here at this moment in history, it is humbling to know that we will be called on to cast a vote that can change a nation. it has happened here before but only rarely. it happened 75 years ago when other senators in a much different era battling through the worst depression in our nation's modern history were called on by a president in a wheelchair to rally and stand for the elderly of america. he asked to create social security, an insurance plan primarily for widows. and and president franklin roosevelt came to this senate, in this chamber, asking each and every one of the senators there to be mindful of the plight of our parents and grandparents in that time.

i can recall in my family it was not uncommon for grandparents to end up living in the same home as their children, because after they'd reached the point where they could no longer work for a variety of reasons, physical or retirement, whatever it happened to be, their savings were meager and the chance of living independently was limited. and so their children took them in, in that spare bedroom, made them part of the family and welcome but understood that that was the only way mom and dad were going to have the dignity they deserved in life. franklin roosevelt had a different vision. he thought that if workers throughout their work life paid a little bit of money each week into a fund, they could be insured that there would be a check waiting for them at retirement that would allow them independence and dignity. he prevailed and senators stood up in that era of the 1930's and

gave him the votes that were needed to change our nation when it came to the way we treat the elderly. those on the other side of the aisle, the republicans, were skeptical, they were fearful of government, fearful of a new program. they argued that we were headed down a path we would regret, echoes of many arguments we are hearing today in opposition to health care reform. and when their time came later, even as recently as a few years ago, they tried to dramatically change and rewrite the social security program. they called for privatizing it, saying we would be much better off if the social security trust fund were actually in the stock market. thank goodness the wisdom of america rejected that idea and within months of the suggestion, it was proven to be totally false, as life savings were lost with the recession that we now are enduring. it's an indication of the

bravery of a president, the courage of a senate, and the fact that they rejected the pleas of those who would say, "do nothing, don't touch it, leave that problem alone." it was about 45 years ago that another great president had another great idea, and that was idea was to create medicare. and with the creation of medicare, to say to those same elderly, it isn't enough to give you a check to get by each month, we want to make sure that you have access to doctors and hospitals when you need them. and loin done baines johnson, the master of the senate, then president, mastered the critics who once again said it's too much government, it's not needed, we shouldn't do it. their counsel was rejected. medicare was created. it wasn't the medicare we know today. it didn't reach the disabled. it didn't provide some of the

basic services that many seniors now desperately need, and it didn't cover prescription drugs, but it was a start. it was a critical decision made to move forward. the same republican party that objected to the creation of medicare has been critical of the program ever since. they have argued that it is wasteful, that it's doomed, that it should be allowed to wither on the vine -- that was actually a quote from a leading republican not that long ago -- and they suggested there was a better way. let's privatize medicare. they love the notion of privatizing -- get government out of the picture. and they came up with this theory with the health insurance industry of something called medicare advantage. this was where those flinty-eyed entrepreneurs would teach government a lesson. they would offer the benefits of medicare and show how to do it at a lower cost.

we accepted their challenge and gave them their opportunity and what we found was they failed. oh, some succeeded, but by and large when it was all over and the accounting took place, those private insurance companies couldn't help but have the urge to maximize profits at the expense of medicare. and so now we spend about $17 billion a year out of medicare subsidizing private health insurance under this so-called medicare advantage program and the experiment has failed. the basic idea of medicare was proven right. it gave to our seniors something that we had promised and hoped we could deliver: longer, healthier lives. it also triggered the creation of a medical health establishment across america, the building of hospitals and medical schools and more medical professionals than our nation had ever seen because of medicare.

because of president lyndon johnson, his courage and because of the united states that could rise to the challenge and pass it despite the critics. well, in the early hours of monday, december 21, 2009, our generation in the united states senate will face our rendezvous with destiny, our opportunity to change this nation, to make such a significant change in the way health care is delivered in america that we can say to future generations, we had our moment and we seized it. to think that we will, with the passage of this bill in just perhaps a few days in the senate and a few weeks on capitol hill, we will enlarge the percentage of americans with the security of health insurance from 83% to 94%, the highest percentage of americans ever insured in the history of our nation. of 50 million uninsured

americans today, 30 million of those people will finally be able to rest at night knowing that they're covered, they have health insurance. it will be judy, the worker in marion, illinois, at the motel, $8 an hour, 30 hours a week, $12,000 in annual wages. she's a diabetic. she's never had health insurance in their life. she goes to work every day and she's 60 years old. she'll have health insurance because of this bill. she'll be covered by medicaid and she won't have to pay for it because judy's wages are at the low end when it comes to the workers in america. i said to her, if you had health insurance, judy, what would you do? she said, senator, i've got a few lumps that i've been worried about for a long time but i can't afford to go to the doctor. i'd go to the doctor. thank god she can. and for a lot of others, those who've lost their jobs, who are unemployed, exhausted their savings, stand to lose their homes, at least the peace of

mind that they'll have health insurance. that's going to come too. and if you have a child with a health problem, as many people do, something they call a preexisting condition, this bill will tell the health insurance companies immediately, you can no longer discriminate against that child. you can't turn down the family or that child for coverage. for someone who's been through that experience, i can't tell you what that means to know that you have that kind of coverage that your child with that child's challenge can go to the doctor they need to see and the hospital they need to be in. when my wife and i were first married and had our first baby, i was in law school and we had no health insurance. and when our baby had a problem, i had to go to children's hospital here in washington and sit in a room filled with people who had no health insurance. i took a number and we waited for a doctor. and every time we went, it was a different one.

and i felt like i had let my family down. at a time when my family needed health insurance, i had not delivered. i know that feeling personally and i know what it must mean 50 million americans who face it today. for 30 million of those americans, this bill will give them that peace of mind that they have health insurance. it also says to companies across america, we're going to change the terms of this relationship between health insurance companies and the people they insure. we're going to finally step in on the side of the consumers of america, the families of ameri america, the ones that are so often turned down because of preexisting conditions, turned down because the companies canceled them when they start really running into high medical bills. for the first time, these people will have legal rights created by this bill to stand up and be covered and to be confident at

the end of the day that they'll have the coverage they paid for their whole life. it's an amazing thing that we are considering. in the middle of it, with all these speeches and all the press releases and all the charts and all the time, it's sometimes difficult to focus on the historical impact of what we are about to do at 1:00 a.m. on december the 21st, 2009. but if we do this and do it right, if 60 senators step forward as they -- i think they will, commitments have been made -- we will make history t. will bmake history t.will be rea that the first time in memory the united states senate has voted for comprehensive health care reform. critics will still be there and they'll say the same thing they did about social security and the same thing they did about medicare: it's too much government, it's not going to work, we shouldn't do it. thank god that counsel was

rejected in the 1930's and the 1960's and it should be rejected on december 21, 2009. we need to stand together for people who otherwise have no voice. the uninsured, many of whom have low-wage jobs and maybe no jobs at all, and their children. really can't afford the best lobbyists in washington. it's time for us to lobby for them. i know that there are a lot of critics of this plan. we've heard them. they've talked about medicare and what this will do to it, this bill. but we know what the professionals have told us. this legislation, this comprehensive health care refo reform, will add nine or ten years of solvency to medicare, put medicare on sound financial footing. and that's exactly what we should do. and it has a bonus. the bonus is, at a time when we are facing deficits and debt which have to be taken serious

seriously, this bill charts a path for us to start retiring that debt. the congressional budget office says that over the first ten years, $130 billion in debt will be relieved by this bill and then in the second decade of this bill's existence andity ans changes, we are -- and its changes, we are going to find up to $1.3 trillion in deficit reduction. there's never been a bill considered on the floor of the united states senate that has had that kind of impact on our nation's debt. and it's going to change life not only for the families uninsured but even those with insurance. for some, it's going to give the luxury that we have as members of congress. i think we're the luckiest people on earth when it comes to health insurance. we team up with 8 million federal employees and their families, and each year we have an open enrollment. if we don't like the way we were treated by our health insurance company in the previous year, we can go shopping, just like you'd shop for a car or a

refrigerator. pick the right one for your family. and we pick the right health insurance for our family. every american should have that luxury. and we move toward creating th that. it was several years ago that i teamed up with senator blanche lincoln of arkansas and senator olympia snowe of maine. we tried to create a program for small businesses in america called the shop act, and this program would give those small businesses the same shopping opportunities for health insurance as members of congress and federal employees. i came up with an unlikely ally when the national federation of independent businesses decided they wanted to join us, when their lobbyists called and said he wanted to meet with me, i said i couldn't wait to meet him because his organization had done everything in their power to defeat me and every election i'd been in and i wanted to see what he looked like. well, he came in and sat down and said we've got to do something about health insurance for small business and we ended up creating an unlikely but

powerful alliance of the national federation of independent business, the realtors, the service employees international union, families u.s.a., from both sides of the political spectrum standing behind the shop bill. the shop bill, with some changes, but the shop bill is now part of health care reform. it's an idea that has been endorsed and it's one that i think is going to make a big difference for individuals. it also, this bill, contains help for small businesses to pay for the premiums. critics on the other side of the aisle say, oh, the taxes go up but the benefits don't start for years. they're -- they've missed it. because initially, we are going to be offering tax assistance to small businesses with 50 employees or fewer. those who have average payroll of $50,000 a worker are going to get a helping hand to buy health insurance not just for the workers but for the owners of the company. i've seen this in my own life. my friends who run small businesses, who've lost their

health insurance because one employee's wife had a very sick baby. that's exactly what happened to my friend. and they went out shopping for insurance on the open market and it was brutal. my friends were in their early 60's and they couldn't buy insurance, and everything they could buy was loaded with exclusions and deductibles and co-pays. well, we're going to make sure that these businesses have a helping hand with the tax credit, and that helping hand is going to allow them to buy good insurance that covers their employees. those on the other side talk about the tax increases in this bill. let's be very blunt what they are. there is a .9% payroll tax increase for individuals making over $200,000 a year and families making over $250,000 a year. what it means is this -- roughly roughly $2,000 a year for families making over $250,000 will have to be paid to make sure that medicare is solvent

and that this program is funded. it may affect some members of congress with our spouses working, but i don't think it's unfair. it's a tax we should be willing to pay to solve major problems in this country. there will be taxes on high-end health insurance policies, and it's very -- it's a very controversial provision with some of my friends in organized labor. but i hope we have hit the right number at 23,000 and i hope that our escalator clause to try to keep up with inflation is a reasonable one. if it is not, we will revisit it. the only law ever written that didn't need amendment might have been the ten commandments, and i don't think this bill, as good as it is, will rise to that level. we're prepared to return to it if we need to to make sure that it works and it works well and we have the time to do that. this is a critical thing. i also know that this bill is going to change -- you will be able to see the change in this bill across america with the construction of community health clinics. one of our great senators here, bernie sanders of vermont, has

been a clarion voice on behalf of community health clinics. he knows as we all do that these clinics placed in cities and towns across america are a lifeline to low-income people so they have primary care at a fraction of the cost of a visit to an emergency room. good care. i've seen them. i've visited them. the erie clinic in chicago, alivio medical clinic in chicago. good, clean, modern clinics with people dedicated to health care and dentistry who can help these people. we envision 10,000 more community health clinics as a result of this bill, at least 10,000, and thousands of primary physicians to be there to help. and that will mean that we will be creating across america a network of care and peace of mind for people who otherwise have few places, if any, to turn. i think the day will come soon when this bill, after it's passed, will become evident to america in terms of what we set

out to do and what we achieved. and if history serves as it has in the past, many of today's critics will not dwell on the fact that they voted no but rather say i had some problems with it and i guess it worked out okay. they may be afraid to acknowledge that now. i think ultimately they will have to. this is clearly an idea whose time has come and it has come because we have a president with the courage, the political courage to step up and make sure that we not back away. as franklin roosevelt did in social security, as lyndon johnson did with medicare, barack obama with health care reform has challenged this congress not to ignore a problem which has haunted the presidencies of seven great men who have previously served in that office. we need to do our historic duty in the early morning hours, so that americans across this nation can wake up to the stories on the news that finally hope is on the way.

i said the other night when i was talking about this, senator dodd, when i put vicki kennedy's "washington post" column in the record -- and i'm glad you did, too -- that this has been called many things. it has an official name. i'm going to call it kennedy care, and i hope some others will, too, because we do it because of the inspiration of a great friend, a great senator, and a great statesman, edward kennedy who i'm sorry can't be here to enjoy this historic moment, but he led us to this moment and he -- as he said in one of his last columns that he wrote about health care, we're almost there, and in four hours, we'll be there. mr. president, i yield the floor. mr. harkin: mr. president? the presiding officer: the senator from iowa. mr. harkin: mr. president, first of all, i want to commend senator durbin for his great leadership. he is our assistant majority leader, and for all of his

handiwork on this bill. he has been one of our strongest proponents for making coverage more affordable for small businesses. and he just spoke about that. in fact, under the manager's amendment, we have expanded even more than what we did in the original bill credits for small businesses. these credits now start in 2010, they start next year. they're available to more small business firms than what we had originally had in the original bill and all of that thanks to the hard work and intervention by senator durbin. i might also note that we have a provision also in the manager's amendment relating to cardiac care, congenital heart disease. i know that senator durbin had a personal tragedy in his own family because of that, and so

we now have a new program to track the epidemiology of congenital heart disease. section 10411, in case anyone is taking notes, and it expands and coordinates research at n.i.h. on congenital heart disease, and we're grateful to senator durbin for including that. and basically, i would say all the things that we have in our consumer protection. the consumers of america have no more dogged champion here in the congress than senator durbin of illinois. no matter what it is that we are passing here. senator durbin always looked to see how consumers are affected, and he has done that also on this health care bill by making sure that the consumers have better protections and health care is more affordable. so i personally want to thank senator durbin for all of his hard work on this bill.

so, mr. president, as senator durbin just said and as our leader senator dodd just said, in about four hours, less, a little less than four hours now, the historic vote will take place in the senate. it will be the defining vote of my senate career. it's been about 25 years i guess i have been here. it probably will be the dough fining vote for all of us during our tenure here in the united states senate. it will be the cloture vote on the manager's package, and from that we move forward. i would hope that after that cloture vote and after we take that cloture vote that the minority side would see fit then since we have the 60 votes, we have crossed that hurdle, that perhaps they would be willing to

close up the debate a little bit sooner than ending on christmas eve, but if that's their desire -- i mean, if they are -- i mean, they have the rules. i mean, we'll abide by the rules. if the republicans want to exercise every single right they have under the rules, they can keep us here until christmas eve, no doubt about it, no doubt about it. but to what end, i ask? to what end? we're going to have the vote at 1:00 that's going to require the 60 votes. and then why stay here until christmas eve to do what they know we're going to do, and that's to have the 60 votes on the manager's amendment, on the substitute, and on the underlying bill. so i would hope that our republican leader and others on the other side would perhaps see that it's not in the best interests of the chamber, it's

not in the best interests of the country -- and i know the -- one of the senators on the other side was talking about waste today. i'm thinking well, you know, this is kind of waste that we're here yakking about this and doing it up until christmas eve when we could collapse all these votes and get it done tomorrow. we could actually be done here tomorrow with this whole bill if the republicans would see fit, but like i say it's up to them. they can keep us here if they want to. but the manager's amendment that we're going to vote on at 1:00 -- again, i keep hearing all day today from the republicans saying they haven't had a chance to read it, they haven't had a chance to read it and we're rushing it. it just came out the other day. well, the republicans had it read word for word, and the few times i came on the floor during the reading, i didn't see many republicans over there listening

to it. so you have to wonder did they all go home and read it? they made the clerk read it. well, why didn't they sit here and listen to it? they would find out what was in it then if they were so interested. so anyway, this is all just gamesmanship around here right now. the people of america understand that, too. they know that we are going to pass health reform, and the first vote is going to be at 1:00 a.m. this morning. i heard the senator from arizona earlier today talking about why should we have it at 1:00? why can't we have it at 9:00 a.m. in the morning? he said the majority leader, senator reid, has the power, he could move it to 9:00 a.m. in the morning and we wouldn't have to drag people here at 1:00 a.m. he referred to the senator from west virginia by name, senator byrd. elderly, frail, but shows up here to vote. dragging hem out of bed at 1:00 a.m. in the morning to come here. he said why don't we do it at

9:00 a.m.? well, i thought that was a pretty good idea, so when i got here to the floor here an hour ago, a couple hours ago, i asked unanimous consent at that time that we have the vote at 9:00 a.m. but that the hours from 1:00 until 9:00 be counted for purposes of the 30 hours. the republicans objected. so much for their concern for the senator from west virginia. so, mr. president, we're on the cusp. we're going to expand small business credits. we're going to reduce administrative costs. we're requiring insurance companies to spend 80% to 85% of their income on health care, on health care. not fancy corporate offices, not high, expensive c.e.o. salaries of millions of dollars a year, not fancy jets, but 80% to 85%

must be spent on health care and paying medical claims. as senator durbin said, we make major investments in community health centers. 10,000 more. 10,000 more community health centers in america. and we're investing in the national health service corps to get more young people to serve in the national health service corps. we have new protections for patients, access to primary care provider of their choice, and an important provision that was championed by the senator from maryland, i think senator cardin to provide access for women and their choice of ob/gyn. in other words, they get to pick who their ob/gyn is, not their primary care provider, not the health insurance company, not anyone else. the individual woman can pick her own ob/gyn. and the amendment that we had before us immediately,

immediately allows children to stay on their parents' health insurance until they are age 26, and this manager's amendment also prohibits insurance companies from imposing pre-existing conditions on children up through the age of 18, right away next year. think about that. think about what that means to a family as a child that maybe was born with the -- with the defect of something that is chronic. insurance companies tend to exclude them. well, our bill says beginning next year, they can't do that any more to children. that's a big deal for so many families in this country, and they have kids that have been afflicted with maybe a birth defect, maybe something happened, maybe they had an accident, maybe they had an illness early in life that has turned chronic. this is a very big deal for

those families. and lastly, for someone like me that represents a lot of rural areas and small towns, we have increased in the manager's amendment more work force. we're going to have more people for rural and underserved communities. we'll increase the funding in the training programs for rural health providers, so small towns and rural areas of the country have a big boost in the manager's amendment. we're going to put more money and more loan repayments for people who want to serve in underserved areas, in rural areas, make sure that they don't have to go someplace where they get a lot of money to pay back their debts for medical school. we're going to be providing some of those payments so that if they serve in a rural area or underserved area. so, mr. president, i know we have now an hour to listen to the republicans tell us why we ought to put this off for another century or so, i suppose, but the people of

america know the time has come now. we are committed to this. at 1:00 a.m., we will have the 60 votes, and we'll get this passed before christmas. it will be one of the best christmas presents this congress has ever given the american people. mr. president, i see my time has expired, and i yield the floor. mr. enzi: mr. president? the presiding officer: the senator from wyoming. mr. mr. enzi: the reason i wasn't on the floor a large part of yesterday is i was wading through the amendment and also the scores. then i had to have the experts interpret it. the american people are having to relying on the stuff heard here on the floor. i get calls from all over the country saying stop this bill any way you can. make them get it right. and i got to tell you, some of

those are from other states, and they're saying my senator is not listening to me. i'm really counting on you. so i rise to speak on the issue of the health care reform. i rise with a great sense of disappointment as i reflect on the debate that might have been. from the very start of this debate i've said we need to reform our health care system. everyone agrees we need the real changes that will allow every american to purchase high-quality affordable health insurance. not a single one of my senate colleagues on either sao*eul supports the casino -- side of the aisle status quo the statuse understand the current system fails too many americans. we want to support reform that provides real insurance options to all americans and help lower the cost of that insurance. as i've said throughout this year and my 13 years in the senate that true reform should be supported on a bipartisan

basis. that should be a prerequisite that any proposal that will affect nearly 20% of our nation's economy and the health care of every single american. unfortunately that was not the process that was followed in developing this bill. instead we have the reid bill which was developed in secret without the input of a single republican. this morning an advisor to president obama was asked about the partisan nature of this bill and the overwhelming opposition of the american people. the overwhelming opposition of the american people. his response spoke volumes of what's wrong with washington today. he essentially responded that the american people don't understand what's in this bill and that once it's implemented they will come to support it. in plain english the washington is saying washington knows best. that attitude is part of the reason why support for congress is at an historic low and why public support for this bill is so weak. instead of having a bill that will provide greater choices and reduce costs, we have a bill that will do the opposite.

the reid bill will deny consumers the ability to make choices and instead substitute the judgment of government bureaucrats who will decide what kinds of insurance you will be allowed to purchase. the bill also fails to address the most important issue for the majority of americans. it fails to do anything to help reduce the cost of health care. president obama promised the american people the health care reform would reduce health care costs. yet, this bill fails to deliver on the president's promise. according to the president's own independent medicare actuary, this bill will actually increase how much we spend on health care. according to rick foster, who is the person from the administration, who keeps track of all medicare and medicaid spending, the bill increases health care costs $234 billion more than if we did nothing. that's a huge cost. in addition to increasing total cost, the reid bill will

increase our national debt and threaten the health care provided to millions of medicare beneficiaries. some of my democratic colleagues are going to come down to the floor and argue the reid bill will reduce the deficit and extend the solvency of the medicare program. they have been doing that for days. they will cite the congressional budget office to support their arguments. i hope that every american hears those arguments and remembers a few inconvenient truths that my democratic colleagues are going to forget to mention. the way my colleagues on the other side of the aisle were able to force c.b.o. to conclude that the reid bill will not increase the deficit was by requiring them to use budget gimmicks and assumptions that would make bernie madoff blush. every time you hear one of my colleagues argue that the bill reduces the deficit you should ask that senator if he really believes that medicare will cut physician payments by 21% in march. that's right. while the reid bill cuts over $470 billion from the medicare program, it will also require that every doctor treating

medicare patients have his or her payments cut by 21% in just two months. that's what c.b.o. had to assume when they did their estimate. if you believe that congress will never allow this to happen -- and we never have -- you cannot really believe this bill will actually reduce the deficit. the truth is that congress has never allowed that level of cut. senate democrats, however, chose to ignore this reality and relied on the promise of a cut to make their bill add up. you should also ask my democratic colleagues if they really believe that medicare payments to doctors will be cut more than 45% over the next decade. again, that's what the reid bill requires c.b.o. to assume. if you don't think that will happen, then you cannot really believe this bill reduces the deficit. you should also ask my democratic colleagues if they think that within a decade one out of every five hospitals, nursing homes and home health agencies will be operating at a loss because of the

unsustainable payment cuts in this bill. we just got a revised c.b.o. estimate that says that there was littler ror there and so there will be less savings by $600 billion. according to the administration's actuary, rick foster, that's exactly what's going to happen if the reid bill is enacted. he said if these policies have to be modified such changes would likely result in smaller actual savings. this means this bill will not reduce the deficit. finally you should ask anyone arguing that this bill reduces the deficit whether they really believe that medicare patients will not be able to get the care they need. again, the administration's own actuary says the payment cuts in reid bill could jeopardize access to care for beneficiaries. i do not know if my colleagues really believe these things will happen. taking note of these facts pushes up the total cost of the bill well over $1 trillion and destroys any pretense of budget

pwafplt unless all the things c.b.o. required to assume actually happened, this bill will actually increase the the deficit. health care reform has to be truly paid for. why? because the federal government has maxed out its credit cards. our out-of-control spending is not even driving -- is now even driving down the value of our money. as the government borrows more money to finance even more spending, the devalued dollar will drive up the cost of goods. oil is a good example. take a country like saudi arabia which is already raising the prices they charge for their oil to compensate for the lower value of our dollars. this means every american will end up paying more for a gallon of gas because of our failure to address growing deficits. if we're going to enact real health reform, we need to use honest accounting and not budget gimmicks and fake assumptions that we all know will not happen. we should pay for expenses like fixing doctors' medicare payments and we should not delay

the start of spending four years after the start of the new taxes just to make the bill look good over ten years. the problem for the president and my democratic colleagues is that their bill is being sold on the strength of accounting tricks that make it appear it won't add to the deficit. in case they do not notice, they are not fooling the american people. it showed up in august. it showed up every time since then and that's why we're not getting to go home on weekends. we don't want the democrats to hear from the people at home who are upset about this. in a recent poll 68% of americans said they believe the democrats health care reform bill will increase the deficit. they're right. the american people understand if the reid bill is enacted deficits will increase. they're right. the same is true for the claims that the reid bill will stand the solvency of medicare program or reduce beneficiary premiums. that can only happen if you make all the assumptions that i previously described. if you don't believe those things will actually happen, then this bill will do nothing to extend medicare or lower

premiums. besides driving up the deficit, the reid bill will also eliminate more than one million jobs. the mandate that employers offer health insurance or pay a penalty will be a massive new job-killing tax. our national unemployment rate is at 10% and the majority leader's attempting to cut off debate on a bill before christmas -- again he doesn't want the people to hear about what's happening but we're going to see that does happen -- on a bill that will force employers to eliminate jobs and reduce wages. businesses do not deny health care to their employers because they're cruel. they do it because they can't afford it. most businesses do not provide coverage do so because they cannot afford health insurance. they can't afford it for their employees and they can't afford it for their own families. they've looked at the costs and figured out they cannot pay for health care and still stay in business. the reid bill fails to do anything to actually lower the cost of health insurance which might mean that these businesses could actually afford health

insurance. instead it will place a new tax on these businesses which the c.b.o. has said will lead to these businesses reducing wages for their workers and eliminating jobs. that's why the national federation of independent businesses which represents small businesses across america estimated the reid bill would cause 1.6 million jobs to be eliminated. that's why they said the reid bill will create a reality worse than the status quo for small business. the worse thing about the reid bill is not how it will increase the deficit or kill a million american jobs. the worse thing is it will reduce the quality of health care we receive. no longer will you and your employer be able to choose the health insurance that best meets your needs. the government will tell you what kind of insurance you have to buy. if you don't you're told the government will place a fine on you. under the reid bill the government will tell your health plan which types of doctors they have to contract with, irrespective of whether that's the doctor you want or need to see.

the reid bill also traps 15 million americans in the worst health care program in america. approximately half of all the people who get the promised health care coverage under the reid bill will get it through the broken medicaid program. states already use price fixing to limit how much they have to pay doctors under the medicaid programs. that's why as many as 40% of all doctors will not see a medicaid patient. i said all along if you can't see a doctor, you don't have health care. but that's exactly what the reid bill will do. promise 15 million people coverage but trap them in a system where we know they won't be able to get the care they need. if anyone doubts what effect the reid bill will have they only need to look at massachusetts. the massachusetts plan was the model for many of the reforms in this bill. the problems they're encountering give us a good indication of what will happen to us all if the reid bill is enacted. to make the massachusetts reforms work, they have a ten-member commission trying to impose a global payment system. under this system, doctors and

hospitals will be forced to join large networks and be paid at a set rate for each patient. this is the same kind of government control we see with medicaid and the results of these changes are equally predictable. fewer doctors will be willing to see people at the exact time when the number of people seeking care is increasing. these are just some of the more serious problems with this bill because many of my colleagues want to be able to discuss the problems with this bill, i've limited my remarks for now. and because the bill was drafted behind closed doors and thrust upon the american people without time to consider the ramifications i'm sure we will find more problems with the legislation after this rush to vote. over the next few days i plan to lay out specific and concrete alternatives to how we could do better. i've been doing that for a long time but they have been not been accepted. republicans have many ideas on how to make this bill better, including several that have bipartisan support. however, if senator reid is successful in cutting off debate

we'll never get the chance to discuss any of these ideas. health care reform is too important for too many americans to be rammed through the senate with little or no debate on the weekend before christmas. it appears my colleagues understand how deeply unpopular this bill is with the american people and they want to force it through when they believe most americans are not paying attention. i want to assure my democratic colleagues that the american people are watching and the voices of august will only grow louder. they will remember the vote to cut off debate on this bill for a long time because they understand that it will mean for them their health care and the future of this country. the person that i served in the wyoming legislature with sent me a little note and said if it's broken, don't break it more. that's what we're doing. i would ask that -- i'd ask unanimous consent that i have some articles inserted in the record. there is one by howard dean that

suggests that the, this reform falls short. of course he's the former chairman of the democratic national committee. i'd also ask that an editorial by matthew dowd, a political analyst for abc news who talks about the danger of success and where the polls are on this and says that if this legislation passed, democrats will be held accountable for any failures or problems in the system. so if americans' insurance premiums rise, they'll blame the democrats. if patients have to wait in line at emergency rooms, it will be the democrats fault. if health care costs don't drop the democrats will face the wrath of the electorate. that's why it is important to have a bipartisan bill. i'd also ask permission that an editorial by e.j. vignone jr. be included in the record and also an article by george will where it says more talk, less support. the more we talk, the less support there is for this bill. so i'd ask unanimous consent -- the presiding officer: without

objection. mr. enzi: and i would yield the floor and reserve the balance of the time. a senator: mr. president? the presiding officer: the senator from texas. mr. cornyn: mr. president, i want to thank the senator from wyoming for his important leadership. he's absolutely right. as much as we would all like to be home with our families, and especially at this time of year, this battle to inform the american people about what is about to happen to them is too important for us to simply give up or acquiesce in what the senator from iowa seems to think is inevitable. there is nothing inevitable about this. the only thing i think inevitable about it is in light of the unpopularity of what is being jammed down the throats of the american people, there will be a day of accounting. we don't know when that day of accounting will be. perhaps one of the first days of accounting will be election day 2010. i just don't understand how people who are elected to

represent their constituents can try to impose something that is so obviously unpopular with their constituents and expect somehow to be patted on the back and said, well, you're right, you really are smarter than we are. you really do know better than we do what's better for our families and what we ought to be limited to when it comes to health care choices. i i just think that is an upside-down way of looking at the world and maybe that's the reason why we have these -- such disparate views of what we are engaged in here. clearly on the other side of the aisle, they -- they believe in -- that government is the answer. they believe government can do a lot better than the private sector in providing choices and in providing cost controls. well, the only way government can do that, of course, is by cost -- price controls, which we've seen happen in medicare and medicaid, which have not worked very well. so here we are, five days before

christmas and we're going to be voting a vote tonight at 1:00 a.m. on a 2,733-page health care bill that we got yesterday morning. now, we do know what's in the bill. we're still reading and apparently the congressional budget office is still trying to figure out the impact of the bill. they've already had to correct one mistake, and because they're being asked to rush to judgment on this bill that will affect one-sixth of our economy and all 300 million americans. but we do know this. we do know that it will cut medicare by $470 billion. now, medicare is paid for by employers and the worker into a trust fund and that trust fund is going to be pilfered, robbed in order to create a brand-new entitlement program that the beneficiaries of that entitlement program never paid

for, like the beneficiaries of medicare. that's one part of this. we also know it's going to increase taxes by $518 billion. well, we already know that president obama's promise that people making less than $250,000 a year, that that promise will not be kept under this bill and that this bill, according to the national federation of independent business, will impact small businesses and their ability to create jobs and retain workers during one of the worst recessions we've had in this country. and then, of course, we know that this bill, without the phony accounting gimmicks like implementing a bill four years into a ten-year budget window, it will actually fail in universal coverage. it will leave 23 million people uninsured, and it will cost roughly $2.5 trillion. and it will increase the cost of premiums for people who already

have insurance. you know, what is so disgusting about this process is this is exactly confirms the most cynical view that the american people have about congress and washington, d.c. and rather than a change in that process, one that is more transparent, one in which everyone's views are considered and where we try to come together in a bipartisan consensus for a solution, this is a -- this is going to be passed strictly along party lines by a political party and by their leadership who apparently cares more about chalking up a victory, albeit a pyrrhic victory, rather than listening to their constituents. you know, the american people want washington to start over again. 56% of voters in this most recent poll said that they want us to stop this bill and start over. well, we know this process is

the product of deals struck behind colleagues doors with special interest groups and their lobbyists. the pharmaceutical industry got 24 democrats to switch their votes on reimportation. what's that all about? to preserve a special deal cut behind closed doors. the insurance industry, which will get $476 billion of tax money from this bill, and then other parts of the health care community which are going to be exempted from cuts by the payment advisory board because they cut their deal behind closed doors and now we know this bill is being attempted to be jammed through when most people are spending time with their families because of the christmas season. even the distinguished majority whip last week said, "i'm in the dark almost as much as other senators are," and he said, "i'm

in leadership." so this bill has been written with a small group of people behind closed doors, including the senator from nebraska, who spent 13 hours -- 13 hours -- on friday behind closed doors with democratic leadership and white house officials. in the meantime, we have left completely in the dark as to what's in this bill other than what we can glean in the limited time that we've been given. you know, after the ill-fated stimulus bill passed at the first part of the year, i remember we got that bill about late thursday night and then we were asked to vote on it less than 24 hours later. less than 24 hours later. we, like that, spent $1.1 trillion, including the interest, in this stimulus bill that was supposed to keep unemployment below 8%. well, we know how well that worked, with unemployment going as high as 10.2% and now at 10%. and one thing the american people told us after that is

they want us -- well, i almost hate to say it, it seems so simple and straightforward -- they want us to read the bill. they want us to understand the bill. they want to be able to read it and understand it before they give their consent to our voting for it. and they want to know what the impact of the bill's going to be on their coverage. is it going to raise their taxes? is it going to raise their premiums? is it going to cut into their medicare benefits if you are a medicare advantage beneficiary, we know it will, for 11 million americans, including a half a million in texas. well, then there was this discussion and i guess this is all for show, too. this was not, obviously, a sincere effort, where we had eight democrats who wrote a letter on october the 6th to the majority leader and said they want the bill 72 hours before the first vote. well, guess what? this historic vote we're going

to have at 1:00 in the morning will occur 40 hours roughly after we got the bill. so much for 72 hours. we know that c.b.o., the congressional budget office, score, the cost, their estimate, even with the phony assumptions that are included in this bill, will only be available for 37 hours. and then we find out there are other sweetheart deals which make this thing begin to stink to high heaven. things like special legislative language saying the state of nebraska, the state of nebraska gets a special pass from new medicaid mandates. vermont and massachusetts have special deals. and then there's a $100 million earmark for an unknown hospital. oh, i can't wait to find out what that's about. and those are just some of the sweetheart deals we know are in these bills, and i'm sure there are more that we will find out about. this process has just gone too fast and gone too far off track.

it reminds me of what rahm emanuel, the president's chief of staff said, when they jammed through the stimulus bill earlier this year. they said, a crisis is a terrible thing to waste. well, it's one thing if we were acting in response to a crisis in a responsible manner, but what this is going to do is to make it even worse, as the senator from wyoming pointed o out. well, i think people listening, the 56% and growing number of americans who are concerned about this deal, they're wondering, are -- are the politicians in washington more interested in jamming this through or getting it right? senator snowe, olympia snowe from maine, on the finance committee, the one republican to vote for the finance committee bill, said she won't vote for cloture on this bill at 1:00 this morning because this is simply an arbitrary deadline.

oh, and guess what? most of the provisions don't kick in for four years. so why are we doing this literally in the dead of night on a phony timetable? well, we know that according to experts like the dean of the harvard medical school, who said in discussions with dozens of health care leaders and economists, i find near unanimity of opinion that whatever its shape, the final legislation that will emerge from congress will markedly accelerate national health care spending rather than restrain it. well, you don't have to go to harvard to figure that out. just go to houston, texas, when a small business owner in houston wrote to me and said, "the proposed health care bill is going to have a negative impact on my business because the cost of employee health insurance will go up." quote -- "i don't believe what some are saying that costs will go down. this bill does not make common -- economic common sens

sense." those are true words from a small business owner in houston, texas, who i suspect has greater understanding of what this bill will be than some of the so-called experts here inside the beltway. we know from the congressional budget office, though, that the premiums for an average american family under this bill will go up $2,100 a year for those purchasing insurance on their own, in the so-called individual market. an independent study talked about premiums in texas specifically and said that premiums in texas for those who purchase insurance on their own will go up by -- b for 61%. 61% of texans purchasing their insurance on their own, their premiums will go up under this bill. what in the world are we doing? under the reid bill, a family of four in houston would see their premiums more than double by

$1,352 a year. now, i find it supremely ironic that perhaps the next vote we have here on the senate floor after this health care bill is going to be a vote to increase the statutory debt limit because congress has maxed out its credit card. currently our credit limit is $12 trillion and that's not enough because of unwise and reckless spending like that reflected here in this bill. i find that supremely ironic. but i suspect there are a lot of americans who find it very sad and even scary. and we know that in a time when people are struggling to keep their job, when businesses are struggling to keep their employees rather than have to lay them off and make the unemployment statistics even worse, people losing their home because they no longer have a job, that this bill will be a job killer.

the only way this is going to be paid for, the pay-or-play mandates put on businesses, is for businesses to take some of the money they would have used to hire new employees and pay this new punitive tax being imposed by the federal government. businesses in texas know this is true. the lubbock chamber of commerce wrote to me and that said an employer mandate would be a job killer, raising the costs of maintaining a work force. job -- small businesses and our consumers will be the ones that suffer. and then there is this medicaid expansion that senator enzi from wyoming talked about. there is an unfunded mandate here because texas didn't get the sweetheart deal that louisiana or nebraska or vermont or massachusetts got. an unfunded mandate of $21 billion over the next ten years. so not only are people's federal

taxes going to go up, they're going to wreck the state budget too by pushing aside other priorities, like public education and the like. totally irresponsible. and then there's the so-called nelson amendment on abortion that was supposed to strike a compromise. well, one of my other constituents, cardinal daniel denardo, who leads texas' largest archdiocese and is chairman of the u.s. conference of catholic bishops, on pro-life activities said, "this legislation will be morally unacceptable unless and until it complies with long-standing current laws on abortion funding such as the hyde amendment. this legislation should not move forward in its current form. it should be opposed unless such serious concerns have been addressed." mr. president, i really am staggered at what we are about to witness here, at the sheer