Floor Statements

Mr. President, I wish to spend time talking about the bill we are considering.

Yesterday afternoon, I had the great fortune--my daughter was performing in Florida and was driving back to New York. I got to see my 7-month-old granddaughter. Anybody who is a grandparent knows what it is like to see your grandchildren. There is nothing wrong with it and everything right with it. You get a picture and see in your grandchildren aspects of your children. It draws back memories.

But I was struck by that encounter with my daughter and granddaughter and, by the way, her dog. What are our hopes and dreams about? What are the hopes and dreams we have for our children and our grandchildren? Our hopes and dreams are that they will have great opportunity to flower and blossom in a way that they can take advantage of their God- given talents and their hard work and become a success in their life's endeavors. And then you contrast that with the heritage of our Nation-- a heritage which is about sacrifice--where one generation makes hard choices, makes difficult decisions, where they sacrifice their own benefits from their own endeavors to create opportunity so that the next generation of Americans can have that opportunity to fulfill and expand their heart's desires.

We heard the Senator from Utah today talk about where the problems were with our Nation, and he talked about where all the gold was in terms of fixing what is wrong. I would have to say I disagree with him. When I look at the U.S. Constitution, and then I look at all the government programs the Federal Government has fostered, passed, and funds, I see a black-and-white slate. I see on the one hand the very limited intent of our Founders, which was spelled out very clearly in

Article I, Section 8 of the enumerated powers--here are the powers you are to have. We are designing this to be a limited Federal Government and we are going to reserve everything else to the people and the States through the tenth amendment. Those words are actually in there. What is not spelled out for the U.S. Federal Government is explicitly reserved for the people and their States.

So when we consider the mess we are in--the fact we had a $1.56 trillion deficit last year, that 43 cents of every dollar we spent we borrowed from our grandchildren, that this year it will be $1.8 trillion, that over the next 9 years we will spend $10 trillion we don't have--and I would put forward most of it on things we don't need--look at it in the light of what our constitutional charge is.

I have made this statement from the floor several times. The oath we take--when I was sworn in, in January of 2005--is to uphold the Constitution. The Constitution is our guideline, our direction for what our responsibility is and what should be left to the States. So I agree with my colleague that unless we reform entitlements, we are going to have a difficult time solving our problems, but there is another answer. Actually, there are two other answers.

One of the other answers is to go through with a fine-tooth comb and look at every Federal Government program and ask: Is it a legitimate responsibility of the Federal Government? And if it is, is it a program we need?

You know, in 2 weeks time, my staff found 640 duplicative programs in the Federal Government, across all agencies, that all do the same thing--105 programs to encourage students to go into technology, math, engineering, and science. There are 105 different programs. So as we look at comparing what is our obligation and what is our charge under the Constitution with what is happening, all of a sudden a wide world opens up of monies we don't have to spend, that aren't absolutely necessary, that aren't absolutely a priority, that we shouldn't be spending money on in a time when we are borrowing and stealing the future of my little granddaughter Katie Rose, and everybody else's granddaughter.

Why would we not demand that we do the hard work of going through what is truly our obligation and eliminating what is not, and eliminating the multitude of duplications that the Federal Government has? Why shouldn't we put ourselves to the same test every other family in America is put to. Once you have maxed out your credit card, once you have passed your limits, they do not continue to extend you money. Unfortunately, what they do is jack up your interest rate. Well, guess what is getting ready to happen to us. We do not have an unlimited credit card. What is going to happen to us over the next few years? We are seeing 30-year bond obligations today going for a higher percentage than what they have ever gone for in the last 4 or 5 years, and we are going to see that trend continue. Out of the $10 trillion we are going to spend--money we don't have--in the next 9 years, $5.6 trillion of that is to pay interest on the national debt. So we are going to find ourselves in the same predicament as that person who has maxed out their credit card who is now paying interest on the interest instead of paying off the debt.

I said there were two ways of looking at this. The second is to go through the Federal Government and eliminate the waste, fraud, abuse, and duplication. One is to eliminate where we don't truly have a responsibility or authority for what we are doing under the Constitution, but the second is we have identified $350 billion a year of waste, fraud, and duplication in the Federal Government. We have done that over a period of hearings over the past 4 years. One amendment out of about 800 I have offered over the last 5 years has been accepted to eliminate something--just one. They have all otherwise been voted down. And they have been voted down because Members of this body refuse to make the hard choices about priorities, because they think we don't have to.

Well, the gig is up. There is a real rumble among the American people. There is a rumble in America about holding us accountable for the future of this country, which means no longer ignoring the hard choices, no longer adding to the credit card. I say all that to talk about the bill that is before us. We have a bill before us that is called the tax extenders bill. But that is not what it is. It is the debt extender bill. Because this bill, in light of all the speeches we will hear in this body, and all of the excuses and all the press releases that are going to be released, is going to add $104 billion to our children's credit card.

Yesterday this body voted to go forward with that. They voted to not make the hard choices, not offset the spending. If these are priority items that we should be doing in this bill, then why aren't we going after some of the waste, fraud, and abuse in the Federal Government and getting rid of it? There is $104 billion over the next 10 years, with this one bill alone, that we are going to add to the debt, and that comes down to $10.4 billion a year. We have $350 billion worth of waste. Yet we refuse to go into that $350 billion worth of waste, fraud, and duplication, and eliminate anything to pay for this. Instead, we are going to steal that opportunity, we are going to steal that future, we are going to put a blight on the blossom of opportunity for our children and grandchildren. I beg America to hold us accountable; to not accept business as usual anymore.

When you get down to it and start talking about what this means--when you take the $104 billion and divide it by the 300 million people in this country and then multiply it by the average family size--what you get is $1,282 per family that this bill will add. So if in fact you go to sleep the day after tomorrow, when this bill has passed the Senate, when 60 Senators vote for it and we go on and do this--35 or 36 will vote against it, but 64 or 65 will vote for it--when you put your head on your pillow at night, you can thank them for jeopardizing the future of your children. And not because what they want to do in the bill is necessarily wrong, but because they lacked the courage to stand up and make the hard choices that are required in times of distress in our country.

If you study our history, our greatest leaders exhibited courage in the face of adversity. They pulled us through by making hard choices, not running away from the hard choices. We had a lot of people who were critical of Senator Bunning because he raised the issue on a $12 billion jobs bill--that isn't going to do anything--and said we ought to pay for it. We voted him down. We said no. But you know what, as I read the American public, about 80 percent of them said we should have paid for it. We should have done that. And those people who were most critical of Senator Bunning on the floor are the people who have hardly ever voted against any spending bill in their entire career in the Senate. They honestly believe it is okay to mortgage the future of our children to benefit their own political careers.

So what we have developing in the Senate isn't partisanship, it is policy differences that will make the difference for this country. And if the ne'er-do-wells of doing it the same old way win, our children won't have a future. What they will have is a debt burden they will never get out of.

We hear speeches, as we did from the Senator from Utah, that tend to push us, and we think, well, we have to figure out how we can fix Medicare and Social Security. Well, how do we fix Medicare and Social Security? We have to delay retirement, lessen benefits, eliminate fraud in Medicare, and delay eligibility. Those are the only answers. Or we have to raise taxes.

But how do you raise taxes on the American people when you know you are spending $350 billion a year that is wasted? How do you, in good conscience, even consider that? I am not against having a tax increase when and if we have done everything we can do to get this government efficient and eliminated what is not our role and gotten rid of the fraud, waste, and duplication. And most of America wouldn't be against that either. But right now they do not trust us. And for good reason they don't trust this body. Because we are not shooting straight with them. We are not telling them that we are going to add $1,282 to their kids' debt.

When you take this number--this 347 figure, and you look at kids 25 years and younger, and you take that out 20 years, here is what you find: Not only

are they going to be responsible for the debt we have today, but the $78 trillion worth of unfunded liabilities for Medicare, Medicaid, Social Security, and all the other trust funds, including Federal employees' retirement, which adds up to $1.3 million for every person in this country under 25, ask yourself: How in the world will they ever own a home or send their kids to college if in fact they are having to support $60,000 a year in interest on a debt they didn't create?

The promise of America was freedom. Debt is a hard taskmaster. But it is doubly hard when it wasn't your debt but that of your parents and your grandparents, yet you are tasked with changing your lifestyle, your opportunities, your hope and vision for your children because this generation didn't have the courage to stand up and say: Enough is enough.

When will it ever be enough--when we can't sell our bonds? When will it ever be okay to offend those who are on the dole and who don't deserve to be on the dole? When will it be okay to eliminate the waste in the Federal Government, if not at a time we are going to have a $1.8 trillion deficit; if not at a time when $50 billion is going to be defrauded out of the stimulus program? When will we ever do it?

We have never been in the financial situation our country is in today--never before in our history.

Our whole foreign policy is now being affected and impacted because of our debt. We have to keep an ear toward China as we conduct our foreign policy, in the fear that they may dump our bonds. Why would we put ourselves in that position when we do not have to? Because there is no spine in the Senate. There is no spine in the Congress. There is no spine to go out and say: Yes, I made the hard choices. You may not like it, but your children deserve that we make hard choices and difficult decisions. If I am not here, it is OK, I did the right thing. I secured our future. I will be able to sleep at night, knowing I was not a part of taking and stealing that blossom of potential from our children and grandchildren.

I will finish by asking a question of the American people. Is it right that you have to make choices within a finite budget, yet your elected leadership in Washington does not? Is it fair for you to have to sacrifice to create a future for your children, when we are destroying that future in Washington?

It is a time for Americans who have never been involved in the political arena, in our Nation, to get involved because the future of your children and your children's children depends on it. We have a very short window within which to recapture the economic renaissance in our country, and it is less than 4 years. If you look at what we are coming to in terms of debt-to-GDP ratio and in terms of the size of the government to the size of the GDP, we will be on an irreversible course that will eliminate American exceptionalism forever because the thing that made us free and kept us free was a fairly limited Federal Government. What we have in front of us is an attempt not to get it back down to a size that is manageable and within the intent of our Founders' vision and the American people's expectation; we have an intent to grow. The discretionary budget of the Federal Government, on the rate that has been passed by this body the last 2 years alone, not counting the stimulus, will cause the Federal Government to double in size in 5 years. We are 40 percent bigger than we were 2 years ago; actually, it is 38.6 percent bigger. We hear the average Federal employee now makes $72,000 and the average private employee now makes $40,000. We have added 170,000 new jobs in the government in the last 7 months, while we have lost three times that in the private sector. Things are out of whack. The only way they are going to change is if the American public demands it to be changed.

I will go back. This is not a tax extenders bill. This is a debt extension bill. We are going to extend another $104 billion of debt across the threshold of opportunity for our children and grandchildren. I am not going to be a part of that. I am not going to be complicit in it. If that is not satisfactory to the people of Oklahoma, I am fine with that. I am ready to make the hard choices to make us a lean mean fighting machine again as an economy, a lean mean fighting machine as far as opportunity. The way to do that is to downsize the Federal Government, put it back within the role of its intended purposes, and return to the States both the money and the authority to handle what is rightfully theirs in the first place.

The second thing that is important is to get rid of the $350 billion worth of waste, fraud, abuse, and duplication that occurs every year that we do nothing about. We do nothing about it. We send out press releases, but when it comes time to vote to make a hard choice, we do not do it. We refuse to do it. We refuse to offend those who are well connected and well heeled, while we send our country into the trash heap of history through financial collapse.

My hope is, my colleagues will stand and say we are not going to pass this debt extender bill until you pay for it, until you make the hard choices about what is waste, what is duplication, what is fraud, and get rid of some of that to pay, if these are truly priority items.

You see, if they are truly priority, if America truly needs them, then there has to be something that is a lower priority that we can take away. But we do not have that kind of thought in the Senate because we just keep putting the credit card into the machine. Thank you, China. It is not going to be too long before we are saying: May we please, China. May we please. May we.

Watch what is happening to Greece. Look at the articles on Ireland today, the hard choices they had to make to get themselves out of trouble. But they are doing it. We are ignoring it in this body, and we are going to pass another $104 billion along to our children and grandchildren.

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

Mr. President, if the Senator will yield, one of the important points he made a moment ago is a doctor sitting down and listening to their patient. Mayo has it right. If you are not going to pay us enough to sit down, we refuse to practice medicine the way Medicare is directing us to practice: Listen a little bit and then cover it with tests.

The reason costs are out of control is because Medicare wouldn't pay for a physician to sit down and truly listen and come to a centered point on what the patient's problem is and the way to get around it. Consequently, what we have seen in the Medicare Program is doctors have to see so many patients that they don't get to listen to them and they consequently cover that lack of listening by ordering more tests.

What do we know about tests? We know we order $\1/4\ trillion worth of tests every year that aren't needed. There are two reasons we are ordering them. No. 1, the reimbursement to sit down to listen to the patient is so low the doctors can't afford to take the time to cover the test; and No. 2 is the threat of tort litigation. So now we are ordering tests not for patients, but we are ordering them for doctors. If we want to change health care, we have to drive costs down. I am proud Mayo recognizes we are not going to sacrifice our quality, so, therefore, we are saying: No, we are not going to take any more Medicare patients because we can't do it in a way that lends a quality outcome at an appropriate cost.

Every summer, we have thousands of kids hit the ER, whether they ran into a pole or they had a baseball bing them in the head. The standard of care now is to put that child through a CT scan. These are children the vast majority of whom have no neurologic signs whatsoever. But now we are not only spending that $1,200 per child, we are exposing those children to radiation they don't need.

So there are two untoward events for what has happened as we see the hijacking of medicine by the trial bar. No. 1 is we spend a whole lot more money unnecessarily, but No. 2 is we are actually now starting to hurt people by exposing them to radiation they don't need.

That is another cost. We know we can bring down costs if we change the tort system in this country to one that is sensible and reasonable and still allows, when doctors make mistakes, for them to be compensated for their economic damages and the harm that was caused to them. No one is saying we should eliminate that. What we are saying is, it should be appropriate and in a venue that represents the real risks without disturbing the practice of medicine because we cannot afford it, and the children who are getting these tests, their bodies cannot afford it. It is just common sense that we would go that way.

I wonder if the Senator will yield for a moment before we lose our time that I might discuss the amendment I am going to have up in a moment.

Mr. President, I ask unanimous consent to take that time, if I may.

Mr. President, we are going to have an amendment on the floor in just a moment that simply requires the Senate to post every time they create a new program and every time they spend money outside of pay-go so that we truly are transparent with the American people about what we are doing.

With great fanfare, we passed pay-go. We made it a statute. The last three bills in a row, we have allocated up to $120 billion outside of pay-go. With all the claims, with all the fanfare, we said we are going to now start paying for everything we do, and the first three bills to come before the Senate, what do we do? We simply say: Rules off; doesn't count; we are going to spend our grandkids' money.

For the life of me, I do not understand the controversy around this amendment. It is about us being transparent with the American people. No more games. No more saying we are doing one thing and doing another. All this amendment says is, when we violate our own rules and we spend money we do not have and we do not pay for programs by eliminating programs that are not effective, that are not a priority, that we are going to list it on our Web site. Nothing could be simpler.

We have offered the Secretary of the Senate our staff to do that work. It takes about 5 minutes a day to post that information and probably 5 minutes every third or fourth day. We will happily pay for that or we will offer one of our staff to put that information on the computer.

We are going to have a side-by-side amendment that does nothing. We understand that. That gives people a way to not vote for our amendment.

If we want to solve the problems in America and we want to solve our financial problems, the first thing we have to do is have real information about what this body is doing. This amendment will do that.

I yield back the remainder of our time.

Mr. President, I object on behalf of the managers who are not present at this time.

Mr. President, we just voice voted an amendment that will not do anything. What this amendment says is, where we violate our own rules in terms of pay-go, we will actually publish both the number of times and the amount of dollars we do that. It is about transparency of the Senate, being honest with the American people.

With great fanfare, the Senator from Montana came down and we put into law a pay-go law. Since that time, including this bill, we will have passed $120 billion of debt to our kids by saying we waive pay-go.

That is OK. That is the right of the body to do that. But it is not OK not to let the American people know that and let them keep track of us.

This amendment is very simple. Anytime we create a new program, anytime we pass and violate the pay-go rules by overriding the pay-go point of order, then we should list that with the American people so they can see what we are doing. It is quite simple, quite straightforward. It doesn't require any time. You will spend forever going to the Congressional Budget Office to find this. This makes it very simple, very straightforward.

I reserve the remainder of my time.

I ask for the yeas and nays.

Madam President, I thank my colleague from Florida. I, along with Senator Barrasso, attended the summit with the President. If I recall his words, we were going to take 4 to 6 weeks to see if we couldn't work out some compromises to get a bill the American people would accept but we also would accept.

Today marks a week since we had that summit. We had an announcement yesterday that it is time to quit talking, it is time to quit negotiating, and they are going to ram a bill through.

I think there is a big contrast. I appreciate what my colleagues have said. The problem in health care in America is not quality, it is cost. Whatever we do is going to expand the amount of dollars we spend on health care if we add people to it. But if we attack the cost, what we can do is add more people with no increase in cost.

The thing that denies somebody access to health care is not not having an

insurance policy, it is having a cost of the system that is unaffordable, whether you have insurance or not.

Malcolm Sparrow from Harvard said he believes 20 percent of all the billings in Medicare are fraudulent. That is over $100 billion a year. That is $100 billion just in Medicare. We have good indications there is $15 billion in fraud in New York City alone in Medicaid, in one city. Why would we not go after the fraud, which is the second largest component of wasted dollars in health care? Some of it the President has accepted. But the No. 1 cost that does not benefit anybody in this country is defensive medicine, and defensive medicine costs up to $250 billion a year.

Let me tell my colleagues why it is so bad and it is terrible for us to ignore that issue. It is not just that we spend money doing tests on patients. When we do tests on patients, we put them at risk. Let me give an example.

If you go to any emergency room in this country this summer on a weekend, you will see a kid in there who has gotten hit with a baseball. What the standard is now because of the legal system in this country is that child is going to be exposed to radiation from a CT scan, not because they need it but because the ER doctor needs it.

The standard of care should be, if you have reliable adults around the child and the child has no neurologic damage and neurologic signs, watching to see, an expectation in case some signs show up and then you return. But the legal system in this country has entrapped us where we do hundreds of thousands of CT scans on children that none of them need because they get hit with a baseball. The ones who have true neurologic changes do need it. The vast majority do not. There are billions of dollars in one summertime event that gets chewed up that is not there to take care of somebody at a level which they can afford because we have added that on to the cost, not because a patient needs it, because the system demands it because doctors have to protect themselves against untoward extortion lawsuits. To ignore that as a part of this bill says you are not going to go where the money is to cut the costs.

I will summarize very shortly. It is said that Republicans do not have any plans. We have not said that, the President has. Then when he acknowledges a plan, he acknowledges only one that covers 3 million. We have a plan. I have a plan. Senator Burr has a plan. Senator Gregg has a plan. Senator DeMint has a plan. Senator Enzi has a plan. They all cover 20 million to 25 million more Americans. They do it by not raising taxes, not stealing money from Medicare, which has a $37 trillion unfunded liability over the near term. We do all that without increasing the cost. We get a true expansion of coverage without an increase in cost.

What we think would be the right thing to do is to center health care on patients, not the government. This plan has 898 new government programs. It has 1,695 times where the Secretary of HHS will write new regulations for health care. What do you think the consequence of complying with those regulations is going to be in terms of cost? We are adding more cost into the system that does not go to help anybody get well but become compliance costs.

We believe in patient centered, not government centered. We believe in expanding options available to patients--patients--not expanding government. We believe in increasing access, not increasing taxes on people. We believe in reducing costs, not quality.

The bill we are going to have before us, no matter what the shenanigans are to pass it, does not attack the underlying problem, and that is cost. Until we look at cost, we will never get out of the problems with Medicare, and we will never truly improve access for Americans.

I yield to my colleague.

Will the Senator yield?

The one problem with the $500 billion worth of cuts, if you read what the CBO said about that, they said it is highly unlikely Congress will ever effectuate those cuts. If that is true, then that means there is $500 billion in costs that are not accounted for. So, one, either you are going to undermine the trust fund and actually lessen the available funds for seniors today or you are not, and you are using a ruse and saying we are going to charge this to our children and grandchildren.

Having been in this body for 5 years, this body will not make those cuts. It will not do it.

I want to make one other point. It is this: We recognize there are difficulties in health care. We recognize that the No. 1 difficulty that is keeping somebody from getting care is the cost of care. This bill does nothing for that. I would go back and worry that when the President said we will look at this for 4 to 6 weeks and now we are less than a week later and he is ramming this through, what is it the American people want us to do? Do they want us to create another entitlement system when every entitlement system we have today is bankrupt and in creating that steal from the bankrupt entitlement systems we have today or do they want a commonsense approach that will go after the cost, that will lessen the cost of care for everybody in America because we will never solve the problem with Medicare and its unfunded liabilities and address the costs.

I see the Senator from Arizona is here, and I am glad he has shown up.

There are three very worrisome provisions in this bill. One is the Medicare Advisory Board that the Senator from Arizona just talked about that will decide what gets paid for and what does not, and Congress will either have to agree to it or agree to some other cuts.

The second is the Cost Comparative Effectiveness Panel which says: We do not care what is best for you, this is the cheapest; therefore, this is what you are going to get, which ignores the doctor-patient relationship in terms of what is best for you as an individual patient.

Finally, the Task Force on Preventive Services, which we saw during the debate in December, had recommended women under 50 not get mammograms because it was not ``cost-effective.'' When you look behind that data, it is 1 to 1,480 versus 1 to 1,460, versus 60 years and above, versus 40 to 50.

What happens is, you now have three government agencies that are going to step between the doctor and the patient when it comes to Medicare and Medicaid in this country, and actually it will fall over and they will mandate it on your own private coverage. That is very inconsistent in terms of saying you want doctors to be in control of health care but you have a bill that has three organizations in it that are designed to allow bureaucrats to make the decision on what your care is going to be.

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

Mr. President, I am going to spend a few minutes talking about an amendment I have, No. 3358, which has already been pending, but I think, first, it is important for us to know that last year we borrowed $4 billion a day in this country. Mr. President, 43 cents out of every $1 the country spent at the Federal level was borrowed.

What does that mean? What that means is that over the next 10 years we are going to be paying $4.5 trillion in interest on the additional $9.8 trillion we are projected to spend that we do not have.

It was less than 3 weeks ago that this body passed a statute. Here is what the statute said: If you do not have the money to spend, then you have to cut something if you are going to spend new money.

As of last night, in the 3 weeks since we passed that bill, this body has said: That does not count. Time out. We are going to spend $120 billion over the next 10 years, but we are not going to pay for it.

That is why when that bill came through, to tell America we were going to finally get some fiscal discipline, we, as a minority, voted against it, because we knew it was not true. As a matter of fact, one of our newer Members wanted to vote for it, as I had in the past when I first got here because I believed what it meant was real.

The fact is, the pay-go rules are a ruse. Pay-go means: American people, you pay, and we will go spend it. Even more than that: What you don't pay, we will go spend anyhow and we will charge it to your children and your grandchildren.

So this amendment I am proposing to be a part of this tax extenders plan would require three things. It would require the Secretary of the Senate to post on the Web site the following three things: the total amount of spending, both discretionary and mandatory, passed by the Senate that has not been paid for. We have this big hullabaloo saying we are going to pay for it and then as soon as the hard choices come of getting rid of something that is a lower priority, we will not do it; we just charge it on the credit card. So this amendment would require us to post on our Web site all the spending we are doing that wasn't paid for. In other words, we are not going to tell America one thing and do another without at least being transparent in knowing we are complicit in not following our own law we passed that said you have to do this.

The second thing it would require is the total amount of spending authorized in new legislation as scored by the CBO. Because what routinely happens here, and what I have been rejected on over the last 5\1/2\ years, is that if you want to start a new program that is well intended to help people, one of the things we ought to do is get rid of the ones that aren't helping people, the

ones that aren't efficient, the ones that are a lower priority. In other words, we ought to have to do what every American family has been doing for the last 2 or 3 years as we have gone through this economic constriction, which is make hard choices. They put priorities on things. The fact is, we are going to have $120 billion inside of 3 weeks that we refuse to prioritize. We are just going to spend another $120 billion.

Finally, the third component of what I am asking for in this amendment is for us to put on the Senate Web site any new government programs we create. What are the new programs we create? That is transparency.

So this amendment is not a gimmick. It is not to try to make people look bad; it is to try to make sure the American people know what we are doing and can see what we are doing. It is also to make sure the American people know when we say one thing and then do another. It is to make sure the American people can see that the Senate has passed $120 billion worth of unpaid-for programs that we, in fact, directly charged to the next two generations, after we have passed a pay-go rule saying we will never do this. It is about credibility. It is about character. It is about honor. It is about fessing up, if you don't have the courage to make hard choices.

So it is very simple. Some of my colleagues think it is a gimmick. I don't think it is a gimmick. It is about being transparent with the truth about our lack of courage to make hard choices.

Ultimately, what is going to happen is the world financial system is going to force us into making hard choices. We all know that is coming. We are going to have a $1.6 trillion deficit this year. Forty-five cents out of every dollar we spend we are going to borrow against our children. When does it stop? When do we start making the difficult choices we were sent to make?

So my hope is that my colleagues will support this amendment and we will, in fact, be honest and transparent with the American people about what we are doing and how we are doing it and how we don't even follow our own rules. There is a Senate rule on pay-go, a budget rule, but now there is a statute. What we have done is, we have conveniently voted in the Senate that we are not going to honor the statute, we are not going to make the hard choices, and we are going to go on and spend the future of the generations who follow.

With that, I yield the floor.

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

Mr. President, I ask unanimous consent to call up amendment No. 3358, that it be pending, and then set it aside.

I am sorry?

This is an amendment that discusses the amount that the Secretary of the Senate will put up on our Web site, the amount of new programs; that we publish the total amount of spending, discretionary and mandatory, passed by the Senate that has not been paid for.

I ask again unanimous consent to call up amendment No. 3358, and immediately after it is called up it be set aside.

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

I thank my colleague from Montana.

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

Mr. President, I ask unanimous consent that the pending amended be set aside and I send up amendment No. 3303.

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

Mr. President, I ask that the amendment be divided in the form which I now send to the desk.

I ask at this time that division I of the original amendment be made the pending amendment.

I have the floor.

Madam President, while the Parliamentarian is doing the work that is necessary at this time, I thought I would spend a few minutes talking about this amendment in the interest of saving some time.

We have a significant problem in front of us as a Nation. We have before us an underlying bill that raises the debt that nobody in this room, save the pages, will ever pay a penny toward reducing--nobody except the pages and their generation will pay a penny toward reducing.

This request for increasing the debt limit of $1.9 trillion, I remind my colleagues, is $200 billion more than the entire Federal Government spent in the year 1999, 10 years ago. So we, in one fell swoop, in 1 year, we are going to increase the debt by $200 billion more than what the entire Federal Government spent 10 years ago.

The whole purpose behind this amendment is a wake-up call to say: Wait a minute, the Congress, in the last 2 years, under its leadership, has increased spending 11.4 percent in 2009 and 11.4 percent this year, not counting a stimulus bill and not counting omnibus bills that were not paid for because they were declared an emergency.

If we add all that up, excluding the stimulus bill, we had a 28- percent increase in the size of the Federal Government in the last 2 years--just in the last 2 years. At that rate, the size of the Federal Government doubles over a 5-year period.

What these amendments are designed to do is to get us doing what every American family is doing today; that is, starting to make some of the hard choices about where we have excess, where we have inefficiency, where we have duplication, and eliminate it because we should not ask the American people to take on more debt when we know we have at least $387 billion worth of waste, fraud, and duplication every year in the Federal Government. Yet that is exactly what we are doing with the underlying bill. We are taking on more debt and not doing anything about the excessive spending or the waste, fraud, or duplication.

The whole purpose behind coming to the floor is to say: Can we not, in light of a 28-percent increase, cut 5 percent in terms of discretionary spending that we just jacked up five times that amount over the last 2 years? Can we not find 5 percent worth of waste? We have identified specifically 640 programs that are duplicative of one another in the Federal Government. We have identified waste. When we go to find out, when we ask the GAO or the Congressional Research Service to help us with this, do you know what they tell us? We cannot; it is too big. We cannot tell you where all the duplication is. That is our own research bodies saying they cannot tell us where it is too big.

This amendment puts a stop to that. It mandates that we in the future, every year, will get a report from the GAO on every program within the Federal Government that duplicates another program and what their recommendations are to streamline or change it.

The reason it is easy to borrow or easy to raise taxes is because we fail to do the hard work of eliminating the spending waste. We just had the Senator from Alabama wanting to put on some caps. That is not going to be adopted. We know it.

The reason I divided this amendment is because my colleagues will take one segment of it and say: Oh, I was for cutting 5 percent out of the Federal budget, but I just did not agree with this one segment, whether it be education or somewhere else, that we should not cut, and, therefore, I voted against the whole amendment.

This puts the American people in the driver's seat, as far as their Senators are concerned. We are going to get to see whether they agree that we ought to continue to waste money; that we ought to steal it from these pages and their generation and not do the hard work of making a choice and putting things in terms of priority like every American family is doing.

Every American family is doing that right now. They do not have an unlimited credit card. They do not have the privilege of going to the bank when they are tapped out and say: Just give me more money, like we are getting ready to do on extending the debt limit.

The other thing that is in this is leading by example. The Senators increased their budget by 5.8 percent this year. We reverse that. Most of us can easily live within the budget we had last year--easily. So we reverse the increase for the Senate back down to what it was last year.

We should not ask the rest of this government to make a sacrifice that we are not willing to demonstrate by leading on the same issue.

This bill can be the first step in a reality check of getting the Congress back aligned with where the American people are, as far as spending.

Just a year ago, in January of 2009, the national debt was $10.6 trillion. Today the national debt is $12.2994 trillion. Forty-three cents of every dollar we spent last year we borrowed, and we are going to do exactly that or worse this next year unless we wake up, unless we come to our senses.

You can have all the arguments you want, but nobody in America believes the Federal Government is not wasteful. Nobody believes it is good enough to just freeze a small portion of discretionary spending. What Americans believe is we need to cut spending. We need to cut out the waste, cut out the duplication, and cut out the fraud. We need efficiency where we can generate efficiency. We need to eliminate duplication where there is duplication.

My friend, President Obama, when he was campaigning said: I promise to spend taxpayer money wisely and to eliminate wasteful redundancy. We are going to help him with that. That is what this amendment does. In 640 programs where there is duplication, we are going to allow an incentive for each department to get rid of it. We are not mandating they have to get rid of it. We are saying: You should do the review. You should take this money, and you should eliminate the duplications. What you need from us to do that, we will give you. But we are giving you the authority to do that with these amendments.

Let me quote from President Obama:

Too often Federal departments take on functions or services

that are already being done or could be done elsewhere within

the Federal Government more effectively. The result is

unnecessary redundancy and the inability of the Federal

Government to benefit from economies of scale and integrated

streamlined operations.

He is right. So now we are going to give the Senators a chance to support his statement and his position.

Nothing has been done in the last year to accomplish that. As a matter of fact, the President sent program after program that he wanted to get rid of. He said they are not effective, they do not work, they are duplicative, and they are not efficient. What did we do?

We did not eliminate a one of them. We just kept funding them. So we cannot claim that the problems lie with the President. The problems do not lie with the President. The problems lie with the elected body of Congress in not making the hard, difficult choices of putting a priority on what is most important and taking the time to do the oversight and explain to the American people why we ought to have the programs consolidated. We may have a goal we want to accomplish and help the American people with, but we certainly ought to do it in the most efficient and effective manner we can.

The other reason to consider this amendment is to think about what is getting ready to happen to us. What is getting ready to happen to us over the next 10 years is we are going to accrue another $9 trillion in debt if we do not start this process with this amendment today. We are going to accrue another $9 trillion. Of that $9 trillion, $4.8 trillion of it is going to be interest. It is going to be interest costs on the debt. We are going to borrow money to pay the interest on the money that we borrow. It does not have to be that way.

My colleagues will come down and say: The big problem is the entitlement programs. There is no question that is two-thirds of our problem. But the easy thing to fix now and saves billions, if not trillions, of dollars on is the discretionary portion of the budget that we do have control over.

We always hear the excuse: That is not the big problem. The reason it is not the big problem is because politicians enamor themselves with people at home by spending money we do not have on things we do not need that are not truly a legitimate role of the Federal Government.

The family budget is getting smaller, and the Federal Government is getting bigger. That is just exactly the opposite of what ought to be happening in this country today. Inflation is near zero, but yet we are increasing spending, like I said, 11.7 percent last year. That does not include the supplemental emergency spending and does not have any connection at all with the stimulus bill. That is what we did with the individual budgets across the Federal Government.

When I come down and make the case for cutting back 5 percent of that, which ends up being $120 billion, nobody should be opining: My goodness, we are going to tear things up. But we are going to hear that. We are going to hear all the reasons we cannot do what I am proposing to do.

America is not going to buy that anymore. They are not buying it anymore, and they should not buy it.

The other thing this amendment will do is it will give us 30 days to come back and assess other areas where we can cut more spending. People in this body think that is hard. It is not hard. Let me give an example of where we can save $80 billion a year in one program.

At a minimum, there is $100 billion of fraud in Medicare a year. We do not have an effective strategy, like any other organization outside of government, to limit the defrauding that goes on in Medicare. We pay, and then we try to chase people we should not have paid.

Senator LeMieux from Florida and others have multiple ideas on how we could take that $100 billion and over the next 6 months save $30 billion or $40 billion of that. That is $30 billion or $40 billion each year over the next 10 years. That comes out to $\1/2\ trillion, which cuts down that $9 trillion in additional debt we are going to be encumbering upon our children. Last year, this country's debt grew $4.2 billion a day. We didn't do anything about that except spend more money, so this year it is going to accrue at $4.3 billion a day. That is how much we are going to spend that we don't have.

Isn't it time that we start facing the situation as it is rather than the way we would like it to be? The cold hard facts are that we have a short timeframe--4 to 5 years at most--to get our house back in order. Now is the time to start. It is not next year, it is not next month; it is right now--right now, when the American people may or may not be focused on the fact that we are going to authorize an additional $1.9 trillion worth of borrowing. You can't even write that many zeros down and have a comprehension of how much it is. At the same time, we don't do anything about solving the problem.

Quite frankly, Congress has a dependency issue. We are addicted. We are addicted to spending. We are addicted to the age-old adage that if I spend enough money, I can go home and tell people how great I am, not ever telling them I am spending their money and their kids' money but claiming I am looking out for them.

The only way you really look out for America is to secure America into the future, and we have not been doing that. It hasn't been done under the Republican watch, hasn't been done under the Democratic watch. What has happened is the same old same old of continuing to ignore the problem and not taking the heat for making the tough choices that will put our country back on the track on which it belongs--a track that will secure a future for our children and grandchildren, that will embrace the heritage that made this country great. What was that heritage? That heritage was sacrifice. In this country, all of us--many--are sacrificing now, and many in the future are going to have to sacrifice.

Others will come down to the floor and they will say: Well, Coburn, all you want to do is cut spending; you don't really want to solve the problem. Well, the first part of solving the problem is cutting the spending and recognizing that the walls don't fall down if you cut 5 percent out of the discretionary spending in our budget. As a matter of fact, very few people will ever notice $120 billion coming out of the Federal Government on these discretionary programs because they will just go to a different grant program that does the same thing and get it there.

Let me go into some of the facts because many of us don't understand. Here are some examples:

There are 14 programs administered by the U.S. Department of Education related to foreign exchanges and designed to increase opportunity for students to study abroad. There is nothing wrong inherently with wanting our students to study abroad, to gain that perspective and to gain that education, but why 14 different programs? Why not one? Why not 1 program and save all the administrative costs of the other 13? Why not do that? Because somebody may not have their name on a program? The fact is, nobody knew that until we discovered it in the last 4 weeks.

There are more than 44 job-training programs administered by 9 different Federal agencies across the bureaucracy, costing $30 billion a year. Forty-four Federal job-training programs? Tell me why we need 44. Maybe 4 to hit different areas in different situations but not 44 and not through 9 different Federal agencies that are all trying to do the same thing and competing to throw out money.

What about 69 early education programs administered by 9 different Federal agencies. Sixty-nine, why would we tolerate that? Why would we continue with the status quo? Now is the time to make changes.

One of my favorites is that we have 105 Federal programs supporting science, technology, engineering, and math--105 different programs where we support that--funding over $3 billion a year. I agree we ought to encourage it, we ought to stimulate it, we ought to support it because we know we have to be competitive in the future, but do we really need 105 different Federal Government programs? The answer is, absolutely not. We don't. But because we don't know what is there, we continue to do the same.

As a matter of fact, there is going to be a Judiciary markup on Thursday that has a new program in it--supposedly new--and the authors of the bill have no idea that we already have a Federal program that does the same thing. That is why the important key component of this global amendment is to make sure the GAO tells us what is out there, what we need to do, and how we need to go about it. We may need some redundancy, but we don't need 105 times redundancy, we don't need 30 times redundancy, we don't need 44 times redundancy, and we don't need 69 times redundancy. As a matter of fact, when we have all these programs, the States have to hire all these different people to understand all the different programs so they can make sure they get their fair share. We could actually save the States a ton of money if they

only had one-stop shopping--if, in fact, it is a truly legitimate government function.

The amendment also rescinds unobligated discretionary funds that have been available for more than 2 consecutive fiscal years. So it doesn't hurt the agencies if the money has been there and they haven't spent it. As a matter of fact, we are giving them so much money, they can't spend it all. We have seen unobligated balances go up because they can't get it out the door. And when we are pushing them to get it out the door, guess what happens to efficiency and accuracy and effectiveness of those programs. It goes way down.

According to the Office of Management and Budget, at year end 2009, that is, September 30, there was $657 billion sitting in unobligated funds. Some of that is military, some of that is war funds, some of that is VA. We exempt war funds and we exempt VA. We exempt DOD, but we shouldn't because there is $50 billion a year in waste in the Pentagon that can easily be demonstrated.

So we direct the GAO to identify those duplicative programs and report to Congress on the findings.

Madam President, may I make an inquiry of the Chair? Has the status of our division been decided?

Madam President, I suggest the absence of a quorum.

No. To answer the Senator's question, we do not even know how many duplicative programs there are out there. These are the 640 we found looking over a 4-week period.

But when we asked GAO or the Congressional Research Service about this, what they say is the task is too big. They do not even know if they can accomplish the task, which goes to the enormity of the problem we face.

I mentioned on the Senate floor earlier, we have a markup tomorrow in the Judiciary Committee for a new program, and it is duplicative of an existing program. But those offering the amendment do not even know it. So it shows we have to stop and reassess. Part of this amendment is creating a mandate that the GAO has to advise us on that.

Would the Senator yield for a question?

No problem there.

Is the Senator aware that the foreign ops appropriation increased by 11 percent in 2009 and 33 percent last year? Yet the Senator is saying we can't trim 5 percent from that budget? Am I hearing the Senator correctly? We increased it 46 percent in 2 years, and we can't cut 5 percent?

Mr. President, reserving the right to object, and I will not object, but I want to convey my appreciation to the leader and his staff for allowing division in the four areas on my amendment.

Mr. President, we just heard the chairman of the Judiciary Committee, who is also chairman of the appropriations subcommittee, give the typical Washington talk on why we can't cut spending. In light of the fact there has been a 45-percent increase in his area of appropriations, we now can't come back and give 5 percent of that back to the American people.

Forty-five percent growth in 2 years, and we are picking winners and losers? We are not picking winners. The only winners we are picking are the American people.

The fact is, there hasn't been a major program eliminated by the appropriations subcommittee in 5 years. What they do is, once they are there, they are there forever, and nobody is willing to make the hard choices. That is typical of all the talk we will hear about why we can't cut $120 billion from the expenditures for this year--$120 billion out of $3.4 trillion, and we can't come up with 5 percent. We can't find it.

We are giving you a way to do that. Everybody is going to get to vote, and we are going to send a message to the American people. At the rate we are growing the government, it will double in the next 5 years, and we can't find 5 percent, when they are having to make 10, 15, 20, and 25 percent cuts in their own budgets.

What we heard was the typical appropriations response: We work hard, let's save this for appropriations. The problem is it never happens because every bill, somewhere, has a small constituency--every program. We listed 640 programs that have duplication, redundancy, and inefficiency. Yet we hear an appropriations subcommittee chairman say: Oh, no, we can't.

Well, the American people don't get that. We ought to be about trimming the waste out of this government, and at a conservative estimate there is at least $387 billion in waste, fraud, or duplication this year.

So we have the tremendous opportunity to come down here and deny the truth the American people know: This government is wasteful, it is not efficient, and most of the time it is not effective. When we try to make a commonsense, small cut after a tremendous growth over the last 2 years, we hear: No, we can't. No, we can't. We hear a sob story. We can't do it.

The fact is, we don't have a future unless we start cutting spending. The President even asked his staff to give him an option on the budget of a 5-percent across-the-board cut. We will hear tomorrow night about freezing discretionary spending. It is easy to freeze discretionary spending. We have just jumped it 27 percent across the board. But the freezing doesn't start until 2011. We are not going to freeze it until 2011. Our problem is today. The problem that our children are going to face is being manifested and made significantly harder because we are fearful to make commonsense cuts.

Mr. President, $100 billion out of this $120 billion comes from $660 billion that is sitting in agencies that haven't expended it over the last 2 years--the $660-some billion. We are saying, of those that haven't been spent, that hasn't been rolled out over the last 2 years, send $100 billion back. It is easy. We are spending money so fast that the agencies can't even get it out the door. When they do get it out the door, it is ineffective and highly inefficient and loaded with fraud.

Why in the world would we reject making commonsense efforts just like everybody else in this country is having to make today? Why would we put in the perspective: Oh, we can't do these little things, from the Foreign Operations Subcommittee, when in fact our country is drowning in debt and the future for our children is in doubt? We cry crocodile tears over some little program somewhere that in the whole realm of things is either duplicated or highly ineffective. We want to keep every last one of them.

We just heard the chairman of the foreign ops subcommittee say we can't do any of this. They are way too valuable; we can't do it.

Well, what is more valuable, taking care of the next generation, embracing our heritage of sacrifice to create opportunity or satisfying a small interest group that is dependent on a government program that is both ineffective and inefficient and also has three or four other programs that do exactly the same thing?

The first component that we are going to vote on is a mandatory request of the GAO to tell us the duplication; tell us across agency lines where we are failing. What do we need to know? Nobody can tell us that today. When we asked the GAO--personally asked the GAO--they said the task is too big. Well, that ought to be our first signal that something is really wrong, when the Government Accounting Agency says the government is so big and convoluted that they can't tell us where we have duplication. They cannot give us recommendations on what to eliminate.

That ought to be our first signal to say time out, stop, cut some spending and let's see who squeals, and we will put back if we have made a mistake.

The American people understand, more than we do, what is at risk in the future. They want a secure future. They want the ability to plan for their children and their grandchildren. They do not want a fiat currency, which is what is coming if we do not rein in spending.

Most of my colleagues know that is the problem before us. The question is, will we have the courage to go after it. It would be different had we not had significant increases over the last 4 or 5 years in this country, in terms of the budget of the Federal Government. But it has doubled. We are going to have an increase in the debt limit for 1 year that is $200 billion more than the entire government spent in 1999. In 10 years we are going to borrow $200 billion more than we spent--just to operate 1 year--than we spent in the entire budget in fiscal year 1999. Of every penny we spend this next year, 44 cents of it is going to be borrowed--$4.4 billion a day.

What this amendment says is let's not make that so. It does not have to be so. Let's cut it to $3 billion or $3.3 billion of that. Let's save the future for our children.

I am reminded that hard things are hard. Habits are hard to break. The habit of Washington is to never have to make a hard choice. We heard a stellar representation by the Senator from Vermont about why things cannot change here--because everybody has a special little project, they want to protect. While they are protecting their special little project, they are forgetting about the country as a whole. That should not be the legacy we want to embrace. The legacy we ought to embrace is that we had the courage to make the hard, tough decisions at a time when it was called for. Now is that time. It is not 2011, it is not next month, it is not when the appropriations bills come, it is now.

Just think what would happen to the dollar tomorrow if the Senate cuts $120 billion of discretionary spending that is wasteful and duplicated and is not going to make a difference in nary an American life. The signal it will send to the world is we are back on track. The value of the dollar will rise, the cost of oil will go down, the standard of living of consumers will go up, and every family this year will benefit to the tune of $794, if we agree to this amendment.

I think the citizens of America are worth that. I know their children and grandchildren are worth it. The question is, will we curry up the courage? Will we meet the challenge that faces this country or will we continue the status quo because we have always done it this way? Doing it this way is exactly what put us $12.4 trillion in debt; by this time next year $14.2 trillion in debt. It is mortgaging and stealing the future of our children.

I look forward to seeing the outcome of the votes, and I know the American people do. This is the first time in a long time we have had a true vote on the floor to make a difference in what is going to happen in the finances of this country. My hope is we will not disappoint, again, the American people.

I yield the floor.

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

I ask for the yeas and nays on my amendment.

Mr. President, this amendment rescinds our increase for our operations. We increased our budget 5.8 percent at a time when there was no inflation last year, zero. The year before that, we had increased our budget in excess of 10.9 percent, which means we effectively increased our own budgets to run our own operations 17 percent in the last 2 years, with less than 1 percent inflation over that period. If, in fact, we can't lead by example to cut our own budgets to help the country move out of the problem it is having, it is probably because we are not very good managers of our own budgets, which belies the problem we now face. I appreciate support on this amendment. The American people would sincerely appreciate support on this amendment.

I reserve the remainder of my time.

Mr. President, it is remarkable what length we will go to defend our budgets. The fact is, the assumption Senator Durbin made is that we are efficient. The fact is, we are not. Everybody in here could turn back at least 10 percent of their budget if they ran their office efficiently. We know that. Nothing in Washington is run efficiently. So to say we can't do it without putting ourselves at risk is poppycock. It is time for us to lead. Now is the time.

I ask for the yeas and nays.

Mr. President, we are going to hear why we cannot do this, kind of along with the debate we just heard from the majority whip. But here are some examples for you. This is what the GAO found.

In 2005, 13 different Federal agencies spent $3 billion to fund 207 programs to encourage students to enter the field of math and science. Mr. President, 207 different programs, and we are going to vote against eliminating them here in just a minute.

In 2003, $30 billion was spent on 44 job-training programs administered by 9 different Federal agencies. Fourteen departments within the Federal Government, 49 independent agencies operate exchange and study abroad programs. So 14 departments, 49 independent agencies operate exchange and study abroad programs; 69 early education programs administered by 9 different agencies; 23 Federal housing programs that target or have special features for the elderly operated by 6 different agencies.

That is just a minimal number.

We are going to hear why we cannot do this. The American people are wanting to know when we are going to do what is right, what is possible, and what is best for the long term, not the short term.

With that, Mr. President, I reserve the remainder of my time.

Mr. President, what the American people are asking is, Why aren't the three nursing programs combined so you have one set of overhead to administer all three programs? That is what they are asking. This does not cut any money for the homeless. What it says is, put all the homeless programs under one set of administration where we save money and are much more effective at what we are doing because we are concentrating it within one area. We can have all sorts of reasons why we cannot do it. Let's find the courage to do it for the American people and the kids who follow.

Mr. President, I yield back the remainder of my time.

Mr. President, I ask for the yeas and nays.

Mr. President, last year Federal agencies ended the fiscal year with $657 billion in unobligated balances. There is no question a great deal of that is associated with the war efforts and other things, but according

to OMB and CBO, approximately $100 billion of that has been sitting for 2 years or longer, never having been obligated for what we have directed it to. So we have $100 billion sitting out there that the agencies have not been able to spend. Obviously, if they haven't been able to spend it in the last 2 years, it is not a priority. If, in fact, we rescind that money to the Treasury, we will cut our deficit $100 billion, and then we can reappropriate what is necessary for this year. The rule in the Federal Government is after 2 years it is supposed to go back to the Treasury anyway, which is not being enforced for everybody except the Treasury Department. They are under that obligation.

So here is an opportunity--it doesn't affect anything because the money hasn't been obligated--to put it back in and start over and reprioritize. That is all it is about. It will actually move $100 billion back and then our appropriators can decide whether they want to put that back this year.

I appreciate your consideration on this amendment, and I reserve the remainder of my time.

Mr. President, the dangerous consequences facing this Nation aren't as outlined by the chairman of the Appropriations Committee. The dangerous consequences facing this Nation are continued spending and borrowing from the next generation and a creditworthiness that is not going to even be BBB. There is no question there is danger before us. It is not this amendment. It is the continuing efforts on the part of those who are in Washington to not recognize the fact that we are wasting money hand over fist and, in fact, we appropriate yearly on many of these projects. So it will not eliminate any as outlined by the chairman. It will give us a chance to reprioritize, which every family in America is doing today.

I ask for the yeas and nays.

Mr. President, I ask unanimous consent that these letters commenting on the Patient Protection and Affordable Care Act of 2009-- the majority's ``health reform bill''--be printed in the Record.

Mr. President. I ask unanimous consent to have printed in the Record the following letter I sent to Mr. Alan Frumin, Parliamentarian of the U.S. Senate, on January 8, 2010, regarding the ruling that occurred in the Senate on December 16, 2009, during consideration of the health care reform bill that permitted Senator Sanders to unilaterally withdraw his amendment during its reading.

Madam President, I know our leader is coming to speak,

but prior to him coming, I will take a portion of my time that has been allotted to me by my side.

I sat here with great interest listening to the Senator from New Mexico. He referenced the State of Massachusetts. I entered into the Record yesterday the 21 percent of the people under the plan who could not get care in Massachusetts because they could not afford the copay and the deductible. This is basically a copy or model off of that.

He also discussed the fact that this shows a $132 billion savings over the next 10 years. That is provided you do not think you are going to allow any increase in doctor payments and you are not going to reverse the 21-percent cut.

Madam President, my leader is here, and I will be happy to yield to him at this time.

Madam President, I would just follow with one comment to my leader as far as his comments.

In 2007, we passed a bill called the Honest Leadership and Open Government Act of 2007. That act requires the posting of any earmarks or direct benefits for Senators in any bill. It has to be posted. We have not seen that with this bill, though we know there are numerous and sundry specific earmarks for Members.

So my hope is that sometime during this process, we will take up the violation of this very law by the leader of this Chamber in terms of ignoring it and flaunting it. What he said, when we passed it, was it was a needed change, and now we see it ignored as they bring this bill to the floor.

I thank the leader.

I want to spend my time this morning kind of talking about how you control health care costs in our country. My experience, just from my qualifications--I have 9 years of experience in manufacturing medical devices. I did that as a young man, had hundreds of employees and a fairly large business. I left that business to become a physician. The call of my life was to help people directly rather than indirectly through my medical device association.

So I want to lay out the two different ways, the two different arguments for how we control health care costs because everybody in this Chamber wants to control health care costs. All the Democrats and all the Republicans do. We have 11 studies that say premiums are going to rise and one that says they are not under this bill. So that is not going to control costs.

But I want to read a story that a lady from my district wrote me because I think it is very important in us considering which way we go.

Dr. Coburn,

I hope you don't mind a personal story, but as I listen to

the health care debate, I can't help but think constantly of

my middle daughter. I am convinced that Chloe would have lost

her chance for a normal life, had these policies--

In this new health care bill--

been in effect two years ago. No government agency could

possibly have understood Chloe's unique needs or her

extremely rare condition.

After a perfectly healthy childhood, my seventeen-year-old

showed me that her left arm was twitching and wouldn't stop.

Within weeks, the entire left side of her body was jerking

constantly, every waking moment of every day. Her MRI

revealed more than one periventricular heterotrophic nodule--

That is a growth around the ventricular system, the fluid system of the brain--

but her first two neurologists weren't sure there was a

connection between the [changes in her movement and the

movement disorder and the symptoms and the nodules]. They

certainly had nothing useful to offer in terms of treatment.

But I made the rash promise to my daughter that someone,

somewhere, knew what to do, and that we would not stop

looking until we found that person. Unlike mothers in a

government run system, I was free to research the options and

apply where I wanted. Our search took less than three months.

Chloe's pediatric movement disorder specialist at Mayo

Clinic called her condition ``unique'' and unclassifiable. He

had to debate her case with his neurology team, but in the

end they were willing to try an unprecedented series of brain

surgeries. Chloe was desperate to live a normal life again,

so my husband and I agreed, though perhaps you can imagine

what an excruciating decision that was. Today, Chloe twitches

a little, but anyone who didn't know her history would think

she is just fidgeting. She is an honors linguistics student

at OU, and she even takes dance lessons. She recently started

driving again. She said once, ``Mom, without the surgery, I

would be strapped into a wheelchair now.

I know that Chloe would never have had the unique care she

needed, if we had been required to petition a government

agency for permission. A less dedicated person than her

subspecialist would have tried to classify her condition and

restrict her to known treatments. In fact, other

subspecialists wanted to make those same restrictions.

Chloe's doctor learned how to treat her by spending a great

deal of time with her, by talking to her and to us for hours

at a time, and by observing her in multiple contexts. I fear

for the next mother whose child has an unclassifiable

condition, and whose treatment is planned by a faraway

committee with a diagnostic manual open on the table.

Chloe won't be in that manual.

The thing that keeps people from getting health care in America today is the cost of health care. We have had all sorts of attempts of, how do we do that? We have had the Massachusetts model, and, as entered into the Record yesterday, they have insurance reform. Almost everybody in Massachusetts is covered. Yet last year 21 percent of those people who were covered could not get care because they could not afford the deductibles and copays. So expanding insurance and expanding the model does not solve it.

So you can either approach controlling costs or you can ration care. What has happened in this bill, as it comes through, is we have chosen to ration care. My colleagues are going to dispute that, but I want to offer significant evidence to offset that and discuss what is in the bill and to also discuss what is not in the bill.

What is not in the bill is a prohibition against rationing, which all of my colleagues on both the Finance Committee and the HELP Committee voted against, which means you are for rationing if you vote against, a prohibition. The leader denied an amendment on the floor of the Senate to eliminate rationing, so we do not get to see where everybody stands. But we understand the intent. So there is no question that the way we are going to control costs is to limit your access by rationing health care.

The other side of controlling costs is to incentivize the prevention of disease and incentivize payments for good outcomes when we manage chronic disease that is there in an efficient and effective way. That is not in the bill. That is not anywhere in the bill. What we have to do is incentivize an insurance company to invest in the management of chronic disease rather than to pay for the consequences of the chronic disease. That is not in the bill either.

So we get two choices.

Now, what do we find in this bill? We find a Medicare advisory commission. They actually dropped the name ``Medicare'' from it, but we find an advisory commission that is going to tell us how much money we have to cut from Medicare, and we either have to cut that amount or make some cuts somewhere else.

We have the U.S. Preventive Services Task Force, and we have already seen during the debate on this bill when they do something that is based on cost alone--not clinical; breast cancer screening for women between the ages 40 to 50--when they do something on the basis of cost instead of clinical, we run in and jump and say no, but we are going to pass a bill that is going to totally empower that. Seventeen times in this bill is the U.S. Preventive Services Task Force referenced in what it is going to tell us what to do, and it is not going to tell us just in Medicare and Medicaid, it is going to tell us in every area what we are going to do. But because there was such a reaction to the first recommendation based on cost--and let me explain what that was. They said that if you are age 50 and over, the incidence of finding somebody with breast cancer is 1 in 1,470 people, but if you are between the ages of 40 and 50, it is only 1 in 1,910 people; therefore, it is not cost-effective. So it does not matter if you have breast cancer between the ages of 40 and 50, we do not think the government ought to be paying for your mammogram and we do not think anybody ought to have one. Well, that is fine for all those people who do not have breast cancer. It is terrible for the people who do have breast cancer and it could be found early with a mammogram.

So we rushed in here and we offset what that task force did. But they are going to be doing it time and time again. And is the Congress going to truly--every time they make a decision based on cost-effectiveness, not clinical effectiveness, are we going to reverse it? We are not. So there is another proof that we are, in fact, going to use the rationing of care to control costs.

I would be happy to.

I am not sure I can answer the question. But it would make it less effective in terms of supposed claims.

I think the Senator from North Carolina is really going to where I am going to get to later; that is, what is the motivation for the decisionmaking? I think my colleagues on the other side of the aisle are well intended, but I don't think they are well informed about the consequences of their intentions.

So if you set up the Task Force for Preventive Health Services and say you are going to rely on it, but we know they are going to make the decisions based on cost-effectiveness, not clinical effectiveness, what we are going to see is the American Cancer Society coming again and again and again because what we are going to do is we are going to cover those where it is cost-effective but not clinically effective. For 80 percent of Americans, they are not going to notice the difference, but one out of five Americans is going to notice the difference.

The second area, which I wish to spend some time on because we have actually modeled it after England, is cost comparative effectiveness. We ought to talk about what is comparative effectiveness research because there is nothing wrong with the research. It is health care research comparing various drugs, devices, and treatments head to head, and the whole goal of that is to find out what works best and what costs the least.

The assumption in this bill is, we can have 24 or 36 people in Washington decide that. In the Framingham studies they have been running for over 50 years on heart disease, we still don't have the answers and we have been studying it for 50 years. But we are going to be making decisions on cost, not on clinical effectiveness, which is going to limit your ability to have what you and your doctor think you need.

So we are going to pull out clinical experience of individual physicians. We are going to eliminate the heart of medicine, which is the combination of vast experience, gray hair, long years of training, family history, clinical history and physical exam and we are going to say: No, it doesn't matter. We are going to say: Here is the way you are going to do it.

Who uses comparative effectiveness research? Well, several countries do. When I share with my colleagues the stories about how it is used, you are going to get a real vision of what is coming with this bill--a real vision.

This bill creates a new agency called the Patient-Centered Outcomes Research Institute to perform comparative effectiveness research. I have already said the idea behind it is good. I strongly support medical research. I strongly support helping doctors and their patients choose the best research and the best treatment. The problem is, this bill doesn't do that. On the contrary, this bill will empower the government to decide which treatments you can have and which ones you cannot have. That is what this does. This removes the judgment of the doctor and replaces it with the judgment of the bureaucracy in Washington. It is not a hypothetical concern, it is a real-world problem.

In Britain, they control health care costs by denying or delaying access to expensive therapies. That is one of the reasons this country has one-third better survival for every cancer you can imagine over Great Britain because we don't do that. As a two-time cancer survivor I am acutely aware as a patient, not as a doctor, in that I want to make sure for my family and my patients they have the best alternatives, not the cheapest, because the cheapest alternatives are the ones that take years away from your life.

I am going to go through some examples. Nobody can dispute this is what is happening now and what will happen under our program. To Senator Baucus's credit, he had a bill that wasn't cost comparative effectiveness; he had one based on clinical comparative effectiveness. That is not in here. What is in here is cost comparative effectiveness. Senator Baucus knew you don't want to use cost as the main thing; you want to use clinical outcomes as the No. 1 deciding agent in how we approach health care--not cost--because if you only look at cost, nobody in this country would get a mammogram between 40 and 50. But this bill is different from what Senator Baucus had offered in his Finance Committee markup.

There is an agency in Great Britain called the National Institutes for Health and Clinical Excellence. It is pronounced NIHCE. Here are some of the decisions of NIHCE in the most recent years. They have a problem in England with cost, too, and they have a single-payer, government-run system. They have the government running it, but they still can't control their costs, so what have they done?

They have repeatedly denied breast cancer patients breakthrough drugs. They have forced patients with multiple sclerosis to wait 2\1/2\ years to receive new innovative treatments that people in this country are getting as soon as they are available. They have denied early stage Alzheimer's patients medication, requiring their condition to worsen before they give them the medicine. What do we know about the medicine? It works best when you have the slightest symptoms of Alzheimer's, not when you get worse. But that is the bureaucratic thinking: We will save money rather than practice good medicine.

They deny life-prolonging treatments to kidney cancer patients. They denied new medicine to all but a small percentage of patients with osteoporosis and then only as a last resort. In other words, you have to about have your bones breaking by standing before you get medicine for osteoporosis in Great Britain. In this country, we have prevented millions of hip fractures through effective medicines to restore the calcium and bone matrix in seniors' bones. But we have Medicare now saying you are doing too many tests to check on that, so you can only do it every 2 years. So we are going to use rationing, and we are.

They denied access to the only drugs available to treat aggressive brain tumors. They denied effective drugs to bowel cancer patients, colon cancer.

Macular degeneration is something that affects a large number of people in this country. That is where the macula--the area that actually allows you to see and concentrate your vision--as we age, we have what is called cystoid macular degeneration or dry degeneration. That is a disease of the eye where it causes vision loss. NIHCE required patients suffering from macular degeneration to go blind in one eye before they could have the medicine that almost every American who has macular degeneration in this country has. She had to go blind first in one eye before you could ever get the medicine. That is a bureaucrat making this decision or a bureaucratic committee because it was cost-effective to allow you to live with one eye. Elderly patients went to court to fight for drugs to keep them from going blind. Twenty- two thousand Britains became totally blind through that ruling by the NIHCE. In one case, an 88-year-old World War II veteran and former Air Force pilot sold his house to pay for the drug after the government said they weren't going to pay for it. The Royal National Institute of Blind People said that as a result of NIHCE's decision, countless people have either been stripped of their sight or stripped of their life savings to pay for private treatment.

For Alzheimer's, they ruled that three drugs, common to many people who are listening today--Aricept, Reminyl, and Exelon--were not cost- effective for patients with early Alzheimer's disease. Well, those are the only ones they work effectively on. One hundred thousand Alzheimer's patients a year were denied treatment that could have slowed the progress of their disease. The British Alzheimer's Society said this decision was disgraceful and victimized the most vulnerable in our society.

Brain cancer. Gliadel and Temodal were not cost-effective for treating brain tumors and severely restricted their access to them. A 47-year-old woman sold her house to buy the drug the government refused to provide. They have been held as the biggest breakthroughs in treating brain tumors in the last 30 years. Finally, in April of the year before last, they finally relented and allowed brain cancer patients to have the drugs that were available on the market.

Erbitux, very effective in resistant colon cancers. In 2006, denied. Seventeen thousand Britons a year get the sort of advanced colon cancer that Erbitux is designed for. Yet they can't have it.

That is the problem with our system today. What we are going to hear them say is the insurance companies do this now. At first, for new treatments, until they are proven effective, most insurance companies don't cover them, but they cover them much sooner than Medicare does today. Today, Medicare is the last to approve the drugs.

We are going to hear that is not any different than the limitations from insurance. That is true. We need to change that. But the fact is, we are getting ready to put all these people into insurance programs, and then we are going to have the Federal Government, which is just as bad or worse than the insurance company, making those decisions.

I wish to finish my point on cost. We get two ways for fixing cost because that is what is keeping people from getting access. We can either ration it--and there are three methods to rationing in this bill which will be used--or we can incentivize outcomes and we can incentivize prevention and we can pay, based on the transparency of outcomes and quality. We haven't done any of that in this bill. We have said we have, but when you look at how do you prevent it--and the model is the 200,000 employees at Safeway and what they have been able to do in using their incentive systems to pay for prevention, to use competitive purchasing to reconnect the employee with the purchase of health care.

I understand my colleague from Nebraska is here, and I will yield to him because I understand he was a unanimous consent request.

Madam President, I have a question for both the Senator from North Carolina and the Senator from Nevada. Can the State of Nevada or the State of North Carolina or the State of Nebraska or the State of Oklahoma be healthy if our country doesn't flourish? So no matter what we do for our own States, if, in fact, we are not thinking about the country as a whole, the best right thing for the country as a whole, none of our States can flourish.

Madam President, I ask unanimous consent to have printed in the Record an article that appeared today. It is a quotation from the founder from the Daily Kos Web site. I will give it to the clerk in a moment. I wish to read a quote from it:

I don't think this is a reform bill. I mean, I think it is

very clear this is not insurance or health care reform. What

it is is allowing more people, 30 million people, to buy into

an existing broken system. It is very important to keep in

mind that health insurance is not the same as health care. If

you go up to Massachusetts, they have a mandate as well. Last

year, in Massachusetts, 21 percent of the people who are

insured could not get health care because they could not

afford it.

That is somebody who is very well respected on the majority side, and it is something we have been saying, and they are saying the same thing. The fact is, what we are going to do is put 15 million people into Medicaid that we know has worse outcomes, we know is an unfunded mandate on the States, and we know 40 percent of the doctors refuse to see them. So you are not going to get to choose the doctor you want to see. You are going to have State mandates in terms of what is available to you and what is not. So we have violated two of the key promises with which to reform health care.

Madam President, I wish to also quote from what I think is a brilliant letter by a Dr. Robert Geist from St. Paul, MN, that was written as a letter to the editor in the Wall Street Journal today. The title of his letter to the editor is, ``The First Cost Controller Will Be Your Own Doctor.'' It is something I have been talking about since we started this. The last thing we want to do in health care in America is to make it where the doctor is not a 100-percent advocate for the patient's best interest.

He quotes very directly the transfer. He said a previous article written:

. . . doesn't emphasize a potential stealth cost-control

aspect proposed in the bill. It will start pilot programs

that would transfer the gatekeeper role to doctors at the

bedside, a role currently held by ``payers'' (HMOs and

government-agency insurers, including Medicare and Medicaid).

The transfer will be via capitation fee payments, making

clinics ``responsible'' for the cost of care of ``insured

lives'' for one year. . . . The illusion of many pundits and

policy makers is that mini provider gatekeepers can control

costs after the very powerful payer gatekeepers--

That is, Medicare, Medicaid, and the large insurance companies--

have failed for decades. The problem for patients is the

dilemma of all managed-care gatekeepers: cost, quality,

access; pick any two. It is not pleasant to think that one's

gatekeeper doctor will have to decide whether to order

surgery for your painful [worn out] hip or only to increase

the dose of--

Anti-inflammatories because they are worried about costs.

That is the key point. We are going to now separate physicians in this country for doing what is best for the patient to meet the demands of the government.

I will be happy to yield.

That is exactly why I am not a member of any HMOs.

Let me finish this for a minute, if I might. Here is the summarizing paragraph:

The economic reality is that no rationing of care supply

will ever control costs, when the problem is demand inflation

driven by popular insurance tax subsidies too sacred to

repeal. Consider that when federal fiscal ``necessity''

overwhelms empty slogans,--

Our empty slogans--

scores of new bureaucracies created in [this bill] would be

able to implement Draconian rationing in collusion with

subservient insurance and ``provider'' corporations. The high

costs, as well as the rationing powers included in the more

than 2,000 pages of the ObamaCare Senate legislation are very

real.

Which is the point I have been making all along. I am going to spend 30 minutes tomorrow talking about the rationing aspects of what we are about to do as we pass this bill.

What we also know from the Congressional Budget Office is that between 9 and 10 million people who today have insurance through their employer will actually lose it. They are going to lose their insurance. That may be good or bad for them. But if you look at the incentives, the subsidy for people who do not get insurance through their employer, if you make $42,000 a year, today with your health insurance through your employer you get a benefit of about $5,749 from the tax system. But under this bill, you will be eligible for $12,500 worth of subsidy.

What do you think an employer is going to do? They are going to look at their employees and they are going to say: I have to pay this penalty if I don't offer this, but it is a significantly smaller amount than what I am paying today. Therefore, I am going to make a decision to no longer offer health insurance, give my employees a small raise because the government is going to come in with $12,500 worth of subsidies to put them in a ``private'' plan inside the parameters of what is in the exchange. How many people do you think it is going to shift?

What we are going to get is adverse selection. So the individual-- let's say I am working and I am making $42,000 a year and my employer decides to do that and let's say I am 35 years old and I know available to me is $12,500. Even though my earnings may go up, I am still 2\1/2\ times better off.

I also know I will have to pay $3,000 or $4,000 of my own money to get that benefit. I will not cover myself because I know I can cover my little incidentals. If I get sick, they have to cover me in the exchange.

So we are going to see adverse selection in the insurance market, people who are between 40 and 64 who are sick are going to pay far more for their health insurance and people who are sick who are younger than 40 are going to pay far more for their health insurance and everybody who is healthy under 40 is going to say: This is an economic bonanza for me. I am not going to buy insurance.

Well, the disappointing thing--and I have worked on this for 5 years, since I have been here--is we are not honest with the American people about how we account for things, and this bill is another example of that. Let me give you the quantifications.

If you read the CBO report on this bill, they talk about it is highly unlikely we will ever actually make the Medicare cuts, because they have never seen it done, and every time we have said it in the past, we haven't done it, like the sustainable growth rate formula in the Balanced Budget Act of 1997. So if you match up revenues and expenses, what you see is a $1 trillion tax increase, a $1 trillion cut in Medicare, and an increasing cost to the economy.

But because there is not the sustainable growth rate--the doctor fix in the bill--that is $247 billion not accounted for, and that is if you keep physician wages frozen over the next 10 years. That is $247 billion, probably closer to $300 billion. So that is $300 billion. The fact is we know the taxes that are going to be collected, people are going to pull down the cost, which is one of their hopes, and they are going to pay for it out of their pocket.

So we are going to see that insurance plans not reach the Cadillac level, and we are counting on revenues from that in terms of billions and billions and billions of dollars. But what they will do is change the deductibles--and that is a hidden tax. Because if your deductible goes up to keep your insurance from going too high, your tax goes up in actual expenditures. So your ability to invest and create additional jobs--in other words, it cascades. The honest accounting for this is that there is no way this saves any money. It will cost money.

The final point I will make is they won't put forward the cuts in Medicare that they are claiming in this bill. Because they know if they truly do put forth the cuts, and patients feel it, they won't be back here. So it won't happen.

I will go back to what Senator Burr started this out with. If you are going to start tomorrow and fix health care, what would you do? You would attack costs. Why are things so costly? One is because there is no transparency in markets. There is no real connectedness to your pocket. No. 3, there is no incentive for prevention of chronic disease or the management of it. In other words, we don't pay people to have less expensive outcomes. We won't incentivize better care in that way. We won't incentivize prevention.

We have done a lot of this on Medicare--and I will talk about it tomorrow--but they have three different agencies within this bill that are going to ration care. They are going to make the decisions for you, and not just on Medicare and Medicaid. Everybody needs to understand that. It doesn't just apply to Medicare and Medicaid, it applies to your choice of your private insurance. The government is going to ration your care.

We know that is true because they wouldn't allow an amendment to prohibit rationing. They all voted against the amendments in committees when we offered amendments to limit rationing. So we know the intention is to ration care. If that is how we are going to control costs, then Bernie Sanders is right--go to a single-payer, government-run system. Bernie Sanders' system is far better than this one--far better than this one--if that is what we

are going to do. If we are going to ration care, let everybody know it upfront. Let's be absolutely honest about it.

If you are 75 years of age and need a hip replacement but the quality of your life is not all that great, we are going to say you can't have it. That is what we are going to do, because that is exactly what they do in England. They have the National Institute of Comparative Effectiveness which makes an evaluation of what your worth is. And no matter what your history, no matter what your family situation, no matter your income, you can't have it.

Canada is getting around that, because they have said you get the right to buy what you want. Their Supreme Court ruled on that 2\1/2\ years ago. So we are seeing a two-tiered system developing in Canada, which ultimately will happen in this country--worse than what we have today.

They will go to Thailand or India.

I thank the Senator for holding this colloquy, and I will make one final point before I stop.

I don't doubt the motivation of our colleagues on the other side of the aisle. They want us to fix this problem--the problem in health care. But the problem is cost. If you don't fix cost, and you expand the same broken system, you haven't fixed anything. You have added to the cost.

Regular order.

Would the Senator yield for a question?

If we are going to tax tanning salons, why don't we tax anybody who goes to the beach? Because true sunlight is much worse for your skin than a tanning salon. So if the intention was to prevent disease, why wouldn't we tax it where most of the disease occurs? Or how about kids' sports in the summer. Let's tax kids' baseball. Or swimming. Let's tax all the swimming pools because we have exposure to UV light.

This shows the precariousness and the silliness of a large portion of this, and I yield back.

I want to raise an issue. It was raised in the Finance Committee markup; it was raised in the health care markup. I have behind me the Medicare cuts, and I understand they have been slightly reduced in home health--in the rebuild--but we are going to cut Medicare. We are not going to cut it significantly in the fraud--$2 billion. That is where the real waste is.

The Senator from Rhode Island came down here and said we are trying to scare people, but when we offered the opportunity for the chairman of the committee to prohibit rationing of health care in this country, both the chairman and the Senator from Rhode Island voted against it. It was simple, straightforward, saying no matter what we do in health care, we are not going to do what other countries have done, and that is ration health care. Straight up-and-down votes--party-line votes-- against it.

In fact, we are going to ration health care. That is what this bill does. The way we are going to control cost is through the mechanisms outlined in this bill that are going to allow government bureaucrats to decide what you can get treated for, when you can get treated for it, and where you can get treated for it. The rebuttal to that is: In Medicare, it is already illegal for them to ration care, so we don't need a prohibition. The fact is Medicare is rationing right now. They are rationing virtual colonoscopies, they are rationing bone densitometry, they are rationing Epogen, they are rationing Neupogen-- two key drugs to maintain survival during the treatment of chemotherapy. They are practicing medicine.

So when given the opportunity to vote and put an absolute prohibition on the rationing of health care, what did the chairman of the Finance Committee do? He voted against that. Because what he recognizes is the ultimate plan. And the answer to Senator Burr's question is: This will collapse. It is not going to be sustainable. The Medicare cuts won't be made by us. We will put it off on a commission and say: Oh, we had to do it, and the result of that will be rationing.

The other result will be what the Senator from Vermont actually wants, which is a single-payer, government-run system. That is why he is intellectually honest. He brought it to the floor and said this is how I think we ought to solve health care. We ought to have the government run it, and we ought to have the government make the decisions. He was honest about it. That is where this bill is going. So if you are a Medicare patient, you should be concerned. If you are a Medicare Advantage patient, you should be concerned.

I have had criticism leveled at me because I do what the chairman of the Finance Committee suggests--I make competitive bidding for Medicare Advantage. But there is a big difference. Mine has no cuts in benefits. They cut benefits 50 percent, in terms of the Medicare Advantage differential.

There are three things you can do to fix health care in this country: You can incentivize prevention and the treatment of chronic disease based on outcome; you can create transparency so that purchasers in the market can actually make a judgment about value and quality; and you can assist those who are on the lower rungs of the economic ladder to get the same kind of care we get. Those are the three things you can do.

I readily admit we don't have a great competitive model in the insurance industry. I want to change that. We had Senator Wyden come to the floor and say that he loves the free enterprise spirit, yet we want to put an artificial fix in terms of the insurance company, in terms of what you have to have for a return. What if an insurance company came up with 20 percent greater efficiency in terms of outcomes and benefits? They still have to spend that money? In the name of the free enterprise system we are going to kill free enterprise? As a practicing physician, I bristle at the way I run into insurance companies. There is no question about it. We need to fix that.

The point Senator Burr was making is this says it is this way or the highway, when the option we offered--the Patients' Choice Act--cuts taxes, doesn't raise taxes; expands exactly to the level or beyond of this bill and it does at in a faster rate. It extends the life of Medicare. It gives Medicaid patients the same kind of care we get. But it was defeated in committee on a party-line vote. It was filed as an amendment here but not accepted. We had 10 amendments voted on from our side on 2,400 pages of legislation--10 amendments. So it is not about being bipartisan, it is about you have to take this or leave it.

What the American people ought to pray for is that somebody can't make the vote tonight. That is what they should be praying for, so that we can actually get the middle--not me, not mine. I understand I am way over here. But we ought to get the middle of America and the middle of the Senate a bill that can run through this country and actually do what we say we all want to do. There is a large difference of opinion, and it is not rhetoric that is unfounded, as Senator Burr outlined, and as Dr. Barrasso outlined with an estimate by NFIB of 1.6 million jobs lost. That may be old data, because who knows what the data is now. We haven't had a chance to look at it, because 30 hours after the bill is introduced for cloture and the cloture motion is filed, we are going to vote on it. I am not sure this is a great way to run the country.

What is in the bill? There are zero guarantees that taxpayers won't finance abortion.

There are zero prohibitions on the rationing of health care--zero. There is not one shred of evidence that we are not going to ultimately ration health care under this bill. We are. And the only reason you would vote against a rationing amendment is because you intend to see rationing carried out.

There are zero Senators required to enroll in either Medicaid or a government-run option, either through OPM or Medicaid.

There are now 10 new taxes created. There are 71 new government programs created. There are 1,697 times that the Secretary of HHS is going to write the regulations, and based on CRS calculations there are between 15,000 and 20,000 new Federal employees who are going to be required to carry out this legislation.

There are 3,607 times, before we got the Reid amendment, that the legislation says the word ``shall.'' ``Shall'' is a very important word because the word ``shall'' takes away your options. There is no option when the word ``shall'' is used. The word ``shall'' also says whoever is directing the ``shall'' obviously has more wisdom, more knowledge, more experience than the person the ``shall'' is applied to.

What we have said is, in all our wisdom, in all our many years of practicing medicine and being involved in the care of patients, that 3,607 times we are going to tell the American people what to do.

One of the big ``shall also's'' that I do not think will ever hold scrutiny before the Supreme Court is, you shall buy an insurance policy. That doesn't fit anywhere in the Constitution that I read. If you do the legal research on it, as my staff lawyers from the Judiciary Committee have done, it is highly unlikely that will ever hold up. So the whole premise of a large portion of the taxes collected in this bill will be out the window.

It also will totally change, through adverse selection, all of the insurance premiums in this country because, if you do not have an individual mandate making people buy insurance, the costs relative to the illness and the age, even though we have compressed the ratios, will rise exorbitantly.

There are still going to be 24 million people left without health insurance in this country. There is a $10 billion cost just for the IRS implementation of this bill. There is at least $25 billion in mandates placed on the States, unfunded mandates. Actually it is much higher now. There is $28 billion-plus in new taxes on employers. There is $100 billion, by conservative estimates, in fraud and Medicare and Medicaid a year, and this bill goes after $2 billion over 10 years. So we are going to go after $2 billion out of $1 trillion--not $200 billion, not $20 billion--we are going after $2 billion.

There is $118 billion in cuts to Medicare Advantage but only for those people who do not live in the State of Florida and a couple of other places. If you happen to live in Oklahoma, citizens under the Medicare Advantage are going to lose.

This is now over $500 billion in new taxes on Americans. There is a quarter of a trillion dollars not in this in expense that everybody knows is an expense. We are going to restore the SGR. We are going to fix that. And that quarter of a trillion dollars is based on no increase in physicians over the next 10 years. How many in this body think we are not going to increase the pay of physicians in Medicare under the next 10 years? The assumptions in the CBO report that accompanied the Reid amendment, if you read what they said, they said it is highly unlikely. So that is a quarter of a trillion dollars even though it was not in their numbers.

It also said if, in fact, the cuts came through, which they thought highly unlikely that they would, and if they didn't, then the fiscal numbers associated with the bill are out the window. The final number everybody ought to be paying attention to is $12.1 trillion; $12.1 trillion is what our kids owe outside of owing ourselves--$1.1 trillion. That is going to double in the next 10 years.

Anybody with a lick of common sense who looked at the numbers on this bill would say: Washington, your accounting programs aren't any different from Enron. The same fate of those who created the Enron scam ought to apply to the Congress of the United States. The very fact we are not considering an SGR fix is evidence of that. At least you have to add a quarter of a trillion dollars every 10 years to this bill just to keep doctors even. And don't forget the fact that 34 million new Americans over the next 10 years are going to enter Medicare--are going to enter Medicare.

What are the alternatives? I will not offer other amendments and make the chairman object to them because I know his answer. He calls it a stunt. It is not a stunt when you do not have vigorous amendments offered on the Senate floor. It is not a stunt. The stunt is not allowing amendments to be offered. To allow only 10 of our amendments to be offered on this bill is beneath the dignity of the Senate--on the biggest bill in the last 100 years in this Congress, the only bill in the last 100 years that is going to affect every American in a personal way but also in a fiscal way, a financial way.

There was an amendment to be offered, a conscience protection for physicians. We didn't get a vote on it. Should we force physicians in this country to perform abortions or should we have a vote on whether, if they have a conscience protection, they ought to be exempted from that? Should that not be a part of health care reform? We are not going to get a vote on that.

How about an amendment to reduce the waste, fraud, and abuse in Medicare and Medicaid Programs and protecting Medicare benefits? And increasing the fraud and waste from $2 billion to $100 billion over the next 10 years, that is just 10 percent of what is there. We are not going to get a vote on that. It is not going to be available. The American people are not going to get to hear the debate on that. They are not going to make up their mind. Why? You don't want them to hear the debate on it. If you truly wanted to have a debate on fraud we would have a debate on fraud, and we would have an amendment saying put your stamp down, or are you for the people who are defrauding? Or are you for the status quo? We are for the status quo. We are for the well- connected.

The amendment on rationing that I talked about--or an amendment to limit the bureaucratic increase associated with this bill, which is an amendment I offered, we are not going to get a debate on that. That is a very straightforward amendment. It just says we are not going to increase the number of bureaucrats to implement this bill. We are going to drive efficiency in HHS; that is where this is going to. We are going to say: You can't get a net increase in bureaucrats so get more efficient. Since we are running $1.4 trillion or $1.5 trillion deficits, that is something that everybody else in the country would be doing, but we are not going to do that. We are not going to allow an opportunity for a vote or debate on that. We are not going to have that opportunity.

I have heard the majority mention several times that we didn't have anything to offer. We offered the Patients' Choice Act. CBO said it cut long-term costs on Medicaid, that it saved money on Medicare. They said it saved $1 trillion over the first 10 years for the State and the estimates. Because we couldn't get the commitment that was made to us by the chairman of the HELP Committee that he would score the bill, the bill didn't ever get scored by CBO--but an outside score says it saves at least $70 billion the first 10 years and far in excess of that afterwards. It covers more people than this bill, saves personal choice, doesn't put somebody between you and your doctor.

I heard the Senator from Rhode Island say we were lying about that happening. It is happening today, both from insurance companies and Medicare and Medicaid. So if we really wanted to reform health care we would be attacking that. Instead, we are going to make it worse.

Let me tell you how we are going to make it worse. We are going to use cost comparative effectiveness, which is exactly what the U.S. Task Force on Prevention Services did. They used cost comparative effectiveness, and when they looked at breast cancer, they said it is not cost effective to screen women before the age of 50. You know what. They are right. It is not cost effective. But it certainly is clinically effective, especially if your wife is the one who is 40 and has breast cancer and it was found by a mammogram.

You see, judgment goes out the window. What do we do? We reversed that finding, one of the first things we did as we started the debate.

Are we going to do that every time the U.S. Preventive Services Task Force issues a ruling that is cost effective but not clinically effective? Are we going to do that every time the cost comparative effectiveness panel says: You will do this, and the American people say: That isn't right, the American Cancer Society says: That isn't right. Every time we get one of those rulings will we have to pass a piece of legislation to change it?

The purpose of the three panels is well intended. The Medicare Payment Advisory Commission is well intended. Help us cut costs. But the only way you go for cost is through prevention and management of chronic disease. You are not going to cut costs any other way because 75 percent of everything we spend is on five chronic diseases. So unless you attack the real problem, the real disease, with our health care system, you are not going to solve it.

The lack of art in medicine will become readily apparent in 2015, 2016, and 2017. We will see bureaucratic decisions in between a patient and their provider. That is not a scare tactic. That is absolute fact. We have it now with Medicare. It is there. If I have a woman who is 55 years of age today and I order bone density testing on her and find she has severe osteoporosis, I put her on medicine but am forbidden by Medicare to do the followup exam that is clinically necessary to see if the medicine is working, and not only that, under Medicare rules, she can't even use her own money to buy that test. So 2 years later, we do the test, and we haven't corrected her disease. Now we change medicines to try to find out, but we can't find out again. So she ultimately falls and breaks her hip. There is a 20-percent mortality rate from falling and breaking one's hip. But those are the rules we are operating under now, right now, that you want to expand.

Government isn't ever compassionate. It is never compassionate. People are compassionate. Thought has

to be in the middle of the practice of medicine, not distant thought, near thought. The very fact that an insurance company tells the doctors what they can and cannot do is no worse than what we are getting ready to do with the rest of government-run health care. We didn't fix that problem. We didn't address that problem with this. We didn't guarantee that you could walk with your feet. We said: Here is how much money you can earn, but we didn't address that.

I will give two examples. Two people I have taken care of for over 15 years, both had no clinical indications that they had anything wrong. I contacted the insurance company. I thought they needed an MRI of the brain. Both of them were denied. I got friends who are radiologists to do their MRI. They both had brain tumors. One is still alive. What we are setting up isn't any different than what you have a complaint and gripe about now with the insurance industry. You didn't fix that in this bill. There is no health care reform in this bill. There is health coverage expansion, but there is no reform.

One of those people is still alive, but had we followed either Medicare guidelines, cost comparative effectiveness panel guidelines, which would have forbidden doing an MRI, that one person out of the two would be dead today. So as we sit here and look at our health care system, my biggest worry is, I will be in Medicare. I will get rationed. I know that. The way we are going about it, that is what is going to happen. We are going to ration care. We will not vote to not ration it. You know it is going to be rationed or you would have voted for the amendment in committee that provided a prohibition.

But my real concern is not my generation. My real concern is those who will follow us with $12.1 trillion worth of debt and the fact that every one of those is 25 years of age and younger today. Twenty years from now, they will be responsible for $1 million of both debt and unfunded liabilities for which we will have to collect, on average, $70,000 a year just to pay the interest on what we are sending them. Before they pay the rest of their income taxes, before they pay payroll taxes, before they pay unemployment taxes, before they send their kids to school, before they buy health insurance, before they buy a home, before they buy transportation, the real worry that should be in front of this country, which is the No. 1 issue on the public's mind, is: How do we get out of this financial mess? That is the No. 1 issue on people's minds. It is not health care.

I have no hopes of convincing my colleagues that through 25 years of practicing medicine, dealing with Medicare, dealing with Medicaid, that that is of any value to you. Because we are hell-bent on passing a health care bill and dealing to make sure we can and creating inequities throughout this country and dividing our country.

We heard the Senator from Rhode Island characterize us as liars, birthers, supporters of the Aryan nation. That is what I heard. I sat and listened to it. I think he doth protest too much, for he knows that is not true. There is nobody on our side of the aisle who cares any less than anybody on the other side of the aisle about fixing health care. The rub is, you believe the government is the most powerful thing and the best way to do it. We don't agree with that. We actually believe in the American people. We actually believe in the entrepreneurial spirit of the average American making good decisions for themselves every day, doing things we never do, which is prioritizing where their money is going to go and how they are going to spend it and working like heck to advance the cause of their own family, their own freedom, and their own liberty. You don't believe that because, if you did, you would never put this kind of bill on the floor. This bill limits liberty. This bill says you shall.

Think of the first big step in this bill. In the United States, you no longer have the ability to not buy health insurance. If you have $\1/2\ million in the bank and you want to put that at risk and say: I don't want to, you either have to pay a fine, a tax, or you have to buy health insurance. So where is the liberty and where is the commerce clause in that and where does that tie in with individual liberty and individual responsibility? We say: If you don't want to be responsible, then we will make you responsible. We don't say: You have to suffer the consequences of your lack of responsibility.

What built this country was people figuring out if you don't act responsibly, it is going to cost you. We are going to put a block on that and say: You don't have to act responsibly. You don't have to act in your own best economic interest. Don't worry. We will take care of it.

Jefferson warned of that. One of the Founders of this country warned us against doing the very thing we are doing today. If you read the Federalist Papers, you will see what Madison wrote about the welfare clause and the commerce clause. He said, whenever the Senate starts to think about claiming it means something different than it does, here is what we want you to know. It doesn't. It is very limited in scope.

I said yesterday in a press conference that this country is at the point of a crisis of confidence such as we have not seen in hundreds of years. It is true. Whether you are a very liberal individual or a very conservative individual, you don't have any confidence in us. The reason you don't is because we don't act in the country's best interest. We act in our political best interest. Republicans are equally guilty. We look at partisan issues rather than principled issues. What we miss in all that is the best right thing for the country. We are missing it with this bill. We are missing the best right thing for the country.

I am happy to yield.

And the outcomes are poor.

Mr. President, if, in fact, we got rid of 50 percent of the fraud in Medicare and Medicaid, we would generate $600 billion every 10 years, more than offsetting the cuts that have been outlined in this bill.

The Senator raises a good question. How long have we known and how long has Medicare been in trouble that we haven't fixed it? We will not fix it. We will do exactly what the Senator says, what we always do, what we have done since I have been in this body. We put the credit card into the machine and say: Transfer this to your grandkids. We take no pain ourselves. What is lacking in our country today is moral character to lead on the basis of sacrifice. It should start with us as Senators in this body.

Mr. President, I understand our time has expired.

Mr. President, I thank the Chair, and I look forward to hearing the remarks in the cloakroom of the chairman of the Finance Committee.

Mr. President, the pending motion to concur to the House amendment would cause an aggregate level of outlays for fiscal year 2010, as set out in the most recently agreed to concurrent resolution on the budget, S. Con. Res. 13, to be exceeded.

Therefore, I raise a point of order under section 311(a)(2) of the Congressional Budget Act of 1974.

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

Mr. President, reserving the right to object, and I do not intend to object, but I want to make a parliamentary inquiry prior to us doing that. And the inquiry is this: Based on the second-degree amendments just filed by the majority leader, as well as the elimination of their language, is it, in fact, the effect that no other amendments will be allowed on this bill?

Further in my parliamentary inquiry, if there were amendments available, could they be filed on this bill?

If, in fact, amendments were available, could amendments be filed to this bill and made pending?

I will restate my inquiry to the Chair. Is it, in fact, a fact that because of the filling of the tree by the majority leader, the opportunity to amend the bill before us will be limited?

Thank you.

I do not object.

Mr. President, I am going to spend a few minutes talking this afternoon. I apologize in advance because the staff is going to stay here, but this is an issue so big, this country has never faced it before. So the inconvenience for us to be here in the Senate Chamber is going to be very well worth it to the American people.

We just heard the assistant majority leader and the Senator from Michigan explain how great what is getting ready to happen is, and I want to tell you, there is a different perspective coming from a country doctor from Oklahoma who has practiced under Medicare and Medicaid for a number of years.

What we heard was, and it is important to the American people listening to this--I am going to go through what the Federal Government has been doing for the last 3 or 4 years, if you want to stay tuned for a civics lesson about the tremendous amount of incompetency and waste in this Federal Government.

We just heard the assistant majority leader talking about amendments. What he did not tell the American people is that the majority required unanimous consent for us to get an amendment and they limited us to 10 amendments over the last 2 weeks. They strung it out so we could not get our amendments up.

The other point I wish to make is that we now have a new amendment-- the one offered by the majority leader--to this bill, which we have no opportunity to amend. It is one-sixth of the bill, but there is no opportunity to amend it. So now we have a $2.5 trillion bill that has had 10 substantive amendments offered to it. The American people should not trust that process.

We heard the Senator from Michigan just say it saves lives. I want to tell you, as a practicing physician, this bill is not going to save lives. It is going to cost lives because we are going to allow the Federal Government to determine what treatment you can get, when you can get that treatment, and who is going to give it to you. That is the ultimate result of this bill. Over the next few days, we will be explaining and showing why that is the case.

The Washington-speak of ``it saves Medicare,'' a program that is bankrupt now, that has an infinite $85 trillion unfunded liability--we are going to cut $1 trillion out of it over the next full first 10 years of this program. And the American people are supposed to expect this is going to save Medicare? It is not going to come anywhere close. And save money? The assistant majority leader quoted the CBO. Let me read to you what he did not quote:

It is unlikely that key cost containment provisions that

are in this bill will remain intact.

That is what CBO said today. You did not hear that statement from the assistant majority leader.

Here is the other thing:

It reduces payments to physicians by 21 percent starting in

2011.

Do you really think we are going to reduce payments to physicians 21 percent in Medicare in 2011? One of the first bills we will see on this floor come January will be $250 billion that will be stolen from our kids to adjust the sustainable growth rate formula for Medicare. It will not be paid for, and that is one of the reasons this thing looks for--that is why the CB0 said: Wait a minute, before you claim this thing is so good, recognize that you are not accounting for $250 billion you are going to call an emergency and not pay for it.

Here is the third thing he did not mention:

An unaccountable, unelected board of bureaucrats must make

arbitrary budget cuts to ensure the cost containments in this

bill.

We are saying we are going to have cost containment, but we are going to pin that on three different programs, boards, and panels in this bill that are not going to cause you to save lives. It certainly might save us money, but it certainly is not going to increase the quality of care and it certainly is not going to save Medicare.

Here is the other thing he did not mention:

CBO cannot predict that the quality of care will not

decline.

That is what they are saying.

It is unclear whether such a reduction in growth rate can

be achieved and, if so, whether it would be accomplished

through greater efficiencies in the delivery of health care

or would reduce access to care or diminish the quality of

care.

That is from the CBO.

Here is the other thing the assistant majority leader did not mention:

The long-term budgetary impact could be quite different if

key provisions of the legislation were ultimately changed or

not fully implemented.

The U.S. Preventive Services Task Force recommended a change in breast cancer screening. They did it based on cost. We reversed it. I will bet a dollar against a nickel that the next three or four they recommend, we will not do, either, which are counted on in CBO's score for us to do. So the numbers on this do not make any sense.

CBO says this will reduce the deficit, but people who understand the CBO from the inside out admit even their best estimates are professional guesses with lots of uncertainty.

I ask unanimous consent to have printed in the Record the comments of Donald Marron, Alice Rivlin, and Phil Ellis.

Mr. President, let's look at Washington's estimate of the cost of health care. We have just run a $1.4 trillion deficit this last year. It is going to be bigger next year. It is going to be bigger. And we are going to have a brandnew health care system where we are going to start collecting taxes with some very minor changes in the health care system.

We are going to have the CLASS Act that is going to collect $72 billion over the next 12 or 13 years, but we are not going to reduce the deficit because we refuse to make the hard choices to do so.

Mr. President, I ask unanimous consent to have printed in the Record CBO's key caveats on the pricetag of the Reid amendment.

Mr. President, the other statement the assistant majority leader made was that no bill was offered that they would not allow to be scored. There are four comprehensive bills out there that they have not allowed to be scored.

Tomorrow afternoon, on this same floor, Richard Burr and I will go through the Patients' Choice Act which saves billions, saves the States trillions, covers exactly the same number of people or more, gives everybody freedom of choice and gets the government out of health care, requires competition, requires coverage of preexisting illness, accomplishes everything we say we want to accomplish in this bill.

So now we are getting ready to turn over $2.5 trillion more of health care to the Federal Government. What kind of job have we done? Let's look at it for a second.

Here is what we have done this year: 43 cents out of every dollar we spent in the Federal Government we borrowed against our children. It is going to be 45 cents next year. As we spend our taxpayers' money--and, oh, by the way, I recall that the Senator from Michigan stated that we are going to improve people's lives. We are going to improve everybody's lives except the generation that follows us and their children. We are going to damage their lives.

So 43 cents of every dollar that the Federal Government spends, we are borrowing. How have we been doing? The claim is Medicare isn't broke. Anybody with a high school accounting class knows it is broke. The reason we know it is broke--and it is not only broke fiscally, it is broke in terms of methodology--is because it is a Ponzi scheme. We have robbed the money. We have promised benefits for years and never raised the taxes to pay for them. We now manage 60 percent of the health care in the country.

Medicare is broke, the State Medicaid Programs are broke, the census is broke. We heard this week that Fannie and Freddie aren't going to require just $400 billion--that is a government-run mortgage insurance company that the Congress created--it is going to require $800 billion, almost $1 trillion to get us out of that. Social Security, we know, is going to be broke. It is fiscally unsustainable. The U.S. Post Office business model is broke; cash for clunkers; the highway trust fund is broke. We can't even get the $8 billion we need to continue to run it. We have done a great job managing that. Now we are going to put another 20 percent

of health care in this country under the auspices of the very people who run the broke programs that have created $1.4 trillion worth of deficits.

What is the meaning of that? How does it affect you? Well, right now, every child, every person, every grandparent in this country owes directly $39,000 in Federal debt, and that doesn't count everything they owe. That just counts what is external debt. That doesn't count internal debt, which is another $39,000. What do we know with regard to Madelyn here? She says: I an already $38,375 in debt--and, by the way, that was in October; it is over $39,000 now--and I only own a dollhouse.

What we know is, this Federal Government spent $33,880 per household this last fiscal year, the highest total in history. The Federal Government collected $18,000 in taxes, and the remaining $15,000 we borrowed, mostly from the Chinese. Over 40 percent of everything we are doing, we can't fund. The inefficiencies of the programs we have created--but with no oversight and we won't manage--we continue to allow to fail.

It is good for us to learn from our Founders. I will quote Thomas Jefferson:

My reading of history convinces me that most bad government

results from too much government.

Creating $2.5 trillion in new health care programs and damaging the health care programs we have today isn't going to save lives, it isn't going to improve health care, and it certainly isn't going to save money. Nobody can name one thing the Federal Government does that saves money. Nobody can--that saves money. So I thought I would spend this afternoon kind of going through the last 4 years of oversight so people could actually get an opportunity to see some of the examples.

It is interesting that in the last 12 days of Christmas, here is what the Congress will have done: On Sunday, December 13, we spent $445 billion on an omnibus package; on Saturday, December 19, we spent $626 billion on fiscal 2010 DOD, plus billions in pork; and on December 24, we are going to create a health care program that is going to consume $2.5 trillion over a 10-year period--or truly $250 billion per year-- and run it through the government.

So in the 12 days of Christmas, the Senate is on pace to spend $1.942 trillion--in the 12 days leading up to Christmas. We are on pace to spend $6.7 billion an hour in the 12 days before Christmas. Then, before you know it, we will have to raise the debt limit by $190 billion. Then we are going to have to come back and raise the debt limit another $1.8 trillion because, statutorily, we can't borrow money we don't have, and we will not make the hard choices to cut wasteful spending. So what we are going to do is we are going to borrow it against our children's future.

I have never voted for a debt increase. I have no intention of ever voting for one in the future. I have every intention to try to stop any debt increase we might vote on because the only thing that will cause us to make the hard priority choices in this country is not having the ability to borrow money from our children and our grandchildren.

If you go to the Web sites of Members--and you can go to coburn.senate.gov--or any other Member site--and look at oversight reports--I thought I would go through a few of them so the American people can see where the waste is in the Federal Government. I am going to spend the time to talk about it because it is ludicrous what we have done and what we continue to do.

Here is the Justice Department. We put out a report this last year showing $10 billion worth of waste a year in the Justice Department. That is $100 billion every 10 years. Here is a synopsis. Here is the report we put out. Nobody in Congress read it, other than my staff and a few other Members who are concerned about our spending:

There were $500 million in grants allowed to recipients who were not legally capable of receiving them; $1.6 billion in unspent, unobligated funds. They are the only Federal agency that has unobligated funds that is allowed to keep them, and we have no management over it.

We have this debate on earmarks--that we ought to be directing--but we will not do anything about allowing the Department of Justice to save the money at the end of the year that they don't spend and then spend it any way they want. We will not even do an oversight hearing on it.

Here is $312 million on conferences for the Department of Justice-- $312 million for conferences. In 2007 alone, they lost 125,476 hours to employees who were supposed to be there that didn't check out, weren't on paid leave, weren't on sick leave, weren't taking unpaid time off, we paid them, and they didn't show up for work. Here is $529.7 million, 1,500 special projects that were earmarked from DOJ funding.

What is an earmark? An earmark is something that benefits somebody politically and benefits somebody parochially and 98 percent of them are never competitively bid. What they are is they are the corruption of this Congress. Yet here we see $529.7 million worth of earmarks through the Justice Department.

I will not go into the details, but if you want to go to our Web site, you can see this report and you can see how $10 billion of your money was wasted in the Justice Department.

How about the Centers for Disease Control and Prevention? A 115-page report detailing the waste and mismanagement at the CDC and wasting billions of dollars in taxpayer money. We have offered amendments to clean up this stuff. They never pass because Members of Congress don't want to make the hard choices. They do not want to offend anybody.

They had $45 million in conferences just last year, $1.7 million for a Hollywood liaison program, where we pay tax dollars to tell Hollywood studios how to get it right in terms of how they portray things. That is a wonderful use of our tax dollars, when we are borrowing $1.4 trillion a year.

Again, a 115-page report outlining instance after instance of waste that the Congress will not do anything about with regard to the CDC.

Here is a special little one that the American people, I know, will love. We are spending hundreds of millions of dollars a year putting sand back on beaches that nature says shouldn't be there. So the people who live in States on beaches share the tax dollars of people who don't rather than pay for it themselves because most of these are earmarked. The lobbying method of choice to get a beach replenished is to get an earmark. So hundreds of millions of dollars every year go out of here to put sand back that we put back 2 years ago, but because of the natural occurrence, it normally washes away.

That is not a Federal responsibility. We are confused about our responsibility. But we are so enamored of the power to look good at home, we send taxpayer money home that is not a priority so we can get reelected.

Here is a report on highway transportation waste: $78 billion has been obligated over the last 5 years for purposes other than the construction and maintenance of highways and bridges. Let me say that, again: Over the last 5 years, $78 billion from the Transportation Department has been spent on things other than highways and bridges and transportation, and we wonder why the highway trust fund is belly up and broke.

This is all detailed. You can go to our Web site and find all the details of the stupid stuff, the low-priority stuff, the things that don't matter in the context of the problems we have and the situation we find ourselves in today of borrowing this kind of money against our children's future.

Then we had a nice little Christmas gift last year--``The Worst Waste of 2008.'' We will be coming up with ``The Worst Waste of 2009.'' There was $2.4 million for a 3D space theater in Indiana--an earmark--so people in Colorado, i would remind the President pro tempore, got to pay for that. I know that has to be a priority. At a time when our country is struggling with 10 percent unemployment and a $1.4 trillion deficit, we are doing that kind of stuff. How about $2.8 million for a visitor center for a hatchery in Missouri? They have the hatchery, but we spent $2.8 million to create a visitor center in the worst economic times we have ever seen.

How about $100,000 for studying Chinese video game habits? That has to be

a priority for our country. We have to know what the habits are of the Chinese population in terms of playing video games. A $298,000 earmark to develop a potato for high-end restaurants or $82 million in SBA loans to liquor stores. That is wonderfully good for our society. Here is $13 million for an art museum in Iraq--not for us, for them. We are going to spend $13 million for that. Then we spent $784,000 for training classes for casino workers in Kansas.

That is a high-quality project. You know, if you have casinos in Kansas maybe you ought to train your own workers rather than take the money from Colorado and Oklahoma to do that.

If you would like to see that, this is a wonderful little--it has Santa Claus on the front, cheery--fits with our time.

Then we put out two stimulus reports. We have a burr under the saddle for some people but, you know, dad-gummit, if we are going to spend $787 billion, and the inspector general says of that $787 billion at least $50 billion is going to get wasted--let me say that again: at least $50 billion is going to get wasted; that is the expectation from Washington--then we ought to be talking about where it is getting wasted and who is benefiting from it. The fact is that the vast majority of the funds that have gone out from the stimulus project so far have not been competitively bid, so the well-connected--those people who give campaign contributions--are the ones who are getting the contracts. Those who are most connected with people who are appropriators get the contracts. They do not have to competitively bid it, it is a gift.

The first stimulus report outlined $5.5 billion. Remember, we have only sent $200 billion out the door on the stimulus, and we have already listed $12 billion in two stimulus reports of pure waste or at least nonpriority items.

How about guard rails for a road over a nonexistent lake in my home State, $1 million? So we have one boondoggle in our State where the Corp of Engineers builds a lake where no water ever comes--never has come and never will come--and then we are going to spend $1 million on the road rather than close the road around a nonexistent lake--but that is the kind of priority we have?

We are going to spend $10 million to renovate a train station that has not been used in 30 years and call this a priority rather than fix bridges that are crumbling in this country. Or how about the town of Union, NY, given a grant to spend money it did not request for a homeless problem it does not have, according to local officials? Or give a Nevada nonprofit a contract to do weatherization after it had been previously fired by the government for not doing good quality work? But we give the same money back to the same people? I wonder if there was any political connection. That is the first stimulus report.

In the second one we sent out $350 million to get a broadband map that we could have bought for $35 million, but we spend 10 times what it was worth to get that done. How are we doing? Do you think we are doing a good job? Do you think we have our eye on the ball? Do we have a priority? Are we spending the American people's money wisely? No, because the Senate refuses to do significant oversight on spending. There is a reason for it because, when you oversight it, you expose the connectedness of the well-connected to Congress. So we do not want to do that.

Then we talk about the census. The census is going to cost at least double what it did 10 years ago.

Where do we find ourselves? We find ourselves with a government we cannot afford and there is not any other way you can describe that. If we were borrowing $1.4 trillion last year, and we are going to borrow $1.5 trillion this year, and the Senate has refused every attempt through the amendment process to cut spending in any area, every attempt--they may pass it when we have the bill, but when it comes out of conference it is always gone. So they want to look good, and then they can deny they knew it was taken out when they vote for the conference report.

So not once in the last 5 years have we passed an amendment that has stuck, that reduced the spending in this country on waste and junk, like I just outlined.

On January 1, 2009, the national debt was $10.6 trillion. It now stands at $12.1 trillion. That is not President Obama's fault. Do not confuse this with a partisan attack. My attack is on the Senate and on the Congress and the irresponsible behavior of Members of Congress who say they want to do one thing and then in the dark do something totally different. Our debt is rising $4.2 billion a day. In January 2009 the unemployment rate was 7.6 percent. Today it is 10 percent. That is not President Obama's fault either. That is our fault. It is the fault of the Members of Congress because in fact we created Fannie Mae and Freddie Mac. We allowed it, we failed to do the oversight. When we had an opportunity to fix it we got it struck down because of the well- connectedness of the financially influential people associated with that program.

What it means is that we lost 12,210 jobs every day since January 1, and we saw an uptick in that this last week.

That debt, as I show in the picture of Madelyn, is $39,000 per citizen. But it is important to think long term, which is my own criticism of my colleagues in the Senate. We think about the next election. We don't think long term. We think: How does this look for the next election?

What the next election is going to show us is that we are going to be $14 trillion in debt; that every young person who is 25 years of age or younger in this country, they and their children when they are 45--that is 20 years from now--will each be responsible for debt and unfunded liabilities of $1,119,000.

Let me say that again. Twenty years from now everybody in this country who is 45 years of age or younger will be responsible for $1,119,000 worth of debt and unfunded liabilities. Those are unfunded liabilities they will get no benefit from. Those are for the people who came before them. So they will be paying about $70,000 per year per individual just to fund the interest on the debt obligation that we are creating for them because we refuse to eliminate the silliness. We refuse to make priorities. We refuse to make the tough choices that may make somebody uncomfortable with us because we are thinking about the next election rather than the next generation.

While individuals, families all across this country are worried about having a job next year, Congress is busy trying to keep their jobs by passing out earmarks; by trying not to offend the well-connected and well-heeled in this Nation.

We have talked a lot about earmarks in the last year. Earmarks went down 6 percent this year in total number. They went down to 12,099 earmarks. Divide that by 100 Senators and see what you get. But the cost of them went up.

In the last 11 months, Congress has passed trillions of dollars in new spending on everything from a multibillion-dollar lands omnibus package stuffed with 100 parochial bills benefiting only a few and endangering the property rights of Americans across the country, to a stimulus bill meant to generate economic growth and create jobs, the vast majority of which hired more government workers and transfer statements to States rather than created true economic activity.

We bailed out the auto industry, we loaned hundreds of billions of dollars to private companies, we passed another omnibus spending bill just this past weekend with a price tag of $500 billion, including $3.7 billion in additional earmarks. Now we hear we are doing another stimulus, another jobs package.

Where are we going to get the money? Where does the House say we are going to get the money? We are going to take the money from TARP that had not been borrowed yet, so we are going to borrow the money for another stimulus package against our children and grandchildren.

The Congressional Budget Office had this to say about our fiscal situation, and we have had the Congressional Budget Office quoted:

Over the long term, beyond the 10-year baseline projection,

the budget remains on an unsustainable path. Unless changes

are made to current policies, the nation will face a growing

demand for budgetary resources caused by rising health care

costs--

Not lowering health care costs, contrary to what we have heard in this body--

rising health care costs and the aging of the population.

Continued large deficits and the resulting increases in

Federal debt over time would reduce long-term economic growth

by lowering the national saving and investment rates. Unless

revenues were increased correspondingly--

And remember what we are talking about: significant, steep, severe tax increases on the American public--

annual deficits would climb and the Federal debt would grow,

significantly posing a threat to the economy. Alternatively,

if taxes were raised to finance the rise in spending, tax

rates would have to reach levels never seen in the United

States--

Never. We have had it up as high as 90 percent, I remind my colleagues--

some combination of significant changes in benefit programs,

rationing, and other spending and tax policies will be

necessary in order to attain long-term fiscal balance.

We actually find our deficit situation endangering our national security now because so much of the value of the dollar is now dependent upon what China does because we have not been good stewards of the American people's money.

If we want to reduce government spending, Congress has to start somewhere, even if it is just eliminating waste. I am going to go through $350 billion worth of waste that occurs every year in the Federal Government--$350 billion. I will not go through every bit of it to allow the clerk and the Presiding Officer and the staff to go home, but I am going to go through enough of it so people get a flavor of where the waste is.

The cover of Newsweek's December 7 issue entitled: ``Steep Debt, Slow Growth, and High Spending Kill Empires--And America Could Be Next'' warns that our current fiscal situation is putting our country at risk and calling into question our position of power in the global economy.

This is how an empire declines. It begins with a debt

explosion. It ends with inexorable reduction in the Army,

Navy and Air Force. . . .

What did we just pass? A 4-percent increase for the military and an average 11 percent increase for every other branch of the Federal Government. We are already starting to see it. We actually increased our own budgets 6 percent, but what did we do to our military? What they are predicting in Newsweek we are already doing. We are destroying the ability to defend ourselves because, financially, we are not secure because we do not have the courage to make the hard choices in Washington.

Government has grown to such an enormous size it is almost impossible to fully grasp just how huge the Federal operation has become. The 2008-2009 U.S. Government Manual now is nearly 700 pages long and provides details on 15 executive branch agencies and nearly 60 independent establishments and government corporations--60. We have 60 government corporations.

The Government Accountability Office found that 13 different Federal agencies spent nearly $3 billion from 2004 to 2007 to fund 207 Federal Government programs to encourage students to enter the fields of math and science.

Let me read that again:

Thirteen different Federal agencies spent nearly $3 billion

. . . to fund 207 Federal programs to encourage students to

enter the fields of math and science.

Why wouldn't we just have one? Why do we have 207 programs run from 13 different agencies to encourage people to go into math and science? That is the idiocy of what we are doing.

Another example, the GAO report said with $30 billion, the Federal Government ``funds more than 44 job training programs, administered by 9 different Federal training agencies across the Federal bureaucracy.''--$30 billion, 44 programs by 9 different agencies. The right hand doesn't have any idea what the left hand is doing. Why not one agency? Why not all job training programs in one agency? We do not have the courage to change that?

How about Federal domestic assistance? Fourteen departments within the Federal Government, forty-nine Federal agencies operating exchanges for study-abroad programs.

Let me say that again. We have 14 different departments within the Federal Government, and 49 independent agencies operating study-abroad programs.

Why not one? And why not ask the question, Is that a role for the Federal Government rather than the State government? Yet despite the decades of government spending hundreds of billions of dollars on programs that address every possible issue from homelessness to job training to obesity to education and everything in between, all these problems are actually worse--they still exist and they continue to worsen.

This calls into question if mortgaging our children's future and endangering the country to spend money we simply do not have on programs that are working is truly an effective way to address the changes we face as a Nation. We have to address these issues.

The reason I am spending time on our fiscal nature is because the thing that got us in trouble in health care, the thing that causes our problem in health care is the lack of any Federal restraint. Now we are going to move one-sixth of our economy under the purview of the Federal Government. Let me outline quickly $387.7 billion worth of waste that could be cut from the Federal Government: The general government in total, $150 billion; Department of Agriculture, $9 billion; Department of Commerce, $5.9 billion; Department of Defense, $36.6 billion; Department of Education, we could cut $6 billion, nobody would ever notice the difference; Department of Energy, $2.2 billion; Department of Health and Human Services, we could cut $1.8 billion and nobody would ever notice the difference. Medicare, by all sorts of studies now, we know that at least there is $100 billion worth of fraud in Medicare. We know that. The bill we are so proud of that our colleagues are going to pass without significant amendments on our part goes after $2 billion of that over 10 years. So they are going to go after two- tenths of 1 percent of the fraud and say they have done something rather than go after the fraud. Medicaid, we could cut $48 billion from it in waste, duplication, and fraud; Indian Health Service, the inefficiency in the AIDS program; Department of Homeland Security, $1.5 billion; Department of Housing and Urban Development, $4.8 billion; Department of the Interior, $2 billion; the Corps of Engineers, $1 billion; Department of Justice, at a minimum $1.6 billion. We have this report that outlines $10 billion of waste. They have $1.6 billion left over at the end of almost every year. They are the only agency that gets to keep their unexpended balances. We have no control over how they spend it. We haven't changed that. We have offered amendments to change it. They have been rejected. We have offered amendments to have that money come back to the Treasury. They have been rejected. Department of Labor, $12.4 billion worth of waste; Department of State, $2.5 billion; Department of Transportation, $4.3 billion; Department of Veterans Affairs, $1.3 billion. That comes to $387.7 billion a year which tomorrow would markedly improve the value of the dollar and could markedly change the long-term curve that we are going to have.

Here is what it is. People need to pay attention to this. Every year we don't get rid of the $387.7 billion and continue to waste it speeds this curve up. Because this chart, which shows where we are now, shows the debt held by the public as a percent of GDP versus where it is going. So if you have a child today who is 1 or 2 years old or you are like Madelyn, the little girl who is 3, where is she going to be in 40 years? Forty years from now puts her at 2050. That means 300 percent of her GDP will be held by the public. What happens when we do that? No growth. Look at the lost decade of Japan. What is the implication for that? The implication is opportunity gets stolen. It is paramount that we change how we operate in the Senate and we start thinking long term. It is not a partisan issue. What it is is a careerism issue and a parochialism issue.

If we care about what our oath is to this little book, the oath that every one of us took to uphold and defend the Constitution, and if we care about what the future holds, we should be worried about this. Because quite frankly, right here the interest on the debt will become $1 trillion a year, and that is irreversible. That will happen. By 2020, the interest on the U.S. debt will be at least $1 trillion a year. That is 10 years from now. We are going to be borrowing money and adding to the debt to pay the interest on the debt. That is called bankruptcy. That is why

the Chinese are so worried about what we are doing and the fact that we are not effectively managing our government. At the end of World War II, with all the debt we had, we were only at 109 percent of our GDP; in 2080, if we don't change what we are doing, 600 percent of our GDP.

Translate that into what that means for somebody's individual life. That means my grandchildren and their children will never be able to buy a home. They will never own a home. They won't send their kids to college to advance their education. They may not even be able to buy transportation for themselves. The reason it is important is because it is counter to the heritage we have. We are the first generation in this country, in its whole history, to leave the next generation worse off. Nobody seems to be worried about it. Nobody is willing to sacrifice their position in Washington to make the hard choices to fix what is wrong with the country. That doesn't mean I don't want to fix health care. I do. I have seen the experience, in 25 years of practicing medicine, of what government-run health care does to health care. And with all these other systems that are broke and all these different agencies that are broke and all this duplication and we won't fix it, what makes you think we will fix it this time?

There is a rumble in America. I said that on the floor the first time 4\1/2\ years ago. It is growing. It is getting big. For the first time in America, independents poll higher than either Democrats or Republicans. There is a reason for it. They can't stand us. We refuse to make the hard choices they send us here to make. Consequently, they are discouraged. There is a crisis of confidence in America about a government that is supposed to be serving them instead of them serving the government.

As this rumble builds, we should make no mistake about what the long- term consequences are, as many of us won't be here because Americans have had enough. If the average American knew what was in this book, the things we have allowed to happen and continue to allow to happen, they should fire every one of us today. There should be a recall election for every one of us. Because no matter where you are on the political spectrum, none of us has done enough to fix what is wrong. None of us has lessened the risk that will happen to our children. None of us has changed the curve of government dominance over liberty. Until we start doing that, that rumble is going to grow.

The only way that rumble calms down is when we start taking the oath to the Constitution and recognizing the enumerated powers and having respect for the tenth amendment that says specifically, everything that is not specifically mentioned in here as a role for the Federal Government is explicitly reserved to people and their States. All you have to do is look at the health care bill that is going to pass Christmas Eve. We are taking a valuable freedom away in that bill. We are taking away a right. We are going to say if you are an American citizen, you have to buy something. That is a big leap on the commerce clause that we have never had before. It is going to get challenged constitutionally. There is no question. But we are stealing liberty with that one little section called an individual mandate; you have to buy something in this country.

What should be our goal in the sunset years of our lives, after serving in this body, is that we should have preserved or increased freedom for people, not lessened it. Whether it is under Republican domination or Democratic domination, liberty has shrunk. As the government grows, liberty declines.

Another one of Thomas Jefferson's sayings:

Compelling a man to subsidize with his taxes the

propagation of ideas which he disbelieves and abhors is

sinful and tyrannical.

That last word is an important word in America. They see tyranny. You are going to tell me I have to buy a health insurance policy. What if I have $250,000 in the bank and I don't want to buy a health insurance policy; you are going to tell me I have to buy it? I have to buy it? That is tyranny. There is no freedom in that. There is no freedom to make an economic choice. There is no freedom to be responsible and accountable. We have said the government will know best.

I will put some information on my Web site so that the Federal Government doesn't have to spend money. If we quit publishing this every day--it is available on line--we could save $6.5 million a year. Nobody reads them. Everybody looks at them on the computer. We could save $6.5 million a year if we quit doing this. But we won't quit doing it. It is $6.5 million peed down the drain every year for something that goes and gets recycled. But we won't do it. We won't do it. Those are the little examples. If you take 100 $6.5 million programs, you get $650 million worth of savings. There is thousands of $6.5 million programs we could all get together and eliminate. But we don't do it. I will make this available on my Web site.

I had my staff use data from the Office of Personnel Management, the Office of Management and Budget, take data from those two areas compiled by the Congressional Research Service. Here is what I came up with in terms of Federal employees. It is pretty revealing. We now have in the Postal Service 762,000 employees; in the Department of Defense, civilians, 677,000 employees; in all the rest of the remainder of the Federal agencies we have 1.247 million employees. The direct compensation, the direct pay cost per person in the Postal Service is $55,614 a year. The Department of Defense civilian is $70,201. The remainder of the Federal agencies is $81,271. That is the direct pay. The benefits, however, at the Postal Service are $24,743 a year. Department of Defense civilian, not our soldiers, not our military, is $18,796 a year. And the remaining of the Federal agencies is $31,754 a year.

So the total per capita compensation for active Federal employees right now is $113,000 a year--2\1/2\ times what it is in the private sector across this country.

So the next time somebody comes to me and says: We need to increase the wages of Federal employees, I am going to lay down and stop it until we create the opportunity our children deserve to have that was given to us. We have wonderful Federal employees, but that is part of the things on which we have to start making a decision. We cannot continue to increase, increase, increase when we are borrowing all the money that we use to increase.

With that, I yield to the Senator from South Dakota.

It is $2.73 trillion.

I think it gets paid for by rationing health care to Americans. That is how I think it gets paid for. You have three different programs within this bill, three different panels that are going to mandate what I as a physician can do with my patients. Once it gets applied, there is not going to be an exception to it. For 80 percent of Americans that is going to be fine. The real key is to ratchet it down by rationing care.

What do we know? We know $1 out of every $3 that is spent on health care today does not help anybody. Do we fix that in this bill? No. We know that $1 out of every $3 does not prevent anybody from getting sick and does not treat anybody's illness. Did we fix that in this bill? No. We did not do anything about it.

I will tell the Senator from South Dakota, the tenent of medicine is you do not treat symptoms. You find the disease and you treat the disease. The bill we have before us is a bill that treats the symptoms. It does not attack the disease. Because that $600 billion a year, at a minimum, that does not help anybody get well and does not prevent them from getting sick--if we just took half of it, we could cover everybody who is not covered in this country today. We could cover everybody and not spend a penny more on health care. But we have not attacked the disease. We are treating symptoms. We are not working to solve the real problems underlying health care.

The problem in America for health care is access to services. The access limitation is because of cost. If you cut costs 15 percent tomorrow, you would increase the same number of people who are increased in the bill in terms of availability. If you had real transparency in the insurance industry, where people could see and actually compete and buy all across this country what they wanted, and we hammered the insurance industry in terms of transparency of outcomes--the same for doctors--you would cut the cost even further. In other words, you put the patient in charge. We have a government-in- charge bill that we are going to be voting on instead of the patients.

So we are treating symptoms. We are not treating the disease. We are treating those who are screaming the loudest, but we are not fixing the problem. We are just making the problem worse and bigger.

Will rise to 21 percent.

You are not fixing the disease.

The Senator has asked a lot of questions. There is an organization that is based out in Oklahoma. It is called Safeway. Safeway has 200,000 employees. They have had a zero percent increase in their health care costs in the last 5 years, doing the things that we talk about in the Patients' Choice Act: using market forces, getting patient participation.

What have they found out? Their workers are healthier. Their absenteeism rate has gone down. They have lost cumulatively thousands and thousands of pounds. Their work product is better and their company is healthier because they are not spending more.

What has happened to their wages? Their wages are going up. One of the statistics most people do not understand is that for every 3.5 percent rise in health care costs, you lose 2.5 percent in real wages. In other words, if health care costs would stay flat, you would get a 2.5-percent increase. If they go up 3.5 percent, you are going to lose that 2.5 percent. If they go up 7 percent, you are going to lose 5 percent. So controlling the costs, when we have a third of it wasted anyway, should be our goal, and that is not where we are headed.

So the disappointment is not that we do not need to fix health care. We do. The disappointment is that--which I think I have outlined here today--the government is highly inefficient at everything it does, and effective only on a limited basis on the things we do fund, and then we are going to move another 20 percent of health care under the control of an organization that has proven itself ineffective at what it does.

That is insanity. The direction of the bill is one that treats the symptoms so we will feel better for a while, but we still die. If we practiced medicine that way, we would be run out of town on a rail. You do not treat symptoms. Symptoms cover up worsening disease. You treat the real disease, and the real

disease is lack of transparency, lack of accountability, lack of reform, lack of tort reform, and lack of a competitive nature, both in the health insurance industry as well as in providers like myself.

Make me compete based on quality and price, and make sure my patients can see it, so that a consumer can make a real choice. If we were to do that--which this bill does none of that--if we were to do that, American consumers could get a much better deal.

I thank the Senator.

Would the Senator yield for a moment?

There is one area I needed to cover that I didn't, and I will do so rather quickly.

Since 1977, this country has said we are not going to take Federal taxpayer dollars to pay for abortions. That is a divisive issue. The only way we change that issue is to change people's hearts in this country. So we are going to have to all agree to disagree on abortion in this country, and it is about a 50-50 split. What is about a 70-30 split is that the vast majority of Americans don't think their tax dollars, whether they are pro-choice or not, should be used to pay for somebody else's abortion.

What we saw come through the Senate this morning is something that every significant pro-life group in this country, including the Catholic Bishops, including Right to Life, including this doctor who has delivered thousands of babies and understands the issues of life, is going to abhor. What we have done is ultimately eliminate the Hyde amendment, and come next September 30, throughout the Federal Government as well as in this bill, the Federal Government is now going to allow taxpayer dollars to be used to pay for abortion.

Congressman Stupak, who is a friend of mine, who made sure the House did not allow that to happen, has recently been quoted today saying this is absolutely unacceptable, and it should be. We should not be using Federal funds for that procedure to end the life of an unborn human being.

With that, I yield the floor and yield back my time.

Well, I would answer my colleague from Tennessee. As a practicing physician, what I see as the historic mistake is we are going to allow the Federal Government to decide what care you are going to get. We are going to compromise the loyalty of your physician so that no longer is he or she going to be a 100-percent advocate for you, he or she is going to be an advocate for the government and what the government says. Because in this bill--even the one that is going to come--there are three different programs that put government bureaucracy in charge of what you can and cannot have. It doesn't consider your personal health, your past history, or your family history; they are going to say here is what you can and cannot do. That is called rationing. That is in the bill. That is coming. That is a historic mistake because it ruins the best health care system in the world in the name of trying to fix a smaller problem in terms of access, and it ignores the real problem.

The real problem is health care in this country costs too much. We all know this bill doesn't drive down costs, it increases costs. So your premiums go up, your costs go up, your care is going to go down because the government is going to tell you what you have to have.

I think that is a historic mistake and we have not addressed that. I wonder what my colleague from Wyoming thinks.

Madam President, if my colleague would yield, yesterday I asked the chairman of the Finance Committee to agree to a unanimous consent request that, in fact, for at least 72 hours the American people would get to see this bill; the Members of the Senate would get to see this bill; that there be a complete CBO score so we can have an understanding. He denied that request.

That comes back to transparency. The American people expect us to know exactly what we are voting on. They expect us to have read what we are voting on. His explanation was: I can't guarantee that. It presumes a certain level of perception on my part, an understanding of delving into the minds of the Senators that they could actually understand. What does understand mean? That is the kind of gibberish the American people absolutely don't want. They want us to know what we are voting on when we get ready to vote on this bill.

I say to my colleagues that one of the things President Obama said he wanted to have was transparency. There has been no transparency in the process. That is why at least if there is not going to be transparency in the process, we ought to at least have it transparent to the American people for 72 hours. This is a quote from the chairman of the Finance Committee:

I think it is impossible to certify that any Senator will

fully understand.

We are going to have a 2,000-plus page bill, and the chairman of the Finance Committee says he thinks it is going to be impossible to certify that any Senator will fully understand this bill. That is the best reason I know not to pass this bill, because if we don't understand it, you can bet the American people aren't going to understand it.

I want to bring up an example. We are going to see this time and time again if the bill goes through. We had the U.S. Preventive Health Task Force put out a recommendation on breast cancer screening through

mammography on the basis of cost. They said it is not cost effective to screen women under 50 with mammograms, because you have to screen 1,900 before you find 1 breast cancer. On cost, they are right; but over 50, you have to screen 1,470.

So what we had was a decision made on cost, not on quality, not on patients, but based on cost. We fixed that as part of an amendment to this bill. We actually fixed that. There are three different agencies within this bill that are going to do the same thing. Every time they make a ruling based on cost, not on clinical outcomes and what is best for patients, are we going to fix it? No. We are transferring the care of the American patient to three bureaucracies within the Federal Government, and they are going to decide what you have to do. If you think about it, this week the wife of a Member of this body was diagnosed with breast cancer. She was diagnosed through a mammogram. Under that task force's recommendation, she would not have gotten that mammogram.

So there is no transparency. What we do know is that we are going to have three organizations, the Medicare Advisory Commission, the Cost Comparative Effectiveness Panel, and the U.S. Preventive Health Task Force that will tell everybody in America what they are going to receive.

What are the unintended consequences of this that they don't know? What we do know is there are 70 new Government programs that will require over 20,000 new Federal employees, and there are 1,690 different times when the Secretary of HHS will write rules and regulations about your health care in America--the Secretary, not your doctor; your doctor isn't going to write the regulations. The Secretary of HHS is going to write the rules.

So we go back to the 72 hours. We are going to get a new bill, but we will not have the opportunity to amend it. We are not going to be able to read it and study it, nor are the American people. What do you think the outcome of that will be?

If I might respond to the question of the Senator, one of the things our President has promised is transparency. We are going to see at sometime in the next week or 10 days another bill--whatever the deal is. It would seem to me that 72 hours with a complete CBO score, much like was asked by 12 Members on their side, before we have to take up or make any maneuvers on that, would be something everybody could agree to since nobody knows, except Harry Reid and the CBO, what is in this bill now. At a later time, after we finish this colloquy, I will be making that unanimous consent request.

To answer the Senator's question, No. 1, as we already know, the Oklahoma State employees' health insurance plan, in 2013, will be considered a Cadillac plan. That is every State worker in the State of Oklahoma. And they can hardly afford their copays and their premiums in that plan today. So what we know is, we are going to tax all the Oklahoma workers. Many of those are schoolteachers who happen to be my patients, and they are struggling today.

So this disconnect between when the taxes are----

Not at all.

Well, our teachers wish they made what the teachers in Texas make, but they do not. But they do not make anywhere close to $200,000. It does not just affect the Department of Human Services workers, it is also going to impact the premium increases that are going to come about before this plan is implemented. We are going to see premium increases. So the small businesses that are now covering people are going to have massive premium increases. The individuals who are buying insurance in the open individual market themselves are going to see premium increases. The fact is, that is all going to happen before the first benefit, the first real benefit--other than preexisting illnesses--before anybody sees any benefit to that.

The other thing that is not talked about is, with the skewing of this and with the relatively low tax on not complying with it, our youngest, healthiest people are going to say: I don't want any insurance because all I have to do is pay, in the first year, $250--or even less--up to $750, and I can save thousands of dollars every year by not buying insurance, and buying it when I get sick.

So we are going to see everything skewed in the insurance market. That is what is going to drive up the premiums.

My constituents, plus my patients, are not happy about the delay. If we are going to make this, what I believe, is a fatal mistake for our country in terms of the quality of health care, then we ought to at least match the revenues with the expenses.

Mr. President, I ask unanimous consent to offer some unanimous consent requests to the chairman of the Finance Committee.

Mr. President, I offer a unanimous consent request that it not be in order for the duration of the consideration of H.R. 3590 to offer an amendment that has not been filed at the desk for 72 hours and for which there has not been a complete CBO score.

Will the Senator yield for a question?

One of the reasons I want this, is it not his belief that the American people ought to get to see this for 72 hours as well and that it ought to be on the Internet and that everybody in America, if we are going to take one-sixth of our economy, ought to have the time to truly read--we are going to have a managers' amendment, and that is actually what mine is focused on.

But to be able to truly not just read the managers' amendment but then go into the bill where it is going to fix the bill.

But the Senator will not agree to it by unanimous consent?

I appreciate the sincerity of the chairman's remarks.

Mr. President, I have another unanimous consent request. The following consent request would be associated with a Coburn amendment that would certify that every Member of the Senate has read the bill and understands it before they vote on the bill. The reason I ask unanimous consent that amendment be agreed to and accepted is that is exactly what the American people expect us to be doing.

So we do not have a bill right now. We do not know what is going to be in the bill. The chairman has a good idea what is going to be in the bill, but he does not know for sure. Only two sets of people--Senator Reid and his staff and CBO--know what is going to be in the bill. I suspect somebody at the White House might.

But we ought to take and embrace the idea of transparency and responsibility, that the American people can expect every one of us to have read this bill, plus the amended bill, and certify that we have an understanding for what we are doing to health care in America with this bill.

I ask unanimous consent that be accepted.

Could I clarify my request?

Let me clarify my request that the individual certify themselves. I am not asking some group of Senators to certify some other Senator. I am saying that Tom Coburn tells his constituency: I have read this puppy. I have spent the time on it. I have read the managers' amendment, and I, in fact, certify to the people of Oklahoma that I know how terrible it is going to be for their health care.

But the Senator won't accept that we as a body, on one- sixth of the economy, ought to say we know what we are doing?

I thank the chairman.

Madam President, I object.

There is objection.

Regular order, Madam President.

Regular order, Mr. President.