Lamar Alexander

Mr. ALEXANDER

Mr. ALEXANDER. Thank you, Mr. President. Will you let me know when 3 minutes remain?

Mr. ALEXANDER. Mr. President, how much time remains on the Republican side?

Mr. ALEXANDER

Mr. ALEXANDER. Mr. President, I thank the Senator from Florida for his insightful remarks. I listened with interest to the Republican leader describe the congressional Democrats' bill, which is now about 2,000 pages. We know we do not have a Senate bill yet. It is being written behind closed doors somewhere, I think in the majority leader's office. We are not sure who is writing it. We will have it sooner or later. But we do know some things about the health care bills. Today what I would like to talk about is just one of those things. Then I want to suggest what the Republican plan is because we have a very different approach toward dealing with health care than the Democratic bills that we have seen. Today I want to talk about Medicare. Medicare is very important to about 40 million Americans and to a lot of other Americans who are about to be of the age to depend on Medicare. To get it down into a nutshell, here is what all of the plans we have seen so far from the Democratic side propose to do: to take about $\1/2\ trillion over 10 years from Medicare--in other words, cut Medicare by $\1/2\ trillion, not to put into the Medicare Program to make it more solvent but to start a big new entitlement program called government-run health insurance for other people. We hear from the other side the Republicans are scaring people about Medicare. The Republicans aren't scaring anybody about Medicare, it is these Democratic bills that are scaring people about Medicare. And they have a right to be worried about them because the Medicare trustees have told us this program, that 40 million seniors depend on, is going to become insolvent between 2015 and 2017. That affects the 40 million of us who are already eligible and a part of Medicare, and it affects tens of millions more who will become eligible for it. The idea would be, if these bills are passed, to pay for new programs by cutting that $\1/2\ trillion from this program that is going broke. The Senator from Kansas, Mr. Brownback, described it this way. He said: This is a lot like writing a big check on an overdrawn bank account to buy a new car. He said: Your bank shouldn't let you do that, and the American people should not let us do this, and I don't think they will, which is why we are glad a number of the Democratic Senators joined with all 40 Republicans and said to the Democratic leader: We want two things about this health care bill by the time it gets to us. No. 1, we want to know what it does; and, No. 2, we want to know what it costs. What that means is, it should go up on the Internet for at least 72 hours, the complete text--that is what the letter from the Democratic Senators, as well as Senator Bunning in the amendment he authored, said--and, No. 2, we want a complete formal estimate from the Congressional Budget Office about what the bill costs because the American people are significantly worried about health care reform. That, as the Republican leader said, is supposed to reduce costs, reduce premiums, reduce the government's debt. But, instead, everything we heard about it so far makes it look like it is more likely to increase the cost of premiums, to increase taxes, and one thing we know for sure, it will cut Medicare. So let's talk about Medicare for a moment. A couple of weeks ago we had the first vote on health care reform. For the country, it was a fortunate vote because we saw a bipartisan act in the Senate. The proposal by the Democratic leader was to run up the debt another $\1/4\ trillion in Medicare spending. But 13 Democrats and all 40 Republicans were not going to do that. We have too much debt today. We had a deficit this year of $1.4 trillion, which is as much as the entire debt of the United States from the days of George Washington until 1990. So we all said: No, slowdown. It may be a worthy thing to do. It is important to deal with the physician reimbursement problem. But we are not going to start off the health care debate by borrowing $\1/ 4\ trillion for more Medicare spending. The Washington Post wrote about that proposal: A decade ago, Congress passed legislation designed to limit health-care costs by slowing the growth of Medicare payments to doctors. Each year, Congress passes a patch to prevent the cuts from taking effect. [The Senator from Michigan] proposed to make this system ``honest'', [in her words] by eliminating the cuts permanently . . . it's a strange interpretation [the Washington Post said] of honesty to separate this $250 billion cost from the health-care bill and then claim that the other bill doesn't raise the deficit. Fortunately, the Senate came to its senses and said no. We are not going to raise the debt $\1/4\ trillion for more Medicare spending. But the House Democrats--who came up with a 2,000-page bill they say they may be voting on in the next few days--apparently did not get that message. Their 2,000-page bill did not include the fix, or the physician reimbursement, which we all know is a part of health care reform. It is a part of the Medicare system. It has to do with the amount of money doctors are paid for seeing Medicare patients. It has to be dealt with. Yet they have left it out to the side and, again, we have a proposal that adds to the deficit $\1/4\ trillion. A Wall Street Journal editorial this week, appropriately titled ``The Worst Bill Ever,'' notes this absence by saying: The House pretends [as some Senators did] that Medicare payments to doctors will be cut by 21.5 percent next year and deeper after that, ``saving'' about $250 billion. According to the Wall Street Journal, making those kinds of assumptions means the 2000-page bill that has been written in the House is more likely to cost closer to $2 trillion over 10 years instead of $1 trillion. So we know the era of the 1,000-page bill is over because we have a 2,000-page bill; and I guess the era of the $1 trillion legislative proposal is over because we have a $2 trillion health care proposal being considered in the House. The article in the Wall Street Journal goes: All this is particularly reckless given the unfunded liabilities of Medicare--now north of $37 trillion over 75 years. In other words, over the next 75 years we have $37 trillion in obligations that the Medicare Program has, $37 trillion more than we have money coming in. How is that going to make you feel if you are part of the Medicare Program and some Member of Congress says: OK, we are going to take this program with $37 trillion in unfunded liabilities, a program on which you rely for your Medicare, and we are going to cut it by $429 billion in order to start a new program for somebody else? I think you are going to say: I don't like that very much. I don't like the sound of it. And, increasingly, as Americans read these bills and understand what it costs and understand what they mean to each American, they come to that same conclusion. So we wait with great interest to see what bill the Senate majority leader will bring from behind his closed doors when he takes the 1,500- page Finance Committee bill and the 900-page--nearly 900-page--HELP Committee bill in the Senate and puts it together, I assume, with this 2,000-page bill in the House, and all of them depend on cutting Medicare for about half of their costs. Any reductions in Medicare, any savings in Medicare, any elimination of waste, fraud, and abuse in Medicare should go to Medicare. We should not be cutting grandma's Medicare to spend money on somebody else. We ought to save money in grandma's Medicare to spend on grandma because grandma's Medicare Program is going broke. That is what the Medicare trustees have told us. What does this mean for seniors? The Senator from Florida outlined them: Nearly $140 billion in cuts to Medicare Advantage--one out of four seniors, I believe, has a Medicare Advantage Program--nearly $150 billion in Medicare cuts to hospitals that care for seniors, more than $40 billion from home health agencies, nearly $8 billion from hospices. My understanding is the House bill also makes roughly $100 billion in Medicare cuts for hospitals that care for seniors--this is the House bill--$57 billion from home health agencies, and nearly $24 billion from nursing homes. The President stated that while ``people who are currently signed up for Medicare Advantage are going to have Medicare at the same level of benefits. . . .'' That was President Obama. Yet the Congressional Budget Office Director, the nonpartisan Congressional Budget Office Director, said after looking at the Senate Finance health care bill that fully half of the benefits currently provided to seniors under Medicare Advantage would disappear. The Congressional Budget Office Director said the charges would reduce the extra benefits, such as dental, vision, and hearing coverage, that would be made available to beneficiaries. What about the cost to the government? Remember, as the Republican leader said, we thought health care reform was about cost. I remember being invited--I appreciated it very much--to a summit President Obama had earlier this year on entitlement spending. The President said he needed to work on that, and every speaker who was there said that if we do not do something about health care spending, about Medicaid and about Medicare, we are going to go broke as a country and that almost all of our debt and deficit problems are related to health care spending. So our goal here is to reduce the cost of premiums to individual Americans and reduce the cost of government to individual Americans. That should be our goal. But according to the Congressional Budget Office, the cost of the 2,000-page House bill reflects a gross spending total of over $1 trillion. Now, who thinks we can spend another $1 trillion without adding to the debt? I don't think many Americans do. This mainly includes outlays for Medicaid, children's health, and subsidies. According to the Budget Committee's staff, though, the real 10-year cost of the Senate Finance Committee bill when fully implemented would be closer to $2 trillion--$1.8 trillion--because the main spending provisions do not go into effect for another few years, starting in 2013. The taxes and the fees--the new taxes, nearly $1 trillion in taxes--start right away, over the full 10 years, but the benefits don't start until 2013. They make some other assumptions along the way such as that there will be a Medicaid commission, which will cut Medicare more. Well, those procedures haven't worked so far. And if there are savings in Medicare, they should be spent on Medicare, not to start some new program. So Republicans--and, we hope, discerning Democrats--are not scaring seniors about Medicare; these bills are scaring seniors about Medicare. And they have a right to be worried. They have a right to be worried because they are the 40 million Americans who depend on Medicare. Just answer the question for yourself. If we are going to take $\1/2\ trillion out of your Medicare Program that the trustees say is going to go broke in a few years and spend it on someone else, what does that do to your Medicare benefits? It puts them in more jeopardy, is the only obvious answer to that. So we have proposals that, so far, cut Medicare, raise taxes, raise premiums, add to the debt, transfer expenses to the State that Democratic and Republican Governors say will bankrupt some States-- these are the Medicaid Programs--and they create a new government-run program. I am already getting e-mails from businesspeople in Tennessee who said that if a bill like this goes through, they are out of providing health care to their employees, they can't stand the costs. And so millions of Americans will be losing their employer insurance and shifting over to the new government program which is being paid for by grandma's Medicare. That is the scheme that is being put together here. Mr. President, how much time is remaining?

Mr. ALEXANDER. I thank the Chair. So here is what we know about the Congressional Democratic health care plan which is 2,000 pages long: higher premiums, Medicare cuts, higher taxes, more debt. It is a government-run plan. When you put the whole scheme together, if you are one of the 177 million whose employer provides insurance to you, you run a great risk--let's say it this way--of losing your employer insurance because the employer says: I can't afford to provide it anymore, and plus, the government started a new program, so you go over to the government program. That could lead to rationing. Your Governor will tell you the States can't afford the costs being transferred to them, so that means either higher State taxes or higher college tuition to pay for the reduced payments to public higher education, and a $2 trillion cost over 10 years, according to the Wall Street Journal. That is not real health care reform. So what is real health care reform? What is the Republican plan or what hopefully could be a bipartisan plan that we could work on? We would suggest, and we have suggested this day after day, week after week, committee meeting after committee meeting: Let's start over. We are headed in the wrong direction. Let's go in the right direction. And the right direction is having the simple goal of reducing costs, costs to those paying for health care insurance, in their premiums, and the cost to the government, which we all have to pay for as well. And how do we do it? Instead of a big, comprehensive, 2,000-page, $2 trillion, full of surprises and mandates bill that terrifies everyone, let's go step by step in the right direction, which in this case is reducing costs. What would that mean? Well, No. 1, we could start with a small business health insurance plan. This permits small businesses all across America to pool their resources and leverage those resources. Let's say you are in a small business and there are 80 employees. Two people get very sick, and they use up all of the available money that small business has to help pay for employees' health care. The employer has to say, I have to reduce everybody's health care; or, I am sorry, I just can't offer it anymore. But if you allow that small business to join with small businesses all across America and pool their resources and leverage their money, then you have a different outcome. According to the Congressional Budget Office, that would mean 750,000 more Americans would be insured. It would mean three out of four people insured by small businesses would pay lower premiums. And it would reduce the cost of Medicaid, as those people went onto their own private insurance, by $1.4 billion. So more people insured at lower costs for premiums and less debt for Medicaid--that is one step on which we should be able to agree. Senator Enzi and the late Senator Kennedy worked on that for a long time, but we have not passed it. Why don't we pass it as the first step? That is 88 pages; that is not 2,000 pages. Then a second step: Why don't we allow Americans to buy insurance across State lines? That increases competition. We have a number of bills that have been introduced that would allow that. Senator DeMint of South Carolina has one of those bills, and that is 30 pages, not 2,000 pages. Junk lawsuits. Virtually everyone who has looked at it agrees that lawsuits against doctors add to the cost of health care that we all pay. Some States have taken some steps and shown it makes a real difference. Maybe it is a small part of the cost, maybe it is a large part of the cost, but it is a part of the cost. Anyone who is injured-- anyone who is injured by a negligent doctor should be paid 100 percent of the damage to that person. But this would begin to restrict the punitive damages that are often added to that which greatly benefit the trial lawyer and increase the cost to all of us. So why don't we take steps to do this? We know of examples in my State of Tennessee--and I am sure in virtually every State--where OB/GYN doctors have moved out of rural counties because their medical malpractice premiums have gone through the roof. They just will not practice anymore. So pregnant women are having to travel to Memphis, 60 or 80 miles, for their prenatal health care and to deliver their babies. They do not have that service in the county where they live. This would help them, those women, and this would help reduce costs. So those are three steps we can take. A fourth step would be equal tax treatment for every individual on our health care tax policy. That is 21 pages. Information technology for health care--this may take a few years to actually reduce costs, but virtually everyone agrees that the record keeping in our health care system is a great drag on the productivity and an obvious addition to the cost. Democrats as well as Republicans have worked on legislation to change this. There is a 13-page bill introduced by Senators Coburn, Burr, and Enzi. I am sure there are good proposals on the Democratic side. We could take that step. And that would be five steps. Then we could help create more health care exchanges. That is in many of the bills. It is common to many of them. It is a supermarket in which any individual can go to buy, more easily, a health care plan for that individual or for that person's family. It just takes eight pages to create better health care exchanges across this country. And then waste, fraud, and abuse. Senator LeMieux from Florida, the new Senator, made his maiden address on waste, fraud, and abuse. It is a scandal that, in the Medicaid Program, for example, $1 out of every $10 is waste, fraud, and abuse. That is $32 billion a year. We can go to work on that in a variety of ways, which he talked about this morning. That is just 21 pages. So there are seven steps in the right direction which are reducing health care costs. We should be able to take those steps in a bipartisan way. So we have a choice of approaches here in the Congress. The American people want real health care reform, but they do not believe that raising taxes, raising premiums, cutting Medicare, increasing the debt, and 2,000-page bills full of surprises are real health care reform. The American people are properly skeptical of a grand and risky scheme that claims we are wise enough to solve everything at once. They know we are more likely to mess up everything at once if we try such risky schemes. So to re-earn the trust of the American people, we should go step by step. Here is the choice: a 2,000-page bill or a 200- page bill. Sometimes, the assistant Democratic leader will come on the floor and say: Where is the Republican plan? I said to him yesterday, if he is waiting for Senator McConnell to bring a wheelbarrow in here with a 2,000-page Republican alternative that costs $2 trillion and is just our way to spend $2 trillion and is full of surprises and our grand and risky scheme, he is going to be waiting a long time because he is not going to see it. We are going to bring up several steps which we know will reduce costs, which we know we can afford, which we know will help people, which we know we can implement, and which we believe will have significant Democratic support as well as Republican support. So is it 2,000 pages or 200 pages? Reduce premiums or increase premiums? Reduce debt or increase debt? Cut Medicare and start some new program with it or make Medicare solvent by taking any savings we can find in Medicare and use it to help Medicare? Higher taxes--I did not say much about that, but there is $900 billion of new taxes in the program when it is fully implemented in the Finance Committee program. And the Congressional Budget Office Director said the obvious about that--by and large, most of those new taxes will be passed on to whom? Those of us who pay insurance premiums. So there is another reason your premiums are going up, and the cost. We should be able to enact a good health care plan this year. The country needs for us to do that. But we Republicans are offering a real choice to the American people. The American people are appropriately skeptical of risky schemes that run up the debt, cost $2 trillion, and are filled with higher premiums, more taxes, and Medicare cuts. To re-earn the trust of the American people, we should set a charge goal of reducing costs and move step by step in that direction. That is the Republican health care plan, and I believe that is a plan Republicans and Democrats can agree upon. I yield the floor.

Mr. ALEXANDER

Mr. ALEXANDER. Mr. President, how much time do I have remaining?

Mr. ALEXANDER. I thank the Presiding Officer. I noticed the Senator from Michigan was on the floor earlier, and she had a chart which said: ``85 Times No.'' I think she should have turned it around and faced it toward the Democratic leader. That means that 85 times the Democratic leader has said no to Republicans: No, you can't offer amendments and we are going to cut off debate. We have had this discussion many times. The Senator from West Virginia, Mr. Byrd, is the expert on this. There are two things that make the Senate unique. One is virtually unlimited debate and virtually unlimited amendments. So if you are from a smaller State, such as Tennessee or Delaware or anywhere in this country, your citizens can send you here and, even if you are in the minority, you are allowed to speak. Your voice can be heard and you are allowed to offer amendments. We have procedures for cutting that off, but we only do it on rare occasions. So what the Senator from Michigan is basically saying is-- and I don't believe I would bring this up, if I were she--that 85 times the majority leader has cut us off and said: We are not going to hear from you. So I think that argument is an argument we should have at the appropriate time, but I have a different point I would like to make. I would like to continue the health care discussion because I think we are making some progress. One of the most eloquent and effective speakers on the Democratic side of the aisle is the assistant Democratic leader, the Senator from Illinois, who is a good friend and a person I admire a great deal. Yesterday, he came to the floor and asked: Where is the Republican alternative on health care and how many pages does it have? He heard me say the other day that the era of the 1,000-page bill is over because we have a 2,000-page bill from the House of Representatives on health care. So he says: Well, where is the Republican health care plan? How many pages in it? The Senator from Illinois was quite proud of the fact that I couldn't say how many pages were in the Senate Democratic plan, but of course I haven't seen it. Almost no one has seen it. It is being written behind closed doors. This was supposed to be the era of great transparency; that we would all know what was going on. President Obama, to his great credit, said: We will have all this on C-SPAN so you will know if the drug companies or if the insurance companies or if the lobbyists are in there writing the bill. So what do we have? We have the majority leader and two Democratic Senators and some people from the White House behind closed doors writing the health care bill. Of course, we don't know exactly how many pages it will have because we aren't let in the room. We can't see the bill. We can't count the lobbyists, if they are there; we can't count the companies with which deals might be made, if they are there. We don't know. But here is what we do know. We do know the HELP Committee, on which I serve, passed an 839-page health care bill. We do know the Senate Finance Committee passed a 1,502-page bill, and we know the House of Representatives is working on a 1,990-page bill, not counting the physicians reimbursement fix, which is bound to push it over 2,000 pages. The pages in these bills are going up faster than the national debt, and it is an issue with the American people. So until the various writers emerge from behind closed doors, we are going to have to go with what we have, which is a 2,000-page congressional Democratic health care bill, of which the Wall Street Journal editorial said yesterday, when fully implemented, would cost $2 trillion over a 10- year period of time. Here is what else we know about the 2,000-page bill. It will raise premiums. The Senator from Idaho just spoke to that. It will cut more than $500 billion in Medicare, and it will cut it from Medicare to spend it on a new entitlement program, even though the Medicare trustees say Medicare is going broke in 2015 to 2017. The Senator from Kansas said it is akin to writing a check on an overdrawn bank account to buy a big, new car. The banker wouldn't let you do it, and the American people shouldn't let us do it. There will be higher taxes. Everyone understands that the $1 trillion, fully implemented over 10 years, will mean higher taxes. Who is going to pay those? Not the medical device companies, not the insurance companies. They are going to pass them right on to whom? The American people--the 250 million of us who have health insurance premiums. So our premiums are going to go up. There will be more debt. Fortunately, on the first vote we had on health care the other day, 13 Democrats, with all 40 Republicans, said: No, we are not going to start off this debate by adding $\1/4\ trillion to the national debt, even for the worthy purpose of fixing the physicians reimbursement problem, which we all want to fix. We are going to have to find some way to pay for that within the health care bill, within the spending we have. We now have a government-run plan. I have always thought that was a little like President Obama saying: In order to keep Ford Motor Company honest, I am going to put the government into the car business. Well, we nearly have, but that usually isn't the way we do things in the United States. But we are going to have a government-owned, government- run health care plan. Of course, we already have two--one is Medicare for seniors, and we have a government-run plan that States can ``opt out of'' called Medicaid. The Presiding Officer, the former Governor of Delaware, and I both know from our previous experience it is a big problem. Medicaid and Medicare have been going up at the rate of 8 or 9 percent a year for many years. State budgets dealing with Medicaid only go up 2 or 3 percent for schools and roads and universities. So what happens is, when the Governor of Delaware or the Governor of Tennessee or the Governor of California sit and make up the budget, you get to the end of the line and there is no money left for higher education because we put it all into Medicaid. That means tuition goes up or services go down. With a government-run plan--and this is something the American people are just now beginning to realize--millions of people who now get their insurance from their employers are going to lose it. They are going to lose it because their employer is going to look at this big, new bill and say: I can't afford this. I am going to pay the penalty. I am out of the health care business, and you can go into the government plan. So all 177 million people who have employer health care insurance run a risk with a government plan--under this framework we are discussing, that we haven't been able to see yet--that an increasing number of employers will say: I am out of here. We will let the government provide the insurance. Suddenly, you will find yourself in the government-run plan. What happens in the government-run plan? Some things are good about Medicare--the government-run plan for seniors--and some things are bad about Medicaid, which is the largest government-run plan. One thing bad about it is, 50 percent of doctors will not see new patients because their physician reimbursement is at about 60 percent of what physicians make when they go to a private insurance company. In Medicare, it is not as bad as that. It is about 83 or 84 percent of doctors are paid what they would get paid if they saw a patient with private insurance. So if you lose your insurance and you end up in the government-run plan, you may end up in a plan such as the Medicaid plan, a government- run plan where 50 percent of the doctors will not see new patients. The Governors of the States are in a state of apoplexy--would be about the only word to describe it--because they are in the worst shape they have been in dozens of years. I know in the State of Tennessee there are $1 billion in just cuts. Everything has been cut, prices are going up, and people are being laid off, even though we have a very conservative, well-managed State. Yet one of the ways being proposed to pay for this bill is to shift some of the cost--about $34 billion at least--to States. Governors--both Democratic and Republican--are saying: Please don't do that to us. We can't afford that. We don't have the money for it. We have to balance our budget. If Washington wants to expand Medicaid, Washington should pay for Medicaid. Higher premiums, Medicare cuts, higher taxes, more debt, government- run plan, millions losing coverage, inevitable rationing, States complaining, some going bankrupt, and a $2 trillion cost is not health care reform. But the assistant Democratic leader asked a good question. He asked: What is the Republican plan? If our plan has 2,000 pages, how many pages does your plan have? Well, I would say, with all respect for him, that if he is looking for someone with a wheelbarrow to wheel into the Senate Chamber a competing 2,000-page Republican bill costing $2 trillion, he is never going to see it. He will be looking in vain because that is not what we propose. We have been saying, over and over again on the Senate Floor and in other places, we are going in the wrong direction; we need to start over; our goal should be to reduce costs--the cost to each of us who pay premiums, the cost to all of us who have to pay the Federal Government debt. We should set a clear goal of reducing costs and move step by step toward that goal of reducing costs to re-earn the trust of the American people. Americans instinctively distrust these comprehensive, change-the- world, never-mind-the-cost, 2,000-page risky schemes, one of which is the health care plan that is coming toward us. We have proven in this Chamber we don't do comprehensive well. We had our best Senators on both sides of the aisle working hard on immigration--Senator Kennedy, Senator McCain, Senator Kyl, Senator Martinez--and what happened? It fell of its own weight. We bit off more than we could chew. The economy-wide cap and trade is running into the same problem. So is health care. With taxes, mandates, surprises, debt, and more Washington takeover, we are scaring the daylights out of the American people with these proposals. Instead of that, we on the Republican side believe we should have health care reform, but its goal should be reducing costs, and we should go step by step toward that goal. Going step by step in the right direction is one good way to get our country where it needs to go. So instead of a 2,000-page congressional Democrats' health care plan, here is the Republican plan, and I have counted the pages. No. 1, small business health care plans. This leverages the number of small businesses and allows them to pool their resources and offer health care to more Americans. That is 88 pages, proposed by Senator Enzi. No. 2, allow Americans to purchase health care across State lines to encourage competition--30 pages, proposed by Senator DeMint. No. 3, reduce junk lawsuits. Medical malpractice lawsuits drive up the cost of health care. There is some question how much it drives it up, but there is no question it drives up the cost. That is Senator Gregg's bill on that, and it is 19 pages. No. 4, equal tax treatment for health care. That is Senator Bennett's bill, which is 21 pages. No. 5, health information technology--a subject we should be able to agree on in a bipartisan way--is 13 pages, by Senators Coburn, Burr, and Enzi. No. 6, health care exchanges, creating more of those for people to look for the lowest cost insurance. That takes eight pages in the bill, proposed by Senators Coburn and Burr. No. 7, Senator LeMieux, one of our newest Senators, proposed a bill on the subject of waste, fraud, and abuse. We know that is a scandal, particularly with Medicaid and Medicare. The Government Accountability Office has said that $1 out of $10 in Medicaid is waste, fraud, and abuse, accounting for $32 billion a year, which is $320 billion over 10 years. So there are seven steps in the right direction of reducing cost. Taking just one of those steps--the small business health care plans, S. 2818, leveraging strength in numbers--here is what the Congressional Budget Office says about the small business health care plan: 750,000 more Americans would be covered. These would be people working for small businesses. It would lower the premium costs for three out of four employees. It would reduce Medicaid spending--and that is the program that is causing the States so many problems--by $1.4 billion. So why don't we pass that? Why don't we pass it? Why don't we take that one step toward reducing costs and then take a second step and a third step and a fourth step? Gradually, as we reduce costs, as the small business health care plans will do, we can add uninsured people to the rolls. That would reearn the trust of the American people. That would be something we could actually get done. That would be something that would be bipartisan, would create confidence, and help us reach the goal we have set for ourselves. We have clear choices. We have 2,000-page bills or the bills I just added up--those seven steps proposed by Republicans, many of which have Democratic support as well--that would be 200. So 2,000 pages or 200 pages; reduce premiums or increase premiums; reduce debt or increase the debt; reduce Medicare or make Medicare solvent; higher taxes or no tax increase. The American people want real health care reform. They want to reduce costs and add coverage, as we can afford it. They are properly skeptical of grand and risky schemes that claim we in the Senate and the House are wise enough to solve everything at once. They know if we try to do that, we are more likely to mess up everything at once. They know about the law of unintended consequences. To re-earn the trust of the American people, we should set a clear goal. That goal should be reducing the cost of health care; the cost of health care when you pay your premium and the cost to your government, the cost of its debt. We should move step by step in that direction. That is the Republican health care plan. I yield the floor.

Mr. ALEXANDER

Mr. ALEXANDER. Knowing the Senator is a very able trial lawyer, it is only because I am courteous that I will do that. Of course I do.

Mr. ALEXANDER. Madam President, if I had to choose an appropriations subcommittee to serve on, this would be it. It includes the things I care the most about: the great American outdoors, clean air, our national parks. I couldn't have the privilege of working with a finer chairman than Senator Feinstein. I like her especially because she says what she thinks. She was a mayor. A former Governor, as the Presiding Officer was, appreciates that. She can make a decision, and she sticks to it. She cares about the great outdoors. She has a long record of work on clean air and the environment, about our forests, about our deserts, so we see eye-to-eye about a great many things. Senator McCain is here to speak on our side in a few minutes. I think Senator Sessions would like 5 minutes. I would say to my Republican colleagues, I don't plan to take but 3 or 4 minutes. After they speak, I don't have any other remarks to make. We may be able to give back some of our time. I thank the full committee, Chairman Inouye and Vice Chairman Cochran and Senators Reid and McConnell for their allowing us to move forward. I am glad this bill will not be part of the omnibus. That is not the way to do business. There were lots of differences of opinion, both in the Senate and with the House--the chairman outlined those and talked about those. My preference, if I were the king, I wouldn't spend this much money on this bill this year. This is a tough time. But I doubt Americans will begrudge spending on national parks, on clean water, and on firefighting. This is the 75th anniversary of the Great Smoky Mountain National Park that was created in the midst of the Great Depression. Each State appropriated $2 million, and then schoolchildren gave their pennies. Even in tough times--maybe especially in tough times--we care about our national parks. President Bush set us on the road with the Centennial Initiative to properly fund them by the time we get to 2016, and this bill continues that. It is also good it includes within the budget the firefighting costs which were outside the budget as emergency appropriations. That is a good way to do business. We do not want the U.S. Forest Service to become the U.S. Fire Service, even though we greatly value its work in firefighting. We want it to also be able to perform other important functions. I am glad to see the support for Land and Water Conservation Funds. Local parks, city parks, are our most popular parks, the ones down the street. The Senator mentioned the Davis-Bacon State revolving funds. I strongly object to that being in the bill. This is the first time it has ever been in. We have applied the Davis-Bacon Act to these state revolving funds. This will mean fewer jobs, higher costs, fewer projects. The States provide 20 percent of the match. They should be able to decide what the wage rates are in their States. The bottom line is that we are appropriating $3.5 billion to get done what last year would have only cost us $2.6 billion to do. We are making a mistake. I fought hard to change that. I appreciate the fact that the conference committee supported my effort to move this from a permanent change to a 1-year change. This is appropriately being considered by the Senate Environment and Public Works Committee on which I serve. I will make my views known there. I thank the chairman again for her courtesies. I see the Senator from Arizona is here. I will yield the floor and give him and other Senators a chance to speak on the bill.

Mr. ALEXANDER. The Senator from Arizona may take as much time as he wishes.

Mr. ALEXANDER. I certainly have no objection at all. The Senator from Alabama is here. As far as I know, he is the only other Republican Senator who wishes to speak at this time. I have no further comments. So if any other Republican Senator wishes to speak, they should come over. After Senator Sessions speaks, we will waive the rest of our time.

Mr. ALEXANDER. Madam President, I see no other Republican Senators who wish to speak, so I yield back our time.

Mr. ALEXANDER. Madam President, could I add my thanks to the staff. They have worked hard. This hasn't been a very easy bill to do. Senator Feinstein mentioned all of their names. I add my thanks to her thanks.

Mr. ALEXANDER. Madam President, I have an important announcement to make on another subject which is of interest to the American people. The era of the thousand-page bill is over. We now have a 2,000-page bill, a new health care bill introduced in the House of Representatives today by Speaker Pelosi. What we will do on the Republican side, and what I hope our friends on the Democratic side will do as well, and what every American expects us to do, is read all 2,000 pages and know exactly what it costs before we begin to vote on the congressional Democrats' health care bill. For example, while we know just a few things about the bill, we know the price tag is likely to be more than $1 trillion. So it is 2,000 pages, more than $1 trillion. We know the physicians Medicare reimbursement rate, which is important to all of us to be included, is scheduled to be treated separately there. Well, it wasn't treated separately here. On what was the first vote on health care a week ago, 13 Democrats joined with 40 Republicans to say we are not going to begin the health care debate by increasing the deficit by $\1/4\ trillion. That was an important statement to the American people. One of the questions we will be asking is how is the physician Medicare reimbursement plan, which is an essential part of any plan for health care over the next 10 years, how is it paid for? Does it add to the debt? We will be looking--and I know the distinguished Senator from New Hampshire who is the ranking Republican on the Budget Committee already is looking--at not just what happens in the first 5 years of this proposed bill but in the second 5 years and the 10 years after that, because our goal is to reduce the cost of health care, the cost of premiums to each of us and to our government. A preliminary look suggests that while the cost may go down to the government in the first 5 years, it might go up in the second 5 years as the plan is implemented. Third, we want to look at the new taxes on small businesses we have been told about. Next, we want to look at the provision in the bill which seems to say that an employer might have to pay 8 percent of his payroll as a penalty if the employer does not provide health care to his employees. Does that mean all employees? Does that mean full-time employees? Does that mean part-time employees? We want to read the bill. We want to know exactly what it says. We want to see a Congressional Budget Office estimate--a formal estimate--of what it costs. There is in the bill a new government-run insurance plan. We have said before that our view on the Republican side--and I know some Democrats have concern about this as well--is the effect of a government-run insurance company--some call it the government option-- is no option because if you are one of the 170 million or 180 million Americans who have health insurance through your employer, the combination of a bill such as this is you are more likely to lose your insurance and the government option is likely to be your only option. We will be asking that question and see what it costs. There is a provision in the bill that expands Medicaid. This is the government-run program for the low-income we already have that has 60 million Americans in it. The State and the Federal Government share the cost of it. My preliminary understanding of this provision is, it increases the cost of the Medicaid expansion, which Governors all across the country are deeply concerned about, and it adds a provision to require that physicians be reimbursed for Medicaid services at the same level as Medicare, which would basically double the cost of the Medicaid expansion. How much of this will the States pay? There are a number of questions to be asked, but the news of the day is this: The era of the 1,000-page bill is over. We have a new 2,000- page health care bill. We will be reading the bill, and we will be trying to understand exactly what it costs.

Mr. ALEXANDER. I will be glad to yield.

Mr. ALEXANDER. I don't know. The Senator from New Hampshire has a wide variety of experiences and may understand the weight of bricks better than I do. I just know the era of the 1,000-page bill is over. We have a 2,000-page bill, and we will need to read it. I ask the Senator from New Hampshire how long should it take the Congressional Budget Office to provide a formal estimate of a 2,000- page bill, based upon his experience--I ask through the Chair--as former chairman of the Budget Committee and the ranking Republican member.

Mr. ALEXANDER. I thank the Senator from New Hampshire. Our concern has been, with the bills we have seen so far, that a bill that is supposed to reduce costs actually raises the cost of premiums, cuts Medicare, and raises taxes. The new government insurance plan will cause millions to lose their employer-based insurance and become a part of the government option and, unless the physicians Medicare reimbursement payment is a part of the plan, it also adds to the debt.

Mr. ALEXANDER. It seems to me it will.

Mr. ALEXANDER. I am always glad to yield for a question by the assistant Democratic leader.

Mr. ALEXANDER. That is a very good question. I saw the Senator from Illinois on the floor the other day saying: A 1,000-page bill, who cares about a 1,000-page bill? I don't think Americans like the idea of a 1,000-page bill. I think they will like even less a 2,000-page bill. I don't think we do comprehensive very well here. I think what the American people want us to do, if I can say to the Senator from Illinois, is not have a comprehensive bill full of higher premiums, taxes, and surprises but to focus on reducing the cost of health care premiums and reducing the cost to the government and go step by step on things----

Mr. ALEXANDER. I am trying to answer his excellent question. Go step by step to meet that goal, such as a provision that would allow small businesses to combine resources and offer their employees insurance, such as provisions that would get rid of junk lawsuits against doctors, which virtually everyone agrees drives up the costs.

Mr. ALEXANDER. Yes.

Mr. ALEXANDER. I thank the Senator from Arizona for his excellent question. I am sure there is no one in this Chamber who more vividly remembers that promise than the Senator from Arizona. We all would like to know what is in this bill and what is going on behind closed doors.

Mr. ALEXANDER. Only if----

Mr. ALEXANDER

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

Mr. ALEXANDER

Mr. ALEXANDER. Mr. President, this is the week of two more 1,000-page bills. The House has produced a nearly 2,000-page health care bill which we are all looking forward to reading. The Senator from New Mexico and I are members of the Environment and Public Works Committee, and this week we have been spending almost all day each day on a nearly 1,000-page bill on climate change. As I said on Tuesday when the bill was presented, I have no problem acknowledging the problem, but I do have a problem with the proposed solution. The National Academies of Science of 11 major industrialized countries, including the United States, have said that climate change is real and that humans are causing most of the recent warming. If fire chiefs with the same reputation said my house was likely to burn down, I would buy some fire insurance. I would buy fire insurance that worked. But I wouldn't buy insurance so expensive that I couldn't pay my mortgage or I couldn't pay my hospital bill. That is my concern about the solution that is a part of the Kerry-Boxer bill which we have been working on this week. The Kerry-Boxer bill is a high-cost clean energy plan that will make it hard for Americans to support their families. When the Boxer-Kerry cap-and-trade Bill is put together with the Energy Committee's Renewable Electricity Standard, it will be even bigger. It will be a combination of an economy-wide cap and trade and narrowly defined energy mandate. It will be a 1,000-page-plus bill of taxes, mandates, and surprises. But some things will not be a surprise. We have heard this week a good deal of detail about the costs. At a time of 10 percent unemployment in America--and that is likely to continue for a while--it will impose a new national energy tax that will raise utility bills and send manufacturing jobs overseas looking for cheap energy. It will collect hundreds of billions of dollars each year from American taxpayers for use in a Washington slush fund for politicians to play with. Already we have corporations all over the country with their hands out looking for their share. The economy-wide cap-and-trade, as has been said before our committee by very distinguished scientists, will be ineffective against fuel. Fuel is 30 percent of our carbon emitted today, which is a contributor to global warming. So the idea is that we put cap and trade on carbon, and it raises the price of fuel. But the testimony before our committee has been that it doesn't do much to reduce carbon emissions because even the large price increase in gasoline, for example, which will be passed on to those of us who drive cars, trucks, and fly in airplanes, would not be enough. It will be enough to cause a lot of pain, but it would not change much human behavior and reduce the amount of fuel consumed. The net result is higher prices but the same emissions. The EPA has done a quick look at this nearly 1,000-page bill. Its conclusion is that its costs and benefits are much like the Waxman- Markey bill passed by the House of Representatives a few months ago. We know what people have said about that bill. President Obama's Budget Director, Peter Orszag, said in March that by giving the allowances to industry for free--instead of auctioning them--would result in the ``largest corporate welfare program in history.'' That is President Obama's Budget Director. The Congressional Budget Office said that the House-passed Waxman- Markey bill would cut up to 3.5 percent of our GDP by 2050. In other words, it will make us poorer than we would otherwise be. The Brookings Institute said the cost is likely to be $300 billion annually by 2030. Former Senator Wirth of Colorado has criticized the bill as a cap-and- tax revenue raiser and said instead, it ought to focus primarily on utilities. James Hansen at NASA, who feels passionately about climate change and believes it is a problem, as I do, says the bill is less than worthless. So taken altogether, the strategy of this bill to deal with climate change is, taxes, expensive energy, and mandates, plus the President's goal of a national windmill policy--a combination of subsidies and incentives and mandates that would have as a goal making 20 percent of our electricity from giant wind turbines. Mr. President, I believe our dream for energy ought to be just the reverse. We should want large amounts of reliable, clean, low-carbon, or carbon-free energy, but it should be cheap energy not deliberate high-cost energy because that is the way we create jobs and avoid hardships for American families. Our dream throughout our existence in this world has been that someday we would have cheap, energy for the people of the world so they could get out of poverty. We are fortunate in this country. We are just 5 percent of the people in the world, and we have 25 percent of the wealth, and we use about 25 percent of the energy. We should be leading the way and not have a policy that deliberately raises the price of energy. We ought to deliberately lower it. So before we deliberately embark on a program to send manufacturing jobs overseas, which this unquestionably will--if you work in an auto plant or auto supplier plant or cement plant or aluminum plant, if this bill passes, your job is more likely to go overseas. Before we deliberately make ourselves poorer, we should try a low-cost strategy, and we have one. Republicans--all 40 Republicans--have a 4-point, low-cost clean energy strategy, which I believe many Democrats agree with, and I believe President Obama agrees with a lot of it. So rather than this economy-wide, high-cost energy strategy, why not the following 4-point strategy: No. 1, create the environment in which we could build 100 new nuclear powerplants in the next 20 years. That is the same number we have today--104. We built those in 20 years, between 1970 and 1990. Those plants produce 70 percent of our carbon-free electricity today. Wind and all of the renewable energies--except for hydropower produce 4 percent. So 100 more nuclear powerplants is No. 1. No. 2, electrify half our cars and trucks in the next 20 years. This can happen. Almost every major automobile manufacturer is making hybrid-electric cars today. I drive a plug-in hybrid. I plug it in every night when I go home, and I put gas in my car about every 6 weeks. So we can electrify half our cars and trucks in 20 years. We can do it by plugging them in at night, when we have so much spare electricity. We can do it without building one new powerplant. That is according to the testimony of a former Brookings Institute scholar who is now in the Obama administration as Assistant Secretary of Energy. No. 3, we can explore offshore for low-carbon natural gas and for our own oil. Natural gas has suddenly become in abundant supply, and the price is low. We can use more of it for energy, for electricity. We need to be careful with that. We did that once before and the price went up to $15. But we have a new abundant supply of natural gas. It is our own and it is not overseas. We should find it and use it. It is low carbon. While we are at it, we should find our oil. Even if we drive half our electric cars--which will reduce our oil from overseas by one- third--we will still be using 12 or 13 million barrels of oil a day just for transportation, and we will be better off if we use our oil instead of oil from places overseas, from countries who don't like us. The fourth item is to launch four mini Manhattan Projects like the one we had in World War II. Secretary Chu, the distinguished physicist who is President Obama's Secretary of Energy, calls them ``innovation hubs.'' We can launch four Mini Manhattan Projects, or innovation hubs, to find ways to recapture carbon from coal plants. We know how to take nitrogen, sulfur, and mercury out of coal plants. We need to find a commercially viable way to take the carbon out. A mini Manhattan Project could make solar power costs competitive. Today, it costs four or five times as much as other electricity. It is too expensive to use in a widespread way. Germany, which has invested much of its future in solar power, gets less than 1 percent of its electricity from solar power. We are nearly at zero in the United States. We need a mini Manhattan Project to make electric batteries better so that our cars can go 400 miles instead of 100 miles with electricity, a mini Manhattan Project to recycle used nuclear fuel in a way that doesn't isolate plutonium. This strategy, as I said, is supported by all 40 Senate Republicans, and many Democrats and, I believe, some of that the President embraces: nuclear powerplants, electric cars, offshore exploration for natural gas and oil, and double energy R&D for four mini Manhattan Projects for carbon recapture, solar power, electric batteries, and recycling used nuclear fuel. This strategy doesn't drive manufacturing jobs overseas. It doesn't put an ineffective cap and trade program on fuel and raise the price of gasoline without reducing much carbon. That is much better than a national windmill policy, which is what the Obama administration and our current subsidies basically have in store for our future. Let me say what I mean by that. To produce an additional 20 percent of our electricity from nuclear power, we would need 100 new nuclear reactors on 100 square miles. Most of them could be built on sites where we now have reactors. We have been doing this successfully since the 1950s. We have a nuclear Navy. We produce 19 percent of our electricity from the 104 reactors we have today. But the proposal of the administration is to build 20 percent of our electricity from wind power. That would require 186,000 50-story wind turbines whose blades are the size of a football field. It would require 19,000 miles of new transmission lines from remote places, through your backyard, over your scenic viewscape, to bring that electricity to your house. It would require $170 billion in taxpayer subsidies over the next 10 years, while the subsidy for the same amount of nuclear power would be about $6.8 billion, according to current law. It would turn our ridge tops and coastlines and treasured landscapes into junkyards in the sky. According to statistics from the American Bird Conservancy these turbines could kill more than 1 million birds a year. These turbines would work one-third of the time. That means we would have to build nuclear power natural gas plants, or coal plants, to back up these 186,000 turbines that would cover an area the size of West Virginia. That is a project for our country that ranges from impractical, to expensive, to preposterous, especially when we have available the possibility of doing what we did before--adding 100 new nuclear reactors, which the rest of the world is doing. What happened to nuclear power? If we were going to war with the successful nuclear Navy created 60 years ago and it was doing exactly what we wanted it to do as the world's leading military, with thousands of our sailors living safely on top of those reactors, why would we stop building nuclear ships and start using sailboats for our national defense? That is tantamount to what the current administration's energy policy is doing with a national windmill policy. We should build 100 new nuclear powerplants as rapidly and as safely as we can. It is the cheapest and most reliable way to reduce carbon and deal with climate change, and it is the fastest way to do that-- just as electrifying half of our cars and trucks would be a fast way to reduce foreign oil and reduce emissions in the transportation sector. We invented nuclear power. It is one of our great technologies--maybe the most important technology in the last 100 years, and we haven't built a new nuclear powerplant in 30 years--even though the old ones we have are producing 70 percent of our carbon-free electricity. What is the rest of the world doing? China is building 132 new nuclear powerplants. The head of a French company that makes large turbines for powerplants was in my office the other day. He told me China is starting a new nuclear plant every 2 to 3 months. France is 80 percent nuclear and has among the lowest electric rates and carbon emission rates in Western Europe. We hear a lot about green jobs. Spain has a lot of green jobs. Unfortunately, many of the rest of Spain's jobs are going to France because the electricity rates are lower in France, and they are high in Spain because they favor unreliable and expensive renewable electricity over nuclear power. Japan is 35 percent nuclear and growing. Taiwan, India, and the United Arab Emirates are building them. Russia is building two nuclear plants a year so they can use their natural gas as currency with the rest of Europe. But we invented nuclear technology and we haven't started a new nuclear powerplant in 30 years. Why don't we go full speed ahead? We believe this is a more sensible, practical, low-cost solution for dealing with climate change. I will speak for myself; we have many different views on climate change in the Republican caucus. We have the whole spectrum. Not everybody agrees with me that it is a real problem and humans are causing it and we ought to deal with it as rapidly as we reasonably can. But here is the way we should do it. If we, by 2030, build 100 new nuclear plants, and if we electrify half of our cars and trucks, we would be producing about 40 percent of our electricity from nuclear. Natural gas would be about 25 percent, hydro would be 10, wind and solar maybe 5 to 10. With these two efforts--nuclear power and electric cars--we would reach the Kyoto protocol goals for carbon emissions by 2030 without a significant increase in energy prices. If in the meantime our mini-Manhattan projects for research, solar, carbon recapture, recycling nuclear waste, and electric batteries worked, we would be even more successful in reducing emissions, all without a national energy tax. One might say: What is going to make all that happen? I would say two words: Presidential leadership. President Obama is very persuasive. He can set a goal and mobilize the country. That is part of the President's job: See a need, develop a strategy, and persuade half of us he is right. I think he can get a lot of Democrats. He could start removing barriers to nuclear plants, speed up approval of designs for them. If China can start them every 2 or 3 months, we ought to be able to do so as well. He could provide incentives, such as $100 billion in loan guarantees--and those would all be paid back not just for nuclear but for all clean energy. His budget could fund the mini-Manhattan projects. Dr. Chu has recommended we do that. At a town hall meeting recently, President Obama said the United States would be ``stupid''--those were his words--not to use nuclear power. I was glad to hear him say that. I was disappointed when he went to the United Nations Climate Change Conference in New York and lectured the other countries about not doing more about climate change and he didn't mention the words ``nuclear power.'' Meanwhile, Chinese President Hu Jintao said his country would ``vigorously'' develop nuclear power to combat climate change and they are building 132 nuclear plants. But I was glad to hear what President Obama said in New Orleans. As we move through the Senate on the debate on climate change, I ask colleagues on both sides to look carefully at this economy wide cap and trade. We have had some experience with cap and trade on small dollars for coal plants and sulfur. That does not translate very well to what is being proposed here. It does not work on fuel, which is 30 percent of our carbon. It raises the price without reducing carbon emissions, it drives manufacturing jobs away, and it raises utility bills. We don't need to do it. With Presidential leadership, we could build 100 nuclear plants, electrify half our cars and trucks, find new low-carbon natural gas, launch the mini-Manhattan projects, and meet our clean energy goals without a national energy tax, without running jobs overseas looking for cheap electricity. All 40 Republican Senators agree with this agenda. So do many Democrats. President Obama agrees with much of it. Then why are we pushing a high-cost national energy tax and subsidizing 186,000 windmills when we should all agree on a low-cost, clean energy plan that will create good jobs and power our economy for the 21st Century? I yield the floor.