Floor Statements

Mr. President, an unusual thing is about to happen here: an actual debate is about to break out on the floor of the Senate about health care. Sometimes we are talking past each other. My friends on the other side talk about jobs and small business, so let me start there.

The difference between the Democratic proposals for health care and the Republicans is the Democrats start with a 2,000-page bill, more or less, with a government takeover, with more than $1 trillion in spending, with new taxes, higher premiums, and Medicare cuts, and we don't believe they can spend that much more money without increasing the debt--in other words, all going in the wrong direction.

We believe we ought to be reducing costs step by step, and the Republican proposals say that step No. 1 should be small business health plans. They are saying they have an idea about small businesses, and we are saying the same thing.

In my few minutes today, I would like to show why our proposals are better than theirs. For example, Senator Enzi of Wyoming, who was chairman and is now the ranking Republican member of the Health, Education, Labor, and Pensions Committee, has a small business health plan he has been trying to get this Senate to vote on for years. In fact, this plan came up before the Senate, and our Democratic friends blocked it. They like to say Republicans are the party of no; they are the party of no because on May 11, 2006, they voted no to small business health plans which would lower health care costs for thousands of employees in this country.

Let me be specific about that and why it is superior to the suggestion that has been made in the Finance Committee bill, the 2,000- page bill which has come out of the Senate Finance Committee. In the Enzi plan, the Republican plan, we would allow small businesses to come together and pool their resources. What that means is, if I have a small business with 50 people and you have one with 100 people and you have someone with open heart surgery, you cannot afford to keep paying for health insurance anymore because that one employee's health care costs make it impossible for you to do that or you have to lay people off or you

have to reduce wages. That is what happens in the real world. What we are saying is, let's let small businesses come together, pool the resources, and offer insurance that way--spread the risk, in other words.

What does the nonpartisan Congressional Budget Office say the effect of that proposal would be on small businesses and their health care costs?

This is what the CBO said: No. 1, enacting the Republican proposal-- which we would hope would gain Democratic support--would extend more insurance to at least 750,000 Americans who are employees of small businesses. That is No. 1, more people insured.

No. 2, it would lower the cost of insurance premiums, not raise them as this 2,000-page bill would--lower the cost of insurance premiums for three out of four employees.

No. 3, it would reduce the cost of Medicaid, the government program for low-income Americans, by $1.4 billion.

More people covered, lower premiums, and a lower cost--that is what they mean by bending the curve. So if that is the proposal, why do the Democrats not allow us to vote on it? You see, we believe these 2,000- page bills with higher premiums and higher taxes, with Medicare cuts-- we have these bills all over the place. Senator Reid, the distinguished majority leader, has one in his office. He has been meeting secretly for weeks with people--we don't even know who--writing a bill which may emerge as early as today. Then when we get it, we will all have to read it. I am sure we will find more premiums, more taxes, more Medicare cuts, probably additions to the debt, probably more transfers of cost to State governments.

We have Governors who are Democrats and Republicans saying: Please don't do that to us. We are in the worst condition we have been in since the Great Depression, and you are going to dump a lot of costs on us that we didn't volunteer to pay. We can't afford it. We have to balance our budgets.

That is probably what is coming. What should we do instead? We said day after day on this floor that we should set a goal--reducing costs, the cost of premiums, the cost of health care to the government--and we should move step by step toward that goal.

We said step No. 1 should be small business health insurance plans. Step No. 2 should be to allow competition for insurance across State lines. That would reduce costs. Step No. 3 would be to reduce junk lawsuits against doctors, which some States have done, and which everyone agrees drives up costs, encourages defensive medicine, and causes doctors to move out of rural areas so that pregnant women have to drive 60 or 80 miles to Memphis or halfway across Alaska to get their prenatal health care or check into hospitals for 3 weeks in a big city so when they have their baby they will have a doctor available. That is the effect of that.

Then health insurance exchanges so you can shop for cheaper health care, then reducing waste, fraud, and abuse. The General Accounting Office has said $1 out of $10 in the Medicaid Program, which the Democratic proposals will expand, is wasted. It goes down the drain every year--$32 billion.

If we really want to reform health care, why do we keep coming up with these 2,000-page bills and trillion-dollar costs and higher premiums and higher taxes and Medicare cuts and additions to the debt at a time when we have 10 percent unemployment? What is that going to do to small businesses? New taxes are going to create more jobs?

We have the Finance Committee bill with $900 billion of new taxes over 10 years when fully implemented. That is not going to create new jobs. New taxes are passed on.

If you run a business with 40 people or 100 people or 150 people, and you get a big new tax, what do you do? You layoff an employee, you reduce wages, you stop offering health care. You have to do that or you go out of business. That is what happens.

We would like to see a debate. We think the way to reform health care is, instead of these 2,000-page bills, let's set a goal--reducing costs. Let's go step by step in that direction to re-earn the trust of the American people. Instead of talking in grand rhetoric about small businesses--they do have a plan embedded in the Finance Committee bill, but it is typically different from the plan we have proposed. Instead of allowing small businesses to pool their resources in the way I suggested so they, the small businesses, could be in control of their own health insurance, make decisions about it--no; the Democratic small business plan would not allow small businesses to pool their resources. It puts the government in charge of making decisions about what kind of insurance the small businesses could purchase. That is really a debate we ought to have.

As President Obama, correctly said earlier this year, the health care debate is not just about health care. The health care debate, said the President--correctly, I would respectfully say--the health care debate is a proxy for the role of the Federal Government in American lives. So would this debate about how to help small businesses be the same.

Mr. President, I am glad I had the opportunity to hear the comments of the Senator from Iowa on Senator Byrd. We all have enormous respect for Senator Byrd. I had a chance this morning to say a word about him and to reflect on, among other things, that when I first came here as a young aide 42 years ago to Senator Baker, Senator Byrd had already been here for 10 years as a Senator.

So it is quite a span of history, and all of us have many stories, including the instructions he would give us to stand behind our desk when we vote, and not work at the table when we preside. He kept order in the Senate, and we are grateful to him for that.

Mr. President, I would like to say a word about health care. The Democratic leader, Senator Reid, today announced that he has completed work on a health care bill. We have been waiting for that. It has been written behind closed doors in Senator Reid's office for the last several weeks, so we have not known exactly what might be in it.

We have had two pieces of legislation from the Senate, one written by the HELP Committee, upon which I serve, another one from the Finance Committee. Now a bill has come from the House of Representatives. It has actually been passed there. Now the Democratic majority leader will be bringing forward his version of the bill. The bill seems to grow each time we have a new one--a little faster than the Federal debt grows even. This one seems to be another 2,000-page, trillion-dollar bill.

But the point I want to make tonight is that the American people's response to this work will be what all of ours should be: We want to read the bill. We want to know what it costs. And we want to make sure we have time to understand exactly how it affects the health of each American.

This is the most personal kind of debate we could have about the health of every single American. It affects 17 percent of our economy. It is a dramatic proposal, an enormous amount of money, at a time when our debt has reached $12 trillion. A great many Americans are concerned about Washington, DC, because we do not seem to have a check and a balance on the various proposals for Washington takeovers, more debt, more spending, more taxes. Tonight I would like to do a simple thing, which is not to make a Republican speech but to read a letter, or parts of a letter, and insert it in the Record, that was written by eight Democratic Senators on October 6 to Senator Reid.

I think their words say a great deal about this bill and about how we should proceed on it. The letter is dated October 6, from eight Democratic Senators. It says, in part:

Dear Leader Reid:

. . . .Whether or not our constituents agree with the

direction of the debate, many are frustrated and lacking

accurate information on the emerging [health care] proposals

in Congress. Without a doubt--

Say these eight Democratic Senators----

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 of creating a bill that lowers health care costs and

offers access to quality and affordable health care for all

Americans.

And then, if I may read a couple more paragraphs from the letter from these eight Democratic Senators to the Democratic leader:

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--

``to vote''----

on legislation that will affect the lives of every American.

The eight Democratic Senators continue:

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.

Let me read that again. That is not 40 Republicans--although all 40 of us agree with it--this is eight Democratic Senators to the Democratic leader: ``The legislative text,'' No. 1, the ``complete budget scores,'' No. 2, ``from the Congressional Budget Office,'' posted on ``a website,'' No. 3, for ``72 hours'' before ``the first vote to proceed on the legislation.''

The distinguished Democratic leader's announcement was only made a few minutes ago, but my understanding is we do not yet have a complete legislative text. Hopefully, that will come tonight or in the morning.

Second, I understand the estimates from the Congressional Budget Office are preliminary estimates. This letter says: ``complete budget scores.'' We know what a ``complete budget score'' is around here. It was talked about in the Finance Committee debate. The Director of the Congressional Budget Office said a complete estimate of the health care bill would take about 2 weeks to do. So the question is, Do they have it? And then: ``72 hours'' before ``the first vote to proceed.''

So I think the eight Democratic Senators, along with all 40 Republican Senators, have a bipartisan agreement here on how we should start this debate. We want to be able to read it, we want to know what it costs, and we want to see how it affects every American. That means, No. 1, a complete text. No holes, no ``We will get back to you later'' a complete text. No. 2, a complete estimate. Those are these words here: A complete estimate of the cost and how it affects every American. And third, for 72 hours on the Web site so not only we in the Senate but our constituents, the people who expect us to weigh in on this, have a chance to read it before we have our first vote, which I don't think is scheduled.

There is other language here, but I ask unanimous consent that this letter from the eight Democratic Senators of October 6 to the Honorable Harry Reid be included in the Record following my remarks.

Mr. President, the last thing I would say is this: I think it is pretty obvious why we want to read the bill and know what it costs and understand how it affects the health care of every American, which it will, but in case anyone is wondering why we want to read the bill, it is because the bills we have already seen increase insurance premiums, raise taxes, and cut Medicare. That is what we have seen from the two Senate bills and the House bill. We on the Republican side think this ought to be about reducing costs, reducing premiums, but the Democrats' proposals increase premiums, increase taxes, and cut Medicare. Not only does it cut Medicare in the bills we have seen so far by $400 billion or $500 billion; it doesn't spend it on grandma, it spends it on somebody else, even though the Medicare Program, the trustees tell us, will begin to go broke by 2015.

There are some other problems with the bills we have seen before, so we would want to be able to ask these same questions about the new bill we haven't yet seen but we are about to see.

On Medicare, how big are the cuts? Then we hear in this new bill there are Medicare taxes, new Medicare payroll taxes. On which employees or which employers? And if their taxes are raised, are they spent to make Medicare solvent or are they spent on a new program? It is inconceivable to me that we could be even thinking about having savings in Medicare and spending it on something else when Medicare is about to go broke.

Then there are some other questions. The Democratic leader said it doesn't add to the debt. I hope he is right, but we have questions to ask about that. Does his proposal include a full dealing with the issue of physician reimbursement? What we mean by that is when we create these big government programs, then some agency in Washington tells how much we can pay doctors for different services and how much we pay hospitals. Right now, in the government programs we have--Medicare, for example--doctors are only paid about 80 percent of what they are paid for serving the roughly 200 million of us who have private plans. And for those who are in Medicaid--low income; that is the largest government program--it is about 60 percent. Doctors are paid about 60 percent of what they were paid if they saw private physicians. Then, as a result, 50 percent of doctors won't see new people in that Medicaid Program, which is why so many people think: I am not so sure a new government-run program of insurance is such a good idea, because I might end up in it and it might be like Medicaid and 50 percent of the doctors won't see new Medicaid patients.

Why might you end up in a government program if you are not there now? Well, in the other bills we have seen--and this would be a question we have about Senator Reid's bill--the combination of sections means that a great many employers are going to look at the bill and the requirements that are placed on them and they are going to write a letter to their employees and say: Congratulations, there is a new government plan. I have sent a check to the government, and instead of having employer insurance, you are in the government plan. Well, you may not have been thinking that was the kind of health reform you wanted.

There is the matter of the States. I will admit that as a former Governor I may be more worried about this than some people, but I see a former mayor in the Presiding Officer's chair today. I won't speak for him, but I know I used to sit back there in Nashville and nothing would make me madder than some Member of Congress coming up with a big idea, pass it into law, issue a press release, take credit for it, and send me the bill when I was Governor. So all of the other bills we have seen say, It is a great idea to expand Medicaid. We are going to dump about 14 million more Americans in this program for low-income Americans and we are going to send the bill for part of it to the State.

Well, our Democratic Governor thinks that is a bad idea, because our State, which is fiscally well managed--Tennessee--and virtually every other State is having the worst time they have had since the Great Depression in managing their resources. Here they have the Medicaid Program going up at 8 percent a year, and they are cutting higher education and other programs. That is what is going on in the States. So we will have to ask the question: How much does this new bill transfer costs to the States?

There are a great many questions we will need to ask, and they are appropriate questions. The Republican leader pointed out that when we did the farm bill, we talked for 4 weeks. We debated, we had amendments, we came to a conclusion, and we had a bipartisan result. When we did No Child Left Behind, it was 7 weeks. I remember on the Energy bill of 2005, which put us on a new direction, Senator Bingaman and Senator Domenici and others worked very hard on it, but on the floor it took 8 or 9 weeks. We need to have a full discussion of whatever bill finally comes to the floor, and this may be the bill. It is at least 2,000 pages. It is at least $1 trillion. Maybe it is a good bill. But the American people will have a lot of questions about whether their premiums are going up instead of down, their taxes are going up instead of down; how much are the Medicare cuts--why are they being spent on somebody else instead of the people in Medicare? What about these Medicare payroll taxes? What about new State taxes? Will I lose my insurance? These are big questions and they deserve to be answered.

A good way to start is to take the advice of the eight Democratic Senators who wrote the Democratic leader and said: Before we have our first vote, Mr. Leader, No. 1, we want to see the complete text which we don't yet have; we want to see a complete estimate by the Congressional Budget Office; and we want it to be on the Internet for at least 72 hours--the words were very strong--because we have a duty to the American people that they know how this affects them, because it is a very personal matter.

I thank the President.

Exhibit 1

U.S. Senate,

Washington, DC, October 6, 2009.

Hon. Larry Reid,

Senate Majority Leader, U.S. Capitol, Washington, DC.

Dear Leader Reid: As you know, Americans across our country

have been actively engaged in the debate on health care

reform. Whether or not our constituents agree with the

direction of the debate, many are frustrated and lacking

accurate information on the emerging proposals in Congress.

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 of creating a bill that lowers health care costs and

offers access to quality and affordable health care for all

Americans.

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

legislative text and complete budget scores from the

Congressional Budget Office (CBO) 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.

By publically posting the legislation and its CBO 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 and communicate their concerns or their message of

support to their Members of Congress. As their

democratically-elected representatives in Washington, DC, it

is our duty to listen to their concerns and to provide them

with the chance to respond to proposals that will impact

their lives. At a time when trust in Congress and the U.S.

government is unprecedentedly low, we can begin to rebuild

the American people's faith in their federal government

through transparency and by actively inviting Americans to

participate in the legislative process.

We respectfully request that you agree to these principles

before moving forward with floor debate of this legislation.

We appreciate your serious consideration and look forward to

working with you on health care reform legislation in the

weeks ahead.

Sincerely,

Blanche L. Lincoln.

Mary L. Landrieu.

Claire McCaskill.

Mark L. Pryor.

Evan Bayh.

Joseph I. Lieberman.

Ben Nelson.

Jim Webb.

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

Mr. President, would you kindly let me know when 9 minutes have expired in my remarks?

Thank you, Mr. President.

Mr. President, not long ago, eight Democratic Senators wrote to the majority leader and said what all 40 Republican Senators have expressed and what most Americans--I think maybe 99 percent of Americans--would say we need to do. They said: Before we proceed to a vote on the health care bill that is so much in discussion across this country today, that we, No. 1, have a complete legislative text; that we, No. 2, have a complete estimate of its costs from the Congressional Budget Office; and, No. 3, it be on the Internet for 72 hours so the American people can read it--read the text, know what it costs, have time to consider both.

We are looking forward to that bill. What we know is, we have a 2,000-page bill that has been passed by the House of Representatives narrowly. The majority leader has had in his office a secret bill that he is working on which we have not seen yet.

This morning, I would like to talk about one of the reasons it is important we be able to read the text, know what it costs, and know how it affects each American. We have talked a lot about how the bills we have seen so far have the effect of raising insurance premiums, increasing taxes, cutting Medicare, and increasing the Federal debt, when what we are supposed to be doing is reducing the cost of health care for individuals and families and reducing the cost of health care to the government which is spiraling out of control in terms of deficit spending.

But all of that obscures an even more serious problem with the health care bills we have seen so far; that is, the effect on the States. As a former Governor of Tennessee, that is what I want to address for a few minutes this morning.

I picked up my newspaper in Nashville on Sunday morning, and here was the headline: ``[Governor] Bredesen Faces Painful Choices as [Tennessee] Begins Budget Triage.'' ``Triage''--that is a sort of talk usually reserved for an emergency room.

I have said several times--and some people, I am sure, thought I was being facetious--that any Senator who votes to expand Medicaid and transfer enormous costs to the States ought to be sentenced to go home and serve as Governor for 2 terms and try to implement the Medicaid Program, which is bankrupting States and ruining public higher education. I am not facetious when I say that because if we have a chance to read these bills and know what they cost, they have the potential to literally bankrupt States and ruin public higher education.

But do not take my word for it. Here is the Nashville Tennessean and the Knoxville News Sentinel writing about Governor Bredesen of Tennessee. Knoxnews.com reports: ``relentless bad news.'' Now, Tennessee is ``fiscally better off than many States.'' The ``shortfall is less severe than the Bredesen administration estimate[d].'' ``But there is no quarrel,'' according to the State's largest newspapers, that Tennessee's State government ``faces a grim situation''--``$750 million in cuts.'' Then things got worse because the money coming in this year is less than was expected. The Governor ``has told his department heads to present him with suggestions for budget cuts of 6 percent and to include contingency plans for adding another 3 percent.''

Those are real cuts. We talk about cuts in Washington. We talk about reducing the rate of growth. Those are not real cuts. In Tennessee and in California and in Illinois, and all across this country, cuts are cuts. You spend less this year than you did the year before.

``Layoffs . . . are likely, the Governor says.'' ``This will be my toughest budget year.''

Charles Sisk, writing in the Tennessean of November 16, says:

Tennessee might release as many as 4,000 non-violent

felons, possibly even including people convicted of drug

dealing and robbery, under a plan outlined Monday by the

Department of Correction to deal with the state's budget

crisis.

The National Governors Association, in an analysis last week, points out a combination of the economic downturn--the deepest since the Great Depression--and the increase in State Medicaid--now, this is not Medicare for seniors we are talking about; this is the largest program for low-income Americans, 60 million Americans for which States pay about one-third of that cost, which the health care plans we have seen intend to dump about 14 million more Americans into--spending for those programs average 8 percent growth this year, while Governors such as Governor Bredesen are making actual cuts. Well, you can imagine what that is doing to other important State programs and tuition.

The Washington Post reported what the Office of the Actuary at the Centers for Medicare and Medicaid Services said over the weekend; which is, generally speaking, when we add more people to the Medicaid Program the doctors and the hospitals who are expected to serve them will not be willing to serve them. I will say more about that in a minute.

So how in the world, in the light of these conditions, could we even be thinking about a provision in this health care bill that would add tens of billions of new costs to the States? We decide in Washington that it is a great idea to expand health care, but we send the bill to the Governors and the legislators who are in their worst fiscal condition since the Great Depression.

That is called an unfunded mandate. If we think it is such a great idea to dump 14 million more Americans into a low-income program called Medicaid--for which 50 percent of doctors will not see new patients because they are so under-reimbursed--then we should pay for it somehow in the Federal budget instead of dumping the bill onto the States.

For Tennessee, the costs will be, according to Governor Bredesen, who is a Democrat and the cochairman of the National Governors Association health care caucus--he says this will cost our State $1.4 billion over the next 5 years.

This is real money. How much money? Well, based on my experience as Governor, I do not see how the State of Tennessee could afford to pay that without instituting a new State income tax or without doing serious damage to higher education in Tennessee or both. And I believe it is true of every State in America. The majority leader thought it was true of his State, so he fixed it for his State and three others, but for just 5 years. Then what happens after the 5 years? Well, you put the bridge out on the chasm a little further and you fall off as far or maybe farther than you already would.

Forty percent of physicians, according to a 2002 Medicare Payment Advisory Committee survey, restrict access for Medicaid patients. So we are saying here we have a great health care reform bill and not only is it going to bankrupt States but it doesn't do any favors for a great many low-income Americans, because we are putting them in a system where 40 percent of doctors won't see them freely, and 50 percent of doctors won't see new Medicaid patients at all. In some States, the number of doctors who will see babies, who will see children, is as low as 20 or 30 or 40 percent. So as a way of partially dealing with that, the House bill says, OK, States are going to be required to pay primary care doctors who see Medicaid patients as much as Medicare doctors are paid. That adds another big new bill to the State, runs up

the State taxes, runs up the college tuition payments when the States are unable to properly fund the colleges and the universities and the community colleges. So my colleagues can see why this is so much trouble: billions more for the Federal Government; billions more for the States. Then it is like giving the low-income Americans who end up in this government program, which is expanding, a ticket to a bus line that doesn't operate half the time, because half the doctors won't see new Medicaid patients.

Thank you very much, Mr. President.

Add to all of that the idea of dumping 14 million more low-income Americans into the Medicaid Program not only ruins States fiscally, hurts public higher education in the States, puts these patients in programs that doctors won't see; it is a program where $1 out of $10 is wasted by fraud and abuse, according to the Government Accountability Office.

Republicans suggest that instead of these comprehensive, sweeping, 2,000-page bills that raise taxes, raise premiums, raise the debt, add to State taxes, hurt higher education because of what I described, and put low-income Americans into a program that half the doctors won't see, we should move step by step to reduce costs. We should start with small business health plans that allow businesses to pool their resources and insure more people at a lower cost; allow purchasing of health insurance across State lines; reduce the number of junk lawsuits against doctors; create health insurance exchanges so more Americans can shop for cheaper health insurance; and do something about waste, fraud, and abuse. If we were to take those steps, that would be real health care reform because it would be reducing costs to the American people and to our government.

Mr. President, I ask unanimous consent that the articles I referred to earlier be printed in the Record.

I thank the Chair and yield the floor.

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

Mr. President, will you please let me know when 10 minutes have expired?

Mr. President, Senator Webb of Virginia, the colleague of the Presiding Officer, and I are introducing legislation today to propose that the United States build its clean energy future upon the lessons of the Manhattan Project of World War II. That helped end the war. It was a millions-of-man-hour effort that the New York Times called ``without doubt, the most concentrated intellectual effort in history.''

Specifically, we will introduce legislation to create the business and regulatory environment to double our country's nuclear power production within 20 years and to launch five mini-Manhattan Projects to make advanced clean energy technologies effective and cost- competitive.

The most important thing I can say is that the senior Senator from Virginia and the junior Senator from Virginia and I have all talked about this subject before. I think we see there is a great deal of consensus in this body about some steps we can take on clean energy. So what Senator Webb and I are hoping to do with this framework is to see on a one-on-one basis whether it is the kind of framework that will permit us to work with other Senators who expressed an interest in nuclear power and energy research and development. And while we are contending about economy-wide cap and trade, we could move ahead with these steps that have to do with clean energy, clean air, climate change, low-cost, reliable energy.

In other words, this is a piece of legislation that you can support if you are for an economy-wide cap and trade or if you are against an economy-wide cap and trade. There are some things we can do to help our country that also help us deal with climate change.

In 1942, President Franklin D. Roosevelt asked Senator McKellar, the Tennessean who chaired the Appropriations Committee, to hide $2 billion in the appropriations bill for a secret project to win World War II. Senator McKellar replied:

That should be no problem, Mr. President. I have just one

question: Where in Tennessee do you want me to hide it?

That place in Tennessee turned out to be Oak Ridge, one of the three secret cities that became the principal sites for the Manhattan Project that split the atom and built a bomb before Germany could. Nearly 200,000 people worked on the project in 30 different sites in 3 countries.

President Roosevelt's $2 billion appropriation would be $24 billion today.

After World War II, in 1947, ADM Hyman Rickover came to Oak Ridge for training that led to the nuclear Navy that helped to defend our country for half a century. Shortly thereafter, in December 1953, President Eisenhower proposed his Atoms For Peace Program that has grown into the world's most effective supplier of large amounts of reliable, carbon- free, low-cost electricity.

The rest of the world has a new interest in this American success story, as countries seek energy independence, clean air, cheap energy for job creation, as well as carbon-free energy to deal with global warming. The Chinese are starting a new nuclear powerplant every 2 or 3 months. The Japanese obtain a third of their power from nuclear plants and build new reactors from start to finish in less than 4 years. France gets 80 percent of its electricity from nuclear power and, as a result, has among the lowest electricity rates and carbon emissions in Western Europe. Russia plans to double its nuclear power capacity. The United Arab Emirates is planning three new reactors by 2020, and just last week the United Kingdom announced it will build 10. Yet the country that invented this remarkable technology, the United States of America, has not started a new nuclear powerplant in 30 years even though we still get 70 percent of our carbon-free electricity and 19 percent of all our electricity from 104 reactors built between 1970 and 1990.

It is true that there are other promising forms of low-carbon and carbon-free renewable energy, but the stark reality is that there is a huge gap between this renewable electricity we would like to have and the reliable, low-cost electricity that a country that uses 25 percent of all the energy in the world has to have.

Today, despite heavy subsidies, wind, solar, geothermal, biomass renewable energy produce only 3 percent of U.S. electricity. The Energy Information Administration forecasts a 22-percent increase in U.S. electricity demand during the next 20 years. For that much electricity, our country simply cannot rely solely on conservation, on windmills and solar panels or even on natural gas. We are fortunate to have a new, massive natural gas set of discoveries in the United States, but a natural gas powerplant still produces about half as much carbon as a new coal plant. And if too many natural gas plants are built, today's low prices could mean high prices tomorrow for farmers, homeowners, and manufacturers.

Add to that a recent Nature Conservancy scientific paper that warned of a coming renewable energy sprawl, especially from biofuels, biomass, and wind turbines, that would consume an area the size of West Virginia. A biomass plant, for example, that would produce as much electricity as one nuclear reactor on 1 square mile would require continuously deforesting an area about 1.5 times the size of the Great Smoky National Park. Producing 20 percent of our electricity from 50- story wind turbines, as some have suggested, would require covering an area the size of West Virginia and building 19,000 miles of new transmission lines.

When these are strung along scenic ridgetops, coastlines, or other treasured landscapes, we will be destroying the environment in the name of saving the environment. Solar and wind installations require between 30 and 270

square miles to duplicate the output of just one nuclear reactor on 1 square mile. Moreover, these energy sources must be backed up by other generation since they only produce power when the wind blows or the Sun shines, and that electricity cannot be stored in large amounts. There is only one wind farm in the entire Southern United States because the wind doesn't blow enough. In the Tennessee Valley Authority region, solar costs at least four to five times as much as other electricity that TVA buys.

As for green jobs, according to the Department of Energy, there will be 250,000 construction jobs for 100 new nuclear plants. This would compare with 73,000 jobs to construct the 180,000 wind turbines needed to produce 20 percent of our electricity from wind. Of course, producing a lot of cheap, reliable energy is the best way to produce new jobs.

Think of it this way. If we were going to war, we wouldn't mothball our nuclear Navy and start subsidizing sailboats. If climate change, as well as low-cost, reliable energy are national imperatives, we should not stop building nuclear plants and start subsidizing windmills. I am on the side of those who say we need to deal with climate change. The national academies of 11 industrialized countries, including the United States, have said humans probably have caused most of the recent global warming.

If fire chiefs of the same reputation said my house might burn down, I would buy fire insurance, but I would buy insurance that worked and that was not so expensive that I couldn't pay my mortgage or my hospital bill.

Fortunately, there are two steps that will benefit our country in multiple ways--namely, cleaner air; more energy independence; more reliable, low-cost power--and will also help fight global warming. The first is to double production of electricity from carbon-free nuclear power, which would mean building 100 new plants as we did between 1970 or 1990 or a larger number of the new, small, and modular reactors now being discussed. The second is to apply to the promising new technologies, such as the renewable technologies, the same discipline and resources we did with the original Manhattan Project in order to make them effective and cost competitive.

That is why the bill Senator Webb and I are introducing today, the Clean Energy Act of 2009, proposes the following: No. 1, loan guarantees: $100 billion to encourage startup of all forms of carbon- free electricity production, expanding the $47 billion loan guarantee program that exists today, and $18 billion of those funds are currently available for nuclear projects.

Secretary Chu has suggested it should be in the forties. I believe that number should be closer to the sixties or the seventies. But the purpose of this is to get the first few nuclear plants up and running, and then the money is paid back. The Congressional Budget Office estimates this could cost up to $10 billion but might cost much less. New reactor designs, $1 billion over 5 years to enable the Nuclear Regulatory Commission to review new designs such as the generation 4 reactors that don't isolate plutonium and, therefore, help solve the used nuclear fuel problems, and small modular reactors that can be built in U.S. factories and assembled on site such as LEGO blocks. No. 3, nuclear workforce, $1 billion over 10 years to ensure a supply of nuclear engineers, operators, and craftsmen such as welders and pipe fitters. Americans have a generation gap in these skilled personnel. No. 4, more power from existing reactors. This would be $500 million over 10 years to increase the efficiency and develop longer lifetimes for our existing 104 reactors. If we did both of these things, we might create the equivalent production of 20 or 30 more reactors. Then, finally, the five new, what we call mini-Manhattan Projects for clean energy.

Here are the five mini-Manhattan Projects: $750 million per year over 10 years for research and development on, No. 1, carbon capture emissions from coal plants. In many ways that is the holy grail of energy R&D. If we can find a way to do that, we can have all of the low-cost, clean electricity we can use. No. 2, develop advanced biofuels from crops that we don't eat; No. 3, improve batteries for electric cars so instead of taking us 100 miles without recharging, they might take us 300 or 400 miles; make solar power more cost competitive.

That has the most promise in terms of renewable energy because we have rooftops on which to put the panels. They just cost too much today. Then recycling used nuclear fuel in a way that doesn't isolate plutonium, that reduces by 99.9 percent the radioactive life of what is left, and by 97 percent the mass we have to deal with. The cost to taxpayers over 20 years would be no more than $20 billion. There would be no new energy taxes or mandates. This $20 billion would compare with $170 billion we would spend in taxpayer subsidies, if we were to produce 20 percent of our electricity from wind, not counting the billions more for transmission lines.

By my computation, if we actually did build 100 nuclear plants in 20 years, as well as electrify half our cars and trucks in 20 years, which we should be able to do without building one new powerplant if we plugged them in at night, we would come close to reaching the 1990 Kyoto global warming protocols without expensive new energy taxes. Reaching that goal is even more likely if some of our mini-Manhattan Projects produce results we hope for from new technologies.

The world nuclear power revival is well underway. With our Clean Energy Act of 2009, that revival might finally reach American shores where it began. The lessons of the Manhattan Project could advance the days when more nuclear power and new forms of clean energy can make us more energy independent, clean our air, help fight global warming, and produce large amounts of reliable, low-cost, clean electricity that will keep American jobs from going overseas looking for cheap energy.

I ask unanimous consent to have printed in the Record a one-page summary of the Alexander-Webb legislation, called the Clean Energy Act of 2009.

I thank the Senator from Virginia, Mr. Webb, for his leadership. He brings a special knowledge to this because of his background in the Navy as an engineer and as Secretary of the Navy. Thousands of our sailors have lived on top of reactors for 50 years safely. This is an idea that has broad support on both sides of the aisle, I believe. We have gotten so stuck on arguing about the economy- wide cap and trade that we have failed to notice the areas where we may be able to agree. We certainly agree on energy research and development.

The President has strongly supported that. We certainly agree on electrification of cars and trucks. The President also strongly supports that.

I believe there is more agreement on nuclear power than we have seen before. So we are going to work with Democratic and Republican Senators who have already expressed such an interest and others who may be thinking about it over the next few weeks to see if this will form a framework for that kind of discussion.

Mr. President, Senator Webb of Virginia, the colleague of the Presiding Officer, and I are introducing legislation today to propose that the United States build its clean energy future upon the lessons of the Manhattan Project of World War II. That helped end the war. It was a millions-of-man-hour effort that the New York Times called ``without doubt, the most concentrated intellectual effort in history.''

Specifically, we will introduce legislation to create the business and regulatory environment to double our country's nuclear power production within 20 years and to launch five mini-Manhattan Projects to make advanced clean energy technologies effective and cost- competitive.

The most important thing I can say is that the senior Senator from Virginia and the junior Senator from Virginia and I have all talked about this subject before. I think we see there is a great deal of consensus in this body about some steps we can take on clean energy. So what Senator Webb and I are hoping to do with this framework is to see on a one-on-one basis whether it is the kind of framework that will permit us to work with other Senators who expressed an interest in nuclear power and energy research and development. And while we are contending about economy-wide cap and trade, we could move ahead with these steps that have to do with clean energy, clean air, climate change, low-cost, reliable energy.

In other words, this is a piece of legislation that you can support if you are for an economy-wide cap and trade or if you are against an economy-wide cap and trade. There are some things we can do to help our country that also help us deal with climate change.

In 1942, President Franklin D. Roosevelt asked Senator McKellar, the Tennessean who chaired the Appropriations Committee, to hide $2 billion in the appropriations bill for a secret project to win World War II. Senator McKellar replied:

That should be no problem, Mr. President. I have just one

question: Where in Tennessee do you want me to hide it?

That place in Tennessee turned out to be Oak Ridge, one of the three secret cities that became the principal sites for the Manhattan Project that split the atom and built a bomb before Germany could. Nearly 200,000 people worked on the project in 30 different sites in 3 countries.

President Roosevelt's $2 billion appropriation would be $24 billion today.

After World War II, in 1947, ADM Hyman Rickover came to Oak Ridge for training that led to the nuclear Navy that helped to defend our country for half a century. Shortly thereafter, in December 1953, President Eisenhower proposed his Atoms For Peace Program that has grown into the world's most effective supplier of large amounts of reliable, carbon- free, low-cost electricity.

The rest of the world has a new interest in this American success story, as countries seek energy independence, clean air, cheap energy for job creation, as well as carbon-free energy to deal with global warming. The Chinese are starting a new nuclear powerplant every 2 or 3 months. The Japanese obtain a third of their power from nuclear plants and build new reactors from start to finish in less than 4 years. France gets 80 percent of its electricity from nuclear power and, as a result, has among the lowest electricity rates and carbon emissions in Western Europe. Russia plans to double its nuclear power capacity. The United Arab Emirates is planning three new reactors by 2020, and just last week the United Kingdom announced it will build 10. Yet the country that invented this remarkable technology, the United States of America, has not started a new nuclear powerplant in 30 years even though we still get 70 percent of our carbon-free electricity and 19 percent of all our electricity from 104 reactors built between 1970 and 1990.

It is true that there are other promising forms of low-carbon and carbon-free renewable energy, but the stark reality is that there is a huge gap between this renewable electricity we would like to have and the reliable, low-cost electricity that a country that uses 25 percent of all the energy in the world has to have.

Today, despite heavy subsidies, wind, solar, geothermal, biomass renewable energy produce only 3 percent of U.S. electricity. The Energy Information Administration forecasts a 22-percent increase in U.S. electricity demand during the next 20 years. For that much electricity, our country simply cannot rely solely on conservation, on windmills and solar panels or even on natural gas. We are fortunate to have a new, massive natural gas set of discoveries in the United States, but a natural gas powerplant still produces about half as much carbon as a new coal plant. And if too many natural gas plants are built, today's low prices could mean high prices tomorrow for farmers, homeowners, and manufacturers.

Add to that a recent Nature Conservancy scientific paper that warned of a coming renewable energy sprawl, especially from biofuels, biomass, and wind turbines, that would consume an area the size of West Virginia. A biomass plant, for example, that would produce as much electricity as one nuclear reactor on 1 square mile would require continuously deforesting an area about 1.5 times the size of the Great Smoky National Park. Producing 20 percent of our electricity from 50- story wind turbines, as some have suggested, would require covering an area the size of West Virginia and building 19,000 miles of new transmission lines.

When these are strung along scenic ridgetops, coastlines, or other treasured landscapes, we will be destroying the environment in the name of saving the environment. Solar and wind installations require between 30 and 270

square miles to duplicate the output of just one nuclear reactor on 1 square mile. Moreover, these energy sources must be backed up by other generation since they only produce power when the wind blows or the Sun shines, and that electricity cannot be stored in large amounts. There is only one wind farm in the entire Southern United States because the wind doesn't blow enough. In the Tennessee Valley Authority region, solar costs at least four to five times as much as other electricity that TVA buys.

As for green jobs, according to the Department of Energy, there will be 250,000 construction jobs for 100 new nuclear plants. This would compare with 73,000 jobs to construct the 180,000 wind turbines needed to produce 20 percent of our electricity from wind. Of course, producing a lot of cheap, reliable energy is the best way to produce new jobs.

Think of it this way. If we were going to war, we wouldn't mothball our nuclear Navy and start subsidizing sailboats. If climate change, as well as low-cost, reliable energy are national imperatives, we should not stop building nuclear plants and start subsidizing windmills. I am on the side of those who say we need to deal with climate change. The national academies of 11 industrialized countries, including the United States, have said humans probably have caused most of the recent global warming.

If fire chiefs of the same reputation said my house might burn down, I would buy fire insurance, but I would buy insurance that worked and that was not so expensive that I couldn't pay my mortgage or my hospital bill.

Fortunately, there are two steps that will benefit our country in multiple ways--namely, cleaner air; more energy independence; more reliable, low-cost power--and will also help fight global warming. The first is to double production of electricity from carbon-free nuclear power, which would mean building 100 new plants as we did between 1970 or 1990 or a larger number of the new, small, and modular reactors now being discussed. The second is to apply to the promising new technologies, such as the renewable technologies, the same discipline and resources we did with the original Manhattan Project in order to make them effective and cost competitive.

That is why the bill Senator Webb and I are introducing today, the Clean Energy Act of 2009, proposes the following: No. 1, loan guarantees: $100 billion to encourage startup of all forms of carbon- free electricity production, expanding the $47 billion loan guarantee program that exists today, and $18 billion of those funds are currently available for nuclear projects.

Secretary Chu has suggested it should be in the forties. I believe that number should be closer to the sixties or the seventies. But the purpose of this is to get the first few nuclear plants up and running, and then the money is paid back. The Congressional Budget Office estimates this could cost up to $10 billion but might cost much less. New reactor designs, $1 billion over 5 years to enable the Nuclear Regulatory Commission to review new designs such as the generation 4 reactors that don't isolate plutonium and, therefore, help solve the used nuclear fuel problems, and small modular reactors that can be built in U.S. factories and assembled on site such as LEGO blocks. No. 3, nuclear workforce, $1 billion over 10 years to ensure a supply of nuclear engineers, operators, and craftsmen such as welders and pipe fitters. Americans have a generation gap in these skilled personnel. No. 4, more power from existing reactors. This would be $500 million over 10 years to increase the efficiency and develop longer lifetimes for our existing 104 reactors. If we did both of these things, we might create the equivalent production of 20 or 30 more reactors. Then, finally, the five new, what we call mini-Manhattan Projects for clean energy.

Here are the five mini-Manhattan Projects: $750 million per year over 10 years for research and development on, No. 1, carbon capture emissions from coal plants. In many ways that is the holy grail of energy R&D. If we can find a way to do that, we can have all of the low-cost, clean electricity we can use. No. 2, develop advanced biofuels from crops that we don't eat; No. 3, improve batteries for electric cars so instead of taking us 100 miles without recharging, they might take us 300 or 400 miles; make solar power more cost competitive.

That has the most promise in terms of renewable energy because we have rooftops on which to put the panels. They just cost too much today. Then recycling used nuclear fuel in a way that doesn't isolate plutonium, that reduces by 99.9 percent the radioactive life of what is left, and by 97 percent the mass we have to deal with. The cost to taxpayers over 20 years would be no more than $20 billion. There would be no new energy taxes or mandates. This $20 billion would compare with $170 billion we would spend in taxpayer subsidies, if we were to produce 20 percent of our electricity from wind, not counting the billions more for transmission lines.

By my computation, if we actually did build 100 nuclear plants in 20 years, as well as electrify half our cars and trucks in 20 years, which we should be able to do without building one new powerplant if we plugged them in at night, we would come close to reaching the 1990 Kyoto global warming protocols without expensive new energy taxes. Reaching that goal is even more likely if some of our mini-Manhattan Projects produce results we hope for from new technologies.

The world nuclear power revival is well underway. With our Clean Energy Act of 2009, that revival might finally reach American shores where it began. The lessons of the Manhattan Project could advance the days when more nuclear power and new forms of clean energy can make us more energy independent, clean our air, help fight global warming, and produce large amounts of reliable, low-cost, clean electricity that will keep American jobs from going overseas looking for cheap energy.

I ask unanimous consent to have printed in the Record a one-page summary of the Alexander-Webb legislation, called the Clean Energy Act of 2009.

I thank the Senator from Virginia, Mr. Webb, for his leadership. He brings a special knowledge to this because of his background in the Navy as an engineer and as Secretary of the Navy. Thousands of our sailors have lived on top of reactors for 50 years safely. This is an idea that has broad support on both sides of the aisle, I believe. We have gotten so stuck on arguing about the economy- wide cap and trade that we have failed to notice the areas where we may be able to agree. We certainly agree on energy research and development.

The President has strongly supported that. We certainly agree on electrification of cars and trucks. The President also strongly supports that.

I believe there is more agreement on nuclear power than we have seen before. So we are going to work with Democratic and Republican Senators who have already expressed such an interest and others who may be thinking about it over the next few weeks to see if this will form a framework for that kind of discussion.

Reserving the right to object, I ask to add an equal amount of time, 2 minutes, to the Republican time.

Earlier today the assistant Democratic leader, who is now presiding, delivered some eloquent remarks about the murders at Fort Hood. I believe there were two soldiers from Illinois who were there. One was from Tennessee, from Mountain City, TN, which is a beautiful little part of our State, way up in the northeastern corner near Virginia. Some people have said it looks like Switzerland and that the people there talk in Elizabethan phrases and tones.

SPC Frederick Greene, according to an article in the Washington Post:

. . . was a Tennessee native so quiet and laid back that he

earned the nickname ``Silent Soldier'' while stationed at

Fort Hood preparing to go overseas.

He hoped to spend the months before his deployment to

Afghanistan with his wife of less than 2 years. She had made

arrangements to leave their home in Mountain City, TN, next

week and move to Fort Hood until January, when Greene was to

ship out.

Instead, [they] are planning his burial in the northeast

corner of the state where he grew up.

This is what Specialist Greene's family had to say about him, and I think it speaks as eloquently about his life and service to our country as anything could. In their words:

Fred was a loved and loving son, husband and father, and

often acted as the protector of his family.

Even before joining the Army, he exemplified the Army

values of loyalty, duty, respect, selfless service, honor,

integrity and personal courage. Many of his fellow soldiers

told us he was the quiet professional of the unit, never

complaining about a job, and often volunteering when needed.

Our family is grateful for the thoughts and prayers from

people around the country. We would like to ask for privacy

during this emotional time because Fred, too, was a very

private person.

We will honor the request for privacy of the family, but we will also honor Fred Greene for his service to our country.

Speaking just for myself, but I am sure most Tennesseans, most Americans, feel the same way--for 8 years now, tens of thousands of men and women from Tennessee have fought in Iraq and Afghanistan to keep terrorism from spreading here.

It is tragic enough when any one of them is wounded or killed in that fight; it is beyond belief when one of them is wounded or killed at home in a terrorist act at Fort Hood. That is hard for us to accept. But in accepting it and asking questions that we inevitably must ask about how this could have happened, we certainly can honor each of those who were killed, each of those who were wounded.

We can respect their service, and I especially want to show my respect for the family of SPC Frederick Greene and for his service.

I ask unanimous consent to have printed following the remarks I just made a brief article from the Washington Post and an article from the Johnson City, TN, Press of Tuesday, November 10.

We are in the middle of the health care debate. We have different points of view. I am sure people are confused by what they hear. I think that would be inevitable with a 2,000-page bill, which is the House-passed bill. That is all we have today while the Democratic majority leader writes his version of whatever we are expecting to act on, behind closed doors.

Earlier this week I talked to a woman in my home town. She expressed what I suppose many people believe. She said: I am very confused by what I hear, but I do not like what I hear. My husband lost his job. He was one of the lucky ones; he got a new job. But it only pays 60 percent of what he was earning doing the same work, and he does not have any benefits.

So, she said: I went back to work. I am a small business woman. We needed the benefits, so I went back to work.

But she said: These proposals I am hearing about do not seem to be working out the way they are supposed to. They are putting more costs on us when we buy our insurance and when, as a small business person, I have to buy insurance.

She said: I do not like what I hear.

I think she is expressing a real concern--it is a complicated bill. There is a lot of concern on both sides. We heard the other side talking about myths and reality. I see the Senator from South Dakota. It looks as though he has the 2,000-page bill with him. It is good that he is young and strong and can carry such things. His eyes are good, and he can read it. It will take a while to do that, which is why, when this bill gets to the Senate floor, we want to make sure we read the bill, we

know what it costs, and we help the American people understand how it affects them.

I would ask the Chair if he would please let me know when I have 60 seconds remaining on my 10 minutes.

What I would like to suggest this morning is that we ought to focus on a forgotten word, and the word is ``cost.'' This is supposed to be about reducing the cost of health care not increasing the cost of health care; reducing the cost of our premiums, which 250 million of us have. We have health care plans upon which we or somebody else pays premiums for us. We would like for those to go down or at least stabilize. That is what this reform is supposed to be about--and reducing the cost of health care to our government because all of us, including our President, have seen that we are going to go broke if we do not do that.

Here is the President speaking at the White House health summit on March 5 in words I thoroughly agree with:

If people think we simply can take everybody who is not

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

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

The Federal Government will be bankrupt. State governments

will be bankrupt.

That is President Obama using the B-word. Yet the bill we have coming toward us is indeed historic. But it is historic in its combination of higher premiums not lower premiums, of higher taxes, of Medicare cuts, and of more Federal debt.

Millions of Americans will be forced into government plans, perhaps including a new one, when their employers look at the option and say: We are out of here. They will write their employees: Congratulations. We are going to write a check to the government. That is better for us as a company, our bottom line, and you are in the government health care plan.

That is going to come as a shock to millions of Americans. We do not hear as much about it here. But one way the House of Representatives plans to pay for this expensive bill, that's going to cost between $2 trillion and $3 trillion, according to various estimates when it is fully implemented over 10 years, is to shift some of the cost to the States.

The numbers we throw around here after a while do not have any reality to them, but if you are a Governor--and our Governor, a Democratic Governor, has said that the House-passed bill--now that is not the Senate bill because the Senate bill is still behind closed doors; we have not seen it--but the House-passed bill will add about $1.3 billion cost to the State of Tennessee over the next 5 years for its share of the Medicaid costs, including reimbursement of physicians.

I have been the Governor of Tennessee. I know how much money that is, and I cannot see how the State of Tennessee can afford to pay for its share of these proposed Medicaid costs unless it institutes a new State income tax or seriously damages higher education or both.

So we should take a different approach. Instead of a 2,000-page bill with higher premiums--people say: Well, that is a myth. Well, it is not a myth. I mean, if you add $900 billion in taxes over 10 years to insurance companies and medical devices, who do you think is going to pay it? The people who pay for insurance premiums are going to pay it. If you tax the oil companies, who do you think is going to pay the tax? The people who buy gasoline. Taxes are not paid out of thin air; companies pass them on. So premiums are going to go up.

They are also going to go up because of government requirements for an ``approved government policy.'' Senator Collins of Maine said 87 percent of people in Maine would be paying more for the premiums they have today if they had to buy them new under the House-passed plan. So why do we not take a different direction? Instead of these 2,000-page bills, that cost $2 or $3 trillion, and are full of surprises and confusion, why do we not just set a goal of reducing costs? Why do we not go step by step in reducing those costs? I bet we could agree on a lot of things. Going step by step in the right direction is one good way of getting where we want to go. It also provides bipartisan support which would provide bipartisan support of the country, which the President and the majority will need to sustain the program. We want the President to succeed because we want our country to succeed. He is our President. But this bill will not help him succeed. It will not help our country succeed.

Just to conclude with one example of what a step would be is the small business health care plan, which we worked on for a long time. Senator Enzi from Wyoming has been the principal sponsor. It would allow small businesses to combine and offer insurance to a larger number of employees.

According to the Congressional Budget Office, such a plan, as I just described, would add nearly 1 million, 750,000 people would become insured. Three out of four people who are employees of small business would have lower rates, and we would reduce the cost of Medicaid by $1.4 billion.

That is just a step, but it is a step in the right direction. So I would hope we can focus on costs, reducing costs. Republicans have a series of steps we would like to take in that direction. We reject these 2,000-page bills that raise taxes and premiums and Medicare cuts. We hope we can come to some agreement before we conclude the debate.

I yield the floor.

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

Mr. President, how much time remains?

I ask the Presiding Officer to inform me when I have 30 seconds remaining.

Mr. President, the House of Representatives passed, by just five votes, a health care reform bill over the weekend. Some said it was historic. It is, indeed, historic. It is a combination of higher premiums, higher taxes, Medicare cuts, and more Federal Government debt.

Millions of Americans, if it were to pass, will be forced into government plans when their employers stop offering health care insurance.

As a former Governor of Tennessee, I simply do not see how Tennessee can pay for its part of the Medicaid expansion without imposing a new State income tax and damaging higher education or both.

Health care reform is supposed to be about reducing costs, not increasing costs. Instead of raising taxes, raising premiums, Medicare cuts, more debt, and transferring new costs to States, we should be taking steps toward reducing health care costs.

On the Republican side, we proposed a number of those, starting with small business health plans which would allow small businesses to pool together their resources and offer insurance to their employees. That would be a good place to start. The Congressional Budget Office has said that the small business health care plan which Senator Enzi has proposed and is waiting for us to pass would reduce the cost of Medicaid, would increase the number of insured by 750,000 at least, and would lower the cost of insurance for 3 out of 4 small business employees.

So instead of this 2,000-page bill that raises premiums, raises costs, cuts Medicare, and increases the debt, why don't we start step by step to reduce costs?

I was privileged to attend the White House fiscal responsibility summit in February. The President invited me, and I was glad to go. He talked then about what is obvious about our country's fiscal situation and said that putting America on a sustainable fiscal course ``will require addressing health care.''

Then, at the President's White House health reform summit in March, the President himself introduced the ``b'' word, the ``bankruptcy'' word, which I am beginning to hear more and more about as these bills come toward us. The President said:

If we don't address costs, I don't care how heartfelt our

efforts are, we will not get this done. If people think we

can simply take everybody who is not insured and load them up

in a system where costs are out of control, it's not going to

happen.

This is President Obama talking in March:

We will run out of money. The Federal Government will be

bankrupt; state governments will be bankrupt.

Well, that is the ``b'' word. That is our President talking. I think we should listen to those words and the repeated warnings from careful advisers that the cost of these health care proposals is going to get us in a state of fiscal ruin.

Here in Washington, we hear more about the Federal deficit, not so much about the condition of our States. At one time, maybe half the Senators were former Governors, as the Presiding Officer is and I was. Today, I think it is 12. But those of us who can remember those days remember what it was like trying to control Medicaid costs.

Governor Bredesen, a Democrat of Tennessee, told us over the weekend, our State--he told all of us that the House-passed bill will add $1.4 billion to the State budget over 5 years. If that is the case--and I know it is hard to put billions, trillions, jillions together up here and make them make sense, but let me try to make sense of what that could mean for our State, which is a conservative, well-run State. I don't see how the State of Tennessee could pay for its State share of the expanded Medicaid Program without instituting a new income tax or without seriously damaging higher education or both. And that is just one part of the new cost.

So what we are saying to the American people is, let's read this bill, let's know what it costs, and let's see how it affects you.

We will be seeing a Senate bill coming out from behind the closed doors of the majority leader within a few days. We look forward to debating it. We look forward to moving ahead with health care reform. But to us, raising premiums, costs, and taxes and cutting Medicare is not health care reform. Reducing costs with small business health plans, competition across State lines, reducing junk lawsuits against doctors--that is the direction we ought to go if we want to avoid seeing that ``b'' word show up on the front pages of our newspapers more and more.

I yield the floor.

Mr. President, how much time remains on the Republican side?

Thank you, Mr. President. Will you let me know when 3 minutes remain?

I thank the President.

Mr. President, we have a lot of unusual things happening in the Senate, the Congress, and the world today, but apparently we are about to be presented with a rare opportunity that very few Senators ever have a chance to vote on. The Democratic congressional health care bill will present Senators--it is still being written from behind closed doors, but from what we can tell from the other bills--with an opportunity to vote for one-half trillion dollars in Medicare cuts and $900 billion-plus in new taxes at the same time. It is very rare that any Senator has a chance to vote for Medicare cuts that big and new taxes that big all at once.

It is not an opportunity that many, if any, Republicans will take advantage of, but that is the proposal that is coming. It caused my colleague from Tennessee to say on the Senate floor yesterday that if Republicans were to propose the same thing--a one-half trillion dollars cut in Medicare, a 60-percent increase in premium costs, which is the estimated increase to Tennesseans who have insurance premiums, according to Senator Corker, plus taxes of $900 billion when fully implemented, it wouldn't get a single Democratic vote. I think Senator Corker is probably right about that.

Whenever we say this, this brings a deep concern from the other side of the aisle. The Senator from Ohio came to the Senate floor and engaged in a colloquy with the assistant Democratic leader yesterday after I left the floor and said:

Imagine this, the Republican Senator from Tennessee is

saying that Democrats are about to cut Medicare. Why would

they say that? It makes me incredulous to hear the Senator

say that Democrats are going to cut Medicare and we are going

to use Medicare cuts to pay for health care reform.

The only reason we and everybody else who reads their bill is saying that is because it is true. The proposal is to cut grandma's Medicare and spend it on their proposal, to cut nearly one-half trillion dollars in Medicare spending and not spend it on making Medicare solvent.

We know the Medicare trustees have said the program is going to go broke in 2015 to 2017, yet we are going to spend that money on a new government program into which many Americans who now have employer- based insurance will find their way. It is not Republicans who are scaring seniors about Medicare cuts; it is the Democratic health care bills that are scaring seniors about Medicare cuts. They have a right to be concerned.

Just in case anybody who might be listening thinks we are making this up on the Republican side of the aisle, I brought with me a few articles from reputable sources that describe the Democratic health care proposals and their proposed Medicare cuts.

Here is the New York Times on September 24, an article by Robert Pear, who writes about this subject regularly. It says:

To help offset the cost of covering the uninsured, the

Senate and House bills would squeeze roughly $400 billion to

$500 billion out of the projected growth in Medicare over 10

years.

That is the New York Times, Mr. President.

From the sanfranciscogate.com, this is an Associated Press article of September 22:

Congress' chief budget officer on Tuesday contradicted

President Obama's oft-stated claim that seniors wouldn't see

their Medicare benefits cut under a health care overhaul.

The head of the nonpartisan Congressional Budget Office,

Douglas Elmendorf, told senators that seniors in Medicare's

managed care plans could see reduced benefits under a bill in

the Finance Committee.

The bill would cut payment to Medicare Advantage plans by

more than $100 billion over 10 years.

Elmendorf said the changes ``would reduce the extra

benefits that would be made available to beneficiaries

through Medicare Advantage plans.''

Then there is the CBO, which in its October 7 letter to Senator Baucus talked about in detail the proposed Medicare cuts. Then there is the Associated Press article of July 30, 2009, which says:

Democrats are pushing for Medicare cuts on a scale not seen

in years to underwrite health care for all. Many seniors now

covered under the program don't like that one bit.

That is not the Republican National Committee. That is the Associated Press reporting on what the bills say. It also says:

The House bill--the congressional proposal that has

advanced the most--would reduce projected increases in

Medicare payments to providers by more than $500 billion over

10 years, a gross cut of about 7 percent over the period. But

the legislation would also plow nearly $300 billion back into

the program, mainly to sweeten payments to doctors.

That still leaves a net cut of more than $200 billion--

Says the Associated Press, describing the Democratic health care plan--

which would be used to offset new Federal subsidies for

workers and their families now lacking health insurance.

In other words, we are taking money from Medicare and spending it on someone else.

The Senator from Kansas said it is like writing a check on an overdrawn bank account to buy a big new car. That is a pretty good description.

I have a couple more. This is the Los Angeles Times, which is not a Republican publication. The headline on June 14 was, ``Obama to Outline $313 Billion in Medicare, Medicaid Spending Cuts.''

That is what Democratic Senators have always called such proposals, that is what the Los Angeles Times calls the proposals, and that is what we call it because that is what they are. The article says:

Reporting from Washington--Under pressure to pay for his

ambitious reshaping of the nation's healthcare system,

President Obama today will outline $313 billion in Medicare

and Medicaid spending cuts over the next decade to help cover

the cost of expanding coverage to tens of millions of

America's insured.

This is from an October 22 NPR report:

Over a decade, the committee would cut $117 billion from

the Medicare Advantage plans.

This is from an article in the Washington Post on October 23:

$500 billion in cuts to Medicare over the next decade.

That is the Washington Post.

This is the Wall Street Journal on September 8:

Other sources of funding for the Finance Committee plan

include cuts to Medicare.

Mr. President, the question is not whether there are going to be cuts to Medicare; that is the proposal. Maybe it is a good idea; maybe it is a bad idea. But we don't need to come to the Senate floor and say that something that is, is not.

The proposal in these large expansive health care plans--the 2,000- page bill coming from the House soon--is that it is basically half financed by cuts in Medicare--not to make the program solvent--a program which has $37 trillion in unfunded liabilities over the next 75 years--but to spend it on a new government program. Those are the facts. That is why it is important that the American people have an opportunity to read the bill and know what it costs and know how it affects them.

The Republican leader and Senator Johanns have talked about taxes in the bill. Rarely does a Senator have an opportunity to vote on so many Medicare cuts and so many new taxes, as we apparently will have when this bill comes to us.

The taxes include a tax on individuals who don't buy government- approved health insurance. The Joint Committee on Taxation, our joint committee, and the CBO estimate that at least 71 percent of that penalty, that tax, will hit people earning less than $250,000. So it is not just taxes on rich people. When you impose, as the Senate Finance Committee bill would, $900 billion-plus in new taxes, when fully implemented, on a whole variety of people and businesses that provide health care, what do they do?

According to the Director of the CBO, most of those taxes are passed on to the consumers. Who are the consumers? The people who are paying health care premiums--250 million Americans. What does that mean? That would mean that instead of reducing the cost of your health care premium, we are more likely to increase it.

I ask, Why are we passing a health care reform bill that increases the cost of your health care premiums, raises your taxes, and cuts Medicare to help pay for that? There are increased taxes on health care providers, manufacturers and importers of brand-named drugs, medical device manufacturers--these will all be passed on to consumers, according to the Joint Committee on Taxation and CBO. The Finance proposal raises the threshold for deducting catastrophic medical expenses, but eighty-seven percent of the 5.1 million taxpayers who claim this deduction earn less than $100,000 a year. They are not millionaires. They earn less than $100,000 a year. In fact, data from the Joint Committee on Taxation and the former Director of the CBO shows, by 2019, 89 percent of the taxes--these new taxes--will be paid by taxpayers earning less than $200,000 a year.

The 2,000-page proposal from the House of Representatives would raise taxes by $729 million. There is a tax on millionaires, but we know what happens to that when it is not indexed. Forty years ago, we were worried about 155 high-income Americans who were avoiding taxes, so the Congress passed the millionaires tax--the alternative minimum tax. Today, if we hadn't patched it, as we say, in 2009, that tax would have raised taxes on 28.3 million Americans. The millionaires tax will hit you if you keep earning money.

I have said quite a bit about Medicare cuts and taxes. I want to conclude my remarks by quickly saying what Republicans think should be done. We believe the American people do not want this 2,000-page bill that is headed our way. We want, instead, to start over in the right direction, which means reducing costs and re-earning the trust of the American people by reducing the cost of health care step by step.

Specifically, we would start with the small business health care plans. That is just 88 pages that would lower premiums, according to the CBO. It could cover up to 1 million new small business employees, and it would reduce spending on Medicaid. Then we could take a step to encourage competition by allowing people to buy health insurance across State lines, and we can take measures to stop junk lawsuits against doctors.

More health information technology could be a bipartisan proposal. We can have more health exchanges. The number of pages are very small. Waste, fraud, and abuse are out of control--$1 out of every $10 spent in Medicaid. Our proposal would offer a choice--a couple hundred pages, not 2,000--reducing premiums and debt and making Medicare solvent instead of cutting it, with no tax increases instead of higher taxes, and reducing costs.

That is the kind of health care plan Republicans have offered and the kind we believe Americans will want. We hope over time that will earn bipartisan support.

I yield the floor.

Mr. President, I thank the Senator from Florida for his insightful remarks. I listened with interest to the Republican leader describe the congressional Democrats' bill, which is now about 2,000 pages. We know we do not have a Senate bill yet. It is being written behind closed doors somewhere, I think in the majority leader's office. We are not sure who is writing it. We will have it sooner or later. But we do know some things about the health care bills.

Today what I would like to talk about is just one of those things. Then I want to suggest what the Republican plan is because we have a very different approach toward dealing with health care than the Democratic bills that we have seen. Today I want to talk about Medicare.

Medicare is very important to about 40 million Americans and to a lot of other Americans who are about to be of the age to depend on Medicare. To get it down into a nutshell, here is what all of the plans we have seen so far from the Democratic side propose to do: to take about $\1/2\ trillion over 10 years from Medicare--in other words, cut Medicare by $\1/2\ trillion, not to put into the Medicare Program to make it more solvent but to start a big new entitlement program called government-run health insurance for other people.

We hear from the other side the Republicans are scaring people about Medicare. The Republicans aren't scaring anybody about Medicare, it is these Democratic bills that are scaring people about Medicare. And they have a right to be worried about them because the Medicare trustees have told us this program, that 40 million seniors depend on, is going to become insolvent between 2015 and 2017. That affects the 40 million of us who are already eligible and a part of Medicare, and it affects tens of millions more who will become eligible for it.

The idea would be, if these bills are passed, to pay for new programs by cutting that $\1/2\ trillion from this program that is going broke. The Senator from Kansas, Mr. Brownback, described it this way. He said: This is a lot like writing a big check on an overdrawn bank account to buy a new car.

He said: Your bank shouldn't let you do that, and the American people should not let us do this, and I don't think they will, which is why we are glad a number of the Democratic Senators joined with all 40 Republicans and said to the Democratic leader: We want two things about this health care bill by the time it gets to us. No. 1, we want to know what it does; and, No. 2, we want to know what it costs.

What that means is, it should go up on the Internet for at least 72 hours, the complete text--that is what the letter from the Democratic Senators, as well as Senator Bunning in the amendment he authored, said--and, No. 2, we want a complete formal estimate from the Congressional Budget Office about what the bill costs because the American people are significantly worried about health care reform. That, as the Republican leader said, is supposed to reduce costs, reduce premiums, reduce the government's debt. But, instead, everything we heard about it so far makes it look like it is more likely to increase the cost of premiums, to increase taxes, and one thing we know for sure, it will cut Medicare. So let's talk about Medicare for a moment.

A couple of weeks ago we had the first vote on health care reform. For the country, it was a fortunate vote because we saw a bipartisan act in the Senate. The proposal by the Democratic leader was to run up the debt another $\1/4\ trillion in Medicare spending. But 13 Democrats and all 40 Republicans were not going to do that. We have too much debt today. We had a deficit this year of $1.4 trillion, which is as much as the entire debt of the United States from the days of George Washington until 1990. So we all said: No, slowdown. It may be a worthy thing to do.

It is important to deal with the physician reimbursement problem. But we are not going to start off the health care debate by borrowing $\1/ 4\ trillion for more Medicare spending.

The Washington Post wrote about that proposal:

A decade ago, Congress passed legislation designed to limit

health-care costs by slowing the growth of Medicare payments

to doctors. Each year, Congress passes a patch to prevent

the cuts from taking effect. [The Senator from Michigan]

proposed to make this system ``honest'', [in her words] by

eliminating the cuts permanently . . . it's a strange

interpretation [the Washington Post said] of honesty to

separate this $250 billion cost from the health-care bill

and then claim that the other bill doesn't raise the

deficit.

Fortunately, the Senate came to its senses and said no. We are not going to raise the debt $\1/4\ trillion for more Medicare spending. But the House Democrats--who came up with a 2,000-page bill they say they may be voting on in the next few days--apparently did not get that message. Their 2,000-page bill did not include the fix, or the physician reimbursement, which we all know is a part of health care reform. It is a part of the Medicare system. It has to do with the amount of money doctors are paid for seeing Medicare patients. It has to be dealt with. Yet they have left it out to the side and, again, we have a proposal that adds to the deficit $\1/4\ trillion.

A Wall Street Journal editorial this week, appropriately titled ``The Worst Bill Ever,'' notes this absence by saying:

The House pretends [as some Senators did] that Medicare

payments to doctors will be cut by 21.5 percent next year and

deeper after that, ``saving'' about $250 billion.

According to the Wall Street Journal, making those kinds of assumptions means the 2000-page bill that has been written in the House is more likely to cost closer to $2 trillion over 10 years instead of $1 trillion. So we know the era of the 1,000-page bill is over because we have a 2,000-page bill; and I guess the era of the $1 trillion legislative proposal is over because we have a $2 trillion health care proposal being considered in the House.

The article in the Wall Street Journal goes:

All this is particularly reckless given the unfunded

liabilities of Medicare--now north of $37 trillion over 75

years.

In other words, over the next 75 years we have $37 trillion in obligations that the Medicare Program has, $37 trillion more than we have money coming in. How is that going to make you feel if you are part of the Medicare Program and some Member of Congress says: OK, we are going to take this program with $37 trillion in unfunded liabilities, a program on which you rely for your Medicare, and we are going to cut it by $429 billion in order to start a new program for somebody else? I think you are going to say: I don't like that very much. I don't like the sound of it. And, increasingly, as Americans read these bills and understand what it costs and understand what they mean to each American, they come to that same conclusion.

So we wait with great interest to see what bill the Senate majority leader will bring from behind his closed doors when he takes the 1,500- page Finance Committee bill and the 900-page--nearly 900-page--HELP Committee bill in the Senate and puts it together, I assume, with this 2,000-page bill in the House, and all of them depend on cutting Medicare for about half of their costs.

Any reductions in Medicare, any savings in Medicare, any elimination of waste, fraud, and abuse in Medicare should go to Medicare. We should not be cutting grandma's Medicare to spend money on somebody else. We ought to save money in grandma's Medicare to spend on grandma because grandma's Medicare Program is going

broke. That is what the Medicare trustees have told us.

What does this mean for seniors? The Senator from Florida outlined them: Nearly $140 billion in cuts to Medicare Advantage--one out of four seniors, I believe, has a Medicare Advantage Program--nearly $150 billion in Medicare cuts to hospitals that care for seniors, more than $40 billion from home health agencies, nearly $8 billion from hospices.

My understanding is the House bill also makes roughly $100 billion in Medicare cuts for hospitals that care for seniors--this is the House bill--$57 billion from home health agencies, and nearly $24 billion from nursing homes.

The President stated that while ``people who are currently signed up for Medicare Advantage are going to have Medicare at the same level of benefits. . . .'' That was President Obama. Yet the Congressional Budget Office Director, the nonpartisan Congressional Budget Office Director, said after looking at the Senate Finance health care bill that fully half of the benefits currently provided to seniors under Medicare Advantage would disappear.

The Congressional Budget Office Director said the charges would reduce the extra benefits, such as dental, vision, and hearing coverage, that would be made available to beneficiaries.

What about the cost to the government? Remember, as the Republican leader said, we thought health care reform was about cost.

I remember being invited--I appreciated it very much--to a summit President Obama had earlier this year on entitlement spending. The President said he needed to work on that, and every speaker who was there said that if we do not do something about health care spending, about Medicaid and about Medicare, we are going to go broke as a country and that almost all of our debt and deficit problems are related to health care spending.

So our goal here is to reduce the cost of premiums to individual Americans and reduce the cost of government to individual Americans. That should be our goal. But according to the Congressional Budget Office, the cost of the 2,000-page House bill reflects a gross spending total of over $1 trillion. Now, who thinks we can spend another $1 trillion without adding to the debt? I don't think many Americans do. This mainly includes outlays for Medicaid, children's health, and subsidies.

According to the Budget Committee's staff, though, the real 10-year cost of the Senate Finance Committee bill when fully implemented would be closer to $2 trillion--$1.8 trillion--because the main spending provisions do not go into effect for another few years, starting in 2013. The taxes and the fees--the new taxes, nearly $1 trillion in taxes--start right away, over the full 10 years, but the benefits don't start until 2013. They make some other assumptions along the way such as that there will be a Medicaid commission, which will cut Medicare more. Well, those procedures haven't worked so far. And if there are savings in Medicare, they should be spent on Medicare, not to start some new program.

So Republicans--and, we hope, discerning Democrats--are not scaring seniors about Medicare; these bills are scaring seniors about Medicare. And they have a right to be worried. They have a right to be worried because they are the 40 million Americans who depend on Medicare. Just answer the question for yourself. If we are going to take $\1/2\ trillion out of your Medicare Program that the trustees say is going to go broke in a few years and spend it on someone else, what does that do to your Medicare benefits? It puts them in more jeopardy, is the only obvious answer to that.

So we have proposals that, so far, cut Medicare, raise taxes, raise premiums, add to the debt, transfer expenses to the State that Democratic and Republican Governors say will bankrupt some States-- these are the Medicaid Programs--and they create a new government-run program.

I am already getting e-mails from businesspeople in Tennessee who said that if a bill like this goes through, they are out of providing health care to their employees, they can't stand the costs. And so millions of Americans will be losing their employer insurance and shifting over to the new government program which is being paid for by grandma's Medicare. That is the scheme that is being put together here.

Mr. President, how much time is remaining?

I thank the Chair.

So here is what we know about the Congressional Democratic health care plan which is 2,000 pages long: higher premiums, Medicare cuts, higher taxes, more debt. It is a government-run plan. When you put the whole scheme together, if you are one of the 177 million whose employer provides insurance to you, you run a great risk--let's say it this way--of losing your employer insurance because the employer says: I can't afford to provide it anymore, and plus, the government started a new program, so you go over to the government program. That could lead to rationing. Your Governor will tell you the States can't afford the costs being transferred to them, so that means either higher State taxes or higher college tuition to pay for the reduced payments to public higher education, and a $2 trillion cost over 10 years, according to the Wall Street Journal. That is not real health care reform.

So what is real health care reform? What is the Republican plan or what hopefully could be a bipartisan plan that we could work on? We would suggest, and we have suggested this day after day, week after week, committee meeting after committee meeting: Let's start over. We are headed in the wrong direction. Let's go in the right direction. And the right direction is having the simple goal of reducing costs, costs to those paying for health care insurance, in their premiums, and the cost to the government, which we all have to pay for as well. And how do we do it? Instead of a big, comprehensive, 2,000-page, $2 trillion, full of surprises and mandates bill that terrifies everyone, let's go step by step in the right direction, which in this case is reducing costs.

What would that mean? Well, No. 1, we could start with a small business health insurance plan. This permits small businesses all across America to pool their resources and leverage those resources.

Let's say you are in a small business and there are 80 employees. Two people get very sick, and they use up all of the available money that small business has to help pay for employees' health care. The employer has to say, I have to reduce everybody's health care; or, I am sorry, I just can't offer it anymore. But if you allow that small business to join with small businesses all across America and pool their resources and leverage their money, then you have a different outcome. According to the Congressional Budget Office, that would mean 750,000 more Americans would be insured. It would mean three out of four people insured by small businesses would pay lower premiums. And it would reduce the cost of Medicaid, as those people went onto their own private insurance, by $1.4 billion. So more people insured at lower costs for premiums and less debt for Medicaid--that is one step on which we should be able to agree. Senator Enzi and the late Senator Kennedy worked on that for a long time, but we have not passed it. Why don't we pass it as the first step? That is 88 pages; that is not 2,000 pages.

Then a second step: Why don't we allow Americans to buy insurance across State lines? That increases competition. We have a number of bills that have been introduced that would allow that. Senator DeMint of South Carolina has one of those bills, and that is 30 pages, not 2,000 pages.

Junk lawsuits. Virtually everyone who has looked at it agrees that lawsuits against doctors add to the cost of health care that we all pay. Some States have taken some steps and shown it makes a real difference. Maybe it is a small part of the cost, maybe it is a large part of the cost, but it is a part of the cost. Anyone who is injured-- anyone who is injured by a negligent doctor should be paid 100 percent of the damage to that person. But this would begin to restrict the punitive damages that are often added to that which greatly benefit the trial lawyer and increase the cost to all of us. So why don't we take steps to do this?

We know of examples in my State of Tennessee--and I am sure in virtually every State--where OB/GYN doctors

have moved out of rural counties because their medical malpractice premiums have gone through the roof. They just will not practice anymore. So pregnant women are having to travel to Memphis, 60 or 80 miles, for their prenatal health care and to deliver their babies. They do not have that service in the county where they live. This would help them, those women, and this would help reduce costs.

So those are three steps we can take.

A fourth step would be equal tax treatment for every individual on our health care tax policy. That is 21 pages.

Information technology for health care--this may take a few years to actually reduce costs, but virtually everyone agrees that the record keeping in our health care system is a great drag on the productivity and an obvious addition to the cost. Democrats as well as Republicans have worked on legislation to change this.

There is a 13-page bill introduced by Senators Coburn, Burr, and Enzi. I am sure there are good proposals on the Democratic side. We could take that step. And that would be five steps.

Then we could help create more health care exchanges. That is in many of the bills. It is common to many of them. It is a supermarket in which any individual can go to buy, more easily, a health care plan for that individual or for that person's family. It just takes eight pages to create better health care exchanges across this country.

And then waste, fraud, and abuse. Senator LeMieux from Florida, the new Senator, made his maiden address on waste, fraud, and abuse. It is a scandal that, in the Medicaid Program, for example, $1 out of every $10 is waste, fraud, and abuse. That is $32 billion a year. We can go to work on that in a variety of ways, which he talked about this morning. That is just 21 pages.

So there are seven steps in the right direction which are reducing health care costs. We should be able to take those steps in a bipartisan way.

So we have a choice of approaches here in the Congress. The American people want real health care reform, but they do not believe that raising taxes, raising premiums, cutting Medicare, increasing the debt, and 2,000-page bills full of surprises are real health care reform.

The American people are properly skeptical of a grand and risky scheme that claims we are wise enough to solve everything at once. They know we are more likely to mess up everything at once if we try such risky schemes. So to re-earn the trust of the American people, we should go step by step. Here is the choice: a 2,000-page bill or a 200- page bill.

Sometimes, the assistant Democratic leader will come on the floor and say: Where is the Republican plan? I said to him yesterday, if he is waiting for Senator McConnell to bring a wheelbarrow in here with a 2,000-page Republican alternative that costs $2 trillion and is just our way to spend $2 trillion and is full of surprises and our grand and risky scheme, he is going to be waiting a long time because he is not going to see it. We are going to bring up several steps which we know will reduce costs, which we know we can afford, which we know will help people, which we know we can implement, and which we believe will have significant Democratic support as well as Republican support.

So is it 2,000 pages or 200 pages? Reduce premiums or increase premiums? Reduce debt or increase debt? Cut Medicare and start some new program with it or make Medicare solvent by taking any savings we can find in Medicare and use it to help Medicare?

Higher taxes--I did not say much about that, but there is $900 billion of new taxes in the program when it is fully implemented in the Finance Committee program. And the Congressional Budget Office Director said the obvious about that--by and large, most of those new taxes will be passed on to whom? Those of us who pay insurance premiums. So there is another reason your premiums are going up, and the cost.

We should be able to enact a good health care plan this year. The country needs for us to do that. But we Republicans are offering a real choice to the American people. The American people are appropriately skeptical of risky schemes that run up the debt, cost $2 trillion, and are filled with higher premiums, more taxes, and Medicare cuts.

To re-earn the trust of the American people, we should set a charge goal of reducing costs and move step by step in that direction. That is the Republican health care plan, and I believe that is a plan Republicans and Democrats can agree upon.

I yield the floor.

Mr. President, how much time do I have remaining?

I thank the Presiding Officer.

I noticed the Senator from Michigan was on the floor earlier, and she had a chart which said: ``85 Times No.'' I think she should have turned it around and faced it toward the Democratic leader. That means that 85 times the Democratic leader has said no to Republicans: No, you can't offer amendments and we are going to cut off debate. We have had this discussion many times. The Senator from West Virginia, Mr. Byrd, is the expert on this. There are two things that make the Senate unique. One is virtually unlimited debate and virtually unlimited amendments. So if you are from a smaller State, such as Tennessee or Delaware or anywhere in this country, your citizens can send you here and, even if you are in the minority, you are allowed to speak. Your voice can be heard and you are allowed to offer amendments.

We have procedures for cutting that off, but we only do it on rare occasions. So what the Senator from Michigan is basically saying is-- and I don't believe I would bring this up, if I were she--that 85 times the majority leader has cut us off and said: We are not going to hear from you. So I think that argument is an argument we should have at the appropriate time, but I have a different point I would like to make.

I would like to continue the health care discussion because I think we are making some progress. One of the most eloquent and effective speakers on the Democratic side of the aisle is the assistant Democratic leader, the Senator from Illinois, who is a good friend and a person I admire a great deal. Yesterday, he came to the floor and asked: Where is the Republican alternative on health care and how many pages does it have? He heard me say the other day that the era of the 1,000-page bill is over because we have a 2,000-page bill from the House of Representatives on health care. So he says: Well, where is the Republican health care plan? How many pages in it?

The Senator from Illinois was quite proud of the fact that I couldn't say how many pages were in the Senate Democratic plan, but of course I haven't seen it. Almost no one has seen it. It is being written behind closed doors. This was supposed to be the era of great transparency; that we would all know what was going on. President Obama, to his great credit, said: We will have all this on C-SPAN so you will know if the drug companies or if the insurance companies or if the lobbyists are in there writing the bill. So what do we have? We have the majority leader and two Democratic Senators and some people from the White House behind closed doors writing the health care bill.

Of course, we don't know exactly how many pages it will have because we aren't let in the room. We can't see the bill. We can't count the lobbyists, if they are there; we can't count the companies with which deals might be made, if they are there. We don't know. But here is what we do know. We do know the HELP Committee, on which I serve, passed an 839-page health care bill. We do know the Senate Finance Committee passed a 1,502-page bill, and we know the House of Representatives is working on a 1,990-page bill, not counting the physicians reimbursement fix, which is bound to push it over 2,000 pages.

The pages in these bills are going up faster than the national debt, and it is an issue with the American people. So until the various writers emerge from behind closed doors, we are going to have to go with what we have, which is a 2,000-page congressional Democratic health care bill, of which the Wall Street Journal editorial said yesterday, when fully implemented, would cost $2 trillion over a 10- year period of time.

Here is what else we know about the 2,000-page bill. It will raise premiums. The Senator from Idaho just spoke to that. It will cut more than $500 billion in Medicare, and it will cut it from Medicare to spend it on a new entitlement program, even though the Medicare trustees say Medicare is going broke in 2015 to 2017. The Senator from Kansas said it is akin to writing a check on an overdrawn bank account to buy a big, new car. The banker wouldn't let you do it, and the American people shouldn't let us do it.

There will be higher taxes. Everyone understands that the $1 trillion, fully implemented over 10 years, will mean higher taxes. Who is going to pay those? Not the medical device companies, not the insurance companies. They are going to pass them right on to whom? The American people--the 250 million of us who have health insurance premiums. So our premiums are going to go up.

There will be more debt. Fortunately, on the first vote we had on health care the other day, 13 Democrats, with all 40 Republicans, said: No, we are not going to start off this debate by adding $\1/4\ trillion to the national debt, even for the worthy purpose of fixing the physicians reimbursement problem, which we all want to fix. We are going to have to find some way to pay for that within the health care bill, within the spending we have.

We now have a government-run plan. I have always thought that was a little like President Obama saying: In order to keep Ford Motor Company honest, I am going to put the government into the car business. Well, we nearly have, but that usually isn't the way we do things in the United States. But we are going to have a government-owned, government- run health care plan. Of course, we already have two--one is Medicare for seniors, and we have a government-run plan that States can ``opt out of'' called Medicaid.

The Presiding Officer, the former Governor of Delaware, and I both know from our previous experience it is a big problem. Medicaid and Medicare have been going up at the rate of 8 or 9 percent a year for many years. State budgets dealing with Medicaid only go up 2 or 3 percent for schools and roads and universities. So what happens is, when the Governor of Delaware or the Governor of Tennessee or the Governor of California sit and make up the budget, you get to the end of the line and there is no money left for higher education because we put it all into Medicaid. That means tuition goes up or services go down.

With a government-run plan--and this is something the American people are just now beginning to realize--millions of people who now get their insurance from their employers are going to lose it. They are going to lose it because their employer is going to look at this big, new bill and say: I can't afford this. I am going to pay the penalty. I am out of the health care business, and you can go into the government plan. So all 177 million people who have employer health care insurance run a risk with a government plan--under this framework we are discussing, that we haven't been able to see yet--that an increasing number of employers will say: I am out of here. We will let the government provide the insurance. Suddenly, you will find yourself in the government-run plan.

What happens in the government-run plan? Some things are good about Medicare--the government-run plan for seniors--and some things are bad about Medicaid, which is the largest government-run plan. One thing bad about it is, 50 percent of doctors will not see new patients because their physician reimbursement is at about 60 percent of what physicians make when they go to a private insurance company. In Medicare, it is not as bad as that. It is about 83 or 84 percent of doctors are paid what they would get paid if they saw a patient with private insurance. So if you lose your insurance and you end up in the government-run plan, you may end up in a plan such as the Medicaid plan, a government- run plan where 50 percent of the doctors will not see new patients.

The Governors of the States are in a state of apoplexy--would be about the only word to describe it--because they are in the worst shape they have been in dozens of years. I know in the State of Tennessee there are $1 billion in just cuts. Everything has been cut, prices are going up, and people are being laid off, even though we have a very conservative, well-managed State. Yet one of the ways being proposed to pay for this bill is to shift some of the cost--about $34 billion at least--to States. Governors--both Democratic and Republican--are saying: Please don't do that to us. We can't afford that. We don't have the money for it. We have to balance our budget. If Washington wants to expand Medicaid, Washington should pay for Medicaid.

Higher premiums, Medicare cuts, higher taxes, more debt, government- run plan, millions losing coverage, inevitable rationing, States complaining, some going bankrupt, and a $2 trillion cost is not health care reform. But the assistant Democratic leader asked a good question. He asked: What is the Republican plan? If our plan has 2,000 pages, how many pages does your plan have? Well, I would say, with all respect for him, that if he is looking for someone with a wheelbarrow to wheel into the Senate Chamber a competing 2,000-page Republican bill costing $2 trillion, he is never going to see it. He will be looking in vain because that is not what we propose. We have been saying, over and over again on the Senate Floor and in other places, we are going in the wrong direction; we need to start over; our goal should be to reduce costs--the cost to each of us who pay premiums, the cost to all of us who have to pay the Federal Government debt. We should set a clear goal of reducing costs and move step by step toward that goal of reducing costs to re-earn the trust of the American people.

Americans instinctively distrust these comprehensive, change-the- world, never-mind-the-cost, 2,000-page risky schemes, one of which is the health care plan that is coming toward us. We have proven in this Chamber we don't do comprehensive well. We had our best Senators on both sides of the aisle working hard on immigration--Senator Kennedy, Senator McCain, Senator Kyl, Senator Martinez--and what happened? It fell of its own weight. We bit off more than we could chew. The economy-wide cap and trade is running into the same problem. So is health care.

With taxes, mandates, surprises, debt, and more Washington takeover, we are scaring the daylights out of the American people with these proposals. Instead of that, we on the Republican side believe we should have health care reform, but its goal should be reducing costs, and we should go step by step toward that goal. Going step by step in the right direction is one good way to get our country where it needs to go.

So instead of a 2,000-page congressional Democrats' health care plan, here is the Republican plan, and I have counted the pages. No. 1, small business health care plans. This leverages the number of small businesses and allows them to pool their resources and offer health care to more Americans. That is 88 pages, proposed by Senator Enzi. No. 2, allow Americans to purchase health care across State lines to encourage competition--30 pages, proposed by Senator DeMint. No. 3, reduce junk lawsuits. Medical malpractice lawsuits drive up the cost of health care. There is some question how much it drives it up, but there is no question it drives up the cost. That is Senator Gregg's bill on that, and it is 19 pages. No. 4, equal tax treatment for health care. That is Senator Bennett's bill, which is 21 pages. No. 5, health information technology--a subject we should be able to agree on in a bipartisan way--is 13 pages, by Senators Coburn, Burr, and Enzi. No. 6, health care exchanges, creating more of those for people to look for the lowest cost insurance. That takes eight pages in the bill, proposed by Senators Coburn and Burr. No. 7, Senator LeMieux, one of our newest Senators, proposed a bill on the subject of waste, fraud, and abuse. We know that is a scandal, particularly with Medicaid and Medicare.

The Government Accountability Office has said that $1 out of $10 in Medicaid is waste, fraud, and abuse, accounting for $32 billion a year, which is $320 billion over 10 years.

So there are seven steps in the right direction of reducing cost. Taking just one of those steps--the small business health care plans, S. 2818, leveraging strength in numbers--here is what the Congressional Budget Office says about the small business health care plan: 750,000 more Americans would be covered. These would be people working for small businesses. It would lower the premium costs for three out of four employees. It would reduce Medicaid spending--and that is the program that is causing the States so many problems--by $1.4 billion.

So why don't we pass that? Why don't we pass it? Why don't we take that one step toward reducing costs and then take a second step and a third step and a fourth step? Gradually, as we reduce costs, as the small business health care plans will do, we can add uninsured people to the rolls. That would reearn the trust of the American people. That would be something we could actually get done. That would be something that would be bipartisan, would create confidence, and help us reach the goal we have set for ourselves.

We have clear choices. We have 2,000-page bills or the bills I just added up--those seven steps proposed by Republicans, many of which have Democratic support as well--that would be 200. So 2,000 pages or 200 pages; reduce premiums or increase premiums; reduce debt or increase the debt; reduce Medicare or make Medicare solvent; higher taxes or no tax increase.

The American people want real health care reform. They want to reduce costs and add coverage, as we can afford it. They are properly skeptical of grand and risky schemes that claim we in the Senate and the House are wise enough to solve everything at once. They know if we try to do that, we are more likely to mess up everything at once. They know about the law of unintended consequences.

To re-earn the trust of the American people, we should set a clear goal. That goal should be reducing the cost of health care; the cost of health care when you pay your premium and the cost to your government, the cost of its debt. We should move step by step in that direction. That is the Republican health care plan.

I yield the floor.