Department of Defense Appropriations Act, 2010

Floor Speech

By:  John Kerry
Date: Dec. 18, 2009
Location: Washington, DC

DEPARTMENT OF DEFENSE APPROPRIATIONS ACT, 2010 -- (Senate - December 18, 2009)


Mr. KERRY. Mr. President, I thank the Senator from Pennsylvania for his comments. I associate myself with them and appreciate what he just said.

We find ourselves in a remarkable situation, where, frankly, there is an extraordinary amount of distortion and fakery taking place on the floor of the Senate. There is a great strategy of deception which the Republicans have engaged in and in which they continue to engage, claiming they are being left out of the process; claiming we ought to go back and start over; claiming they haven't been included; claiming they do not know what is going on. We are where we are today after a year and a half of effort in this initiative specifically--years and years beyond that if you want to go back to Teddy Roosevelt and Harry Truman and every President since then.

But right now we have a specific effort going. We began in the Finance Committee a year and a half ago, the summer of a year ago, where we assembled over at the Library of Congress, and we had an entire day during which time we had Republicans and Democrats. We listened as a committee to experts from across the country about how to do health care.

Subsequent to that we began hearings, constant hearings. And then at the beginning of this year, 11 months ago, we began what we hoped would be a bipartisan process. No chairman in the 25 years I have been here and working here has ever reached out as much as I watched Chairman MAX BAUCUS reach out in an effort to try to get a bipartisan effort. How many Senators from the other side came to the table? For the entire summer, 3 months were taken up with the so-called Gang of 6, 6 Senators--3 Republicans and 3 Democrats.

Unfortunately, several of the Republicans have already walked away because they didn't like something that 60 Members of the Senate might want to do. So they walked away. The Senator from Utah is one. He was part of those early negotiations. Then he said: I am not going to do this.

In the end, the Senator from Colorado, Senator Enzi, and Senator Grassley, the Senator from Iowa, walked away. And Senator Snowe, to her credit, has stayed at the table, worked hard with people, and continues to try to have a dialog about what it might need or not need. But somehow they come here with the notion that they have a right to dictate what is in the bill that 60 Senators might think otherwise about, and because they just cannot get their way on the big picture, they are even willing to try to block the funding for the troops in Afghanistan and Iraq. That is just stunning to me.

I learned full well firsthand what it is like to be fighting in a war when people back home are not supporting it. I vowed when I came back that would never be a mistake we might make again. We might disagree with the war, but we would never confuse the war with the warriors, the people fighting it.

In fact, these folks don't care, the folks on the other side. They are willing to just hold it hostage, do anything they can--not just to defeat health care because they don't like it because it is different philosophically from how they would approach it.

Incidentally, they opposed Medicare. I hope America hears this. This is the party over here that opposed Medicare when it was put in. They opposed Medicaid. They do not believe in that. They run around talking about the ills and dangers of a government program for health care. Which of them has brought an amendment to the floor ever or a bill to the floor to say: Stop Medicare, end it? They never do that.

It is a government program. How many of them want to take away veterans health care, a government program? They never do that. But they come to the floor and they jumbo mumbo the words around on the floor and confuse America and make everybody believe this bill is somehow what it is not. These are tried and true tactics. In a lot of places you call it demagoguery.

They have come here relying on crude but effective emotionally laden buzz words, tried and tested in focus groups, funded with millions of dollars. Where do the millions of dollars come from? They come from the people who want the status quo. Fourteen thousand people a day in America lose their health insurance. Where is their plan to put those 14,000 people back on the rolls? They don't have one. But we do; we do. That is what we are here to do.

There is so much good in this bill. Is it perfect? Of course it is not perfect. I will talk about that in a minute. But it is extraordinary to me that the folks who oppose it philosophically--they are never going to change. They keep talking about let's go back and start over. Going back and starting over to them means let's write the bill the way we want it even though there are only 40 of us and literally to hell with the rest of you 60 who represent the majority of the country. That is their idea of going back to the beginning.

It is not going back to the beginning and coming up with a constructive way to approach it because they had that chance. All year long they had that chance. All they want to do is beat President Barack Obama. That is their theory.

I was here in 1994. Unfortunately it has some potency out there. You make the institution look bad, make the entire Congress look bad, and then the voters will say: O, my God, who is running it? Oh, it is those guys. We better go to the other guys now. Just make it look bad because people will not discern who is really responsible.

Let me be very clear. We are trying to move this forward. We have tried and tried, again and again, to reach out in a bipartisan way which requires compromise. Some people have come to the Senate in modern times with a new definition of compromise. Their definition is ``do it my way,'' not meet you halfway, not give in to what a majority might believe they have a right to say is a fundamental bedrock principle of the way they want to approach a particular piece of legislation.

Here we are with some of our folks now on our side of the fence actually being emboldened by the comments they hear that distort the bill on the other side, to say: Oh, you guys better throw it in. Don't vote for it.

Yesterday we heard a person I admire and like and have become a good friend of, Howard Dean, who worked his heart out in 2004 to try to win, and then worked his heart out in 2008 to help elect this President.

Yesterday he wrote something which, incidentally, had some errors in fact about what was included and not included in the bill. But he said yesterday:

Let's kill the bill and start over.

As another person whose work I greatly admire because I think he holds things accountable, Keith Olbermann said Wednesday night:

This is not health, this is not care, this is certainly not reform.

I respectfully--and I mean that--respectfully disagree with both of them. I don't think they fully evaluated what is in this bill and what it accomplishes for America, nor fully evaluated the realities of what it would mean if you said kill it and start over. There is no President who is going to step up in the next few years if we don't make progress. There is no Senator who is going to invest in a process after this, if we don't make this reform work now.

If you follow that kind of advice and give up now because this bill isn't everything you want it to be individually, then the very reforms people have spent their life working for, reforms that the Democratic Party has been proposing for decades that are in this bill, many of us ran on them and said: This is why we want to come to Washington to accomplish this--they would be destroyed. That would be it. It would be gone. What a mistake that would be.

The fact is, there are things I wanted that are not in this bill. I am a passionate supporter of a public option. Do you know what our public option was in this bill? Our public option, ultimately, in this bill required the people who take part in it to carry the option with their premiums, not very different from a regular plan, except that it wasn't for profit. It had no public money to support it, and it wouldn't allow public money to come in and bail it out. It had to abide by the actuarial values and rules of the marketplace, the way private insurance companies do. But it just wouldn't have shareholders and a for-profit structure. It could drive competition in order to have those companies that we all know have not stepped up when it comes to making sure that they are there for the patients. Why? Because if you are for profit and you are one of these insurance companies answerable to Wall Street and your shareholders, your principal concern is to drive that profit. So what do they do? They hold onto the money until the last minute because they get the float in the market. As long as the money is in your coffers, then you are working the interest on it or you have it to use for your company. If you pay out at the last moment, you make more money. If you pay less than you have to pay, you make more money. If you cut people off, which they would do all the time, you make more money. If you tell people who bought their insurance, who thought they had the insurance: Sorry, we don't have that insurance for you because of a little clause down here that you didn't read, too bad for you, but you don't have the insurance, even though you have stage 4 cancer and you have two kids and you are a divorced parent, too bad for you, you don't have insurance. They do that because then they make more money. These are real stories. You can find thousands of them across America. How else do you lose 14,000 people a day who lose the insurance they thought they had or wanted?

This wasn't easy for Franklin Roosevelt when he tried to do it. It wasn't easy for Harry Truman when he tried to do it. It wasn't easy for Bill Clinton when he tried to do it. Some of us were here and tried with him. We understand how difficult it is. But you don't sound retreat. You don't ignore history and say: We are going to be better off by giving in to 40 people who are trying to destroy a Presidency and simply can't stand the fact that there are 60 votes here and there is a President who has an agenda to fix things. So the best thing they can do is try and stand and stop it.

Some of our progressive friends have said because it doesn't have the public option, we ought to do that. Even though it doesn't have a public option, the bill encourages the creation of more not-for-profit insurers, which I will say a little more about in a minute, that have the ability to drive costs and increase competition. We don't have that today. Is that not worth fighting for on the Senate floor and putting into this bill?

Again, my friend, Howard Dean, wrote in the Washington Post that real health care reform needed this public option to ``give all Americans a meaningful choice of coverage.''

I happen to know this because he and I spent some time combating each other for the Presidency. In 1993, Howard Dean said of Medicare:

One of the worst Federal programs ever and a living advertisement for why the Federal Government should never administer a national health care program.

That shift of opinion on something as important as this leaves me asking whether they have analyzed, all these folks, the level of reform in this bill.

We need to step back and see the forest for the trees of what this legislation does. I believe this legislation, even though it doesn't have the public option I want--and there are a lot of other things it doesn't do that could make the bill more effective--I believe when you take the totality of this bill and measure it against the problems we have in America today in delivery of health care and you look at the ways in which this bill increases coverage for seniors, provides lower cost drugs for seniors, expands the number of people who will be able to afford health care, helps to promote any number of individual reforms, almost every single idea that is worth considering that has been put forward by any think tank or any group in America is in this legislation in an effort to do what we call bending the cost curve--a terrible phrase, a Washington phrase.

It just means lower the cost increase in health care. Bring it down so it is reasonable with respect to what people can afford in relation to the rate of increase of inflation and other costs in our lives.

The Senate bill that is attracting all this trumped up, completely inapplicable but effective politics of destruction, this Senate bill, in fact, provides a provision that will allow the States to establish health care coverage for people between 133 percent and 200 percent of poverty. It allows States, not the Federal Government telling them what to do, no government from Washington, as everybody is trying to pretend this does, it doesn't tell the States what to do, but it allows the States to contract directly with plans that provide insurance. It allows those States to have the authority. This is States rights. This is the party that always talked about States rights. We are empowering Governors, we are empowering States individually to have the right to negotiate the premiums, the cost sharing, and the benefits for their citizens.

Something else the Senate bill does. It provides $6 billion in startup funding under the Consumer Operated and Oriented Plan, CO-OP program. This money fosters the creation of a new nonprofit member-run health insurance that offers coverage in the individual and small group markets. Those are the markets where the costs have gone up most rapidly and where Americans have the hardest time surviving.

I just came back from Boston. A fellow came up to me, an unemployed pilot, at the airport and talked to me about the $1,100 a month he pays for his family premium and how it was killing them. It goes up 20 percent a year. It is the market that is squeezing most Americans out. We lower those costs. We dampen down that increase, and we make it more affordable for people who are at the lowest end of the income scale, who deserve to buy insurance, deserve to have insurance. We make it more accessible to them and affordable for them.

The press has reported that one of the options being considered in the managers' amendment is the creation of the Office of Personnel Management-administered plan. That is a plan administered by the Federal Government that would offer individuals an option to get a national nonprofit plan. I would say to Keith Olbermann and Howard Dean, take a look at this. Look at the OPM-managed and co-op-managed plans that actually provide a not-for-profit option at the Federal level.

When I ran for President, I proposed allowing everyone to have access to the same health care coverage offered to Federal employees and to Members of Congress. Ask any American, do you think you should have access to the same health insurance that the Members of Congress give themselves? They will say yes. That is exactly what we do. We give Americans the option of participating in a plan administered by the same entity that administers the health insurance for Members of Congress. I think leveraging the role of OPM to encourage creation of a national nonprofit plan is a key way to lower health care costs and to roll more Americans into plans that devote a higher premium portion of dollars to medical dollars.

Some of our progressive friends have also said we ought to kill this bill because it has an age-rated premium. They want us to kill this bill because it has an age-rated premium. I don't like age-rated premiums. It would be wonderful to get rid of them altogether. An age-rated premium is a premium, let's say for a lot of young people, because young people are healthier. When an insurance company looks at the young person, they say the odds of that young person having high blood pressure, any number of other diseases that seniors tend to have more because they are older, is less, therefore, we ought to charge those people less and we are going to charge the seniors a whole bunch more because they are much more likely to be a lot sicker, and it costs the system more. That does make sense to some degree. But the whole theory of insurance is to spread the risk of being sick among everybody.

Those young people are going to be old people one day--not a bad idea that they are going to be able to pay an affordable premium for good health care when they are older too. So maybe there is a sharing across the board. That is how you do your home insurance. That is how you do car insurance. It is spread across the entire population of users and risks that are within those user fields. Although there is some allocation, even in automobile insurance, we all understand, for age ratings and the likelihood that if you are young and a new driver, you may have an accident, more prone, and we have some deferential there, as we do in this bill.

People who are criticizing this bill ought to stop and take a look at what it does. Insurance companies are going to be prohibited from denying coverage or charging more because of a preexisting condition. How many people in America complain: I can't get insurance. They turned me down because, once upon a time, I had this or I had cancer 4 years ago, but now I am cured but they won't give me insurance because they think it may come back and I am going to be sick later on. That is what insurance is for. But companies have been allowed to say no. This bill will prohibit companies from denying insurance to people because they have a preexisting condition.

I introduced the Women's Health Insurance Fairness Act, which prevents insurers in the individual market from charging women higher premiums than men. That is what has been happening all this time. I am happy to say that in this legislation, in our bill, we prohibit discrimination in those premium increases for women. Insurance companies will also be prohibited from dropping coverage once someone becomes seriously ill, and they are going to be required to renew your coverage each year. Why would Americans across the board not say: Wow, you guys are going to protect me so I can't be kicked off. You are going to guarantee that I can buy it, even though I had a preexisting condition. That sounds pretty reasonable to me.

Our colleagues don't come to the floor and talk about that. They just use a lot of scare tactics, pretending they don't know what is in the bill. They know what is in this bill because we did it in the HELP Committee, and we did it in the Finance Committee, and we have been doing it for 11 months.

So insurance companies are going to be prohibited from providing a lifetime cap or an unreasonable annual limit on coverage. That sounds pretty reasonable to me.

Now, I also wish the bill would include an age rating so that insurance could not charge older Americans more. I hope older Americans are listening to this carefully because the fact is, the Senate bill imposes a 3-to-1 limit on age rating, i.e. the rating charged seniors is restricted to three times the level of premium that is charged to a young person.

A lot of people are going to react: Oh my God, you mean I am going to pay three times more than a young person? That doesn't sound fair to me. Guess what. When it began in the bill, it was 5 to 1. Under current state, premiums can be 25 to 1. There are States that charge 25 to 1, 20 to 1, 15 to 1. That is the way it is today. That is what seniors face today without this bill.

Guess what. In this bill, in the Finance Committee, we knocked it down from 5 to 1 to 4 to 1, and then, in the merged bill, we knocked it down to 3 to 1. In the House bill, it is 2 to 1. I ask a simple question: Is 3 to 1 or 2 to 1 better than 25 to 1 or 20 to 1? That is what is in this bill. This limits the age rating disparity in America. I offered an amendment to try to limit it to 2 to 1, but we were not able to carry that in the committee. Republicans spoke out against imposing a cap age rated premiums.

Charging older Americans nearly three times as much for health insurance is by no means ideal. I know that. But, boy, when you look around the country, the majority of States have no rating structure in the individual market at all, and there is a huge rate disparity, as I described, in the small group market. So you have no rating restraints. So we get down, at least, to 3 to 1. The House is at 2 to 1. Today, in most places in America, there are no restraints, nothing--zero--for the individual market, and there are high rating bands, as I said, of 20, 25 percent for the small group market.

Let me give you an example for Kentucky. We have a couple Senators from Kentucky on the Republican side. The rate bands in the small group market in Kentucky are as high as 25 to 1. I guess that is OK with them because they do not want this bill.

In Utah, the rate bands in the small group market can be as high as 34 to 1. I guess that is OK with them.

As I said, the 3 to 1 is too high, but, boy, is it a vast improvement over current law.

Some of our friends have said we should kill this bill because the exchanges are not strong enough. Well, I have been working on the exchanges with about 70 different groups in America ranging from seniors' representatives, union representatives, small business, and other representatives, all of whom are concerned about the exchanges being strong. I am pleased to say those who claim the exchanges in this Senate bill are not strong enough have not read the bill. You do not have to get past the first 200 pages in this bill to see how the exchanges have been strengthened.

In the Finance Committee, I offered an amendment to allow State exchanges to engage in prudent, selective purchasing of insurance. Under my proposal, exchanges would negotiate with plans for lower bids, encourage plans to form select networks, and exclude plans that did not offer good cost and good value.

The Senate bill we are looking at now provides exchanges with strong authority to certify whether a plan can participate in the exchange based on a number of criteria, including whether the plans meet certain marketing requirements, whether it has broad provider networks, whether they deliver quality benefits for the price. They can literally negotiate for all of those things. You do not have that today. You just have plans, and you have no control over what is in them.

So we actually create an exchange that can negotiate down the prices. And they have the power to approve the participation of plans if they are determined to be in the best interests of qualified individuals and qualified employers in the State.

I have advocated for these provisions because of a simple reason. In Massachusetts today we have this ability. We do this, and it has driven down the premiums. In Massachusetts, we have something called the Connector. In fact, the exchange that is in this bill is significantly based on the Connector in Massachusetts. In that, the Connector has the ability to negotiate contracts for what is called Commonwealth Care, and it has placed pressure on the carriers to reduce the rates overall. We have had this in place for 3 years now. The average premium increases have been only 4.7 percent compared to 8 percent average premium increases for private insurance.

The language in the Senate bill is modeled after the strength of the exchanges in Massachusetts, and I believe it will ensure that taxpayer dollars are spent in a smart way. That is what this does. It guarantees you can go negotiate for lower premiums, so you are driving down the cost to the taxpayers.

This bill also will ensure that all Americans have access to quality, affordable health care and will create the transformation within the health care system necessary to contain costs. The Congressional Budget Office has determined that it is fully paid for--fully paid for--and it is going to provide coverage to more than 94 percent of all Americans. Even as it does that, it stays under the $900 billion limit President Obama established. It reduces the costs of health care in America, and it reduces the deficit over the next 10 years and beyond.

I cannot think of how few the times were over the course of 25 years where we had a piece of legislation that accomplished a social goal that managed to simultaneously lower the deficit. That is an enormous accomplishment.

This bill includes immediate changes to the way health insurance companies do business to protect consumers from discriminatory practices, and it provides Americans with better preventive coverage--something we do not do enough of in America. We spend an amazing amount of time in our health care system just responding to symptoms, addressing disease, hospitalizing people with expensive procedures. A classic example of that is diabetes because we do not screen people. Because a lot of Americans do not have coverage, they do not get screened at an early stage. Therefore, when they are discovered to have diabetes, it becomes a far more acute treatment as a consequence of having gone all those years without the discovery. So you wind up with expensive alternatives, such as the amputation of limbs, dialysis, instead of having treated them earlier with oral intake of a pill or other treatments, diet, and other kinds of things that ultimately would save billions.

Well, this bill tries to encourage the embrace of better coverage for prevention and wellness. It empowers people in America. It does not say, in Washington: You have to do this or that. It is not command and control. It puts information at the disposal of Americans, so every American can decide what they want, where they want to go get it, who will treat them. That fundamental principle of American health care is absolutely, totally preserved and sacrosanct in this bill. Every American can choose their own doctor, choose their own plan. No one is told to go do this or go do that.

Uninsured Americans with a preexisting condition can have access to an immediate insurance program and help them avoid medical bankruptcy. One of the huge bankruptcy causes in America is health care. How many seniors have had the situation where they have had to spend down by selling their homes, selling--if they are lucky enough to have any stocks--whatever assets they have, sell the family farm, sell the small business because they are very ill and they do not have the money, the kids do not have the money? But they hope to leave that money to their kids. They hope to leave something to their children. Instead, we just wipe it out because we do not provide a lot of those folks with the insurance they deserve.

The new health insurance exchanges will make coverage affordable and accessible for individuals and small businesses. Premium tax credits and cost-sharing assistance is going to help people who need assistance. Insurance companies are going to be barred from discriminating based on preexisting conditions, health status, and gender.

The bill also improves the quality and efficiency of health care itself. As the Presiding Officer knows, we are strengthening the Medicare Program for America's seniors. I cannot believe the distortion that has been taking place over the course of these last weeks, months. Time and again, someone on the other side of the aisle will come to the floor and say this is attacking Medicare or this is going to tax the benefits.

Well, we believe--we, the party that created Medicare; we, the party that expanded Medicare; we, the party that has lifted a huge percentage of Americans out of poverty over the last 50, 60 years through Medicare--that it is a sacred trust, and we are going to keep it. This bill helps, in fact, to extend the life of Medicare. The cost of inaction is unacceptable for seniors and the Medicare Program that serves them. In fact, the Medicare hospital trust fund, as we know, is expected to go broke in over 7 years. This bill makes Medicare stronger. It makes it more sustainable. It extends the solvency by 9 years.

Medicare currently reimburses health care providers on the basis of the volume of care they provide rather than the value of the care they provide. For each test, scan, or procedure conducted, Medicare provides a separate payment. So we do that regardless of whether that was necessary or whether it had anything to do with the outcome for that particular patient. That does not make a lot of sense. We do not pay people to build our home the wrong way, or to build something we did not ask for and charge us more, or a whole bunch of other kinds of examples. But Medicare is doing that.

I think Americans deserve to get something better out of their taxpayer dollar. This bill includes a number of proposals to move away from what we call the ``a la carte'' Medicare fee-for-service system so that we begin to pay for quality and value, and that reduces costs to America's seniors.

This bill promotes, as I said, preventive care and improves the public health to help Americans live healthier lives and to help restrain the growth of health care costs over time. It, importantly, eliminates copays and deductibles for recommended preventive care, and it provides individuals with information they need to be able to make good decisions about their health care and improves education on disease prevention, public health, and invests in a national prevention and public health strategy. It does all of that. All of those things just put to shame the idea of just scrapping this legislation.

Currently, 65 million Americans live in communities where they cannot access a primary care provider. An additional 16,500 practitioners are required to meet their needs. If you scrap this, that number is going to go up, and the number of millions--65 million today--of Americans who do not have access to a primary care provider is going to go up.

This bill addresses the shortages in primary care in other areas of practice by making necessary investments in the Nation's health care workforce.

Specifically, this bill will invest in the National Health Service Corps, scholarship and loan repayment programs. It will expand the health care workforce. The bill includes incentives for primary care practitioners and for providers to serve underserved areas.

Don't listen to me on the transformational changes. Listen to a fellow by the name of Jon Gruber, who is a very respected and renowned economist from MIT, and here is what he writes:

The United States stands on the verge of the most significant change to our health care system since the 1965 introduction of Medicare. The bill that was passed by the House and the parallel bill before the Senate would cover most uninsured Americans, saving thousands of lives each year and putting an end to our status as the only developed country that places so many of its citizens at risk for medical bankruptcy. Moreover, the bill would accomplish this while reducing the Federal deficit over the next decade and beyond. They would reform insurance markets, lower administrative costs, increase people's insurance choices, and provide ``insurance for the insured'' by disallowing medical underwriting and the exclusion of preexisting conditions. The Senate bill in particular would move us closer to taming the uncontrolled increase in health care spending that threatens to bankrupt our society.

That is what this bill does. That is what the Republicans are opposing.

These aren't minor things. These are things we have been striving to accomplish here for decades. I see colleagues who were here with me back when we struggled with the Clinton administration's effort on health care and every one of us would have been more than happy back then to have accepted--right then and there, we would have accepted what we have here today. I will tell you something: We would have had Republicans, such as Senator John Chafee, and I think Bob Packwood and others at that time, who would have tried to get a compromise passed, not totally dissimilar from the direction we are moving in here, and it was totally rejected by the Clinton administration.

So now is the time to examine what we have promised our people and decide where we stand. We know where the other side stands when they say ``let's begin over,'' pretending to America there is some place to begin over here. They have engaged in fear-mongering and deliberate misinformation. Those have been the core of the arguments they have used, fundamentally, to stop the success of President Obama.

They are also continuing now, obviously, to use procedural tactics, chewing up the Senate's time. The week before Christmas: Boy, let's see if we can back this right up and make it look as bad as possible and try to make the Congress look as bad as possible; make them fold. So they use this idea, and they are willing to block the funding for our troops so we can go on with this delay. We could have voted today, but they have said no.

There is no reason to do this. I think there is a snow storm coming to Washington. I suspect they are hoping the snow will prevent some Senator from getting here and then they won't be able to vote, because normal decency would have said, Hey, why don't we convenience everybody and have the vote before the snowstorm, but no. So they link it to blocking the money for the troops. I hate to think what some of those troops think is going on here. It is embarrassing.

We have heard repeatedly from Republicans that our health care reform bill is going to drive insurance premiums sky high for families. That is what they say, but the Congressional Budget Office says the opposite. It says that the 134 million Americans who get their insurance through their employer would end up paying 3 percent less for their premiums if we passed the reform measure before us. In addition, the CBO says the subsidies included in the measure would result in a 59-percent reduction in costs for nearly 18 million Americans who purchase their own insurance--a 59-percent reduction for a
lot of Americans out there who buy their insurance individually. You don't think they want a 59-percent reduction? And despite the fact that the CBO says there is a 59-percent reduction, they continually come out here and tell people otherwise. Because one of the things we have learned in American politics is that if you throw the mud out there, throw the lie out there, throw the distortion out there enough, enough people will hear it and they won't know the difference.

Health care reform has dramatically reduced the premiums in Massachusetts. Premiums fell by 40 percent. We are not here conjecturing as to what is going to happen. This isn't some pie-in-the-sky theory that if we do this, here is what is going to happen. We have done it. In Massachusetts, we are insuring over 97 percent of all of our citizens, the highest level of insurance in the United States of America. Guess what. The number of companies participating in the program has gone up since it was passed, and they like it. The premiums fell by 40 percent, from $8,537 at the end of 2006 to $5,143 in mid 2009, while the rest of the Nation saw a 14-percent increase. So in Massachusetts, premiums go down for the individual market by 40 percent; the rest of the Nation they go up 14 percent. What do you think most Americans would rather have, the 40-percent reduction or the 14-percent increase? Our bill gives Americans the opportunity to experience the same success we have enjoyed in Massachusetts.

We have also heard repeatedly from Republicans that this bill will add billions of dollars to the Federal budget deficit, despite the fact that the CBO analysis concludes that the bill is not going to add one dime to the Federal deficit--not one dime. From the very beginning of this debate, our colleagues on the other side of the aisle have tried to make the case that seniors' Medicare benefits--benefits--are jeopardized by our reform measure. Well, it is patently false, but we keep hearing it. It gets repeated again and again no matter how many times it has been shown to be false. The bill before us, in fact, does exactly the opposite. It actually adds benefits for seniors.

For example, there are new screening benefits. The bill shrinks the so-called doughnut hole in the Medicare prescription drug benefit. When we passed the prescription drug benefit, millions of seniors had a large gap in coverage. In 2009 seniors will experience a $3,454 coverage gap. Even though they must continue to pay their monthly premium, they will receive no assistance with their drugs costs between $2700 and $6,154. That is a lot of money out of pocket for seniors. Well, we have reached an agreement where now that will be closed, and no longer will those seniors be out of pocket for the costs of drugs in the middle of that bracket.

In addition, the nonpartisan National Committee to Preserve Social Security and Medicare sent a letter to every Senator a few days ago. The Republicans and Democrats alike got this letter, but it hasn't stopped them from continuing to make the argument, but here is what the argument says: Not a single penny in the Senate bill will come out of the pockets of beneficiaries in the traditional Medicare Program. In fact, the letter adds that our reforms: ``will positively impact millions of Medicare beneficiaries by slowing the rate of increases and out-of-pocket costs and improving benefits, and it will extend the solvency of the Medicare trust fund by 5 years.''

To me, and to I think all of my colleagues here on our side of the aisle, that is a win-win for seniors, and it is a win-win for the Medicare Program.

Since sending that letter, the CMS actuary released a report saying that the solvency of the Medicare trust fund would be extended by 9 years as a result of the Senate bill. So it has been interesting to watch Republicans speak about protecting Medicare, as I said earlier, a program that their party has opposed since the very beginning. While claiming to be trying to protect Medicare, they have simultaneously warned us many times about the evils of a government-run program. Again, I would ask, if they are so opposed to a government-run program, why don't they come to the floor with an amendment or a proposal to do away with Medicare? They won't, of course, because Medicare prevents millions of seniors from falling into poverty due to health care costs.

They also always promote the idea that competition is good for the marketplace, yet they adamantly oppose adding an option that could help provide some of that competition.

President Obama said it clearly, that a public plan would help keep the private plans honest. I couldn't agree more.

Like some of our friends, some of our progressive friends, the Republicans have argued again and again about starting over. Let me remind my colleagues about one of the greatest legislators of the Senate's attitude about that, and one of the greatest champions of health care. Ted Kennedy fought for health care from the day he came here. One of his early speeches on the Senate floor was about health care. He often said that the biggest political mistake that he personally made in the 46 years he legislated was turning down a health care deal with Richard Nixon in 1971 that for the first time would have required all companies to provide a health plan for their employees, with Federal subsidies for low-income workers. That is how far the Republican Party has drifted from one of their own Presidents who, most people would agree, despite what happened in terms of what cost him the presidency, that he was a strong and capable President with respect to social policy in America.

The fact is that for the first time, all companies would have been required to cover their employees. That is the plan Richard Nixon offered Ted Kennedy and Ted Kennedy made the mistake of turning it down. He backed away from that deal under heavy pressure from fellow Democrats who wanted to hold out for a single-payer system once the party recaptured the White House in the wake of the Watergate scandal.

Well, 38 years have passed and single payer is still out of reach; not even on the table. Some people want to give up what we have available to us here and repeat that greatest mistake.

The lesson Teddy learned is this: that when it comes to historic breakthroughs in America, especially in social policies, you make the best deal you can and then immediately start pushing for ways to improve the deal.

Let me share a quick story with my colleagues. We all remember how Ted Kennedy on the floor of the Senate kept pushing and pushing to raise the minimum wage, which hadn't been raised in years. Finally, he pushed so hard that Robert Dole, who was then the majority leader and who was then running for President, decided he couldn't run for President while Ted Kennedy was pushing that hard, tying up the Senate, to get the legislation passed. It might raise people just a little bit; it wouldn't even get them up to par. Robert Dole resigned from the Senate to go run for President. He said, Ted Kennedy doesn't run the world, but he did.

Trent Lott came in. Senator Lott from Mississippi became the majority leader. He vowed the same thing. He said: This isn't going to happen. Within months, within months, Senator Kennedy was doing the same thing again, pushing for the rise in the minimum wage. Senator Lott acceded to him. We got the minimum wage passed. And at a rally where he was celebrating the rise of the minimum wage, which was then not even up to par, he was in the victory moment and he turned to Congressman George Miller and he said: I am introducing a bill to raise the minimum wage. George Miller said, What do you mean? We haven't even let the dust settle. He said, We have to move on this.

That is what is going to happen with this bill. We all know there are things we are going to have to watch, there are things we are going to have to do, things we are going to have to improve, things that aren't in it that we want to get in it. But to pass up the opportunity for all of the things I have talked about and listed would be an enormous--an enormous--mistake.

Since 1965, when Medicare and Medicaid were created, they have involved and improved over the years.

When Medicare first passed, it didn't cover individuals with disabilities or individuals with end-stage renal disease. Now it does. Similarly, Medicaid evolved to allow States to cover additional services such as home- and community-based care. Now, both Medicare and Medicaid are indispensable elements of the social contract of the United States.

Our march to this point has been too long and too slow--almost a century, in fact. It began in 1912 when Teddy Roosevelt ran for President promising government protection against, as he put it, ``the hazards of sickness.'' There have been fits and starts ever since--through the shouting and distortions and big interests clinging to the status quo, and we cannot allow that to continue any longer.

We know the legislative process is a long one. But 97 years is way too long for America to finally join the other major industrialized nations in guaranteeing health care for all of our people. That we are here today, with an opportunity to take a giant step, shows not only what a challenge this undertaking has been, but it shows what hard work, skill, and dedication a lot of Senators have shown trying to get us here.

I particularly applaud the effort of Senator Reid, who personally has sacrificed the effort to help move this, and the entire leadership, including Senator Baucus, chairman of the Finance Committee, and Senator Dodd, of the HELP Committee, who was carrying that load for Senator Kennedy. Tom Harkin is now doing that job, and he and Barbara Mikulski and Jeff Bingaman were central to shaping what is coming to the floor.

Hundreds of Republican amendments were accepted during that process. Senator Baucus considered hundreds of amendments on the Republican side. The bill is not perfect. Tell me what bill is. All of us would like to change it here and there, but none of us can credibly claim we didn't get a chance to have input to this bill.

Make no mistake, this legislation, with cooperation and bipartisanship, can make history and improve the lives of Americans for decades to come, and that is important to this country and to our economy. It can help change who we are as a country. Ninety-four percent of Americans will have health care. Just think of that. If we do nothing, things are only going to get worse--more expense, more bankruptcies, and more people without coverage.

I can't help but think how often we have private conversations around here at the Prayer Breakfast, at the National Prayer Breakfast, at the Senate Prayer Breakfast, and in private conversations about what the duties and obligations are of good adherence to most of the organized religions of the world and certainly most of the philosophies of the world. They all embrace a component of the Golden Rule. You can go to any Scripture and you can read about one person's human responsibility to another human. These kinds of opportunities to live up to those guidelines, these values, don't come very often. Many of us here saw that pass in 1993. We learned a lot of tough lessons then.

I say to my progressive friends in this country, after that, we did a little better with the Children's Health Insurance Program, and we did better with portability and little pieces here and there. But still the system is out of whack and gets more expensive, and still more Americans lose their health insurance. Still, we wind up with institutionalized unfairness.

I remind my colleagues of when Ted Kennedy worked on the Children's Health Insurance Program. Do you know who the minority cosponsor was? It was Orrin Hatch. He said that passing it was the mark of a compassionate, caring Congress. We still have millions of kids who are not covered by health insurance.

Compassion can be the mark of this Congress, if we act with respect, courage, and with cooperation. I don't think we can stop now. I don't think there is any object but to get this job done after all these years.

I yield the floor.


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