Lamar Alexander

Mr. ALEXANDER

Mr. ALEXANDER. Mr. President, how much time do we have on this side?

Mr. ALEXANDER. Mr. President, please let me know when 1 minute remains. Mr. President, we are here on this early Saturday morning, as we lead up to Christmas Day, to finish work on the Defense appropriations bill. But the country knows the focus of our attention, the reason we are here, is because of the health care debate. We are in our 20th consecutive day of considering health care, and we still do not have a final bill. In other words, we do not yet know what we are voting on, how much it costs, or how it affects the American people. On October 6, 2009, eight Democratic Senators wrote the majority leader a letter which expressed the view also of all 40 Republican Senators, and it said what ought to be obvious: that when debating even a minor bill, but certainly a major bill of this magnitude, the ``public's participation in this process''--so the letter went--``is critical to our overall success of creating a bill that lowers health care costs and offers access to quality and affordable health care for all Americans.'' The letter from the eight Democratic Senators continues: Every step of the process needs to be transparent, and information regarding the bill needs to be readily available to our constituents before the Senate starts to vote on legislation that will affect the lives of every American. The letter continues: The legislative text and complete budget scores from the Congressional Budget Office of the health care legislation considered on the Senate floor should be made available on a website the public can access for at least 72 hours prior to the first vote to proceed to the legislation. Likewise, the legislative text and complete CBO scores of the health care legislation as amended should be made available to the public for 72 hours prior to the vote on final passage of the bill in the Senate. Further, the legislative text of all amendments filed and offered for debate on the Senate floor should be posted on a public website prior to beginning debate on the amendment on the Senate floor. Lastly, upon a final agreement between the House of Representatives and the Senate, a formal conference report detailing the agreement and complete CBO scores of the agreement should be made available to the public for 72 hours prior to the vote on final passage of the conference report in the Senate. Mr. President, that is wise advice from Senator Lincoln, Senator Bayh, Senator Landrieu, Senator Lieberman, Senator McCaskill, Senator Nelson, Senator Pryor, and Senator Webb. What they are saying is, before we vote on a health care bill that affects nearly every 1 of all 300 million Americans we ought to have 72 hours to read the bill and know what it costs. We know the current version, when fully implemented, will spend $2.5 trillion, which the Chief Actuary of the government says insofar as we know it will increase the cost of health care rather than reduce it. We know that the version we have seen so far will take $1 trillion out of Medicare when the bill is fully implemented and not use it to strengthen Medicare--which is becoming insolvent in the years 2015 to 2017, according to the trustees of Medicare--but instead would spend that money on some other program. We know it would--as David Brooks in a New York Times column said yesterday--create a huge tax, $1.42 trillion in the second decade of its operation to help pay for this, which the Director of the Congressional Budget Office has said would inevitably be passed along to consumers and cause premium costs to go up, not down. And we know it would expand Medicaid, the other large government program we already have for low-income Americans, sending a bill of $25 billion to the States that has been roundly denounced by almost every Governor in the country, Democratic and Republican. Because at a time when the States are struggling more than they have since the Great Depression with their own budgets, when they cannot print money, when they have to balance their budgets, we are expanding health care and sending them a huge bill to help pay for it. This inevitably will force States to raise taxes, raise college tuition; and, in my State, the Governor is considering releasing up to 4,000 nonviolent offenders from the prisons as a result of some of the budgetary pressures that are on him. So that is what we do know about the bill. But we do not have the final version of the bill. Yet it is said we should vote on this by Christmas when, in fact, most of the provisions of the bill do not take effect until 2014. That is 4 years from now. Only a few provisions start right away. Mr. President, $73 billion in taxes start right away. Medicare cuts start right away. Mandates start right away. A few benefits start right away. But, basically, the thrust of this massive legislation that affects 17 percent of our economy does not take effect for 4 years. So if we do not have the bill, and if most of the legislation does not take effect for 4 more years, then why are we spending this time staying up all night, rushing to enact the bill by Christmas? I believe it is because the majority knows the longer the public sees the bill, the more they know about it, the less they will like it, and they want to try to pass it before people know what is in it. Otherwise, we would already have the bill. Otherwise, we would be taking the time we took with the farm bill, with the Education bill, with the Energy bill, with other major legislation that takes 5, 6, 8, 10 weeks. Otherwise, we would have worked across party lines and had many different kinds of views. So this is a rush. There has been a lot of talk about making history on health care. The problem is, there are different kinds of history. In this case, the Democratic majority seems to be determined to pursue a political kamikaze mission toward an historic mistake. If it succeeds, the results will be disastrous for the Democrats in 2010, I would predict. But, unfortunately, it will be a bigger disaster for our country. Now, this will not be Congress's first historic mistake. The Smoot- Hawley tariff of 1930 ``to buy American'' sounded pretty good. It sounded like a good way to protect jobs by keeping foreign products out. But historians agree it was an historic mistake, setting off retaliatory waves, tariffs, and making the Great Depression worse. The Alien and Sedition Acts of 1798 sounded good too. The idea was, let's protect the country from enemies within our midst, mostly French then. But that turned out to be an historic mistake encouraging more protests and offending our traditions of free speech. In 1969, the Congress found 155 Americans who were not paying taxes and said: Let's have a millionaires tax. That sounded good too. It turned out to be another historic mistake. Last year, it caught 28 million Americans before we rushed to patch it, to fix it for a year. More recently, there was the Catastrophic Coverage Act of 1988 to help seniors deal with financial losses. The trouble is, seniors resented paying for it, and angry crowds surrounded the chairman of the House Ways and Means Committee in his home district. Congress repealed that mistake, and the leader of those angry seniors is now a Congresswoman from Illinois. Then there was the luxury tax on boats in 1991. That sounded good: We are going to get all those people who have boats that cost more than $100,000. The trouble was, it raised about half the revenue projected, and it nearly sank the boat industry, putting 7,600 people out of work. A change in Congress repealed that one too. Rather than make history of this sort, Congress should learn from history. We should take Governor Schwarzenegger's advice this week. He suggested: So I would say, be very careful to the federal overnment before you go to bed with all this. Let's rethink it. There's no rush from one second to the next. Let's take another week or two and come up with the right package. The Governor, of course, was concerned about the Medicaid expansion costs in his State--$3 billion for California. He said: [The] last thing we need is another $3 billion of [state] spending when we already have a $20 billion deficit. So why the rush? We do not have the bill. We have plenty of time to deal with this. Most of it does not take effect for 4 more years. And what if in trying to fix everything all at once we get it wrong--will Congress be rushing back to fix health care again? Because if Congress makes another historic mistake, it will not be nearly as easy to fix as repealing a boat tax. I thank the Acting President pro tempore, and I yield the floor.

Mr. ALEXANDER

Mr. ALEXANDER. Madam President, I thank the Senator from Arizona for his comments. We have two physicians in the Senate, Dr. Coburn from Oklahoma and Dr. Barrasso from Wyoming. I wonder if they would bear with me for a minute or two to reflect on something the majority leader said--minority leader said--I hope he is the majority leader before too long--and the Senator from Arizona. The minority leader, the Republican leader, talked about a historic mistake. There has been a lot of talk around here about making history on health care. The problem is there are many different kinds of history, as the Republican leader has pointed out. It seems our friends on the other side are absolutely determined to pursue a political kamikaze mission toward a historic mistake which will be disastrous for them in the elections of 2010, but much more important, for the country. I did a little research on historic mistakes. We have made them before in the United States. Maybe we would be wise to take Governor Schwarzenegger's advice and slow down and stop and learn from our history rather than try to top our previous historic mistakes, such as the Smoot-Hawley tariff. That sounded pretty good at the time in 1930 when the idea was to buy American, but most historians agree it was a mistake and it contributed to the Depression. There was the Alien and Sedition Act of 1798. It sounded good at the time. We were going to keep the foreigners in our midst--they were mostly French then--from saying bad things about the government, but it offended all of our traditions about free speech. In 1969 Congress enacted the ``millionaires' tax,'' they called it, to try to catch 155 Americans who weren't paying any tax. That turned out to be a historic mistake, because last year it caught 28 million American taxpayers until we had to rush to change it. Just a couple more. There was the Catastrophic Coverage Act of 1988. That was well named, but it turned out to be a catastrophe, a congressional catastrophe. The idea was to help seniors deal with illness-related financial losses, but seniors didn't like paying for it. They surrounded the chairman of the Ways and Means Committee in Chicago and now the leader of that group is a Member of Congress. Then there was a luxury tax on boats over $100,000, another historic mistake, because it raised about half the taxes it was supposed to and it nearly sank the boating industry and it put 7,600 people out of jobs. I ask my friends from Oklahoma and Wyoming--it is going to be a lot harder for Congress, if they try to fix the health care system all at once, to come back and repeal it than it was to repeal a boat tax. Do my colleagues think we ought to take the time to avoid another historic mistake?

Mr. ALEXANDER. I say to the Republican leader and the Senator from Kentucky, I believe there is another bit of history being made. This process is historic in its arrogance. This isn't very hard to understand. The proposal is to take 17 percent of our economy, affecting 300 million Americans, and nothing could be more personal, as the Republican leader has said, than our health care. But now we don't have the bill. We do not have the bill. It is being written in secret in another room. If there is any part of this debate that went through to every single household in America, I believe it was when the Finance Committee voted down a motion--the Democrats voted down a motion that the bill should be on the Web for 72 hours so that the American people could see the text, know what it costs, and know how it affects them. Eight Democratic Senators wrote the Democratic leader and said they want to insist that they know what the text is, and that they have the official score from the Congressional Budget Office, and that they have it for 72 hours before we move to vote. We don't have the bill. We don't have the official score from the CBO. Seventy-two hours is three more days, and even though eight Democratic Senators and all the Republican Senators said we want to know what it costs, know what it is, and how it affects us, they want to run it through before Christmas.

Mr. ALEXANDER. We come to the floor every day and point out the problems with the bill. We don't have a bill now, we can't read it, and we don't know how much it costs or how much it affects the American people. It raises taxes and premiums. It will increase the debt, because it doesn't include things such as the physicians Medicare reimbursement. It cuts Medicare by $1 trillion over 10 years once it is fully implemented. We point out what we think should be done. My colleagues have talked about it many times. Instead of wheeling in another 2,000-page bill, we should focus on the goal of reducing costs, and we should take several steps toward doing that. The Senator from Arizona talks about one of those things, which is reducing the number of junk lawsuits against doctors. I don't think that is in the bill, unless it is secretly being added in the back room today.

Mr. ALEXANDER. Madam President, I thank the Senator from Arizona. I was thinking as I listened to the Republican leader, I wonder if the Senator noticed the comments of the Governor of California on Monday. Governor Schwarzenegger said on ``Good Morning America'' that he supports the idea of overhauling health care, but: ``the last thing we need,'' said Governor Schwarzenegger, ``is another $3 billion in spending when we already have a $20 million deficit.'' He was referring to one of the unintended consequences of this bill, which is big State costs for Medicaid being shifted to the States-- unfunded mandates. So here is Governor Schwarzenegger's advice, following up on the comments of the leader: ``So I would say be very careful to the Federal Government.'' This is from the Governor of California: Before you go to bed with all this, let's rethink it. There is no rush from one second to the next. Let's take another week or two. Let's come up with the right package. I wonder if the Senator saw it.

Mr. ALEXANDER

Mr. ALEXANDER. Mr. President, I congratulate the Senator from Idaho for his amendment to help the President keep his commitment. That is basically what it is. I would think our friends on the other side would all want to join us in that. The President said he would not raise taxes on people making less than $250,000 a year. It is amazing to hear the comments that I have just heard. The whole construction of the bill--when we think about it, regardless of whatever the Democrats decide to do about the so-called public option, they still seem determined--at least the majority leadership seems determined--to engage in this political kamikaze mission toward a historic mistake. There is all this talk about history. But there are lots of different kinds of history. A lot of historic mistakes have been made about taxes. For example, there was the Smoot-Hawley tariff of 1930, which was a big tax. It sounded like a good idea. President Hoover, a Republican, recommended it to protect American jobs by keeping out cheaper foreign products. That led us into the Great Depression. It was a historic mistake. More recently, there was the boat luxury tax. This sounds good. It was part of the budget deal of 1990. Congress put a 10-percent luxury tax on boats costing more than $100,000. Sound familiar? We were going to hit the rich people. But it got the working people, not the rich people. The unintended consequence was that it sank the boat industry, costing 7,600 jobs, according to the Joint Economic Commission, and Congress repealed that historic mistake. There was also the Medicare Catastrophic Coverage Act of 1988, another good-sounding goal, to help older people reduce the risk for illness-related catastrophic financial losses. But a lot of our senior Americans resented the idea of paying additional taxes for that coverage, and they revolted. Congress, less than a year and a half later, repealed it. We all remember the millionaires tax. That is a matter of history. In the late 1960s, there were 155 high-income Americans who weren't paying any Federal income taxes, so Congress imposed something called the alternative minimum tax. Last year, that affected 28 million American taxpayers. I say to my friend from Idaho, I think he is doing the country and the President a great service by offering this amendment to help keep the promise because whatever the majority leader decides to do about the government option, this legislation--when fully implemented--still contains $1 million in Medicare cuts 5 years before Medicare is scheduled to go broke, according to their trustees. It is nearly $1 trillion in new taxes over 10 years when fully implemented, as the Senator from Idaho has pointed out. There is no question about that, it is an increase in premiums for most Americans, according to the Congressional Budget Office. And yesterday on this floor, we talked about the huge bill we are about to send to States to help pay for this in the Medicaid Program. It is important to support the Crapo motion. It is important for our country not to have this historic mistake thrust upon them.

Mr. ALEXANDER. I agree with the Senator from South Dakota. People who might be watching this must be thinking: Wait a minute. Let me ask the two members of the Finance Committee: What the Democrats are trying to say is, a Medicare cut is not a Medicare cut and that a tax increase is not a tax increase and that a premium increase is not a premium increase. Isn't it true that when the bill is fully implemented, there will be nearly $1 trillion in Medicare cuts, and isn't it true that there will be nearly about $1 trillion, when fully implemented, in new taxes? Isn't it true the Congressional Budget Office has said that will all be passed on to people? Isn't it true that all the taxes start in January, if the bill passes? Isn't it also true the Congressional Budget Office has said premiums are going to continue to go up and, for people in the individual market, they will go up even more? Isn't that all true?

Mr. ALEXANDER

Mr. ALEXANDER. Mr. President, I thank the Senator. I am impressed with the number of Senators here this afternoon. One thought comes to mind, and I wonder if some of my colleagues may want to talk about it. I woke up one day and saw on television a sign that said ``32 percent tuition increase for the students of California.'' The University of California could be the best public institution of higher education in the world. One of the great things the United States has--which keeps us competitive and gives us a chance to continue to grow and create new jobs--is a superior system of higher education. About half of the best universities--Harvard, Yale, and the private universities--half or more than half are public universities, where tuition is a few thousand dollars a year. Well, what is going to happen with this? All of us who have been Governors have gone through this. You have a pot of money left, and it either goes into higher education or Medicaid. For the last 30 years, we have been having to fight to fund Medicaid, and as a result States have not been funding public higher education properly and the quality has gone down and the tuition has gone up. What is this bill saying? It says that, after 3 years, we are going to dump a huge new cost on the States. I don't believe I am overstating it when I say that in our State of Tennessee, given the terrible fiscal condition our States are in today--and our State is more conservatively run than most--I believe our State could only fund this through a new State income tax and/or serious damage to higher education or both. I wonder if that is not the case in all of the other States represented here.

Mr. ALEXANDER. I thank Senator Corker from Tennessee. We have our usual situation on the Republican side--a lot of Senators who wish to speak on the subject of Medicaid--so I am going to keep my remarks brief. But looking around I see one, two, three, four of us who have been Governors of a State. The Acting President pro tempore was the Governor of the State of Virginia. Senator Corker, himself, was mayor of Chattanooga and the chief operating officer of the Tennessee State government. Why do I bring that up? Because the Medicaid Program we are discussing--I know to many people listening to this debate, it gets confusing. Medicare is the program for seniors on which 40 million to 45 million people depend. We have talked about that a lot, and how the cuts to Medicare are going to be used to pay for this bill. But we have not talked as much about Medicaid, which is an even larger government program. Sixty million people depend on Medicaid, and they must be low- income people in order to qualify for the program. This bill would add 15 million more Americans to the Medicaid Program which, as Senator Corker said, is like giving someone a bus ticket to a bus line that only operates half the time, because about 50 percent of the time, doctors will not see new Medicaid patients. But there is another problem with the Medicaid proposal, which all of the Governors here--I know if they are like me, nothing made me any angrier than to see a bunch of Washington politicians come up with a big idea, announce it, take credit for it, and then send me the bill when I was Governor. Usually we would find them back at the Lincoln Day Dinner or the Jackson Day Dinner the next spring making a big speech about local control. Well, what happens here is a huge bill for this Medicaid expansion that is going to be sent to the States. I would say to Senator Corker, hasn't our Governor, a Democratic Governor, Governor Bredesen--who like all of us has struggled with paying for Medicaid--has he not said this will cause about $750 million in added expense? I would ask the Senator from Tennessee, wouldn't that require either big cuts to higher education or big tax increases to pay for it?

Mr. ALEXANDER

Mr. ALEXANDER. Let me ask the Senator from South Dakota to lead the colloquy on the Republican side.

Mr. ALEXANDER. Madam President, may I ask the Senator from South Dakota, unless the Senator from Arizona wants to, to lead the colloquy.

Mr. ALEXANDER. I congratulate the Senator from Arizona for his comments and his own leadership on this issue. I want to add my commendations to the Republican leader. My thought is that the reason we are working so well together is because we are afraid our country is about to make a historic mistake. There is a lot of talk about making history. There are a lot of ways to make history. Put aside all of the laws about race--don't talk about them. When we talk about race, that is often misunderstood. We didn't fail to make a historic mistake on laws about race until the 1960s, when we began to correct those laws. Let's put aside all the historic mistakes we might have made in failing to stop aggression before World War II. We know about those mistakes. We can remember historic mistakes. I ask the Republican leader if the Smoot-Hawley tariff sounded like a good idea when President Hoover pushed it in the late 1920s. We were going to raise tariffs on 20,000 imported goods, create more American jobs, and it created the Great Depression. The Alien and Sedition Act sounded like a great idea. That made a little history. Shortly after our country was founded, we made it a crime to publish false and scandalous comments about the government. It has never been repealed. Our Supreme Court said it was a historic mistake. Then there was the Medicare Catastrophic Coverage Act of 1988. I wonder if the Senators might have been here then. So we are capable of making historic mistakes. As the Senator from Arizona has said very well, most Americans, if presented with a problem, would not try to turn the whole world upside down to solve it. They would say: What is the issue? The issue is reducing costs. We can all talk to family members and others--we know what they are paying monthly for premiums, and we would like that to be less, and we would like for the government's costs to be less. Why don't we, as we have proposed day after day, and as the Senator from Arizona has said--why don't we go step by step in the direction of reducing costs. I will not go into a long litany of proposals we have made. We can take five or six steps on small business health plans, reducing junk lawsuits against doctors, or buying health insurance across State lines. We should be able to agree on that instead of a 2,000-page bill that raises premiums, raises taxes, and seems to have a new problem every day. I think the cohesion on the Republican side is not so partisan. I like to work across party lines to get results. That is why I am here. I am just afraid that our country is about to make a historic mistake, and we are trying to help and let the American people know what this bill does--what it does to them and their health care.

Mr. ALEXANDER. Well, ``unsavory'' would be a minimum word that comes to my mind. The problem I have is that Americans have a perfect right to their view, and the pharmaceutical industry has a perfect right to advocate its point of view. As I hear the Senator describe what has been going on, am I hearing correctly? I mean, the pharmaceutical industry is saying we don't like drug reimportation. The White House says: OK, we will cut a deal with you behind closed doors--as far as we can tell--and we will change the law this way, and then--

Mr. ALEXANDER. I see the Senator from Idaho is here. We both had the experience of being Governors, as did the Presiding Officer in her State of New Hampshire. We were talking the other day--and I hope he doesn't mind me repeating that--I worked with a Democratic legislature the whole time I was Governor. But what we always did on anything important was we sat down together. We had our different positions, we fought during elections, but we worked things out. We didn't go forward unless we found a way to agree. That meant I usually didn't get my way. I got some of my way, but I had to take into account that someone else--in this case, the Democratic legislature in Tennessee--might have a different idea. Sometimes it was a better idea. I ask the Senator from Idaho, we talk a lot about bipartisanship around here. The reason for bipartisanship is that these big bills are tough bills. We are expected to make difficult decisions: Are we going to reduce the growth of Medicare? Are we going to expand Medicaid? Are people going to be required to buy insurance? What are we going to do about health care premiums? Many of these decisions are controversial. When the American people look at Washington and they see that just one side of the political spectrum is pushing a bill through and the other side says: Absolutely not, what kind of confidence is that going to give the American people? On the other hand, if they look at Washington as they did with the civil rights legislation we talked about in the 1960s when Lyndon Johnson, a Democrat, was President and Everett Dirksen was the Republican leader, they saw the Republican leader and the Democratic President saying: OK, this is a tough problem, but we have a solution with which we both agree. Then the American people had some confidence in that. Bipartisanship is not just a nice thing; it is a signal to the American people that people of different points of view think a controversial decision is in the country's interest. Isn't that totally lacking here? Isn't that bipartisanship signal lacking across the country?

Mr. ALEXANDER. Before Dr. Barrasso speaks, just listening to the Senator from Arizona, it seems to me it puts the Democratic leadership in the extremely awkward position of even its leadership--proposing a bill that affects 17 percent of our economy and the leadership of the Democratic Senate doesn't yet know what is in the bill, we certainly don't know what is in the bill, and they are in the awkward position-- at least they have been the last few days--of filibustering their own bill at a time when they are insisting that we pass the bill before Christmas, which we can hear the sleigh bells ringing. It is just a few days before that happens.

Mr. ALEXANDER. Well, if I am remembering right, earlier this year the Republican leader made a talk on the Senate floor. The attitude of the White House toward a large company in Kentucky, as I remember, was: If you don't agree with us on health care, we will tax you. That was the attitude, it seems, to come out. If you don't agree with us, we will tax you, or we will make it difficult for you to do business. If you do agree with us, we will make a deal with you that affects your profits.

Mr. ALEXANDER. So it is a negotiation between the White House, the President, and big industry about profits: I will do this, you do that, and then you go out--and my understanding is that you write in as part of the deal that the industry spends $150 million on television advertisements in support of the deal. Is that the deal?

Mr. ALEXANDER

Mr. ALEXANDER. If I can make a short comment, I thank the Senator from Idaho for his leadership on taxes. But Senator McConnell's comment about those two events on December 9--the poll from CNN and the report from the Centers for Medicare and Medicaid Services chief actuary--made me think about the immigration bill 2 years ago, in 2007. There were a lot of our best Senators working to pass comprehensive immigration bill, including Senators McCain, Kennedy, Kyl, Martinez, Members on both sides of the aisle, who worked very hard to do it. There seemed to be a sense of inevitability that that bill might pass. The President was even behind it. But then it began to have so many problems, and the red flags began to pop up just like they are popping up with this comprehensive health care bill. There came a time, perhaps much like December 10, when the sense of inevitability was replaced by a sense that we were making a historic mistake, and a bill that got on the floor with 64 votes only had 46 to get off. I have a feeling this bill, the more we learn about it, the wiser thing to do is to let it fall of its own weight. Then we can start over, step by step, to reearn the trust of the American people by reducing health care costs. We can do that. That is the sense I have. I appreciate the Republican leader's observation about those important events on the 9th.

Mr. ALEXANDER. We have about 6 minutes remaining in our time. I wonder if the Senator from Georgia, having heard the comments, has any additional recommendations on the chief actuary's report.

Mr. ALEXANDER. Madam President, how much time remains?

Mr. ALEXANDER. Certainly.

Mr. ALEXANDER. I wonder if I might ask the Senator from Idaho and the Senator from Kansas, both the Senators are on the Finance Committee, I believe, and have been working on this health care bill for a long time. It is typical of a big, complex bill such as this that it is difficult to pass, and you get a sense every now and then of whether it is likely to pass or unlikely to pass. This week has been a particularly difficult week for the bill. I have noticed the majority leader trying to create a sense of inevitability about the bill. But, increasingly, it seems to me, with it becoming clear that with so much of it being paid for by new taxes, and then last night the chief actuary of the Centers for Medicare and Medicaid Services saying the cost is going up, premiums are going up; with the Mayo Clinic saying it is beginning to not take Medicare patients, and the idea of putting millions more Americans into a program already going broke which you are taking $1 trillion out of is a bad idea; I wonder if in all--and all this talk about history being made and the inevitability of this bill, that the Senator from Idaho might not think, looking back over this whole debate, that maybe there are a lot of different ways to make it--that maybe a growing number of Senators might be thinking--not saying yet--might be thinking that this bill would be an historic mistake and that all the king's horses and all the king's men are not going to be able to push this up over the top.

Mr. ALEXANDER. I ask the Senator from Georgia, while this is a complex document, in many ways, isn't it a matter of common sense that if you take a program that is going broke and you take $1 trillion out of it and you add millions of people to it, isn't the end result going to be there is not going to be anyone left to take care of the patients who need help? Isn't that the logical result, just as this report says?

Mr. ALEXANDER. I see the Senator from Nebraska is here, and we had a conversation earlier about the attitude of people in Nebraska. It is very helpful to have independent evaluators who tell us that if you cut $1 trillion out of a program that is going bankrupt and then add more people to it, doctors and hospitals are going to go broke. We have heard that before from the Mayo Clinic, and I think Senator Johanns has been hearing that in the State of Nebraska.