7 will not change our mission there. Whether Abdullah or Karzai wins, our mission will be the same, and time is not on our side. General McChrystal's August report said we have only 1 year. It is now down to 10 months, and it will take time to get troops in-country.

I want the President to know and the American people to know that Republicans will support the President if he follows through on his strategy and provides General McChrystal with the resources he needs. But this must be done in a timely fashion. The strategy can only succeed if it is implemented within the next 10 months and with the resources that have been recommended.

The stakes are high in Afghanistan. When President Obama announced his strategy last March, he said:

If the Afghan government falls to the Taliban or allows al-

Qaida to go unchallenged, that country will again be a base

for terrorists who want to kill as many of our people as they

possibly can.

Mr. President, he was right. The Afghan people are watching. When I was in Afghanistan this past April and visited with tribal elders in Kandahar, for example, it was very clear the Afghan people were looking to the United States for a commitment to their security. If we can't provide that security to them, they will be forced to make accommodations with the Taliban.

Pakistan is also under threat, as Secretary Clinton recently pointed out. She said:

The extremists in Pakistan, whatever their titles or

whatever their affiliation, are increasingly threatening the

authority of the state.

We all know if nuclear-armed Pakistan were to fall into extremists' hands, the world would face a monumental crisis. Moreover, if Pakistan senses a lack of commitment on our part, how long will it be until it seeks accommodation with al-Qaida and affiliated terrorist groups?

For these reasons, we must not shortchange the mission in Afghanistan. General McChrystal was very clear about the need for more troops. In his assessment he said the following:

ISAF, [the International Security Assistance Force]--

Of which the United States is a part--

requires an increase in the total coalition force capability

and end strength.

During an August speech to the Veterans of Foreign Wars, President Obama made this pledge to our Armed Forces:

I will give you a clear mission, defined goals, and the

equipment and support you need to get the job done. That is

my commitment to you.

Of course, the President can now demonstrate that commitment by following the advice of his general and providing the resources that have been requested.

What exactly is General McChrystal's plan? Well, I think his assessment demonstrates both a thorough understanding of the Afghan people and the enemy we are fighting. He described the situation as:

Three regional insurgencies [that] have intersected with a

dynamic blend of local power struggles in a country damaged

by 30 years of conflict.

Not an easy situation, obviously, and he described the enemy as follows:

The conflict in Afghanistan can be viewed as a set of

related insurgencies, each of which is a complex system with

multiple actors and a vast set of interconnecting

relationships among those actors. The most important

implication of this view is that no element of the conflict

can be viewed in isolation.

In other words, we can't defeat al-Qaida without also addressing its support networks--the Taliban and the so-called Haqqani groups. These are the groups that work with al-Qaida, protect it, and give it a place to hide when we attempt to deal with al-Qaida.

In order to effectively counter this enemy, General McChrystal proposed a comprehensive plan that would effectively implement the President's strategy--improve the performance of the Afghan security forces, prioritize responsible and accountable governance, gain the initiative to reverse the insurgency's momentum, and focus our resources on areas where vulnerable populations are the most threatened.

One of the key principles of General McChrystal's plan is increasing Afghan ownership of its own security. He said in his assessment:

ISAF, with the Afghan National Security Force, must shift

its approach to bring security and normalcy to the people and

shield them from insurgent violence, corruption, and

coercion, ultimately enabling the Afghan government to gain

the trust and confidence of the people while reducing the

influence of insurgents.

Further, General McChrystal describes this step as necessary to fix what he calls the ``crisis of confidence'' in the Afghan Government and coalition forces.

General McChrystal has also said that more effective integration and partnership between Afghan and coalition forces will enable a more rapid expansion of the Afghan security force's capacity and responsibility for security. The same method was implemented in Iraq, resulting in a dramatic increase in the quality of Iraqi security forces.

So those who say we should only train more Afghan troops and police present a false choice. General McChrystal proposes a total counterinsurgency strategy with both more Afghan police and military forces; but until they are trained sufficiently to do the job, an adequate and sufficient group of U.S. and NATO forces to both train the Afghan forces and provide the security that is necessary during that interim period of time.

General McChrystal stated in his assessment:

Ideally, the Afghan National Security Forces must lead this

fight, but they will not have enough capacity in the near

term given the insurgency's growth rate. In the interim,

coalition forces must provide a bridge capability to protect

critical segments of the population. The status quo will lead

to failure if we wait for the ANSF to grow.

That is to say, the National Security Forces of Afghanistan.

So, again, to simply argue we should train more NATO and U.S. security forces in the interim is a false choice. We need to do both. But in order to do the former, we must do the latter; that is to say, we have to increase our own troop strength in order to have the ability to both hold the line and train the Afghan forces who will ultimately be able to provide security for that country.

Now to the matter of time. General McChrystal said in his assessment:

Time matters; we must act now to reverse the negative

trends and demonstrate progress.

One of the key points the general made in his assessment was this: He said:

I believe the short-term fight will be decisive. Failure to

gain the initiative and reverse insurgent momentum in the

near term (next 12 months)--while Afghan security capacity

matures--risks an outcome where defeating the insurgency is

no longer possible.

As he said, time is of the essence. By the way, this 12-month clock started ticking in August when he submitted his report. So at this point, 10 months remain on the general's stopwatch to turn the tide of this war.

Even if the President makes the right call without further delay and gives General McChrystal the resources he needs to prosecute the strategy the President ordered in March, it will take months before additional troops are available for the mission.

Unlike Iraq where we did have at least a nominal infrastructure in place, in Afghanistan there are few roads and fewer other amenities and facilities with which to support the troops. All of that takes additional time to create.

The troop surge in Iraq didn't turn the tide of that war until 6 months after President Bush announced it. As I said, that was on terrain significantly easier to navigate than Afghanistan's mountainous border region where many of our soldiers are fighting today.

Coalition forces are losing ground to the Taliban with current troop numbers. According to General McChrystal:

Many indicators suggest the overall situation is

deteriorating, despite considerable effort by ISAF.

So I submit that President Obama should delay no longer a decision to deploy troops that are necessary within

this 12-month timeframe set out by General McChrystal in order to retake the momentum of this war.

Finally, I mentioned earlier the Afghan election should not delay the President's decision. I disagree with the argument some have made that there should be some sort of test to determine whether the Afghan Government will be a reliable partner before we decide to commit additional troops.

The very reason U.S. troops are fighting in Afghanistan is because there is no strong government to maintain security and fight corruption there. The point is to make it more reliable, to influence it to be less corrupt, and to protect the Afghan people so they will reject Taliban control and support their government.

We need to help foster a situation in which the Afghan Government can grow into an institution that can provide for its people. That is what a successful exit strategy will look like. We should not curtail our effort in Afghanistan because of a less-than-ideal political situation today.

President Karzai noted last week:

The [Afghan] institutions are just young toddlers in this

democracy that resembles a toddler. It walks and falls. We

have to understand that, and we have to accept the Afghan

elections in the context of the Afghan situation and the

poverty and lack of means in this country.

I add to that that President Karzai and his administration need to be more forceful in helping to bring those institutions about, to ensure that the election is not fraudulent and to ensure that his government is not corrupt and to do what is necessary to gain the trust of the Afghan people.

But are we likely to have more influence in achieving that result by deciding that we can't commit the troops necessary to carry out the recommendations of General McChrystal, all of which will probably push the Afghans further toward the Taliban or by making the point that we are going to help establish the kind of government that is reliable and we are going to do that by engaging in this counterinsurgency strategy with everything that it takes, including the additional troops that are required, and thereby have the kind of influence over the Afghan Government that will bring it into a more reliable situation and enable them to rely on the security we provide rather than making accommodation with the Taliban?

General McChrystal stated in his assessment that one of the key sources of the Taliban's strength is the perception by Afghans that a victory by the Taliban is inevitable. We need to make sure it is not. How can the United States expect to influence matters in Afghanistan if we are viewed as looking for a way out and not putting in the troops General McChrystal has requested?

Very importantly, this same question applies to Pakistan. We ask Pakistan to help us fight the Taliban and al-Qaida and other terrorist groups who are active in Afghanistan. But if we are viewed as an unreliable partner because we are not willing to commit sufficient troops, the people of Afghanistan and Pakistan will hedge their bet with the terrorists and their supporters. That is what has happened there in the past.

When I went there last April and talked to Ambassador Holbrooke before I went, I said: Mr. Ambassador, what message would you like us to try to convey?

He said: Help them understand we are there for the long run. We are not going to cut and run; we are going to stay with them and help them and do whatever is necessary for them to gain control of their country.

I conveyed that message, and I believed it, and I want to believe it. But if we do not make the decisions to carry out this strategy the President announced in March, then the Pakistanis are going to be asking the same questions we did a few months ago: Will you be with us? Will you stand with us or are we going to have to make accommodations with people neither you nor we like very much? One individual said: Why would they make enemies with the people they are stuck with long after we have left? In other words, they don't live in a very good neighborhood. I think that is what General McChrystal's request is about--proof that we are committed to seeing this fight through against the common enemy.

Interestingly, we faced a similar situation in Iraq. If we had opted against the surge in 2007, at a time when Iraq's central government was extremely weak and unable to protect its citizens from the insurgency there, the Iraqi people most likely would not have been able to eventually take ownership of their own security. But they did.

Similarly, if President Obama were not to provide the additional troops General McChrystal needs, I believe we risk allowing Afghanistan to become the country it was on September 10, 2001--a result that none of us want.

In Iraq, the surge created the space for Prime Minister Maliki to take greater control and reduce corruption in the Iraqi Government, and a troop surge in Afghanistan would allow President Karzai--or a new President Abdullah if he were to win--to do the same.

A stable and legitimate government in Kabul is critical to the security of Afghanistan. But the United States cannot hinge its strategy on the current reliability of the Afghan Government, and the President should not wait until after the election to announce his troop decision. To do so would suggest that the United States doesn't have a core national interest of its own in Afghanistan, one based on our security. Yes, we aim to help establish the rule of law in Afghanistan, but our core national interest in that nation does not change based on who is elected in their November 7 runoff.

Mr. President, in conclusion, I believe General McChrystal's assessment really rises above the political fray. It offers an objective description of what is happening on the ground and what resources are needed to turn the tide of this war. This report may represent our only chance to successfully implement the President's March strategy--as I said, a strategy with which I think we all agree-- and it will require the forces General McChrystal has recommended.

Regardless of the current status of the Afghan Government, we must foster a situation in which it can grow into a government that can provide basic services, and that will require, first of all, providing security for its people. Our influence over this process will be far greater if we make it clear that we are there to stay until our goals are achieved.

It has been 2 months since General McChrystal sent his assessment to Washington. I respectfully submit my recommendation to the President that he approve this full troop request and that he do so as soon as possible. If he does, as I said, I believe Republicans will be very supportive of his policy.

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

Madam President, first of all, let me associate myself with the remarks of the Republican leader just now. I came to the floor because I wanted to reflect a little bit on what the majority leader said a few moments ago at a press conference. He announced that as a result of the efforts of a couple weeks of discussions behind closed doors--namely, in his office--he and a few other Democrats in the Senate have decided on what will be in the health care reform legislation. That is the first matter I wished to discuss, briefly.

The American people were told by the President they would be a full participant in the development of the legislation. They would know what it says. They would all be on C-SPAN. They would get to see everybody hash out all the details, and they would understand what the Senate was about to do. On the contrary, what has happened is, a small group of Senators on the Democratic side went behind closed doors in the Democratic leader's office, and they have been working now for many days to put together this piece of legislation. We still don't know exactly what it says, but the majority leader has described it very generally, and he has described one of the most contentious pieces. It will have government-run insurance, he assures us. Well, government-run insurance is a very controversial concept. Obviously, that is going to be the subject of a lot of debate. But the American people have a right to understand what this is all about, what it means.

I think the first thing I would like to do is to say that Republicans are going to stand for certain principles in the consideration of this legislation. The first thing is we are going to want to know what it says. The American people have a right to know what it says. So as we find out, little by little, as the majority leader trickles out details about what is in here--or maybe one of these days we will actually get a written copy and we can read it and understand what is in it--we will share that information with the American people.

They have a right to know what it says. They have a right to know what it costs. Obviously, one of the things that has to happen is that the Congressional Budget Office or CBO, which has this responsibility, needs to examine the legislation, do all of its cost estimates and revenue estimates, and tell us what they think it costs. The American people have a right to know because they are very concerned about passing on the costs of this legislation to the next generation--to our kids and grandkids.

That brings up the third thing: How much will this increase the deficit? Does anybody believe that a $1 trillion health care bill is not going to increase the deficit? I don't know of anybody who doesn't believe that it is going to increase the deficit. But by how much? A week ago, we had the first vote on the health care debate, and it was on a bill to borrow $247 billion in order to ensure that physicians fees would not be cut. I am all for paying physicians. We need to pay physicians. My personal view is we need to pay them more, not less. But this legislation should have been part of the health care reform debate, because it is part of the overall cost of Medicare--for example, how much we reimburse physicians to take care of Medicare patients. No, that was going to be inconvenient because it would actually result in creating a larger deficit and, therefore, adding to our national debt. So we take that piece out and try to run it through as a separate bill--and by ``we'' I mean the majority leader. And he got a rude surprise. All of the Republicans said, of course, no, we should not do it that way, and 13 of his Democratic colleagues agreed. They cared about the deficit. They said: We don't want to add to the debt and, therefore, this is the wrong way to go about it. We need to find a better way.

Another question the American people need to have answered is not only how much will it cost but how much will it add to the deficit, and then how much will it add to the debt that our children and grandchildren will have to pay? Republicans believe that any legislation should provide protection to all patients, whether they be seniors on Medicare, folks relying on Medicaid, or people in the private sector. Nobody should interfere with their physician or get between them and their physician. That is a very sacred relationship-- the doctor-patient relationship--and the government should not get in between that. But that is what government-run insurance is all about.

Republicans are going to insist on protection of the American people from a delay and denial of care. Why do we raise delay and denial of care? Throughout the legislation considered by the committee so far, there have been numerous provisions that will result in the delay and denial of care and, in the long run, rationing of health care. I have talked about that on the Senate floor. We will examine the legislation that has now come out from behind the majority leader's closed doors and see what kinds of protections they have built in. If it is not much different than the bills already considered, my guess is there won't be any protections. Republicans will have to again present better ideas, our alternatives, that include protections for patients from having their care delayed and denied to the point that it is even rationed.

Another thing Americans are going to want to insist on with this new spending is they are not going to pay for it indirectly in the form of higher taxes or premiums. I think No. 5 or 6 on my list is that Republicans will want to provide protections so that the increased costs of the legislation are not passed on to the American consumer in the form of higher taxes or in the form of higher premiums.

Why am I concerned about that? Because, again, the CBO, which examined the legislation before the committees already, has said that the costs imposed on the insurance companies and others in the form of higher taxes will be passed through to their customers, to the beneficiaries, in the form of higher premiums. It is inevitable that when you have these taxes imposed among competing companies, in order for them to stay in business, they are going to have to pass some of these taxes on, and they are going to pass some of the increased fees on, and they are going to pass on the premium increases that will be required for them to satisfy the various government mandates.

Another question is, exactly what are the government mandates here? What

are people going to be required to do that they don't have to do today? Most people have insurance today. It works for them and they don't want it interfered with. Under this legislation, every single American will be required under law to buy a product, an insurance product--not just any product, but the product defined by the Federal Government. If the government has the authority to make you buy something and has the authority to tell you what has to be in it, it also has the authority to tell the people who create that what they can and cannot put in their product. Sure enough, that is what they have done with the insurance companies. They have said to them that you all have to offer the exact value--four different kinds of policies; you have to offer at least the middle two, and you may offer the other two, but you cannot offer any less or any more, and they all have to have the same value, and we will mandate what they have to cover. Since we are going to have a ``one policy includes everybody'' product, the same insurance policy will have to provide the benefits I need, the benefits you need, the benefits the occupant of the chair needs, and the benefits the American people watching this need. Some of us are old, some are young, some are male, some are female, some have illness, and some don't. You have all kinds of conditions. If we can buy our own insurance, usually we can find a policy tailored to fit our needs, and it doesn't cost as much money because it doesn't cover as many things. When you have to have one policy that covers everything for everybody for any conceivable issue, you will have a huge policy with all kinds of things covered and with the concomitant costs--namely, costs that cover all of those things--meaning a premium. That is one of the reasons premiums will be increased.

I think another thing we are going to have to find out about this legislation is, does it do what the other bills do, which is cut Medicare? This is important, because we have made a promise to America's seniors, and a lot of us have a lot of seniors in our States. I certainly do in Arizona. We have made a promise to seniors that we will provide basic care in the form of Medicare. They will have to pay a certain amount and the government will pay a certain amount, and it will provide certain benefits. Well, the seniors have said: But we think maybe our benefits are going to be cut. The President, Senator Baucus, and others have said: No, no, don't worry, your benefits will not be cut. The people who tell you that are trying to scare you.

Let me quote a couple of things. Last week, a USA Today-Gallup poll showed that Americans overwhelmingly oppose cutting Medicare to pay for health care reform. Sixty-one percent of Americans oppose it--almost 2 to 1 in opposition to cutting Medicare in order to pay for health care reform.

How do we know it will cut benefits and that, therefore, seniors do have a right and a reason to be concerned? Let's go again to the nonpartisan CBO. What does it say about the legislation that has been debated so far? It estimates that the cost of the most moderate bill-- and there are five bills all told, and now we have a new one coming out of the leader's office we have not read yet. But of the five bills, the most moderate is the so-called Baucus bill. According to the CBO, it would cut Medicare by nearly $\1/2\ trillion--about $450 billion. What do these cuts go to?

Here are the specifics: $162.4 billion in permanent reductions for most Medicare-covered services, such as services supplied by hospitals, nursing homes, and hospice. Those are real benefits; $117.4 billion in cuts to private Medicare plans, known as Medicare Advantage. Well over 30 percent of the people on Medicare in Arizona have this Medicare Advantage-type plan. And $32.5 billion in cuts to home health care. This is something a lot of people count on, and that is a significant cut. There will be $22.3 billion in savings from a new Medicare commission that will propose automatic cuts. A lot of people laugh and say these commissions always propose cuts and Congress never ends up adopting them. That may well happen here. I know that one of two things will happen: Either we are not going to reduce expenses and we won't have enough money to pay for the new entitlement programs created by the legislation, because Congress won't follow the recommendations and adopt them, or it will and there will be real cuts in Medicare benefits. One of those things is true, and neither is a good result.

Here is what CBO said about Medicare benefits. Remember, $117.4 billion is being cut from Medicare Advantage. CBO spoke to that. It confirms in writing, and also to the members of the Finance Committee when Dr. Elmendorf appeared before us, that the value of the extra benefits offered by Medicare Advantage will drop from $135 per month to $42 per month by 2019. It gradually goes down from $135 to $42 per month. What are these benefits? They include dental care, vision care, preventive screenings, chronic care management--a whole host of things that are important for America's seniors.

What is the annual value of the reduction in benefits per enrollee? It is only $1,116. We are not cutting benefits for seniors? Only to the tune of $1,116. We are cutting benefits, and seniors have a right to be concerned.

Those who argue that Republicans should not be pointing this out to seniors--those who want to muzzle or gag us from telling seniors this will happen I suggest should consult CBO and realize that what they are asking seniors to do is beyond what they should be required to do, which is to take these kinds of cuts for a new entitlement.

Let me share some comments from some of my constituents who have actually written to me about the kinds of cuts they will suffer under this legislation. I have gotten a lot of letters. I asked my staff to compile a few so that I could share with my colleagues where they are concerned about losing drug coverage, preventive care, and a decline in the overall quality of their care. This is what they talk about. They realize you cannot cut nearly $\1/2\ trillion dollars and not cut care. That is what it is all about.

One patient wrote that the Medicare Advantage plan helps him afford the seven medications he takes every day. He said:

I have been on Medicare now for four years and . . . my

Medicare Advantage plan is the best deal around for seniors.

The benefits for my prescriptions are a lifesaver. I could

not afford my prescriptions without my Medicare Advantage

plan. Having numerous medical problems and taking over 7

prescriptions per day--that can add up.

Another senior wrote this, again, talking about the savings and preventive care that would be lost under the plans for Medicare Advantage:

Please do not cut Medicare Advantage. It provides me with

so many savings on doctor visits and prescriptions, including

preventive care and the Silver Sneakers fitness program.

Let me digress for a moment. We hear a lot of talk about trying to get people healthier, to take care of their own bodies, as it were, and to provide incentives for people to eat better, have a better diet, to lose weight, not to smoke, and to go to the gym and work out a little bit. When we have a program that incents seniors to do these kinds of things, we should be happy to support that program and cut it only after great consideration, if at all. I suggest that we don't cut it. This constituent talks about that kind of preventive care. He says:

I will be 77 in a few weeks. I have not had any major

surgery or hospitalization (thank God) and go to the fitness

center three or four times weekly--something I could not do

if Medicare Advantage is cut. I urge you not to cut this very

important aid to senior citizens.

Another Medicare Advantage patient wrote to explain how the extra benefits she gets help her. She said:

I have never written to anybody in Congress because I

didn't feel it necessary. Now I do because of the threat to

cut my Medicare Advantage Plan.

When I turned 65 three years ago, I opted for a Medicare

Advantage plan. I have been well taken care of and truly like

my Health Net Ruby 3 plan and want to continue on it. For a

small amount of $38 extra a month, I not only get dental

coverage, but also vision and benefits for a fitness program.

These extra benefits have been a great savings for me, and I

do not want to have them taken away. Please do not vote for a

cut to my Medicare Advantage plan. I want to keep my

benefits.

One more letter. This one, I thought, was especially touching. It is from a gentleman whose wife has pulmonary fibrosis and relies on Medicare Advantage for her treatments. They worry that the quality of her treatments will

decline if Medicare Advantage is cut, as proposed by this legislation.

Here is what he said:

If we lose Medicare Advantage, we are in trouble. United

Healthcare Secure Horizons has provided us with great doctors

that understand the disease. . . . It would be disastrous if

she got a lung infection and had to go on a bureaucratic

waiting list rather than being able to call our primary

doctor as we do now. Please do not let them cut this great

program.

The reason I quoted that letter is because another one of the things that is touted as a way to bend the cost curve and provide better care in the process is to coordinate the care from the primary physician right on through to any specialists and, Heaven forbid, if an individual has to go into a hospital, have surgery, or even have posthospital care in some kind of a facility. One can see how that kind of continued or coordinated care could be a real advantage to people and also end up saving money in the long term for the individual, for the insurance company that may take care of them, or the U.S. Government if we are paying for it as we do under Medicare Advantage, for example.

So here is a woman who talks about the fact that this kind of plan has been made available to her and why would we want to take it away. It has always been puzzling to me that because Medicare Advantage is actually administered by insurance companies, there seems to be something evil about it that a lot of our friends on the other side of the aisle would like to get rid of. They talk about having a government choice or a government option in their health care bill, but when it comes to options or choices for Medicare patients, they are not for that. They just want government only. They don't want the Medicare Advantage plan because it is actually administered by insurance companies.

What these companies do is provide a health maintenance organization- type of coverage where we have the continuum of care from the primary physician all the way through to whatever care may be required. This individual is talking about his wife being benefited by that kind of care. Why would we want to do away with that simply to save money so we can create a new entitlement? At the very time Americans are asking for better care, to ensure their care is not taken away from them, that is precisely what is being proposed by the other side.

Maybe I will be very surprised. Maybe we will finally have a chance to read the Reid bill or however the distinguished majority leader wishes to characterize it, and we will find they decided not to cut Medicare after all. If there are no Medicare cuts in the legislation, then I will be the first to come to the floor and say: Thank you. Thank you for not cutting seniors' Medicare. But if, in fact, as with the other bills that have been considered, this legislation ends up cutting Medicare anywhere from $450 billion to $500 billion, then I think the concerns that have been expressed to me by my constituents need to be taken into account, and Republicans will insist on protection for our constituents. People should not have to go through the difficulties that are projected by these real people if this legislation ends up cutting their benefits.

We just talked about a few of the things. We have additional things we are going to talk about later on this week, about the tax increases and how the tax increases are going to be passed on to all Americans, even though they may, first of all, be levied against a device manufacturer.

For example, if you have heart surgery and there is a stint that is used in your treatment, that is a very sophisticated device. There is going to be a tax on that device. You are going to get taxed on that device. It may be placed on the device itself. It will be in your bill. When you look at your hospital bill, I guarantee you they are going to be passing it on to you.

There are other taxes. By the way, if you don't buy the insurance they require you to have, you are going to get a tax on that, too, administered by the friendly IRS, which raises a whole host of other problems. To have the Internal Revenue Service endorse a provision of this law is going to require a lot more folks down at the IRS to have the authority to look into your records and talk to your doctor and figure out whether you have bought insurance. If so, is it the right kind of insurance? Is it the kind of insurance the government says you have to have? If so, they will be happy to slap a tax on you, and you will have to pay for it. That is another tax you will be required to pay. There are others. As I said, we will talk about that later this week.

Then there are the premium increases. There was a real dispute about this issue. Folks said: We are not going to increase premiums after all. The whole exercise is to reduce the cost of health care, to cut premiums.

We said: That is a wonderful goal. We said: Let's see if you can come up with a goal that actually reduces health care premiums for people.

After all this time, it turns out they cannot do it. The Congressional Budget Office--again, the nonpartisan group of accountants we in the Congress have hired to analyze the cost of all these things and the effect of them--concluded that under this legislation that has been considered in the committees, the cost of the legislation, the cost of insurance is going to go up for the average family, not go down, compared to what it is costing them today.

There have been numerous studies on this issue. One of the studies broke it down by States and by region. They said the overall national increase, by the way, would be about $3,300 per year increase cost in premium. Think about that. We are sporting a bill, the idea of which is to make health care less costly, but our insurance premiums are going to go up $3,300 and our taxes are going to go up. Do you know the reason? You cannot spend $1 trillion and add a whole lot more people to the rolls and not have it cost more money, and it will cost more money. Should it?

I think we can achieve these objectives, as I have said many times from this podium, with targeted solutions to the specific problems that exist without increasing taxes or premiums. We have demonstrated how we can do that. The study I spoke of, though, said in certain States, such as the State of Arizona from which I come, the cost is going to be far greater than $3,300. In fact, it is going to be, I believe it was some $7,400 per family per year increase. That is astounding. That is as much money as some people pay for their insurance to begin with.

This study demonstrated that the increases could be as much as 95 percent. I guess that makes sense. If it costs $8,000 for a policy today, and it is going to be increased by $7,400, that is almost a 100- percent increase. It is incredible we would think about doing that on the American people. Yet that is the result of this absolutely nonpartisan study that was done by an entity that looked into all the different factors. They didn't cherry-pick the information. I know there was another group that was criticized because the insurance industry had hired them. That is not the study of which I speak. I am talking about the Oliver Wyman study.

There are so many things about this legislation we are going to need to know and that the American people are going to need to know. We are going to have to have plenty of opportunity to both read the bill and know how much it costs. Then we need to know how much it puts us in debt.

If the answer is it is not going to put us in any more debt or create a big deficit, we will just keep raising taxes until we have enough money to take care of it, that is not the answer either. It is not the way to get out of a recession, it is not the way to help hard-working families, and it is not the way to treat people we are trying to help by reducing their health care costs.

I hope as the next several days unfold, we will be able to read this product, this bill that was written in the majority leader's office. Maybe we will be surprised that it does not raise taxes, that it does not raise premiums, that it does not reduce care or ration care, that it does not cut Medicare. But I am not going to hold my breath. My guess is it will do all of those things, and when the American people confirm that is the result of this so-called health care reform, I am not going to blame them for saying: Absolutely not. We want no part of reform if that is what you are talking about.

I am reminded of a line. I haven't tracked down where it is, so I will not attribute it. I thought it came from Charles Dickens' ``A Tale of Two Cities.''

There was a character, Madame Defarge, who may have said this.

Again, the question of the French Revolution was on their minds. This person said: ``Reform? Sir, don't talk of reform. Things are bad enough already.''

That is apropos to this health care debate. We have costs going up right now. We don't need them to go up any more.

As another wag put it: You think health care is expensive now, wait until it is free. We all know there is no such thing as a free lunch. The money has to come from somewhere. As it turns out, in these bills, it is going to come from seniors, people who have private insurance and subsidize those on government insurance, and it is going to come from all taxpayers, including those who make less than $200,000 a year, who the President said would not be taxed. A large percentage of the money, I think 87 percent in one case, will come from people making less than $100,000 per year. Some of the tax provisions specifically impact primarily people who make less than $50,000 a year. Health care reform should be about making it better for the American people, not making it worse.

It is going to be very interesting when we finally have an opportunity to review the legislation that was created behind closed doors to see whether it is going to pass these tests. We want to read it. We want to know how much it costs. We want to know that it is not going to add to the deficit or the debt. We are going to want to know that it will not result in the delay and denial of our care. In effect, we are going to want to know that the protections that are important for our constituents are in place.

I think there are some better ways to do this. Again, we will talk about those another day. We have already talked about them.

In the event you are saying, what kind of ideas are the Republicans talking about, I will mention one and stand down here.

We have been talking a lot about health care premiums and health care costs because doctors have to practice defensive medicine because if they are not careful, if they do not order a lot of tests, send their patients to a lot of different specialists, they are liable to get sued for malpractice. With this jackpot justice system we have, it costs a lot of money. The defensive medicine some have said can amount to $100 billion or well over $100 billion a year. There are two studies that put it over $200 billion a year. Another study said just the cost of malpractice insurance premiums for doctors represents 10 cents on every health care dollar spent.

If we could reform medical malpractice laws, we could not only make the delivery of health care less expensive, we could make it less difficult for physicians to do what they consider to be the right thing without fear of getting sued, and we could dramatically reduce the cost of health care premiums. This is a way to solve three problems that need to be solved, not cost a dime and, in fact, generate a huge amount of savings.

Why wouldn't we want to do this? As former Governor Dean of Vermont, former chairman of the Democratic National Committee, said on August 17 of this year at a townhall meeting in Virginia: The reason we haven't tackled medical liability reform is that we don't want to take on the trial lawyers.

I understand that. He is right. The Democratic majority did not want to take on the trial lawyers. But that is exactly what is wrong with Washington today.

We know what the problems are, we know what a lot of the fixes are, but we wouldn't want to take on the special interests such as the trial lawyers because that would not be good for us politically.

Republicans are saying: Yes, we do. It is time to take on those special interests. It is time to focus solutions on specific problems rather than trying to reform the entire health care system, including with a big government-run insurance company, in order to solve a problem that can be solved in a less intrusive way, less government intervention, less government expenditure, more private freedom, more money left in our pockets, and a greater assurance at the end of the day that we are going to continue to receive high-quality health care and not have it denied to us because of someone sitting in Washington,

The following Senator is necessarily absent: the Senator from Utah (Mr. Hatch).

Further, if present and voting, the Senator from Utah (Mr. Hatch) would have voted ``nay.''

Madam President, I am voting no on the conference report to the fiscal year 2010 DOD Authorization Act.

This was not an easy decision. This is a very important bill in view of the important policies it puts in place for our men and women uniform and I commend the leadership of the committee's chairman and ranking member for their commitment to the well being of our nation's armed forces. This conference report also contains several important provisions I authored or coauthored.

However, I believe is unconscionable that this bill has been taken hostage by the far Left to advance its hate crimes agenda. I cannot provide my vote for a bill that uses our military in this way if we permit it this time, where will it end?

Because of this, while this is an important conference report, and mostly a good one, I cannot vote in favor of it today.

The Defense Authorization Act authorizes more than $680 billion for national defense programs; this figure includes authorization for funding for ongoing operations in Iraq, Afghanistan, and the war on terror. It also authorizes funding for such crucial programs as Department of Defense military assistance to for Afghanistan and Pakistan. And it includes $7.5 billion to train and equip Afghan security forces and $1.3 billion for the Commanders' Emergency Response Program, which provides funds for commanders in Iraq and Afghanistan to spur local security and reconstruction projects.

The bill appropriately caps F-22 production at 187 aircraft--which the Pentagon requested--and it includes $6.7 billion for armored vehicles including the new M-ATVs, $600 million for equipment shortfalls in the National Guard, and more funding for defense health and family support programs. It also includes a 3.4 percent across-the- board pay raise for the men and women in the military

I am also pleased that the conference report contains several provisions I authored or coauthored, including an amendment requiring a comprehensive review by the Government Accountability Office on the successes, failures and unmet objectives of the Stockpile Stewardship Program. This is an important report for future debates on START and other matters, a provision I coauthored, section 1254, with Senators Bayh and Lieberman on imposing sanctions on Iran if it continues its illegal nuclear weapons program. I am disappointed that this provision was watered down in conference, as it passed the Senate with its unanimous endorsement that the Iranian Central Bank should be sanctioned if Iran continues to defy the world on uranium enrichment. However, I am pleased that it continues to state the strong support of the Congress for the proposition that Iran must comply with the U.N. Security Council Resolutions directing it to halt uranium enrichment a provision I authored, Section 1251, with several of my colleagues, including the Republican leader and the ranking member of the Armed Services Committee, regarding the START follow-on.

I am pleased that the conference report enshrines in law that the President must deliver to the Congress a report on the plan to modernize the nuclear weapons stockpile and complex, as well as the delivery vehicles.

The Perry-Schlesinger Commission was clear that further reductions in the U.S. nuclear weapons force are only prudent if the weapons that remain are highly reliable and credible. This is only possible with a robust modernization program, which has to include full and timely Lifetime Extension Programs for the B61 and W76 warheads consistent with military needs; funding for a modern warhead that includes new approaches to life extension involving replacement, or, possibly, component reuse; full funding for stockpile surveillance work through the nuclear weapons complex, as well as the science and engineering campaigns at the national laboratories; and full funding for the timely replacement of the Los Alamos plutonium research and development and analytical chemistry facility, the uranium facilities at the Oak Ridge Y-12 plant, and a modern pit facility.

This provision greatly strengthens the DOD authorization bill, and, I think, makes it more likely the Senate will be able to ratify a follow- on treaty to START, especially if the President heeds the Senate's advice, in this section, that missile defense, space systems, and advanced conventional modernization, which includes nonnuclear

global strike capability are not subjects for this follow-on agreement.

I would have been proud to cast my vote for legislation providing these policies for our men and women in uniform; and I am grateful for the leadership of the chairman and ranking member on these issues.

I am, however, concerned by several provisions of the bill. First, I opposed the inclusion of funding for an alternate engine for the F-35, or Joint Strike Fighter. At a time when we are fighting two wars, the $560 million authorized in this bill for the development and procurement of an alternate engine could be better spent to support our troops. The Secretary of Defense opposes this program, and the administration so strongly opposes the alternate engine that the President's advisers have recommended he veto the bill over this provision.

Our national debt is spiraling out of control. Critical defense programs, like missile defense, are underfunded. The F-35 alternate engine is a prime example of an unnecessary program that should not be authorized in this bill.

I am also greatly concerned about the manner in which missile defense is addressed in the conference report. I joined Senators Lieberman and Sessions in offering an amendment to the Senate version of the NDAA that would require the administration to certify that any proposed alternative to the planned missile defense sites in Poland and the Czech Republic be at least as cost effective and operationally effective as the original plan. In particular, I wanted to ensure that any alternative proposal was capable of protecting the United States as well as our European allies against long-range Iranian ballistic missiles. This amendment was adopted unanimously on the floor of the Senate, while a similar version was also included in the House-passed version of the NDAA.

Unfortunately, the conference report only authorizes funding for the alternative proposal and eliminates entirely the certification requirement that the alternative be as least as effective as the planned deployments in Poland and the Czech Republic. As such, I believe the administration is moving forward with a plan for missile defenses in Europe that will leave most of Europe and the United States more vulnerable to the threat of long-range Iranian ballistic missiles than the previous plan.

I would also note that this authorization bill endorses an approach to missile defense that emphasizes theater missile defense over the protection of the U.S. homeland. Under the previous plan, protection for the United States against future Iranian and North Korean intercontinental ballistic missiles was to be guaranteed by 54 ground- based interceptors: 40 deployed in Alaska, 4 in California, and 10 in Poland. The Obama administration has curtailed this to deployment to 30 ground-based interceptors in Alaska. Attempts by the minority to restore funding for the deployment of additional ground-based interceptors were rejected by the majority in both the House and the Senate. America will be less secure as a consequence.

Finally, the so-called hate crimes bill should not have been attached to the defense authorization act. Adding this left-wing priority onto the legislation that authorizes funding for our troops in battle is not in our troops' best interest.

A hate crimes bill should have been considered by this Chamber as a stand-alone bill that would pass or fail on its own merits. By attaching it to the unrelated, and must-pass, NDAA, the sponsors of this legislation clearly indicated that they anticipated they would encounter trouble in successfully getting a hate crimes bill through the regular legislative process on its own. And with good reason the hate crimes legislation is unnecessary Federal Government interference in an issue that is adequately handled by the States.

Forty-five States and the District of Columbia already have hate crimes laws. To my knowledge, States have a track record of aggressively prosecuting hate crimes, making a Federal hate crimes prevention act an unnecessary imposition on state jurisdiction. After all, State, rather than Federal, courts exist to adjudicate local crimes. Matters that can be handled adequately by the States, like hate crimes prosecution, should be left to them.

Everyone in this Chamber undoubtedly wants to ensure that all Americans are protected from crime. But flawed legislation that unnecessarily takes responsibility away from States and further taxes the Department of Justice's resources does not enhance the protection of people from these crimes.

The chairman and ranking member worked hard to complete a conference report that I would have been able to support absent the so-called hate crimes bill. However, I cannot support using our men and women in uniform as pawns to satisfy the liberal base of the Democratic Party. For that reason, I must oppose the conference report.

The following Senators are necessarily absent: the Senator from Utah (Mr. Hatch) and the Senator from Alaska (Ms. Murkowski).

Further, if present and voting, the Senator from Utah (Mr. Hatch) would have voted ``no.''

Mr. President, I ask unanimous consent that the time controlled by the Republican side be allocated as follows: Senator Kyl, 10 minutes; Senator Alexander, 10 minutes; Senator Gregg, 10 minutes; Senator Wicker, 10 minutes; and Senator LeMieux, 20 minutes.

Mr. President, I ask the Chair to please inform me when I have consumed 9 minutes since I don't want to go over my time.

Mr. President, I had propounded a unanimous consent request. Has that been agreed to?

Thank you, Mr. President.

Mr. President, I wish to talk this morning about the same health care issue the Senator from Kentucky just addressed. I think Republicans have always had a lot of very good alternatives to deal with two critical problems: No. 1, the rising costs of health care and, secondly, the problem of some uninsured in this country needing help to get that insurance. Unfortunately, our ideas have not been included in the legislation passed by the committees. In fact, when we have offered amendments to propose these alternative ideas, they have been rejected.

One of the primary ways we know we can reduce costs is through the mechanism of medical malpractice reform. That deals with the problem of the jackpot justice system that currently is abused by trial lawyers where they file lawsuits, they get big recoveries or they force settlements, and the net result is two things which I spoke about yesterday.

First of all, liability insurance premiums for physicians now consume about 10 cents for every health care dollar spent. If we had medical malpractice reform, we could reduce that. We wouldn't, obviously, get rid of it, but the cost for physicians would be significantly less.

For example, we know some specialties, such as obstetrics, neurosurgery, and some others, including anesthesiology, for example, will frequently have annual liability premiums in the range of $200,000. That, obviously, is a cost that is passed on. When they bill patients, they have to cover the cost of their medical malpractice insurance.

I mentioned yesterday a study by the former president of the American Academy of Orthopedic Surgeons, Dr. Stuart Weinstein. He has written about the extra cost of delivering a baby because, he said, if a doctor delivers 100 babies a year and pays $200,000 for medical liability insurance, $2,000 of the delivery cost for each baby goes to pay the cost of the medical liability premium. So we could reduce by $2,000 the cost of delivering a baby if we were able to pass meaningful medical liability insurance reform.

The even bigger cost is defensive medicine--the kinds of things doctors do, not because they are necessary to take care of their patients, but because if they don't do them they might get sued and some expert will claim they should have had this extra test or done this extra procedure; and if they would have just done that, then maybe the patient would have been all right. So as a result, defensive medicine results in hundreds of billions of dollars of expenses every year.

In fact, a 2005 survey published in the Journal of the American Medical Association found that 92 percent of the doctors said they had, indeed, made unnecessary referrals or ordered unnecessary tests just to shield themselves from this liability. How much does this potentially cost? I said hundreds of billions. Well, let me cite two studies.

All of the studies I have seen are roughly within the same ballpark. They differ just a little bit. For example, Sally Pipes, who is president of the Pacific Research Institute, found that defensive medicine costs $214 billion a year. A new study by PricewaterhouseCoopers reveals similar findings, pegging the cost at $239 billion per year. Well, $214 billion, $239 billion, we can quibble about the amount; it is not insignificant. So when we are talking about well over $200 billion a year in defensive medicine, we know there is a big amount of money to be saved, and we could pass those savings on to the consumers of health care.

Yesterday I cited the statistics from Arizona and Texas where both States have implemented medical liability reforms of different kinds, but both States have found significant reductions in insurance premiums for physicians, fewer malpractice cases filed, and, in the case of Texas, an infusion of a remarkable number of physicians into Texas because it is a more benign environment now in which to practice their profession.

The reason I mention all of this is we have been talking about this for months now and not one of the Democratic bills contains medical malpractice reform. The reason is clear. Democrats are frequently supported by trial lawyers, and trial lawyers don't like medical malpractice reform. That is how they make a lot of money, so they don't want to see the reform. We ought to reform the system for the benefit of our constituents rather than to not do it in order to help trial lawyers.

Again, the reason I mention this is because a bill we are going to be taking up later today, the so-called ``doc fix''--and that is a very bad name for it--is a bill that would deal with the formula under which doctors are compensated for Medicare. One of the things that has been reported in newspapers is that the American Medical Association will not push for medical malpractice reform if they are able to get this bill passed. I find that to be a very troubling fact because all of the physicians I know realize we need medical malpractice reform.

Here is how the Washington Post editorialized it yesterday morning, and I am quoting:

The so-called ``doc fix'' is being rushed to the Senate

floor this week in advance of

health reform not because it has nothing to do with health

reform, but because it has everything to do with it. The

political imperative is twofold: To make certain that

Republicans don't use the physician payment issue to bring

down the larger bill--

That is because of the fact that it would add to the deficit--

and to placate the American Medical Association.

The concern I have is that it doesn't help the physicians. All this legislation does is to say that the formula which has been in effect since 1997, but never adhered to by the Congress, will not be the formula that goes forward in the future, but it doesn't fix the payment problem. Every year, because the formula would result in huge cuts to physicians who take care of Medicare patients--and everybody agrees that is a bad thing--we say we are not going to pay attention to the formula. We are going to raise the doctors' reimbursements by a percentage point or a half percent or some modest amount.

All this legislation does is to freeze physician payments for 10 years--to freeze them--zero; not even any kind of cost-of-living increase. I guarantee that after 10 years, physicians not getting any kind of an increase at all are going to be hurting.

I know what is going to happen, which is that physicians and groups such as the American Medical Association will have to come back to Congress every year and say they need to have some kind of a modest increase. Republicans want to be able to offer amendments on this legislation to provide for such modest increases. Incidentally, those modest increases would be offset--that is to say, the cost to the government would be offset--so that we wouldn't be adding to the deficit. It is very clear there is no new formula in place, no new formula has been proposed, so this legislation doesn't solve the problem. It simply says, well, we are not going to adhere to the formula in the future. Big deal. We have never adhered to it in the past. We are never going to adhere to it because it makes no sense. Everybody agrees with that. So what do we get out of this? Nothing. A freeze for 10 years is not a solution to the problem.

I hope physicians don't see this as a solution as a result of, as I said, this having been reported in some of the media, so that they will decide not to push for medical malpractice reform because physicians know how important that is. I have just talked about how important it is.

We need solutions to problems. One of the problems is we have increases in the costs of providing health care. One solution to that-- and we are talking about well over a couple of hundred billion dollars, as I indicated, from the studies I cited a moment ago. One solution to that is to tackle this problem of medical liability reform. Some States, probably about four or five, have done this, and they have demonstrated it can work.

The President's approach is, well, let's have a study about it. Let's maybe have a demonstration project. We have some demonstration projects. One of them is Arizona and one of them is Texas, and they demonstrate that it works. Since the Federal Government has to pay about half of all of the cost of health care in the country because of Medicare, Medicaid, and veterans care and so on, the Congressional Budget Office says we, the Federal Government, could save ourselves $54 billion if we had meaningful medical malpractice reform. We could expect the same amount for the private sector.

The bottom line is, the bill we are going to be voting on later today doesn't solve any problem. It does not help the physicians. One way we can help not just physicians but patients by reducing their cost of care is accepting some of the Republican alternative ideas that have been proposed, starting with medical liability reform.

Mr. President, I yield the floor to the Senator from Tennessee.

Mr. President, the goal shared by all of us in the Senate is to make health care more affordable for Americans. Some ask why there hasn't been more support for medical liability reform--a popular, cost- free measure that would unquestionably yield significant savings for patients and doctors. The most honest answer to that question came from former Vermont Governor and Democratic National Party Chairman Howard Dean, who said at an August townhall meeting in Virginia that medical liability reform has not been included in any of the Democrats' bills because they don't want to take on the trial lawyers.

Protecting trial lawyers should not be the goal of health care reform. Their multimillion-dollar ``jackpot justice'' lawsuits drive up the cost of health care for everyone and are a big reason America's health care premiums have soared. Why? To help guard themselves from ruinous lawsuits, physicians must purchase expensive medical liability insurance, often at a cost of $200,000 a year or more for some specialists such as obstetricians and anesthesiologists.

Because doctors pay for this insurance, patients do too. Hudson Institute economist Diana Furchtgott-Roth estimates that 10 cents of every dollar paid for health care goes toward the cost of doctors' medical liability insurance. Dr. Stuart Weinstein, the former president of the American Academy of Orthopedic Surgeons, has written about the extra cost of delivering a baby because of the high cost of these premiums. If a doctor delivers 100 babies a year and pays $200,000 for medical liability insurance, then ``$2,000 of the delivery cost for each baby goes to pay the cost of the medical liability premium,'' Dr. Weinstein wrote. So the costs of this insurance, passed on to patients, are real.

An even bigger cost related to the threat of lawsuits is doctors' use of defensive medicine. The looming specter of lawsuits makes most doctors feel they have no choice but to take extra or defensive precaution when treating patients. A 2005 survey published in the Journal of the American Medical Association found that 92 percent of doctors said they had made unnecessary referrals or ordered unnecessary tests and procedures solely to shield themselves from medical liability litigation.

To say the costs of defensive medicine are high is an understatement. Sally Pipes, president of the Pacific Research Institute, has found that defensive medicine costs $214 billion per year. A new study by PricewaterhouseCoopers reveals similar findings, pegging the annual cost at $239 billion. So you have the approximate amount here--$214 billion and $239 billion. In any event, defensive medicine imposes a huge cost on the American public.

Medical liability reform would work to bring down health care costs for patients and doctors. Among the ways to do it are capping noneconomic damage awards and attorney's fees and implementation of stricter criteria for expert witnesses who are testifying in these medical liability lawsuits. Trial lawyers frequently use their own experts to criticize the defendant doctor's practice. Well, the experts should have no relationship with or financial gain from the plaintiff's lawyer, and they should have real expertise in the area of medicine at issue.

Some States, including my home State of Arizona, have already implemented medical liability reform measures with positive results.

Dr. James Carland, who is president and CEO of MICA, which is Arizona's largest medical liability insurer, wrote a letter to me recently to describe some of the results he has seen from medical liability laws implemented in Arizona, specifically from two statutes-- one that reformed expert witness standards and another that imposed a requirement to inform the defendant, before trial, of expert witness testimony and to preview the substance of that testimony. Dr. Carland wrote that the enactment of these two statutes has ``reduced meritless medical malpractice suits'' in Arizona. Indeed, after their enactment, medical liability suits dropped by about 30 percent. That drop has been accompanied by a drop in medical liability premiums. Since 2006, MICA has reduced premiums and returned about $90 million to its members in the form of policyholder dividends.

Another State that has had success with medical liability reform is Texas, which passed a series of measures in 2003, including limits on noneconomic damages and a higher burden-of-proof requirement for emergency room negligence. The number of doctors practicing in Texas has now skyrocketed, while costs have plummeted. It has been widely reported that since those reforms were implemented, medical licenses in Texas have increased by 18 percent and 7,000 new doctors have moved into the State.

To reduce costs for both physicians and patients, Senator Cornyn and I have introduced legislation that would achieve medical liability reform by combining what has worked best in our two States, Texas and Arizona. We have taken the Texas stacked cap model for noneconomic damages and coupled it with expert witness statutes proven to limit the filing of meritless lawsuits.

Republicans offered these kinds of liability reform amendments during the Finance Committee markup, but all of them were ruled out of order by the chairman of the committee. One of these amendments, recently scored by the Congressional Budget Office, would have saved the Federal Government $54 billion in health care costs over the next 10 years. My colleague from Nevada, Senator Ensign, asked the Director of the CBO if we could expect a similar approximate reduction in cost in the private sector, since about half of all medical costs are paid for by government and the other half in the private sector. Dr. Elmendorf, the Director of the CBO, agreed that we could expect approximately the same additional amount of savings in the private sector. That would be well over $100 billion.

Medical liability reform enjoys heavy support among our bosses--the American people. According to a new Manhattan Institute paper, 83 percent of Americans want to see it in any health care bill passed by the Congress. Despite this support and the concrete evidence that it would lower health care costs for doctors, patients, and the government, none of the health care bills being written by congressional Democrats tackle medical liability reform. It makes no sense that in debates about bringing down cost, this commonsense measure is ignored by the majority party. If we are serious about making health care more affordable, we must have medical liability reform. We will work for the American people, not the trial lawyers.

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

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

Mr. President, I wish to speak to an issue that is very timely because the United States and Russia are beginning today their seventh round of negotiations on the so-called START treaty. This is a treaty that could limit the number of nuclear warheads and delivery vehicles by both countries and provide an extension of various compliance and verification procedures that are currently followed by both countries.

It is interesting to me that the Russians do not appear to be in much of a hurry to complete the negotiations before the treaty expires, and it expires on December 5 of this year. According to Assistant Secretary of State Richard Verma, in a letter to me and several fellow Senators, I quote:

Russian views with respect to the meaning of these two

terms--

And he is specifically talking about the definitions of ``strategic delivery vehicle'' and ``associated warheads,'' both of which are obviously key to the treaty, in any event--

Russian views with respect to the meaning of these two

terms have not yet been fully explained by the Russian

Federation.

We are in the seventh round of negotiations, as I said. When these two fundamental terms have not yet had an

explanation by the Russian side as to what they mean and, in effect, what they are tabling in the way of proposals, it is pretty clear we are not far enough down the road to see much light at the end of the tunnel.

With regard to the verification rules, which are the heart of the START treaty, he wrote:

The Russian Federation has not, as yet, elaborated

sufficiently on its views concerning verification for the

United States to judge the nature of its approach.

Again, it is interesting that this letter, which is dated October 5, suggests the Russians had not yet provided to us their position on key provisions of this treaty. Yet we are supposed to have the negotiations completed before the treaty expires on December 5.

It is increasingly clear to me, as a result of all this, there will not be a treaty by December 5; certainly not one that is ratified by the Senate, which is a process the Senate will require several months, obviously, to complete. As I said, I think it is doubtful we will even see one signed by the United States and Russia by December 5.

It is clear to me the Russians have sensed an opportunity that they can use time to their advantage. They saw an overly ambitious American agenda, which went far beyond extending the compliance and verification measures of the existing treaty to actual proposals to significantly cut the numbers of warheads and delivery vehicles. They saw this obviously ambitious agenda pushing up against a very short timeframe-- in this case December 5. I think they have cleverly manipulated the situation, among other things, by throwing additional subjects into the mix, such as missile defenses and advanced conventional modernization and our nonnuclear conventional strike capabilities. By throwing these things into the mix, they have created a situation where it is going to be impossible to conclude negotiations by December 5, at least if the United States wants to stand firm on its position that neither the conventional strike capability nor missile defenses should be a subject of these negotiations.

I think the Russians think they can scoop up a bunch of concessions from the United States because of this short timeframe and the fact that the United States will obviously want to conclude the negotiations, if they can, by December 5. I think an example of concessions would be the recent decision of the United States to leave ourselves more exposed to a long-range missile threat from Iran as a result of taking out the so-called missile shield we had previously committed to the countries of Poland and the Czech Republic. I think the Russians may have correctly assessed that the Obama administration would be willing to make trades such as the one on European missile defense in order to get nuclear force levels lower because this would show progress on President Obama's agenda for a nuclear weapons-free world. At the same time, the Russians are attempting to constrain the United States.

It is interesting they are actually developing programs, systems that would be prohibited by the START treaty. One is the RS-24 multiple warhead ballistic missile, which the Russians tested as recently as May 29, 2007. That would be illegal for the Russians to deploy under START. So why are they testing it? They seem very happy to negotiate for fewer missiles because they would be able to add multiple warheads on the missiles they have.

That is known as MIRVing or the multiple reentry vehicles. You just add more warheads on the same missile and you can accomplish the same thing, as if you had more missiles with an individual warhead on each one. It is clearly not progress, especially since the purpose of START, among other things, is to promote greater stability, which comes from reducing the number of multiple-warhead weapons.

If the administration had simply limited the agenda to preserving and continuing the START treaty verification measures, we probably could have met the December 5 deadline and we could have preserved the treaty and avoided issues such as missile defense that have now been raised by the Russians.

Although the Senate will have to participate in this ratification process--and very soon, quite possibly--we really have no idea yet how the administration will deal with the expiration of START on December 5. What options does it have in mind to deal with that expiration date? How will it seek to extend the treaty? What are the legal consequences for information sharing and inspections both here and in Russia? What are the separation-of-power issues of the various approaches having to do with a treaty ratified by the Senate which expires, with the administration making treaty-like commitments to continue abiding by the treaty during the course of time prior to the Senate's ratification of the treaty? All of these are questions to which we have not gotten answers. Yet time is wasting.

Several of my colleagues and I have asked for the answers to these questions in our August 14 letter to Assistant Secretary Gottemoeller. The October 5 response from Mr. Verma ignored the questions about the expiration date, and we need the answers.

Beyond December 5, getting a new treaty ratified is not going to be an easy proposition. Many Members of the Senate have been clear that because the administration is seeking nuclear force reductions, it must concomitantly take responsibility for the nuclear forces that will remain. We will have fewer of them. We need to know that they will work and that they are safe.

Of course, both of these issues are related to the nuclear posture review, which isn't really due until January. But since the administration rushed to its analysis to justify warhead and delivery vehicle reductions, it must now act quickly to assemble a comprehensive modernization plan that includes warheads, the nuclear weapons complex, and delivery systems. That plan has to be presented to the Senate no later than when they send the treaty up to the Senate, and the fiscal year 2011 budget will need to be sent at roughly the same time because it is the first year of the effectuation of the plan they would be presenting. Presumably, the plan will encompass maybe, let's say, a decade of nuclear weapons complex modernization, but next year's budget will really be the first time we will be able to verify the administration's seriousness about this modernization effort.

So as to ensure there is no doubt on what ``comprehensive modernization plan'' means, let me refer to the definition provided by the Perry-Schlesinger Congressional Commission on the Strategic Posture of the United States. The essential elements of such a program identified by the Perry-Schlesinger Commission are, first, full and timely Lifetime Extension Programs for the B61 and W76 warheads consistent with our military needs; second, funding for a modern warhead that includes new approaches to life extension involving replacement or, possibly, component reuse; third, full funding for stockpile surveillance work through the nuclear weapons complex as well as the science and engineering campaign at our National Laboratories; fourth, full funding for the timely replacement of the Los Alamos plutonium research and development and analytical chemistry facility, the uranium facilities at the Oak Ridge Y-12 plant, and a modern pit facility. These are the essential components the President needs to present. It is the minimum that should be included.

I might add that this is already required as part of the fiscal 2010 Defense Authorization Act I presume this body will soon pass and send to the President's desk. If anything short of this is submitted, the resulting delay in consideration of the treaty will be through no fault of the Senate; instead, blame will be with the administration and its failure to heed numerous admonitions from Senators. We needed this plan submitted at the same time as the treaty.

It goes without saying that the administration must also understand that any limitations on U.S. missile defense or nonnuclear global strike capability will also be a deal breaker in the Senate.

Finally, I will refer again to the issue of Russia's multiple-warhead RS-24. In this case, it appears the Russians have cheated--if not in the letter of the START agreement, at least in its spirit--by converting one of their existing missiles, the TOPOL-M, to this new multiple-warhead variant.

However, if you look at the 2005 Section 403 Report, which is also known as

the Adherence to and Compliance With Arms Control, Nonproliferation, and Disarmament Agreements and Commitments report, prepared by the State Department's VCI Bureau, there are a litany of other outstanding issues regarding Russia's failure to comply with START.

In fact, to quote from the 2005 report:

A significant number of longstanding compliance issues that

have been raised in the START Treaty's Joint Compliance and

Inspection Commission remain unresolved.

Mr. President, I ask unanimous consent to have printed in the Record at the conclusion of my remarks the portion of the 2005 report dealing with Russia's noncompliance with its obligations under the 1991 agreement.

Mr. President, it is clear that the administration needs to tell the Senate whether this 2005 finding is still valid. In fact, I think the administration owes the Senate answers to the following questions:

When will the State Department submit the next section 403 compliance report?

Will the Senate see it before being asked to provide advice and consent on the START follow-on agreement? If not, why not?

Does the State Department expect the compliance issues with the 1991 agreement to be resolved prior to the expiration of that agreement?

Does the State Department expect the follow-on agreement to include a mechanism for swift resolution of compliance issues? Have our START negotiators proposed such a mechanism? If so, can the negotiators brief the Senate, either in open Senate or a closed venue, on how it would work?

I encourage the administration to provide answers to these questions soon. The longer it takes to receive answers, the more it appears there is something to hide. Senators will want to know why we should ratify a new treaty when the administration is not enforcing provisions of the existing treaty.

Mr. President, keeping START from expiring without replacement should not have been such a difficult matter. I regret that choices made by the administration have made it so. I encourage the administration to respond to the inquiries I have raised today, respond to the letters, the correspondence we have sent, and be able to provide to the Senate the answer to the key question: Why would we be asked to ratify a new treaty when we have not enforced compliance with the treaty it would seek to replace? All of these questions, as well as the requirement that a new modernization program be submitted, at the latest, at the same time the treaty is submitted, are important requirements for the Senate to provide its advice and consent with respect to a new START treaty.

I yield the floor.

Exhibit 1

Adherence to and Compliance With Arms Control, Nonproliferation, and

Disarmament Agreements and Commitments

III. Overview

expansion of start compliance section

Section 403 of the Arms Control and Disarmament Act--the

legislative basis for the submission to Congress of this

series of Noncompliance Reports--requires that the Report

provide greater specificity about compliance concerns. To

wit, the law requires the Report to include ``a specific

identification, to the maximum extent practicable in an

unclassified form, of each and every question that exists

with respect to compliance by other countries with arms

control, nonproliferation, and disarmament agreements with

the United States.'' To comply with this requirement, this

edition of the Report has included more information than ever

before on, among other things, Russia's implementation of the

Strategic Arms Reduction Treaty (START).

To facilitate this effort, in 2003 the United States

conducted consultations with the Russian Government regarding

a number of longstanding, unresolved U.S. concerns about

Russian compliance with the START Treaty--some of which

actually date back to the first year of START implementation.

These included Russia preventing U.S. inspectors from

measuring the launch canisters of certain Intercontinental

Ballistic Missiles (ICBMs) or verifying that certain ICBMs do

not contain more warheads than attributed under the Treaty.

The U.S. concerns also included Russia failing to provide all

required telemetry materials for some START-accountable

flight tests, failing properly to declare certain ICBM road-

mobile launchers accountable under the Treaty, and locating

some deployed SS-25 ICBM launchers outside their declared

restricted areas. With respect to this last issue, however,

it should be noted that Russia has taken steps that have

resolved U.S. compliance concerns.

V. Compliance by Successors to Treaties and Agreements Concluded

Bilaterally With the Soviet Union

the strategic arms reduction treaty (start)

Belarus, Kazakhstan, Russia, and Ukraine are in compliance

with the START strategic offensive arms (SOA) central limits.

Both the United States and Russia met the START seven-year

reduction final ceilings of 1,600 delivery vehicles and 6,000

attributed warheads by the December 4, 2001, deadline. By

December 2001, these four Former Soviet Union (FSU) successor

states had reduced their aggregate forces to 1,136 deployed

launchers, 5,518 deployed warheads, and 4,894 deployed

ballistic missile warheads, as defined by Article ll of the

Treaty, and all strategic weapons had been removed or

eliminated from the territories of Ukraine, Belarus, and

Kazakhstan. Additionally, START required the four FSU

successor states to eliminate at least 154 heavy ICBM (SS-18)

silo launchers by December 2001. In the original MOU, dated

September 1, 1990, the Soviet Union declared 308 SS-18

heavy ICBM silo launchers. As of November 30, 2001, a

total of 158 SS-18 silo launchers had been eliminated--104

in Kazakhstan and 54 in Russia--leaving a total of 150

deployed heavy ICBMs.

Notwithstanding the overall success of START

implementation, a significant number of longstanding

compliance issues that have been raised in the START Treaty's

Joint Compliance and Inspection Commission (JCIC) remain

unresolved. The Parties continue to work through diplomatic

channels and in the JCIC to ensure smooth implementation of

the Treaty and effective resolution of compliance issues and

questions.

The United States raised six new compliance issues during

the period of this report. The United States considers four

of these to have been closed. However, several previous--

often long-standing--compliance issues remain unresolved. A

number of these issues, some of which originated as early as

the first year of Treaty implementation, highlight the

different interpretations of the Parties about how to

implement the complex inspection and verification provisions

of the START Treaty.

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

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

Mr. President, I believe my colleague, Senator Thune from South Dakota, will be here in a few minutes. Until he arrives, I thought this might be of interest. I promised my constituents I would tell my colleagues what they told me to tell them. I think it would be of interest to share some of these remarks.

I went to a meeting on Saturday morning that I thought was going to be a rather staid affair with folks who were primarily senior citizens, but not all of them were. It turned out to be a little bit reminiscent of some of those townhall meetings we saw on television during August because the subject most people wanted to talk about was health care. They weren't happy with what they were hearing the Senate was about to do. Among other things, they wanted to get it clear with me right off that I would pass on their concerns about this to my colleagues. I promised that I would. So let me summarize what some of them had to say and what I think the clear consensus of the group was.

First of all, they have a hard time understanding how Senators would pass a bill before we read it or even know how much it costs. I assured them that the procedure we would follow in the Senate was that we would have at least 72 hours after the bill had been finally written and after the Congressional Budget Office had scored the bill--that is to say, told us how much it would cost in all of its component parts and the ways it would be paid for. The reason I can feel fairly certain that will happen is because a number of colleagues on both sides of the aisle have either written to the majority leader or made it clear to him that they will not support a motion to proceed to a bill until we have had an opportunity to, in effect, read it and see how much it costs. That process could take some time, I told my friends. The Congressional Budget Office Director told the members of the Finance Committee, on which I sit, that it can take 2 to 3 weeks after the bill is written to come up with all of these calculations.

You will hear many people say we need to move this process on, even before we have the numbers. But I think that given the fact that most of us are committed to ensuring we have the numbers and can digest them and share them with our constituents before we debate and amend the bill, I assume the process will unfold in the Senate in such a way that we do know what it costs, and that means after the final CBO report is provided to us.

The next thing they wanted me to convey was that they were very worried about--in fact, maybe that would be a euphemism. They were more than concerned about the degree of government involvement in health care once this process is over. They fail to understand why we had to have what amounts to a government takeover of insurance in this country and dictating everything from what kind of insurance policy you have to have, to how doctors and hospitals are paid, in order to solve the two key problems that exist: No. 1, there are some Americans who need help buying insurance; second, that the costs of health care premiums continue to go up every year, and it is especially hard for small businesses to provide coverage for employees.

They asked me: Why do we have to change the entire system, with the government essentially taking it over?

I happen to believe we don't. I provided the two basic alternatives to them. One is a step-by-step approach that targets specific problems we have and matches up specific solutions to the problems, on the one hand, which is the approach I favor; on the other hand, essentially changing the insurance we all have today, creating a new insurance exchange, and all insurance would have to go through there. Even if you like your policy, it will change, and you are not going to be able to keep it.

Estimates are that, as a result of all of this, in an effort to cover 18 or 20 million more people with insurance, it is going to cost us close to a trillion dollars. It will raise taxes, it will raise insurance premiums, and it will require deep cuts in Medicare. They didn't like that. I guess that brings up the third thing.

With regard to Medicare, they were pretty perceptive in asking me the following basic question. One person said: One of two things is going to happen. Either it will be business as usual where we say we will make cuts in Medicare, but the Senate and the House never have the courage to do that, in which case this bill is going to cost a lot of money that is not offset by concomitant savings, or the savings are going to be made, and when they are made, it is going to deeply cut our benefits under Medicare.

That person was right. One of those two things is true, and neither one is a good result.

I remember a few years ago when we tried to reduce the growth in Medicare by about $10 billion. Republicans and President Bush were excoriated; we were going to ruin Medicare, and our colleagues on the Democratic side took great glee in the public reaction to that proposal to decrease the growth in Medicare by $10 billion.

Now we are talking about cutting Medicare by--I said $500 billion. The Finance Committee money is actually $450 billion. So let's be accurate. If that is the way this bill comes out, $450 billion, $120 billion of that is reduction of benefits under Medicare Advantage. So when people say: You would not have your benefits cut, that first $120 billion is a direct cut in benefits, and in my State a lot of seniors have Medicare Advantage policies.

The other way in which Medicare is cut--there are basically two things. One is reducing the amount of money we pay doctors and hospitals, and that cannot help but reduce the care we get. The final mechanism is a Medicare Commission is being established to provide--I think it is every year; maybe every 2 years, but let's say every year-- an amount of money that will have to be cut and will automatically be cut from Medicare unless the Congress finds a different way to do it, but Congress would still have to cut the same amount. So we either do it the way we want to do it or we do it the way the commission recommends it. In any event, their recommendation automatically goes into effect if Congress does not act.

I have a couple thoughts about that point. We have never been able to effect these cuts in the past because seniors know that it cuts deeply into their care, and they have told us and we have reacted by saying: OK, we will not do it. We could react that way again, in which case all of the savings, or at least a great deal of the savings, that were supposed to result and offset the costs of the bill would not be there. So now the bill is no longer deficit neutral. Now it is not balanced. Now it does add to the deficit and to the debt. If we do allow those cuts to go into effect, seniors are clobbered by deep reductions in the care they receive all the way from nursing homes to physicians to hospitals to hospice, medical devices--you name it. As I said, neither of these results is a good result.

There were several people who wanted me to convey their thoughts in that regard. I happen to agree with them, so I could do that.

I met, after visiting with this group, with a group of spinal surgeons from all over the country and, in fact, from outside this country. I saw the agenda of their meeting. I was the last speaker. For a layman, such as you and I, Mr. President, it was daunting to read through that agenda--all of the latest techniques in using new laser and stints and all kinds of things that I did not understand, but it was the very latest technology and techniques for treating spinal diseases and conditions.

What they told me was--I was the last person to make a presentation-- all of these great things we are doing for our patients we are not going to be able to do under this legislation, first of all, because it will be presumed to cost too much; second, because it will take the FDA and the other government agencies way too long to authorize its use for treating Medicare patients, for example; and, third, because the comparative effectiveness research which has in the past been used by these doctors to help them appreciate the best way, clinically, to treat someone is now going to be used to decide what Medicare can afford to pay. A lot of the more leading-edge techniques and technologies are not going to be approved for that purpose.

Their point was that people in China and Europe are going to be treated with the latest techniques more than Americans will because the American system of health care is going to deny people such as these experts the ability to do what they do.

One way this is being accomplished is by taking money away from specialists and giving it to general practitioners. There is a rationale for paying general practitioners--family doctors--more money. They are not making enough, and they are the first place most of us enter the medical world. If we have something that does not feel right, we go to our doctor. It is usually a family doctor. Frequently, he can help us, but frequently he says: I think there is something about what you have here that tells me I have to send you to a specialist. We go to the specialist then and he orders some specialized tests and he examines them and he may end up having to provide some kind of very specialized treatment and care that is probably going to cost more money.

While the family doctor needs to be paid more, we don't solve that problem by taking money away from the specialists. If we have to add money to the system to ensure that we have enough doctors who can provide quality care, then there is no free lunch and we have to pay for what we get. We should not make it a zero-sum game and take it from Dr. B in order to pay Dr. A. That was another strong message of these specialists.

I also happened to meet on Friday afternoon with a group of physicians in Phoenix from all different practices--from specialists to generalists, hospital physicians to others. To a person, they had this question for me. The way they asked it was, Why isn't anybody talking about medical malpractice reform?

I said: I am talking about medical malpractice reform.

They said: You are not getting through.

I said: The problem is there are a bunch of folks on the other side of the aisle who don't want medical malpractice reform, and you know why. And, yes, they understood the answer why.

I remind friends who might not have remembered, Howard Dean, a former Governor of Vermont and a former Democratic candidate for President and a former Democratic Party chairman was very candid in a townhall meeting in Northern Virginia on August 17 with Representative Moran where he told the group assembled there that the reason medical malpractice reform was not in the legislation is because they did not want to take on the trial lawyers.

That is true, but it does not make it right. Maybe somebody should take on the trial lawyers because there are a lot of estimates of how much money could be saved through meaningful medical malpractice reform. This jackpot justice system of ours that pays trial lawyers and requires physicians to pay as much as $200,000 a year in liability insurance premiums--all of which, of course, have to be passed on to the cost of our care, and perhaps even worse than that, practice what is called defensive medicine--raises the cost of our health care. Defensive medicine is having all kinds of tests performed and maybe putting someone in the hospital an extra day or two all in order to protect from a liability claim that their doctor did not do everything he could to take care of this poor patient and, as a result, the patient got sicker and something bad happened.

There are a lot of estimates. First, one estimate is from a study that says 10 cents on every dollar spent on health care is paid in insurance premiums by physicians. Obviously, some of that will still have to be paid with medical malpractice reform, but it could be reduced as has been the experience in the State of Arizona and the State of Texas, which is the reason Senator Cornyn from Texas and I have introduced legislation that will provide modest reforms to the tort system by putting some modest caps on noneconomic damages awards and providing that expert witnesses who testify have to be really expert witnesses in the area of the alleged malpractice.

These two things have saved enormous amounts of money. In Arizona, we don't even have caps on damages, but the Requirement that expert witnesses really be expert has ended up saving millions of dollars and reducing the malpractice premiums for physicians in the State of Arizona.

This is a reform we could accomplish on a bipartisan basis that not only would not cost anything, it would actually reap financial benefits. The Congressional Budget Office says just the savings to the U.S. Government--because we provide care under Medicaid, Medicare, and to our veterans--would save $54 billion. There are a lot of estimates that are higher than that. There is one estimate that is over $100 billion a year.

The Director of CBO acknowledged to people of the Finance Committee when we asked that $54 billion savings would actually be approximately doubled if we take into account the private sector as well. In other words, not only the Federal Government would save that much money, which pays about half of all health care dollars in the United States, the private sector, which pays the other half, could save a like amount of money.

These constituents wanted to know why doesn't anybody ever talk about it. I had to tell them we are talking about it. It is just that nobody is listening.

That kind of brings up the last point I want to pass on. After meeting with these three different groups in Phoenix and talking with people elsewhere I went over the weekend, it is pretty clear to me people are becoming very frustrated with their government, and this is not good. They don't think their government is listening to them. We are elected to be their representatives, to bring their ideas to Washington. Since they can't all study up on the issues as thoroughly as we are supposed to do, they trust us to not just to do what they want, not what they say, but to use our best judgment. But they do want us to listen to what they are saying and translate that into action.

What I hear them saying and what public opinion polls verify is they are very worried about the breadth and the depth of this proposed health care reform. They say it costs too much money; it is going to get us in debt; it will raise taxes which are going to be passed through to them; it is going to raise insurance premiums; and it is going to involve a massive government intrusion into what is primarily a private matter between them and their physician, with their insurance company added into the mix. They see this along the same lines as the government takeover of banks and insurance companies and car companies and everything else, and they don't like it.

One of the reasons they don't like it is because they see their own health care being delayed or denied as a result. They appreciate the fact that if the government gets so involved that it can begin to tell insurance companies what they can pay for and tell doctors what they can do for patients, that the next thing that will happen is their care will be delayed and denied and ultimately rationed.

I read a chapter in a book by our former colleague, former majority leader of the Senate, Dr. Bill Frist, a renowned heart surgeon. I talked with former Senator Frist about it last week. He actually served for about a year in England under their health system. He makes the point in his book that there are some good things about their health system. He said the bad thing is that if someone has a serious condition, unless they are at the top of the list, they run the risk of never having their serious condition dealt with.

He gave an example of a list of 100 patients who needed heart surgery. He said they would do two a day and gradually work down the list. He said what he found was that after a few weeks, peoples' names were being taken off the list. They didn't need the surgery anymore because they had died. He said that would never happen in America. He said if we have 100 people who need heart surgery in America, we would figure out a way to get that heart surgery for them right away, and we wouldn't do two a day until we ran out of time and they ran out of life. He said that is really the difference in a system in which we are controlled by the amount of money the government chooses to put into the system every day versus the kind of system we have that takes care of people and worries about the cost later. That is why it is possible for us to say that even people without insurance get cared for. No one in this country should die because they don't have insurance because we will take care of them.

Obviously, having insurance makes the delivery of care easier, more timely, and much more cost-effective, which is why at the end of the day we want to see that everybody is insured.

The bottom line is that we do not need to throw out the baby with the bathwater, get rid of the system we have that currently takes care of most people very well in order to insure that last group of folks who don't have insurance. We can provide a voucher or subsidy to them and get them coverage.

The other thing we have to do is help to bring down the costs. Republicans have offered numerous solutions on how to do that without having the government take over the system. I mentioned one: Medical malpractice reform. It does not cost a dime, it will save billions of dollars, and it is good policy besides. So why don't we do it? Because there is a vested special interest that does not want it done. It will take money out of their pockets. That is wrong.

My question to all of my colleagues is, When are we going to stand up to the special interests? Everybody likes to whack at the insurance companies. How about taking a good hard look at the trial lawyers? And, by the way, while we are talking about insurance companies, Republicans offered several ideas on how to add more competition for the insurance companies so in those situations where they have it good, if we provide for certain reforms that we have offered, such as association health plans, small business plans, more flexible HSAs, interstate sales of insurance, all these things would provide more competition for the insurance companies and force them to lower their rates. This would make health care more affordable because it would help small businesses in providing health care for their employees.

All these things came up during these meetings. As I said, I promised my constituents I would be sure to pass their ideas on to my colleagues, and I make these comments in that spirit, hoping that we will listen to our constituents not just in Arizona but in South Dakota and everywhere else around the country. And as a result of listening to a bunch of pretty commonsense folks, perhaps we will make wiser decisions here than we otherwise would have.

I see my colleague from South Dakota is here. He had some very erudite comments to make on one of the television shows on Sunday, and I am happy to yield the floor for Senator Thune.

Mr. President, in the coming weeks, the Senate will consider S. 908, the Iran Refined Petroleum Sanctions Act. Passing this bill should not be difficult 76 Members of this body are registered as cosponsors--but it is vital that we do.

I support strong sanctions to build pressure on Iran to end its illegal nuclear weapons program, which, in light of the recent disclosure of the Qom uranium enrichment facility, may be far more advanced than we realize.

However, China and Russia continue to thwart meaningful action in the United Nations Security Council. As Bob Robb, a columnist for the Arizona Republic notes, both nations have commercial ties to the Iranian regime and are unlikely to abandon their interests and assist the United States in building pressure on the Iran.

Mr. Robb also emphasizes that U.S. efforts to halt Iran's nuclear program have taken on a new urgency after the President cancelled the deployments of the ground-based interceptors to Poland and the Czech Republic.

Had the President managed to get support from Russia for more sanctions on Iran in exchange for sacrificing missile defense, things might look different. However, as shown by Secretary Clinton's recent visit to Moscow, Russia's position has not changed, and the U.S. has nothing to show for breaking its strategic commitments with two important allies.

Time is not on the administration's side. Every day the Iranians stockpile more uranium and get closer to having long-range missiles capable of delivering the world's most dangerous weapons against our allies, our deployed forces, and our homeland. The time to act is now.

Mr. President, I ask unanimous consent that the op-ed by Mr. Robb be printed in the Record.

Madam President, I wish to take 10 minutes this morning to respond to some comments made by my friend from Illinois, my counterpart, the Democratic whip, comments made in response to Minority Leader McConnell's remarks earlier this week.

Yesterday, Senator Durbin made a couple of points. One I specifically want to focus on has to do with the national debt. Senator McConnell had talked about the fact that spending by the Democrats, especially with regard to proposals for new health care legislation, was going to increase the national debt. The Senator from Illinois came back and said he agreed the debt is too high, but he said we need to understand that the reason it is too high is the Bush administration--that, in effect, President Obama inherited the debt. That is not exactly accurate. Here are the actual facts regarding the debt today. On Tuesday, 2 days ago, the Treasury Department reported that the deficit this past fiscal year totaled $1.4 trillion. That is a figure higher than the previous 4 years combined. The previous 4 years were Bush years. Last year was primarily the Obama administration.

The Republican leader said:

Since January 20 of this year, the Federal Government has

borrowed $1.2 trillion or more than $10,500 for every

household in the United States.

What is the significance of January 20? That is the day President Obama was sworn in as President.

Under the President's budget that every Democrat voted for this year, we will have budget shortfalls or deficits averaging $1 trillion each year for the next 10 years. We can't blame this on the Bush administration if spending was as much as the last 4 years combined and the budget shortfall is going to be $1 trillion for the next 10 years. It was never $1 trillion. It wasn't even half that much ever under President Bush.

Let me put this in perspective. The President's budget, supported by every Democrat, will double the national debt in 5 years, increasing it from $5.8 trillion to $11.7 trillion. It would almost triple the debt in 10 years. These are estimates from the Congressional Budget Office. By contrast, look at the last 219 years in the history of the country. From 1789 to 2008, Americans amassed a $5.8 trillion national debt. In other words, in 5 years, this President will have a debt equal to all of the previous Presidents from George Washington all the way through George W. Bush. We cannot claim that is inherited from the past.

This President's deficit spending is not sustainable. By the end of the budget period, the debt will have skyrocketed to 82 percent of the gross domestic product, which everyone agrees, including the President's advisers, is not sustainable. Think about the interest payments. Think about your own credit card interest payments for interest payments on debt. These will soon

be the single largest item in the Federal budget.

What if debt interest payments were the single largest item in your own family budget? More than $800 billion a year in 10 years will be spent on interest alone--$800 billion a year. That eclipses what we spend on national security. It is four times as much as we spend on education, energy, and transportation combined. These are not abstract numbers. This will have an effect on every American.

In 2019, under the President's plan, each U.S. household's share of the Federal debt will be more than $130,000. That is more than most of us owe on our mortgages. Notably, since the Democrats have taken over the Congress--we are not talking about ``inherited'' now--the Congress has increased the debt limit four times, and the administration has made a request for a fifth increase that we anticipate occurring this November.

So should we be worried about the debt? I believe so. Was it a problem inherited from the Bush administration? No. The real problem is what we have done since January 20, since President Obama came into office, since Democrats have been in control of the Congress and the adoption of a budget which is going to triple our debt in just 10 years. And in 5 years we will have more debt than every single President and Congress in the entire history of the country right up through George W. Bush accumulated--in one budget of this administration.

The other thing I would like to speak to is comments the Senator from Illinois made on Tuesday. Again, he was critical of Senator McConnell, who noted that all of these bills passed in the House and in the Senate were passed on essentially partisan votes, and that Republican ideas had been ignored. My colleague said: Well, in the HELP Committee there were 150 amendments adopted that had been offered by Republicans. The vast majority of those were purely technical corrections, misspellings, typos, and things of that sort. I do not think anybody can contend that Republicans have had a fair voice in the creation of the health reform legislation around here.

Then there was an attack on the messengers. There have been several reports that demonstrate that insurance premiums are going to go up, not down, in this legislation. The attack was not to contend that the figures were wrong but, rather, to attack the messengers--in two cases--to say: Well, the insurance industry actually paid for some of those reports. Does that make the reports wrong? It might raise a question in our minds as to whether they are appropriate, but how about analyzing them to see whether they are wrong.

The majority whip then went on to say that the Congressional Budget Office even disagrees with the Republican leader and predicted that the health care premiums would actually not go up. Specifically, he said: ``They predicted if health care reform went through, health care insurance premiums would go up'' on American families.

The Senator from Illinois said:

Well, there are those who disagree, people with the

Congressional Budget Office and others. . . .

Let me quote the Congressional Budget Office. It does not disagree. The Congressional Budget Office specifically supports what Senator McConnell said:

Premiums in the new insurance exchanges would tend to be

higher than the average premiums in the current-law

individual market.

CBO was very clear in conversations we have had with them that specifically with regard to American families premiums will be higher.

So the Senator from Kentucky, the Republican leader, was correct and the Democratic whip was incorrect. CBO says premiums will be higher.

This report issued yesterday from Oliver Wyman said premiums will increase in the individual market approximately $1,500 for single coverage and $3,300 for family coverage every year.

In my State and some other States it is even worse. For Arizona, Idaho, Kentucky, Virginia, and the District of Columbia, we will have the highest premium increases, where premiums could increase by as much as $2,619 for individuals and--think about this--$7,426 for families. Think about that as a premium increase under a bill that is supposed to help us afford our health care, but we get socked with a $7,000 increase in the health care premium for our families.

Part of this is because of the minimum benefit requirements the bill provides for. They note this will increase costs about 10 percent in the individual market and 3 percent in the small group market. This is under the Baucus bill. Small employers purchasing new policies in this new market will experience premiums that are up to 19 percent higher in year 5 of the reform. Premiums are going up.

Milliman, another independent actuarial firm, found that the average actuarial value of a high deductible plan is 48 percent. In Arizona, incidentally, it is 61 percent. What does this mean? Under the legislation, the lowest insurance plan value is defined by the Federal Government. It has to be 65 percent. That means there will be an increase in health insurance premiums by 35 percent for those with high deductible plans. Individuals enrolled in individual health plans with a lower actuarial value than 65 percent will see their premiums increase by 18 percent. So to the allegation that somehow Republicans are wrong when we criticize the Baucus bill for raising individual and family insurance premiums, the reality is, all the experts agree, including the Congressional Budget Office.

Then there was another question that had to do with medical devices. The reality is, because of taxes imposed in the Baucus bill, there are going to be a lot of increased expenses, including expenses that are going to be passed on to individuals. One of those is in the medical device industry.

Let me quote a letter that some Democratic colleagues of ours-- Senators Klobuchar, Bayh, and Franken and then Senator Lugar on the Republican side sent to Chairman Baucus. I am quoting from it:

[T]he provision would harm economic development and health

care innovation nationwide.

[W]e are concerned that this tax will stifle technological

innovations that can improve patient outcomes and lower

health care costs.

It is also a fact, as I said, that these expenses are passed through. There are several studies that demonstrate that--as well as the comments of the Congressional Budget Office and the Joint Tax Committee--all of whom say it is virtually a dollar-for-dollar passthrough. So if we raise taxes on the medical device industry by $40 billion, then people are going to be paying $40 billion more in insurance premiums because the cost of those medical devices will be reflected in the cost to the insurer and, therefore, the cost to the people who are paying the premiums.

There was a concern expressed by my colleague from Illinois that insurance companies will raise their premiums--the point I have been making--but they will do it in a collusive fashion and maybe we should look at the antitrust laws in that regard.

Well, they do not have to collude to raise their premiums. Every one of them has an incentive--as the Congressional Budget Office and these other reports demonstrate--for them to be able to stay in business; they have to be able to raise their premiums to reflect their cost of doing business. They do not have to collude to do that.

Then the Democratic whip made what I would say is a rather odd argument: Republicans have been critical of the concept of government- run insurance. The Democratic whip said: Well, we have government-run insurance--Federal employees and Members of Congress--and we think it is a good program. And he said under the program, there are nine different health plans to choose from, and we pick the best one for us, and the employer pays part of it and we pay part of it, and so on.

That certainly is all true, except for one thing: It is not government run. As he noted, there are nine private plans. This is no different than any other employer. Most large employers, such as the Federal Government, give their employees a choice of two, three, four, maybe sometimes as many as nine or ten plans if they are a big enough employer. The Federal Government is a huge employer, so we can offer nine different plans. But there is no Federal insurance. This is not federally run.

This is the Federal Government as the employer doing the same thing

that Honeywell as an employer would do for its employees. It gets three or four insurance companies with different kinds of plans and says to its employees: We will pay for part of the cost. You get to pay for the rest of it. That is not federally run or government-run insurance. So the Democratic whip is simply wrong when he says the plan Members of Congress and Federal employees have is government run. That is simply not true.

I mentioned the medical device issue. I would note Senator Kerry is another one of our colleagues who, like me and like others, has expressed concerns about this issue because of the fact that the taxes paid by the medical device industry will, in fact, be passed on to consumers.

Finally, the Democratic whip asked where the Republican health care plan is. I do not know how many times we have to repeat this, but let me do it one more time. Time and time again, we have said: Here are things we believe will reduce the cost of health care, will help people get coverage who do not have it now, and will reform the system.

What are some of the ideas we have proposed? By the way, each of these were offered as amendments in the HELP Committee and in the Finance Committee and in the House of Representatives, and Democrats voted against every one of them every time. So it is not as if we do not have ideas and alternatives that would solve specific problems, it is that the Democrats do not like the ideas and, therefore, have rejected them. But I will repeat a couple of them one more time.

Republicans lead with medical malpractice reform, to try to do something about this jackpot justice system where lawyers end up getting most of the money, and doctors and hospitals have to practice defensive medicine to anticipate litigation and to be able to protect themselves against it. There are estimates: as much as 10 cent out of every health care dollar spent is on premiums that doctors have to pay for their liability insurance. There is over $100 billion a year that can be saved from defensive medicine practices if we are able to have medical malpractice reform. The CBO even scored it--in a very narrow way--at $54 billion just in savings to the Federal Government.

As my colleague, Senator Ensign, pointed out in an exchange with the CBO Director in the Finance Committee, one could anticipate that about twice that much savings would occur if we add in all of the savings to the private sector as well. So we could be talking about well over $100 billion in savings. This is a huge amount of money. It does not cost the Federal Government a dime. It makes the system more fair, and it is a savings that can be passed on in the form of lower premiums and lower health care costs.

Another idea we have talked about a lot--you have heard it--the sale of insurance across State lines. Let's make the insurance companies have to compete with each other. Sometimes they have little monopolies; there are only two or three companies in a particular State. Well, if we could buy our health insurance like we can buy our casualty insurance, our homes or our car insurance, from any company anywhere in the country, those insurance companies in our States would have to be better competitors. My guess is they would lower our rates and they would give us better benefits. That competition would help us. Again, it does not cost a dime.

How about association health plans, letting small businesses and groups band together to create larger risk pools? Risk pools help define the coverage. If we have a big risk pool, chances are we can get cheaper coverage. If we have a small risk pool, it is hard. That is why small businesses find it so hard. So we talk about larger risk pools through association health plans.

Madam President, I think I have exceeded my 10 minutes. We could go on and on with Republican ideas that have been proposed but get shot down by the Democrats. So it is not a matter of looking for a Republican proposal.

Let me conclude with this: It is true that Republicans will probably not propose a massive trillion-dollar bill as the Democrats have. That is true. We are not going to because we do not do 1,000-page bills in the Congress very well. We do not know the consequences of them. The cost is always enormous.

Republicans have a better approach. We believe we should do this step by step: First, regain the trust of the American people that we can do it right, and that we are listening to them about what they want rather than coming up with some grand scheme that a bunch of staffers and consultants in Washington, DC, came up with.

Let's listen to the American people, hear what it is they want. They do not want a massive, big spending bill that is going to add to our deficit, that is going to raise their taxes and raise their insurance premiums, and, in the end, not insure very many more Americans. That is not reform.

Madam President, I see my colleague from Tennessee is in the Chamber. He has been an eloquent spokesman on this issue, and I am pleased to yield the floor.

The following Senator is necessarily absent: the Senator from Mississippi (Mr. Cochran).