Floor Statements

Mr. President, I ask unanimous consent that the Committee on Indian Affairs be authorized to meet during the session of the Senate on February 11, 2010, at 2:15 p.m. in room 628 of the Dirksen Senate Office Building.

Mr. President, I ask unanimous consent that the Committee on the Judiciary be authorized to meet during the session of the Senate, on February 11, 2010, at 2:15 p.m., in S-120 of the Capitol, to conduct an executive business meeting.

Mr. President, I ask unanimous consent that the Select Committee on Intelligence be authorized to meet during the session of the Senate on February 11, 2010 at 2:30 p.m.

Mr. President, I ask unanimous consent to speak in morning business for up to 25 minutes.

Mr. President, I rise this morning to join Chairman Leahy's eloquent and inspiring remarks of yesterday and express my strong disagreement with the Supreme Court's decision released last week in Citizens United v. the Federal Election Commission.

In this astonishing decision, the slimmest of 5-to-4 majorities overturned legal principles that have been in place since Theodore Roosevelt's administration. The five Justices who make up the Court's conservative bloc opened floodgates that had for over a century kept unlimited spending by corporations from drowning out the voices of the American people. It would be hard to call this decision anything other than judicial activism.

Let me start by reminding my colleagues of the long history of successful and appropriate regulation of corporate influence on elections. Federal laws restricting corporate spending on campaigns have a long pedigree. The 1907 Tillman Act restricted corporate spending on campaigns. Various loopholes have come and gone since, but the principle embodied in that law more than 100 years ago--that inanimate business corporations are not free to spend unlimited dollars to influence our campaigns for office--was an established cornerstone of our political system. Monied interests have long desired to wield special influence, but the integrity of our political system always has had champions--from Teddy Roosevelt a century ago to Senators McCain and Feingold in our time, who won a bruising legislative battle with their 2002 bipartisan Campaign Finance Reform Act.

Last week, that activist element of the Supreme Court struck down key protections of our elections integrity, overturned the will of Congress and the American people, and allowed all corporations to spend without limit in order to elect and defeat candidates and influence policy to meet their political ends. The consequences may well be nightmarish. As our colleague, Senator Schumer said, one thing is clear: The conservative bloc of the Supreme Court has predetermined the outcome of the next election; the winners will be the corporations.

As my home State paper, the Providence Journal, explained:

The ruling will mean that, more than ever, big-spending

economic interests will determine who gets elected. More

money will especially pour into relentless attack campaigns.

Free speech for most individuals will suffer because their

voices will count for even less than they do now. They will

simply be drowned out by the big money. The bulk of the cash

will come from corporations, which have much more money

available to spend than unions. Candidates will be even more

unlikely to take on big interests than they are now.

What could make a big interest more happy than that? The details of this case were quite simple. Citizens United is an advocacy organization that accepts corporate funding. It sought to broadcast on on-demand cable a lengthy negative documentary attacking our former colleague, now-Secretary of State Clinton, who was then a candidate for President. The law prohibited the broadcast of this kind of corporate- funded electioneering on the eve of an election. Citizens United filed suit, arguing that this prohibition violated the first amendment. The conservative Justices agreed, holding that all corporations have a constitutional right to use their general treasury funds, their shareholder funds, to pay for advertisements for or against candidates in elections.

Although the decision was cast as being about the rights of individuals to hear more corporate speech, its effect will be with corporations--big oil, pharmaceutical companies, debt collection agencies, health insurance companies, credit card companies and banks, tobacco companies--now all moving without restriction into the American election process.

To highlight the radical nature of this decision, let me put this in the context of true principles of judicial conservatism. Justice Stevens explained in his dissent that the principle of stare decisis-- ``it stands decided''--assures that our Nation's ``bedrock principles are founded in the law rather than in the proclivities of individuals.''

It is jarring that the unrestrained activism of the conservative bloc on the Supreme Court led them to pay so little heed to longstanding judicial precedents, brushing them aside with almost no hesitation. Justice Stevens noted that ``the only relevant thing that has changed [since those prior precedents] . . . is the composition of this Court.''

Is it truly just a coincidence that this same bloc of Judges just last year invented a new individual constitutional right to bear arms that no previous Supreme Court had noticed for more than 200 years or is something else going on here where core Republican political goals are involved? Is stare decisis now out the window, at least with the Republican activist judges?

Another supposed conservative principle thrown aside by these activists was the approach to constitutional interpretation that focuses on the original intent of the Founders. Read the opinions. By far, the most convincing discussion of that original intent appears in Justice Stevens' dissent, not in the majority opinion or in Justice Scalia's concurrence. Justice Stevens, in dissent, correctly explains that the Founding Fathers had a dim view of corporations. They were suspicious of them. They considered them prone to abuse and scandal, and that those corporations that did exist at the time of the founding were largely creatures of the State that did not resemble contemporary corporations. Justice Stevens rightly describes it as:

. . . implausible that the Framers believed ``the freedom

of speech'' would extend equally to all corporate speakers,

much less that it would preclude legislatures from taking

limited measures to guard against corporate capture of

elections.

This lack of historical awareness is, as I will explain, not the only flaw of the majority opinion. Only the dissent points out the most basic point:

. . . that corporations are different from human beings . .

. corporations have no consciences, no beliefs, no feelings,

no thoughts, no desires.

I would add they have no souls. The dissent explains:

Corporations help structure and facilitate the activities

of human beings, to be sure, and their ``personhood'' often

serves as a useful legal fiction. But they are not themselves

members of ``We the People'' by whom and for whom our

Constitution was established.

The majority just bypasses this elemental point.

One bedrock principle in our democracy is that the will of the people should be supreme except in very limited circumstances. In the judicial context this means that courts should hesitate before striking down statutes enacted by Congress. But it seems that is not so when core tenets of the Republican platform are involved.

It is not just this one case. There is a pattern that is discernible when these five men get together to strike down laws of Congress they do not like and make new law more to their liking. The pattern is not just discernible, it is unmistakable. It is undeniable. It appears, indeed, to be without exception.

Look at the evidence: There is virtually perfect concordance between the major departures by the activist bloc from conservative judicial tenets--such as judicial restraint, original intent, States rights--and the result in those cases of achieving current Republican political goals. One could probably call this practice ``situational judicial restraint.'' A rational person could conclude, based on the evidence of the Court's behavior, the observable results that this and other decisions by the five-man conservative bloc would more properly be characterized as political prize-taking than judicial lawmaking.

The only unchecked power in the American political system is that of a majority of a court of final appeal. When a small group can seize majority power in a court of final appeal, they answer to no one and can rule as they please. That danger is why courts are ordinarily so careful to answer to rules of judicial practice, respect for precedent, answering the narrowest question, and engaging in honorable, neutral, and logical analysis to arrive at decisions. That is why this conservative majority's departure from these rules of judicial practice and the association between these departures and outcomes favorable to their political party is so unpleasant.

The steady march of the activist rightwing bloc to establish its conservative political priorities as the law of the land should come to observers as no surprise. It represents the fruit of a longstanding and often very public effort to turn the law and the Constitution over to special interest groups and conservative activists. Conservative institutions, such as the Federalist Society, were created to groom and vet the ideological purity of foot soldiers in the conservative movement. Consider legal historian Steven Teles on the role of the Federalist Society in the Reagan administration:

Society membership was a valuable signal for an

administration eager to hire true-believers for bureaucratic

hand-to-hand combat. In addition, by hiring this Society's

entire founding cadre, the Reagan administration and its

judicial appointees sent a very powerful message that the

terms of advancement associated with political ambition were

being set on their head: clear ideological positioning, not

cautiousness, was now an affirmative qualification for

appointed office.

The results of this meld of political ambition, ideological positioning, and judicial appointees have been terrible. Fringe conservative ideas, such as hostility to our Nation's civil rights, environmental protection, and consumer protection laws, have been steadily dripped into the legal mainstream by endless repetition in a rightwing echo chamber. The mainstream of American law has been shifted steadily to the right by force of this effort, backed by seemingly endless corporate funds. This ``rights movement'' for corporations, for the rich, the powerful, and the fortunate, has been pursued in a manner--deliberate infiltration of the judicial branch of government-- that should concern anybody who respects the law and, in particular, respects our Supreme Court.

The Republican effort to capture that institution for those interests has been a remarkably aggressive and surprisingly explicit effort. Usually, political efforts to capture great public institutions come, as it were, in sheep's clothing. But this wolf came as a wolf. Consider for example the official Republican Party platform of 2000, which ``applauded Governor Bush's pledge to name only judges who have demonstrated that they share his conservative beliefs and respect the Constitution.'' All that was left out was that they should be willing to bend the law and overturn precedents to impose those beliefs.

The pattern is not complicated. America's big corporate interests fund Republican candidates for office, and those corporate interests want those Republicans to help them. That is as old as politics. Republicans, once elected, make it a priority to appoint judges who want to help them--judges who may give obligatory lip service opposing judicial activism but will actually deliver on core Republican political interests; the conservative bloc of judges overrules precedent and 100 years of practice to open the doors to unlimited corporate political spending; and corporations can now give ever more money into the process of electing more Republicans. Connect the dots: The Republicans are the party of the corporations; the judges are the appointees of the Republicans; and the judges just delivered for the corporations. It is being done in plain view.

The Washington Post recently explained:

``The U.S. Chamber of Commerce is now free to spend

unlimited amounts of money on advertisements explicitly

attacking candidates.''

The Chamber of Commerce already had announced in November ``a massive effort to support pro-business candidates.'' So the response from the Republicans, as reported by the Washington Post, should come as no surprise:

Republican leaders cheered the ruling as a victory for free

speech and predicted a surge in corporate support for GOP

candidates in November's midterm election.

Now that the Court has taken the fateful step of forbidding any limits on corporation spending to limit campaigns, we can expect to see corporate polluters under investigation by the Department of Justice running unlimited ads for a more sympathetic Presidential candidate; financial services companies spending their vast wealth to defeat Members of Congress who are tired of the way business is done on Wall Street; and defense contractors overwhelming candidates who might dare question a weapons program that they build.

The Court was so eager to give artificial corporations the same rights as natural living human beings that it virtually overlooked foreign corporations. The activist Republican majority leaves wide open the possibility of constitutionally protected rights to influence American elections being held by a Saudi oil company interested in American energy policy, a Third World clothing manufacturer opposed to American labor standards, or a foreign farm conglomerate concerned about America's food safety rules. Is the five-man conservative bloc's fealty to corporate power so absolute that they could not bring themselves to say that the first amendment doesn't protect foreign companies wishing to drown out the voices of American citizens?

Our government is of the people, by the people, and for the people. By refusing to distinguish between people and corporations, the Citizens United opinion undermines the integrity of our democracy, allowing unlimited corporate money to drown out ordinary citizens' voices. So look out for government of the CEOs, by the CEOs, and for the CEOs, who now have special privileged status: Not only may CEOs use their personal wealth to influence elections, they now get the added megaphone--not available to regular citizens--of being able to direct unlimited corporate funds to influence elections. CEOs now have twice the voice or more of everyday Americans.

I won't belabor the record here, because it is something of a technical matter, but before I conclude I have to say from the point of view of judicial practice, the majority opinion is disturbing in several ways: First, it uses rhetorical devices that are more consistent with polemic than judicial determination--vastly overstating the opponents' arguments, using false analysis, knocking over a straw man, indulging in selective quotation and unsupported fact finding.

One example: This is what the conservative bloc found as a fact. And remember, fact finding is not the proper province of an appellate court in the first place, but here is what they found regarding elections:

We now conclude that independent expenditures, including

those made by corporations, do not give rise to corruption or

the appearance of corruption.

They just decreed that. So a company comes in, drops a couple of a million dollars in a smear campaign

against an opponent at the bitter end of a race, when it can't be answered, and the next thing you know the person they defended against the opponent is in their pocket. No appearance of corruption? Well, the Supreme Court has decided it: No appearance of corruption. That is clear to them.

Here is another finding of fact by this bloc of judges:

The appearance of influence or access, furthermore, will

not cause the electorate to lose faith in our democracy.

They made that up out of whole cloth. There are hundreds of thousands of pages of findings to the contrary in the record of previous Supreme Court decisions they overruled. But, no, they made these unsupported findings.

It is novel, it is naive, and it contrasts with the actual findings of this Senate 100 years ago, which said the following:

The evils of the use of [corporate] money in connection

with political elections are so generally recognized that the

committee deems it unnecessary to make any argument in favor

of the general purpose of this measure. It is in the interest

of good government and calculated to promote purity in the

selection of public officials.

The evils of the use of corporate money in connection with political elections was so generally recognized 100 years ago that the Senate committee working on that legislation deemed it unnecessary to make any argument in favor of the measure--it was too obvious. Yet now this appellate tribunal has made fact findings that that is all wrong.

Moreover, a small band of conservative Justices departs from regular judicial practice by relying for precedent on its own members' previous concurring and dissenting opinions, as if they were their own little court, building a scaffold of arguments alongside the law, in wait for the right case with a sufficient majority to abandon the law and jump to their scaffold of argument. As Justice Stevens accurately pointed out, the majority opinion of the right wing bloc is essentially an ``amalgamation of resuscitated dissents.''

Finally, and most disturbingly, the Chief Justice evaluates precedent in terms of whether his five-member bloc objects to it. He is surprisingly outright about this. He said this: ``Stare decisis,'' the principle that a settled question is settled, that it stands decided-- ``stare decisis effect is . . . diminished when the precedent's validity is so hotly contested that it cannot reliably function as a basis for decision in future cases.''

He later continues: ``The simple fact that one of our decisions remains controversial . . . does undermine the precedent's ability to contribute to the stable and orderly development of the law.''

As anybody looking at this can see, it is a completely self- fulfilling theory, and it allows the five-man right wing bloc on the Court to gradually undermine settled precedent, to tunnel under it with quarreling objections, hotly contesting it, perhaps even to accelerate the process of undermining it; then, at some point, decree that the settled precedent is no longer valid because they have quarreled with it. Now it must fall.

There can be little doubt that the conservative bloc is laying the foundation for future right wing activism in a seemingly deliberate and concerted effort to expand its political philosophy into our law. Of course, always the dramatic changes observably fall in the direction of the Republican Party's current political doctrine and interests.

I will close by quoting Justice Stevens, who I think puts the fundamental issue of the Citizens United majority opinion in clear relief. ``At bottom,'' he says:

. . . the court's opinion . . . is a rejection of the

common sense of the American people, who have recognized a

need to prevent corporations from undermining self-government

since the founding, and who have fought against the

distinctive corrupting potential of corporate electioneering

since the days of Theodore Roosevelt. It is a strange time to

repudiate that common sense. While American democracy is

imperfect--

Justice Stevens concludes--

few outside the majority of the Court would have thought that

its flaws included a dearth of corporate money in politics.

I yield the floor.

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

Mr. President, as we continue to debate our Nation's debt limit on the Senate floor, I rise today to review how we came to this point of serious budgetary imbalance and, in particular, how $9 trillion of it is Bush-Republican debt.

At a time when tens of millions of Americans are out of work and families across the Nation are struggling to heat their homes and pay their bills and buy their prescriptions and put food on the table, our constituents are rightly frustrated at America's lack of fiscal restraint. They deserve to hear the whole story. The unfortunate truth is that President Bush left us with a budget so warped and imbalanced and an economy in such disarray that President Obama and this Congress have had no choice but to run temporary deficits. The previous administration must bear at least $9 trillion worth of the blame.

Let's roll back to the time when George Bush took the oath of office as President of the United States. In his first address to the Nation, he pledged to ``call for responsibility and try to live it as well.'' It had been a divisive election, and many Americans now found some comfort and hope in those words. They were to be disappointed. But on the budgetary front, there was good reason for optimism on that January morning in 2001. After decades of deficit spending, President William Jefferson Clinton had set the Nation on its healthiest fiscal path in generations.

After 28 straight years of multibillion-dollar budget deficits, our Nation saw surpluses beginning in 1998 under President Clinton.

In President Clinton's last full year in office, we saw the largest budget surplus in our Nation's history--a budget surplus of $236 billion under President Clinton--and that good budgetary news looked forward as well.

The month George Bush first moved into 1600 Pennsylvania Avenue, our Congressional Budget Office--the nonpartisan accounting arm of Congress--projected that we would continue to see surpluses throughout the following decade.

Those budget surpluses, the product of responsible governing--some might even say fiscally conservative governing--were projected to be enough to completely wipe out our national debt by 2009. That was the picture we looked forward to when George Bush took office in 2001-- predictions by the Congressional Budget Office that our national debt would be zero by 2009.

Indeed, there was actually debate in academic circles about whether a debt-free America was a good idea. That discussion seems rather bitter now.

In other words, at that time, the hard work had been done. The Nation was on a strong financial course. If President Bush had stayed that course of fiscal responsibility, he could have been the first President since Andrew Jackson in 1836 to govern a debt-free United States of America. If President Bush had chosen the responsible path, we would be having a very different debate today.

Of course, President Bush and the Republicans who governed Congress did not choose the responsible path. This chart illustrates the difference between the surpluses that George Bush inherited and the deficits he created. This top line, at the top of the red, shows the CBO budget outlook I have described that was projected by CBO in January of 2001, climbing with increased surpluses over the years to come. The bottom line at the bottom of the red shows what the Bush administration actually did, the budget results under the Bush administration.

The difference between the anticipated path President Clinton left this country on and what President Bush actually did is a mind-boggling $8.9 trillion. For purposes of rounding, I will call it $9 trillion. That is a conservative figure that does not include the likely cost of servicing that debt over the years. We have to pay interest and not just pay back our borrowing. It also does not include the spending President Obama had to do to offset fiscal disaster because of the financial meltdown he inherited. That spending by President Obama was not anything President Obama wanted to do. It was not anything he campaigned on. It was not on his agenda. It was an emergency measure necessary to clean up the economic wreckage left by the Bush administration.

Look at one particular contrast. Our current majority leader, Harry Reid, has worked to craft a health care reform bill that would not only achieve near universal coverage but would do so without adding one penny to the national debt. In contrast, when George Bush and his Republican allies in Congress designed a Medicare prescription drug benefit, they did so without offsetting at all the hundreds of billions of dollars in new spending. Indeed, they even larded it up with special deals for the pharmaceutical industry. In other words, the Republicans relied entirely on deficit spending to fund a huge new entitlement program. That was the way they actually did business. The Republicans relied entirely on deficit spending to fund a huge new entitlement program. That is the fact.

Now Republicans inaccurately and, frankly, hypocritically, rail on budgetary grounds against our efforts to extend health care coverage. But unlike their costly prescription drug bill, our health care bill improves our budget baseline.

The baseline we inherited from President Bush desperately needs improvement. This next chart shows the deterioration of annual deficits under the previous administration. The facts are plain. George Bush vastly increased spending while cutting tax revenues. The structural deficit he built in and left to President Obama simply cannot be sustained. But how soon our friends on the other side of the aisle forget.

In fact, as this next chart shows, the national debt limit had to be increased seven times--seven times--while George Bush was President. President Bush inherited from President Clinton a $5.95 trillion national debt limit. By the time he left office, his reckless spending and his tax policies favoring the rich at the expense of working Americans necessitated a debt limit almost twice as high, at $11.52 trillion.

We should not take lightly the borrowing expansion we are now forced to pursue to help recover from the Bush economic meltdown. But we should also not forget how we ended up in this position.

Each borrowed dollar, borrowed under the Bush administration, involves a debt service cost, and the Republican explosion of debt between 2001 and 2009 now makes everything we do, from running the government to stimulating the economy, more expensive.

Balancing our budget is a priority at which Democrats have succeeded in the past. It is one of the legacies of President Clinton. I am confident Democrats will succeed at it again because we believe in responsible governance.

But now is not the time to play games with our Nation's finances and put essential programs on which families depend at risk. In the worst economic recession since the Great Depression, the analogy between family budgets and the Federal budget is a false one. If the Federal Government contracted its spending, shrunk its

spending at the time when States, municipalities, companies, and families are all shrinking and constraining their spending, it would further shrink the economy. It would worsen the recession. It would make things worse for American families. Period. Saying anything else is simply false.

Unemployment hovers around 10 percent nationwide and even higher in hard-hit places such as my home State of Rhode Island. Economic recovery must remain our top national priority. Indeed, we need to do even more to put Americans back to work. The increased borrowing power we are now considering will give us the flexibility to enact new job- creating legislation.

Let me make one point very clear. An upfront commitment of resources to creating jobs need not add to our Nation's long-term liabilities. Let me give some examples.

Throughout the Nation, there are bridges condemned or under weight restrictions. We have bridges in Rhode Island that are condemned or under weight restrictions. There are roadways that the U.S. Department of Transportation has deemed unfit for further maintenance. In my State, the Providence viaduct is in that condition. We have, across the country, water treatment facilities that release raw sewage into our waterways after it rains. We have old school buildings that pose demonstrated safety hazards for our students. We have numerous other structures in demonstrable disrepair. We have an infrastructure deficit.

All these projects need repair, and repairing them is going to require our attention sooner or later. Thus, getting that work done now would not add in a meaningful way to our national long-term liabilities. We have to rebuild this failed infrastructure. We are not going to let those bridges fall into the rivers. Why not do it now when we need the jobs? Why not do it now when the old adage ``a stitch in time saves nine'' prevails?

Every American understands, whether they are working on their car or making repairs on their house, that when you get after maintenance earlier, the cost is always lower. So there is no need to be concerned about the Nation's fiscal liabilities when we are engaged in the repair of decrepit infrastructure.

A vote to increase the debt limit should be taken in proper context. When he was sworn in, President Obama faced the twin evils of a deep recession--a recession that for many American workers is as bad as the Great Depression--and he faced the $9 trillion Bush debt, run up in a time when things were fine. It was fair-weather spending, fair-weather debt.

Our top priority now must be to continue working on job creation until our economic prosperity is restored, until we have recovered from this great recession. We must not sit still for lectures in fiscal probity from the party that ran up $9 trillion in fair-weather debt to fund a war that need not have been embarked on, to fund tax cuts for the wealthiest Americans who did not need them, and to pursue economic policies that led to the recession we are trapped in now. Those policies lit the fires President Obama still is fighting to put out.

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

Madam President, I thank Chairman Baucus.

As we are here in the Senate today, Washington rests under a blanket of snow, reminding us here of the Christmas spirit across the Nation, the spirit that is bringing families happily together for the holidays. Unfortunately, a different spirit has descended on this Senate. The spirit that has descended on the Senate is one described by Chief Justice John Marshall back in the Burr trial: ``those malignant and vindictive passions which . . . rage in the bosoms of contending parties struggling for power.''

Two-time Pulitzer Prize winner Richard Hofstadter captured some examples in his famous essay, ``The Paranoid Style in American Politics.'' The malignant and vindictive passions often arise, he points out, when an aggrieved minority believes that ``America has been largely taken away from them and their kind, though they are determined to try to repossess it and to prevent the final destructive act of subversion.''

Does that sound familiar in this health care debate? Forty years ago, he wrote that. Hofstadter continued, those aggrieved fear what he described as ``the now familiar sustained conspiracy''--familiar then, 40 years ago; persistent now--whose supposed purpose, Hofstadter described, is ``to undermine free capitalism, to bring the economy under the direction of the federal government, and to pave the way for socialism. . . .'' Again, familiar words here today.

More than 50 years ago, he wrote of the dangers of an aggrieved rightwing minority, with the power to create what he called ``a political climate in which the rational pursuit of our well-being and safety would become impossible''--``a political [environment] in which the rational pursuit of our well-being and safety would become impossible.''

The malignant and vindictive passions that have descended on the Senate are busily creating just such a political climate. Far from appealing to the better angels of our nature, too many colleagues are embarked on a desperate no-holds-barred mission of propaganda, falsehood, obstruction, and fear.

History cautions us of the excesses to which these malignant, vindictive passions can ultimately lead: tumbrels have rolled through taunting crowds; broken glass has sparkled in darkened streets; ``strange fruit'' has hung from southern trees; even this great institution of government that we share has cowered before a tail gunner waving secret lists.

Those malignant moments rightly earned what Lord Acton called ``the undying penalty which history has the power to inflict on wrong.'' But history also reminds us that in the heat of those vindictive passions, some people earnestly believed they were justified. Such is the human capacity for intoxication by those malignant and vindictive political passions Chief Justice Marshall described. I ask my colleagues to consider what judgment history will inflict on this current spirit that has descended on the Senate.

Let's look at what current observers are saying as a possible early indicator of the judgment history will inflict. Recently, the editor of the Manchester Journal Inquirer editorial page wrote of the current GOP, which he called this ``once great and now mostly shameful party,'' that it ``has gone crazy,'' is ``more and more dominated by the lunatic fringe,'' and has ``poisoned itself with hate.'' He concluded, they ``no longer want to govern. They want to emote.''

A well-regarded Philadelphia columnist recently wrote of the ``conservative paranoia'' and ``lunacy'' on the Republican right. The respected Maureen Dowd, in her eulogy for her friend, William Safire, lamented the ``vile and vitriol of today's howling pack of conservative pundits.''

A Washington Post writer with a quarter century of experience observing government, married to a Bush administration official, noted about the House health care bill, ``the appalling amount of misinformation being peddled by its opponents''; she called it a ``flood of sheer factual misstatements about the health-care bill,'' and noted that ``[t]he falsehood-peddling began at the top. . . .''

The respected head of the Mayo Clinic described recent health care antics as ``scare tactics'' and ``mud.''

Congress itself is not immune. Many of us felt President Bush was less than truthful, yet not one of us yelled out ``You lie!'' at a President during a joint session of Congress. Through panics and depressions, through world wars and civil wars, no one ever has-- never--until President Obama delivered his first address. And this September, 179 Republicans in the House voted to support their heckler comrade. Here in the Senate, this month, one of our Republican colleagues regretted, ``Why didn't I say that?''

A Nobel prize-winning economist recently concluded thus:

The takeover of the Republican Party by the irrational

right is no laughing matter. Something unprecedented is

happening here--and it's very bad for America.

History's current verdict is not promising.

How are these unprecedented passions manifest in the Senate? Well, several ways.

First, through a campaign of obstruction and delay affecting every single aspect of the Senate's business. We have crossed the mark of over 100 filibusters and acts of procedural obstruction in less than 1 year. Never since the founding of the Republic--not even in the bitter sentiments preceding the Civil War--was such a thing ever seen in this body. It is unprecedented.

Second, through a campaign of falsehood: about death panels, and cuts to Medicare benefits, and benefits for illegal aliens, and bureaucrats to be parachuted in between you and your doctor. Our colleagues terrify the public with this parade of imagined horrors. They whip up concerns and anxiety about ``socialized medicine'' and careening deficits, and then they tell us: The public is concerned about the bill. Really?

Third, we see it in bad behavior. We see it in the long hours of reading by the clerks our Republican colleagues have forced. We see it in Christmases and holidays ruined by the Republicans for our loyal and professional Senate employees.

It is fine for me. It is fine for the Presiding Officer. We signed up for this job. But why ruin it for all the employees condemned by the Republicans to be here?

We see it in simple agreements for Senators to speak broken. We see it, tragically, in gentle and distinguished Members, true noblemen of the Senate, who have built reputations of honor and trustworthiness over decades being forced to break their word, and doublecross their dearest friends and colleagues. We see it in public attacks in the press by Senators against the parliamentary staff.

The parliamentary staff is nonpartisan; they are professional employees of the Senate who cannot answer back. Attacking them is worse than kicking a man when he is down. Attacking them is kicking a man who is forbidden to hit back. It is dishonorable.

The lowest of the low was the Republican vote against funding and supporting our troops in the field in a time of war. As a device to stall health care, they tried to stop the appropriation of funds for our soldiers. There is no excuse for that. From that there is no return. Every single Republican Member was willing to vote against cloture on funding our troops, and they admitted it was a tactic to obstruct health care reform.

The Secretary of Defense warned us all that a ``no'' vote would immediately create a ``serious disruption in the worldwide activities of the Department of Defense.'' And yet every one of them was willing to vote ``no.'' Almost all of them did vote ``no.'' Some stayed away, but that is the same as ``no'' when you need 60 ``yes'' votes to proceed. Voting ``no'' and hiding from the vote are the same result. And for those of us here on the floor to see it, it was clear: The three who voted ``yes'' did not cast their ``yes'' votes until all 60 Democratic votes had been tallied and it was clear that the result was a foregone conclusion.

And why? Why all this discord and discourtesy, all this unprecedented, destructive action? All to break the momentum of our new, young President. They are desperate to break this President. They have ardent supporters who are nearly hysterical at the very election of President Barack Obama: the ``birthers,'' the fanatics, the people running around in rightwing militias and Aryan support groups. It is unbearable to them that President Barack Obama should exist. That is one powerful reason.

It is not the only one. The insurance industry, one of the most powerful lobbies in politics, is another reason. The bad behavior you see on the Senate floor is the last thrashing throes of the health insurance industry as it watches its business model die. You who are watching and listening know this business model if you or a loved one has been sick: the business model that will not insure you if they think you will get sick or if you have a preexisting condition; the business model that, if you are insured and you do get sick, job one is to find loopholes to throw you off your coverage and abandon you alone to your illness; the business model, when they cannot find that loophole, that they will try to interfere with or deny you the care your doctor has ordered; and the business model that, when all else fails, and they cannot avoid you or abandon you or deny you, they stiff the doctor and the hospital and deny and delay their payments for as long as possible--or perhaps tell the hospital to collect from you first, and maybe they will reimburse you.

Good riddance to that business model. We know it all too well. It deserves a stake through its cold and greedy heart, but some of our colleagues here are fighting to the death to keep it alive.

But the biggest reason for these desperate acts by our colleagues is that we are gathering momentum, and we are gathering strength, and we are working toward our goal of passing this legislation. And when we do--when we do--the lying time is over. The American public will see what actually comes to pass when we pass this bill as our new law. The American public will see firsthand the difference between what is and what they were told.

(Mr. FRANKEN assumed the chair.)

Facts, as the Presiding Officer has often said, are stubborn things. It is one thing to propagandize and scare people about the unknown. It is much tougher to propagandize and scare people when they are seeing and feeling and touching something different.

When it turns out there are no death panels, when there is no bureaucrat between you and your doctor, when the ways your health care changes seem like a good deal to you, and a pretty smart idea--when the American public sees the discrepancy between what is and what they were told by the Republicans--there will be a reckoning.

There will come a day of judgment about who was telling the truth. Our colleagues are behaving in this way--unprecedented, malignant, and vindictive--because they are desperate to avoid that day of judgment. Frantic and desperate now and willing to do strange and unprecedented things, willing to do anything--even to throw our troops at war--in the way of that day of reckoning.

If they can cause this bill to fail, the truth will never stand up as a living reproach to the lies that have been told, and on through history our colleagues could claim they defeated a terrible monstrosity. But when the bill passes and this program actually comes to life and it is friendly, when it shelters 33 million Americans, regular American people, in the new security of health insurance, when it growls down the most disgraceful abuses of the insurance industry, when it offers better care, electronic health records, new community health centers, new opportunities to negotiate fair and square in a public market, and when it brings down the deficit and steers Medicare toward a safe harbor--all of which it does--Americans will then know, beyond any capacity of spin or propaganda to dissuade them, that they were lied to. And they will remember. There will come a day of judgment, and our Republican friends know that. That is why they are terrified.

Mr. President, I yield the floor.

Mr. President, I know the Senators have been waiting longer than I have. It is a personal courtesy from them to me to allow me to join Senator Rockefeller and Senator Lieberman as a cosponsor and have our remarks follow in series. I am grateful to both of them.

I am here to speak in support of the amendment offered by Senators Rockefeller, Lieberman, and myself, which would strengthen the provisions of the reform bill creating a nonpartisan group of experts to put the brakes on out-of-control medical spending.

One of the first things we can count on in terms of this amendment being one to protect Medicare beneficiaries is that the prime sponsor is Senator Rockefeller, a man who has dedicated his career since long before I was here--even during his days in West Virginia--to looking out for seniors and for the disabled and, since he has been in the Senate, looking out for Medicare. That is a credential that deserves great respect with respect to this amendment.

One of the most persistent concerns in this health care debate is, of course, cost control. I have spoken many times on the floor about the overriding importance of cost containment for the future of health care and especially the need for innovative delivery system reforms, which can be driven by the way you pay providers.

Our Republican attackers complain that Democrats on the bill are just doing more of our usual taxing and spending and that we won't impose any discipline on the system. Mr. President, as somebody who has worked for years on health care delivery system reform, I can tell you that is simply not true. This bill undertakes the most comprehensive redesign of our chaotic, wasteful system ever attempted.

One leading health economist and expert in cost containment, MIT professor Jonathan Gruber, recently wrote of the Senate Democrats' efforts in this bill that he couldn't ``think of a thing to try that they didn't try. They really made the best effort anyone has ever made. Everything is in here. . . . You couldn't have done better than they are doing.''

Many critics talk about cost control as if it were just a matter of political will, that Congress can come here and cut costs by flipping a switch. Well, that may be true if you want to cut benefits for the elderly and disabled or if you want to throw the elderly and disabled off of coverage or if you want to pay doctors even less for treating Medicare patients. But those would be brutal, callous cuts that would create human misery and suffering. Better to tackle the waste in the system, the $700 billion annually in excess costs found by President Obama's Council of Economic Advisers--a number that may actually be as high as over $1 trillion every year, according to the Lewin Group and to George Bush's former Secretary of the Treasury, Paul O'Neill.

By this method, you save money by improving the quality and efficiency of care; by tackling the multiple sources of waste and inefficiency in the system; by improving quality and access to care and giving doctors, hospitals, employers, and employees all the correct financial incentives to adopt healthy, cost-saving, efficient practices. The complexity of getting those incentives right, aligned with top-flight health care, versus the power of the interest groups that are involved, has historically paralyzed Congress.

History teaches that the significant national dialog and debate we are now having about health care is a momentary exception rather than the general rule. It is possible this debate will usher in a sustained period of focus on health reform, but the steepening fall of our health care system toward catastrophe should counsel us to protect against that congressional institutional paralysis.

This independent, nonpartisan board of experts to help control costs in a way that is smart, humane, and not all politics, is important. The independent Medicare advisory board will force Congress to act by issuing recommendations to reduce cost and increase efficiency that will automatically go into effect if Congress does what we so often do around here--nothing. If Congress can agree to different ideas, it can change the board's recommendations, but we still have to reduce Medicare costs by a minimum savings target. In other words, the board will force Congress to engage thoughtfully and for the public good on the most important fiscal and health issue our Nation faces.

Senator Rockefeller's amendment strengthens this board in several important ways: It expands the circumstances in which the board's recommendations go into effect when Congress does nothing. It raises the maximum level of savings that the board's recommendations must achieve. It ensures all providers of health care services, including large hospitals, are equally responsible for bringing down Medicare costs. It empowers the board to issue recommendations for improving Medicare over the long term, even in years where spending is under control.

My colleagues on the other side of the aisle have depicted the board as a frightening, Orwellian, all-powerful dictator that will cut Medicare benefits. Hogwash. The bill specifically prohibits the board from doing anything to increase premiums, ration care, restrict benefits, or modify eligibility.

The facts no longer seem to matter to our friends on the other side. They have called this group the ``rationing

commission.'' If you look at page 1004, lines 3 and 4, it says this:

The proposal shall not include any recommendation to ration

health care.

You are entitled to your own opinion--and we all have one--but not your own facts.

It is actually that kind of demagoguery about Medicare that proves the case for creating the board. Thoughtful, smart, technically expert people under congressional oversight but protected from these partisan spasms of congressional vitriol, passion, and folly will make careful and consistent decisions for all of our benefits, without diminishing the power of the American people and their elected representatives, so that we can preserve and protect Medicare.

I urge my colleagues to support Senator Rockefeller's amendment, in which Senator Lieberman and I have so proudly joined him.

I yield the floor with my thanks to the Senator from Michigan for being so gracious in allowing me to join my colleagues in sequence on the bill.

Mr. President, will the Senator from Illinois yield for a question?

I am interested in the parliamentary situation that took place earlier whereby one of our Members was actually obliged to withdraw an amendment that was going to be voted on by all of us because of an insistence on the part of the other side that 800 pages be read by our poor clerk before that vote should take place.

I have also heard the other side say that we want to get going, we want to move toward votes. I would be interested in the reflections of the distinguished majority whip on the extent to which a procedural objection to force the clerk to read 800 pages of an amendment, and deny one of our colleagues his vote, fairly represents a desire to move forward and get through our votes.

If the Senator from Illinois would yield for another question.

I was elected just about 3 years ago, and I came in with the new majority, so I did not have a chance to serve in this body when there was a Republican President and a Republican majority. I wonder if the Senator, who was here at that time, would reflect on how the other side viewed Defense appropriations for our troops during the Iraq war when they were in the majority. Were they desirous of delay and obstruction and debate and procedural maneuver on Defense appropriations at that time or is this a new strategy of theirs?

Mr. President, I ask unanimous consent that the distinguished Senator from Iowa be recognized for 20 minutes, and that I be recognized at the conclusion of his remarks for up to 20 minutes.

Mr. President, I thank the Presiding Officer and yield the floor.

Mr. President, it appears to be just the two of us here, so if the Senator from Iowa wishes to take a few more minutes to conclude his remarks, I have no objection.

Very well. Mr. President, I have had the chance to sit yesterday where the Presiding Officer is sitting today and hear several hours of Republican criticism of the health care bill, much of it focusing on the recent report from the CMS Office of the Actuary and the concern about cost. I wish to say a few words about that.

Clearly, the problem of cost is a very real and dramatic one. This is the curve of our national health care spending, starting back in 1955, the year I was born, at $12 billion and increasing at an accelerating rate until in 2009 we were at $2.5 trillion every single year. Of course, if we look at the curve, we are not going to level out next year at that level; it is going to keep rocketing upward to the point where in my home State of Rhode Island, if we don't do anything, by 2016--which is just over the horizon; it is not too far to look forward to, even in this building--$26,000 is what it will cost the average family of four for their health insurance. So the problem of cost is a very real one and the numbers involved are staggering.

However, if you are going to look at the CMS report, I would suggest there is not just one number to look at, there are several numbers. Then there is an alternative consideration that I think we need to consider.

The Republicans have focused on page 4 of the CMS report where the Actuary estimates that total national health expenditures under this bill would increase by an estimated total of $234 billion, or 0.7 percent during the calendar years 2010 to 2019, over those 10 years. That is an important number, I will grant them that, but I think there is another number that is equally important--indeed, more important, and that is on the page before. On page 3 the CMS Actuary says that: ``Under this legislation, an additional 33 million people would become insured by 2019.''

An additional 33 million Americans would become insured by 2019. Think about that. We have over and over again come to the floor and told of stories from our home States, heard our colleagues tell us stories from their home States about the terrible toll and tragedy that befalls families when they are uninsured or underinsured. Just 30 years ago when we were about here on the chart, only 8 percent of American families filing for bankruptcy protection did so as a result of medical bills. Now it is 60 percent. Sixty percent of family bankruptcies relate back to medical emergencies, unforeseen diagnoses, medical bills that have broken the family. Thirty-three million people with adequate health insurance so they don't face that trauma and that catastrophe, that is something real.

It has been estimated that because of a lack of insurance, 40,000 people a year die prematurely. Forty thousand Americans dead as a consequence of lack of insurance. So this bill would cover 33 million people and lift that burden of worry, of anxiety, of financial catastrophe, of illness, even of death, off of all of those families. That is not something to shrug off. Yet, not once did I hear that number mentioned by the other side. Not once did they even mention that this bill would cover 33 million Americans who would otherwise be without health insurance. They must hear the same stories at home. It is not that in Republican States there are no bankruptcies and no deaths because people are uninsured and no misery, no tragedy. They just come to this floor and don't bother to count that side of the equation.

Another number out of the report is that if you took just the savings side, the net savings from the Medicare-Medicaid growth trend and class proposals in the bill are estimated to total about $564 billion--net savings totaling $564 billion, before you get to those 33 million. When you cover them, that is how it gets to that $224 billion. If you do rough math, and if you have 33 million Americans and they start getting coverage, say, 5 years out--so that there is 5 years of coverage in this for them--divide by $234 billion, it is about $1,500 per person per year to have those 33 million people insured.

Anybody who thinks for 1 minute about the human side of our health care tragedy cannot help but think that that would be a wise investment--for $1,500, to give somebody the security of health insurance. Of course, that assumes that this bill actually does, when it is implemented, raise costs by $234 billion.

As somebody used to say on the radio, that is not the end of the story. The end of the story takes a little bit of development. I note that the Actuary himself said that the actual future impacts of this act on health expenditures, insured status, and individual decisions, and employee behavior are ``very uncertain.''

Why? Because few precedents exist for use and estimation. Consequently, ``the estimates presented here are subject to a substantially greater degree of uncertainty than is usually the case with more routine health care proposals.''

In the conclusion, the CMS Chief Actuary reiterates that, saying:

These findings are subject to much greater uncertainty than

normal. Many of the provisions are unprecedented or have been

implemented only on a smaller scale. Consequently, little

historical experience is available with which to estimate the

potential impact.

Where does that affect the bill? It doesn't affect it in new coverage. We know how much it costs to cover people. It doesn't affect it with expanding access to health care. We know how much that costs. Where it affects it is on the savings side.

It is not just the CMS Actuary who says that. As I will get to in a moment, that is also the conclusion of the Congressional Budget Office. They agree on this. If we are going to get something done about this health care increase, we are going to have to do something about reforming the delivery system, about taking out waste and excess costs. Those things are, by definition, hard to predict. They don't lend themselves to the actuarial prediction that the CMS Actuary does and that CBO does. But there is a big target out there. Here is President Obama's Council of Economic Advisers. They had a report out in July:

Efficiency improvements in the U.S. health care system

potentially could free up resources equal to 5 percent of

May I have an additional 5 minutes?

Dr. Gawande continues:

Pick up the Senate health-care bill--yes, all 2,074 pages--

and leaf through it. Almost half of it is devoted to programs

that would test various ways to curb costs and increase

quality.

Just like Professor Gruber said:

. . . I can't think of a thing to try that they didn't try.

They really make the best effort anyone has ever made.

Everything is in here. . . . I can't think of anything I'd do

that they are not doing in the bill. You couldn't have done

better than they are doing.

Dr. Gawande continues:

The bill is a hodgepodge. And it should be.

Which of these programs will work? We can't know. That's

why the Congressional Budget Office doesn't credit any of

them with substantial savings. . . . But we should not lose

faith.

He concludes:

. . . there's no piece of legislation that will have all the

answers. . . . But if we're willing to accept an arduous,

messy, and continuous process we can come to grips with a

problem even of this immensity. We've done it before.

So when the other side comes to the table and argues that this bill is a cost disaster, a nightmare, and all the things they are saying, I urge people to consider two things. First is that they have been pretty clear that they do not want a bill at all, ever, any bill, none. Their desire to deny our new President this victory is an ulterior goal they have declared. Senators have said they want it to be his Waterloo. They have said: It is our goal to break him, to break his momentum.

So when they say start over, it is a little hard to believe it. If they were candid, they would say: No, stop dead and leave things just the way they are. Obviously, they could not say that because America would not get behind that. So they have come up in the last few days with this ``start over'' theory.

When you look at what their political purpose is, to break President Obama, to break his momentum, to stop any health care bill from happening, it is worth considering their protestations on the floor in that light.

The other light in considering them is in this one: If we are going to save significant money by making the delivery system more efficient, all experts agree you cannot cost it out in advance. The actuaries cannot figure it out. But the tools we need to make it happen, the intent of the Obama administration to make it happen is in there.

The savings target is between $700 billion and over $1 trillion a year. When we achieve those savings, we are improving the quality of health care. It is less duplicative, it is less wasteful, it is less paperwork, and the quality goes up.

A perfect example is the famous Keystone Project in Michigan where they practically eliminated hospital-acquired infections in intensive care units in a number of hospitals in Michigan. In 15 months, they saved 1,500 lives and $150 million. When they started that project, could an actuary have predicted that would happen? No, never. Never. And at the beginning of the agricultural revolution, when agricultural extension agents first went out and we modernized the American agricultural center, could they have predicted what Dr. Gawande reported? No, they could not. You cannot predict it, but this President can direct it. He can make it happen. We will give him the tools.

For those who are concerned about cost, there is very significant grounds for optimism about what happens in this bill. If we don't do it this way with those delivery system reforms, we are going to be left with a bloody toolbox, cutting people off, throwing them off, chopping the benefits, paying providers less. It will be to health care reform what a Civil War surgeon's toolbox was to modern medicine--saws, knives, cauterizing irons, and the patients screaming. It does not have to be that way. There is a better way, and it is in the bill.

I thank the distinguished Senator for yielding me the extra time. I yield the floor.

Mr. President, I would love to interject a question to the distinguished Senator from Michigan.

We are in a situation in which the other side is repeatedly coming to the Senate floor to ask us to delay, to stop, to slow down, to start over. I am curious, as somebody who has watched this debate very closely, what the Senator from Michigan thinks about where we would be if we acceded to that wish? Bearing in mind that one of the sort of ideological firebrands who seems to be leading a measure of the debate on the other side has indicated this is not about health care and people; this is about giving President Obama a Waterloo; this is about creating a political defeat for the President of the United States on their side; it has nothing to do with health care; it is entirely about creating a defeat for this new President; when, in the face of all the obstruction the distinguished Senator from Michigan described so eloquently, this recordbreaking, ``unprecedented in the history of the Senate'' obstruction we are seeing, the person whom I think right now seems to characterize the leadership of the radicalized rightwing and is running the Republican Party, Rush Limbaugh, is telling the other side they have not been obstructive enough.

So if we were to go back, start all over, and reach out our hands again to our friends on the Republican side, is there any reason to believe that we would not be just as rebuffed going forward as we have been in the long arduous process of negotiation and hearing and public meeting and all of the work that has taken us to this point right now?

If we were to wait, does the Senator think there is any likelihood people on the other side would suddenly want to cooperate with President Obama and not hand him a defeat? If Rush Limbaugh would say: OK, Republicans in the Senate, go ahead, work with the Democrats now; don't just be the party of obstruction and delay but try to work cooperatively for the American people, does the Senator think there is any likelihood of that happening?

I share the disappointment of the Senator from Michigan; that the promise and the outreached hands have been rejected and rebuffed; that this place has become so bitterly partisan. This is my first time in the Senate with a Democratic President, and I have been surprised at the tone of the debate, at the lack of truth of a great many of the arguments, of the very apparent motivation.

I have spoken to members of our caucus who I think are probably viewed as some of the most moderate when it comes to seeking bipartisanship, who are calm and respected Members of the Senate and who have been here a long time, and I have asked them how this compares to their long years of experience in the Senate. One of them said he has literally never seen anything like it in all the years he has been in the Senate. He has never seen anything like it. They are always on message, he said, but I have never seen them so off truth.

I think it is regrettable, but if your mission is to destroy a strong and important piece of legislation, not because it is bad legislation but because you can't stand having this new President win a political victory, are you going to go out and disclose that is your motivation? No, you are going to come up with a bunch of other cockamamie arguments to paper that over. You will talk about death panels and you will go through all the nonsense we have seen and it is regrettable.

I think those were the Republican amendments that were accepted into the HELP Committee bill. In fact, I think there were 161, if I remember correctly from my time sitting on the committee. We took Republican amendment after Republican amendment after Republican amendment trying to reach out to them.

Mr. President, I rise today to introduce the Commercial Advertisement Loudness Mitigation Act of 2009--the CALM Act. I want to thank my original cosponsor Senator Schumer for his support of this straightforward and commonsense legislation, which would require the Federal Communications Commission, FCC, to limit the volume of television advertisements to a level no louder than the average volume level of the programs during which the advertisements appear. This time for this Act is overdue. All too often over the years, Americans, sitting down after a long workday or workweek to enjoy their favorite television shows, have been assaulted by commercials at volumes that are degrees of magnitude louder than the shows themselves. The FCC first received enough complaints from viewers to look into the problem in the 1960s--when television was in its earliest stages--but technology did not exist to fix the problem. Each decade, as consumer complaints piled up, the FCC had to reexamine the loudness issue. Unfortunately, it took no action

even with the technology improved. The complaints continue to this day; in the 25 quarterly reports on consumer complaints released by the FCC since 2002, 21 have listed as a top complaint the loudness of television commercials.

But now, with the digital transition complete and new broadcast technology available, we can finally take this long-overdue action. We now have a common digital platform used by all broadcasters, which presents a terrific opportunity to standardize the loudness of the ads broadcast into our living rooms. As Consumers Union, the nonprofit organization that publishes Consumers Report has stated, in testimony before the House of Representatives, ``the CALM Act provides an elegant and commonsense solution to finally ending a forty-five year consumer complaint in the United States.''

The House has already begun its consideration of companion legislation, and I applaud the leadership of Representative Eshoo on this issue. The television industry has been deeply involved in the drafting of this legislation, and the standards it adopts are practicable, affordable, and effective. I hope my Senate colleagues will act quickly to pass the CALM Act and finally put an end to this longstanding irritation.

Mr. President, I will speak for just a moment because I know the Senator from Pennsylvania wishes to speak. When he comes to the floor, I will quickly yield to him. While there is a moment in between, I want

to speak to some of the arguments we have heard.

There is always the question of the substance of an argument. There is also the question of the credibility of an argument. I think as people watch this debate and discuss the credibility of the concern expressed by our friends on the other side of the aisle about the deficit impact of the CLASS Act, it is worth considering a few facts just to evaluate that.

First is that the CLASS Act is required to be actuarially self- sustaining. People pay into it and, from those funds, under the insurance principle, funds come back out. It is required to be self- sustaining that way.

Second, it is voluntary. Nobody has to contribute. If you want to contribute, then you can become eligible for the benefit once you have vested. But nobody is forced into this; it is entirely voluntary. The CBO, on which we rely in a nonpartisan fashion, has said this is solvent for 75 years.

Finally, because we think--at least on this side--this matters. It will help the disabled and elderly at that critical point of decision, when their ability to stay home, their ability to stay independent, or their ability to stay at work depends on just a little bit of help to accommodate their age or disability, it is then that this will make a difference. What a difference it will make in human lives.

I know the Senator from Connecticut wishes to use an example. I will yield to him on his signal. We have seen this before. We saw this not long ago on the public option, which would compete with insurers head to head on a fair and level playing field. It was completely voluntary, and it had to be actuarially self-sustaining. It had to meet the solvency laws of the State in which it operated. In both cases, our colleagues on the other side have rushed to the floor to talk about deficits and how these will contribute to the deficit.

These are both actuarially self-sustaining programs required to stay solvent. Yet here they come to raise the specter of deficits. But this is the same party that pays for 14-percent subsidies to private insurers to compete with Medicare. As my son would say, duh, if you are getting 14 percent extra, it is pretty easy to compete.

When they asked for that deal, they promised they would drive costs down. In fact, they have driven costs up, and they put it in their pockets. It is not fair to the insurers that are not in the program. It is greedy on their part. All we want to do is hold them to their promises.

Do we hear any concerns about the deficit problem on the 14-percent subsidy for the Medicare Advantage Program? No, dead silence--guess what--because it helps the insurance industry.

When the Part D program came in, our friends on the other side forced through a provision--a unique provision--that gave the pharmaceutical industry a special privilege that the U.S. Government could not negotiate with it over price--could not negotiate with it. Lord knows how much that has added to our deficit. But have they ever come to complain? No, because the beneficiary is the pharmaceutical industry. But when things help regular people, when things help competition in the insurance market, even where they are required to be actuarially self-sustaining and solvent, then suddenly they turn up. They can detect the threat of deficit in parts per billion when it helps somebody. But a patent, actual living, breathing, deficit-enhancing subsidy that is on the books right now, they don't care about if it helps the pharmaceutical industry or the insurance industry.

As we have this discussion, that is a point worth bearing in mind because it is not just the substance of the amendment, it is the credibility of the argument that counts.

I said I would yield to the distinguished Senator from Pennsylvania when he arrived, and he has arrived. Without further ado, I yield the floor.

Mr. President, those of us who have been privileged to hear our friends on the other side debate the public option have seen a relentless insistence on the public option operating on a level playing field with the private insurance industry. I can't tell the number of times we have heard that. Indeed, even when we designed the public option so that it did operate on a level playing field with the private insurance industry, they still complained. But now we have a situation in which we have private industry operating at a 14-percent advantage and subsidy against Medicare. Suddenly, the other side's interest in a level playing field has evaporated. Suddenly their interest is in doing what is, once again--in the astonishing coincidence that characterizes debate--in the interest of the insurance industry.

I have yet to see an argument made from the other side of the aisle that doesn't happen to coincide with the interests of the insurance industry. It could not be more stark on this point. If it is a public option, they want it to compete on a level playing field. And even then they are against it. If it is privately subsidized coverage, getting an advantage against the public system, then they are for it.

I urge consistency and support of the effort to bring some discipline to Medicare Advantage, as the private insurance industry promised. We are doing no more than holding them to their word.

I suggest the absence of a quorum.

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

Madam President, I intend shortly to call up an amendment once the procedural posture is clarified and has been cleared on the Republican side, an amendment to protect the Social Security surplus and the CLASS program savings in this act. When I do, I will then ask for its immediate consideration, but at the moment, that is still being worked out from a parliamentary standpoint, so my words will come in advance of that.

I wish to describe the amendment for my colleagues. It is a sense-of- the-Senate resolution that demonstrates the Senate's commitment to meaningful deficit reduction in this legislation while also protecting both the Social Security surpluses generated by the legislation and savings generated from a significant element of the bill, the long-term voluntary insurance program created by the Community Living Assistance Services and Supports Act, what we call the CLASS Act. The amendment expresses the sense of the Senate that surpluses generated by this bill for the Social Security trust fund be reserved for Social Security and that the savings for the long-term insurance program created by the CLASS Act be reserved for the CLASS program.

The CBO has estimated that this bill will save $130 billion over the first 10 years and roughly $650 billion over the next 10 years. This amendment stands for the proposition that these impressive savings will be protected vis-a-vis the CLASS Act and the Social Security trust fund.

I wish to speak in particular today about the CLASS Act. This act creates a voluntary insurance program for seniors and individuals with disabilities. This program will enable them to afford long-term care even after they have exhausted coverage offered by Medicare or their private insurer. Let me make clear that this is not a mandatory program. It does not increase taxes on anyone. It is a completely voluntary program that offers an additional insurance option for the disabled. Without such insurance, disabled people often cannot afford the massive costs of long-term care. Under current law, they are often forced to sell their homes or otherwise what is called ``spend down'' their assets until they meet a poverty threshold before they can begin receiving the help they need.

Certain colleagues on the other side of the aisle have argued that the CLASS plan would lead to a financially unstable entitlement program and would rapidly increase the Federal deficit. That is simply not accurate. The CLASS plan is fully self-sustaining and actuarially sound, funded by the premiums paid by those individuals who voluntarily opt into this insurance plan. There are no taxpayer dollars involved.

After individuals pay premiums for 5 years, they become eligible to receive a cash benefit of no less than $50 per day to assist with the various costs associated with the onset of a disability or long-term health condition. These benefits could be used to pay for transportation to work, for instance, or the construction of a wheelchair ramp or the hiring of a personal aide--the sorts of things that so often make the difference between somebody remaining an independent and productive member of society and requiring the support of assisted living or nursing home care.

I think we can all agree that it is in everyone's best interest to try to provide this kind of assistance to people when an unexpected disability begins to affect their lives, to allow them the support they need to continue as best they can in their homes, in their apartments, with their families, at their jobs, and remain, as I said, both independent and productive.

The Congressional Budget Office has concluded that this plan is fiscally solvent. In fact, it projected that the program would be solvent for at least 75 years.

There was a helpful amendment offered in the HELP Committee when we considered and debated and passed that piece of legislation. The amendment was offered by the distinguished Senator from New Hampshire, your colleague, Senator Gregg, the ranking member on the Budget Committee. It passed unanimously, and it ensures and requires that the program be actuarially sound for 75 years.

CBO has projected that, in fact, it would be solvent for at least 75 years. CBO further estimated that the program would reduce the deficit by $72 billion over 10 years, saving $1.6 billion for Medicaid during the first 4 years of the program. So it has a substantial fiscal upside.

I am surprised that our colleagues on the other side are criticizing this element of the bill. It seems to run contrary to the findings that have been made by the nonpartisan Congressional Budget Office. It is certainly a stark contrast to their tolerance for their own Medicare Part D Program, the pharmaceutical program the other side touted so proudly, which is different from the CLASS Act in many respects: It was vastly expensive; it was completely unpaid for; it was a massive handout to the pharmaceutical industry, containing within it the, to me, appalling proposition that the government was forbidden by law, forbidden by a previous Congress, to negotiate with the pharmaceutical industry over the price of drugs and had to take it or leave it, whatever the pharmaceutical industry charged. Frankly, it is irresponsible to put the government into that situation. It is fiscally irresponsible, and it is irresponsible from a management point of view. It is irresponsible in more ways than I can name. Yet they happily went that way, the path of fiscal irresponsibility, when it suited the pharmaceutical industry. Of course, in order to do so, they had to leave a hole in the Part D pharmaceutical program for seniors to fall into, what the Presiding Officer knows well and what my colleagues know well as the dreaded doughnut hole that has caused so many unsuspecting seniors so much surprise, chagrin, fear, anxiety, and misery. Now, having been the architects of that program, they criticize the CLASS Act even though the CBO has found it to be fiscally sound.

It seems there is an enormous double standard between programs designed for the benefit of, say, the pharmaceutical industry, or perhaps the insurance industry, and the standards they would apply to programs that benefit people who suffer from the onset of a disability--regular Americans, regular families. This is something that happens to people across this country all the time.

That is really the most important effect of the CLASS Act. As good as it is on deficits, as much as the CBO has confirmed that it is to our fiscal advantage to proceed with the CLASS Act, the most important effect is not on deficits, it is on people.

It is on families. This insurance program will allow disabled people, young and old, to live more financially secure and productive lives, free from the fear that medical expenses will impoverish or bankrupt them, able to make those investments in their own adaptation to their disability so they can maintain the lifestyle, the job, and the home they are accustomed to and comfortable with. Studies show that less than a quarter of private long-term care insurance policies provide a lifetime of benefits. The CLASS Act fills an important void that has been left by the public sector for people who seek this protection and this insurance on a paid-for basis. The CLASS plan is a win-win for reducing costs in our health care system and protecting Americans who require long-term care. Our current system plain fails to protect those who aren't healthy or wealthy enough for private market coverage. It fails to create an opportunity for individuals to plan and save for their future lifetime care needs. It fails to provide a sustainable safety net for individuals who require long-term services and supports to keep the familiar aspects of their life around them--job, family, home, hearth.

I will shortly ask that my colleagues support the amendment when it is called up. It will put the Senate on record as protecting Social Security. It will put the Senate on record as protecting the CLASS Act savings scored by CBO. It will put the Senate on record as supporting the impressive deficit reduction in the bill. I look forward to favorable consideration when we have a parliamentary agreement on calling it up.

I yield the floor.

Mr. President, I now call up amendment No. 2870, an amendment to protect the Social Security surplus and CLASS program savings in this act and ask for the amendment's immediate consideration.

Mr. President, I ask unanimous consent that reading of the amendment be dispensed with.

Mr. President, I yield the floor to the distinguished assistant majority leader.

Will the assistant majority leader yield?

I just wanted to ask the distinguished assistant majority leader to yield for a question through the Chair. Since the distinguished assistant majority leader was here at the time, and I am newer to this body and was not here at the time when the Medicare Advantage Program was originally proposed, I wonder if the distinguished assistant majority leader would remind us of what the promises and assertions were that were made by the private insurance industry at that time as they sought this foothold to get their hands on this Medicare population.

Mr. President, if I could ask the Senator to yield for a question, it would appear, then, that not only is there this subsidy that goes to the private insurance industry, funded by a tax on all other Medicare recipients, but those private insurance companies are actually doing their level best to try to pick out a disproportionately healthy Medicare-eligible population, so what we end up doing is not only paying more for Medicare Advantage but also for a healthier population. So it is a double subsidy.

I know the Senator from Pennsylvania wishes to speak very shortly, and I will yield to him when he is present on the floor. But I did wish to react to two points that were made by the very distinguished Senator from Utah. I say that with true sincerity. He has been a friend to me since I have been in the

Senate. He sets a very valuable standard in this institution for collegiality and dignity and bipartisanship and scholarliness, and he comes from an extremely distinguished career, prior to his distinguished career in the Senate, as a lawyer, a leader of the Utah bar.

But I do think that, as easy as it is to make fun of a 2,074-page bill, the House bill, which is not significantly different in scale from this bill, was reviewed. If you look at the substantive language in it--in a bill, of course, there is a lot of language that simply connects things into place and is tables and indexes and things such as that. If you look at the actual language you would read if you were interested in the substance of the bill on the House side and do a word count on it, it has fewer words than a ``Harry Potter'' novel. I don't think it is too much to expect that Members of the Senate should be prepared to leaf through the equivalent of a ``Harry Potter'' novel when they are embarking on as significant an effort and endeavor as we are in reforming the health care system. I think it was about 256,000 words, if I am not mistaken. It is smaller print, admittedly, than a ``Harry Potter'' book because of the way in which the bill is presented in its traditional format. It is very few words per page, so it looks big and one can make very entertaining demonstrations with it on the floor. When you actually get down to reading it, it is about the same as plowing through--actually less than plowing through a ``Harry Potter'' novel, and I don't think that should be too much to expect.

I also suggest the reason for the lack of current bipartisanship on this bill might very well be the arrogance of power of the Democratic majority--it might be. But I would suggest the facts might also support a different hypothesis. If you look back at the history of the development of this bill, it began on a very bipartisan note. It began with Senator Baucus's ``prepare to launch'' program at the very beginning of the year, a full-day, bipartisan effort to begin to focus on the delivery system reform issues. It began with a bipartisan group negotiating in the Finance Committee. It began with a HELP Committee bill that allowed for 161, I believe was the number, Republican amendments in a very open and completely bipartisan process.

Then along came August and the townhall meetings and the beginning of the radicalization of the Republican Party. We heard, out of that process, charged buzz words such as ``death panels,'' ``socialized medicine,'' ``benefits for illegal immigrants,'' ``rationing of care''--all these words that incite and inflame passions but make no reasoned case and advance no helpful alternative.

We saw those words and those arguments presented with a crudeness and a venom that are frankly new to American politics; for example, the President portrayed with a Hitler mustache. I don't recall, for 8 years, President Bush ever being portrayed with a Hitler mustache. Poor President Obama comes in and within his first months people are running around America portraying him with a Hitler mustache because we want to reform health care.

Certainly, there are a great number of us who believed President Bush was less than truthful when he came and spoke to us about Iraq and other subjects, but nobody yelled out ``You lie.'' In President Obama's first appearance, he was heckled from the floor of the Congress of the United States.

This September, after the tea bag group and after the townhall death panel group had become active, 179 Republicans in the House of Representatives of the Congress of the United States voted to support their heckler comrade.

Something changed with the radicalization of the Republican Party, and I am not the only one to have noticed this. A very well-regarded Philadelphia columnist wrote recently of the Republican right:

If they can get some mileage . . . nothing else matters.

The columnist went on to decry what he called ``the conservative paranoia'' and ``lunacy'' afoot in our national debate.

The editor of the Manchester Journal Inquirer editorial page wrote of the GOP, which he called ``this once great and now mostly shameful party,'' that it ``has gone crazy,'' that it is ``more and more dominated by the lunatic fringe,'' and that it has ``poisoned itself with hate.'' He concluded, they ``no longer want to govern. They want to emote.''

The respected Maureen Dowd of the New York Times, in her column eulogizing her friend, the late William Safire, lamented the ``vile and vitriol of today's howling pack of conservative pundits.''

A Nobel Prize-winning economist has said:

The takeover of the Republican Party by the irrational

right is no laughing matter. Something unprecedented is

happening here, and it's very bad for America.

A well-regarded Washington Post writer with a quarter century of experience covering government and politics, married to a Bush administration official--we are hardly talking about commentary from the leftward fringe--has noted about the House health care bill and the arguments surrounding it ``the appalling amount of misinformation being peddled by its opponents.'' She called it a ``flood of sheer factual misstatements about the health-care bill.'' She noted that ``[t]he falsehood-peddling began at the top'' of the Republican Party. Her ultimate question was this:

Are the Republican arguments against this bill so weak that

they have to resort to these misrepresentations and

distortions?''

Even the respected head of the Mayo Clinic has recently described the health care antics we have witnessed as ``mud'' and ``scare tactics.''

It is possible, as the distinguished Senator from Utah suggests, that the reason bipartisanship is elusive is because Democrats have been gripped by the arrogance of power. But as somebody who has been witness to intense efforts to try to recruit Republican support for this bill, the evidence at least as well supports the theory that something has happened to the Republican Party in the past months, as the radicalized Republican right has emerged and taken over and provoked all of these responses from respected, neutral, seasoned veterans observing the political scene. I suggest that is at least a possibility.

I would like to change topics for a moment, given that Senator Casey is not present, and make an additional point that I believe merits mention. I will yield as soon as he appears to have arrived.

I am delighted to yield.

Of course. How long would the Senator wish?

I yield 5 minutes to the distinguished Senator from Utah right now.

Would the Senator yield back for one moment?

I had the opportunity to be on the floor yesterday, and the time was all under agreement. My time was concluded, and I was leaving the floor. The Senator from Utah had the occasion to offer some very kind words about me. Because of the procedural posture we were in, I did not have the chance to reply or respond at that time. This is the first time we have been on the floor together since then, when I have had the chance to have the floor, and I do want to let him know how much I value what he had to say. I know there are very well-established standards of protocol here in which we say nice things about each other, but I felt that what he had to say was not just protocol but was sincere and heartfelt, and it really does mean a lot to me and is reciprocated on my part.

I think Senator Hatch brings enormous, as I said earlier, dignity, erudition, principle, collegiality--many good characteristics to the floor. He is a force for good in this body, and I am delighted to have him count me a friend.

I yield him the next 5 minutes.

Mr. President, I see the distinguished Senator from Iowa as well as the distinguished Senator from Pennsylvania. Whichever one of them would like to proceed, I am prepared to yield. It looks as if it will be the distinguished Senator from Iowa.

I had the very great honor of serving on the HELP Committee during the time that the HELP Committee section of this bill was prepared. One of the most vital and important elements of this bill is its new focus on wellness and prevention to help Americans stay healthy so that it truly is health care and not just sick care, so that the medical establishment is not incented to add more and more tests and procedures because that is what they get paid for but won't have an e-mail contact or won't have a phone call to help talk a patient through something because they can't get reimbursed.

The potential value of wellness and prevention in this country is astonishing. It has been underinvested in because the people who are responsible for making those choices really don't get the benefit of them under our present perverse system.

The Senator from Iowa has shown great leadership. He is now chairman of the HELP Committee, but he certainly chaired, through the committee deliberations, the health and wellness portions. It was my honor to watch him in action and see the astonishing results he achieved.

I yield the floor to him and ask unanimous consent that at the conclusion of the remarks of the distinguished Senator from Iowa, the Senator from Pennsylvania, Mr. Casey, be recognized.

Mr. President, I thank the chairman of the committee.

I thank the Presiding Officer. I am delighted to be on the floor, along with the distinguished chairman of the Finance Committee and the distinguished Senator from Michigan, who has worked so hard on these issues.

I am sure I am not going to be the only person to say this, but I would like to respond briefly to the colloquy that just took place between the Senator from Wyoming and the Senator from Alaska because, as I understand it, the Mikulski amendment provides for preventive services that are in the A and B category as a floor, not a ceiling, at a minimum, and it instructs the Health Resources and Services Administration to provide recommendations and guidelines for comprehensive women's preventive care and screenings. Once that is done, then all plans would be required to be totally apart from the A or the B.

In terms of the Health Resources and Services Administration being an entity that wants to get between you and your doctor, these are actually scientists, not bureaucrats. It is an independent panel.

I think it comes with some irony to hear the concern expressed on the other side of the aisle repeatedly about bureaucrats coming between Americans and their doctors and telling them what care they can and cannot have when my experience in Rhode Island leading up to this debate, the Presiding Officer's experience in Illinois leading up to this debate, Senator Stabenow's experience in Michigan leading up to this debate--all of our experience in our home States leading up to this debate--has been that the problem has been that the private for- profit insurance industry is out there denying care every chance it gets.

I think the distinguished Senator from Illinois was presiding when I told the story of a family member of mine who died recently who was diagnosed with a very serious condition. He went to the National Institutes of Health to get the best possible treatment. He got the best specialist on his particular diagnosis in the country, and when he took that back to New York, his insurance company said: I am sorry, that is not the indicated care. That is just one experience I have had. Hundreds of Rhode Islanders have been in touch with me about their nightmare stories over and over again, whether it is because you have a preexisting condition and they won't insure you; or once you get diagnosed, they won't authorize your doctor to proceed with the care you need; or even if you go ahead and get the care, they will do everything they can to avoid paying the doctor and create every kind of administrative, bureaucratic headache for the doctor. The private insurance industry is standing between you and the care you need.

I have not once--not once since I have been here--heard anybody on the other side of the aisle express any concern about the bureaucrat between you and your doctor as long as it is an insurance company bureaucrat. It seems to me they actually approve of bureaucrats getting between you and your doctor as long as it is a bureaucrat who is an insurance company bureaucrat who has a profit motive to deny you health care. Then it is OK. Then they don't complain. But when it is independent scientists working hard to generate the best science that can be done so that people get the best information to make decisions, then suddenly we hear about bureaucrats.

I think the people listening to this should have that history in mind as they evaluate this claim that we are trying to put bureaucrats between Americans and their doctors. By stripping the abuses away from the insurance company, this bill does more to relieve that problem than any other piece of legislation I can think of.

I yield to the distinguished Senator from Michigan.

If the Senator will yield.

That is the business model of the private health insurance industry now. They want to cherry-pick out anybody who might be sick, and that is why we have the preexisting condition exclusion.

Then they have an absolute army of insurance company officials whose job it is to deny care. I went to the Cranston, RI, community health center a few months ago. It is a small community health center providing health care in the Cranston, RI, area. It doesn't have a great big budget. I asked them how difficult it is to deal with the insurance companies in order to get approval and get claims paid. They said: Well, Senator, 50 percent of our personnel are engaged not in providing health care but in fighting with the insurance industry to get permission for care and to get claims paid.

Yes. Half of the staff of the community health center was dedicated to fighting with the insurance industry, and the other half was actually providing the health care.

In addition, they had to have a contract for experts, consultants, to help fight against the insurance industry. That was another $200,000-- $200,000 for a little community health center, plus half of their staff.

What we have seen in the past 8 years is that the administrative expense of the insurance industry has doubled. That is what they are doing. It is like an arms race. They put on more people to try to prevent you from getting care because it saves them money when they do. They have a profit motive to deny people.

In the case of a member of my family whom they tried to deny, he had the fortitude to fight back and eventually they caved. But for every person like him who fights and gets the coverage they paid for and are entitled to, some will be too ill, too frightened, too old, too weak, too confused, or some simply don't have the resources, when they are burdened with a terrible diagnosis like that, to fight on two fronts. So they give up and the insurance company makes money.

It is systematized. Not once have I heard anybody on the other side of the aisle in the Senate complain about that. It is a scandal across this country. It is the way they do business. I don't think there is a person on the Senate floor who hasn't heard a story of a friend or a loved one or somebody they know and care about who has been through that process. It is not hypothetical. It is happening now, and it is happening to all of us. But it is only when we come in and try to fight that suddenly this concern is raised, this ``oh my gosh, you are going to get bureaucrats.'' But they happen to have no

profit motive. They will work for the government and will be trying to do the right thing and be experts. But suddenly it is no good.

I do.

As the Senator noted, there is an astonishing similarity between the interests of the private health insurance industry and the arguments made by our friends on the other side on the floor. It is amazing. They are identical, virtually, to one another. I have yet to hear an argument about health care coming from the other side of the aisle that does not reflect the interests and the welfare of the private insurance industry, about which for years I never heard them complain while they were denying care.

We have another example beyond Medicare. I am struck that today is the first day since the President's speech in which he announced another 30,000 men and women will be going over to Afghanistan in addition to the ones there. All of us in the Senate and in America are proud of our soldiers. We wish them well. Those of us who have visited Afghanistan know how challenging an environment it is and how difficult it is to be away from one's family. There can be no doubt in our minds that we want the best for our men and women in the service. Everybody agrees we want the best for them. Our friends on the other side also want the best for them.

When we give them health care, what do we give them that we think is the best? We give them government health care through TRICARE and through the Veterans' Administration. I have not heard a lot of complaining about that, about stripping our veterans out of the Veterans' Administration and letting them go to the tender mercies of the private health insurance industry because when there is not an issue that involves the essential interests of the private health insurance industry, then they will do the right thing and recognize that is best for our service men and women. That is best for our veterans and, of course, we all support that. It makes perfect sense. It belies the arguments we are hearing today.

If I may interject, I add that it is a relatively familiar American principle to put public and private agencies side by side in competition, in fair competition, and let the best for the consumer win. We see it in public universities. Many of us have States with public universities that we are very proud of. They compete with private universities. I think every one of us has a public university in our State, and it is a model that works very well in education. Many of us--unfortunately not in Rhode Island--have public power authorities that compete with the private power industry.

In fact, some of the most ardent opponents of a public option go home and buy their electricity from a public electric cooperative or a public power authority. We see it in workers compensation insurance. A lot of health care is delivered through workers compensation insurance.

I think it is the oldest principle of competition, as the distinguished chairman of the Finance Committee pointed out.

I think it does.

All of those, and a public option. All of that adds to a better environment. One of the interesting things about this is you only have a good and fair market. America is founded on market principles. We all believe in market principles. One of the things about the market is that people will cheat on it if there are not rules around the market. If you don't make sure that the bread is good, honest, healthy bread, some rascal will come and will sell cheap, lousy, contaminated bread in the market. You have to have discipline and walls to protect the integrity of the market.

That is what the health insurance market has lacked. That is overdue. I think it will enliven the market in health insurance and animate the market principle.

Nothing.

The American Academy of Family Physicians and the American Nurses Association support this legislation because they know that instead of interfering between the doctor and the patient, we are actually lifting out the interference that presently exists at the hands of the private insurance for-profit industry between the patient and the doctor. They want to see this, and that is one of the important reasons.

Another important reason, something the distinguished chairman of the Finance Committee is very responsible for, beginning all the way back at the start of this year when the Finance Committee, under his leadership, had the ``prepare to launch'' full-day effort on delivery system reform.

What you will see is doctors empowered in new ways to provide better care, to have better information.

There are a great number of ways and much of it is thanks to the chairman's leadership and Chairman Dodd on the HELP Committee. We put together a strong package melded by Leader Reid. The main ingredients are taking advantage of electronic health records so you are not running around with a paper record, you are not having to fill out that clipboard again, they are not having to do another expensive MRI because they cannot access the one you had last week. If you have drugs you are taking, the drug interactions that might harm you will be caught by the computer and signal the doctor so they can be aware of it and make a decision whether to change the medication. The electronic health record is a part of that.

Investment in quality reform is a huge issue. Hospital-acquired infections are prevalent throughout this country. They cost about $60,000 each on average. They are completely preventable. Nobody knows this better than Senator Stabenow from Michigan because it was in her home State that the Keystone Project began, which has since migrated around the country. It has gone statewide in my home State through the Rhode Island Quality Institute. It has been written up by the health care writer Dr. Atul Gawande in the New Yorker magazine. What the information from Senator Stabenow's home State of Michigan shows is that in 15 months, they saved 1,500 lives in intensive care units and over $150 million by better procedures to prevent hospital-acquired infections.

It is a very important point. Again, this is not something that emerged suddenly or overnight. The distinguished Senator from the Finance Committee has been working hard on this a long time, back even before ``prepare to launch,'' which is an early reflection of the work he has been doing.

As we look at this bill, and as people who have been watching this debate have seen, this legislation saves lives, saves money, and saves medicine. We can vouch for that through the findings of the Congressional Budget Office. But the Congressional Budget Office has been very conservative in its scoring.

There is a letter the CBO wrote to Senator Conrad. There is testimony and a colloquy he engaged in with me in the Budget Committee that makes clear that beyond the savings that are clear from this legislation, there is a promise of immense further savings. What he said is:

Changes in government policy--

Such as these----

have the potential to yield large reductions in both national

health expenditures and Federal health care spending without

harming health. Moreover, many experts agree on some general

directions in which the government's health policies could

move.

The chairman of the Finance Committee has developed those general directions through those hearings and it is now in the legislation. But the conclusion he reaches is:

The specific changes that might ultimately prove most

important cannot be foreseen today and could be developed

only over time through experimentation and learning.

The MIT report that came out the other day, Professor Gerber, Dr. Gerber said the toolbox to achieve these savings through experimentation and learning is in this bill. I think his phrase was everything you could ask for is in this bill.

As the distinguished chairman of the Finance Committee knows better than I do, there are big numbers at stake here. If you look at what President Obama's Council on Economic Advisers has estimated, there is $700 billion a year--when we talk numbers, we usually multiply by 10 because it is a 10-year window. So when people say there is this much in the bill, it is over 10 years. This is 1 year, $700 billion in waste.

The New England Health Care Institute estimated $850 billion annually in excess costs and waste. The Lewin Group, which has a relatively good opinion around here, and George Bush's former Treasury Secretary, Secretary O'Neill, have estimated it is over $1 trillion a year. So whether it is $700 billion or $850 billion or $1 trillion, even if these tools in the toolbox that we will refine through learning and experimentation achieve only a third, it is $200 billion or $300 billion a year.

May I offer a specific example from the bill as an illustration of this?

One of the very few areas in which the Congressional Budget Office is prepared to document savings from these quality improvements is in the area of hospital readmissions. The chairman of the Finance Committee worked very hard to get hospital readmission language in his bill, I think we had it in the HELP bill as well, Chairman Dodd, and it is in the bill Leader Reid put together. What it does is it strips, over 10 years, $7 billion--I think is the number--$7 billion of money that hospitals would otherwise be paid when somebody gets out of the hospital and is readmitted within 30 days for the same condition.

The reason they are willing to apply those savings is because now you can demonstrate that if you have better prerelease planning, then people will go out and they will do better on their own. They will do better at home or they will do better in a nursing home, and therefore they will not come back. So you save lives because the health care is better, and you save money because they do not come back to the hospital. You improve on the front end. The hospital will do that. They will invest and improve on the front end because they don't want to pay on the back end if they are not recovering their costs with the readmission. It is a win-win for everyone. The individual American who has to be readmitted to the hospital and undergo, once again, all the procedures and all the risks that being in a hospital entails because he or she didn't get a proper discharge plan is not helped out by having to go back to the hospital.

Part of what the distinguished chairman worked so hard on was to put in place the program so we will be able to begin to reimburse doctors for those kinds of discussions.

Right now, our payment system is driving them away from having that kind of simple discussion. It doesn't always support the electronic prescribing that would let you know they are not picking up their meds. But President Obama did a great job on that, with the electronic health record funding he put through.

But this question of doing what you are paid to do, if all you are paid for are procedures, then the hospital doing the discharge summary, if they couldn't get paid for that, but they did get paid when the person came back and was readmitted and maybe $40,000, $50,000 a day, it doesn't take too long to figure out where their effort is going to be. It is not going to be in those areas that save money for the system but hurt them financially because we have set up the payment system with all these perverse incentives.

Madam President, I had the occasion to listen to some of the remarks of our colleagues on the other side of the aisle. It forces the conclusion that the irony department of the Republican Party is working overtime these days.

The criticisms of this bill are over deficit and cost. We are hearing these criticisms about deficit from the party that, when it had control in the Bush years, ran up over $8 trillion in our national debt--$8 trillion, the biggest spendthrifts in history, an orgy of fair-weather debt. They didn't have any hesitation about deficits then. On the wars in Iraq and Afghanistan, we have never heard any interest in having those paid for on a current basis. Borrowing for wars is completely satisfactory to them, it appears. When they had the chance to amend Medicare, they added Part D, and they ran up the cost immensely by providing a special protection for the pharmaceutical industry so that it can dictate prices to the Federal Government. The Federal Government can't negotiate with the pharmaceutical industry for Part D pharmaceuticals. That costs the Federal Government a fortune. Do they mind? No. They spend on deficits over and over. Now, when at last we take on the insurance industry, suddenly they discover a concern about deficits. Well, I would urge that based on that trajectory, these remarks have a lot less to do with the deficit than they do with protecting the insurance industry.

There is another clue of this as well, and that is the concern about cost. We all, indeed, are concerned about cost. But I think the best thing we could do about cost in health care is to pass a public option. Why do I say that? I say that because the Director of the Congressional Budget Office has said that changes in government policy which we adhere to in this bill have the potential to yield large reductions in both national health expenditures and Federal health care spending without harming health. It is not just a possibility. He goes on to say: Many experts agree on the general direction in which the government must go to get those cost savings. But they conclude they can't put a specific score on them yet for the following reason: The specific changes that might ultimately prove most important cannot be foreseen today and could be developed only over time through experimentation and learning.

Now, who is going to develop those changes that will save costs while improving the quality of our health care system over time through experimentation and learning? The public options. There will be public options, if the original health plan is followed, in all 50 States. Each would have to stay within its State on balance, solvent, could not go to the Federal Treasury to make up losses. So they have to look for reform in order to continue to succeed. They would be 50 engines of reform, of experimentation, and of learning.

Who is against the public options? The insurance industry, because they don't want the competition. They love an environment in which they are immune from the antitrust laws--almost uniquely in American business--and in which they have incredible market share. In many cases, there are only two dominant insurers in the entire market around this country. So they love having these huge market shares to be able to dictate price, to be immune from the antitrust laws, and they don't want the competition.

Guess who else is against the public options. Our Republican friends. It is very hard to find any daylight between the position of the insurance industry and the position of our Republican friends.

The problem with this is that it is not just about numbers and it is not just about statistics; it is about people. It is about people by the hundreds of thousands, but it makes their stories better when you actually come down to cases. So let me mention a few cases.

I talked a few weeks ago about one of my very dearest family members who fell victim to the system when his insurance company tried to deny him the indicated treatment prescribed by a world-class physician from the National Institutes of Health on the grounds that it was so-called ``not the indicated treatment.'' This was an individual who had received a devastating diagnosis. He had gone to the top expert for that diagnosis in the country at the National Institutes of Health. He had been told what he should do. He had been told, indeed, that was very standard. This was not anything exotic; this was essentially the automatic way you should treat a particular condition. When he filed it with his insurance company, some faceless bureaucrat said: No; we know better than the top expert at the National Institutes of Health. That is not the indicated treatment.

From that, and from thousands and thousands of Americans who have had their claims denied and have had insurers try to intrude between them and their doctor and interfere with the care their doctor thinks they need, we can tell one thing: the insurance companies do this for a bad motivation, which is to save costs. Of all of the stories I have heard, of all of the stories our colleagues have related here on the Senate floor, never once has there been a story of an insurance company that stepped in and said: Oh, wait a minute, that is not the indicated treatment; the indicated treatment is actually more expensive than what your doctor has indicated. Always, it is less expensive. Go figure.

I wish to share another story today about a person who is close to me, a member of my staff. His name is Richard Pezzillo, and he has hemophilia. He has gotten the treatment he has needed so far, but he has been lucky, and it illustrates how luck now enters into our equation in health care.

In 2003, after a very turbulent airplane flight, Rich unfastened his seatbelt from the airplane, collected his things, and suddenly realized things were going badly wrong. He started to feel tremendous pain. He started vomiting blood. Simply wearing his seatbelt in that turbulent aircraft had caused Rich to begin to bleed internally, inside of his stomach, eventually requiring that his gallbladder be removed.

Rich is a kind and thoughtful young man from North Providence, RI. He was hospitalized in very serious condition. He spent nearly 3 weeks in the hospital. Thankfully, he received excellent treatment, and today he works here in my Washington office. The doctors, the nurses, and the hospital staff in Rhode Island gave Rich the best treatment. He now leads an energetic, vigorous life and does well at a challenging job.

But the stunning part about Rich's story is his treatment and his treatment cost--$1.5 million. At least that is what they said. If you look at a copy of the billing sheet, you will see that the insurance company said that his billing, here, for instance, was $366,240.

The insurance company allowed only $106,000. That is what was actually paid, which gives you a sense of how much funny business is going on in the private health insurance industry and in the health care sector, when an insurance company can get away with paying about one-third of the bill's cost.

We have heard a lot of talk about how burdensome it is for Members of Congress to make it through a 2,000-page long health care bill. If you actually reduce its size to the substantive

language--and I am elaborating on what the House bill would do, which is about the same as ours--the substantive language is less than a Harry Potter novel. My daughter could read Harry Potter novels when she was 13. I don't think it is asking too much of our colleagues to plow through a bill that represents one-sixth of our economy--when it is the size of a Harry Potter novel. It would be a good idea.

Rather than fighting about the 2,000-page bill, how about Rich's $1.5 million health care bill? The hard truth is, Rich was able to get lifesaving treatment because he was lucky, since he hadn't graduated from college yet and was still covered by his parents' insurance policy. Because he was covered, the hospital only charged his insurer less than half of that--$106,000. What if things had been different? What if he needed treatment a couple of years later when he wasn't on his parents' policy and couldn't afford his own? What if he had applied for his own coverage but was denied by an insurance company because his illness was deemed a preexisting condition? What if Rich's father lost his job and his health insurance along with it or what if Rich's parents' policy had a limit on benefits, and they had to pay the rest of the $1.5 million out of pocket?

Rich would have been a victim not just of his illness but of the health care status quo. If he or his family had been uninsured, they almost certainly would not have been able to afford the full care Rich needed. Their financial future would have been irrevocably altered-- probably ruined.

Luck is no way to run a health care system. Unfortunately, Americans need all the luck they can get when dealing with health insurance companies that use every bit of their bureaucratic guile and financial might to delay and deny health insurance benefits they are obligated to provide.

For example, in March 2006, the Arizona Department of Insurance ordered health insurance giant United Healthcare to pay fines of more than $364,000--the largest in the department's history. Regulators found that the company illegally denied more than 63,000 claims by doctors without examining all of the information needed to accept or deny a claim. It looks as if they were just on automatic pilot to deny them.

In January 2008, California insurance regulators found that a subsidiary of United Healthcare had committed more than 130,000 violations of law in handling claims. For example, the company inappropriately denied more than $750,000 in claims on the grounds that insureds had a preexisting condition. The regulators found that the companies ``made large-scale and willful decisions to use broken systems to process claims and respond to providers, while continually and effectively collecting premiums.'' The total potential liability of the company for all violations is $1.3 billion.

Last year, United Healthcare's CEO, Stephen Helmsley, made $3.2 million and holds almost $120 million in stock options.

The health care reform bill we are talking about today would right this massive power imbalance between the health insurance industry and ordinary Americans who are getting rolled over by it. It would empower average Americans to take control of their health and financial future. Rather than taking their health insurance premium dollars to the health insurance ``casino,'' they could take them to the bank.

Unfortunately, many on the other side of the aisle wildly misrepresent both the status quo and how reform would empower consumers. The opponents of reform depict our bill as an Orwellian takeover of the system.

Madam President, let me close with a story that illustrates how ironic and completely wrong these cries of ``death panels'' or ``government interference'' really are.

In 2000, Christiane Hymel--insured by a subsidiary of Blue Cross Blue Shield of Louisiana--scheduled an appointment for a routine physical. During the examination, she reported to her doctor her history of back pain and weakness in her legs over the past year and a half. Her doctor ordered x rays of her spine and referred her to a neurologist.

The neurologist, after detecting troubling symptoms, ordered an MRI. In accordance with her insurance policy, the doctor sent Blue Cross a request to preauthorize the MRI. The day before the MRI was scheduled, Blue Cross denied that request on the basis that the service was for a preexisting condition--Mrs. Hymel's back pain.

Mrs. Hymel appealed the insurance company's decision in accordance with the terms of her policy, but Blue Cross never processed the appeal.

After Blue Cross denied coverage for the MRI, Mr. and Mrs. Hymel were told that the MRI would cost about $4,000. They started saving up for it. It took 3 months to save up the money necessary to pay cash for the procedure, but they eventually did. The MRI showed that Mrs. Hymel had massive tumors involving ``nearly the entire cervical and thoracic [spinal] cord.'' She was immediately scheduled for surgery. Helpfully, Blue Cross stepped in to deny coverage for that as well, stating it was for a preexisting condition.

Mrs. Hymel's neurosurgeon later testified at trial:

Tumors inside the spinal cord are growing tumors, as they

grow, they cause damage to vital structures in the spinal

cord, which are important to walking, sensation, and

breathing.

The longer the wait in removing a tumor, the more damage the tumor will cause to the spinal cord. The doctor testified:

Two-thirds of Mrs. Hymel's current condition and

disabilities were the direct result of the growth of the

tumor during the 3 to 4-month delay between the time Blue

Cross denied the MRI until the time Mrs. Hymel was able to

pay for it by herself. Additionally . . . this delay also

caused the tumor's quick recurrence, necessitating the second

surgery.

In ruling for Mrs. Hymel in her lawsuit against Blue Cross, the court described the consequences for Mrs. Hymel of this 3-month delay the insurance company caused by denying her MRI:

Mrs. Hymel testified that when she first woke up from

surgery, she could not move her arms or head and she thought

she was paralyzed. She felt painful burning sensations in her

body. . . . While she was in the surgical ward, she

contemplated committing suicide. During her hospital stay,

she suffered from bowel obstruction, fecal impaction, and had

to wear diapers. Mrs. Hymel didn't see her children in the

hospital until two weeks after the surgery, and when her

children finally saw her, they were scared of her and would

not touch her. Mrs. Hymel spent approximately eight months in

a wheelchair after her surgery.

Mrs. Hymel is house-bound, she cannot take a shower, work

in her garden, ride a bike, swim, or drive, as she had

frequently enjoyed prior to the surgery. . . . Mrs. Hymel

must also take large doses of medication to relieve the

burning and shocking sensations from which she suffers. She

cannot be touched on her back or leg, because the second

something touches her lower back, it's like fireworks that go

off.

Every day that insurance companies delay or deny payment is another day they earn interest on your premiums, adding to their profits and adding to the funds that support their massive executive pay packages. When Blue Cross of Louisiana failed to pay for Mrs. Hymel's MRI, it wasn't just making a mistake, it was making a calculated decision--a heartless, profit-maximizing decision. Christiane Hymel's story isn't just a sad tale, it is a symptom of a disease that is spreading through the private health insurance system.

For many Americans like Christiane and Rich, our health care system is a casino, where a roll of the dice or spin of the roulette wheel determines one's fate. Such an irrational and random system doesn't comport with the society that Franklin Roosevelt described in his 1944 State of the Union:

We have come to a clear realization of the fact that true

individual freedom cannot exist without economic security and

independence. Necessitous men are not free men.

These days I think it would be more proper to say necessitous men and women are not free men and women.

By passing health care reform, we will take health insurance off the casino floor for the average American family and make it a reliable part of every family's economic foundation. No longer will happenstance or chance determine whether treatment will be paid for. No longer will the casino wheel determine whether Rich Pezillo gets his treatment or that Christiane Hymel does not. Parents of kids like Rich Pezillo would not worry whether their son's illness could lead him to be

turned down for that preexisting condition or whether a layoff or lack of insurance could deny their son the treatment he needs.

Necessitous men and women are not free men and women. Let's redeem FDR's promise by passing health care reform. Let's bear in mind, as we go forward, the nature of the arguments that are made against health care reform and the astonishing coincidence between the arguments made between health care reform by our Republican colleagues and by the barons of the health insurance industry. There seems to be literally no daylight between those arguments.

If we are going to turn around the extraordinary spiraling costs of health care, we are going to have to do it by reforming the delivery system. The best way to do that is the public option. Yet they oppose it.

Madam President, I yield the floor and suggest the absence of a quorum.

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

Mr. President, I rise in this great Chamber of debate, this greatest deliberative body, to speak about the upcoming debate on health care on which, thanks to the extraordinary work of our leader, Senator Harry Reid, we are about to embark. I am here to urge that we in the Senate lift the tone and direction of our national debate.

Let me start by saying I appreciate and enjoy vigorous debate. Senator Byrd gave an eloquent eulogy for Senator Kennedy, noting that our beloved, late colleague saw politics as a contact sport. There is nothing wrong with a clean hit in the public arena. Nobody here needs to tiptoe around. A well-marshaled argument, buttressed by the facts, is a beautiful thing, even when delivered hot. Dynamic and vigorous debate is how a democracy sorts through the thorny issues we face. What an ideal time now would be for strong, reasoned arguments about health care reform in the Senate in the coming weeks.

Contrast what we have heard for months on the airwaves and in townhall meetings: charged buzzwords such as ``death panels,'' ``socialized medicine,'' ``benefits for illegal immigrants,'' and ``rationing of care''--words that inflame passions and ignite fear rather than making a reasoned case for advancing an alternative.

Worse, these messages have been delivered with a crudeness and a venom; for example, the President portrayed with a Hitler mustache. That is unprecedented in my experience in government. Many of us felt President Bush was less than truthful, but for 8 years, no one yelled out in a State of the Union Address: ``You lie.'' Yet this September, 179 Republicans in the House of Representatives of the Congress of the United States voted to support their heckler comrade.

The media, so often in our history a check on the use of falsehood and distortion by powerful interests, has too often been a part of the problem, not part of the solution. For significant parts of the media, facts do not need to be true to be repeated, conclusions do not need to be logical to be reached, and spin is the order of the day.

FOX News the other day launched an attack on President Obama for having too many so-called czars. Let's set aside that George Bush had more. FOX showed a graphic of 30 officials whom, it said, ``didn't have to be confirmed,'' 9 of whom actually had been confirmed by this Senate. My young niece did a better fact-checking job at her summer job for a literary magazine than that.

Recently, FOX used footage from a different event to make attendance at a Republican rally look bigger. A constituent sent me a letter expressing concern that she heard on the Glenn Beck show that President Obama was planning a national civilian security force that would report only to him, akin to the Nazi SS. What did I think of that, she asked. This was a well-meaning Rhode Islander.

We checked, and it turned out the President had given a speech about expanding the Peace Corps, AmeriCorps, the Foreign Service, and other government service programs. I ask you, Mr. President, in what fevered and distorted imagination does national service to AmeriCorps, to the Peace Corps or in the Foreign Service become an SS-type militia? Yet Mr. Beck actually said that.

Another rightwing piece on President Obama's support for AmeriCorps suggested a parallel with Hitler Youth.

Its author said:

If I need to make my point, I'm going to make it in a

provocative manner, because that's how it attracts attention.

The truth should provide terrets through which arguments must run-- but not now. As a very well-regarded Philadelphia columnist wrote of the Republican right, ``if they can get some mileage . . . nothing else matters.''

He went on to decry the ``conservative paranoia'' and ``lunacy'' afoot in our national debate.

The editor of the Manchester Journal Inquirer editorial page wrote of the GOP, which he called this ``once great and now mostly shameful party,'' that it ``has gone crazy,'' that it is ``more and more dominated by the lunatic fringe,'' and that it has ``poisoned itself with hate.''

He concluded:

They no longer want to govern. They want to emote.

The respected Maureen Dowd of the New York Times, in her column eulogizing her friend, the late William Safire, lamented the ``vile and vitriol of today's howling pack of conservative pundits.''

Even the staid, old U.S. Chamber of Commerce has descended into such irresponsible advocacy that Apple, PG&E, Levi Strauss & Company, PNM Resources, Nike, and Exelon have distanced themselves from it, PNM citing the Chamber's ``recent theatrics.''

There comes a point when debate unhinges from reality. When that happens, you leave the sunlit fields of argument and deliberation and you enter a shadowy realm of sloganeering, fear mongering, and propaganda. In these dark and twisted Halls, democracy suffers as debate seeks to scare people or deceive them rather than informing or explaining. It is so easy if you want to go there.

Of course, you can get seniors up in arms by telling them their final years will be subject to the whims of death panels. Of course, you can inflame the passions of people without health insurance by telling them their tax dollars will go to provide health insurance to illegal immigrants. Of course, you can provoke people's attention by telling them reform will keep them from

their doctors. But none of these claims is true.

The respected head of the Mayo Clinic recently described the health care antics we have witnessed as ``mud'' and ``scare tactics.''

A well-regarded Washington Post writer with a quarter century of experience, married to a Bush administration official, noted about the House health care bill: ``The appalling amount of misinformation being peddled by its opponents.'' She called it a ``flood of sheer factual misstatements about the health-care bill'' and noted of the House Republicans that ``[t}he falsehood-peddling began at the top. . . .''

Her ultimate question was this:

Are the Republican arguments against the bill so weak that

they have to resort to these misrepresentations and

distortions?

Where does this lead? The ill-informed, the gullible, those already on the razor's edge of anger about the very election of this President may well be tipped by all this poisonous propaganda into actions we would all regret--I hope we would all regret. When do anger and frustration fomented in this debate begin to spill over into dangerous or violent acts? When does some havoc occur, such that we all look back with sorrow and wish we had better leashed our dogs of rhetorical war? Where do we restore civility and reason to the health care debate before it gets too late?

I say history's charge to the Senate is to rise above the poison of our recent public debate. This greatest deliberative body is intended to set an example for public argument, not get swept into its downward spiral. We may find agreement; we may not. At the end of the day, some of us may be happy and others of us not. Some may lose and some may win. But the Senate will go on.

After the health care debate has raged through this great Chamber, other debates will follow, and ultimately what will matter more than the outcome of those debates is whether our proud American democracy has come through them with its head held high.

When debate and our democracy lose its footing in the facts, when things are said for public effect without regard to whether they are true, when the din of strife blots out the voice of reason, something of great and lasting value to America is sacrificed.

Democracy does not prosper on a diet of propaganda and fear. The current tone of much of our debate is, frankly, unworthy of us. Most in America agree something must be done to fix our health care system. If we can agree something must be done, it should not be difficult to debate our differences as to what must be done in a civil, thoughtful, and factual manner. Let the Senate be the place where we take a stand, rejecting the incivility and falsehood that has surrounded us on our public airwaves. Through history, that is what this Chamber, at its best, has always achieved and needs now to achieve again.