Lamar Alexander

Mr. ALEXANDER

Mr. ALEXANDER. Thank you. Mr. President, will the Acting President pro tempore please let me know when I have consumed 12 of the 15 minutes.

Mr. ALEXANDER. Thank you very much, Mr. President.

Mr. ALEXANDER. Mr. President, I ask unanimous consent to speak in morning business for up to 15 minutes.

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 President, I ask unanimous consent that the order for the quorum call be rescinded.

Mr. ALEXANDER

Mr. ALEXANDER. Mr. President, it was my privilege last Thursday, along with some other Members of the Senate, to attend a health care summit at the invitation of President Obama. It went on a long time. We learned one thing we already knew, that our President is smart and knows a lot about health care. So he stayed the whole time. But it gave those of us on the Republican side a chance we do not have the opportunity to have as often, which is, to be on center stage and let the American people know, A, who we are, and, B, what our ideas are. So it was a terrific way for us to show, for example, that our goal is to reduce health care costs, that we wish to move step by step toward that goal. We identified a number of areas, such as being able to buy health insurance across State lines, allowing small business health plans to pool together, reducing junk lawsuits--all of which will tend to bring down the cost of premiums, which is what most Americans want. During the discussion, early on, actually, the President and I had a little disagreement about whether his plan, which is based upon the Senate bill, which passed on Christmas Eve, would raise premiums. What I had said in my opening remarks on behalf of Republicans was that millions of Americans, under the Democratic plan, would pay higher insurance premiums in the individual market because of government mandates and taxes. The President says that is wrong. I cited a Congressional Budget Office report to show I was right. And rather than dispute the President of the United States in public--I thought I had enough time to make my case--I said I would send him a letter, which I did that same day. So I ask unanimous consent, Mr. President, to have printed in the Record the letter I gave to President Obama on Thursday.

Mr. ALEXANDER. But today what I wish to do in the next few minutes is explain why I believe I am correct, that under the President's health insurance plan, which is based upon the Senate plan, for millions of Americans in the individual market, premiums would go up because of one-size-fits-all government mandates, because of taxes that are passed on to consumers; but for other reasons as well--by shifting costs. When you dump 15 million people or 18 million people into a program called Medicaid, what happens is, we do not pay the doctors and the hospitals well enough to take care of those folks. So those providers shift the costs to people who are paying with private insurance, and premiums go up. Costs for young people in the individual market will go up under this plan because if you put in a rule that says my insurance at my age cannot go up more than a certain amount compared with my son's insurance, then his insurance goes up, and because a scheme like the Democratic plan depends upon requiring everybody to buy insurance. There is a weak provision for that, and I suspect many young people will rather pay the $750 fine rather than buy a $2,500 insurance policy, which they think they cannot afford. The President made the point in his usual very persuasive way that, wait a minute, actually you would be getting better insurance. But that is comparing apples and oranges. As George Will said on ABC's ``This Week'' yesterday--he asked this question: If the government required you to buy a better, more expensive car, even if it was better than the car you have, it would still be more expensive, would it not? That is the case with the President's health care plan. In fact, premiums will go up for millions of Americans in the individual market, up more than they otherwise would over the next several years--and we all know how rapidly they are rising--and the whole exercise we have been going through over the last year is to bring premiums down, not help drive premiums up. What I said to the President, with respect, was that the Congressional Budget Office, on November 30, said this about the Senate bill: The Congressional Budget Office and the Joint Committee on Taxation estimate that the average premium per person covered for new nongroup-- That means individual policies-- would be about 10 to 13 percent higher in 2016 than the average premium for nongroup-- That is individual coverage-- in the same year under current law. In other words, if you buy an individual policy--that means not a policy with your employer--by 2016 it will be at an average of 10 to 13 percent higher than it otherwise would. I ask unanimous consent to have printed in the Record the relevant parts of the Congressional Budget Office letter of November 30 to Senator Evan Bayh on this point.

Mr. ALEXANDER. Now, the President said: Wait a minute. The premiums in the individual market will go down 14 to 20 percent. That is also in the same letter. Of course, he is right about that. They go down because of administrative efficiencies and new enrollment, but he left out that there are other factors involved so that the government mandates will drive them up 27 to 30 percent or, in the end, the average, as the CBO said, premium per person covered in an individual policy would be up 10 to 13 percent. The bill has subsidies in it for some Americans. The same letter says about half of Americans who buy in the individual market will get a subsidy. Well, we are paying for that subsidy, but let's concede that point. Still, that leaves half of the people in the individual market for whom premiums will go up on an average of 10 to 13 percent. Why is that? One reason is because the Senate bill says people will have to buy a richer policy than they have today. That means it has a higher actuarial value. They call it in the bill ``minimum creditable coverage.'' It means this is the amount of insurance I think you should have before you buy a policy. That might be a good decision. It undoubtedly would be good to have the insurance. It just costs 27 to 30 percent more than today's average. The National Federation of Independent Businesses wrote a December 12 letter in opposition to the Senate bill saying the benefit mandates will put small business owners ``at risk of having to drop coverage due to cost increases that outpace their health budgets.'' I ask unanimous consent to have printed in the Record the letter from NFIB to Senator McConnell and Senator Reid, dated December 8.

Mr. ALEXANDER. The one-size-fits-all provision in the Democratic bill says all individual and small group policies must have an actuarial value of 60 percent. Senator Susan Collins of Maine, who was the insurance commissioner of Maine, made a speech on the Senate floor on December 18, and pointed out that 87 percent of the individual policies that are purchased in Maine today would cost more under the Reid bill. I commend to my colleagues the Senator's testimony of December 18, 2010. Senator Collins used the example that the most popular individual market policy sold in Maine costs a 40-year-old about $185 a month. Under the Senate bill that 40-year-old would have to pay at least $420 a month, more than twice as much for the policy that meets the new minimum standard, or face a $750 penalty. It is true Maine citizens, as is true for all Americans--about half of them--would receive subsidies to help them buy that policy, but the average premium for the other half of the 87 percent is going to go up under the Democratic bill. We believe Americans ought to have more choices than that. That is a fundamental difference of opinion. Should Washington decide you need to buy a richer policy, or should you decide that for yourself based upon the other needs of your family? The Congressional Budget Office does state, as I have mentioned, that there are a number of enrollees--about half--who would have the subsidies, and that is in the letter I have already introduced into the Record. But someone is paying for those subsidies: the taxpayers are paying for them, which brings up the second reason I said on Thursday that premiums for millions of Americans in the individual market will go up. The commonsense idea is that if you tax an insurance company or a medical device company or a manufacturer of drugs, they will pass the taxes on to whom? To us, who are buying insurance policies or medical devices or drugs. So we end up paying. In fact, one part of the President's proposal deliberately does that. It is a 40-percent excise tax on insurance companies for what we call Cadillac plans, the high- cost private insurance plans. A letter from the Joint Committee on Taxation, dated February 24, says the 40-percent excise tax will raise $32.7 billion, all of which will be passed along to consumers in the form of higher insurance premiums. That may be a good thing. In fact, I think it is because it helps to discourage the purchase of more expensive policies. But it does raise premiums in the individual market. The Joint Committee on Taxation Memorandum on High Cost Plans, dated September 29, says: The excise tax would be mainly passed along through increases in premiums. Because the new tax is indexed to regular inflation plus 1 percent instead of medical inflation, which goes up very much higher and quicker, the new tax, like the alternative minimum tax, will pretty soon start to hit Chevy and Buick insurance policies and not just Cadillac policies. But there are other taxes in the President's proposal. There are up to $\1/2\ trillion in new taxes, which will be passed on to consumers: $20 billion in excise taxes on lifesaving medical devices, $33 billion on drugs, and $60 billion on health insurance companies. In the previously mentioned CBO letter and a JCT letter to Senator Grassley in October of last year, both said these taxes will be passed on to patients, increasing health insurance premiums. The Chief Actuary of the Center for Medicare and Medicaid Services, who is a part of the Obama administration said: We anticipate such fees would be generally passed through to health consumers in the form of higher drug and device prices and higher insurance premiums. That was on December 10 of last year, about the Senate bill. The Lewin Group, on October 30, said: Employer spending would increase steadily under the [Democratic] act, reflecting the cost of paying the various excise taxes under the act. Total employer health spending would increase by 2.1 percent by 2019. I ask unanimous consent to have printed in the Record the executive summary of the Lewin Group letter.

Mr. ALEXANDER

Mr. ALEXANDER. Mr. President, today Senator Carper and I have joined with Senators Klobuchar, Collins, Gregg, Kaufman, Graham, Feinstein, Shaheen, Schumer, Lieberman, and Snowe to introduce the Clean Air Act Amendments of 2010. This bill is about clean air and the effect of sulfur dioxide, nitrogen oxides, and mercury emissions of coal-fired power plants on health, jobs, and tourism. This bill does not address carbon emissions. To me the most important aspect of this bill is that for the very first time it puts into federal law requirements that we cut mercury emissions by 90 percent from coal plants, which produce 50 percent of our electricity today. This bill will reduce sulfur dioxide, nitrogen oxides, and mercury emissions from power plants by directing EPA to cut mercury emissions at least 90 percent through the best available technology and strengthening national limits on emissions of sulfur dioxide and nitrogen oxides from power plants with new trading systems that will enable cost-effective reductions of these two pollutants. For Tennesseans this is a bill about our health, it is about tourism in our State and it is about our jobs. 400,000 Tennesseans have asthma that is affected by the dirty air in our state. Sulfur dioxide and nitrogen oxides can trigger asthma attacks and cause chronic lung problems. 400,000 Tennesseans with asthma are at a daily risk due to poor air quality. The more we learn about mercury the more we understand that it gets in our food supply, it gets in our water supply, some of it comes from our coal plants and it especially affects women and children. Nationwide, EPA estimates this bill will save more than 215,000 lives and more than $2 trillion in health care costs by 2025. In our State, we are privileged to have the most visited national park in America, the Great Smoky Mountains National Park--we are intensely proud of it. But we want the 10 million tourists who come there every year to see the blue haze that the Cherokee Indians used to sing about, not the smog that is produced by dirty air blowing into our State and some of the dirty air that we produce. Finally we have become an automobile State. When auto parts suppliers move to Tennessee and want to locate near the Nissan plant or near the Volkswagen plant, one of the first things they have to do is to get a clean air permit. Our State simply cannot clean up our air all by ourselves without strong national standards to require the rest of the country to stop producing dirty air that blows into our State. So for Tennesseans this is about our health, about our tourism and our mountains, and this is about our jobs. The Environmental Protection Agency says the bill will only cost electricity consumers about 1.5 percent to 2.5 percent increases in their utility bills by 2020. This may only be about $2 a month per customer. I think $2 a month is worth it for savings of $2 trillion in health care costs. In summary, this bill helps save hundreds of thousands of lives, saves trillions of health care dollars, enables communities to meet new EPA air quality requirements and create new jobs, and protects the scenic beauty of some of our greatest natural treasures. Cleaner air is something we can all support and I ask my colleagues to join Senator Carper and me in this effort. Mr. President, I ask unanimous consent that a description of the bill be printed in the Record.

Mr. ALEXANDER

Mr. ALEXANDER. Mr. President, today Senator Carper and I have joined with Senators Klobuchar, Collins, Gregg, Kaufman, Graham, Feinstein, Shaheen, Schumer, Lieberman, and Snowe to introduce the Clean Air Act Amendments of 2010. This bill is about clean air and the effect of sulfur dioxide, nitrogen oxides, and mercury emissions of coal-fired power plants on health, jobs, and tourism. This bill does not address carbon emissions. To me the most important aspect of this bill is that for the very first time it puts into federal law requirements that we cut mercury emissions by 90 percent from coal plants, which produce 50 percent of our electricity today. This bill will reduce sulfur dioxide, nitrogen oxides, and mercury emissions from power plants by directing EPA to cut mercury emissions at least 90 percent through the best available technology and strengthening national limits on emissions of sulfur dioxide and nitrogen oxides from power plants with new trading systems that will enable cost-effective reductions of these two pollutants. For Tennesseans this is a bill about our health, it is about tourism in our State and it is about our jobs. 400,000 Tennesseans have asthma that is affected by the dirty air in our state. Sulfur dioxide and nitrogen oxides can trigger asthma attacks and cause chronic lung problems. 400,000 Tennesseans with asthma are at a daily risk due to poor air quality. The more we learn about mercury the more we understand that it gets in our food supply, it gets in our water supply, some of it comes from our coal plants and it especially affects women and children. Nationwide, EPA estimates this bill will save more than 215,000 lives and more than $2 trillion in health care costs by 2025. In our State, we are privileged to have the most visited national park in America, the Great Smoky Mountains National Park--we are intensely proud of it. But we want the 10 million tourists who come there every year to see the blue haze that the Cherokee Indians used to sing about, not the smog that is produced by dirty air blowing into our State and some of the dirty air that we produce. Finally we have become an automobile State. When auto parts suppliers move to Tennessee and want to locate near the Nissan plant or near the Volkswagen plant, one of the first things they have to do is to get a clean air permit. Our State simply cannot clean up our air all by ourselves without strong national standards to require the rest of the country to stop producing dirty air that blows into our State. So for Tennesseans this is about our health, about our tourism and our mountains, and this is about our jobs. The Environmental Protection Agency says the bill will only cost electricity consumers about 1.5 percent to 2.5 percent increases in their utility bills by 2020. This may only be about $2 a month per customer. I think $2 a month is worth it for savings of $2 trillion in health care costs. In summary, this bill helps save hundreds of thousands of lives, saves trillions of health care dollars, enables communities to meet new EPA air quality requirements and create new jobs, and protects the scenic beauty of some of our greatest natural treasures. Cleaner air is something we can all support and I ask my colleagues to join Senator Carper and me in this effort. Mr. President, I ask unanimous consent that a description of the bill be printed in the Record.

Mr. ALEXANDER

Mr. ALEXANDER. Mr. President, I look forward to the President's State of the Union Address on Wednesday, as I know most Americans do. There is a lot of talk about how the President might reconnect with the American people. The President himself said a couple of days ago, after Massachusetts elected a Republican Senator, that perhaps he had not been talking to the American people directly about core values. If I may do this in a respectful way, I would like to make a suggestion about what the President might say on Wednesday evening. To reconnect with the American people, I suggest in his State of the Union Address the President talk first about creating jobs; second, about reining in the national debt; and make terrorism his third subject. Then it would not hurt my feelings one bit if he stopped his speech right there and focused his unswerving attention on jobs, debt and terrorism until he has them all headed in a better direction. After all, in my view, the President struggled in his first year not only because his agenda veered too far to the left but because he took too many big bites out of too many apples and tried to swallow them all at once. Years ago, I learned that a Governor who throws himself into a single issue with everything he has for as along as it takes can usually wear out everybody else. I think that is true for Presidents, too. In 1952, President Dwight D. Eisenhower said, ``I shall go to Korea.'' Then he focused on that one problem, ended the conflict, and Americans thanked him for it. I hope President Obama would focus with Eisenhower-like intensity on jobs. In the 1980s, I found the best way to do that was not to try to turn my State, Tennessee, upside-down all at once. We were then the third poorest State in the Union. My goal was raising family incomes. I didn't try to turn it upside-down all at once, but I went step by step--sometimes learning as I went--amending banking laws, defending right-to-work, keeping debt and taxes low, recruiting Japanese industry and then the auto industry, building four-lane highways so the auto suppliers could get to the auto plants, and finally a 10-step ``Better Schools'' plan which included centers and chairs of excellence for higher education. In my view, a step-by-step job strategy for the country should include tax cuts, less regulation, certainty so people can make their plans, free trade, a balanced labor climate, good educational opportunities, and clean but cheap energy. Unfortunately, the President has too often proposed higher taxes, more regulation, uncertainty, protectionism, expensive labor policy, higher college tuitions (as Medicare costs are passed on to States), a national energy tax, and new costs for the businesses that we count on to create jobs. As for debt, Democrats in Congress are trying this week to raise the national debt limit by $1.9 trillion, an amount that is more than the total Federal budget in 1999. To be sure, President Obama inherited some of this, but he has run up a $1.5 trillion debt in just one year and it took President Bush 8 years to accumulate a $2 trillion debt. The solution for a boat sinking because it has a hole in it is not to put more holes in it. Finally, the President deserves credit for his decisions on Iraq and Afghanistan but bringing terrorists from Guantanamo to Illinois, trying the 9/11 mastermind in New York City, and failing to interrogate the Christmas Eve ``underwear bomber'' in Detroit shows dangerous confusion about how to deal with terrorists. When I became Governor, Ned McWherter, then the Democratic house speaker, said, ``I want to help because if the Governor succeeds the State succeeds.'' In the same way, I want President Obama to succeed. The best way for him to do that, I respectfully suggest, is to declare an end to the era of the 2,700-page bills and to work with both political parties, step by step, on jobs, debt, and terrorism to help Washington re-earn the trust of the American people. I yield the floor.

Mr. ALEXANDER

Mr. ALEXANDER. Madam President, I yield the floor.

Mr. ALEXANDER. Madam President, during our recent health care debate I heard a number of times from our friends on the other side of the aisle this question: What are Republicans for? Well, they will wait a long time if they are waiting for the Republican leader, Senator McConnell, to roll into the Senate a wheelbarrow filled with a 2,700-page Republican comprehensive health care bill or, for that matter, a 1,200-page climate change bill or a 900-page immigration bill. If you have been listening carefully to the Senate debate, you will know that on health care, as well as on clean energy, debt reduction, and immigration, for example, Republicans have been offering the following alternative to 1,000-page bills: going step by step in the right direction to solve problems in a way that re-earns the trust of the American people. Comprehensive immigration, comprehensive climate change, and comprehensive health care bills have been well intended, but the first two fell of their own weight, and health care, if enacted, would be a historic mistake for our country and a political kamikaze mission for Democrats. What has united most Republicans against these three bills has not only been ideology but also that they were comprehensive. As George Will might write: ``The Congress. Does. Not. Do. Comprehensive. Well.'' Two recent articles help explain the difference between the Democratic comprehensive approach and the Republican step-by-step approach. The first, which appeared in the new journal, National Affairs, and was written by William Schambra of the Hudson Institute, explains the ``sheer ambition'' of President Obama's legislative agenda as the approach of what Mr. Schambra calls a ``policy President.'' Mr. Schambra says the President and most of his advisers have been trained at elite universities to govern by launching ``a host of enormous initiatives all at once . . . formulating comprehensive policies aimed at giving large social systems--and indeed society itself--more rational and coherent forms of functions.'' This is governing by taking big bites of several big apples and trying to swallow them all at once. In addition, according to Mr. Schambra, the most prominent organizational feature of the Obama administration is its reliance on ``czars''--more than the Romanovs, said one blogger--to manage broad areas of policy. In this view, systemic problems of health care, of energy, of education, and of the environment simply can't be solved in pieces. Analyzing the article, David Broder of the Washington Post wrote this: Historically, that approach has not worked. The progressives failed to gain more than a brief ascendency and the Carter and Clinton presidencies were marked by striking policy failures. The reason for these failures, as Broder paraphrased Schambra, is that ``this highly rational comprehensive approach fits uncomfortably with the Constitution, which apportions power among so many different players.'' Broder then adds this: Democracy and representative government are a lot messier than the progressives and their heirs, including Obama, want to admit. James Q. Wilson, a scholar, writing in a memorial essay honoring Irving Kristol in the Wall Street Journal a few months ago, says the law of unintended consequences is what causes the failure of such comprehensive legislative schemes. Explains Wilson: Launch a big project and you will almost surely discover that you have created many things you did not intend to create. Wilson also writes that neoconservatism, as Kristol originally conceived of it in the 1960s, was not an organized ideology or even necessarily conservative, but ``a way of thinking about politics rather than a set of principles and rules. . . . It would have been better if we had been called policy skeptics.'' The skepticism of Schambra, Wilson, and Kristol toward grand legislative policy schemes helps to explain how the law of unintended consequences has made being a member of the so-called ``party of no'' a more responsible choice than being a member of the so-called party of ``yes, we can''--if these three recent comprehensive bills on health care, climate change, and immigration are the only choices. Madam President, it is arrogant to imagine that 100 Senators are wise enough to reform comprehensively a health care system that constitutes 17 percent of the world's largest economy and affects 300 million Americans of disparate backgrounds and circumstances. How can we be sure, for example, that one unintended consequence of spending $2.5 trillion more for health care over 10 years will not be higher costs and more debt? Won't new taxes be passed along to consumers, raising health insurance premiums and discouraging job growth? Won't charging insolvent States $25 billion over 3 years for a Medicaid expansion raise State taxes and college tuitions? Ask any Governor. And how can a Senator be so sure that some provision stuck in a 2,700-page partisan bill in secret meetings and voted on during a snowstorm at 1 a.m. will not come back around and slap him or her in the face, such as trying to explain why Nebraska got a cornhusker kickback to pay for its Medicaid expansion and my State did not? James Q. Wilson also wrote in his essay that respect for the law of unintended consequences ``is not an argument for doing nothing, but it is one, in my view, for doing things experimentally. Try your idea out in one place and see what happens before you inflict it on the whole country,'' he suggests. If you will examine the Congressional Record, you will find that Republican Senators have been following Mr. Wilson's advice, proposing a step-by-step approach to confronting our Nation's challenges 173 different times during 2009. May I say that again? During 2009, Republican Senators, 173 different times on the floor of the Senate, have proposed a step-by-step approach toward health care and other of our Nation's challenges. On health care, for example, we first suggested setting a clear goal; that is, reducing costs. Then we proposed the first six steps toward achieving that goal: No. 1, allowing small businesses to pool their resources to purchase health plans; No. 2, reducing junk lawsuits against doctors; No. 3, allowing the purchase of insurance across State lines; No. 4, expanding health savings accounts; No. 5, promoting wellness and prevention; and No. 6, taking steps to reduce waste, fraud, and abuse. We offered these six proposals in complete legislative text. It totaled 182 pages, all 6. The Democratic majority rejected all six of our proposals and ridiculed the approach, in part because our approach was not comprehensive. Take another example. In July, all 40 Republican Senators announced agreement on 4 steps to produce low-cost, clean energy and create jobs: No. 1, create 100 new nuclear powerplants or at least the environment in which they could be built; No. 2, electrify half our cars and trucks; No. 3, explore offshore for natural gas and oil; and No. 4, double energy research and development for new forms of energy. This step-by-step Republican clean energy plan is an alternative to the Kerry-Boxer national energy tax which would impose an economy-wide cap- and-trade scheme, driving jobs overseas looking for cheap energy and collecting hundreds of billions of dollars each year for a slush fund with which Congress can play. Here is another example. In 2005, a bipartisan group of us in Congress asked the National Academies to identify the first 10 steps Congress should take to preserve America's competitive advantage in the world so we could keep growing jobs. The academies appointed a distinguished panel, including now-Secretary Chu, that recommended 20 such steps. Congress enacted two-thirds of them. The America COMPETES Act of 2007, as we call it, was far-reaching legislation, but it was fashioned step by step. Another example. When I was Governor of Tennessee in the 1980s, my goal was to raise family incomes for what was then the third poorest State. As I went along, I found that the best way to move toward that goal was step by step--some steps smaller, some steps larger--such as changing banking laws, defending right-to-work policies, keeping debt and taxes low, recruiting Japanese industry, and then the auto industry, building four-lane highways so suppliers could get to the auto plants, and then a 10-step better schools program, 1 step of which made Tennessee the first State to pay teachers more for teaching well. I did not try to turn our whole State upside down all at once, but working with leaders in both parties, I did help it change and grow step by step. Within a few years, we were the fastest growing State in family incomes. According to a recent survey by On Message Inc., 61 percent of Independents, 60 percent of ticket splitters, and 77 percent of Republicans answered yes to the following question: I would rather see Congress take a more thoughtful step-by-step approach focusing on commonsense reforms. Human experience has always taught that enough small steps in the right direction is one good way to get you where you want to go and also a good way along the way to avoid many unexpected and unpleasant consequences. Tuesday's election in Massachusetts is the latest reminder that the American people are tired of risky, comprehensive schemes featuring taxes, debt, and Washington takeovers, as well as lots of hidden and unexpected surprises. It is time to declare that the era of the 1,000- page bill is over or the era of the 2,000-page bill is over or the era of the 2,700-page bill is over. A wise approach would be to set a clear goal, such as reducing health care costs, take a few steps in that direction and then a few more so that we can start solving the country's problems in a way that reearns the trust of the American people. Madam President, I ask unanimous consent to have printed in the Record an article from the Wall Street Journal of Monday, September 21, written by James Q. Wilson, an article by David Broder from the Washington Post of September 24, and an article from the magazine National Affairs written by William Schambra.

Mr. ALEXANDER

Mr. ALEXANDER. Mr. President, Massachusetts voters yesterday sent a clear message that the Democratic majority in Congress is not in touch with the American people and that we ought to restart the health care debate. Senator-elect Scott Brown's independent voice will provide a much needed check and balance to a Congress that has become dominated by more taxes, more spending, and more cash takeovers. Nothing demonstrates that need more than the so-called health care reform bill, a 2,700-page attempt to remodel 17 percent of the American economy that was concocted in secret, presented to the Senate over the weekend before Christmas during the worst snowstorm in years, voted on in the middle of the night, and passed 5 days later, on Christmas Eve, without one single Republican vote. Now that the people have spoken in Massachusetts, we should abandon these arrogant notions of trying to turn our entire health care system upside down all at once and, instead, set a clear goal of reducing health care costs and then work together, step by step, to re-earn the trust of the American people--an approach Republican Senators urged exactly 173 different times on the floor of the Senate during last year. If you will examine the Congressional Record, you will find that Republican Senators have been proposing a step-by-step approach to confronting our Nation's challenges 173 different times during 2009. On health care, we first suggested setting a clear goal: reducing costs. Then we proposed the first six steps toward achieving that goal: one, allowing small businesses to pool their resources to purchase health plans; two, reducing junk lawsuits against doctors; three, allowing the purchase of insurance across State lines; four, expanding health savings accounts; five, promoting wellness and prevention; and, six, taking steps to reduce waste, fraud, and abuse. We offered these 6 proposals in complete legislative text totaling 182 pages. The Democratic majority rejected all six and ridiculed the approach, in part, because our approach was not comprehensive. A good place to restart the health care debate would be to abandon plans to send a huge bill to States--that is, every State except Nebraska--to pay for Medicaid expansion. The 60 Senators who voted for this so-called health care reform legislation ought to be sentenced to go home and serve as Governor for two terms to try to pay for it because what these Senators would find is that States are broke, and there will either be higher State taxes or higher college tuition or both to pay for what the Democratic Governor of Tennessee has called ``the mother of all unfunded mandates.'' That mandate arrogantly expands Medicaid and, to help pay for it, would send a 3-year, $25 billion bill to Governors who, in turn, will send the bill to State taxpayers and then to college students. That is akin to your big-spending Uncle Sam hiring someone to paint your house and then sending the bill to you, even though you told Uncle Sam you already spent all your available money sending your kid to college. Of course, Uncle Sam does not have to balance its budget and you do. I speak today not just as a Senator but as a former Governor worried about our States and as a former president of a great public university worried about our college students, many of whom are seeking an education to get a job. Washington policies are turning our Federal constitutional system upside down. They are transforming autonomous State governments into bankrupt wards of the central government. In doing so, they are making it harder for States to support public higher education; therefore, damaging its quality and damaging the opportunity for Americans to afford it. Governor Schwarzenegger of California said: With a $19 billion deficit, the last thing we need is another $3 billion bill for Medicaid. At the University of California, students are paying a 32-percent tuition increase. Why? Because, according to the New York Times, ``the University of California now receives only half as much support from the State per student as it did in 1990.'' Why is that? Because when Governors make up their budgets, it usually comes down to a choice between exploding Medicaid costs and higher education, and Medicaid, hopelessly entangled with expensive Washington policies and mandates, usually wins. This is not a new problem. It was a problem when I was Governor 30 years ago. It became a bigger problem between 2000 and 2006, when Medicaid spending for State governments rose 63 percent, while spending for higher education went up only 17 percent. The Association of American Universities and President Obama's Budget Director both have warned us that the drop in State support is hurting the quality of American public higher education, and the problem gets worse. Some estimates predict the State share of Medicaid spending will go from $138 billion in 2007 to $181 billion in 2011. Yet instead of fixing the problem of exploding Medicaid costs and its impact on higher education, the health care bill would make it worse. Over the Christmas holidays in my State, the most talked about part of the health care bill was the so-called cornhusker kickback, which makes taxpayers and students all over America pay for Nebraska's Medicaid so Nebraskans will not have to raise their taxes and tuition. I can guarantee you any Senator who is sentenced to go home and serve as Governor--except perhaps in Nebraska--would not vote for this health care bill. The second recent big blow to States and to higher education has been the stimulus package, which was hailed as bailing States out but instead will soon push them over the financial cliff. This is how the Democratic Lieutenant Governor of New York explained it in a Wall Street Journal article on January 8. He said: . . . states, instead of cutting spending in transportation, education, and health care, have been forced to keep most of their expenditures at previous levels and use Federal funds only as supplements. The net result of this: The federal stimulus has led states to increase overall spending in these core areas, which in effect has only raised the height of the cliff from which state spending will fall if stimulus funds evaporate. On top of all this is the dramatic deterioration of the autonomous role of the States in our Federal system. Thanks, in part, to the stimulus, federally collected tax dollars have risen to 40 percent of State budgets. So instead of serving as autonomous laboratories of democracy in a Federal system, States are becoming little more than heavily regulated and increasingly insolvent administrative divisions of the central government in Washington. Some are suggesting a new stimulus to bail out the States. Why should we even consider that when the last one is helping to push States off the financial cliff? Why should we pass a new health care bill that makes it worse for States; that is, every State except Nebraska. Wouldn't it be better to restart the health care debate and take a series of steps to reduce health care costs without the Medicaid mandate? Instead of expanding Medicaid and sending the States the bill, why not reform Medicaid, which has become an embarrassing administrative nightmare, where $30 billion a year goes to waste, fraud, and abuse, according to the Government Accountability Office. Instead of dumping 15 million to 18 million more low-income Americans into a Medicaid Program, in which 50 percent of doctors--50 percent of doctors--will not take new patients, shouldn't we try a better idea? Lieutenant Governor Ravitch suggests that one place to start is relieve States of the responsibility for those patients who draw services from both Medicare and Medicaid. That would save States about $70 billion a year and would place all the responsibility on Washington for reforming the program so taxpayers could afford it. Thirty years ago, when I was Governor, I met with President Reagan and proposed a grand swap: that the Federal Government would take over all of Medicaid in exchange for giving the States all the responsibility for elementary and secondary education. President Reagan liked the idea. I still think fixing the responsibility for both education and Medicaid in a single government would make it work better and force its reform. The No. 1 topic on the minds of most Americans today is jobs. Running up the cost of health care, raising State taxes, damaging the quality of universities and community colleges, and restricting access to them is a good way to kill jobs, not create jobs. There still is time to restart the health care debate, to work together on a step-by-step plan to reduce health care costs, while avoiding expensive mandates on States that increase State taxes and increase college tuitions. The surest way to cause this to happen is to tell those 60 Senators who voted for this health care bill that if it becomes law, they will be sentenced to go home and serve as Governor for two terms to try to pay for it. Mr. President, I ask unanimous consent to have printed in the Record three newspaper articles.

Mr. ALEXANDER

Mr. ALEXANDER. I certainly do agree with that. I think most Americans, when presented with a problem, would not try to change it all at once but would say: Let's identify the goal which is reducing costs and go step by step. Madam President, I ask unanimous consent to have printed in the Record a column by David Brooks in the New York Times on December 18.

Mr. ALEXANDER. Most of us--we are pretty split up here: 60 there, 40 here. They are for it, and we are against it, this bill anyway.

Mr. ALEXANDER. I thank the Senator from South Dakota. The answer is no. The difficulty with a big, comprehensive plan is it sounds good but has lots of unintended consequences. If our real concern right now is reducing costs in health care, then the idea of a small business health care plan that has no new taxes and no new mandates but creates opportunities for small businesses to pool their resources and offer more insurance at a lower cost to their employees would seem a logical place to start.

Mr. ALEXANDER. I thank the Presiding Officer and I yield the floor.

Mr. ALEXANDER. It clearly does. It enjoys widespread support everywhere, except the Senate. When Senator Enzi brought it up, it was rejected by our friends on the other side.

Mr. ALEXANDER. No, I thank the Senator. I yield the floor.

Mr. ALEXANDER. I thank the Senator from Wyoming and appreciate his leadership on this bill. It is of tremendous value to have within our body two practicing medical doctors to help us interpret the effect of this bill, which affects all 300 million Americans so dramatically. We find, when we discuss this bill with our colleagues on the other side of the aisle, we sometimes become exasperated with one another because it seems like they are talking about one set of facts and we are talking about another set of facts. So what I would like to do is take a moment and talk about Medicare. If anyone is watching our debate, you hear the Democrats talk about three things: We are saving Medicare, we are extending its length, and you hear Republicans say they are cutting Medicare. So who is right? Well, let me tell you why we talk about Medicare cuts. Medicare, of course, is a government program which 40 million seniors depend on. We all pay into it, and then when we get to be of a certain age we depend upon it for our medical care. For many Americans, it is very important. It was established with broad bipartisan support in the 1960s. What are the proposals that have to do with Medicare? Well, basically half this health care bill is paid for by reductions in the growth of Federal spending for Medicare. Those are Medicare cuts. Who says they are? Well, the President of the United States, for one, says we will have no deficit from this bill. So the way we are going to do that, for this bill, which the Congressional Budget Office figures show us will cost $2.5 trillion over 10 years when fully implemented, is basically paid for one-half by Medicare cuts and one-half by new taxes. Give the Democrats credit for that, that helps to avoid a large part of the deficit. The rest is done by sending a huge bill to States to help pay for another big government program called Medicaid, but I will leave that to the side for a moment. The Medicare cuts which are reductions in the spending for Medicare, are $466 billion over the first 10 years and over a fully implemented 10 years it is about $1 trillion in Medicare cuts. That is money coming out of the Medicare Program and going somewhere. Where does it go? Well, it goes to start a new program. What is wrong with that? Well, one thing wrong with it is the trustees of Medicare say that there is already more money coming out of Medicare than is being paid in, and by the year 2015 or 2017 it will be insolvent. That means going broke. These aren't Republican trustees or Democratic trustees, these are the men and women whose job it is to report to the Nation on the condition of this program that takes care of 40 million people and their medical care. Already we see that the Medicare Program is under some stress. The doctors, for example, who serve Medicare are only paid about 83 or 84 percent as much as doctors who serve patients with private health care. As a result of that, we have to come along year after year and appropriate more money to reimburse doctors who serve Medicare patients. If we do not do that, they will not be serving Medicare patients, and Medicare will become similar to Medicaid, the program for low-income Americans, where about 50 percent of doctors will not take a new Medicaid patient. It is akin to telling somebody: I am going to give you a ticket to a bus line where the bus only runs about half the time. So what the Democrats are saying to us is that by taking $1 trillion out of Medicare over 10 years when fully implemented, and there is no dispute about that amount of money, and spending it to pay for this new program that is somehow good for Medicare and for the seniors who depend upon it. I mean, they are suggesting we believe if you take $135 billion from hospitals and $120 billion from the 11 million seniors who participate in Medicare Advantage and $15 billion from nursing homes and $40 billion from home health agencies and $7 billion from hospices, that somehow that is good for seniors. Perhaps it could be, if all that money were put back into Medicare; if the money were taken from grandma and spent on grandma. But no, this money is taken out and spent on a new program. The Director of the Congressional Budget Office--not a Republican, not a Democrat, the nonpartisan Director said, for the 11 million on Medicare Advantage that one-half of their benefits will be diminished. That is what he said about these cuts. Even when it is all said and done, we completely leave out the $\1/4\ trillion that we need to appropriate to pay the physicians to serve Medicare patients. Because if we don't, their payments are going to be cut by 21 percent next year and fewer of them will see Medicare patients. We have already heard the Mayo Clinic, for example, is beginning to restrict some patients on Medicare because they lost $840 million serving Medicare patients last year. I have taken a few moments to talk about Medicare. That is just one thing wrong with this bill. But when you hear the other side say they are helping Medicare, and if you listen to what I said about how can you take $1 trillion out of the Medicare Program--which is going broke--when it is fully implemented over 10 years and claim you are helping Medicare by starting a new program, I don't think that is possible. That is the source of the great concern on our side of the aisle about this bill on that one issue. I see the assistant Republican leader, the whip. I have heard a number of people say, and I will just propound this question and then I will yield the floor, if I may, to the Senator from Arizona. But I have heard them say: Why are Republicans keeping everybody in here this week? We want to go home and see our families. We all want to see our families. But there is a reason this bill was suddenly presented to us in the middle of the greatest snowstorm in the history of Washington in the month of December, and we were asked to start voting on it in the middle of the night on the same day, and to finish the work by Christmas. If I am not mistaken, and this is my question to the distinguished assistant Republican leader who has been here a number of years, who is in the leadership and whose job is to help manage the floor: Is it not entirely the prerogative of the majority leader of the Senate to schedule what comes up on the floor? Is that not his job? Isn't it true that if Senator Reid wanted to say let's take this bill down, let's go home, let's let the people hear about it, let's come back and vote on it after Christmas, after New Year, after Valentine's Day, could he not do that and isn't that peculiarly his power and not our power?

Mr. ALEXANDER. Mr. President, I agree with the Senator from Wyoming. I think it is important for the American people to know, the 400-page amendment that was added to the underlying bill over the weekend is being presented to us in way that will not allow the bill to be amended. So something that affects one-sixth of the economy, which we have had a day and a half to read, which is part of an overall bill that will raise taxes, cut Medicare, and send big bills to States could be improved with amendments but cannot be amended under the current procedure.

Mr. ALEXANDER. Madam President, the telephone townhalls are interesting. This is the 21st consecutive day and the third weekend we have been debating this bill. One would think we could probably do a better job of it, if we were going back home every weekend to hear what people thought about what we were doing. But maybe the strategy has been to keep us here talking to each other, bring the bill up in a snowstorm, pass it in the middle of the night and go home for Christmas, and the people won't find out what we are doing until it is too late. One way to find out is tele-townhalls. I was skeptical before I did one but it is a pretty interesting way to stay in touch with people from Tennessee. You get on the telephone and an automated system calls thousands of people and says: The Senator from Wyoming or Illinois or North Carolina or Tennessee wants to talk with you about health care. People can either stay on the phone when they get the call or they can hang up. What normally happens is a person stays on the call, this time a surprisingly large number of people stayed on the call, because of their strong interest in this issue. The other night I did the phone call between 7:30 and 8:30. I called to about 18 west Tennessee counties, including Shelby, which is Memphis, and as reported to me by the service, about 30,000 people were on the telephone sometime during that hour, with a maximum number of 3,016 on the call at any one time. Someone might pick up the phone and say: Senator Barrasso is on the phone. They might tune in for 15 or 20 minutes and then hang up. Maybe they have to cook dinner or the ball game comes on. Maybe they get tired of talking to you, but they are on for 15 or 20 minutes. During that time, I was able to take a number of questions. After it was over, 563 messages from constituents were sent to my Web site. It was interesting to me. People who know my history, know that to be elected Governor 30 years ago, I walked across the State of Tennessee. Instead of going to a Republican meeting or a rotary club, I would visit with random people during my walk. It took me 6 months and I would see 1,000 people a day. These random phone calls kind of reminded me of that. It was as if the people were randomly selected. They were not on any Republican list or Democratic list or list of doctors or patients. They were just in the phonebook. They talked and acted like they were normal citizens who I had interrupted after dinner, probably because it was 6:30 to 7:30 in that part of Tennessee. I was able to ask those citizens three questions. I am not about to say this is a Gallup poll of Tennessee, because I know that surveys like that have to be done in a scientific way, but after being here for 21 straight days, not able to go home because we have been debating this bill, these opinions are straws in the wind. The first question was: Do you believe the Senate should rush to pass this health care bill before Christmas? In this case, 943 people, 83 percent, said no, and 108 said yes; that is 9 percent. Second question: Do you support the health care bill moving through the Senate? On this one, 1,496 said no, or 75 percent. 352 said I don't know, which is 18 percent, and 154 said yes, that is 8 percent. No. 3: Do you agree that Congress doesn't do comprehensive legislation well and ought to go step by step to bring health care costs under control? On this question, 1,285 said yes, that is 80 percent, 14 percent said I don't know and 7 percent disagreed. I have often heard our friends on the other side say: Where is the Republican bill? My response has been, day after day, if you are looking forward to seeing the Republican leader role a wheelbarrow in here with a 2,700-page Republican comprehensive bill, you will be waiting forever. We have a different approach. Our approach is to set a clear goal--reducing cost. The bill we are voting on increases costs. Our goal is to find five or six steps to go in the direction to reducing costs. Without going into detail, although the Senators from South Dakota or Wyoming may want to, we focus on five or six steps that would clearly reduce health care costs. By that, I mean your premium, the cost of your government. And once we do those five or six steps, we could go on. We could do that without taxes, without mandates, without running up the debt, without a big bill with lots of surprises. Just to take one example--and then I will yield to my friends from Wyoming and South Dakota--one of those examples is the small business health care plan. The current bill, the Democratic bill, has in it a credit for small businesses, but we would argue that by the time small business men and women get through paying the mandates and the taxes the bill also imposes, it is not going to be much help to them. What we have is a bill that would allow small businesses to pool their resources. In other words, if you are a small business man or woman and you have 60 employees and 2 get cancer, suddenly the costs of those 2 employees prohibit you from providing insurance to the other employees. But if you could pool your resources with small businesses all around the country, then the pool would be large enough that you could offer insurance. That proposal has been made by Senator Enzi. It has been through the HELP Committee. The Congressional Budget Office said it did not add to the deficit. In fact, it reduces the deficit, and it would permit 750,000 more employees of small businesses to be insured and their premiums would be lower than they otherwise would be. That is a single step to moving toward reducing health care costs, but if we took that step and the other steps we have proposed, that would be a good way to start. We could do that together, and we would not have this partisan bill with so many questions and so many concerns. So I wonder if my friends from South Dakota and Wyoming--I know they have thought a good deal about this step-by-step approach toward actually solving the real problem of health care costs.

Mr. ALEXANDER

Mr. ALEXANDER. Mr. President, I intend to take 10 minutes of the Republican time. Will you please let me know when 1 minute remains?

Mr. ALEXANDER. Thank you, Mr. President. Mr. President, there may be a number of Americans who are switching over from the Minnesota v. Carolina football game and they may be wondering what in the world is the U.S. Senate doing coming into session at midnight on a Sunday in the middle of a snowstorm and getting ready to vote at 1 a.m.? So let me try to explain that for a moment. The reason is, the Democratic majority leader, who is the only one who can set our schedule, showed up yesterday with a 400-page amendment--yesterday. This amendment had been written in secret for the last 6 weeks. The assistant Democratic leader said, last week, on the floor, he had no idea what was in it. Of course, none of us on the Republican side knew what was in it. So almost no one here knew what was in it. It was presented to us. Then the Democratic leader said: Well, we are going to start voting on it, and we are going to pass it before Christmas. This is an amendment to the health care bill, which when fully implemented, will cost about $2.5 trillion over 10 years, according to the Senate Budget Committee; which restructures a sixth of our economy; which affects 300 million people; which will raise taxes by about $1 trillion when fully implemented over 10 years; and which will cut Medicare by about $1 trillion when fully implemented over 10 years. It doesn't cut Medicare to make Medicare more solvent which, as we know, it is going to become insolvent, according to its trustees, by 2015, but to spend on a new entitlement. It will also shift to the States a great many expenses, so much so that our Democratic Governor in Tennessee has said it is the mother of all unfunded mandates. The Governor of California says it is the last thing we need, take your time, get it right. But the Democratic leader and his colleagues insist that we need to bring this up in the middle of a snowstorm, write it in secret, vote on it in the middle of the night, and get it passed before Christmas Eve. Why would they want to do that? Well, I think the answer is very clear. It is because they want to make sure they pass it before the American people find out what is in it. Because the American people, by nearly two to one, according to a CNN poll, do not like what they have heard about the health care bill. When they have to start explaining what is in it, they are afraid it will be worse, and it will never pass. Republicans are not the only ones who believe we ought to stop and think about big issues before we deal with it. Eight Democratic Senators--Senators Lincoln, Bayh, Landrieu, Lieberman, McCaskill, Nelson, Pryor, and Webb--wrote Senator Reid on October 6, saying to Senator Reid: As you know, Americans across our country have been actively engaged in the debate on health care reform. . . . Without a doubt, reforming health care in America is one of the most monumental and far-reaching undertakings considered by this body in decades. We believe the American public's participation in this process is critical to our overall success. . . . I am quoting from the eight Democratic Senators. They go on to say they want to make sure the bill is on a Web site ``for at least 72 hours'' before we vote on it. This bill was given to us yesterday--400 pages of it--we had not seen before. Seventy-two hours would be Tuesday. So the minimum requirement, according to the eight Democratic Senators and all 40 Republican Senators, would be that we should not even think about voting on it until at least Tuesday. And then one would think we would be amending it and debating it and considering it and thinking about it and trying to find out what it actually does. According to the eight Democratic Senators: By publicly posting the legislation and its [Congressional Budget Office] scores 72 hours before it is brought to a vote in the Senate and by publishing the text of amendments before they are debated, our constituents will have the opportunity to evaluate these policies. . . . As their democratically- elected representatives . . . it is our duty to listen . . . and to provide them with the chance to respond to proposals that will impact their lives. Yet, we are presented with it in the middle of a snowstorm on Saturday, we are meeting at midnight, we are voting at 1 a.m. It is being demanded that it be passed, even though most of the provisions, as the Senator from Maine has said, do not even begin to take effect for 4 more years. What is the rush? I think the rush is that our friends on the other side do not want to explain to 40 million seniors how you can cut $1 trillion out of Medicare--it is exactly $470 billion over the next 10 years, but when fully implemented $1 trillion out of Medicare--and spend it on a new program without reducing Medicare services to 40 million seniors. The Director of the Congressional Budget Office has already said that for the 11 million seniors who are on Medicare Advantage that fully half their benefits will be affected. I think our friends on the other side do not want the American people to understand why the $578 billion in new taxes that are going to begin to be imposed next year--they are going to have a hard time explaining how that will create new jobs in America, at a time when we have 10 percent unemployed. New taxes? They do not want the American people to find out the Director of the Congressional Budget Office said that if we put those new taxes on insurance providers, on medical devices, almost all of those taxes will be passed on to the consumers and, as a result, premiums will go up. There are some very strong words that have been coming from the other side about Republicans saying this bill will actually increase the cost of health care. It is not Republicans who are saying that. Here is what David Brooks of the New York Times said in his analysis of the bill when he gave the reasons for it and the reasons against it this week and came to the conclusion that if he were a Senator he would vote against it. Mr. Brooks said: The second reason to oppose this bill is that, according to the chief actuary for Medicare, it will cause national health care spending to increase faster. That is right, we are going to raise taxes, cut Medicare, send a big bill to the States--all for what? `` . . . according to the chief actuary for Medicare, it will cause national health care spending to increase faster.'' So if you are paying X for premiums, you are going to be paying more as a result of this bill. Continuing, David Brooks said: Health care spending is already zooming past 17 percent of [our gross domestic product] to 22 percent and beyond. Then it is going to be hard to explain to the 9 million people who the Congressional Budget Office letter said would lose their employer insurance under this bill why that will happen. Of course, it will happen because under the bill as a whole, as employers look at the mandates and the costs, many will decide not to offer health insurance, and so those employees will find themselves either in Medicaid, the program for low-income Americans--into which 15 million more Americans are going; a program for which 50 percent of doctors will not see new Medicaid patients; it is like giving you a ticket to a bus when the bus only runs half the time--that is where many of these Americans will go, or they will go into the individual market, and the individual market will have higher premiums. The other side says: Ah, but there will be subsidies for some of you. But the premiums are going to be higher, the health care costs are going to be higher. The majority does not want to explain why this bill changes the bipartisan agreement not to have Federal funding for abortion that has been agreed to since 1977. They do not want to take time for the American people to understand the CLASS Act, the long term insurance act, a new entitlement which sounds wonderful, but the Democratic chairman of the Budget Committee described it as a Ponzi scheme worthy of Bernie Madoff. That is because the amount of money that would be paid in, if a person pays a premium of $2,880 per year for 5 years, would be $14,000, and then they would have a $1,500 monthly benefit for a long time after that. It is obvious why the majority has cooked up this amendment in secret, has introduced it in the middle of a snowstorm, has scheduled the Senate to come in session at midnight, has scheduled a vote for 1 a.m., is insisting it be passed before Christmas, because they do not want the American people to know what is in it. It is a deeply disappointing legislative result. But our friends on the Democratic side seem determined to pursue a political kamikaze mission toward a historic mistake, which will be bad for the Democrats, I am convinced, but, unfortunately, even much worse for our country. Mr. President, I yield the floor.