Floor Statements

Last night, I held a telephone townhall meeting. As usual, because we get over 10,000 people on the telephone townhall talking to us, I said: This is a meeting that is open to any subject you can talk about.

Overwhelmingly, they all wanted to talk about health care. I had one call where the fellow said he liked this health care bill. He was a small businessman. He said: This will help me as a small businessman, and why are you opposed to it?

I said to him: I have been a small businessman, and I would like to point out to you that NFIB, the organization that helps small business, is opposed to it. And I went through some of the reasons. Then I told him of other small- or

medium-size businessmen in Utah who have said to me: If this bill passes, we are out of here. We could do our manufacturing overseas. We could send our product to South America and have it made there. We have stayed in Utah more out of patriotism than money. But if this bill passes, the impact on us in small business will be sufficiently great that we will leave Utah. We will leave America. We will take all of these jobs and go overseas.

That was that one discussion with the one caller. Every other caller talked about the health care bill and said: Don't pass it. Every other caller was opposed. There was only the one who made comments in favor of it, comments on which I think I was able to dissuade him.

Every other one came up: Do you want to talk about Afghanistan?

No, we want to talk about health care. We are opposed to this bill.

Do you want to talk about some other aspects of what is going on in Washington?

No, we want to talk about health care, and we are opposed to this bill.

Over and over, the only other subject that came up that I can recall with any regularity--there were several calls that talked about cap and trade and expressed their opposition to that. But, overwhelmingly, the entire hour was people who were saying: We are opposed to this bill.

I want to share with the Members some aspects of the reaction of Utahns to the campaigns that have been mounted by various groups in favor of this bill. Let's go to the campaign that has been mounted by the AARP. AARP is one of the strongest lobbying organizations in the country. Indeed, there are those who say it is the most powerful lobbying organization. AARP, in an effort to make sure this bill gets passed, has prepared preprinted petitions and sent them out to their members. Here is a copy of one. It is addressed directly to me and was sent to people in the State of Utah: ``Petition to Senator Robert F. Bennett. Dear Senator Robert F. Bennett, As one of your constituents . . . '' so on and so forth.

Then all the AARP member has to do is sign it and send it to me. This one was sent to me. But as we can see, he didn't just sign it, instead he wrote on it. This is what it says in handwriting:

Absolutely not! Please vote against current legislation

being proposed by the current administration and endorsed by

the AARP.

The ``not'' is underlined. He signed his name. I have taken it off this facsimile to protect the man's privacy, but he made it clear that he was not in favor of what the AARP was saying and doing in this situation. We have others who have said the same kind of thing.

Here is a letter I will quote from:

Senator Bennett, please do not vote to pass the health care

bill that contains a public option. The present medical is

broken and surely needs fixing. However, it should be done in

ways that do not bankrupt the country, close hospitals and

doctors offices.

Who is saying this? He says:

I will probably withdraw from AARP since they support the

present health care proposals. Several of my doctor friends

have withdrawn from the AMA due to its support of these

proposals.

Then he signed his name, and his initials make it clear he, too, is a physician, a member of AARP who clearly wants to drop out of AARP, and a member of AMA who supports those who drop out of the AMA.

Let me quote from another physician who wrote a lengthier letter, more analytical. I will quote from parts of the letter. He starts out:

As a practicing Utah physician, I see and treat patients

every day. I try to accurately diagnose what their troubles

are and offer an incremental plan for their recovery. I am

thorough, methodical and exacting in my plan, purposely first

doing no harm, as my Hippocratic oath reads, not making the

situation worse, not causing more pain or suffering. The

Senate bill before you will make America more ill, with

increased pain and suffering. I plead with you to first do no

harm. Please do not make the situation worse as with the

current bill. It is beyond repair. Please recognize that the

Senate plan will add to America's ills.

Then he goes on later in the letter to make this comment:

Patients ask me why the AMA appears to support this bill.

They sense that the AMA is not looking out for patients and

doctors. I agree that the AMA is misdirected and explained

that the AMA represents fewer than one in five U.S. doctors

and has compromised its mission.

I find that interesting. I didn't realize that the AMA membership had dropped so low. When I first became interested in politics, the AMA represented virtually every doctor in the country. Not anymore.

I tell my patients about the multitude of other medical organizations of which I am a member, state medical organizations, speciality groups, and the Coalition to Protect Patients Rights, representing thousands of doctors who actively oppose the Senate bill in its entirety and are fighting for patients and the right fixes for affordable, quality care.

Well, as I found out in my telephone town meeting, which covered the entire State--and with no filtering on the part of my staff as to who could get in and who could not--this is, indeed, very clearly the majority opinion for members of the State, seniors who presumably belong to AARP, and physicians who either used to belong to the AMA or understand the AMA.

Here is an e-mail from a doctor. I cannot pronounce the specialty he is in. He says:

As a constituent and practicing--

And then he goes on to say whatever kind of ``ologist'' he is--

I strongly urge you to oppose the passage of the current

Senate healthcare reform legislation. . . . Although our

nation would benefit from targeted healthcare reform, the

proposed legislation is not the answer and will harm, not

help, healthcare delivery in our nation. . . .

As surgeons, we take pride in our work and strive to

provide the best patient care possible. We will support

reform efforts that truly preserve access to high qualify

specialty care without jeopardizing the physician-patient

relationship. As such, I oppose the ``Patient Protection and

Affordable Healthcare Act'' as it has the potential to

seriously compromise the delivery of healthcare in the United

States by creating additional pressures on an already

overburdened healthcare system.

Well, I have a number more. I will not go into all of them; I will just pick a few from the stack I brought with me.

Here is one:

I am a Surgeon who has been practicing for about 30 years.

I am against the total overhaul of the health care system.

All entitlement programs are not cost effective and all are

in danger of bankrupting the U.S.

Here is one, who is a retiree, who says:

Please vote against these healthcare ``reforms'' that will

limit options, cost us all more and reduce our freedoms. We

need real change: portability, tort reform, and less

government control.

Back to the doctors. He says:

Dear Mr. Bennett,

I am a pediatrician in Utah and met you at the hospital in

Orem. Thank you for your opposition to the current process

happening in Washington. We do not need to rush through and

push the American people into government run health care and

more red tape. Medicaid is already my biggest head ache in my

practice.

And so on and so forth, as I say.

I want to make this other point with respect to all of these people who are so concerned that we will have an immediate bad impact if this bill passes. They do not realize--and I did my best to point this out to those who were on the telephone townhall meeting last night--that this bill will not fully take effect--indeed, most of the aspects of this bill will not take effect--until January of 2014. That is correct, January of 2014--4 years away.

Here we are meeting on weekends, coming in here on Sunday, driving to get this done by Christmas because it is so pressing that we have to do it, and, by the way, we are not going to start, really, any of these reforms for 4 years. So these people who are writing me, these doctors who are complaining about AMA's endorsement, these people who are complaining about AARP not representing them, are worried about an immediate impact.

Let me tell you what the immediate impact of this bill will be. The immediate impact of the bill will be financial. The taxes will take place immediately upon passage. The increase in premiums will begin to start on passage, as the pressure on the insurance companies, the pressure on manufacturers, the pressure on pharmaceutical companies will all begin with the passage of this bill. But all of the wonderful things we are being promised as benefits from this bill will be delayed for 4 years. Why? There is only one reason why: in order to use smoke and mirrors in the budgetary process to

make it look as if this is cheaper than it really is. If you get the money coming in for 10 years but the expenses only going out for 6 years in your calculation, it looks as if it is a whole lot cheaper than it really is.

The only honest way to score this is to say the expenses start the same day the taxes start, the expenses going out start the same day the revenue coming in starts. Then you get an accurate description of how much this costs.

I cannot imagine any businessman going before his board of directors and saying: I have a new program I want to institute in this company, and it is going to cost X, and here is how I have calculated it is going to cost X. I am calculating the revenue from the sales of the product over a 10-year period, but the actual sales will only occur in the last 6 years.

His board of directors would take one look at him and say: There is no way we can make a strategic plan based on that kind of smoke and mirrors. What in the world is wrong with you to do accounting of that kind?

He will say: That is the kind of accounting I learned from the U.S. Senate--start counting the revenues immediately, but don't count the expenses until 4 years later.

Well, let's look at the impact of that 4-year gap and tie it to the messages I am receiving from my constituents, and I think we will see something very interesting happen. Between now and the time the benefits of this bill begin to take hold, there will be three or four open seasons of people who will look at their health care plan and be allowed to make changes in it. They will see the costs go up, and they will say: Wait a minute, what is happening here? The costs are going up, but there are no changes coming from this bill the Senate passed back in 2009--or 2010, if we push it until next year. What is happening?

Well, your costs are going up in anticipation of the costs of this bill that will take hold in January of 2014.

At that point, the anger we are seeing from constituents now will get worse. The anger we are seeing in the e-mails and letters I am receiving now will get more intense, and people will start to say: You mean I am being forced to pay extra premiums in 2010 because the government needs to accumulate cash against the time when these great changes hit us in 2014? When they start writing me that kind of complaint, I will say: That is exactly what I mean. The government is going to start taxing you in 2010, but they are not going to do this program until 2014--at which point, the outcry from constituents will be: Well, let's stop the taxes and let's kill the effective date of 2014.

I am not sure I can predict that with certainty, but I can go back in history and remember the catastrophic bill that was passed with respect to Medicare, and the senior citizens suddenly discovered how much it was costing them. The outcry was so overwhelming that the Congress, within a matter of 6 months of the passage of the bill, repealed the bill. I remember the pictures that appeared in national magazines of Congressmen Rostenkowski, who was at the time the chairman of the Ways and Means Committee, being accosted physically when he went home to Chicago by seniors who would stand in front of his car and not allow him to move, who would sit on the hood of his car to block his way in every conceivable way. The outcry was enormous when they saw this increased cost for something where they did not see a corresponding benefit, and Congress responded to that outcry and repealed that bill.

In this case, there will be a 4-year period for the outcry to build before they start to see the benefits, if, indeed, the bill does confer benefits. There will be a 4-year period with that many open seasons for people to look at their programs and see their premiums go up and see their plans change and see the adjustments made in preparation for this, adjustments they will not want; 4 years in which they will see the statement of the President of the United States, that ``if you like your plan, you don't have to lose it,'' prove not to be the case.

In that 4-year period, it is entirely possible that the outcry from constituents, like the ones who are complaining now, will have tremendously more impact and more force. I hope that is, indeed, the case, if we pass this bill. I hope that in that 4-year period, before we start to see the wonderful things we are being promised from the other side of the aisle come to pass--the increased premiums, the increased taxes, and the increased costs will be with us--the people of this country will rise up and say: We want this bill repealed. They have 4 years in which to do it, 4 years in which to think about it, 4 years in which to experience it.

Why are we rushing to get this done before Christmas when we have 4 years before the thing finally kicks in? Let's take the time to do it right. Let's take the time to listen to our constituents. Let's take the time to listen to the American people who are examining this bill and, by ever-increasing margins, telling us again and again that they do not like it.

We have heard from many people the reactions of the polls. The Quinnipiac Poll made the comment: It is a good thing the Senate is not letting the American people vote on this bill because the American people are against it. We have seen the Gallup Poll show a tremendous swing, as their people are against it. The more they know about it, the less they like it. Yet we are trying to rush it through in the holiday season to get it done before Christmas even though it is 4 years away before all of the wonderful things that are being promised will surface.

Mr. President, I think my constituents have it right. I think those people who belong to AARP who are saying they are going to drop out because of AARP's endorsement are right. I think those physicians who say they are either not members of the AMA or they are going to drop out from the AMA because of the AMA's position are right. And I think if we cram this thing through in a sense of urgency, even though it is 4 years from implementation, we will see an outcry in the intervening 4 years from the American people that will cause Members of the Senate to wish they had taken more time to examine it all, to do it right, and not to panic over pressure from various special interest groups that see ways in which they can profit from this.

The American people, the American physicians, the American patients all see ways in which they will be hurt, and I speak for them, as they say: Slow this down. Do this thing right. Do not panic under pressure of an artificial time deadline.

I yield the floor.

Mr. President, I ask unanimous consent to proceed as in morning business, not to exceed 10 minutes.

Mr. President, in this morning's Washington Post, we have, once again, an outstanding article by Robert Samuelson, this one entitled: ``Health-care Nation: Medical spending threatens everything else.'' Mr. Samuelson has been critical of Republicans--and he is in this article--and he has been critical of Democrats--and he is in this article--but he makes some points I think are worth bringing to our attention, the primary one being that we are not focusing on the right issue, which is making some kind of attempt to turn the cost curve down--using the budgetary doublespeak--with respect to health care.

Let me quote a few comments from Mr. Samuelson's presentation. He says, first:

The most obvious characteristic of health spending is that

government can't control it.

As demonstrated by our past history, that is a very true statement, which I will show in a moment. He goes on to say:

[The] consequence is a slow, steady, and largely invisible

degradation of other public and private goals. Historian

Niall Ferguson, writing recently in Newsweek, argued that the

huge Federal debt threatens America's global power by an

``inexorable reduction in the resources'' for the military.

Ferguson got it half right. The real threat is not the debt

but burgeoning health spending that, even if the budget were

balanced, would press on everything else. ``Everything else''

includes universities, roads, research, parks, courts, border

protection, and--because similar pressures operate on States

through Medicaid--schools, police, trash collection and

libraries. Higher health spending similarly weakens families'

ability to raise children, because it reduces households'

discretionary income either through steeper taxes or lower

take-home pay, as higher employee-paid premiums squeeze

salaries.

He concludes:

. . . Obama talks hypocritically about restraining deficits

and controlling health costs while his program would increase

spending and worsen the budget outlook. Democrats

congratulate themselves on caring for the uninsured--who

already receive much care--while avoiding any major overhaul

of the delivery system. The resulting society discriminates

against the young and increasingly assigns economic resources

and political choice to an unrestrained medical-industrial

complex.

Mr. President, I ask unanimous consent to have printed in the Record the entire article at the conclusion of my remarks.

To demonstrate the accuracy of what Mr. Samuelson has to say, I have some charts. This one shows the breakdown of Federal spending in 1966. Why do I pick 1966? Because that was the year for the beginning of Medicare. At that time, 26 percent of the Federal budget went for mandatory spending--overwhelmingly Social Security--7 percent went to pay interest on the national debt, and 44 percent went for defense, with 23 percent for nondefense.

Where are we now? In 2008, mandatory spending had more than doubled and had gone to 54 percent, interest costs remained about the same--8 percent--defense had shrunk to 21 percent, cut in half, and the nondefense discretionary, 17. The difference? Medicare and Medicaid taking over the mandatory side.

What do we see as we look out to 2019. We can't break down the difference between defense and nondefense because that would require an analysis that is not available to us in that future year. But mandatory by that time will have grown to 61 percent. The size of the debt increasing costs now, interest costs have grown to 10 percent and defense and nondefense discretionary have shrunk to 29--a complete reversal. That is roughly what mandatory was when Medicare was started.

I am not saying we should not have Medicare, and I am not saying we should not have Medicaid, but I am saying we should be focusing on how we make people healthier, how we reward people for not using the system, how we do something to control the costs, instead of increasing the status quo with respect to health care spending.

This chart was drawn up before we had the bill before us. I think it is very likely, if the bill before us passes, this mandatory will grow even further and we find ourselves in this situation with respect to 2010. I watched the budget as it came down and it said, in 2010, Federal revenues were going to be $2.2 trillion and mandatory spending was going to be $2.2 trillion, which means every dime of everything else had to be borrowed.

I worked with Senator Wyden and a number of others on both sides of the aisle to craft a health care plan that would turn the cost curve for health care down. We didn't even get a vote in the Finance Committee. We didn't even get anybody to consider what we had to say because everyone was focused entirely on the issue of let's cover the uninsured. The position is: Let's cover the uninsured by taking what we are doing now and spreading it even wider.

As Mr. Samuelson says, very clearly, in his column today: That squeezes out the money for everything else. That is an uncontrolled expenditure. We are not focusing on changing the system in a way that can cause cost curves to come down, we are focusing on taking the present system and spreading it wider.

The cost curve can come down. I have quoted this before. The Dartmouth study talks about where the best health care is available in America, and it is in three cities, according to Dartmouth: Seattle, WA, Rochester, MN, and Salt Lake City, UT. Then they go on to say, if every American got his or her health care in Salt Lake City, UT, it would be the best in the country and one-third cheaper than the national average. It is one-third cheaper than the national average because the focus in that plan, as it is in Rochester, MN, at the Mayo Clinic, and other places, is trying to make health care better and, therefore, cheaper, instead of focusing on taking the present system and perpetuating it.

If we don't get into that mentality, if we just take the present system, which this bill does, and spread it over a wider number of people, which this bill does, we will see the spending go up and we will see everything else suffer as a result of it and the health care will not get any better for the people who are involved.

Exhibit 1

[From the Washington Post, Dec. 7, 2009]

Health-Care Nation

(By Robert J. Samuelson)

President Obama's critics sometimes say that he is

engineering a government takeover of health care or even

introducing ``socialized medicine'' into America. These

allegations are wildly overblown. Government already

dominates health care, one-sixth of the economy. It pays

directly or indirectly for roughly half of all health costs.

Medicine is pervasively regulated, from drug approvals to

nursing-home rules. There is no ``free market'' in health

care.

What's happening is the reverse, which is more interesting

and alarming: Health care is taking over government.

Consider: In 1980, the federal government spent $65 billion

on health care; that was 11 percent of all its spending. By

2008, health outlays had grown to $752 billion--25 percent of

the total, one dollar in four.

Even without new legislation, the health share would grow,

as an aging population uses more Medicare (insurance for the

elderly) and Medicaid (the joint federal-state insurance for

the poor, including the very poor elderly). Obama would

magnify the trend by expanding Medicaid and providing new

subsidies for private insurance. Thirty million or more

Americans would receive coverage.

All this is transforming politics and society. The most

obvious characteristic of health spending is that government

can't control it. The reason is public opinion. We all want

the best health care for ourselves and loved ones; that's

natural and seems morally compelling. Unfortunately, what we

all want as individuals may harm us as a nation. Our concern

sanctions open-ended and ineffective health spending, because

everyone believes that cost controls are heartless and

illegitimate. The recent furor over proposals to reduce

mammogram screenings captures the popular feeling.

The consequence is a slow, steady and largely invisible

degradation of other public and private goals. Historian

Niall Ferguson, writing recently in Newsweek, argued that the

huge federal debt threatens America's global power by an

``inexorable reduction in the resources'' for the military.

Ferguson got it half right. The real threat is not the debt

but burgeoning health spending that, even if the budget were

balanced, would press on everything else.

``Everything else'' includes universities, roads, research,

parks, courts, border protection and--because similar

pressures operate on states through Medicaid--schools,

police, trash collection and libraries. Higher health

spending similarly weakens families' ability to raise

children, because it reduces households' discretionary income

either through steeper taxes or lower take-home pay, as

higher employer-paid premiums squeeze salaries.

A society that passively accepts constant increases in

health spending endorses some explicit, if poorly understood,

forms of income redistribution. The young transfer to the

elderly, because about half of all health spending goes for

those 55 and over. Unless taxes are increased

disproportionately for older Americans (and just the opposite

is true), they are subsidized by the young. More and more

resources also go to a small sliver of the population: In

2006, the sickest 5 percent of Americans accounted for 48

percent of health spending.

Political power in this system shifts. It flows to groups

that promote and defend more health spending--AARP, the lobby

for Americans 50 and over, and also provider organizations

such as the American Medical Association (AMA), which

represents doctors. Predictably, AARP has been active in the

present debate. It claims to have participated in 649 town-

hall and other meetings and to have reached more than 50

million people through ads this year. Not surprisingly, AARP

and the AMA recently conducted a joint TV ad campaign.

The rise of health-care nation has confounded America's

political and intellectual leaders, of both left and right.

No one wants to appear unfeeling by denying anyone treatment

that seems needed; no one wants to endorse openly meddling

with doctors' independence. It's easier to perpetuate and

enlarge the status quo than to undertake the difficult job of

restructuring the health-care system to provide better and

less costly care.

Obama's health-care proposals may be undesirable (they

are), but it's mindless to oppose them--as many Republicans

do--by screaming that they'll lead to ``rationing.'' Almost

everything in society is ``rationed,'' either by price (if

you can't afford it, you can't buy it) or explicit political

decisions (school boards have budgets). Health care is an

exception; it enjoys an open tab. The central political

problem of health-care nation is to find effective and

acceptable ways to limit medical spending.

Democrats are no better. Obama talks hypocritically about

restraining deficits and controlling health costs while his

program would increase spending and worsen the budget

outlook. Democrats congratulate themselves on caring for the

uninsured--who already receive much care--while avoiding any

major overhaul of the delivery system. The resulting society

discriminates against the young and increasingly assigns

economic resources and political choice to an unrestrained

medical-industrial complex.

Mr. President, I see the Senator from Iowa wishes to ask me a question and I am happy to respond, but tell me how much time I have remaining. Maybe some of it will have to come off his time.

In my 2 minutes remaining, unless it is a long question, I will be happy to respond to any question my friend may ask.

Mr. President, if I can reclaim my 2 minutes to respond to the Senator from Iowa, I can give you data that indicates it is not just the fact there are a lot of people who don't smoke and don't drink in Utah that makes them healthier. I agree there are many things in this bill that are for wellness, and I approve of that. But the fact is, the bill does not go anywhere near far enough in this direction to change the paradigm that has created the situation we find ourselves in.

Every expert I have talked to, in the 3\1/2\ years I have immersed myself in this issue, has repeated that. They have said the only way you are going to deal with this is to do something dramatically different, which is what Senator Wyden and I tried to do and we got the cold shoulder. All right, I understand, if you don't have the votes, you can't get anywhere. But the fact remains, we are not going to be able to afford all the things we want to do in this country, militarily and otherwise, in this cost projection that we are on with respect to health care right now.

That is right; my time has gone. I will be happy to respond to the Senator from Montana, if he wants to take the time to let me.

If I may, it is not just Intermountain. There are other agencies in Utah that do a good job.

Responding to the question of the Senator from Montana, I am delighted there is as much of that in the bill as there is, but I still believe the basic structure of the bill is fatally flawed because it perpetuates the present system in ways that will guarantee the cost curve will continue to go up. I disagree with him about the Samuelson article. I do not think he is being overly pessimistic. I think he is being very realistic.

Mr. President, I certainly hope this legislation will surprise me by producing----

The result the Senator from Montana is hoping for.

I am not going to hold my breath, however.

I say to the Senator from Arizona and others who have commented, home health care is not the only way seniors will be hurt by this. I am quoting from an article by Tom Scully, one of the designers of the Medicare Part D benefit, on the impact of this bill on Medicare Part D for seniors. Let me quote the key points of the article. I ask unanimous consent to have the entire article printed in the Record.

He says:

There is a little-noticed provision buried deep in both the

House and Senate health care reform bills that is intended to

save billions of dollars--but instead will hurt millions of

seniors, impose new costs on taxpayers, and charge employers

millions in new taxes.

Here is the core of it:

This fall, congressional staff, looking for a new revenue

source to pay for health reform, proposed eliminating the tax

deductibility of the subsidy to employers. The supposed

savings were estimated by congressional staff to be as much

as $5 billion over the next decade.

It sounds smart--except that nobody asked how many

employers will drop retiree drug coverage. Clearly, many

will. The result is that, instead of saving money, the

proposed revenue raiser will force Medicare Part D costs to

skyrocket as employers drop retirees into the program.

He concludes with this comment:

There are many reasons to pass health care reform. There is

no reason to hurt seniors, employers and taxpayers in the

process. Businesses are struggling and the Medicare trust

funds have plenty of problems as it is. It makes no sense to

make these problems worse.

So not only are the programs going to be cut, but the drug costs are going to be dumped into the program, with an increased number of people involved. You are going to see tremendous financial distortions as a result of the passage of this bill.

Mr. President, I thank the Senator from Arizona.

My mind goes back to a personal experience I had that I would like to share with my friends on the left. It was an entirely different bill-- No Child Left Behind. We were all for it on this side of the aisle because our President had proposed it. My staffer said to me, listening to the debate: You know, Senator, if President Clinton had proposed this, you would vote against it because you would think it was too heavyhanded with government interference. I said: You know, you are right. I have to do the right thing. I was one of the few Senators who voted against it.

If we had proposed what the Democrats had proposed, every argument we are currently hearing from the right side of the aisle would be coming with great roars and insistent statements on the other side of the aisle. But because it is their President who proposed it, they are somehow keeping their consciences under control. I hope they will recognize the irony of that and that at least one Senator--that is all we need in order to stop this bill--would recognize that conscience ought to prevail and this bill ought to be stopped.

Let's be clear. If this bill is stopped, health care reform will not die as a cause. Indeed, health care reform will be reborn in a bipartisan sense of, let's solve the problem, rather than in a partisan sense of, let's jam something down somebody's throat.

I hope that is what will happen, that conscience will prevail somewhere and one member of the Democratic Party who feels in his or her heart that this is a dumb idea will let his or her conscience prevail.

I see the Republican leader.

Mr. President, I have enjoyed this colloquy. I have enjoyed the enthusiasm that is here. I noticed that the sense of passion to get something done properly for the American people is on this side of the aisle. A great of sense of defensiveness is on the other side of the aisle.

We all have an been caught one time or another in the struggle between support for a leadership position or a Presidential position and our own sense of what is the right thing to do. I join with my leader from Kentucky in saying that the people of Utah have never been more worked up about any issue than this one. I have never seen any circumstance where they have been more firm and unanimous in their demand that this bill be stopped.

The Senator from Kentucky said if there is somebody in Kentucky who is for this bill, he has not met him. I have met some people in Utah who are for this bill. They have spoken to me about it, as I pass through airports or I walk down the street in the hearing of other people from Utah. As soon as anybody hears someone tell me, Vote for this bill, there is a chorus of voices that spontaneously come up around that and say: Don't listen to him; listen to us. This is a terrible bill. This is a terrible circumstance.

I have been proud in the debate to point out that in Utah, the Dartmouth study says we have the best health care available in the United States, and if everybody got their health care there, it would not only be the best, it would be one-third cheaper than the national average.

I have spent a lot of time talking with the people who provided that result. Unanimously they tell me this bill would damage that result. It would damage the quality, and it would raise the price. Why in the world would we want to do those two things?

Mr. President, I listened with some interest to the comments made when I came on the Senate floor. I simply want to make this one observation about Medicare Advantage. President Obama promised that Americans who have coverage they like would not lose the coverage they have. There are a number of Americans who have Medicare Advantage. They like it, and they want to keep it. This Congress is about to say: No, you can't. This Congress, through this bill, if it passes, is going to eliminate Medicare Advantage. Frankly, the people who go after Medicare Advantage because they like it are going to be the ones who are disadvantaged. They are going to be the ones who will see President Obama's pledge violated.

Frankly, I don't think they much care about how much an executive is paid or what happens in the company. They care that they have coverage they like, coverage they are paying for, coverage they have chosen, and they are being told by the Federal Government they cannot have what they want.

There is another aspect to this that I would like to explore in the time I have. We keep hearing so much about the CBO and all of the scores the CBO is pointing out along with rhetoric that says we can't afford to wait, we need a solution now, the status quo is unacceptable. I would like to point out that the status will remain quo for 4 years if this bill passes. In the budget smoke and mirrors that have been put into this bill in order to make it look as if it costs less money, they make the effective date in 2014, so there will be 4 years after the passage of this bill where Americans will not see any kind of change in their plans. What they

will see is an increase in their premiums. They will see an increase in taxes.

Why do I say that? Between January of 2010 and January of 2014 there will be four open seasons in which plans can be changed. As the taxes start to hit, as the costs start to hit, those companies that are involved in offering these plans will say: OK, we have to get ready for the expenditures. What do we do? We have four open seasons in which to change our plans before this thing hits.

Obviously, that cannot be scored by CBO because CBO does not know what changes will be made. But do we really think we can go through four open seasons with no change whatsoever in the face of this enormous change that will hit in January of 2014? Do we really think everything is going to remain static? That is what the CBO computers are. Do we really think the $500 billion they want to take out of Medicare to help pay for this will not be hashed over again and again?

One of two things will happen. No. 1, the Democrats will blink in the face of the anger of senior citizens and say: We really didn't mean it. Yes, the bill cuts Medicare by $500 billion, but we really didn't mean it. We have 4 years in which to fix it; that is, 4 years in which to replace that $500 billion. Of course, when that $500 billion is replaced, if that is the way they decide to go, then we will know that the numbers we are getting out of CBO are completely phony. Then we will know the statement that this bill is revenue neutral is a nonstarter. Then we will know there was never any intention to try to deal with this cost.

Suppose future Congresses stand firm and say: Yes, we are going to stand firm in this 4-year period. We are going to stand firm against the anger of senior citizens who are seeing their Medicare benefits get cut. We are going to take the $500 billion out of Medicare. Then we will see the promises that are being made around here--that there will be no cut in Medicare services--all disappear.

I hear people say: We are not cutting benefits. We are just cutting payments to providers. That statement is being made over and over again on the other side of the aisle: We are not cutting benefits. We are going to take that $500 billion away from the providers, but the benefits will remain the same.

In my State, I have plenty of providers that are on the edge, right now, financially. They are on the edge of going out of business, right now, financially because of the cuts that have been made in Medicare in the name of cutting down payments to providers.

What happens to the people who are in a nursing home that is currently dependent upon Medicare payments in order to survive if they come in and say: All right, we are not going to do anything to the benefits these people are entitled to in this nursing home, we are just going to cut enough payments to the nursing home that the nursing home goes out of business. What happens to the people who are in the nursing home under that circumstance? Well, they are going to have to go someplace else and there is going to have to be money to pay for them to go someplace else and the money is going to have to flow through Medicare someplace else and then we are back to the first option I talked about, which is we were not serious when we said we were going to take $500 billion out of Medicare. We were not serious. In order to make sure you do not lose your benefits, we are going to have to start reinvesting in some of these providers. We have seen providers go out of business because of the cuts into Medicare. We need to start putting that money back into Medicare. Then we are back into the circumstance we have been talking about all along: This thing is not paid for.

One final point I wish to make: We had a hearing today with the Chairman of the Federal Reserve. Ben Bernanke is up for reappointment and, of course, the entire conversation was about the economy and what is the future of the economy. There were a number of people who had a conversation about the past, but I wished to focus on the future.

I pointed this out to the Chairman and asked for his comments with respect to the future of our economy. Most of my constituents do not understand what I am about to say. Frankly, most of the people in the press do not understand it, and maybe even some Members of this body do not understand it. When we talk about the Federal budget, two-thirds of the Federal budget is beyond the control of this Congress. Two-thirds of the Federal budget is on autopilot, unless this Congress changes entitlements.

Somebody says: Well, what does this word ``entitlement'' mean? Why do you talk about entitlements? Entitlement means, by law, these individuals are entitled to this money, whether we have it or not. The Federal Government has made a contract with them. All right, it is a social contract rather than a legal contract, but it is as binding politically where the Federal Government has to spend the money, whether it has it or not.

Indeed, that is what we have seen in fiscal year 2010. The budget we passed said revenues are going to be $2.2 trillion and entitlement spending is going to be $2.2 trillion, which means every function of the government--our Embassies overseas; our troops, wherever they may be; education; national parks; whatever it is--every dime will have to be borrowed in fiscal year 2010, every single dime because every penny coming into the Federal Government is already programmed to go out, without coming through the Congress. It does not go through the appropriations process. We do not get to vote on it. People are entitled to receive this money, and it is going to go out there.

What are we talking about? We are talking about creating a new entitlement, a very expensive new entitlement. How are we going to pay for it? According to this bill, we are going to pay for it by transferring money from an existing entitlement. Anyone who thinks that is what is going to happen, in the face of the anger that is being generated by people who read about this, believes a fairytale.

The whole notion of trying to balance the cost of this tremendous new entitlement by somehow a bookkeeping entry that says we will take it out of the Medicare account and we will put it in this account, and the computers that do not think--the computers simply compute--will say: Well, then, if you put it in this account, then this account is revenue neutral. But the government's account is not revenue neutral. This thing is going to cost $500 billion, wherever we get the money. It is a cynical ploy, smoke and mirrors of the worst kind, in a budgetary bait and switch, to say we are going to take this out of Medicare.

I hear from my constituents--I hear from people who are not my constituents who recognize me as a Senator in airports and other places--as they say, increasingly: Do not pass this bill. We see it in the polls, but we see it in the passion of the people who come up to us and let us know how firmly they are opposed to this bill. The American people do not want it, and the American people are right.

I yield the floor.

Mr. President, I wish to commend and congratulate Real Salt Lake for winning the 2009 Major League Soccer Cup. I am delighted to do so, and feel it is a privilege to honor the MLS Cup champions on the Senate floor. The story of Real Salt Lake is more than just a story about a soccer team capturing the MLS title; it is a story about banding together to overcome obstacles and defying the odds after being counted out and dismissed by ``the experts.'' In many ways, the story of Real Salt Lake is part and parcel of the American experience.

On November 22, 2009, in Seattle, WA, Real Salt Lake, or RSL, faced off against the better-known and widely acclaimed L.A. Galaxy. Just to give a sense of what RSL was up against, listed on the roster for the Galaxy were U.S. National Team star Landon Donovan, and the internationally acclaimed, indeed iconic, David Beckham. The RSL roster, on the other hand, didn't include what's known as a ``designated player,'' or in other words, a recognized superstar. If that wasn't enough, the Galaxy entered the postseason riding high, having finished at the top of the Western Conference in the regular season with a 12-6-12 record, and were expected by most to perform well if not to win the championship. RSL had a far different experience during their regular season, finishing with an 11-12-7 record. Indeed, they barely managed to make it into the eight team playoff that would determine the MLS Cup Champion.

Considering these facts, it would have been easy for RSL to give up. But that wasn't their attitude. When asked about not having a star player, instead of bemoaning that fact, the team's captain, Kyle Beckerman, said, ``We've really bought into the `star is the team' here in Salt Lake. When we work as a team and [are] doing well it's because everybody's playing well. It pays off.'' This team unity had initially paid off in the postseason for RSL as they defeated the defending champion Columbus Crew, and beat the Chicago Fire in the Eastern Conference finals. Despite this, many doubted whether they could win against the Galaxy in the championship game. When asked

about their chances, head coach Jason Kreis sarcastically replied, ``Wow, it sounds like we better not even go. We don't even have a chance, do we?'' He knew RSL possessed something special.

Even in the final match, such outspoken optimism would be tested. By halftime, RSL was trailing 1-0. Two of their key players were unable to continue playing, sidelined by injury and illness. If ever there was a time to give up, it seemed that this was it. But that wasn't their attitude. Coach Kreis made a pair of substitutions, and encouraged his players to ``be confident,'' and play aggressive. And, well you can see where this is going. After 90 minutes of play, 30 minutes of overtime, and seven rounds of penalty kicks that included two blocked shots by RSL goalkeeper Nick Rimando, defender Robbie Russell converted the final penalty kick to seal the victory, establishing RSL as the champions of Major League Soccer.

Now I wish to place this victory into some context. This was significant for Utah in that it was the first professional sports crown to go to the State of Utah since the Utah Stars basketball team won the American Basketball Association title back in 1971. RSL's victory was notable not only because Jason Kreis, at the age of 36, became the youngest manager in MLS history to lead his team to the title, but also because RSL became the first franchise in professional sports history to win a championship after finishing the regular season without a winning record. Think about that for a minute--if there is ever a reason to dismiss a team, a losing record in the regular season should be it. But that wasn't RSL's attitude. Rather than dwelling in self- pity and regret, RSL fought on, determined to prove their detractors wrong. They believed they could beat the entire league, and they went out and did just that. Their story exemplifies the American values of hard work, resilience, and overcoming the odds.

Once again, I congratulate RSL for their victory; I join with their fans in celebration of this championship; and I hope that this is one of many more championships to come for Utah.

I ask unanimous consent that during the next hour, those Senators who come to the floor may be allowed to proceed in a colloquy.

I came to the floor early so I could listen to what my Democratic friends have had to say. I found it quite enlightening, and I have a few comments with respect to it.

They have been debating vigorously against the status quo. They have been giving us examples, heart-tugging, real-life examples of people who are finding difficult problems in the situation as it now exists-- as if the debate were between the status quo and doing something.

The debate is between the solution that has been offered by the majority leader and other solutions, which people on this side of the aisle have been trying to bring forward through the entire time and have not been allowed to come forward.

We recognize that things need to be done to fix problems with respect to the health care situation. We realize the legislation we have been living with for all these years needs to be amended. We have been unable to get any of our ideas to come forward. Now we are told there is such urgency to deal with the status quo that we must pass this bill, and we must pass it virtually without amendment.

I would like to point out, as I have done before, if there is such urgency with respect to the challenges we have in health care, why do we wait until 2014 to have those changes come? We have heard all these examples coming on the Democratic side of the aisle of people who have terrible problems under their health care plan. We must act, we must act immediately, and the act will be to say to all of these people: We will solve your problem in 2014. We will delay all of these reforms we are talking about until 2014.

I made that point the other day, and the Senator from Maryland said, no, some parts of this bill will begin immediately. And he is exactly right. The parts of the bill that would begin immediately are the taxes. We will start taking in money in 2010 if this bill passes. The annual pharmaceutical manufacturers fee would drive up the price of everybody's drugs, an annual nondeductible $2.3 billion fee. That will begin in 2010. The medical device manufacturers fee, another $2 billion, will begin in 2010. The medical insurance provider fee, that will begin in 2010. The cosmetic surgery fee, that will begin in 2010. In 2011, there will be a limit on contributions and in 2013 a high-cost insurance excise tax. All the taxes are front-loaded, but all of the reforms they promise this bill will bring to all of the people whose stories they told us will not take place until 2014. The status for them will remain quo. For all of these attacks on the status quo, the one change we will get is they will start charging the taxes but they will not start delivering any kind of health care reform until 2014.

Why are we delaying until 2014? Not because they do not think people need it but because they realize that if they start spending at the same time they start taxing, the score they will get out of the Congressional Budget Office will point out the true cost of this bill. And it is the true cost of this bill that is the kind of thing we need to be debating and talking about rather than listing story after story. My State is full of them, and I am just as sympathetic as anybody of people who have problems with the present health care system. That is a false debate.

We all realize, all 100 of us realize that something has to be done to make the health care system better. This is not, should we do nothing; this is a debate about what should be done. The proposal we have from the majority leader is not the answer to the problems we face.

I say to my friend from Arizona, he reminds me of a real-life experience of a husband who at Christmastime came back to his wife and presented her with a brilliant Christmas present that she had not been expecting. She said to her husband: How could we afford this because the only amount we had in our Christmas budget was--pick a number--$200, and this is obviously worth more than $200.

He said: Oh, don't worry about it. I paid $200 for it.

She said: How in the world did you get $200?

He said: The department store agreed to take the other $1,000 in payments later on.

That is exactly what is happening here. We are making a downpayment and telling ourselves that the total cost is covered as outlined by the Congressional Budget Office.

I say to my friend from Arizona, and then I will yield to my friend from Tennessee, Senator McCain just asked a question: Does anybody really believe these cuts will take place?

I share with him an experience I had driving home from the Senate just this week. I was listening to the radio, and the first story on the radio was this vote coming up. The Senate is going to vote at 8 o'clock on Saturday. The second story was that the House of Representatives just passed a doc fix of $200 billion. So we already have action by the House of Representatives proving that the comment by Senator McCain is exactly right. Before this bill even gets passed, they are reversing the cuts over in the House of Representatives. Senator Reid tried to do it here before we got to this bill, and we voted him down. So the House is going to take care of it, and they will ping-pong the bill over here.

There is no question that these cuts will not take place.

My friend from Tennessee wishes to comment.

If I could make the comment, Mr. President, among the people who do not believe these changes would not occur is CBO itself. CBO itself agrees this is smoke and mirrors. They do it in very polite language, but let me share with you the language. They say:

These longer-term calculations assume that the provisions

are enacted and remain unchanged throughout the next 2

decades, which is often not the case for major legislation.

That is about as gentle a way as CBO can put it. They don't believe this thing is going to stand without these kinds of changes. Yes, they have come forward because their computers say: You put the numbers in this way, this is the result you get. But human beings are saying that is not what is going to happen over the next two decades.

Obviously, I would not respond in the way the folks across the aisle have responded to this health care crisis. The example the Senator has given is a valid one. That is not how you deal with it.

The other point I would make is that if I had a serious problem that was causing difficulty for the survival of the company, I would not put the solution off for 4 years while I raised prices on the existing products to try to pay for it. I would try to do what I could to get the fix upfront as soon as possible.

As both Senators have pointed out, we Republicans have fixes that could start now and don't have to wait until 2014 in order to get a good CBO score.

I point out the CBO makes the same point at these 10 years. Again, quoting the CBO letter, talking about the 10 years following, when you have the full 10 years of expenditures instead of just 5 or 6 years of expenditure, it says:

Under the legislation federal outlays for health care would

increase during the 2010-2019 period, as would the federal

budgetary commitment to health care.

So those who are saying this is going to be a saving to the government and you are going to turn the cost of health care--turn the cost curve with respect to health care down, the CBO has said: No, that is not the case. The Federal commitment would go up in those years.

Again, by delaying the implementation of the expenditure while implementing immediately the implementation of the revenue, they are creating the kind of financial chicanery that, as Senator McCain has said, put Bernie Madoff in jail.

Mr. President, if I could share with Senators this statistic. We hear a lot of talk about everybody has to be covered. We talk about the United Kingdom, where they have a plan where everybody is covered. The cancer survivor rate for women with breast cancer in the United Kingdom, after diagnosis, is 57 percent. The cancer survivor rate in the United States, where we have people who are not covered, is 67 percent. I do not think we want to move in the direction of bringing that rate down.

Mr. President, I would like to share another statistic in this whole circumstance that I think we need to focus on because, back to the Broder column Senator McCain talked about, we are talking about the amount of expenditures and the creation of a new entitlement.

Let's go back to the debate on the budget. We got the numbers that said the projected revenue for fiscal year 2009 was $2.2 trillion. The entitlement spending for 2009 was $2.2 trillion. That means everything we have done in government--our embassies overseas, our military, the national parks, education, whatever it is--absolutely everything in 2009, other than entitlement spending, had to be borrowed money.

What are we doing with this bill? We are going to increase entitlement spending. We are going to increase the role of government that this Congress or future Congresses have no direct control over through the appropriations process. I have been chairman of an appropriations subcommittee. The amount we have control over in the Ag Subcommittee is about $17 billion. The total bill was $80 billion. The rest of that $80 billion was off-limits to the Appropriations Subcommittee because it was on autopilot as entitlement spending.

The entitlement spending for farm subsidies is small potatoes, to use a farm subsidy word, compared to the entitlement spending for health care. So facing the kinds of deficits we are facing, facing the runaway entitlement spending we have, the largest portion of which is entitlement spending for health care, what are we being told to do? Increase the entitlement spending for health care and put future Congresses in an even deeper financial bind by taking even more of the total portion of the Federal budget that is outside the appropriations process and putting it on autopilot. That is the issue we must keep in mind as we look at this whole circumstance.

Mr. President, I wish to make the point, again, following up on what the Senator from Tennessee has had to say, that the argument we are hearing from the other side is a false argument when they say it is either this bill or the status quo and the Republicans have nothing to offer.

We have been offering proposals all along. I have been immersed in this for 3\1/2\ years, cosponsoring, with my Democratic friends, ideas on the way to go forward. Those proposals were not even allowed to be considered in committee. The 2,000 pages we see before us were written without a single Republican knowing where the room was, let alone being in the room. Then we are told: But you stand for the status quo, and the status quo is unacceptable.

I repeat what I said earlier: The way this bill is constructed, the status will remain quo until 2014, as far as benefits are concerned, but the taxes will start immediately. But we all know the revenue that comes from those taxes will not be held in trust to pay for the benefits in 2014. They will go for other things, to pay for the $1.4 trillion deficit we have this year. Then, in 2014, when the expenses start, the money will all have been spent that had been brought in, in the 4 years previously, and, as the CBO says, there will be change.

I yield the floor.

Mr. President, I enjoyed listening to my colleague from Maryland. He says to us repeatedly the status quo is not acceptable. I agree with that. I would point out to him that the bill that has been presented to us by the majority leader guarantees the status will remain ``quo'' until 2014. This bill delays implementation until 2014. For 4 years the status will remain ``quo'' on key provisions.

I am happy to yield.

I understand, but the key provisions of the bill that cost significant money are postponed until 2014. Why? Because unless you make that postponement you cannot get the score down to the point where it is in the majority leader's bill.

The challenge is that the real cost of health care is substantially more than this bill demonstrates as it comes out of the Congressional Budget Office. Why? Because the Congressional Budget Office is required by law to give costs over a 10-year period. If this whole thing started at the time the bill was passed and ran for the whole 10 years, the cost would be so high that it could not be offset with the programs that have been put in the bill. So the easy way to save costs and bring it down below the level that is acceptable is to delay the implementation until 2014.

We saw that in the Finance Committee. The Baucus bill moved the date of implementation from January 1, 2013, to July 1, 2013, to save money. Now the Reid bill moves it from July 1, 2013, to January 1, 2014, an entire year of additional ``savings.''

These are not savings at all. These are simply a delay in the implementation and therefore a delay in the expenditures.

I want to move to the point the Senator from Mississippi was making with respect to the impact of this on the national debt and the national deficit. The last time we had a budget from President Bush, the last Bush budget said the total expenditures would be $3.1 trillion.

President Obama's budget called for expenditures of $3.6 trillion or \1/2\ trillion more.

OK, \1/2\ trillion more, you would assume, therefore, that the deficit that would occur would be roughly \1/2\ trillion more than the Bush deficit. But the last deficit of the Bush administration, before the financial crisis hit us, was $116 billion. That is .1 trillion of the $3.1 trillion. And the first deficit of the Obama administration is $1.4 trillion.

You say: Wait a minute. Those numbers do not add up. The reason they do not add up is, we can control how much we spend, but we cannot control how much we take in. How much we take in is a function of the economy.

Let's go back to the budget that was submitted and passed by the Obama administration and passed on the floor of the Senate by the Democratic majority. It projected $2.2 trillion in revenue, and it projected $2.2 trillion in entitlement spending, mandatory spending. That meant that everything else in government had to be borrowed. Money for the Defense Department had to be borrowed, the State Department, all of our embassies overseas, all of that money had to be borrowed. The money for transportation, for the Federal Aviation Administration had to be borrowed. The money for national parks had to be borrowed. The money for education had to be borrowed.

It wasn't that the expenditures went up an extra $1\1/2\ trillion to get a $1.4 trillion deficit. It was that the revenues went down. Yes, the expenditures did go up. The expenditures under the Obama budget went up roughly $\1/2\ trillion from the expenditures under the Bush budget. But the big problem was, the revenues went down at the same time.

The cautionary tale that comes out of this is, again, we can control how much we spend, but we cannot control how much we get in. That is a function of the economy. Money does not come from the budget; money comes from the economy. When the economy is weak, as it is now, we are going to have deficits, no matter how big an effort we make to try to avoid them, because the money simply doesn't come in.

The reason I make that point is because, back again to the numbers that we realized when we were debating the budget, the money coming in was $2.2 trillion and the money already committed in entitlement benefits that the Congress did not deal with in the appropriations process was $2.2 trillion. What we will do, if we pass the bill the majority leader has introduced or will introduce, is to increase the amount of mandatory spending, increase the commitment of the Federal Government to make expenditures in the health care area that will be beyond the reach of the Appropriations Committee, that will be going out whether or not we have the money coming in to pay for them.

I know the score out of CBO says this will save money for the Federal Government, but let's get into the details of what the CBO had to say to see how much it would save and see why it would save.

The CBO says, about the longer term calculations with respect to this bill:

These longer-term calculations assume that the provisions

are enacted and remain unchanged throughout the next two

decades, which is often not the case for major legislation.

I think that is one of the understatements of the year. Major legislation does not often go unchanged for two decades. Congress will add goodies. Congress will delay some of the tax provisions. We see that every year with respect to the legislation known around here as the doc fix. It is in the law right now that every year we cut reimbursements to doctors under Medicare, and every year the Congress comes in and says: We won't do it this year. The doc fix comes in and says: We will change this earlier situation. That means any score that depends on our not passing a doc fix is going to be wrong. CBO says that. Again:

These longer-term calculations assume that the provisions

are enacted and remain unchanged throughout the next two

decades,

which is often not the case for major legislation.

We keep hearing how the costs are going to come down. What does CBO have to say about that? This is the quote that has to do with what I was talking about with respect to expanding the Federal commitment for entitlement spending in health care. Quoting again from CBO:

Under the legislation, federal outlays for health care

would increase during the 2010-2019 period, as would the

federal budgetary commitment to health care.

The Federal budgetary commitment to health care will increase. So how do we get a score that says we will save money? You get the score because you have projected revenues that will increase. You have tax provisions in there that say we will get the money from this tax, we will get the money from that tax. Then it will be a saving to the Federal Government. It is not a saving to the Federal Government; it is a raising of Federal revenues above the commitment to spend. But as I pointed out in the beginning, the raising of Federal revenues is not an automatic thing upon which we can depend. It is dependent upon the economy. What happens if we make the commitment to the spending and then the economy is not good and the revenues do not come in at the level CBO is projecting? These are all assumptions CBO is making, feeding into the computers. The computer cannot and does not project any kind of economic downturn, any kind of recession, any kind of problem. It just says: If, if, and if, you will get this number. And then they plug that number in, and that number says it will be big enough to pay for all of this. But make no mistake, what CBO says on the side where we can control it, the spending side, it says it would increase the Federal budgetary commitment to health care.

So once again we have entitlement spending. We have the demand for money going out going up on the hope that the revenues coming in will somehow be greater than the amount going up, and therefore we can project that this will save the government money.

How accurate has CBO been in the past with respect to the spending side? Well, we can go back to Lyndon Johnson and Joe Califano, who created Medicare, and take their original projections as to how much Medicare would cost. I have given that speech on the floor before. The answer is, Medicare costs 20 times more than was projected at the time it was put in place. We could do the same thing with Medicaid. It is not quite that big, not quite 20 times. SCHIP, whatever it is. With the exception of Medicare Part D, which was a Republican initiative, every single time the Federal Government has put in a Federal program for medical activity and medical expenditures, the actual expenditures have exceeded projections, sometimes 20 times exceeding it, going back to Medicare. That is the spending side.

We cannot produce that kind of money on the revenue side because we cannot really control the amount of revenue that comes in. The amount of revenue that comes in is a function of the economy.

Once again, where are we this year? Mr. President, $2.2 trillion in revenue, substantially below the amount of revenue that came in in the Bush administration. It is not Bush's fault that there was more or less. It was the economy that made a downturn. And if we think in this body we can repeal the business cycle and see there will be no more downturns in the future, we are really kidding ourselves. There will be downturns, and there we will be, with the commitment in place, the increase in the Federal budgetary commitment to health care, without the revenue to pay for it.

This is CBO again:

The long-term budgetary impact could be quite different if

key provisions of the bill were ultimately changed or not

fully implemented. If those changes arose from future

legislation, CBO would estimate their costs when that

legislation was being considered by the Congress.

In other words: We will make no attempt to guess what is going to happen in the future, but we can tell you that any kind of tinkering with this in the future is going to make all of our predictions wrong. That is the logical thing for them to say, it is the prudent thing for them to say, and it is the accurate thing for them to say.

There are many things about this bill that I don't like. I am convinced it will increase premiums for those who currently have health insurance. There is no way it can produce the kinds of results my friend from Maryland talked about of covering 30 million more people and cutting costs for everybody in Middle America without costing a lot more money someplace else. One of those places is going to be either in your tax responsibilities or in increased premiums or in the States.

We all know how the Governors feel about this proposal. The Governors have said this proposal will bankrupt us by the rolling of Medicaid costs onto the States--not Republican Governors, it is Democratic Governors who have come forward and said: We can't handle this. So there are lots of things about this bill I don't like.

But I believe the score that has been put together is not an honest one. I am not accusing CBO of doing anything wrong. I am accusing those who wrote the bill of putting in provisions so that we will delay this implementation there, we will call for this tax here and the score that goes there and so on. And it ends up that when we feed all of that information into the computer and then say: O mighty computer, none of this will change, what is the number, the computer gives you a number, but it is a number based on assumptions that are based on smoke and mirrors.

There is an old saying: Where there is smoke, there is fire. This bill has a lot of smoke in it, and, in my opinion, it is the American people who are going to get burned.

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

Madam President, as we approach the commemoration of Veterans Day, I rise to speak in recognition of veterans across the country, but particularly those in Utah. In doing this, I wish to be careful to not allow the regularity of this topic diminish its significance or make our veterans seem ordinary. Those who know them best know they are anything but.

When speaking of our veterans, perhaps we remember news clips of heroic jungle rescues, a frozen, rocket-blasted hill, or soldiers fighting bravely in the searing heat of the desert. We rightly celebrate them for what they did, but more than that--let us celebrate them for who they are.

As meaningful as words of praise may be, they often are all we give to our veterans. It is too rare when we can present our veterans with a gift--a concrete reminder that this Nation honors those individuals who fight to keep us free. Today, I am especially pleased to recognize the opening of the George E. Wahlen Veterans' Nursing Home in Ogden, UT. On November 19, officials and the public will gather to commemorate the opening of the nursing home and present this impressive facility to the veterans of northern Utah. As with any major accomplishment, the list of people to thank stretches long, including public officials from local, State, and Federal Government, particularly State Representative Brad Dee and State Senator Pete Knudson who sponsored the legislation that made this all possible. However, I would also like to recognize two Utah veterans, whose contributions made this project a reality.

Terry Schow is a Vietnam veteran and the director of the Utah Department of Veterans Affairs. His efforts to reach out to his fellow veterans are not confined to his professional obligations. Rather, his passion and unmistakable tenacity give power to his fundamental belief that kind words simply are not enough when it comes to caring for our veterans. Determined to make sure that all veterans receive the support they deserve, Terry was instrumental in seeing that no bureaucratic or logistical obstacle prevented the creation of the veterans' nursing home.

Finally, I wish to speak of the late George Wahlen. A World War II veteran and recipient of the Medal of Honor, George passed away on June 5, 2009, just 5 months before completion of the facility that he fought so hard to establish. Along with several of his colleagues, George made the repeated trek to the Capitol building in Salt Lake City, UT, to persuade legislators of the need to provide funding for a veterans' nursing home in northern Utah. It is noteworthy that in fighting for the needed funding, George never sought any personal benefit. He never knew the nursing home would be named in his honor. Instead, at a time when he could have retired and spent his life in comfort and quiet, he chose to take up this cause, a symbol of his dedication to the service of his fellow veterans. After numerous meetings, phone calls, and hearings, the persistence of George as well as dozens of other veterans paid off when on January 24, 2008, the State House, and later on February 29, 2008, the State Senate voted unanimously to advance all funding for the construction of the facility. This measure was then signed into law by Governor Jon Huntsman, Jr. on March 18, 2008.

For George Wahlen and Terry Schow, their work for their country and fellow servicemen did not end when they became veterans. These two men have inspired many of us in Utah by their integrity, character, and passion to ensure our country returns the favor for the many sacrifices made by our servicemen and women. You see, it is not that George or Terry or any number of veterans did this one single thing or that. What sets them apart is the character which leads them to do it again, and again. When honoring our veterans this Veterans Day, let us not forget their valiant acts of courage--but may we always remember their character.

As a Senator, I am acutely aware of the many issues that face veterans. I am sure each of us would like to give them more. But, while much remains to be done, let the George E. Wahlen Veterans' Nursing Home in Ogden, UT, stand as undeniable evidence that America is a nation that honors its veterans.

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

Madam President, I ask unanimous consent that I be allowed to proceed as in morning business.

Thank you, Madam President.

We are in a time when we are talking about money; we are talking about debt; we are talking about taxes; we are talking about stimulus; and we are talking about health care. I wish to put the whole situation with respect to money into some perspective.

Having been a businessman, I did my best to try to draw up a balance sheet for the United States. This is a very simplified balance sheet. It is in summary numbers only. But by going to the Federal Reserve Board and the Social Security and Medicare trustees and the Census Bureau, I have come up with the following balance sheet for citizens of the United States.

We start out with assets and liabilities. These are personal assets and personal liabilities. It is amazing to me that the number of household assets on a per-person basis is this high, but it is. If you take all of the personal assets in the United States, lump them together, and then divide them by the number of people in the United States, you get personal assets of $218,000 per person, and personal liabilities or household debt of only $45,000 per person. So the balance sheet looks pretty good.

However, as citizens of this country, we have debt beyond our personal debt. So when we add the national debt and each individual's share of it to the balance sheet, that adds an extra $37,982, so that the amount of debt goes up when you add each individual's share of the national debt.

The national debt is not the only debt we have. Let's add State and local government debt on a per-person basis, and it goes up another $7,500. But that is not the only debt we have. We have obligations, each one of us, with respect to Social Security. There is a Social Security liability and the present value of that Social Security liability is another $17,251 per person.

All right. It still looks like a pretty good balance sheet. With the assets at $218,000, this is about half. But there are two other liabilities we have to put on the balance sheet. The first one is the present value of Medicare hospital insurance. Over the next 75 years, the present value of that unfunded liability is $43,616 per person, almost as much as the total amount of debt that each one of us has as an individual. Now the balance sheet is looking a little scarier.

But we have one more item we have to put on the balance sheet, and that is the present value of Medicare supplemental medical insurance, and that is another $79,095 per person. So when you add it all up, this is the balance sheet we are facing today: $218,000 in assets, and $231,000 in liabilities. If this were a corporation with this balance sheet, we would say the corporation is underwater.

As we begin to break this down, we realize that the Medicare liability is more than everything else put together. The Medicare liability is more than our personal debts, our share of the national debt, our share of State and local debts, and our share of Social Security. The Medicare liability is more than all of that put together. Is it any wonder, then, that the No. 1 issue we should be talking about when we are talking about health care is how to get the health care costs under control; to use the terms that the budgeteers use, how to turn the cost curve downward on health care. We can talk about earmarks. We can talk about spending on appropriations bills. We can talk about holding down discretionary spending on other issues. All of those things are worth talking about, but they are dwarfed by the challenge of turning down the cost curve on health care.

I have said this before, but it still works: One of the statements that has gotten into American folklore is a statement attributed to Willie Sutton. Willie Sutton was a bank robber. Not very many people knew much about his robbing banks, but he kept doing it. He would get arrested, he would get out on parole or he would leave prison and he would rob another bank. Finally someone said to him: Willie, why do you keep robbing banks? He said: Because that is where the money is.

If we are going to talk about the balance sheet that every American faces in debt and debt obligations, we have to talk about health care because that is where the money is: more for health care liabilities than everything else put together.

Let's discuss this question of turning the cost curve down. How good a job have we done as a government in making projections as to the cost of health care? On the second chart, let's look at the years and at the projections. In 1965 when Medicare was first proposed, we made a cost projection. We, the government, made a cost projection as to how much it would cost us, and that is represented by that red bar there on that chart. Then the actual numbers came in, and they are represented by the green bar on the chart. Let's look at 1965 Medicare hospital insurance. That is a separate program. The cost projection is there in the red bar; the actual figures that came in are in the green bar. In 1987, we added Medicaid, and the Congress told the people: Medicaid won't cost much at all. You see, it is hard to find even on the chart. The actual cost was 17 times the projection that was made. In 1988 we added Medicare for home care. It was going to cost a little more. Once again, the gap between the red bar and the green bar--it has always cost more. We did a little better with SCHIP, but SCHIP is still a relatively new program, created in 1997, so the disparity between the projection and the reality is relatively small, but, once again, the reality has been greater than the projection.

There is one exception, and that is Medicare Part D, and that is the final pair there. The red bar shows what was projected that Medicare Part D would cost and the green bar shows, almost magically, this one costs less than the projection. Why?

I wish to quote from an editorial in the Wall Street Journal where they quote from White House Budget Director Peter Orszag. Peter Orszag was the head of the Congressional Budget Office at the time that cost projection was made. This is what the Journal has to say:

But as White House budget director Peter Orszag told

Congress when he ran the Congressional Budget Office, the

``primary cause'' of these cost savings is that--

quoting from Orszag

the pricing is coming in better than anticipated, and that is

likely a reflection of the competition that is occurring in

the private market.

I will repeat that: That is a reflection of the competition that is occurring in the private market.

The Journal goes on to point out something I recall, because I was here during that debate. I was part of that debate. The Journal says:

Liberal Democrats fought that private-competition model

(preferring government drug price controls), just as they are

trying to prevent private health plans from competing across

state borders now.

The lesson here is that spending on nearly all federal

benefit programs grows relentlessly once they are

established. This history won't stop Democrats bent on

ramming their entitlement into law. But every Member who

votes for it is guaranteeing larger deficits and higher taxes

far into the future. Count on it.

The history of cost containment with respect to health care is not a pleasant one. The history of predicting what health care will cost is not a pleasant one. The only example we have where costs have come in lower than projected has been in that circumstance where competition in the private sector has been protected. That has been the core of the bill Senator Ron Wyden and I have introduced as the Healthy Americans Act: private competition absent a government plan. We look at the history and see that will turn the cost curve down. That will begin to save money.

CBO examined our bill. Peter Orszag was the head of CBO when they looked at our bill and said it is revenue neutral--that is a good start--and then likely to save money in the future. They didn't put a number on it, but the Lewin Group has put a number on it and said that the Healthy Americans Act, cosponsored by Senator Wyden and myself, would save $1.3 trillion over the next 10 years. I don't know whether that number is right or wrong. I do know. It is wrong. I don't know how far wrong it is. But the point is it demonstrates turning the cost curve down rather than turning the cost curve up. And that is what we have to

do, as our balance sheet reminds us so dramatically.

Let me talk briefly about the idea of a government-run plan, a public option, or whatever it is we want to call it, as the way to turn the cost curve down. Once again, the history of government plans is not encouraging as far as turning the cost curve down as we look at Medicare and how little it was supposed to cost and how dramatically much it has cost.

Let me quote Robert Samuelson from his column that appeared in the Washington Post recently:

Medicare has low marketing costs because it's a monopoly.

But a non-monopoly public plan would have to sell itself and

would incur higher marketing costs. Private insurers' profits

(included in administrative costs) also explain some of

Medicare's cost advance. But profits represent only 3 percent

of the insurance industry's revenue. Moreover, accounting

comparisons are misleading when they don't include the cost

of Medicare's government-supplied investment capital.

So we are trying to mix apples with oranges when we say, look at the low administrative costs with Medicare and the high administrative costs with private insurance. Medicare can do it cheaper. Every projection about Medicare doing it cheaper has demonstrated not to work out.

Samuelson says this:

The promise of the public plan is a mirage. Its political

brilliance is to use free-market rhetoric (more ``choice''

and ``competition'') to expand government power. But why

would a plan tied to Medicare control health spending, when

Medicare hasn't?

. . . A favored public plan would probably doom today's

private insurance.

I think that is true. That is one of the reasons I am opposed to that kind of thing.

Samuelson goes on to make this final comment:

Many would say: Whoopee! Get rid of the sinister insurers.

Bring on a single-payer system. But if that's the agenda, why

not debate it directly? It's not insurers that cause high

health cost; they're simply the middlemen. It's the

fragmented delivery system and open-ended reimbursement.

Would strict regulation of doctors, hospitals and patients

under a single-payer system provide control? Or would genuine

competition among health plans over price and quality work

better?

That's the debate we need.

I agree. That is the debate we need. That is the debate that focuses on, how do you get this cost curve under control? How do you start to turn it down? How do you get the kind of score that Senator Wyden and I have gotten from CBO that says our plan is revenue neutral and that others say will save $1.3 trillion over the next 10 years, compared to the cost history of government-run plans that say they are only going to cost this much and end up costing that much and driving us to this kind of present value liability--twice as much as everything else put together. That is a staggering thing to contemplate, but that brings us back to what I said in the beginning. The core of this debate should be focused on how we turn the cost curve down.

I have one more comment to make with respect to that. As I have worked with Senator Wyden over the last 3\1/2\ years to try to understand this issue and come up with solutions to it that make marketplace sense rather than political sense, I have come to a great truth that we don't seem to be discussing in this debate at all, and that is this: The greatest cost control factor in health care is quality. The best health care is the cheapest. And we have built into the system now incentives that drive us away from the best care. Most of the perverse incentives that drive us away from the best care and to the highest costs are in Medicare. They are in the Medicare system that has gone 10 times, 20 times above its original cost, and they are still there, and the care they produce is less than the maximum care people can get when they go to the places that give us the best health care.

It is parochial for me to repeat this, but I am happy to do it on every occasion. Dartmouth has done a study as to where the best care is available throughout the United States, and they said it is in three cities: Seattle, WA; Rochester, MN; and Salt Lake City, UT. And then they say that if every American got his or her health care in Salt Lake City, UT, it would be the best in the United States and one-third cheaper than the national average, and that is because of a variety of reasons. They practice the best health care, and they have focused on outcomes rather than the kinds of perverse incentives that are built into government-run programs.

We have a lot to do and a long time to go before this health care debate is finished, but I hope we recognize that hanging over us, regardless of everything else we say with respect to health care, is the fiscal reality that our current value obligations for health care dwarf every other debt we have in the United States. Personal household debt, the national debt, State and local debt, and Social Security debt all put together do not add up to the amount of health care debt we are facing.

The challenge of turning the cost curve on health care down is the No. 1 issue we should be addressing as we are talking about this. The irony of it is, if we are successful based on what we know, we can get the cost curve down and produce a better health care outcome and result.

I yield the floor.

Mr. President, I ask unanimous consent that I be allowed to proceed as in morning business.

Mr. President, it has been a little over a year since a group of us met in the Foreign Relations Committee room headed by the distinguished Senator from Connecticut, Mr. Dodd, to talk about the financial crisis we were facing and how we would deal with that. We came out of that meeting, held a press conference where we sounded perhaps more optimistic than we should have at the time about having a solution to that problem. And out of that has come now a name that is well known throughout the country called TARP. We did not call it that at the time.

But we talked it through in a completely bipartisan and substantive way and voted for the rescue package that came out of that discussion. I voted for that package. I voted for the original disbursement of TARP. I stand by that vote a year later. It was the right vote, the right situation, the right time, and the right thing to do.

But I will share now some of the thoughts that went into my participation in that particular meeting and some of the things that came out of it. In anticipation of the meeting, I called some people whose judgment I trust and discussed this. I was told Treasury cannot physically push $700 billion out the door. You cannot sign that many contracts. That is far too much money.

The suggestion I made was: Why don't we give them $50 billion, because I was told that is the most they could spend in any one month. Why don't we give them $50 billion for 5 months or $250 billion and see how it works before we buy into the $700 billion number that Secretary Paulson was talking about.

No, Secretary Paulson let us know he had to have $700 billion as the headline. He could not calm down the markets, the international markets, unless he had a number that big. We talked it over in that room and came up with this solution, which I think was a good one. We would give them a $700 billion headline, because we authorized $700 billion, but we actually only gave him $350 billion and said he would have to come back to the Congress for the second 350.

Also in that group--and it was not by any means my suggestion or anyone else's suggestion--it was overwhelmingly the consensus: We have to put some controls in here. We have a congressional oversight committee that we created. We have to create an inspector general. I remember one of the members of the group saying: I do not trust any Treasury Secretary, no matter how bright he is, with $700 billion and absolutely no reporting or transparency or control situation.

One of the things that was discussed and that I thought was put in the bill was that when the money starts to come back--because, understand, TARP was not a bailout program in the sense that we gave money to people never to recover anything. It was a program where we were acquiring things, either acquiring collateral or acquiring stock. When the money starts to come back, it will be used to pay down the national debt. If we are going to expend $700 billion to stabilize the system, when the $700 billion comes back, it goes to reduce the debt that was created when it went out. That was my understanding of the agreement we made.

Well, I voted for the TARP and I voted for the first $350 billion. After we came to the second tranche, the second $350 billion, listening to the inspector general and listening to what the congressional oversight committee had to say, and looking at how well the first $350 billion had worked in stabilizing the situation and getting us past the panic we were facing, I voted against the second $350 billion because I was afraid it would turn into somewhat of a bailout fund that could be used for things other than acquiring assets that could be liquidated and bring money back to the Treasury. That is indeed what has happened, because much of the money went for things very different than that which we were talking about in that room that morning.

The amendment I will offer to the bill, when we get on the bill, will be to sunset TARP at the end of this year. This is where we are. Treasury is sitting on about $370 billion in the TARP fund right now. The recession certainly is not over and the challenge in our economy is still there with tremendous force. But the crisis we were facing when we had that meeting is over, and Treasury, to deal with that kind of a crisis, no longer needs that money.

The fear I have is that Treasury is starting to recycle the money and it is not going to pay down the national debt. It has become something of a slush fund to say: All right, if we have a circumstance here where we wish to spend some money, we cannot get it from the Congress, let's take it out of the TARP. If there is a situation over here where we think it might be helpful, and we cannot get the Congress to support us, let's take it out of the TARP. The temptation, sitting on $370 billion, to spend that money, is overwhelming.

When Secretary Geithner came before the Banking Committee or the Joint Economic Committee--I am sorry, I cannot, with my memory right now, put the exact committee to it--the question arose about repaying the national debt rather than recycling the money. He said the lawyers from the Treasury Department had looked at the act of Congress, and they made it clear we in the Congress had made it clear the money could be recycled, it could be relent, it could go out again. That came as a great surprise to me because I thought the conversation we had in that room, as the bill was being written, made it clear the money had to go to pay down the national debt. But I am not in a position to sue the Treasury and argue with their lawyers, and even if we did over the actual meaning of what was in the bill, it would take so many years to adjudicate there is no point in it.

But it comes as a great surprise, as I say, to me that as the money comes back in--and money is coming back in from TARP--it does not go to pay down the national debt, and that it is being treated as a revolving fund, almost a revolving credit card, if you will, that the Treasury can use for the purposes it deems well.

So I will offer an amendment that will sunset TARP at the end of this year. I will point out, the inspector general and the congressional oversight committee we set up on that occasion still have a number of questions about TARP and the way it is being used, and there is great concern that the transparency we had hoped for is not there.

I had come to the decision to offer this amendment for myself and Senator Thune--and we will do so, if we are allowed to, when we get on the bill--long before the Wall Street Journal offered an editorial. But on October 27, the Wall Street Journal had an editorial entitled ``Rolling up the TARP,'' which I ask unanimous consent be printed in the Record following my remarks.

The lead paragraph I wish to quote. It says:

The Troubled Asset Relief Program will expire on December

31, unless Treasury Secretary Timothy Geithner exercises his

authority to extend it to next October.

They obviously did not know about my amendment or I am sure they would have endorsed it.

We hope he doesn't. Historians will debate TARP's role in

ending the financial panic of 2008, but today there is little

evidence that the government needs or can prudently manage

what has evolved into a $700 billion all-purpose political

bailout fund.

We supported TARP to deal with toxic bank assets and

resolve failing banks as a resolution agency of the kind that

worked with savings and loans in the 1980s. Some taxpayer

money was needed beyond what the FDIC's shrinking insurance

fund had available. But TARP quickly became a Treasury tool

to save failing institutions without imposing discipline

(Citigroup) and even to force public capital onto banks that

didn't need it. This stigmatized all banks as taxpayer

supplicants and is now evolving into an excuse for the

Federal Reserve to micromanage compensation.

I think we take the decision for Secretary Geithner and we sunset TARP on December 31, and that will be the amendment I will offer when we get on the bill.

Exhibit 1

[From the Wall Street Journal, Oct. 27, 2009]

Rolling Up the TARP

The $700 billion for banks has become an all-purpose

bailout fund.

The Troubled Asset Relief Program will expire on December

31, unless Treasury Secretary Timothy Geithner exercises his

authority to extend it to next October. We hope he doesn't.

Historians will debate TARP's role in ending the financial

panic of 2008, but today there is little evidence that the

government needs or can prudently manage what has evolved

into a $700 billion all-purpose political bailout fund.

We supported TARP to deal with toxic bank assets and

resolve failing banks as a resolution agency of the kind that

worked with savings and loans in the 1980s. Some taxpayer

money was needed beyond what the FDIC's shrinking insurance

fund had available. But TARP quickly became a Treasury tool

to save failing institutions without imposing discipline

(Citigroup) and even to force public capital onto banks that

didn't need it. This stigmatized all banks as taxpayer

supplicants and is now evolving into an excuse for the

Federal Reserve to micromanage compensation.

TARP was then redirected well beyond the financial system

into $80 billion in ``investments'' for auto companies. These

may never be repaid but served as a lever to abuse creditors

and favor auto unions. TARP also bought preferred stock in

struggling insurers Lincoln and Hartford, though insurance

companies are not subject to bank runs and pose no ``systemic

risk.'' They erode slowly as customers stop renewing

policies.

TARP also became another fund for Congress to pay off the

already heavily subsidized housing industry by financing home

mortgage modifications. Not one cent of the $50 billion in

TARP funds earmarked to modify home mortgages will be

returned to the Treasury, says the Congressional Budget

Office.

As of the end of September, Mr. Geithner was sitting on

$317 billion of uncommitted TARP funds, thanks in part to

bank repayments. But this sum isn't the limit of his check-

writing ability. Treasury considers TARP a ``revolving

fund.'' If taxpayers are ever paid back by AIG, GM, Chrysler,

Citigroup and the rest, Treasury believes it has the

authority to spend that returned money on new adventures in

housing or other parts of the economy.

A TARP renewal by Mr. Geithner could thus put at risk the

entire $700 billion. Rep. Jeb Hensarling (R., Texas) and

former SEC Commissioner Paul Atkins sit on TARP's

Congressional Oversight Panel. They warn that the entire

taxpayer pot could be converted into subsidies. They are

especially concerned about expanding the foreclosure

prevention programs that have been failing by every measure.

TARP inspector general Neil Barofsky agrees that the

mortgage modifications ``will yield no direct return'' and

notes charitably that ``full recovery is far from certain''

on the money sent to AIG and Detroit. Mr. Barofsky also notes

that since Washington runs huge deficits, and interest rates

are almost sure to rise in coming years, TARP will be

increasingly expensive as the government pays more to borrow.

Even with the banks, TARP has been a double-edged sword.

While its capital injections saved some banks, its lack of

transparency created uncertainty that arguably prolonged the

panic. Federal Reserve Chairman Ben Bernanke and former

Treasury Secretary Hank Paulson recently admitted to Mr.

Barofsky what everyone figured at the time of the first

capital injections. Although

they claimed in October 2008 they were providing capital only

to healthy banks, Mr. Bernanke now says some of the firms

were under stress. Mr. Paulson now admits that he thought one

in particular was in danger of failing. By forcing all nine

to take the money, they prevented the weaklings from being

stigmatized.

Says Mr. Barofsky, ``In addition to the basic transparency

concern that this inconsistency raises, by stating expressly

that the `healthy' institutions would be able to increase

overall lending, Treasury created unrealistic expectations

about the institutions' conditions and their ability to

increase lending.''

The government also endangered one of the banks that they

considered healthy at the time. In December, Mr. Paulson

pressured Bank of America to complete its purchase of Merrill

Lynch. His position is that a failed deal would have hurt

both firms, but this is highly speculative. Mr. Barofsky

reports that, according to Fed documents, the government

viewed BofA as well-capitalized, but officials believed that

its tangible common equity would fall to dangerously low

levels if it had to absorb the sinking Merrill.

In other words, by insisting that BofA buy Merrill, Messrs.

Paulson and Bernanke were spreading systemic risk by stuffing

a failing institution into a relatively sound one. And they

were stuffing an investment bank into one of the nation's

largest institutions whose deposits were guaranteed by

taxpayers. BofA would later need billions of dollars more in

TARP cash to survive that forced merger, and when that news

became public it helped to extend the overall financial

panic.

Treasury and the Fed would prefer to keep TARP as insurance

in case the recovery falters and the banking system hits the

skids again. But the more transparent way to address this

risk is by buttressing the FDIC fund that insures bank

deposits and resolves failing banks. The political class has

twisted TARP into a fund to finance its pet programs and

constituents, and the faster it fades away, the better for

taxpayers and the financial system.

Mr. President, I am pleased to come to the floor and recommend passage of the energy and water conference report for the fiscal year 2010. Despite the President sending up his budget in May, nearly 4 months after the budget had been traditionally sent to Congress, this subcommittee worked hard to produce a conference report that is ready earlier than any that I can remember. I compliment my chairman, Senator Dorgan, for his hard work in developing a balanced bill in a legitimate time period.

The subcommittee produced a bill that is under the President's budget request by nearly $1 billion. That is quite extraordinary in this world where we are trying to shovel more money out the door, to come in with a number that is less than the request of the President.

The House and Senate bills differed significantly in their priorities, but I believe the conference report before us balances the funding interests of both bodies and those of the administration as well. The Corps of Engineers remains an area of great interest. The budget request for the corps is down $277 million from fiscal year 2009. The conference report has restored $320 million to meet the large number of member requests, and the conferees allocated $313 million to work off significant construction backlogs.

The Senate bill did not include new starts in the mark. Both the House and the administration proposed new starts, so we had to resolve that issue in the conference. The conference provides $100,000 per project in new starts in this bill.

Turning to the Bureau of Reclamation, the budget request was $55 million below fiscal year 2009 levels. The conferees provided an additional $67 million for the Bureau of Reclamation, which is 6.3 percent over the request and 1 percent over fiscal year 2009. Once again, as the Corps of Engineers, the Bureau of Reclamation has a tremendous backlog of underfunded and meritorious projects, and we did our best to try to work into that backlog.

Finally, as to the Department of Energy, the conference report recommends $27.1 billion for the Department of Energy, which is $1.3 billion below the President's request and $318 million above the current year.

We cannot ignore the fact that $44 billion was provided in stimulus funding for the Department this year, including $16 billion provided for renewable energy accounts. That is why we have been able to make the changes we did.

In restoring balance to the energy programs, the committee recommends an additional $25 million for nuclear energy R&D, including an $85 million increase for the Nuclear Power 2010 Program.

With respect to the concerns raised by the Senator from Oklahoma, I point out the Senate adopted his amendments by unanimous consent. I was in support of those amendments and would be happy to support them again as they come in other appropriations bills. The reaction on the part of the House was that there were two amendments proposed by the Senator from Oklahoma: one they were willing to accept and one they were not. We had to make a decision as to which of the two we would support and, with Senator

Dorgan, I supported one of the amendments of the Senator from Oklahoma that made it into the conference report. I am sorry we were unable to get the other one in, but we did our best and we would be happy, as I say--at least I would be happy; I will not speak for the chairman--I would be happy to support this at some point in the future.

I yield the floor and whatever remainder of the time I may not have used I ask accrue to Senator Dorgan.

Mr. President, along with my colleague, I noticed, with great interest, the headline in this morning's paper that said the Congressional Budget Office has said the health plan that is coming out of the Finance Committee will not increase the deficit. I thought: That is a little bit hard to believe. Then I looked at the details, and all of this reminded me of a scene out of an old movie. The movie is not worth talking about, but the scene is worth talking about to describe what is happening.

It was a circumstance where a spendthrift husband comes home to a frugal wife with a new car. The wife takes one look at the new car and says: Why in the world are we doing this? We can't afford a new car.

He said: No. Remember, we got that windfall. There was an inheritance that came through. We got some extra money. We can afford the new car, and it will not add--to use the terms of politicians--a dime to the deficit because we have this windfall coming in and we can spend it on the new car.

She said: Are you kidding? The roof is leaking. The college fund for the kids is empty. Our house payments are in arrears. We got that windfall. We could take care of some of these other problems. We don't need a new car.

Well, he said: We got the money and I have already spent it on the car and there is nothing you can do about it now.

As it turned out in the movie, the new car got repossessed later on because he had only made a downpayment on it, and they could not afford the payments to keep the car.

Why do I say the health care debate reminds me of this scene from the movie? The Federal debt is rising. The deficits from the regular appropriations bills are enormous. We are wallowing in red ink in the Federal Government. But this bill is not going to add to the deficit because we found $1 trillion as a way to pay for it. We found $1 trillion someplace else we can use to pay for this bill. We can buy this new car, and, OK, the roof is leaking, the college fund is gone, the house payments are in arrears, but somehow we have a trillion extra dollars that we think is best spent on the new car.

If the new car is that much better than the old car, maybe the case could be made that we should take this $1 trillion and spend it on the new car. What do we get for $1 trillion from the Baucus bill? The $1 trillion, which, if it is available to make this thing deficit-neutral, could very well be spent in balancing other budgetary problems and paying down the national debt and doing other things with it.

If we do have $1 trillion to spend here, what are we getting for it when we are spending it entirely on the Baucus bill? Well, we are getting a continuation of defensive medicine because there is no significant malpractice reform, tort reform in this bill.

In his speech to the Congress, President Obama said:

I don't believe malpractice reform is a silver bullet, but

I have talked to enough doctors to know that defensive

medicine may be contributing to unnecessary costs.

I do not want to argue with the President that much because I was delighted when he said that, and I was on my feet applauding with others for that particular statement. I would say, defensive medicine not ``may be'' contributing to unnecessary costs; defensive medicine ``clearly is'' contributing to unnecessary costs. But we are not dealing with that in the Baucus bill. We are raising $1 trillion somewhere else so we can continue business as usual with respect to defensive medicine and malpractice awards within our present system. So the new car is no better than the old car. It is costing us a lot more money, but it is no better than the old car.

Are we getting coverage of the 47 million Americans whom we hear about over and over again in the debate, when they say: Well, the whole purpose we have to undertake this is because we have 47 million Americans who do not have health care coverage. Are we getting them taken care of? Do we have room for them in the new car? Well, not really.

According to the paper this morning, we are going to get 29 million of the 47 million taken care of, which means roughly 20 million left out. We can go into the details of who the 47 million are. As we do, we find out it is a very mixed bag of people who are just passing through that category, people who deliberately choose not to be there. If we are spending $1 trillion just to get to 29 million out of the 47 million, we are not getting a very good new car. We are not getting an improvement over what we have already.

Again, that $1 trillion could be spent in a much better and wiser way. If, indeed, we have an extra $1 trillion we can spend on health care--if, indeed, we do have an opportunity to buy a new car--this is the kind of thing we could get for the $1 trillion, if we said: All right, we have an extra $1 trillion lying around, let's put it in health care. We could double cancer research funding; we could provide treatment for every American whose diabetes or heart disease is going unmanaged; we could create a global immunization campaign to save millions of children's lives; and we would still have enough money left over to keep doing these programs for at least a decade and probably more.

That is what we could get for a new car in the form of health care reform, if we were willing to spend the trillion dollars on trying to improve people's health. Instead of trying to improve people's health, we are simply trying, through this bill, to keep the present system as it is.

I have heard my friends from the other side of the aisle say repeatedly: The present system is broken. The present system is not an acceptable alternative. The present system must be changed. I say: Hooray. I agree. I just wish the Baucus bill would deal with the present system. I just wish the Baucus bill would give us, in fact, a new car rather than simply replacing the old car with a duplicate of the old car that happens to cost an extra $1 trillion.

So I am hoping that as we move things forward, we can make some significant changes in it because at the present time what we have here is a program that would spend Federal cash for a clunker.

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

Mr. President, I thank Senator Vitter for proposing this amendment. It follows the idea of the bill I introduced a few weeks ago that is now S. 1688, the Fairness in Representation Act.

My bill, obviously, will not pass before we get so far down the road to deal with this issue. So it is appropriate for the amendment to be offered, and we can accomplish the same thing with the amendment that would happen if my bill were to pass.

Since my bill was introduced, I have had three primary objections to it. I

wish to deal with each of those, because they would probably be raised with respect to this amendment as well.

No. 1, you cannot ask somebody who is an illegal alien to identify himself or admit that he is here illegally when you are doing the census calculation. Well, it may surprise some people to know that the Census Bureau already asks for this information. It collects it on the ongoing American community survey. That is not as comprehensive as the entire census. If it were, we wouldn't need to do it here. But the Census Bureau already has a track record of asking this question without running into that particular difficulty. The information collected by the census is 100 percent confidential under penalty of law, and the census takers can make that clear to any individual who might be concerned about that. So that is not a major problem.

No. 2, people say, well, since the census data is used to determine funding levels for a variety of programs, and since the illegal aliens get involved in the funding, if you do this, you will be cutting funding for State programs that service the illegal aliens, and that is not fair. The reality is that this amendment, and my bill, do not cut funding. There is nothing in the bill that would say that funding formulas would change. This is an attempt to find out how many illegal aliens we have in this country and where they live--the statistical information, which we do not fully have now, as a result of the American community survey. We have a hint at it in the American community survey, but we are extrapolating for that and making a guess.

Since the census is a once-every-10-year attempt to discover what America is like, who the Americans are, and where they live, it seems to me very logical that the census should add this particular piece of information to it.

Well, after these two arguments have been made and dismissed, the third argument--and we get this most strongly from the people at the Census Bureau--is that it is too late, too bad; you should have brought it up earlier, Senator Bennett, but we started to print our surveys already and we cannot reprint them; it is too late.

I wonder if they have ever thought of printing an extra sheet or extra card. You don't have to reprint the whole survey if you have one additional question you want answered. I have seen books where there have been errors in the book that have come out after the book is published with an errata sheet--that on page so-and-so this particular entry is not correct. It is not that big a deal for the Census Bureau to do some kind of addendum that could be printed and made available so we could solve this particular problem.

All right. Aside from knowing, what do we intend to do with this data if we get it? Senator Vitter made reference to this in his discussion of the amendment. I want to use it today to deal with the question of the apportionment of the voting powers in the House of Representatives. If we go back in history, we find there was no more controversial issue in the writing of the Constitution than the question of representation in Congress. Small States wanted it by State. Large States wanted it by population. The great compromise came along that created this body and said that membership in the Senate would come by State, and membership in the House of Representatives would come by population. But it was left up to the State legislatures to determine how that population would be apportioned. Each State was given a number of representatives based on the population. But the State legislatures could determine where the lines were drawn and how the districts would be created. We had a situation develop over time where States would draw a line and simply leave it. People would move from one congressional district to the other, but the line would not be changed. There was a situation where there were many congressional districts whose representation, numerically, was substantially less than that of some other congressional districts in the same State.

This brought about a lawsuit that went before the U.S. Supreme Court. In the decision in the case of Reynolds v. Symms, issued in 1964, the Supreme Court gave us the one man, one vote rule, which said that the districts should be close enough in population that, in effect, every voter had the same weight of representation in the House of Representatives.

If we have this tremendous number of illegal aliens concentrated in a few States, we have an impact of changing the one man, one vote dictum of the Supreme Court; that is, a State with a large number of illegal immigrants will see to it that its voters have greater representation than voters where the illegal immigrants are not.

All we ask in this amendment and in the bill I proposed is that the Census Bureau be instructed to ignore the presence of illegal aliens when allocating the number of representatives in a State. As I say, it has nothing to do with the funding of programs, because the programs have to be funded where the people are, and we understand that. I believe it is entirely constitutional that the allocation of the congressional seats can be done on the basis of those who are here in a legal circumstance.

As the Senator from Louisiana has pointed out, this is not a trivial matter. There will be eight States that will lose representation to four States if this is not done. Four States' voters will be overrepresented in the House of Representatives because of the large population of illegal immigrants in those four States, and nine States will be underrepresented because of the fact that their voters do not happen to live in a State where there is a large population of illegal aliens.

I am happy to join my colleague from Louisiana in cosponsoring this amendment. I hope our colleagues in the Senate will see fit to support it.

With that, I suggest the absence of a quorum.

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

Mr. President, NASA is at a very difficult crossroads right now in determining the future of human space flight, and I would like to talk about that.

NASA is in the process of deciding where to put its full support and funds--whether it should be behind the current Constellation Program or whether it should change course and go in another direction.

The Augustine Commission has announced some recommendations and described them both but leaves it up to NASA to make the decision as to where it will go. I am very concerned NASA will agree with those recommendations that will relate to access to the International Space Station and will affect low-Earth orbit in these difficult budgetary times.

We have just finished the space station. So the time comes now to decide how to use it to its greatest advantage. The space station was built with the shuttle program, and it has always

been understood that the space shuttle will be retired next year. After that happens, we will be relying upon Russia to get our astronauts into space.

The original plan was that once the shuttle was retired, the next vehicle to get us into space would be the Ares I. That is the pivotal point where the decision has to be made: Shall we go ahead with Ares I?

I am very concerned that NASA may want to divert precious resources from the Ares I program in the hope that the commercial space industry can fill the void. Well, it is disconcerting to me because we have a successful track record of the Ares program but a less than desirable record of the commercial space industry. We have invested over 4 years and $6 billion in the Ares I and Orion programs, and it is on track.

Just last month, we had a successful ground test of the new Ares I rocket in Utah. Later this month, NASA will conduct the first flight test--on track to deliver a safe, reliable rocket.

Changes in NASA's plan should only be made if alternatives are available to provide significant advantages in cost, schedule, performance, and safety. The program that is working should not be dropped unless those advantages are very clear, and as of now there are no credible alternatives. To me, it makes sense to stay committed to a program we have already invested billions of dollars in and which has met its significant benchmarks.

Right now, the Ares I is the only credible solution we have for getting crew and cargo services into space once the shuttle is retired. The Ares I system came out of the Gehman report that followed the Columbia accident, recommending that the shuttle be replaced with a launch system that would maximize crew safety. Aries will achieve those standards.

The system builds on an existing manufacturing infrastructure that builds on our strengths. We already have the industrial base to go ahead with Ares. We do not have to invent anything new. We paid for the research. Why would we forego years of successful research and billions of dollars in the promise of an untested method of getting into space? Why would we take the gamble? If it turns out the hope that the commercial people could fill the void is wrong, we will have lost the industrial base that preserves our existing alternative to the commercial system.

What will NASA do then, if that which they might place their hopes in turns out to fail, and they have dismantled the program we now know works? How much money would we save if we were confronted with that situation a few years down the road? We risk losing the industrial base that is paramount to American competitiveness.

I know I will be accused of being parochial because a good portion of that industrial base is in my home State of Utah, but that does not lessen its significance or its competence.

The Ares program takes advantage of facilities and an already-trained workforce that has made the most reliable rockets in the world, having flown and tested over 200 of these solid rocket motors. We are already seeing reductions in our manufacturing base in this circumstance in Utah. Just this last week, 550 more people who would be critical to NASA in maintaining that base have lost their jobs, and if we abandon the Ares program, we could lose thousands more. Yes, I am interested because it is important to my State, but I am equally, if not more, interested because I think it is important to the Nation not to take this kind of gamble.

I seriously urge the administration to take a look at the bird they have in their hand, the bird that has flown over 200 times successfully, and not be too excited about the bird that may lie waiting for them somewhere in the bush.

I yield the floor.

I move to lay that motion on the table.

The motion to lay on the table was agreed to.

Mr. President, I will not prolong this a great deal, but I need to stand as Orrin's junior colleague and acknowledge not only all the things the two leaders have acknowledged, but the great friendship I have experienced coming here as a Senator.

Orrin, we shall now reveal, was somewhat enamored of my opponent when I ran the first time. He, at the same time, in great fairness, reached out to me to become acquainted with me, and after we had a particular problem arise in that campaign, Orrin reached out to my opponent and settled that problem with the kind of diplomacy and capacity he always has. From that time forward, I could not have had and could not have wished for a more reliable or more supportive senior colleague than Orrin Hatch.

I am senior to him when it comes to age. You wouldn't think that, but it happens to be true. But never at any time has he treated me as anything but a complete equal. He has acted as a mentor.

I am grateful to the two leaders for their setting aside this time. I wish to join with them in congratulating Orrin on his 12,000th vote.

Mr. President, I have said repeatedly that I would vote against my own bill, even if it were to pass the Senate unanimously, unless there were an ironclad guarantee--iron is not strong enough; carved in marble guarantee--from the President that he would veto a conference report that came back that did not have the kinds of protections I think my bill has.

I agree completely with the Senator from Arizona. The big fear is that we craft something in the Senate that is reasonable and then submit it to a conference and it comes back in a conference report that is not amendable and gets passed by a majority vote here and we are stuck with it.

As important as it is that we try to get the Senate bill right, we must recognize that there are two Houses of Congress. At the moment, the other body is not showing the degree of analysis we are trying to get going here in the Senate. The House bill is completely unacceptable.

If I could pick up on the comment about the consequences of what is being done with respect to Medicaid, I will add the experience from the State of Utah to the experience that has been referred to for other States.

In Utah, an expansion of Medicaid, as outlined in the Finance Committee bill, would mean anywhere from an additional $150 million to $248 million to Utah taxpayers. I realize that in a State such as California that is multiple billions of dollars in debt, an extra $150 million to an extra quarter of a billion is not a lot of money. But in Utah, it is a significant amount. We need to pay attention to the fact that every State is facing those kinds of significant increases.

I call the attention of the Senate to an analysis that is in today's Congressional Quarterly, dated September 30, talking about the bill as it is moving through the Finance Committee. I quote:

Under current law, taxpayers can deduct expenses that

exceed 7.5 percent of their adjusted gross income. Under the

Baucus original proposal, that floor would have been raised

to 10 percent, starting in 2013.

Then further:

According to data from the Joint Committee on Taxation, 45

percent of the taxpayers affected and 53 percent of the

revenue from the change would come from people 65 and over.

So for those who are asking--and we read about them in the paper all the time--why are the elderly upset, they have Medicare? The elderly are smarter than that, and they recognize that 53 percent of the increase that would come as a result of these proposed changes would come from them.

They certainly are going to want us to read the bill and be honest with them as to what is in it. They are going to want us to go into the managers' package, into the small details that usually are considered technical and get passed over, and be very specific in saying to our constituents: We know what is in the bill, and we are being very upfront with you in telling you what is in the bill.

One of the things we need to be upfront about is the amount of increase this will cost seniors and the amount of impact it will have on States. States will then have to turn around and raise their taxes, and seniors will pay twice, with the increase at the Federal level and the increase at the State level.

Mr. President, I will make this comment with respect to the remarks of the Senator from Tennessee with reference to the CBO. We need hard numbers, but we do have a preliminary understanding already.

The Director of the CBO, Mr. Elmendorf, was asked if it is true that the fees established in the bill would ultimately be passed on down to the health care consumer, and his response:

Our judgment is that the piece of legislation would raise

insurance premiums.

If we go more deeply into the CBO analysis, we find that not only would premiums in the individual market be higher than under the proposed reform, but taxes on insurers and drugs and devices would be passed on to consumers in the form of higher premiums. Finally, CBO also says that the premiums would be extremely high even after the proposed reforms because taxpayers would be subsidizing expensive plans. We clearly need the kind of careful analysis that clothes these comments with actual numbers. Without those, how can we vote with any kind of clarity on the proposal before us.