Floor Statements

Madam President, the Senator from Arizona and I and Senator Barrasso, who will be here in a few minutes, had the privilege of

being invited by the President to a lengthy health care summit a couple of weeks ago at the Blair House, a historic location right across from the White House.

Over the 7\1/2\-hour discussion, there were some obvious differences of opinion. In fact, my friend, the majority leader, said: Lamar, you are not entitled to your own facts. I think he is right about that. We want to use the real facts. But the American people, once again, seem to have understood the real facts.

In the Wall Street Journal yesterday, March 10, there was an article by Scott Rasmussen and Doug Schoen. Mr. Rasmussen is an independent pollster, and Mr. Schoen was President Clinton's pollster. Here is one of the things they said. We were saying, with respect to the President: Mr. President, your plan will increase the deficit. This is a time when many people in America believe the deficit is growing at an alarming rate and will bring the country to its knees in a few years if we do not do something about it. The President and his Democratic colleagues said: No, the Congressional Budget Office says we do not increase the deficit.

The American people do not believe that, according to Mr. Rasmussen and Mr. Schoen. They say:

. . . 66 percent of voters believe passage of the President's

plan will lead to higher deficits.

They are right about that. Why do I say that? Because not included in the comprehensive health care plan that the President has yet to send up--we do not have a bill yet. We have an 11-page memo which is suggested recommendations in a 2,700-page Senate bill. We do not have a bill. But the plan does not include what it costs to prevent the planned 22 percent pay cuts for doctors that serve Medicare patients over the next 10 years. According to the President's own budget--and Paul Ryan, the Congressman from Wisconsin, brought this up at the summit--that costs $371 billion over 10 years.

Let me say that once more. What we are being asked to believe is, here is a comprehensive health care plan that does not add to the debt, but it does not include what it costs to prevent the planned 22 percent pay cuts for doctors that serve Medicare patients. That is akin to asking you to come to a horse race without a horse. Does anybody believe a comprehensive health care plan is complete and comprehensive if it does not include what you actually are going to pay doctors to see Medicare patients? Of course not. You have to include that in there. That adds $371 billion to the President's proposal, and that, by itself, makes it clear the proposal adds to the deficit.

The Senator from Arizona is here, and I say this to the Senator. Also in the article in the Wall Street Journal it said:

Fifty-nine percent of the voters say that the biggest

problem with the health care system is the cost. . . .

That is what we have been saying over and over again. Let's don't expand a program that costs too much. Let's fix the program by reducing costs.

According to the survey--remember this is an independent pollster and a Democratic pollster:

Fifty-nine percent of voters say that the biggest problem

with the health care system is the cost: They want reform

that will bring down the cost of care. For these voters, the

notion that you need to spend an additional trillion dollars

doesn't make sense. If the program is supposed to save money,

why does it cost anything at all?

Asked the pollsters.

I ask the Senator from Arizona that question. If this program is supposed to save money, reduce costs, why does it cost anything at all?

Madam President, I appreciate the Senator from Arizona bringing this up, and I think it is important for the American people to be reminded that the Senator from Arizona has a certain amount of credibility on this matter because about 4 years ago--when we were in the majority and we became frustrated because

Democrats were blocking President Bush's judicial appointments--it was the Republicans who said--I didn't, but some Republicans said--well, let's just jam it through. We won the election, let's get it with 51 votes. Let's change the rules.

But Senator McCain and a group of others said: Wait just a minute. He said then what he has said just today. He said the U.S. Founders set up the Senate to be a protector of minority rights. As Senator Byrd, the senior Democratic Senator, has said: Sometimes the minority is right. And it was Alexis de Tocqueville who said, when he wrote his observations about our country in the 1830s, that potentially the greatest threat to American democracy is the tyranny of the majority.

This is supposed to be a place where decisions are made based upon consensus, not just a majority. As Senator Byrd has said: Running the health care bill through the Senate like a freight train is an outrage. It would be an outrage.

I would ask the Senator from Arizona whether he believes it is not just the higher premiums and the higher taxes and the extra costs to States; that, in the end, the reason this health care bill is so deeply unpopular is because of the process because, first, there were 25 days of secret meetings, and now they are jamming it through by a partisan vote. Something this big, this important ought to be decided by consensus in the Senate.

I wonder if the Senator from Arizona would agree with me that what is happening is the President is inviting the House Democrats to join hands and jump off a cliff and hope Senator Reid catches them.

Well, when they jump, they may be. But Senator Reid and his Democratic colleagues, I would say to my friend from Arizona, are not going to have any incentive to catch these House Members who vote for the bill because the President will have already signed it into law, and he will be well on his way to Indonesia, as the Senator from Arizona has just said. We have 41 Republican Senators who have signed a letter saying that you are not going to make new deals and send them over here and change them by reconciliation.

Madam President, I congratulate the Senator from Arizona for his consistency, for 5 years ago saying to members of his own party that the Senate is a place where minority rights are protected. As Senator Byrd has said, sometimes the minority is right. It slows things down, yes; but it forces us to get it right.

I ask unanimous consent to have printed in the Record the editorial from the Wall Street Journal to which I referred a little earlier.

Madam President, I ask unanimous consent that the Senator from Wyoming be allowed to lead the colloquy in our remaining time.

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

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

Thank you. Mr. President, will the Acting President pro tempore please let me know when I have consumed 12 of the 15 minutes.

Thank you very much, Mr. President.

Mr. President, it was my privilege last Thursday, along with some other Members of the Senate, to attend a health care summit at the invitation of President Obama. It went on a long time. We learned one thing we already knew, that our President is smart and knows a lot about health care. So he stayed the whole time.

But it gave those of us on the Republican side a chance we do not have the opportunity to have as often, which is, to be on center stage and let the American people know, A, who we are, and, B, what our ideas are. So it was a terrific way for us to show, for example, that our goal is to reduce health care costs, that we wish to move step by step toward that goal.

We identified a number of areas, such as being able to buy health insurance across State lines, allowing small business health plans to pool together, reducing junk lawsuits--all of which will tend to bring down the cost of premiums, which is what most Americans want.

During the discussion, early on, actually, the President and I had a little disagreement about whether his plan, which is based upon the Senate bill, which passed on Christmas Eve, would raise premiums. What I had said in my opening remarks on behalf of Republicans was that millions of Americans, under the Democratic plan, would pay higher insurance premiums in the individual market because of government mandates and taxes. The President says that is wrong. I cited a Congressional Budget Office report to show I was right. And rather than dispute the President of the United States in public--I thought I had enough time to make my case--I said I would send him a letter, which I did that same day. So I ask unanimous consent, Mr. President, to have printed in the Record the letter I gave to President Obama on Thursday.

But today what I wish to do in the next few minutes is explain why I believe I am correct, that under the President's health insurance plan, which is based upon the Senate plan, for millions of Americans in the individual market, premiums would go up because of one-size-fits-all government mandates, because of taxes that are passed on to consumers; but for other reasons as well--by shifting costs.

When you dump 15 million people or 18 million people into a program called Medicaid, what happens is, we do not pay the doctors and the hospitals well enough to take care of those folks. So

those providers shift the costs to people who are paying with private insurance, and premiums go up.

Costs for young people in the individual market will go up under this plan because if you put in a rule that says my insurance at my age cannot go up more than a certain amount compared with my son's insurance, then his insurance goes up, and because a scheme like the Democratic plan depends upon requiring everybody to buy insurance. There is a weak provision for that, and I suspect many young people will rather pay the $750 fine rather than buy a $2,500 insurance policy, which they think they cannot afford.

The President made the point in his usual very persuasive way that, wait a minute, actually you would be getting better insurance. But that is comparing apples and oranges. As George Will said on ABC's ``This Week'' yesterday--he asked this question: If the government required you to buy a better, more expensive car, even if it was better than the car you have, it would still be more expensive, would it not?

That is the case with the President's health care plan. In fact, premiums will go up for millions of Americans in the individual market, up more than they otherwise would over the next several years--and we all know how rapidly they are rising--and the whole exercise we have been going through over the last year is to bring premiums down, not help drive premiums up.

What I said to the President, with respect, was that the Congressional Budget Office, on November 30, said this about the Senate bill:

The Congressional Budget Office and the Joint Committee on

Taxation estimate that the average premium per person covered

for new nongroup--

That means individual policies--

would be about 10 to 13 percent higher in 2016 than the

average premium for nongroup--

That is individual coverage--

in the same year under current law.

In other words, if you buy an individual policy--that means not a policy with your employer--by 2016 it will be at an average of 10 to 13 percent higher than it otherwise would.

I ask unanimous consent to have printed in the Record the relevant parts of the Congressional Budget Office letter of November 30 to Senator Evan Bayh on this point.

Now, the President said: Wait a minute. The premiums in the individual market will go down 14 to 20 percent. That is also in the same letter. Of course, he is right about that. They go down because of administrative efficiencies and new enrollment, but he left out that there are other factors involved so that the government mandates will drive them up 27 to 30 percent or, in the end, the average, as the CBO said, premium per person covered in an individual policy would be up 10 to 13 percent.

The bill has subsidies in it for some Americans. The same letter says about half of Americans who buy in the individual market will get a subsidy. Well, we are paying for that subsidy, but let's concede that point. Still, that leaves half of the people in the individual market for whom premiums will go up on an average of 10 to 13 percent.

Why is that? One reason is because the Senate bill says people will have to buy a richer policy than they have today. That means it has a higher actuarial value. They call it in the bill ``minimum creditable coverage.'' It means this is the amount of insurance I think you should have before you buy a policy. That might be a good decision. It undoubtedly would be good to have the insurance. It just costs 27 to 30 percent more than today's average.

The National Federation of Independent Businesses wrote a December 12 letter in opposition to the Senate bill saying the benefit mandates will put small business owners ``at risk of having to drop coverage due to cost increases that outpace their health budgets.''

I ask unanimous consent to have printed in the Record the letter from NFIB to Senator McConnell and Senator Reid, dated December 8.

The one-size-fits-all provision in the Democratic bill says all individual and small group policies must have an actuarial value of 60 percent.

Senator Susan Collins of Maine, who was the insurance commissioner of Maine, made a speech on the Senate floor on December 18, and pointed out that 87 percent of the individual policies that are purchased in Maine today would cost more under the Reid bill.

I commend to my colleagues the Senator's testimony of December 18, 2010.

Senator Collins used the example that the most popular individual market policy sold in Maine costs a 40-year-old about $185 a month. Under the Senate bill that 40-year-old would have to pay at least $420 a month, more than twice as much for the policy that meets the new minimum standard, or face a $750 penalty. It is true Maine citizens, as is true for all Americans--about half of them--would receive subsidies to help them buy that policy, but the average premium for the other half of the 87 percent is going to go up under the Democratic bill.

We believe Americans ought to have more choices than that. That is a fundamental difference of opinion. Should Washington decide you need to buy a richer policy, or should you decide that for yourself based upon the other needs of your family?

The Congressional Budget Office does state, as I have mentioned, that there are a number of enrollees--about half--who would have the subsidies, and that is in the letter I have already introduced into the Record. But someone is paying for those subsidies: the taxpayers are paying for them, which brings up the second reason I said on Thursday that premiums for millions of Americans in the individual market will go up.

The commonsense idea is that if you tax an insurance company or a medical device company or a manufacturer of drugs, they will pass the taxes on to whom? To us, who are buying insurance policies or medical devices or drugs. So we end up paying. In fact, one part of the President's proposal deliberately does that. It is a 40-percent excise tax on insurance companies for what we call Cadillac plans, the high- cost private insurance plans.

A letter from the Joint Committee on Taxation, dated February 24, says the 40-percent excise tax will raise $32.7 billion, all of which will be passed along to consumers in the form of higher insurance premiums. That may be a good thing. In fact, I think it is because it helps to discourage the purchase of more expensive policies. But it does raise premiums in the individual market.

The Joint Committee on Taxation Memorandum on High Cost Plans, dated September 29, says:

The excise tax would be mainly passed along through

increases in premiums.

Because the new tax is indexed to regular inflation plus 1 percent instead of medical inflation, which goes up very much higher and quicker, the new tax, like the alternative minimum tax, will pretty soon start to hit Chevy and Buick insurance policies and not just Cadillac policies.

But there are other taxes in the President's proposal. There are up to $\1/2\ trillion in new taxes, which will be passed on to consumers: $20 billion in excise taxes on lifesaving medical devices, $33 billion on drugs, and $60 billion on health insurance companies. In the previously mentioned CBO letter and a JCT letter to Senator Grassley in October of last year, both said these taxes will be passed on to patients, increasing health insurance premiums.

The Chief Actuary of the Center for Medicare and Medicaid Services, who is a part of the Obama administration said:

We anticipate such fees would be generally passed through

to health consumers in the form of higher drug and device

prices and higher insurance premiums.

That was on December 10 of last year, about the Senate bill.

The Lewin Group, on October 30, said:

Employer spending would increase steadily under the

[Democratic] act, reflecting the cost of paying the various

excise taxes under the act. Total employer health spending

would increase by 2.1 percent by 2019.

I ask unanimous consent to have printed in the Record the executive summary of the Lewin Group letter.

The National Federation of Independent Business letter says the same. There are other reasons the premiums will go up.

Mr. President, seeing no one else here, I wonder if I might ask unanimous consent for 5 additional minutes.

I thank the President.

Here is a third reason, in addition to government mandates and taxes, that will cause premiums to rise. We call it cost-shift. Premiums will increase because the bill dumps 15 million to 18 million more Americans into the government program called Medicaid. This is the analysis of the Chief Actuary on January 8, 2010.

I ask unanimous consent that the relevant portions be printed in the Record.

The point is, Medicaid only pays doctors and hospitals about 60 percent of the cost of serving the 60 million patients who are now there. The Democratic bill would add 15 million to 18 million more patients. So what do the doctors and hospitals do? They see these patients, but then they shift the costs to the patients they see who have private insurance.

The President himself said that adds about $1,000 to every policy today, this cost-shifting. I have included that comment from the Chief Actuary.

The PriceWaterhouseCoopers report on the Senate Finance Committee bill in October of 2009 indicated that the net effect of the bills before Congress will make the Medicare and Medicaid cost-shift even more severe, raising the cost of private insurance premiums for large employers by $255 a year between 2015 and 2019.

I ask unanimous consent to have printed in the Record the relevant portions of the PriceWaterhouseCoopers report.

Younger Americans in the individual market will pay higher premiums under the Democratic plan because, as I mentioned earlier, it will mandate for individual coverage that I can't pay more than three times as much as my son can pay for an insurance premium. That might help keep my premiums down, but it is going to send his up pretty far because 42 States, including Tennessee, allow more variance of that. So young people across America, who include about 30 percent of the uninsured, are in for a big surprise when their individual policies jump up 30 to 35 percent, which is what the Oliver Wyman report on September 28 said theirs might do, or when, since they are uninsured, they are required to buy insurance and they find the insurance they are required to buy is very expensive.

I ask unanimous consent to have printed in the Record the conclusion of the Oliver Wyman report.

Finally, the young and the healthy can skip out of this. That will drive up premiums. They may decide they would rather pay a $750 fine than $2,500 for a health insurance policy they think they don't need.

The American Academies of Actuaries wrote a letter on the Reid bill on November 20 that said: ``Any premium variations by age limited to a 3.1 ratio between the highest and lowest premiums,'' and then it goes on to say, ``would cause higher premiums on average relative to current premiums.''

I ask unanimous consent to have printed in the Record the letter from the American Academy of Actuaries of November 20, 2009.

All in all, these factors suggest why, when Senator Collins took a look at Maine, she found that 87 percent of people in Maine are paying less for their individual policies than the policies would cost under the Reid bill. It is true that half or more of them would receive some subsidy, which would reduce their costs, but around half of them will pay more. In Tennessee, Blue Cross Blue Shield, which covers about one-third of Tennessee's individual market, estimates the premiums for those individuals will increase by 30 to 45 percent under the Reid bill.

I ask unanimous consent to include a chart which demonstrates that.

At our summit on Thursday, there were a number of good ideas about reducing health care costs that the President seemed to share with Republican Members who were there. There was some obvious irritation on the part of the majority leader and others when we said things such as there is $\1/2\ trillion worth of cuts in Medicare, which there are. Our real objection to it is that the cuts are not used to save Medicare, which is going broke, but spent on a new program-- $\1/2\ trillion in new taxes. There is $\1/2\ trillion in new taxes.

As I have just said, they tend to increase premiums for millions of Americans. There are premium increases. There is a deficit increase.

It is true the CBO has said that what was presented to them didn't increase the deficit, but what was not included in what was presented was paying doctors to serve patients in the government program we call Medicare. That is like having a horse race without the horses. How are you going to have a comprehensive health care bill and not include within its costs paying doctors to serve patients in the government program? When you put it in, the deficit goes up.

Then there is a problem of the passing off to States these expanded Medicaid costs without paying for them. I know as a former Governor-- and I see the former Governor of Virginia in the chair--I struggled with that every single year. All the Governors are today in both parties. They don't want us sending them a bill for expanded health care. They can't pay the bills they have. We shouldn't do that. If we want to expand it, we should pay for it. That is another part of the bill.

So I came to the floor today to, No. 1, express my appreciation to the President for inviting us Thursday. It gave us a chance to show who we are and what we are for. I thought it was a good discussion. I believe there are 8 or 10, maybe a dozen different good ideas Senator Coburn and people on both sides of the aisle suggested. There are some differences between those ideas but, basically, they represent a way to move forward to reduce health care costs. That is what we ought to do. We don't do comprehensive very well in the Senate. Comprehensive immigration failed of its own weight. Comprehensive economy-wide cap and trade seems to be failing, again of its own weight. Comprehensive health care is very difficult to pass. That shouldn't be a surprise to any of us. This is a very big, difficult, complicated country with people of many different backgrounds and, in my judgment, we are just not wise enough for a few of us to rewrite the rules for 17 percent of our economy.

I think the American people have tuned into that. They want us to fix health care, but they want us to reduce costs. Again, we on the Republican side are ready to set that goal and, as we said 173 different times on the Senate floor the last six months of last year, we have offered 6 steps to move toward that goal. Maybe the President can think of six more. Maybe we can think of six more. We did that with the America COMPETES Act. We asked the national academies: What are the 10 steps that can help us become more competitive as a country? They gave us 20, and we passed most of them. In clean energy, we are coming together on nuclear power, offshore drilling, and energy development. Those are steps toward a goal that would be a more sensible way for us to work.

In the meantime, the unpleasant truth is, the current bill being considered--will cut Medicare, not spend it on Medicare--will raise taxes, and it will, as I have tried to demonstrate with respect to the President, raise individual premiums because of the one-size-fits-all government mandates and tax increases.

Finally, I commend to my colleagues today's editorial from the Wall Street Journal detailing how the Massachusetts health care plan has unexpectedly caused premiums to rise over the last couple years and what lesson there might be in that for us.

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

Mr. President, today Senator Carper and I have joined with Senators Klobuchar, Collins, Gregg, Kaufman, Graham, Feinstein, Shaheen, Schumer, Lieberman, and Snowe to introduce the Clean Air Act Amendments of 2010.

This bill is about clean air and the effect of sulfur dioxide, nitrogen oxides, and mercury emissions of coal-fired power plants on health, jobs, and tourism. This bill does not address carbon emissions.

To me the most important aspect of this bill is that for the very first time it puts into federal law requirements that we cut mercury emissions by 90 percent from coal plants, which produce 50 percent of our electricity today.

This bill will reduce sulfur dioxide, nitrogen oxides, and mercury emissions from power plants by directing EPA to cut mercury emissions at least 90 percent through the best available technology and strengthening national limits on emissions of sulfur dioxide and nitrogen oxides from power plants with new trading systems that will enable cost-effective reductions of these two pollutants.

For Tennesseans this is a bill about our health, it is about tourism in our State and it is about our jobs.

400,000 Tennesseans have asthma that is affected by the dirty air in our state. Sulfur dioxide and nitrogen oxides can trigger asthma attacks and cause chronic lung problems. 400,000 Tennesseans with asthma are at a daily risk due to poor air quality.

The more we learn about mercury the more we understand that it gets in our food supply, it gets in our water supply, some of it comes from our coal plants and it especially affects women and children. Nationwide, EPA estimates this bill will save more than 215,000 lives and more than $2 trillion in health care costs by 2025.

In our State, we are privileged to have the most visited national park in America, the Great Smoky Mountains National Park--we are intensely proud of it. But we want the 10 million tourists who come there every year to see the blue haze that the Cherokee Indians used to sing about, not the smog that is produced by dirty air blowing into our State and some of the dirty air that we produce.

Finally we have become an automobile State. When auto parts suppliers move to Tennessee and want to locate near the Nissan plant or near the Volkswagen plant, one of the first things they have to do is to get a clean air permit. Our State simply cannot clean up our air all by ourselves without strong national standards to require the rest of the country to stop producing dirty air that blows into our State. So for Tennesseans this is about our health, about our tourism and our mountains, and this is about our jobs.

The Environmental Protection Agency says the bill will only cost electricity consumers about 1.5 percent to 2.5 percent increases in their utility bills by 2020. This may only be about $2 a month per customer. I think $2 a month is worth it for savings of $2 trillion in health care costs.

In summary, this bill helps save hundreds of thousands of lives, saves trillions of health care dollars, enables communities to meet new EPA air quality requirements and create new jobs, and protects the scenic beauty of some of our greatest natural treasures.

Cleaner air is something we can all support and I ask my colleagues to join Senator Carper and me in this effort.

Mr. President, I ask unanimous consent that a description of the bill be printed in the Record.

Mr. President, today Senator Carper and I have joined with Senators Klobuchar, Collins, Gregg, Kaufman, Graham, Feinstein, Shaheen, Schumer, Lieberman, and Snowe to introduce the Clean Air Act Amendments of 2010.

This bill is about clean air and the effect of sulfur dioxide, nitrogen oxides, and mercury emissions of coal-fired power plants on health, jobs, and tourism. This bill does not address carbon emissions.

To me the most important aspect of this bill is that for the very first time it puts into federal law requirements that we cut mercury emissions by 90 percent from coal plants, which produce 50 percent of our electricity today.

This bill will reduce sulfur dioxide, nitrogen oxides, and mercury emissions from power plants by directing EPA to cut mercury emissions at least 90 percent through the best available technology and strengthening national limits on emissions of sulfur dioxide and nitrogen oxides from power plants with new trading systems that will enable cost-effective reductions of these two pollutants.

For Tennesseans this is a bill about our health, it is about tourism in our State and it is about our jobs.

400,000 Tennesseans have asthma that is affected by the dirty air in our state. Sulfur dioxide and nitrogen oxides can trigger asthma attacks and cause chronic lung problems. 400,000 Tennesseans with asthma are at a daily risk due to poor air quality.

The more we learn about mercury the more we understand that it gets in our food supply, it gets in our water supply, some of it comes from our coal plants and it especially affects women and children. Nationwide, EPA estimates this bill will save more than 215,000 lives and more than $2 trillion in health care costs by 2025.

In our State, we are privileged to have the most visited national park in America, the Great Smoky Mountains National Park--we are intensely proud of it. But we want the 10 million tourists who come there every year to see the blue haze that the Cherokee Indians used to sing about, not the smog that is produced by dirty air blowing into our State and some of the dirty air that we produce.

Finally we have become an automobile State. When auto parts suppliers move to Tennessee and want to locate near the Nissan plant or near the Volkswagen plant, one of the first things they have to do is to get a clean air permit. Our State simply cannot clean up our air all by ourselves without strong national standards to require the rest of the country to stop producing dirty air that blows into our State. So for Tennesseans this is about our health, about our tourism and our mountains, and this is about our jobs.

The Environmental Protection Agency says the bill will only cost electricity consumers about 1.5 percent to 2.5 percent increases in their utility bills by 2020. This may only be about $2 a month per customer. I think $2 a month is worth it for savings of $2 trillion in health care costs.

In summary, this bill helps save hundreds of thousands of lives, saves trillions of health care dollars, enables communities to meet new EPA air quality requirements and create new jobs, and protects the scenic beauty of some of our greatest natural treasures.

Cleaner air is something we can all support and I ask my colleagues to join Senator Carper and me in this effort.

Mr. President, I ask unanimous consent that a description of the bill be printed in the Record.

Mr. President, I look forward to the President's State of the Union Address on Wednesday, as I know most Americans do. There is a lot of talk about how the President might reconnect with the American people. The President himself said a couple of days ago, after Massachusetts elected a Republican Senator, that perhaps he had not been talking to the American people directly about core values. If I may do this in a respectful way, I would like to make a suggestion about what the President might say on Wednesday evening.

To reconnect with the American people, I suggest in his State of the Union Address the President talk first about creating jobs; second, about reining in the national debt; and make terrorism his third subject. Then it would not hurt my feelings one bit if he stopped his speech right there and focused his unswerving attention on jobs, debt and terrorism until he has them all headed in a better direction. After all, in my view, the President struggled in his first year not only because his agenda veered too far to the left but because he took too many big bites out of too many apples and tried to swallow them all at once.

Years ago, I learned that a Governor who throws himself into a single issue with everything he has for as along as it takes can usually wear out everybody else. I think that is true for Presidents, too. In 1952, President Dwight D. Eisenhower said, ``I shall go to Korea.'' Then he focused on that one problem, ended the conflict, and Americans thanked him for it.

I hope President Obama would focus with Eisenhower-like intensity on jobs. In the 1980s, I found the best way to do that was not to try to turn my State, Tennessee, upside-down all at once. We were then the third poorest State in the Union. My goal was raising family incomes. I didn't try to turn it upside-down all at once, but I went step by step--sometimes learning as I went--amending banking laws, defending right-to-work, keeping debt and taxes low, recruiting Japanese industry and then the auto industry, building four-lane highways so the auto suppliers could get to the auto plants, and finally a 10-step ``Better Schools'' plan which included centers and chairs of excellence for higher education.

In my view, a step-by-step job strategy for the country should include tax cuts, less regulation, certainty so people can make their plans, free trade, a balanced labor climate, good educational opportunities, and clean but cheap energy. Unfortunately, the President has too often proposed higher taxes, more regulation, uncertainty, protectionism, expensive labor policy, higher college tuitions (as Medicare costs are passed on to States), a national energy tax, and new costs for the businesses that we count on to create jobs.

As for debt, Democrats in Congress are trying this week to raise the national debt limit by $1.9 trillion, an amount that is more than the total Federal budget in 1999. To be sure, President Obama inherited some of this, but he has run up a $1.5 trillion debt in just one year and it took President Bush 8 years to accumulate a $2 trillion debt. The solution for a boat sinking because it has a hole in it is not to put more holes in it.

Finally, the President deserves credit for his decisions on Iraq and Afghanistan but bringing terrorists from Guantanamo to Illinois, trying the 9/11 mastermind in New York City, and failing to interrogate the Christmas Eve ``underwear bomber'' in Detroit shows dangerous confusion about how to deal with terrorists.

When I became Governor, Ned McWherter, then the Democratic house speaker, said, ``I want to help because if the Governor succeeds the State succeeds.'' In the same way, I want President Obama to succeed. The best way for him to do that, I respectfully suggest, is to declare an end to the era of the 2,700-page bills and to work with both political parties, step by step, on jobs, debt, and terrorism to help Washington re-earn the trust of the American people.

I yield the floor.

Madam President, during our recent health care debate I heard a number of times from our friends on the other side of the aisle this question: What are Republicans for?

Well, they will wait a long time if they are waiting for the Republican leader, Senator McConnell, to roll into the Senate a wheelbarrow filled with a 2,700-page Republican comprehensive health care bill or, for that matter, a 1,200-page climate change bill or a 900-page immigration bill.

If you have been listening carefully to the Senate debate, you will know that on health care, as well as on clean energy, debt reduction, and immigration, for example, Republicans have been offering the following alternative to 1,000-page bills: going step by step in the right direction to solve problems in a way that re-earns the trust of the American people.

Comprehensive immigration, comprehensive climate change, and comprehensive health care bills have been well intended, but the first two fell of their own weight, and health care, if enacted, would be a historic mistake for our country and a political kamikaze mission for Democrats.

What has united most Republicans against these three bills has not only been ideology but also that they were comprehensive. As George Will might write: ``The Congress. Does. Not. Do. Comprehensive. Well.''

Two recent articles help explain the difference between the Democratic comprehensive approach and the Republican step-by-step approach.

The first, which appeared in the new journal, National Affairs, and was written by William Schambra of the Hudson Institute, explains the ``sheer ambition'' of President Obama's legislative agenda as the approach of what Mr. Schambra calls a ``policy President.''

Mr. Schambra says the President and most of his advisers have been trained at elite universities to govern by launching ``a host of enormous initiatives all at once . . . formulating comprehensive policies aimed at giving large social systems--and indeed society itself--more rational and coherent forms of functions.''

This is governing by taking big bites of several big apples and trying to swallow them all at once. In addition, according to Mr. Schambra, the most prominent organizational feature of the Obama administration is its reliance on ``czars''--more than the Romanovs, said one blogger--to manage broad areas of policy. In this view, systemic problems of health care, of energy, of education, and of the environment simply can't be solved in pieces.

Analyzing the article, David Broder of the Washington Post wrote this:

Historically, that approach has not worked. The

progressives failed to gain more than a brief ascendency and

the Carter and Clinton presidencies were marked by striking

policy failures.

The reason for these failures, as Broder paraphrased Schambra, is that ``this highly rational comprehensive approach fits uncomfortably with the Constitution, which apportions power among so many different players.'' Broder then adds this:

Democracy and representative government are a lot messier

than the progressives and their heirs, including Obama, want

to admit.

James Q. Wilson, a scholar, writing in a memorial essay honoring Irving Kristol in the Wall Street Journal a few months ago, says the law of unintended consequences is what causes the failure of such comprehensive legislative schemes. Explains Wilson:

Launch a big project and you will almost surely discover

that you have created many things you did not intend to

create.

Wilson also writes that neoconservatism, as Kristol originally conceived of it in the 1960s, was not an organized ideology or even necessarily conservative, but ``a way of thinking about politics rather than a set of principles and rules. . . . It would have been better if we had been called policy skeptics.''

The skepticism of Schambra, Wilson, and Kristol toward grand legislative policy schemes helps to explain how the law of unintended consequences has made being a member of the so-called ``party of no'' a more responsible choice than being a member of the so-called party of ``yes, we can''--if these three recent comprehensive bills on health care, climate change, and immigration are the only choices.

Madam President, it is arrogant to imagine that 100 Senators are wise enough to reform comprehensively a health care system that constitutes 17 percent of the world's largest economy and affects 300 million Americans of disparate backgrounds and circumstances.

How can we be sure, for example, that one unintended consequence of spending $2.5 trillion more for health care over 10 years will not be higher costs and more debt? Won't new taxes be passed along to consumers, raising health insurance premiums and discouraging job growth? Won't charging insolvent States $25 billion over 3 years for a Medicaid expansion raise State taxes and college tuitions? Ask any Governor. And how can a Senator be so sure that some provision stuck in a 2,700-page partisan bill in secret meetings and voted on during a snowstorm at 1 a.m. will not come back around and slap him or her in the face, such as trying to explain why Nebraska got a cornhusker kickback to pay for its Medicaid expansion and my State did not?

James Q. Wilson also wrote in his essay that respect for the law of unintended consequences ``is not an argument for doing nothing, but it is one, in my view, for doing things experimentally. Try your idea out in one place and see what happens before you inflict it on the whole country,'' he suggests.

If you will examine the Congressional Record, you will find that Republican Senators have been following Mr. Wilson's advice, proposing a step-by-step approach to confronting our Nation's challenges 173 different times during 2009. May I say that again? During 2009, Republican Senators, 173 different times on the floor of the Senate, have proposed a step-by-step approach toward health care and other of our Nation's challenges.

On health care, for example, we first suggested setting a clear goal; that is, reducing costs. Then we proposed the first six steps toward achieving that goal: No. 1, allowing small businesses to pool their resources to purchase health plans; No. 2, reducing junk lawsuits against doctors; No. 3, allowing the purchase of insurance across State lines; No. 4, expanding health savings accounts; No. 5, promoting wellness and prevention; and No. 6, taking steps to reduce waste, fraud, and abuse. We offered these six proposals in complete legislative text. It totaled 182 pages, all 6. The Democratic majority rejected all six of our proposals and ridiculed the approach, in part because our approach was not comprehensive.

Take another example. In July, all 40 Republican Senators announced agreement on 4 steps to produce low-cost, clean energy and create jobs: No. 1, create 100 new nuclear powerplants or at least the environment in which they could be built; No. 2, electrify half our cars and trucks; No. 3, explore offshore for natural gas and oil; and No. 4, double energy research and development for new forms of energy. This step-by-step Republican clean energy plan is an alternative to the Kerry-Boxer national energy tax which would impose an economy-wide cap- and-trade scheme, driving jobs overseas looking for cheap energy and collecting hundreds of billions of dollars each year for a slush fund with which Congress can play.

Here is another example. In 2005, a bipartisan group of us in Congress asked the National Academies to identify the first 10 steps Congress should take to preserve America's competitive advantage in the world so we could keep growing jobs. The academies appointed a distinguished panel, including now-Secretary Chu, that recommended 20 such steps. Congress enacted two-thirds of them. The America COMPETES Act of 2007, as we call it, was far-reaching legislation, but it was fashioned step by step.

Another example. When I was Governor of Tennessee in the 1980s, my goal was to raise family incomes for what was then the third poorest State. As I went along, I found that the best way to move toward that goal was step by step--some steps smaller, some steps larger--such as changing banking laws, defending right-to-work policies, keeping debt and taxes low, recruiting Japanese industry, and then the auto industry, building four-lane highways so suppliers could get to the auto plants, and then a 10-step better schools program, 1 step of which made Tennessee the first State to pay teachers more for teaching well. I did not try to turn our whole State upside down all at once, but working with leaders in both parties, I did help it change and grow step by step. Within a few years, we were the fastest growing State in family incomes.

According to a recent survey by On Message Inc., 61 percent of Independents, 60 percent of ticket splitters, and 77 percent of Republicans answered yes to the following question: I would rather see Congress take a more thoughtful step-by-step approach focusing on commonsense reforms.

Human experience has always taught that enough small steps in the right direction is one good way to get you where you want to go and also a good way along the way to avoid many unexpected and unpleasant consequences.

Tuesday's election in Massachusetts is the latest reminder that the American people are tired of risky, comprehensive schemes featuring taxes, debt, and Washington takeovers, as well as lots of hidden and unexpected surprises. It is time to declare that the era of the 1,000- page bill is over or the era of the 2,000-page bill is over or the era of the 2,700-page bill is over. A wise approach would be to set a clear goal, such as reducing health care costs, take a few steps in that direction and then a few more so that we can start solving the country's problems in a way that reearns the trust of the American people.

Madam President, I ask unanimous consent to have printed in the Record an article from the Wall Street Journal of Monday, September 21, written by James Q. Wilson, an article by David Broder from the Washington Post of September 24, and an article from the magazine National Affairs written by William Schambra.

Madam President, I yield the floor.

Mr. President, Massachusetts voters yesterday sent a clear message that the Democratic majority in Congress is not in touch with the American people and that we ought to restart the health care debate.

Senator-elect Scott Brown's independent voice will provide a much needed check and balance to a Congress that has become dominated by more taxes, more spending, and more cash takeovers. Nothing demonstrates that need more than the so-called health care reform bill, a 2,700-page attempt to remodel 17 percent of the American economy that was concocted in secret, presented to the Senate over the weekend before Christmas during the worst snowstorm in years, voted on in the middle of the night, and passed 5 days later, on Christmas Eve, without one single Republican vote.

Now that the people have spoken in Massachusetts, we should abandon these arrogant notions of trying to turn our entire health care system upside down all at once and, instead, set a clear goal of reducing health care costs and then work together, step by step, to re-earn the trust of the American people--an approach Republican Senators urged exactly 173 different times on the floor of the Senate during last year.

If you will examine the Congressional Record, you will find that Republican Senators have been proposing a step-by-step approach to confronting our Nation's challenges 173 different times during 2009. On health care, we first suggested setting a clear goal: reducing costs. Then we proposed the first six steps toward achieving that goal: one, allowing small businesses to pool their resources to purchase health plans; two, reducing junk lawsuits against doctors; three, allowing the purchase of insurance across State lines; four, expanding health savings accounts; five, promoting wellness and prevention; and, six, taking steps to reduce waste, fraud, and abuse.

We offered these 6 proposals in complete legislative text totaling 182 pages. The Democratic majority rejected all six and ridiculed the approach, in part, because our approach was not comprehensive.

A good place to restart the health care debate would be to abandon plans to send a huge bill to States--that is, every State except Nebraska--to pay for Medicaid expansion. The 60 Senators who voted for this so-called health care reform legislation ought to be sentenced to go home and serve as Governor for two terms to try to pay for it because what these Senators would find is that States are broke, and there will either be higher State taxes or higher college tuition or both to pay for what the Democratic Governor of Tennessee has called ``the mother of all unfunded mandates.''

That mandate arrogantly expands Medicaid and, to help pay for it, would send a 3-year, $25 billion bill to Governors who, in turn, will send the bill to State taxpayers and then to college students. That is akin to your big-spending Uncle Sam hiring someone to paint your house and then sending the bill to you, even though you told Uncle Sam you already spent all your available money sending your kid to college. Of course, Uncle Sam does not have to balance its budget and you do.

I speak today not just as a Senator but as a former Governor worried about our States and as a former president of a great public university worried about our college students, many of whom are seeking an education to get a job.

Washington policies are turning our Federal constitutional system upside down. They are transforming autonomous State governments into bankrupt wards of the central government. In doing so, they are making it harder for States to support public higher education; therefore, damaging its quality and damaging the opportunity for Americans to afford it.

Governor Schwarzenegger of California said:

With a $19 billion deficit, the last thing we need is

another $3 billion bill for Medicaid.

At the University of California, students are paying a 32-percent tuition increase. Why? Because, according to the New York Times, ``the University of California now receives only half as much support from the State per student as it did in 1990.''

Why is that? Because when Governors make up their budgets, it usually comes down to a choice between exploding Medicaid costs and higher education, and Medicaid, hopelessly entangled with expensive Washington policies and mandates, usually wins.

This is not a new problem. It was a problem when I was Governor 30 years ago. It became a bigger problem between 2000 and 2006, when Medicaid spending for State governments rose 63 percent, while spending for higher education went up only 17 percent.

The Association of American Universities and President Obama's Budget Director both have warned us that the drop in State support is hurting the quality of American public higher education, and the problem gets worse.

Some estimates predict the State share of Medicaid spending will go from $138 billion in 2007 to $181 billion in 2011. Yet instead of fixing the problem of exploding Medicaid costs and its impact on higher education, the health care bill would make it worse.

Over the Christmas holidays in my State, the most talked about part of the health care bill was the so-called cornhusker kickback, which makes taxpayers and students all over America pay for Nebraska's Medicaid so Nebraskans will not have to raise their taxes and tuition.

I can guarantee you any Senator who is sentenced to go home and serve as Governor--except perhaps in Nebraska--would not vote for this health care bill.

The second recent big blow to States and to higher education has been the stimulus package, which was hailed as bailing States out but instead will soon push them over the financial cliff.

This is how the Democratic Lieutenant Governor of New York explained it in a Wall Street Journal article on January 8. He said:

. . . states, instead of cutting spending in transportation,

education, and health care, have been forced to keep most of

their expenditures at previous levels and use Federal funds

only as supplements. The net result of this: The federal

stimulus has led states to increase overall spending in these

core areas, which in effect has only raised the height of the

cliff from which state spending will fall if stimulus funds

evaporate.

On top of all this is the dramatic deterioration of the autonomous role of the States in our Federal system. Thanks, in part, to the stimulus, federally collected tax dollars have risen to 40 percent of State budgets. So instead of serving as autonomous laboratories of democracy in a Federal system, States are becoming little more than heavily regulated and increasingly insolvent administrative divisions of the central government in Washington.

Some are suggesting a new stimulus to bail out the States. Why should we even consider that when the last one is helping to push States off the financial cliff? Why should we pass a new health care bill that makes it worse for States; that is, every State except Nebraska.

Wouldn't it be better to restart the health care debate and take a series of steps to reduce health care costs without the Medicaid mandate?

Instead of expanding Medicaid and sending the States the bill, why not reform Medicaid, which has become an embarrassing administrative nightmare, where $30 billion a year goes to waste, fraud, and abuse, according to the Government Accountability Office.

Instead of dumping 15 million to 18 million more low-income Americans into a Medicaid Program, in which 50 percent of doctors--50 percent of doctors--will not take new patients, shouldn't we try a better idea?

Lieutenant Governor Ravitch suggests that one place to start is relieve States of the responsibility for those patients who draw services from both Medicare and Medicaid.

That would save States about $70 billion a year and would place all the responsibility on Washington for reforming the program so taxpayers could afford it.

Thirty years ago, when I was Governor, I met with President Reagan and proposed a grand swap: that the Federal Government would take over all of Medicaid in exchange for giving the States all the responsibility for elementary and secondary education. President Reagan liked the idea. I still think fixing the responsibility for both education and Medicaid in a single government would make it work better and force its reform.

The No. 1 topic on the minds of most Americans today is jobs. Running up the cost of health care, raising State taxes, damaging the quality of universities and community colleges, and restricting access to them is a good way to kill jobs, not create jobs.

There still is time to restart the health care debate, to work together on a step-by-step plan to reduce health care costs, while avoiding expensive mandates on States that increase State taxes and increase college tuitions. The surest way to cause this to happen is to tell those 60 Senators who voted for this health care bill that if it becomes law, they will be sentenced to go home and serve as Governor for two terms to try to pay for it.

Mr. President, I ask unanimous consent to have printed in the Record three newspaper articles.

Mr. President, I intend to take 10 minutes of the Republican time. Will you please let me know when 1 minute remains?

Thank you, Mr. President.

Mr. President, there may be a number of Americans who are switching over from the Minnesota v. Carolina football game and they may be wondering what in the world is the U.S. Senate doing coming into session at midnight on a Sunday in the middle of a snowstorm and getting ready to vote at 1 a.m.? So let me try to explain that for a moment.

The reason is, the Democratic majority leader, who is the only one who can set our schedule, showed up yesterday with a 400-page amendment--yesterday. This amendment had been written in secret for the last 6 weeks. The assistant Democratic leader said, last week, on the floor, he had no idea what was in it. Of course, none of us on the Republican side knew what was in it. So almost no one here knew what was in it. It was presented to us. Then the Democratic leader said: Well, we are going to start voting on it, and we are going to pass it before Christmas.

This is an amendment to the health care bill, which when fully implemented, will cost about $2.5 trillion over 10 years, according to the Senate Budget Committee; which restructures a sixth of our economy; which affects 300 million people; which will raise taxes by about $1 trillion when fully implemented over 10 years; and which will cut Medicare by about $1 trillion when fully implemented over 10 years. It doesn't cut Medicare to make Medicare more solvent which, as we know, it is going to become insolvent, according to its trustees, by 2015, but to spend on a new entitlement.

It will also shift to the States a great many expenses, so much so that our Democratic Governor in Tennessee has said it is the mother of all unfunded mandates. The Governor of California says it is the last thing we need, take your time, get it right. But the Democratic leader and his colleagues insist that we need to bring this up in the middle of a snowstorm, write it in secret, vote on it in the middle of the night, and get it passed before Christmas Eve.

Why would they want to do that? Well, I think the answer is very clear. It is because they want to make sure they pass it before the American people find out what is in it. Because the American people, by nearly two to one, according to a CNN poll, do not like what they have heard about the health care bill. When they have to start explaining what is in it, they are afraid it will be worse, and it will never pass.

Republicans are not the only ones who believe we ought to stop and think about big issues before we deal with it. Eight Democratic Senators--Senators Lincoln, Bayh, Landrieu, Lieberman, McCaskill, Nelson, Pryor, and Webb--wrote Senator Reid on October 6, saying to Senator Reid:

As you know, Americans across our country have been

actively engaged in the debate on health care reform. . . .

Without a doubt, reforming health care in America is one of

the most monumental and far-reaching undertakings considered

by this body in decades. We believe the American public's

participation in this process is critical to our overall

success. . . .

I am quoting from the eight Democratic Senators. They go on to say they want to make sure the bill is on a Web site ``for at least 72 hours'' before we vote on it. This bill was given to us yesterday--400 pages of it--we had not seen before. Seventy-two hours would be Tuesday. So the minimum requirement, according to the eight Democratic Senators and all 40 Republican Senators, would be that we should not even think about voting on it until at least Tuesday. And then one would think we would be amending it and debating it and considering it and thinking about it and trying to find out what it actually does.

According to the eight Democratic Senators:

By publicly posting the legislation and its [Congressional

Budget Office] scores 72 hours before it is brought to a vote

in the Senate and by publishing the text of amendments before

they are debated, our constituents will have the opportunity

to evaluate these policies. . . . As their democratically-

elected representatives . . . it is our duty to listen . . .

and to provide them with the chance to respond to proposals

that will impact their lives.

Yet, we are presented with it in the middle of a snowstorm on Saturday, we are meeting at midnight, we are voting at 1 a.m. It is being demanded that it be passed, even though most of the provisions, as the Senator from Maine has said, do not even begin to take effect for 4 more years.

What is the rush? I think the rush is that our friends on the other side do not want to explain to 40 million seniors how you can cut $1 trillion out of Medicare--it is exactly $470 billion over the next 10 years, but when fully implemented $1 trillion out of Medicare--and spend it on a new program without reducing Medicare services to 40 million seniors. The Director of the Congressional Budget Office has already said that for the 11 million seniors who are on Medicare Advantage that fully half their benefits will be affected.

I think our friends on the other side do not want the American people to understand why the $578 billion in new taxes that are going to begin to be imposed next year--they are going to have a hard time explaining how that will create new jobs in America, at a time when we have 10 percent unemployed. New taxes?

They do not want the American people to find out the Director of the Congressional Budget Office said that if we put those new taxes on insurance providers, on medical devices, almost all of those taxes will be passed on to the consumers and, as a result, premiums will go up.

There are some very strong words that have been coming from the other side about Republicans saying this bill will actually increase the cost of health care. It is not Republicans who are saying that. Here is what David Brooks of the New York Times said in his analysis of the bill when he gave the reasons for it and the reasons against it this week and came to the conclusion that if he were a Senator he would vote against it. Mr. Brooks said:

The second reason to oppose this bill is that, according to

the chief actuary for

Medicare, it will cause national health care spending to

increase faster.

That is right, we are going to raise taxes, cut Medicare, send a big bill to the States--all for what? `` . . . according to the chief actuary for Medicare, it will cause national health care spending to increase faster.'' So if you are paying X for premiums, you are going to be paying more as a result of this bill.

Continuing, David Brooks said:

Health care spending is already zooming past 17 percent of

[our gross domestic product] to 22 percent and beyond.

Then it is going to be hard to explain to the 9 million people who the Congressional Budget Office letter said would lose their employer insurance under this bill why that will happen. Of course, it will happen because under the bill as a whole, as employers look at the mandates and the costs, many will decide not to offer health insurance, and so those employees will find themselves either in Medicaid, the program for low-income Americans--into which 15 million more Americans are going; a program for which 50 percent of doctors will not see new Medicaid patients; it is like giving you a ticket to a bus when the bus only runs half the time--that is where many of these Americans will go, or they will go into the individual market, and the individual market will have higher premiums.

The other side says: Ah, but there will be subsidies for some of you. But the premiums are going to be higher, the health care costs are going to be higher.

The majority does not want to explain why this bill changes the bipartisan agreement not to have Federal funding for abortion that has been agreed to since 1977.

They do not want to take time for the American people to understand the CLASS Act, the long term insurance act, a new entitlement which sounds wonderful, but the Democratic chairman of the Budget Committee described it as a Ponzi scheme worthy of Bernie Madoff. That is because the amount of money that would be paid in, if a person pays a premium of $2,880 per year for 5 years, would be $14,000, and then they would have a $1,500 monthly benefit for a long time after that.

It is obvious why the majority has cooked up this amendment in secret, has introduced it in the middle of a snowstorm, has scheduled the Senate to come in session at midnight, has scheduled a vote for 1 a.m., is insisting it be passed before Christmas, because they do not want the American people to know what is in it.

It is a deeply disappointing legislative result. But our friends on the Democratic side seem determined to pursue a political kamikaze mission toward a historic mistake, which will be bad for the Democrats, I am convinced, but, unfortunately, even much worse for our country.

Mr. President, I yield the floor.

I thank the Senator from Wyoming and appreciate his leadership on this bill. It is of tremendous value to have within our body two practicing medical doctors to help us interpret the effect of this bill, which affects all 300 million Americans so dramatically.

We find, when we discuss this bill with our colleagues on the other side of the aisle, we sometimes become exasperated with one another because it seems like they are talking about one set of facts and we are talking about another set of facts. So what I would like to do is take a moment and talk about Medicare.

If anyone is watching our debate, you hear the Democrats talk about three things: We are saving Medicare, we are extending its length, and you hear Republicans say they are cutting Medicare. So who is right?

Well, let me tell you why we talk about Medicare cuts. Medicare, of course, is a government program which 40 million seniors depend on. We all pay into it, and then when we get to be of a certain age we depend upon it for our medical care. For many Americans, it is very important. It was established with broad bipartisan support in the 1960s.

What are the proposals that have to do with Medicare? Well, basically half this health care bill is paid for by reductions in the growth of Federal spending for Medicare. Those are Medicare cuts. Who says they are? Well, the President of the United States, for one, says we will have no deficit from this bill. So the way we are going to do that, for this bill, which the Congressional Budget Office figures show us will cost $2.5 trillion over 10 years when fully implemented, is basically paid for one-half by Medicare cuts and one-half by new taxes. Give the Democrats credit for that, that helps to avoid a large part of the deficit. The rest is done by sending a huge bill to States to help pay for another big government program called Medicaid, but I will leave that to the side for a moment.

The Medicare cuts which are reductions in the spending for Medicare, are $466 billion over the first 10 years and over a fully implemented 10 years it is about $1 trillion in Medicare cuts. That is money coming out of the Medicare Program and going somewhere. Where does it go? Well, it goes to start a new program.

What is wrong with that? Well, one thing wrong with it is the trustees of Medicare say that there is already more money coming out of Medicare than is being paid in, and by the year 2015 or 2017 it will be insolvent. That means going broke. These aren't Republican trustees or Democratic trustees, these are the men and women whose job it is to report to the Nation on the condition of this program that takes care of 40 million people and their medical care.

Already we see that the Medicare Program is under some stress. The doctors, for example, who serve Medicare are only paid about 83 or 84 percent as much as doctors who serve patients with private health care. As a result of that, we have to come along year after year and appropriate more money to reimburse doctors who serve Medicare patients. If we do not do that, they will not be serving Medicare patients, and Medicare will become similar to Medicaid, the program for low-income Americans, where about 50 percent of doctors will not take a new Medicaid patient. It is akin to telling somebody: I am going to give you a ticket to a bus line where the bus only runs about half the time.

So what the Democrats are saying to us is that by taking $1 trillion out of Medicare over 10 years when fully implemented, and there is no dispute about that amount of money, and spending it to pay for this new program that is somehow good for Medicare and for the seniors who depend upon it. I mean, they are suggesting we believe if you take $135 billion from hospitals and $120 billion from the 11 million seniors who participate in Medicare Advantage and $15 billion from nursing homes and $40 billion from home health agencies and $7 billion from hospices, that somehow that is good for seniors.

Perhaps it could be, if all that money were put back into Medicare; if the money were taken from grandma and spent on grandma. But no, this money is taken out and spent on a new program. The Director of the Congressional Budget Office--not a Republican, not a Democrat, the nonpartisan Director said, for the 11 million on Medicare Advantage that one-half of their benefits will be diminished. That is what he said about these cuts.

Even when it is all said and done, we completely leave out the $\1/4\ trillion that we need to appropriate to pay the physicians to serve Medicare patients. Because if we don't, their payments are going to be cut by 21 percent next year and fewer of them will see Medicare patients. We have already heard the Mayo Clinic, for example, is beginning to restrict some patients on Medicare because they lost $840 million serving Medicare patients last year.

I have taken a few moments to talk about Medicare. That is just one thing wrong with this bill. But when you hear the other side say they are helping Medicare, and if you listen to what I said about how can you take $1 trillion out of the Medicare Program--which is going broke--when it is fully implemented over 10 years and claim you are helping Medicare by starting a new program, I don't think that is possible. That is the source of the great concern on our side of the aisle about this bill on that one issue.

I see the assistant Republican leader, the whip. I have heard a number of people say, and I will just propound this question and then I will yield the floor, if I may, to the Senator from Arizona. But I have heard them say: Why are Republicans keeping everybody in here this week? We want to go home and see our families.

We all want to see our families. But there is a reason this bill was suddenly presented to us in the middle of the greatest snowstorm in the history of Washington in the month of December, and we were asked to start voting on it in the middle of the night on the same day, and to finish the work by Christmas. If I am not mistaken, and this is my question to the distinguished assistant Republican leader who has been here a number of years, who is in the leadership and whose job is to help manage the floor: Is it not entirely the prerogative of the majority leader of the Senate to schedule what comes up on the floor? Is that not his job? Isn't it true that if Senator Reid wanted to say let's take this bill down, let's go home, let's let the people hear about it, let's come back and vote on it after Christmas, after New Year, after Valentine's Day, could he not do that and

isn't that peculiarly his power and not our power?

No, I thank the Senator. I yield the floor.

Mr. President, I agree with the Senator from Wyoming. I think it is important for the American people to know, the 400-page amendment that was added to the underlying bill over the weekend is being presented to us in way that will not allow the bill to be amended. So something that affects one-sixth of the economy, which we have had a day and a half to read, which is part of an overall bill that will raise taxes, cut Medicare, and send big bills to States could be improved with amendments but cannot be amended under the current procedure.

Madam President, the telephone townhalls are interesting. This is the 21st consecutive day and the third weekend we have been debating this bill. One would think we could probably do a better job of it, if we were going back home every weekend to hear what people thought about what we were doing. But maybe the strategy has been to keep us here talking to each other, bring the bill up in a snowstorm, pass it in the middle of the night and go home for Christmas, and the people won't find out what we are doing until it is too late. One way to find out is tele-townhalls. I was skeptical before I did one but it is a pretty interesting way to stay in touch with people from Tennessee. You get on the telephone and an automated system calls thousands of people and says: The Senator from Wyoming or Illinois or North Carolina or Tennessee wants to talk with you about health care. People can either stay on the phone when they get the call or they can hang up. What normally happens is a person stays on the call, this time a surprisingly large number of people stayed on the call, because of their strong interest in this issue.

The other night I did the phone call between 7:30 and 8:30. I called to about 18 west Tennessee counties, including Shelby, which is Memphis, and as reported to me by the service, about 30,000 people were on the telephone sometime during that hour, with a maximum number of 3,016 on the call at any one time. Someone might pick up the phone and say: Senator Barrasso is on the phone. They might tune in for 15 or 20 minutes and then hang up. Maybe they have to cook dinner or the ball game comes on. Maybe they get tired of talking to you, but they are on for 15 or 20 minutes. During that time, I was able to take a number of questions. After it was over, 563 messages from constituents were sent to my Web site.

It was interesting to me. People who know my history, know that to be elected Governor 30 years ago, I walked across the State of Tennessee. Instead of going to a Republican meeting or a rotary club, I would visit with random people during my walk. It took me 6 months and I would see 1,000 people a day. These random phone calls kind of reminded me of that. It was as if the people were randomly selected. They were not on any Republican list or Democratic list or list of doctors or patients. They were just in the phonebook. They talked and acted like they were normal citizens who I had interrupted after dinner, probably because it was 6:30 to 7:30 in that part of Tennessee. I was able to ask those citizens three questions. I am not about to say this is a Gallup poll of Tennessee, because I know that surveys like that have to be done in a scientific way, but after being here for 21 straight days, not able to go home because we have been debating this bill, these opinions are straws in the wind.

The first question was: Do you believe the Senate should rush to pass this health care bill before Christmas? In this case, 943 people, 83 percent, said no, and 108 said yes; that is 9 percent.

Second question: Do you support the health care bill moving through the Senate? On this one, 1,496 said no, or 75 percent. 352 said I don't know, which is 18 percent, and 154 said yes, that is 8 percent.

No. 3: Do you agree that Congress doesn't do comprehensive legislation well and ought to go step by step to bring health care costs under control? On this question, 1,285 said yes, that is 80 percent, 14 percent said I don't know and 7 percent disagreed.

I have often heard our friends on the other side say: Where is the Republican bill? My response has been, day after day, if you are looking forward to seeing the Republican leader role a wheelbarrow in here with a 2,700-page Republican comprehensive bill, you will be waiting forever. We have a different approach. Our approach is to set a clear goal--reducing cost. The bill we are voting on increases costs. Our goal is to find five or six steps to go in the direction to reducing costs.

Without going into detail, although the Senators from South Dakota or Wyoming may want to, we focus on five or six steps that would clearly reduce health care costs. By that, I mean your premium, the cost of your government. And once we do those five or six steps, we could go on. We could do that without taxes, without mandates, without running up the debt, without a big bill with lots of surprises. Just to take one example--and then I will yield to my friends from Wyoming and South Dakota--one of those examples is the small business health care plan. The current bill, the Democratic bill, has in it a credit for small businesses, but we would argue that by the time small business men and women get through paying the mandates and the taxes the bill also imposes, it is not going to be much help to them.

What we have is a bill that would allow small businesses to pool their resources. In other words, if you are a small business man or woman and you have 60 employees and 2 get cancer, suddenly the costs of those 2 employees prohibit you from providing insurance to the other employees. But if you could pool your resources with small businesses all around the country, then the pool would be large enough that you could offer insurance.

That proposal has been made by Senator Enzi. It has been through the HELP Committee. The Congressional Budget Office said it did not add to the deficit. In fact, it reduces the deficit, and it would permit 750,000 more employees of small businesses to be insured and their premiums would be lower than they otherwise would be. That is a single step to moving toward reducing health care costs, but if we took that step and the other steps we have proposed, that would be a good way to start. We could do that together, and we would not have this partisan bill with so many questions and so many concerns.

So I wonder if my friends from South Dakota and Wyoming--I know they have thought a good deal about this step-by-step approach toward actually solving the real problem of health care costs.

It clearly does. It enjoys widespread support everywhere, except the Senate. When Senator Enzi brought it up, it was rejected by our friends on the other side.

I thank the Senator from South Dakota. The answer is no. The difficulty with a big, comprehensive plan is it sounds good but has lots of unintended consequences. If our real concern right now is reducing costs in health care, then the idea of a small business health care plan that has no new taxes and no new mandates but creates opportunities for small businesses to pool their resources and offer more insurance at a lower cost to their employees would seem a logical place to start.

I certainly do agree with that.

I think most Americans, when presented with a problem, would not try to change it all at once but would say: Let's identify the goal which is reducing costs and go step by step.

Madam President, I ask unanimous consent to have printed in the Record a column by David Brooks in the New York Times on December 18.

Most of us--we are pretty split up here: 60 there, 40 here. They are for it, and we are against it, this bill anyway.

I thank the Presiding Officer and I yield the floor.

Mr. President, how much time do we have on this side?

Mr. President, please let me know when 1 minute remains.

Mr. President, we are here on this early Saturday morning, as we lead up to Christmas Day, to finish work on the Defense appropriations bill. But the country knows the focus of our attention, the reason we are here, is because of the health care debate. We are in our 20th consecutive day of considering health care, and we still do not have a final bill. In other words, we do not yet know what we are voting on, how much it costs, or how it affects the American people.

On October 6, 2009, eight Democratic Senators wrote the majority leader a letter which expressed the view also of all 40 Republican Senators, and it said what ought to be obvious: that when debating even a minor bill, but certainly a major bill of this magnitude, the ``public's participation in this process''--so the letter went--``is critical to our overall success of creating a bill that lowers health care costs and offers access to quality and affordable health care for all Americans.''

The letter from the eight Democratic Senators continues:

Every step of the process needs to be transparent, and

information regarding the bill needs to be readily available

to our constituents before the Senate starts to vote on

legislation that will affect the lives of every American.

The letter continues:

The legislative text and complete budget scores from the

Congressional Budget Office of the health care legislation

considered on the Senate floor should be made available on a

website the public can access for at least 72 hours prior to

the first vote to proceed to the legislation. Likewise, the

legislative text and complete CBO scores of the health care

legislation as amended should be made available to the public

for 72 hours prior to the vote on final passage of the bill

in the Senate. Further, the legislative text of all

amendments filed and offered for debate on the Senate floor

should be posted on a public website prior to beginning

debate on the amendment on the Senate floor. Lastly, upon a

final agreement between the House of Representatives and the

Senate, a formal conference report detailing the agreement

and complete CBO scores of the agreement should be made

available to the public for 72 hours prior to the vote on

final passage of the conference report in the Senate.

Mr. President, that is wise advice from Senator Lincoln, Senator Bayh, Senator Landrieu, Senator Lieberman, Senator McCaskill, Senator Nelson, Senator Pryor, and Senator Webb. What they are saying is, before we vote on a health care bill that affects nearly every 1 of all 300 million Americans we ought to have 72 hours to read the bill and know what it costs. We know the current version, when fully implemented, will spend $2.5 trillion, which the Chief Actuary of the government says insofar as we know it will increase the cost of health care rather than reduce it. We know that the version we have seen so far will take $1 trillion out of Medicare when the bill is fully implemented and not use it to strengthen Medicare--which is becoming insolvent in the years 2015 to 2017, according to the trustees of Medicare--but instead would spend that money on some other program. We know it would--as David Brooks in a New York Times column said yesterday--create a huge tax, $1.42 trillion in the second decade of its operation to help pay for this, which the Director of the Congressional Budget Office has said would inevitably be passed along to consumers and cause premium costs to go up, not down. And we know it would expand Medicaid, the other large government program we already have for low-income Americans, sending a bill of $25 billion to the States that has been roundly denounced by almost every Governor in the country, Democratic and Republican.

Because at a time when the States are struggling more than they have since the Great Depression with their own budgets, when they cannot print money, when they have to balance their budgets, we are expanding health care and sending them a huge bill to help pay for it. This inevitably will force States to raise taxes, raise college tuition; and, in my State, the Governor is considering releasing up to 4,000 nonviolent offenders from the prisons as a result of some of the budgetary pressures that are on him.

So that is what we do know about the bill. But we do not have the final version of the bill. Yet it is said we should vote on this by Christmas when, in fact, most of the provisions of the bill do not take effect until 2014. That is 4 years from now. Only a few provisions start right away. Mr. President, $73 billion in taxes start right away. Medicare cuts start right away. Mandates start right away. A few benefits start right away.

But, basically, the thrust of this massive legislation that affects 17 percent of our economy does not take effect for 4 years. So if we do not have the bill, and if most of the legislation does not take effect for 4 more years, then why are we spending this time staying up all night, rushing to enact the bill by Christmas?

I believe it is because the majority knows the longer the public sees the bill, the more they know about it, the less they will like it, and they want to try to pass it before people know what is in it. Otherwise, we would already have the bill. Otherwise, we would be taking the time we took with the farm bill, with the Education bill, with the Energy bill, with other major legislation that takes 5, 6, 8, 10 weeks. Otherwise, we would have worked across party lines and had many different kinds of views. So this is a rush.

There has been a lot of talk about making history on health care. The problem is, there are different kinds of history. In this case, the Democratic majority seems to be determined to pursue a political kamikaze mission toward an historic mistake. If it succeeds, the results will be disastrous for the Democrats in 2010, I would predict. But, unfortunately, it will be a bigger disaster for our country.

Now, this will not be Congress's first historic mistake. The Smoot- Hawley tariff of 1930 ``to buy American'' sounded pretty good. It sounded like a good way to protect jobs by keeping foreign products out. But historians agree it was an historic mistake, setting off retaliatory waves, tariffs, and making the Great Depression worse.

The Alien and Sedition Acts of 1798 sounded good too. The idea was, let's protect the country from enemies within our midst, mostly French then. But that turned out to be an historic mistake encouraging more protests and offending our traditions of free speech.

In 1969, the Congress found 155 Americans who were not paying taxes and said: Let's have a millionaires tax. That sounded good too. It turned out to be another historic mistake. Last year, it caught 28 million Americans before we rushed to patch it, to fix it for a year.

More recently, there was the Catastrophic Coverage Act of 1988 to help seniors deal with financial losses. The trouble is, seniors resented paying for it, and angry crowds surrounded the chairman of the House Ways and Means Committee in his home district. Congress repealed that mistake, and the leader of those angry seniors is now a Congresswoman from Illinois.

Then there was the luxury tax on boats in 1991. That sounded good: We are going to get all those people who have boats that cost more than $100,000. The trouble was, it raised about half the revenue projected, and it nearly sank the boat industry, putting 7,600 people out of work. A change in Congress repealed that one too. Rather than make history of this sort, Congress should learn from history. We should take Governor Schwarzenegger's advice this week.

He suggested:

So I would say, be very careful to the federal overnment

before you go to bed with all this. Let's rethink it. There's

no rush from one second to the next. Let's take another week

or two and come up with the right package.

The Governor, of course, was concerned about the Medicaid expansion costs in his State--$3 billion for California. He said:

[The] last thing we need is another $3 billion of [state]

spending when we already have a $20 billion deficit.

So why the rush? We do not have the bill. We have plenty of time to deal with this. Most of it does not take effect for 4 more years. And what if in trying to fix everything all at once we get it wrong--will Congress be rushing back to fix health care again? Because if Congress makes another historic mistake, it will not be nearly as easy to fix as repealing a boat tax.

I thank the Acting President pro tempore, and I yield the floor.

Madam President, I thank the Senator from Arizona.

I was thinking as I listened to the Republican leader, I wonder if the Senator noticed the comments of the Governor of California on Monday. Governor Schwarzenegger said on ``Good Morning America'' that he supports the idea of overhauling health care, but: ``the last thing we need,'' said Governor Schwarzenegger, ``is another $3 billion in spending when we already have a $20 million deficit.''

He was referring to one of the unintended consequences of this bill, which is big State costs for Medicaid being shifted to the States-- unfunded mandates.

So here is Governor Schwarzenegger's advice, following up on the comments of the leader: ``So I would say be very careful to the Federal Government.''

This is from the Governor of California:

Before you go to bed with all this, let's rethink it. There

is no rush from one second to the next. Let's take another

week or two. Let's come up with the right package.

I wonder if the Senator saw it.

Madam President, I thank the Senator from Arizona for his comments. We have two physicians in the Senate, Dr. Coburn from Oklahoma and Dr. Barrasso from Wyoming. I wonder if they would bear with me for a minute or two to reflect on something the majority leader said--minority leader said--I hope he is the majority leader before too long--and the Senator from Arizona.

The minority leader, the Republican leader, talked about a historic mistake. There has been a lot of talk around here about making history on health care. The problem is there are many different kinds of history, as the Republican leader has pointed out. It seems our friends on the other side are absolutely determined to pursue a political kamikaze mission toward a historic mistake which will be disastrous for them in the elections of 2010, but much more important, for the country.

I did a little research on historic mistakes. We have made them before in the United States. Maybe we would be wise to take Governor Schwarzenegger's advice and slow down and stop and learn from our history rather than try to top our previous historic mistakes, such as the Smoot-Hawley tariff. That sounded pretty good at the time in 1930 when the idea was to buy American, but most historians agree it was a mistake and it contributed to the Depression.

There was the Alien and Sedition Act of 1798. It sounded good at the time. We were going to keep the foreigners in our midst--they were mostly French then--from saying bad things about the government, but it offended all of our traditions about free speech.

In 1969 Congress enacted the ``millionaires' tax,'' they called it, to try to catch 155 Americans who weren't paying any tax. That turned out to be a historic mistake, because last year it caught 28 million American taxpayers until we had to rush to change it.

Just a couple more. There was the Catastrophic Coverage Act of 1988. That was well named, but it turned out to be a catastrophe, a congressional catastrophe. The idea was to help seniors deal with illness-related financial losses, but seniors didn't like paying for it. They surrounded the chairman of the Ways and Means Committee in Chicago and now the leader of that group is a Member of Congress.

Then there was a luxury tax on boats over $100,000, another historic mistake, because it raised about half the taxes it was supposed to and it nearly sank the boating industry and it put 7,600 people out of jobs.

I ask my friends from Oklahoma and Wyoming--it is going to be a lot harder for Congress, if they try to fix the health care system all at once, to come back and repeal it than it was to repeal a boat tax. Do my colleagues think we ought to take the time to avoid another historic mistake?

I say to the Republican leader and the Senator from Kentucky, I believe there is another bit of history being made. This process is historic in its arrogance. This isn't very hard to understand. The proposal is to take 17 percent of our economy, affecting 300 million Americans, and nothing could be more personal, as the Republican leader has said, than our health care.

But now we don't have the bill. We do not have the bill. It is being written in secret in another room. If there is any part of this debate that went through to every single household in America, I believe it was when the Finance Committee voted down a motion--the Democrats voted down a motion that the bill should be on the Web for 72 hours so that the American people could see the text, know what it costs, and know how it affects them.

Eight Democratic Senators wrote the Democratic leader and said they want to insist that they know what the text is, and that they have the official score from the Congressional Budget Office, and that they have it for 72 hours before we move to vote.

We don't have the bill. We don't have the official score from the CBO. Seventy-two hours is three more days, and even though eight Democratic Senators and all the Republican Senators said we want to know what it costs, know what it is, and how it affects us, they want to run it through before Christmas.

We come to the floor every day and point out the problems with the bill. We don't have a bill now, we can't read it, and we don't know how much it costs or how much it affects the American people. It raises taxes and premiums. It will increase the debt, because it doesn't include things such as the physicians Medicare reimbursement. It cuts Medicare by $1 trillion over 10 years once it is fully implemented.

We point out what we think should be done. My colleagues have talked about it many times. Instead of wheeling in another 2,000-page bill, we should focus on the goal of reducing costs, and we should take several steps toward doing that. The Senator from Arizona talks about one of those things, which is reducing the number of junk lawsuits against doctors. I don't think that is in the bill, unless it is secretly being added in the back room today.

Mr. President, I congratulate the Senator from Idaho

for his amendment to help the President keep his commitment. That is basically what it is. I would think our friends on the other side would all want to join us in that. The President said he would not raise taxes on people making less than $250,000 a year.

It is amazing to hear the comments that I have just heard. The whole construction of the bill--when we think about it, regardless of whatever the Democrats decide to do about the so-called public option, they still seem determined--at least the majority leadership seems determined--to engage in this political kamikaze mission toward a historic mistake. There is all this talk about history. But there are lots of different kinds of history.

A lot of historic mistakes have been made about taxes. For example, there was the Smoot-Hawley tariff of 1930, which was a big tax. It sounded like a good idea. President Hoover, a Republican, recommended it to protect American jobs by keeping out cheaper foreign products. That led us into the Great Depression. It was a historic mistake. More recently, there was the boat luxury tax. This sounds good. It was part of the budget deal of 1990. Congress put a 10-percent luxury tax on boats costing more than $100,000. Sound familiar? We were going to hit the rich people. But it got the working people, not the rich people. The unintended consequence was that it sank the boat industry, costing 7,600 jobs, according to the Joint Economic Commission, and Congress repealed that historic mistake. There was also the Medicare Catastrophic Coverage Act of 1988, another good-sounding goal, to help older people reduce the risk for illness-related catastrophic financial losses. But a lot of our senior Americans resented the idea of paying additional taxes for that coverage, and they revolted. Congress, less than a year and a half later, repealed it.

We all remember the millionaires tax. That is a matter of history. In the late 1960s, there were 155 high-income Americans who weren't paying any Federal income taxes, so Congress imposed something called the alternative minimum tax. Last year, that affected 28 million American taxpayers.

I say to my friend from Idaho, I think he is doing the country and the President a great service by offering this amendment to help keep the promise because whatever the majority leader decides to do about the government option, this legislation--when fully implemented--still contains $1 million in Medicare cuts 5 years before Medicare is scheduled to go broke, according to their trustees.

It is nearly $1 trillion in new taxes over 10 years when fully implemented, as the Senator from Idaho has pointed out. There is no question about that, it is an increase in premiums for most Americans, according to the Congressional Budget Office. And yesterday on this floor, we talked about the huge bill we are about to send to States to help pay for this in the Medicaid Program.

It is important to support the Crapo motion. It is important for our country not to have this historic mistake thrust upon them.

I agree with the Senator from South Dakota. People who might be watching this must be thinking: Wait a minute. Let me ask the two members of the Finance Committee: What the Democrats are trying to say is, a Medicare cut is not a Medicare cut and that a tax increase is not a tax increase and that a premium increase is not a premium increase. Isn't it true that when the bill is fully implemented, there will be nearly $1 trillion in Medicare cuts, and isn't it true that there will be nearly about $1 trillion, when fully implemented, in new taxes? Isn't it true the Congressional Budget Office has said that will all be passed on to people? Isn't it true that all the taxes start in January, if the bill passes? Isn't it also true the Congressional Budget Office has said premiums are going to continue to go up and, for people in the individual market, they will go up even more? Isn't that all true?

I thank Senator Corker from Tennessee.

We have our usual situation on the Republican side--a lot of Senators who wish to speak on the subject of Medicaid--so I am going to keep my remarks brief. But looking around I see one, two, three, four of us who have been Governors of a State. The Acting President pro tempore was the Governor of the State of Virginia. Senator Corker, himself, was mayor of Chattanooga and the chief operating officer of the Tennessee State government.

Why do I bring that up? Because the Medicaid Program we are discussing--I know to many people listening to this debate, it gets confusing. Medicare is the program for seniors on which 40 million to 45 million people depend. We have talked about that a lot, and how the cuts to Medicare are going to be used to pay for this bill. But we have not talked as much about Medicaid, which is an even larger government program. Sixty million people depend on Medicaid, and they must be low- income people in order to qualify for the program. This bill would add 15 million more Americans to the Medicaid Program which, as Senator Corker said, is like giving someone a bus ticket to a bus line that only operates half the time, because about 50 percent of the time, doctors will not see new Medicaid patients.

But there is another problem with the Medicaid proposal, which all of the Governors here--I know if they are like me, nothing made me any angrier than to see a bunch of Washington politicians come up with a big idea, announce it, take credit for it, and then send me the bill when I was Governor. Usually we would find them back at the Lincoln Day Dinner or the Jackson Day Dinner the next spring making a big speech about local control. Well, what happens here is a huge bill for this Medicaid expansion that is going to be sent to the States.

I would say to Senator Corker, hasn't our Governor, a Democratic Governor, Governor Bredesen--who like all of us has struggled with paying for Medicaid--has he not said this will cause about $750 million in added expense? I would ask the Senator from Tennessee, wouldn't that require either big cuts to higher education or big tax increases to pay for it?

Mr. President, I thank the Senator. I am impressed

with the number of Senators here this afternoon. One thought comes to mind, and I wonder if some of my colleagues may want to talk about it. I woke up one day and saw on television a sign that said ``32 percent tuition increase for the students of California.'' The University of California could be the best public institution of higher education in the world.

One of the great things the United States has--which keeps us competitive and gives us a chance to continue to grow and create new jobs--is a superior system of higher education. About half of the best universities--Harvard, Yale, and the private universities--half or more than half are public universities, where tuition is a few thousand dollars a year. Well, what is going to happen with this? All of us who have been Governors have gone through this. You have a pot of money left, and it either goes into higher education or Medicaid. For the last 30 years, we have been having to fight to fund Medicaid, and as a result States have not been funding public higher education properly and the quality has gone down and the tuition has gone up.

What is this bill saying? It says that, after 3 years, we are going to dump a huge new cost on the States. I don't believe I am overstating it when I say that in our State of Tennessee, given the terrible fiscal condition our States are in today--and our State is more conservatively run than most--I believe our State could only fund this through a new State income tax and/or serious damage to higher education or both. I wonder if that is not the case in all of the other States represented here.

I congratulate the Senator from Arizona for his comments and his own leadership on this issue. I want to add my commendations to the Republican leader.

My thought is that the reason we are working so well together is because we are afraid our country is about to make a historic mistake. There is a lot of talk about making history. There are a lot of ways to make history. Put aside all of the laws about race--don't talk about them. When we talk about race, that is often misunderstood. We didn't fail to make a historic mistake on laws about race until the 1960s, when we began to correct those laws. Let's put aside all the historic mistakes we might have made in failing to stop aggression before World War II. We know about those mistakes. We can remember historic mistakes.

I ask the Republican leader if the Smoot-Hawley tariff sounded like a good idea when President Hoover pushed it in the late 1920s. We were going to raise tariffs on 20,000 imported goods, create more American jobs, and it created the Great Depression. The Alien and Sedition Act sounded like a great idea. That made a little history. Shortly after our country was founded, we made it a crime to publish false and scandalous comments about the government. It has never been repealed. Our Supreme Court said it was a historic mistake. Then there was the Medicare Catastrophic Coverage Act of 1988. I wonder if the Senators might have been here then.

So we are capable of making historic mistakes. As the Senator from Arizona has said very well, most Americans, if presented with a problem, would not try to turn the whole world upside down to solve it. They would say: What is the issue? The issue is reducing costs. We can all talk to family members and others--we know what they are paying monthly for premiums, and we would like that to be less, and we would like for the government's costs to be less.

Why don't we, as we have proposed day after day, and as the Senator from Arizona has said--why don't we go step by step in the direction of reducing costs.

I will not go into a long litany of proposals we have made. We can take five or six steps on small business health plans, reducing junk lawsuits against doctors, or buying health insurance across State lines. We should be able to agree on that instead of a 2,000-page bill that raises premiums, raises taxes, and seems to have a new problem every day.

I think the cohesion on the Republican side is not so partisan. I like to work across party lines to get results. That is why I am here. I am just afraid that our country is about to make a historic mistake, and we are trying to help and let the American people know what this bill does--what it does to them and their health care.

Well, ``unsavory'' would be a minimum word that comes to my mind. The problem I have is that Americans have a perfect right to their view, and the pharmaceutical industry has a perfect right to advocate its point of view.

As I hear the Senator describe what has been going on, am I hearing correctly? I mean, the pharmaceutical industry is saying we don't like drug reimportation. The White House says: OK, we will cut a deal with you behind closed doors--as far as we can tell--and we will change the law this way, and then--

So it is a negotiation between the White House, the President, and big industry about profits: I will do this, you do that, and then you go out--and my understanding is that you write in as part of the deal that the industry spends $150 million on television advertisements in support of the deal. Is that the deal?

Well, if I am remembering right, earlier this year the Republican leader made a talk on the Senate floor. The attitude of the White House toward a large company in Kentucky, as I remember, was: If you don't agree with us on health care, we will tax you. That was the attitude, it seems, to come out. If you don't agree with us, we will tax you, or we will make it difficult for you to do business. If you do agree with us, we will make a deal with you that affects your profits.

Before Dr. Barrasso speaks, just listening to the Senator from Arizona, it seems to me it puts the Democratic leadership in the extremely awkward position of even its leadership--proposing a bill that affects 17 percent of our economy and the leadership of the Democratic Senate doesn't yet know what is in the bill, we certainly don't know what is in the bill, and they are in the awkward position-- at least they have been the last few days--of filibustering their own bill at a time when they are insisting that we pass the bill before Christmas, which we can hear the sleigh bells ringing. It is just a few days before that happens.

I see the Senator from Idaho is here. We both had the experience of being Governors, as did the Presiding Officer in her State of New Hampshire. We were talking the other day--and I hope he doesn't mind me repeating that--I worked with a Democratic legislature the whole time I was Governor. But what we always did on anything important was we sat down together. We had our different positions, we fought during elections, but we worked things out. We didn't go forward unless we found a way to agree. That meant I usually didn't get my way. I got some of my way, but I had to take into account that someone else--in this case, the Democratic legislature in Tennessee--might have a different idea. Sometimes it was a better idea.

I ask the Senator from Idaho, we talk a lot about bipartisanship around here. The reason for bipartisanship is that these big bills are tough bills. We are expected to make difficult decisions: Are we going to reduce the growth of Medicare? Are we going to expand Medicaid? Are people going to be required to buy insurance? What are we going to do about health care premiums? Many of these decisions are controversial.

When the American people look at Washington and they see that just one side of the political spectrum is pushing a bill through and the other side says: Absolutely not, what kind of confidence is that going to give the American people? On the other hand, if they look at Washington as they did with the civil rights legislation we talked about in the 1960s when Lyndon Johnson, a Democrat, was President and Everett Dirksen was the Republican leader, they saw the Republican leader and the Democratic President saying: OK, this is a tough problem, but we have a solution with which we both agree. Then the American people had some confidence in that.

Bipartisanship is not just a nice thing; it is a signal to the American people that people of different points of view think a controversial decision is in the country's interest. Isn't that totally lacking here? Isn't that bipartisanship signal lacking across the country?

Madam President, may I ask the Senator from South Dakota, unless the Senator from Arizona wants to, to lead the colloquy.

Let me ask the Senator from South Dakota to lead the colloquy on the Republican side.