Thomas Coburn

Mr. COBURN

Mr. COBURN. Will the Senator yield for a question?

Mr. COBURN. Mr. President, I appreciate the opportunity to speak on this issue. It is very interesting. The American people should hear what has just gone on here. What we have heard is rhetoric without responsibility. There is no question that by moving, as Senator DeMint has, we finally got the Appropriations Committee to endorse what was passed in the ethics legislation. However, after the ethics legislation was passed, I spoke on the floor. I was the last person to speak on the floor late that evening. I made the statement--and it is now proving to be true--that it was ethics reform in name only, no substance. We now hear an argument that says: We should not pass the most significant portion of the ethics bill in a stand-alone process so that we can, in fact, do what the American people want, which is transparency in this Government. It is interesting, if you know how this place operates, that if in fact you have an earmark reform on appropriations only, and no earmark reform on an authorization, you have no earmark reform because once something is authorized in an authorizing bill through an earmark, it no longer will apply to the appropriations bill. So we will have the same thing going on. The reason we are seeing an objection to earmark reform is because we truly, in the majority of cases, don't want earmark reform. What we are doing is, we are doing it--talk about piecemeal--only in one area. What we will do is, there won't be an earmark on an appropriations bill. What we will do is authorize them now. Since we won't apply the earmark rule to authorization bills, the American public will once again be hoodwinked. They won't know whose financial interest it is nor who it will benefit. The problem with ethics in Washington isn't the lobbyists, isn't the campaign contributions, it is the Members of Congress. Until that changes, until the American people demand accountability--what we just heard was a flimsy excuse for not accepting this into the rules of the Senate. We voted on it. The American people deserve it. It is a sham. I again ask unanimous consent that the Rules Committee be discharged from further consideration, and the Senate now proceed to S. 123; further that the resolution be agreed to and the motion to reconsider be laid upon the table.

Mr. COBURN

Mr. COBURN. I ask unanimous consent to speak as in morning business for the next 10 minutes.

Mr. COBURN

Mr. COBURN. Mr. President, I listened with interest to the Senator from New York. As a practicing physician and somebody who has delivered over 4,000 children, I cared for both toddlers and young adults with type 1 diabetes. There is nobody who doesn't want to see that disease fixed. The problem is, we shouldn't promise things we don't know are accurate. What we do know is that yesterday on CNN, an article was released from JAMA showing the treatment of 13 young Brazilians who had type 1 diabetes who are now free from using exogenous insulin. They are on no medicine whatsoever and their sugar is totally controlled. That is one step going forward in all the areas of medicine. The other comment I will make before I make my final points is, if you talk to anybody in the area of research on Alzheimer's-- Alzheimer's, and we heard it time and time again, is a devastating disease for individuals who have it, and it is a devastating disease for families who care for their loved ones with it--I don't know of anybody in embryonic stem cell research or in research in medicine by themselves who has great hopes for a cure of Alzheimer's with embryonic stem cells. We have heard that claim time and time again. It is not a great hope for Alzheimer's. There is hope. There is beta secretase, which is an enzyme that causes Alzheimer's to be laid down. There are great medicines coming forward. Some are in trials in primates right now that tend to stop Alzheimer's in its tracks. We ought not to be promising things we don't know or are not realistic in terms of Alzheimer's. That is the case. I want to sum up where we are, the differences between the two bills. One bill, S. 5, has lots of positives in it. We hear it is not going to destroy any other embryos, there is going to be a grandfather of the embryos that have been created since. We heard the Senator from New York say something different. We heard the Senator from California yesterday talk about the 400,000 embryos that are frozen today, of which only 2.8 percent are available and less than that number--so less than 250 lines--could totally be created out of all the embryos that are available in this country today. The answers are kind of sleight of hand. To have an effective embryonic stem cell program, other than what is provided in S. 30, means we are going to use Federal taxpayer dollars, indirectly or directly, to destroy embryos. You can say you are not, but the fact is that will happen. What are the positives of S. 30? The positives of S. 30 are that it looks at everything. It looks at all the new and upcoming methods. One is altered nuclear transfer. No. 1, you don't destroy any embryo, you don't create an embryo, but yet you get identical cells to what an embryonic stem cell would be, totally pluripotent, totally capable of doing everything an embryonic stem cell can do. Why is there resistance to that? Why would there be any resistance to that? There shouldn't be. The second point is what we call germ cell pluripotent stem cells. Those are made from the testes and ovaries of us, each of us, and we can have treatments designed for ourselves. Every tissue type in the body has now been produced from germ cell pluripotent stem cells, either ovarian or testicular, again, applying the same pluripotent stem cells you get from an embryo, but you never destroy a life. My friend from Minnesota, one of the coauthors of this bill, makes a great point. Whatever happens at the end of the day--right now this glass of water represents what is happening on embryonic stem cell research with Government funds in this country. There is a whole lot of other research going on with embryonic stem cells outside the Government. It has not dead stopped. As a matter of fact, it is advancing forcefully without Government money. But this represents what is there. If S. 5 is passed out of this body and the House, this is what we will see next year: the same amount, because this bill is going to be vetoed. However, if S. 30 is passed, what we will see is this much research, a doubling of the research next year. So one says help people play the political game when we know it is going to be vetoed. S. 30 says let's do something real. Let's give an answer to the hope. Let's double it up and let's do it in a way that is an ethically good way. The final point I wish to make is to anybody who wants us to do embryonic stem cell research, anybody who has a family member with a chronic disease, anybody who has a child with diabetes, anybody who has any need that has hope coming from ``embryonic stem cell research,'' the question I put forward to them is this: If we can show you the science is going to give us exactly the same results with never destroying an embryo, what would your choice be--destroy an embryo and get the results or do not destroy an embryo and go one of the multitude other ways to accomplish exactly the same purpose? That is the real question that is facing this body. That is the question the American people ask. The science is 2 to 3 years ahead of the debate in this body today. A lot of times my colleagues accuse me of not making much sense on the floor when I talk about these issues because it is a medical issue, it is a scientific issue. I am a doctor. I understand the science, so I tend to not use the words as plainly as I should. But the ethical question still arises: Do you want a doubling of the research to go forward and answer the very human need that is out there or do you want to play the political game and have exactly what we have today? I say to Senator Harkin, that is what will happen if S. 5 goes through. It is going to be vetoed. It will not be overridden in the House. Or we can have S. 30 that does as much or more than S. 5 and we will see a difference for the American people. The hope my colleagues talk about will be realized when S. 30 gets passed, when S. 30 gets signed. The President has said he will sign it. It makes available everything we will need and still accomplishes the same goals but does it twice as fast. That is the real question: Do we want to play politics with this issue? Do we want to say somebody's legitimate position of valuing life, that they have an illegitimate position because they value life at the expense of somebody with chronic disease, or can they value life, come with an answer that actually accomplishes the same purpose in a better timeframe with better results with S. 30? That is the real question for us. I understand the political game we are playing. I understand the diseases. But when you read the basic raw research that is going forward today, we are not even close to what is happening, we are not even talking about what is happening out there. Final point. Make sure you understand that if you believe in embryonic stem cell research as a viable ethical alternative, you also have to believe in cloning because the only way you will get a treatment that is good for you without rejection, without rejecting the very treatment that is being given to you, is for you to clone yourself. That is the dirty little secret nobody wants to talk about in this debate because once we accomplish with true embryonic stem cells versus altered nuclear transfer, any treatment will require antirejection drugs or you having to clone yourself. The language is very specific. There is no cloning as far as implanting into a uterus, but it doesn't mean you don't clone yourself and destroy yourself to meet a need for you. It is a very complicated ethical issue about which we ought to be very clear. It is not just destroying embryos. It is going the next step now to have an effect from that treatment. I believe there will be good treatments come out of embryonic stem cell research. I don't have any doubt about that. I believe exactly those same treatments will come and be better from altered nuclear transfer, from dedifferentiation, which is a term that says you take a cell that is more mature and dedifferentiate it back to a pluripotent cell, or from germ cells, either ovarian or testicular. We can accomplish the desires of everybody who is hurting in our country today who has a hope and do it in a realistic way with S. 30 that will deliver the goods, deliver taxpayers' dollars to make a difference. S. 5 will deliver nothing, nothing for at least 2 years, because this President won't sign it. So the consequence and the question that comes back to us is: Are we going to do something that is meaningful or are we going to play the political game that in the long term has no meaning, at least for the next 2 years? I yield back my time to the Senator from Georgia.

Mr. COBURN

Mr. COBURN. A shade over 4,000.

Mr. COBURN. I wanted to add one other thing. When the American people think about stem cells and potential treatments, the thing that is never talked to them about is the idea of tissue rejection. There isn't going to be an embryonic stem cell that produces a cell that can be used in any human without the use of antirejection drugs. The only way you can get around that is to clone yourself. The only way you can get around it totally, without any rejection whatsoever, is to be a female and clone yourself, because cells have these wonderful little engines in them called mitochondria. They have separate DNA. That DNA of the cloned egg will be accomplished as a part of that. So this idea we think we are going to have this great answer, even once we get to treatments--treatments that use embryonic stem cells rather than altered nuclear transfer, or oocyte-assisted reprogramming--those cells will all have to have accompanying with them, all those treatments, anti-rejection drugs. If you know anybody who has had any type of organ transplant, ask them how it is to take those drugs. The only way you do that is, we come to the next ethical dilemma: Is it OK for you to clone yourself, then destroy that life you have cloned so you can take part of that for you? All those ethical dilemmas are gone in altered nuclear transfer because now you are inserting stem cells from your own body. They are your own cells. There is no rejection. In this study in Brazil I just put in the Record, there is no rejection because they are using their own cells. They have eliminated the ability of their body to destroy their islet cells in their pancreas and have done that with their own cells. There is no rejection so they are not on any medicines. They are not on insulin anymore because they are now producing insulin. So the fact is, we should make sure we understand if and when--and there is no guarantee the ``when'' is going to come--we have embryonic stem cell treatments, those are going to be accompanied by antirejection treatments as well. However, if you use your own cells for the same treatment--we heard Senator Brownback talk about the numerous studies that are ongoing now with autologous or self-giving reparations from your own body--there is no rejection issue. So it is easy for us to talk, and it is easy for us to offer hope, but we need to make sure when we talk about that hope, when we talk about embryonic stem cells, we are balancing it with a realism that we are not off treatment, even though we offer a cure, because now we have a treatment to make sure the cure works. So it is a step that is positive, but it is not the panacea that has been described on this floor today.

Mr. COBURN. Mr. President, I thank my colleagues for this bill. Senator Coleman and Senator Isakson have put a great deal of time into this bill, and I am pleased to work with them in bringing about this formulation. If I am not already a cosponsor, I ask unanimous consent to be added as a cosponsor.

Mr. COBURN. Unlike many in the Chamber, I am a scientist. I am a physician. I have delivered, at last count, somewhere over 4,000 babies. I understand embryology. I understand the science of molecular biology. This debate is going to come down to a couple of moral questions. There are really two moral questions that this country has to answer. I will talk about those, and then I will talk about a few other things that most people don't want to admit to or discuss, issues surrounding this topic. The first moral issue is, do we have the capability to destroy life in the name of saving life? That is what we are talking about with embryonic stem cells. We selectively snuff out a life so that we can potentially have a treatment in the future. That is the first great moral question. I have seen the various early stages and then every other stage through pregnancy what that life potential is. It is not to be taken lightly, this step of ignoring life or neutralizing life under the proxy of saying we are going to benefit someone. We have heard many people talk about the promise of embryonic stem cells. They do yield promise for us. However, it is a long way off. But we need to be careful with this step in the direction of destroying life in the name of saving life. I thought Senator Isakson did a very good job of explaining embryos that no longer grow. They have quit dividing. They won't be frozen. They won't be implanted. They, in fact, will be discarded. But they still have tremendous value for us for research. As he noted, 5 of the 21 lines presently being researched, and 3 of the 10 lines that presently have no problems whatsoever came from dead embryos, embryos that still have live cells but won't divide again unless induced to do so, and then won't divide into an embryo. This is a big question for us because how we answer this question today is going to say a lot about the decisions we make in the future. One of the things we are going to hear about is the tremendous amount of excess embryos around. Here is a RAND study report that disputes that. Here is a scientific research organization that looked at the availability of excess embryos and in fact says the claims are not supported by the facts. I ask unanimous consent to print this in the Record.

Mr. COBURN. The second question we have to ask ourselves is, if you are a mother of a juvenile diabetic, a 2- or 3-year-old, or you are the wife of a Parkinson's patient or the caregiver of somebody with a spinal cord injury, if we told you that in fact we can do everything to produce a cure, to give you the exact same opportunity for a cure without ever destroying the first embryo, which would your choice be? Would your choice be to destroy that embryo or to do it in a nondestructive way getting exactly the same results? That is where the science is today. That is going to be disputed. But the false hopes that have been created that that is the only way that we can find these cures is nothing but hogwash, scientifically proven hogwash. The fact is, we don't know what is going to come from embryonic stem cells. We know a lot that will come from other treatments. I just shared with Senator Coleman, we will have a treatment for juvenile diabetes within 5 years, but it won't come from stem cells. It is going to come from the tobacco plant. That is very new research. It has been repeated in mice. It is working. We will have that cure. That is going to get funded, and it will be produced long before anything else that comes to an actual cure. By the way, autologous stem cells, cells taken from yourself, have already cured five juvenile diabetics by taking the cells from a tube inside the pancreas and growing those cells, regenerating beta cells, and reimplanting those into children who have juvenile diabetes, who are off insulin today. So there are lots of opportunities. The second moral question that Americans need to ask themselves, as do Members of this body, is if we can do everything without destroying the first embryo, why do we want to destroy embryos? Because it is easy? Because it is convenient? Because we are locked in a mantra that says this is the only way. Think for a minute about what else is going on. We now produce almost every cell type that man has from germ cells, research done in this country, proven in Germany, in Japan, another source of stem cells. Didn't destroy the first embryo, but we have it. Altered nuclear transfer, assisted reprogramming, which you heard Senator Coleman talk about, has not been done in humans yet because it hasn't been funded. The fact is, it has been done in mice. You sit and think, what can happen. When we heard that these were theories by the Senator from Iowa, going to the Moon was a theory, but we did it. The fact is, there are lots of other theories on how to treat disease out there that we are going to be accomplishing that aren't going to have anything to do with stem cells. It is important that we don't take our eye off the ball. This is a very key moral question that has to be answered. It has to be answered by all the disease groups out there. If, in fact, we can supply the same product in the same timeline with the same results, why would we want to destroy an embryo? If we could do it in an ethically, morally correct way, why would we do it in an ethically less correct way? Then there is the little problem that you never hear talked about with stem cells. The only way a stem cell therapy is ever going to work without antirejection drugs, the only way it is ever going to work is if you clone yourself. They don't want to talk about that right now. But for a treatment to happen that will keep you free from rejecting that stem cell, that treatment, that set of cells that is not purely yours will mean anybody who gets a treatment from an embryonically derived stem cell will be on antirejection drugs the rest of their life, which has multiple complications. The solution to that--they don't want to talk about it--is you have to clone yourself. So now we are into cloning ourselves and then destroying ourselves so we can have a treatment for ourselves? That is the dirty little secret that nobody with embryonic stem cells wants to talk about. The interesting answer to that is altered nuclear transfer, oocyte- assisted reprogramming, which has none of those problems because you use one of your cells into an egg, reprogram it to produce pluripotent cells that never produce an embryo. Nobody wants to talk about the real scientific issue of the problems of a treatment for a disease that we have no treatments for yet, that is well down the road, and the big kicker that will come is, what if we get a treatment and then we try to give it and everybody is going to have to be on an antirejection drug. Everybody knows somebody who has had a transplant. Ask them how they like taking their drugs. They like taking them because they have a new liver or heart or kidney, but if they could not take those drugs and have it, they would much rather have that. So we set up a false choice. The false choice is, embryonic stem cells or nothing. That is not a real choice for this country. I believe America is a great land, made up of good people. If we answer this second moral question, if we can do this, and we can, through multiple ways, why would we destroy the first embryo? We do not have to destroy the first embryo. I think we ought to be considering the moral questions, but also the facts that are going to come about as a result of this fascination and hope for a cure. I have had mothers of juvenile diabetics in my office. I have had family members of Alzheimer's patients. I have had a Parkinson's patient plead with me to do this. When I explain to them what is on the horizon, when I explain to them what the potentials are, all of a sudden this hope that has no substance to it yet whatsoever does not have near the meaning as all the other things that are going on that do have meaning. So we need to refocus on the real search, the real potential that is in front of our country and answer this best, most important moral question: Do we steal life from the innocent to potentially give life to the maimed or the injured or diseased, or do we, in fact, do it in a way that never steals life and accomplishes the same goal? That is the real question before the Senate. S. 30 does that. S. 5 does not. That is the division. One says: To heck with the ethics, to heck with the problems associated with it, to heck with the rejection, to heck with the antirejection drugs, to heck with the idea we cannot clone ourselves, we want to go this way only. S. 30 allows all the options, all the accomplishments, all the potential without violating the first ethical clause. That is the question America needs to ask itself in this debate. We can give to all those who are desirous of all these needed benefits of cure and treatment, and we can do it in an ethically responsible manner that will send us down the right road for this country, not the wrong road. With that, I yield the floor.

Mr. COBURN. Mr. President, I have been listening to the debate on this bill from my office. I have written down some of the miraculous statements that have been made on the floor of the Senate, and I thought I would resubmit some of them with some constructive criticism. Seventy-eight stem cell lines are no longer useful. That is not accurate. All stem cell lines are contaminated with mouse feeder cells. Not true, either. The policy does not work. Not true. Research on stem cells under the present cannot go forward. I would remind the body that stem cells, embryonic stem cells are being researched every day in this country with private money. This is about using Federal dollars to destroy embryos; it is not about blocking embryonic stem cell research. The statement was made by the Senator from California that these are embryos that would already be destroyed. Now that is not accurate at all. Only S. 5 embraces all forms of stem cell research. S. 30 embraces every form of stem cell research, including embryonic stem cells, but it makes the correct distinction of taking a nonviable embryo that is still viable for embryonic stem cells but not viable to create a human and uses those instead of the true potential-for-life embryos. There would be no limitation on the numbers of these. If we go to a fertility clinic today where embryos are created, what we see is a range of embryos in terms of their quality. Then they are graded. Some are implantable. Some are frozen. Some have quit dividing. Those that quit dividing but are not dead but don't have the potential are the ones S. 30 will allow to be used for embryonic stem cells. It bypasses the ethical dilemma we have and still gives us embryonic stem cell research. It was just released by the Journal of the American Medical Association and was on CNN, 13 young people from the ages of 14 to 31, now living in Brazil, who had type 1 diabetes were treated with their own immune cells given back to them, and they now live without insulin. That was released today. It didn't have anything to do with an embryonic stem cell. Someone during the debate said: We all know embryonic stem cells hold the most potential. I believe the Presiding Officer now in the chair said that. That is not true. They don't hold the most potential. They hold great research potential, but what we ought to be interested in is therapeutics. How do we treat diseases? How do we accomplish therapies to do the most good for the most people? What we are going to find out is, there will be some potential from embryonic stem cells. But if I had a child with diabetes, I would want it fixed as soon as I could, not 10 or 15 years from now. The fact is, we have all these treatments that are coming about. I am convinced, as much as I am alive and standing here today, that within 10 years new onset type 1 diabetics will be cured within 2 months of the onset of their disease. That is going to happen. We are going to see that. We will see tremendous treatments for that, whether from germ cell lines, embryonic stem cell lines that are harvested correctly and ethically, and other treatments, including autologous or their own stem cells used to treat the body. I introduced into the Record the RAND study on the available embryos. We had it quoted today, there are 400,000 of them out there. That is not true. It is more like 13,000 available. So when we have this exaggerated claim that 400,000 embryos are waiting to be destroyed for embryonic stem cell research, that is not true.

Mr. COBURN. I am happy to yield.

Mr. COBURN. That is correct.

Mr. COBURN. There is no question it happens every day. One of the things we have seen in our State is, we sometimes overfertilize eggs and create too many. But when it comes down to the individual couple who says: We are going to try this implantation, we are going to save these, then if they have a child, they may want to have another child, so that many of these are saved in reserve for that family. To say there are 400,000 when, in fact, there are probably less than 13,000 that could be available, if you look at the other side of that, how many nongrowing, nonviable embryos are available today? Fifty to seventy to one hundred thousand of the stage 3 embryos that can be used for embryonic stem cell that doesn't violate the ethical dilemma we face today. So the reason I put the RAND study in there is so the Record will show the facts, not the desire of a Member of the Senate to overstate the case. The fact is, there are less than 13,000 available. The fact is, level 3 embryos, there are 100,000 available. Nobody talks about that. In fact, 3 of the 10 that are the best lines right now running came from exactly that source. So we know that is the potential. Let me continue. We had the statement: Science without ethics is like a ship without a rudder. That is true. Therefore, when we start destroying life, where is our rudder? When we start marginalizing the weakest and the most vulnerable in our society to say we are going to do something good somewhere when, in fact, the science doesn't show that yet, where is our rudder? That is what S. 30 does. S. 30 gives an ethical option for every need we have in the scientific community to accomplish everything the scientific community wants to accomplish. There are no limitations in S. 30. The Senator from Minnesota has made the point, President Bush is going to veto S. 5. He has already said he is going to veto it. So a year from now, where do we want to be in terms of stem cell research? Do we want to have more embryonic stem cell lines and do we want to have more embryonic stem cell lines the NIH can use money to research on? The answer is, yes, we do. There is one way to do that. That is S. 30. S. 30 allows that. I am convinced, as an obstetrician and as a scientist, that 10 years from now we won't use embryos whatsoever to produce stem cells. We will use embryonic stem cells to help us research genetics and drug treatments for difficult diseases that we already have, and we will use other methods to produce cell lines that will give us cures to disease. I ask unanimous consent to print in the Record the recent announcement of the article in JAMA on CNN, ``Type 1 diabetics live without insulin in stem cell experiment.''

Mr. COBURN. There are two ethical questions America has to answer. One is, is it OK to destroy life with the potential of helping cure maladies--we haven't seen it yet--with the potential, the hope to cure maladies? In the midst of that ethical question, is it OK to destroy that life when you could do the same thing without destroying life by using class 3 embryos? That is the first ethical dilemma. The second ethical dilemma we face as a nation and as citizens of this country and as Members of this body is, if in fact it is true there are other ways to get to the exact same goal of treatments--we all want to fulfill the hopes and the desires, whether they are paraplegics, quadriplegics, diabetics, Parkinson's or others, all these tremendous diseases that we know we are going to be able to eventually find a cure for--if we can do that without ever having to destroy the first embryo, wouldn't we all rather go that way? That is what S. 30 offers. S. 30 offers an opportunity to accomplish exactly the same thing without destroying the first life. How we answer that question is going to say a lot about our country. My hope is a year from now we are standing on this floor and seeing all this promise come true, whether it be altered nuclear transfer, whether it be germ cell, which I happen to believe is going to be another great option in terms of multipotent and pluripotent stem cells, that we will see the fruits and the wisdom of the Senate that passes a bill, S. 30, which actually makes a difference. S. 5 isn't going to make any difference. It is going to get vetoed. It is not going to do anything to help us except create a political posture that the President has said he will not bow to. He is not going to sign it. He is going to veto it, and the House will not override it. So the question is, if you want to give hope, if you want to promote a potential for treatment and cures for all these strong and tough diseases families are facing and individual patients are facing, the way to do that is to make sure S. 30 becomes law. It will, in fact, be the thing that makes the difference. S. 5 won't. S. 5 is going to get vetoed, and we will be back here doing the same thing next year and the next year and the next year. The point is, let's do what we can today, and S. 30 accomplishes that. I thank the Senator and yield the floor.

Mr. COBURN

Mr. COBURN. Mr. President, under the previous order, I believe I have several amendments pending. I rise to discuss those with my colleagues. I will call up several of them as I go along. It is important for the American public to know what is going on. If we go back to 2003, what we can see is a major growth in emergency spending. Why is that important? It is important because emergency spending is totally outside the budget parameters on which the Senate works. Emergency spending doesn't count against any total cap on what our spending will be. It doesn't count against the budget deficit, and it doesn't count against the budget rules. We merely spend the money outside of any rules of control, and we charge it. We take a credit card and we say: Kaching, grandchildren, you are up. As my colleagues can see from this chart, from 2003, 2004, 2005, 2006, to 2007, as the bill before us today, we see an average of over $100 billion a year, about $110 to $115 billion a year outside of a $3 trillion budget. So no taxpayer dollars presently are going to go to pay for any of this. What we are going to do is ask the Treasury to issue bonds and notes. Guess who will be redeeming those notes. Our grandchildren. Who is at fault in all this? Partly the administration because part of this funding has been for a war that should have been budgeted through the Defense appropriations bill. That will happen next year. But the fact is, we can take $80 billion out of this across the year and apply it to the war. What about the other $30 billion every year on average that doesn't have anything to do with the war and doesn't have anything to do with an emergency? Remember, this is supposedly emergency spending. How long have we been in this war? Four years. There is nothing emergency about it. We know the spending. It should go through the regular process. Our budget rules define ``emergency'' as something unforeseen, unexpected. We have to question the intellectual honesty of our body when the $18.7 billion that is added on to the defense request in this bill is deemed an emergency. The first amendment I will talk about is $100 million that is an emergency to fund increased security at the conventions, both in Minneapolis-St. Paul and in Denver. We have known we were going to have conventions every 4 years for a long time. Never before have we funded the security required for these conventions out of an emergency bill. So in essence, what we are going to do is we are going to have two big parties and we are going to send the bill for those parties to our grandkids. The first amendment I have actually eliminates that $100 million. We have plenty of time under the regular appropriations process with which to supply the money within the budget guidelines. Every billion we spend outside of the budget guidelines means that is another billion which is going to be spent inside, which means we are actually doubling the spending. Something that should have been inside, now we are going to spend outside of the budget. We are going to charge it to our children, and then we are going to spend more money. How did we get where we are? The important thing to look at as to how we got where we are is to look at what has happened to Defense appropriations every year. There is a requirement that is asked for from the Pentagon in the budget. It is within our budget numbers. What happens when it comes out of here? What happens is, it gets underfunded intentionally. Why does it get underfunded intentionally? So that we can create, in 2003, 2004, 2005, 2006, and 2007, additional spending inside the budget, and then we come back and get the actual defense needs in an emergency. It is a shell game that is being played on the American public that says: We are going to underfund what we know we need in defense. Then we know there is going to be an emergency supplemental, and we will make up for that when the emergency supplemental comes. But because we underfunded defense, we can therefore spend the money somewhere else outside of the budget. It is a game that we continue to play that is unfair to the American public. Amendment No. 648 I call up amendment 648.

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

Mr. COBURN. Amendment No. 648 removes $100 million. This is not about being against security for people who are going to attend the conventions. It is ironic that the decisions which are made at the conventions will have already been made probably in February or March. But we are going to charge the American taxpayers $100 million for security outside of the budget. Who are we really charging? We are charging our grandkids. This has never before happened. Always before, if we funded money for convention sites, we have done it within the budget. So it isn't an emergency, and it is markedly unethical to take money that should be inside our budget and place it outside and ask our grandchildren to pay for us to all have a party in August and September. H.R. 4613, the fiscal year Department of Defense appropriations bill, provided $50 million for discretionary grants for this same purpose associated with the 2004 nominating conventions. We did that in the 2005 bill. We did it within the budget. We have done it before. Let's talk about the criteria of what is an emergency: necessary, essential, and vital, plus sudden, quickly coming into being, not building up over time, an urgent, pressing, compelling need requiring immediate action, subject to unforeseen, totally unpredictable and unanticipated, not permanent and temporary nature. There is no question the funding for the conventions for the Democratic and Republican parties does not meet any of those criteria. Yet here it is in the bill. Why do we find it in this bill? So we don't have to spend the money inside the budget limitations that are placed on Congress. Here is $100 million outside of that budget limitation that we are then going to spend, another $100 million, because we have not paid for this one, and we should have paid for it within the budget. This isn't sudden. It is not urgent. It is not pressing. It does not require immediate action, is not unforeseen, not unpredictable, and it was not unanticipated. There have been nominating conventions since 1832. The year 2008 will be the second Presidential election since the 9/11 terrorist attack. There is no question that increased security is required. But this is the first time we have said it is an emergency. It is like saying we don't know the census is coming in 2010. We will have an emergency supplemental for the census. As a matter of fact, we have done that before. The war on terror is an emergency. Having a party for politicians and their political parties doesn't qualify. We are going to have a vote on this amendment. I expect to lose the vote. But I also expect the American people will ask: Why in the world would we be doing this? Why would we violate their good will by playing games for the political parties? Why would we do that? It comes back to the point of where we are in the Senate, why are we addressing this legislation? Why is there $18.7 billion worth of additional items added to this bill other than to fund the Defense Department? We will hear all sorts of answers: We need it. We didn't do it. We have emergency agricultural appropriations in this bill. Actually, I believe there is an emergency in farm country, and we ought to be doing something about it. But we ought to be paying for it. I haven't yet talked to a farmer from Oklahoma who thinks his grandchildren ought to be paying for us to do an emergency supplemental in terms of agriculture. They believe we ought to find it within. The fact is, Senator Carper and I held 49 hearings in the last Congress and discovered over $200 billion of waste, fraud, abuse, or duplication within the discretionary budget. That is within $1 trillion, 20 percent. Most Americans probably believe that. The problem is, most politicians don't have the nerve to challenge where that spending is because there is an interest group that wants it spent. There is an interest group, and it is us. It is self-serving that we are going to spend $100 million on increased security for the conventions and not pay for it and spend that money inside the budget on something else. Probably the greatest moral question is, Are we going to have a party on our unborn next generation? They are going to be the ones who pay back this $100 million. It is not going to be $100 million when they pay it back; it will probably be $500 million or $600 million by the time we get to paying it back with the compound interest. What would this $100 million do if we were not spending it on security at party conventions? It would buy 31,797 sets of body armor. It would uparmor 658 humvees. It would uparmor 529 ambulances, medic carriers for the guys who are helping our guys in the field. Instead, we are going to use a bill, intended to cover the cost of winning the war, to protect our national security, fight the war on terrorism, to add $100 million to our national debt that already exceeds $8.7 trillion. We added $1,000 to that debt last year for every man, woman, and child. We added $1,000. If you pass this bill-- ``emergency''--what we are going to do is add another $400 for every man, woman, and child in this country--the debt just for this bill. So it ought to be about real emergencies. Federal funding also is already planned for the conventions. The Department of Justice did not request this $100 million. The administration budgeted $15 million for the Secret Service to provide the security at these conventions. Each convention has been designated as a national security, special security event, making security personnel eligible for other Federal tax dollars through grants to cover the expenses. Why are we doing it? There has not even been a security plan for which we are throwing $100 million at formalized for the conventions. I believe if you are a young person in this country today, what we are doing on this bill, especially with this item, has to be heartbreaking. April 15 is coming up pretty soon. We all look at our pay stubs and see what we are paying in Federal taxes. What you do not see when you get that pay stub is how much additional you are going to owe at the end of the year because we were not responsible. We were not responsible with the taxpayers' money. Yet we play all these shell games of hiding money, underfunding defense so we can bring it back in a supplemental, so we can spend money elsewhere rather than making the tough choices. Let's read about what was in the news after the last conventions. It is pretty interesting to know. One hundred million dollars of your money for the following: USA Today reported the convention featured more than 200 parties by corporations, lobbyists, trade groups, and other organizations. These were in addition to the high-dollar donor meals, golf tournaments, sporting events held during the convention week. Top sponsorship at these events can cost up to $250,000--golf tournaments, breakfast at Tiffany's, Yankee Stadium fundraisers, champagne and cigar celebration, baseball games. We are going to spend $100 million of our grandkids' money to protect politicians while they have a party. To me, it is unconscionable. It is even more unconscionable to do it in this bill. There is nothing about this that is an emergency. There is nothing about this that was not foreseen. There is nothing about this that was not anticipated. This is a game. The last election reminded us--my party--you cannot say one thing and do another, except that is what we are seeing with this bill. Amendment No. 649 Mr. President, I wish also to spend some time on amendment No. 649. Over the last 5 years, the University of Vermont has received $400 million in earmarks for things for that university. In this bill is an earmark for $2 million. The first thing we said is we are not going to have earmarks that are not published: who put them in, who sponsored them, and what they are for. This is an emergency bill. There is no question we ought to honor former Senator Jeffords. There is no question we ought to do that. But in an emergency bill that is unpaid for, that does not have anything to do with fighting the war on terror, we are going to send another $2 million to a university that has gotten $400 million over the last 5 years? This is not a place for it. It is not the time for it. It is not the way to do it. Supposedly, we are free of earmarks, and yet here is an earmark for which we do not have the money. We are not going to be able to pay for it, even though the claim is this is offset. It is offset with student loan management money. That is how they have offset it to say it does not cost any money. Which is more important? More students getting loans and effective management so more people get student loans or giving another $2 million to a university that has already gotten $400 million of the taxpayers' money? I do not think there is any question in the average American's mind in regard to that. Let me read what the University of Vermont has gotten: year 2000, $54 million for 201 different programs; year 2001, $60 million; year 2002, $69 million; year 2003, $76 million for 249 different programs; year 2004, $70 million; year 2005, $68 million. There is a lot of money that has already gone up there, a lot of it borrowed. At the present time, the University of Vermont has an endowment of $282,594,000. Now, the interest on that, at 6 percent, gives you about, oh, close to $15 million a year--just the interest off that endowment. I believe they have plenty of money to fund this chair to honor Senator Jeffords. The endowment grew 16 percent last year. Its growth last year was 20 times the amount of this earmark. Again, it is not unanticipated, certainly not an emergency, certainly it is not something we have to do now. Again, is it necessary? Essential? Is it not merely useful or beneficial? It is useful. It will be beneficial. Did the demand for this quickly come into being? No. It was part of an earmark in the Labor-HHS bill that was not included in last year's appropriations. Is it urgent, pressing, and compelling, requiring immediate action? No. Was it unforeseen or unpredictable or unanticipated? Is it temporary in nature? No. It is not temporary. It is the start of many years of giving $2 million a year on the same thing. This project violates the Appropriations Committee's own earmark moratorium. On December 11, Chairman Byrd and Congressman Obey announced there would be no more congressional earmarks until the new rules were put in place to make the process more transparent and more accountable. Those rules are not in place. The transparency and accountability is not there. Yet we see an earmark. Here is what the joint statement said: We will place a moratorium on all earmarks until a reform process is put in place. Earmarks included in this year's House and Senate bills will be eligible for consideration in the 2008 process subject to new standards for transparency and accountability. We will work to restore an accountable, above-board, transparent process for funding decisions and put an end to the abuses that have harmed the credibility of Congress. More of the same. There is no end in sight. This earmark was previously included in the report language--not the law, in the report language--for the fiscal year 2007 Labor-HHS appropriations bill. That was on page 251 of that report. It is the first of the earmarks to be resurrected from last year. I might say as an aside, the Congressional Research Service has refused to honor a request from myself and Senator DeMint to give us a list of the earmarks in the 2007 appropriations bills--a flat-out refusal. There is a lot of speculation as to why they do not want the American people to know what the earmarks were last year. Come 2008, we are going to get to find out them all under the Transparency and Accountability Act that myself and Senator Obama and several others cosponsored, which became law last year. When we questioned the University of Vermont about this earmark, we asked: What were the estimated costs of the project long term? They could not give us an answer. Who was going to finance it after the program was established? They could not give us an answer. How will the Federal funding be expended? They could not tell us that. Did the university request the funding? We do not know the answer to that either. None of these questions have been answered by the University of Vermont. This $2 million could be spent for our troops. It would buy 2,857 carbine rifles the National Guard presently does not have so they could conduct training. It would buy 4 mine-protected vehicles or 13 uparmored humvees. Mr. President, I wish at this time, without giving up my right to the floor, to yield time to the Senator from Virginia.

Mr. COBURN. Madam President, reclaiming my time, as the floor is under my control.

Mr. COBURN. This is simple. It is not an emergency. Eighteen months from now we are going to have the Presidential nominating conventions. In Atlanta, during the Olympics, for a month the entire security was $10 million. If we triple that amount for a month, you have $30 million. This bill allows $100 million for conventions and for decisions that are already going to be made prior to that so that the political parties can have a good time. Yet we are going to ask our children to pay for it. You are going to vote to ask your grandchildren to pay for a party you aren't having now, when the President already has $15 million in his budget for Secret Service for both of these conventions, which they feel is adequate at this time. The question is not whether we should do it. If we are going to do it, we should do it inside the confines of the budget. Two, it is not an emergency. We have 18 months. We have plenty of appropriations bills to pay for this.

Mr. COBURN. Mr. President, the amendment we are considering says the agriculture supplemental we put forward is going to be paid for. The Agriculture Department is the sixth largest corporation in the United States, when you look at it. What it says is we ought to be able to use some of the $8 billion they have sitting in the pot now and we ought to be able to find a way to make them 3 percent more efficient so we can actually pay $4.1 billion to help in the agricultural emergency we have in this country. It does not add it. We do not charge it to our grandchildren. We say we are going to be responsible, and we are going to take it out of the money that is in there now that is easily findable. We will actually pay for helping our farmers who need our help today. It is the exact same language the appropriations bill has for both cattle producers and grain producers. It just says: Find it within the agency, pay for it, and we will do it.

Mr. COBURN. I thank the Chair.

Mr. COBURN. I would like to continue, since my time is going to be limited by what I will be allowed to discuss on my amendments in terms of total time, I wish to spend a minute talking about amendment 657. There is no question we have some critical needs among many of our agricultural suppliers in this country--needs that were unforeseen, needs that were unanticipated, needs that we should have addressed last year but didn't; needs that we should have addressed in the CR, but we were precluded from offering an amendment to offer a way to supply those needs. What this amendment does is it provides farm relief to both our production agriculture individuals, as well as our cattle, in a fiscally responsible manner. I wish to give some quotes, before I go into the details, from last year's debate with Senator Conrad and Senator Dorgan. Here are the following quotes: I am very much in sympathy with Senator Coburn on the notion of paying for this. I appreciate very much--as the Senator knows, I wish to pay for this all as well. We have a way to do a pay-for, but I am precluded from doing so by the rules. On the question of paying for it, I have complete agreement with the Senator from Oklahoma. I wish the rules permitted us to offer an amendment for pay-for. I don't have disagreements about the issues of paying for it. I suggest we do a unanimous consent. I would do a unanimous consent to pay for it. These things ought to be paid for. We have hundreds of billions of dollars come through here with hardly a blink, none of it paid for. That ought to change. I am with the Senator from Oklahoma. Let's try to change that. The fact is this does not have a pay-for, not because Senator Conrad doesn't want it there or I don't want it there; it ought to be there. Well, here is the chance to put those words into action. What this amendment does is strike all nonessential items in the farm title so the scarce resources we have can be maximized for crop and livestock disaster assistance. The language in this amendment leaves verbatim that language in the underlying bill. It requires, though, the underlying funding for the emergency in this bill to be paid for within existing funds at the Department of Agriculture. You are going to hear all this screaming: They can't do it. You know what. They have $8 billion in the bank right now unspent, unobligated; money that is sitting there from this last year and this year that they haven't spent. This total will come to $4.15 billion, $4.15 billion to take care of the real needs of the consumer, the production agriculture in this country that has had 3 years of drought, has had 3 years of floods, has had 3 years where they didn't produce a crop. Those who actually bought crop insurance are going under anyway. What it would not do is add the other $1 billion to the outside of that for special interests that aren't the heart of agriculture in this country and when we do that, we are going to pay for it. How dare you take money from the Department of Agriculture. The Department of Agriculture is, if you compared it on size and budget, the sixth biggest business in the United States. There isn't a big business out there that if they had to scrimp, couldn't save 4 or 5 percent on their business. As a matter of fact, they do it every day. As soon as their stocks start getting low, they start trimming, becoming more efficient, better ideas, better efficiency, and they cut their costs. We can do that at the Department of Agriculture. This body isn't about to vote for this amendment because they don't want to have that fight. They don't want to have the hard work of making the Department of Agriculture efficient and not allowing the waste, fraud, abuse, and duplication that goes on in the Department of Agriculture. The $1.6 billion of food stamp payments that are paid out to people who are ineligible every year, who are ineligible, who have plenty of money, yet they are getting food stamps. All the other programs that have waste, fraud, and abuse in them, we are not going to take the step and say: Department of Agriculture, take the money that you have now--you have almost $8 billion in the bank--work real hard, trim yourself about 2 or 3 percent, save the money and go out and do what is going to make a difference to the production of agriculture in this country. No, we are going to do what is easy when this amendment goes down. What we are going to do is we are going to say: Grandkids, we didn't have the courage to do what was right in 2007. We didn't have the courage to look at the programs that weren't efficient. We didn't have the courage to challenge somebody when they were being wasteful. We didn't have the courage to find it within ourselves to not lessen your standard of living because we wanted our standard of living taken care of. So what they are going to see is an extra $5 billion or $6 billion coming out of their pockets 20 and 30 years from now when we attempt to try to pay back this money, and they are going to wonder: What did we do? What were the standards under which we operated? What was the character trait in us, as a body, that allowed us to not demand efficiency from an agency of the Federal Government and yet go the easy way and demand it out of the livelihood and opportunity of our grandchildren? That is what they are going to ask. What is the character flaw in that? Is it laziness? The Members of this body obviously care about this country. What is it? What is it that would not make them do the hard work of challenging the inefficiency that we all know is out there in the Federal Government and we all know is within the Department of Agriculture? Not that the Department of Agriculture employees aren't great. They are. They work hard. They are dedicated. But there is still enough money in the sixth largest corporation in America, the Department of Agriculture, to find $4.15 billion and bail out the guys and gals who need to be bailed out right now, just like we have tried to bail out Louisiana. What is the character flaw? Is it self-centeredness? Is it laziness? Is it not willing to fight to make things better? Or is it so easy to put the credit card into the machine and say: I am not going to worry about tomorrow. I am going to think about the short run right now. Long term doesn't have any consequence to it. I am not going to consider that. Now, what does this amendment get rid of? What it keeps is $2.09 billion in crop assistance and $1.64 billion in livestock assistance. What does it get rid of? It gets rid of individual earmarks for individual Senators. It gets rid of $40 million for the tree assistance program which includes Christmas trees, shrubs, nursery bushes. It gets rid of $30 million in administration for hiring additional Farm Service Agency personnel and computer upgrades. You tell me we can't find $30 million in the sixth largest corporation in this country to finally fix the computers? Sure we can. It will be hard, but we can do it. But it will never happen unless Congress asks for it to happen--demands that it happen. Once you start asking one agency to do that, it will be easy to ask the next agency to do that. Pretty soon, before you know it, Americans are starting to get good value for their money. If, in fact--it is not ``if, in fact,'' it is actually a fact. Eighteen to twenty percent of all the discretionary funds spent by the U.S. Government are either waste, fraud, abuse or duplicative. Think about that. That means 20 cents out of every taxpayer dollar you pay in the discretionary side of the budget, one-third of the budget--the rest of it is Medicare, Medicaid, and Social Security--is not efficiently managed, spent or directed for the purposes it was intended. So why would we not force this? We are going to hear it is impossible. You can't ask them to find it. I will guarantee, if they were a public company and their stock was tanking and they weren't doing well, they would hire a new CEO and, before you knew it, that would happen. The $4 billion would be made up through efficiency, innovation, and programmatic changes that directed the programs to the most needy at the best time, at the best efficiency, with the least cost and the greatest skill.

Mr. COBURN

Mr. COBURN. I yield the floor and suggest the absence of a quorum.

Mr. COBURN. People may be saying: Well, how do you know this will work? There is a great little company named MedEncentive. They have been running pilot programs all across the country. Let me explain what they do. They get doctors to agree to follow a certain set of protocols called best practices, and they sign up communities, municipalities, and their employees, and then they do a couple of things. They take them under coverage, and they reward the employee--i.e, the patient--if they will use those doctors. What is unique about this system? One is, after the patient has finished their office visit with the doctor, they have a patient-doctor interactive form they fill out that says: The doctor wants me to take this medicine. I understand this. Here is the reason he wants me to take this. So they have to fill out the form to say they really understood. The other thing is, on the professional side, the practitioner side, they agree to follow the best-practice model in how they treat these patients. That was actually developed by Vanderbilt, where they followed a best-practice guideline which helps them decide what to order, what not to order, what to do, what not to do in terms of what is best for that patient. They can get off if they choose to, if they think in their medical judgment that they need to. What has been the result? The three published results that I know of, in all three communities, in the first year of operating this where there was this competitive model, best-practice quality outline, patient followup, because the insurance company is involved in making sure the patient does that--what happened to their health care costs? One down 18 percent, one declined 22 percent, and one declined 12 percent. Now, that is just in three. Each one of them had 300 or 400 patients and took all comers, chronic disease or not. How did their costs go down? The costs went down for a lot of reasons. One is they were practicing not defensive medicine, they were practicing real medicine. They were not throwing tests at a patient because they were worried but because they had the background of the excellence of Vanderbilt University as a practice guideline at their defense. So what we know is that in the various test models where true marketing, true competition, true transparency as far as price, true concern for the patients' well-being, not just at the office visit but thereafter, wellness and prevention were modified, what happens is costs go down. That is just in three cities in Oklahoma. It has been done all across this country. But what we do know is that if we attack it in a nonbureaucratic way, but we allow competitive forces--which would you rather have, an insurance company that is invested to try to make your health better or one that just wants to make a dollar on you and turn on you? So going back, let me just kind of summarize. The system we have today limits our ability to do what we as Americans do well; that is, discern value for what we have purchased--discern whether we get value for it, discern how to do it, and we discern that on an individual basis. Our health care is not designed on an individual basis. In many places, we get one-size-fits-all; what the Government says you will have or what the State says you must have, you must buy this. I believe a lot of our problems have come because we have tried to micromanage it from Washington and from the statehouse. What we are talking about is giving freedom of choice, not just to patients and providers but to insurance industries. Imagine the tremendous possibilities that will come into a market that says: This is a new day. I get to market all sorts of different things that might match up with different people. All of a sudden, now I will have to compete not only with people in my State but all across the country for the best plan that gives me the best value that meets my needs. Why would we not want that? We have that in every other thing. Why would we not want to capture the best aspect of the American consumer, which is discernment? Not long ago I was sitting with some friends and put forth the fact that I believe Americans are smart enough to know what they want in health care. The idea got pooh-poohed. I thought, how insulting. We can figure out what computer to buy and how much memory we want and how big a hard drive we want and whether we want a photo section on it or a print lab. We can figure out all of those things--as a matter of fact, our 10-year-old kids can figure that out--but we can't figure out how to buy health care. We are going to say to the American people: You are not sophisticated enough, you are not smart enough to know what is good for you or to know what you need. So, therefore, the Government is going to tell you what you need. That is what we have today, whether it is the Government or your employer or somewhere else. This bill changes all that. This is a bill that will create transparency so you as a consumer can know what something is going to cost. It is going to create a situation where you can perceive whether you have value. It is going to create an incentive to save for health care for the future and an incentive for wellness, not just by what the insurance company will come to sell you but by the $20 billion that we are now spending, of which less than $2 or $3 billion makes any difference at all in somebody's health care. We are going to focus that on true prevention. We are going to direct that the HHS relook at every one of these programs and develop a model to where we educate the American people about the risk. Let me give a personal story. I am a colon cancer survivor. What we do know is with good prevention and good screening, one out of every two people who are going to get colon cancer we can keep from getting it. Why wouldn't we do that? Why wouldn't we prevent half the colon cancer in this country? We don't have a good reason. One of the reasons is because we have an ineffective prevention program. I am a small government person; I admit that. But there is a legitimate role for the Federal Government when it comes to teaching America about our health needs, prevention, and wellness. We have plenty of money to do it if we take the same money we have now and redirect it in a way that educates the American people. Innovation works. We know that. Competition works. Take, for example, a year ago a 46-inch plasma TV cost $11,526. Today you can buy the same thing for $2,300. Next year you will be able to buy it for $1,400. The next year you will be able to buy it for $700. Why? Competition. Competition breeds quality and value, only if you have a market under which you can operate. We don't have that today in health care. Innovation also works in health care. Look at Lasik. Here is a procedure that is not paid for by the Government. It is not paid for by any of the insurance industry. But if you are nearsighted and you want to be able to look far away, you can get that done. When it first started, it was $4,000 an eye. Now there are places you can get it done--the same piece of equipment, the same computer--for $500 an eye. Why won't that work? It will work in health care. It will work. Innovation will come as a result of that. What happens when we innovate. What we get is better quality at a lower price and better value. I am hopeful that as the American people look at this, they will be reminded of a couple things. This is universal coverage. Everybody in America gets treated the same by the Federal Government when it comes to health care. Everybody in America is on equal footing as far as the Income Tax Code is concerned when you go to buy your health care. No longer do we advantage the very rich with $2,700 a year in tax benefit and the very poor with $100. We totally neutralize that and say: Everybody ought to be treated the same under the Tax Code for health care. It is universal coverage. No. 2, it takes away discrimination. Because you are poor, because you don't have the ability to have a job that has insurance coverage today, and if, in fact, you are at 133 percent of poverty, why should you be discriminated against because you are on the Medicaid Program? This is no offense to any practicing professional out there because there are great professionals who are taking care of Medicaid patients. But if you look at the marketeering, the ones with the best doctors, as a rule, because Medicaid pays so low, do they have time to take care of Medicaid patients? No. What happens is, somehow they don't have time. So what we have done is discriminated down with Medicaid patients. Why shouldn't a Medicaid patient get the best doctor every time, just like a Senator? Why shouldn't they have access to capability? Why should they be discriminated against by having a Medicaid stamp on their forehead? We are talking about universal access, equality of care, and personal freedom and choice. You get to decide what is best for you and your health care and your family. By the way, when you get this money and you haven't spent it all, you get to save it for next year and the year after and the year after. You can buy what is best for you with that money. This money also goes to retirees. If you retire at 60 and are not eligible for Medicare, you still get your tax credit. We don't discriminate against anybody. Everybody gets the tax credit. The final thing I would say, it doesn't cost the American taxpayer one additional dollar in income tax. There will be no increased cost with this plan. Actually, we have tried to make it revenue neutral. My worry is that it will save us money. We have tried to make it where it does not. We have tried to make it the most generous thing we can to get the most coverage for everybody out there. Again, prevention first, free choice, freedom, and liberty. You get to decide who cares for you, what insurance, what hospital, and every American gets that. It is the Government not telling you what you must do but saying here is what you can do if you want. I yield to the Senator from North Carolina if he has any additional comments.

Mr. COBURN. I thank the Chair. Mr. President, if you go out in our country and you ask, besides the war, what is on people's minds, the No. 1 topic you will hear about is health care. And what are the questions that you hear? Why can't I choose my own doctor? Why can't I pick my own health insurance plan? Why do my premiums increase every year but my benefits don't increase? Why do I have trouble understanding which benefits my health plan offers? Why does my employer get a tax break from my health care but I don't? Who can make the best health care decisions for my family, us in Washington, the insurance bureaucrats, other people, my employer, or how about me? How about me getting to make a decision about my health care? There is no question America's health care is broken. It is not that we are getting bad care, it is that we pay a tremendous amount for what we get in our care. The estimates are anywhere from $1 out of every $3 to $1 out of every $4 we spend on health care doesn't go to help anybody get well in this country and doesn't go to help anybody prevent having an illness. That is $2.2 trillion, and it will be over $2.3 trillion this year. When you see what happens--and these are not my numbers, by the way; these are Price Waterhouse numbers, a breakdown on health care dollars--what you see are some pretty interesting statistics. You see that when we go to spend $1 on health care, 35 percent of it goes to hospitals, 21 percent of it goes to doctors, 15 percent goes to prescription drugs, and 5 percent goes to equipment. All the rest of that, the medical liability insurance--nobody realizes that is 10 percent. Ten cents out of every dollar we spend goes to medical liability. We are insuring against a problem in health care--10 percent. It costs us 6 percent to process the claims. One-half of all the claims filed against all the insurance companies in this country are denied because the people haven't met their deductible, and yet we keep sending the claims, keep spending the money. One out of every three people who works in a hospital, one out of every three people who works in a doctor's office doesn't do anything to help anybody get well. Why is that? It is because of the system we have set up. If you add this 10 percent for liability insurance, 6 percent for processing, 5 percent for marketing, 23 percent for the insurance industry profit--and I doubt seriously it is that low--what you come up with is 24 percent, as a minimum, that doesn't have anything to do with helping anybody get well. Now, why is that? Why is it we have this system? It is because we have somebody besides the patient choosing what they will get in terms of health care. In Medicaid, it is your State. Oftentimes in Medicaid it is your State paying a very low rate, so now you get to choose from those who will accept the lowest rates. In Medicare, they tell you exactly what the price is. We spend all our time around here trying to change Medicare, because when we push on the balloon one way, something else pops out. So whether it is the Deficit Reduction Act or some of the other things we have had, what we find is we cannot control this tiger because we have a bureaucratic maze that nobody understands. When we try to use price controls, when we try to limit expenditures, we end up losing control. So what happens? Who makes your health care decisions? Either CMS, the Center for Medicare Services, in conjunction with your State, either for Medicare or Medicaid, your employer, or an insurance company. Whatever happened to you making decisions about your health care, about which doctor, about which insurance policy, about which hospital you want to go to? And why is it that if you happen to be Medicaid, you get to choose less than somebody who doesn't happen to be Medicaid? Why is it we are treating in an unequal fashion those who are the poorest among us? Why shouldn't we have the right to pick what insurance benefits are best for us? Why shouldn't we have the right to choose who is going to be our caregiver, whether it is a doctor, a nurse practitioner, a physician's assistant, a chiropractor, or an optometrist? Why shouldn't we get to choose that, rather than an insurance company or an employer deciding who we can or cannot see? They also decide the price we are going to pay because we are trying to control all these costs. They are also going to decide which hospital we go to. But how is it that we have a system now where everybody except the patient gets to decide what happens to them in terms of their health care? We can't afford the health care system we have today. For one thing, 16 percent of our GDP, the highest of any country in the world by 50 percent, is spent on health care. Although we have good health care, we don't have better health care than those countries that are spending less. We are spending 16.2 percent, or $2.3 trillion, per year on health care, so we should be 50 percent better off. We should have a 50-percent better life expectancy, 50 percent less heart disease, and 50 percent less cancer. Of the money we spend on health care, fully three-quarters of that is spent on five diseases. Think about that: 75 cents out of every dollar that actually gets into health care, which is only 60 to 70 percent of the money we actually pay into health care, 75 cents of that goes for either heart disease, stroke, chronic obstructive pulmonary disease, diabetes, or cancer. Five diseases, most of which are readily preventable--not partially preventable but readily preventable--through increased prevention activities. This Government this year will spend $20 billion on prevention in 12 different agencies, through 27 different programs, none of which are coordinated to try to maximize the education of the American people to what they need to know about their health care so they can make decisions on prevention. Consequently, we are very ineffective with prevention. If you look down the road at what is coming in terms of Medicare and Medicaid, what you see is an unfunded liability of over $60 trillion-- $60 trillion--we are adding. This isn't about health care now. That $60 trillion that is getting ready to hit our kids and grandkids in terms of Medicaid and Medicare that we have promised for the future, that we have no way to pay for now, one of the great ways of lessening that number is to change what we do on prevention. Prevention is the key. Grandma was right: An ounce of prevention is worth a pound of cure. As a matter of fact, it is said in 2070 $1 out of every $2 that Medicare spends, at our current rates, will be spent on diabetes--$1 of $2. So when you look at this Medicare number, with the vast majority of the baby boomers who are going to retire and then their generation is going to retire, $1 of every $2 that will be spent by Medicare will be spent on one disease only, which means we only have $1 to spend on all the rest of health care for seniors, plus any attempts at prevention and at early diagnosis or new and modern treatments. We can't continue without a coherent plan on health care. The other problem that is facing us as a nation is right now we can't compete globally in many areas because of health care costs. When you compare GM and Toyota, there is a four times greater differential for what goes into a car made in this country by one of the Big Three versus what goes into a car made outside of this country by their competitors. So there is no way that we can, in fact, be competitive globally until we handle health care. There is no way we can handle Medicare and Medicaid until we change the health care system. Myself and Richard Burr and several other Members of the Senate will be introducing a bill tomorrow that addresses every problem our health care system faces today, whether it is tort liability, and making sure people get awarded what they need when a mistake is made during the practice of medicine, or whether it is immunizations. The fact is, we have very few States where we have achieved 90-percent immunization. We are going to address every problem we face, the liability that comes at us in the future through Medicaid and Medicare, the problems we face on liability, the problems on access, the inequality that somebody, because they happen to work at a very low-paying job, gets stamped with something on their forehead that says, you are of less value than somebody who happens to work someplace that has great insurance and a higher paying job. Our bill changes all of that, and instead of going to the Department of Motor Vehicles to wait in line, we are talking about a health care system where you, the consumer, are No. 1. The government isn't No. 1, the doctor isn't No. 1, the hospital isn't No. 1, the drug company isn't No. 1, but you, the patient, become No. 1. You get to choose what insurance you want, you get to choose what kind of insurance you want, and you get to choose how much you will pay for it. We create a new insurance market where everybody gets to play by an even set of rules. How do we do that? We do that by giving everybody the same advantage in this country when it comes to health care, and that is a refundable tax credit, $2,000 for every individual, or $5,000 for every family. What that means is, if you are earning about $120,000 a year or less in this country, you will gain in terms of your taxes off of this bill. If you are making $120,000 or less, what is going to happen is you are going to have the option of staying with your employer, if you like what they have, and that tax credit will be available to your employer. But if you decide you want something different, maybe it offers something you don't get covered today or doesn't cover a whole lot of things you think you need, you can take that tax credit and buy that insurance and save the difference in the money for your future health care. The Universal Health Care Choice and Access Act provides $2,000 for every one of the 45 million uninsured tomorrow, every one of them as an individual. Now, what does that buy? People say: That won't buy much. Well, if you go to Kentucky and you happen to be 35 years of age, you can buy a $2,000 yearly deductible policy for $897 and have $1,300 or $1,100 left over between that and the deductible. If you try to buy that same policy in the Chair's State, it is almost $6,000 for that identical policy. Why? Because government has decided in New Jersey differently than what government has decided in Kentucky. Therefore, the cost of getting this minimal coverage, because of the mandates put on by government--not what a patient wants but by what government says patients should have--makes that unavailable in New Jersey. How do we fix that? We allow people to buy insurance anywhere they want, just like they buy their auto insurance today; like they buy their homeowner's insurance. They can buy it from any company anywhere in America, as long as they have a registration with a State. We create a primary and a secondary location for that. So if you want to buy something that has a better price, that fits your needs, you have the capability to do that and put the difference into a health savings account, where you can use it for future health care needs, that you can use to apply to any deductible, or if you get enough money in it, you can bring it down to where, if you want to, you can have a zero deductible--if you want--but most people will not want to do that. We allow you to select a health plan that truly meets your family's needs, not what some Government bureaucrat says or some Senator says you must have. It is what you want. We allow individuals to choose what they want in terms of their health care. What will that do in terms of the market? That is going to create innovation in the health care market all across this country. It is going to cause competition like crazy for the dollars. Once we truly have competition, which is something we do not have in health care today, which we tremendously need, then we are going to see a big change. The other thing this does is it gives access for affordable health care for a ton of people who do not have it today. They get to choose their health care provider. The patient gets to choose who takes care of them. Not the Government, not their employer, not the Senate, not their State insurance commissioner, but they are going to get to choose who is going to take care of them. It is the right to choose who is going to care for you. How do we do that for the States? We do not mandate anything for anyone. We do not say anybody has to do anything. But we create a lot of incentives. We tell the States that, if you want to, you can take your Medicaid funds and your disproportionate share funds and anybody who is Medicaid eligible, under the 133 percent of poverty level, you can take their $2,000, plus the Medicaid money, plus the DSH money, and you can help them buy an insurance policy in your State. If you want to stay with Medicaid, you can stay with Medicaid. There is no mandate from the Federal Government other than to get people into coverage. You ask any government tomorrow if they would take $2,000 per eligible person in their Medicaid program, would they take a deal with them having the freedom to design what is best for their State? Every Governor will tell you yes. Every Governor will tell you yes. Why? Because now we are given the resources there to allow a Medicaid patient to be just like everybody else--a Senator, their mayor or somebody who works at the best factory in town. They have an option to not be discriminated against because they show a Medicaid card. Now they have an insurance card. People ask: What about the people who do not want to have insurance? We allow the States the opportunity to have a default mechanism. If the State of Tennessee--I see the Senator from Tennessee here. If the State of Tennessee wants to decide we will option, if we have people in our State who are going to be so irresponsible that they will not even buy themselves coverage and they have an opportunity to take tax money to do that, then we are going to create a default mechanism whereby the State of Tennessee--if you are a 25-year-old motorcycle rider and you don't want to buy insurance, they can take your tax credit and buy a high-deductible policy for you so when you go to the ER, all the rest of us don't have to pay all your costs. What is happening in our health care system is we keep transferring the costs so we have a rationale for jumping up the price because they are doing something for somebody else at a low price. What the real facts are--and we never hear it--the real facts are, when you look at the hospitals out there, all--the vast majority of them--and this is a very key, important point--the vast majority are nonprofit entities. That means they pay no income taxes, they pay no payroll taxes. On order, the vast majority, and on average, offer 10 percent of their total billed care as indigent care. But that is not a real number. The reason it is not a real number is because they bill the highest prices they have for that indigent care. If you look at the cost of that care, it would be far below that. I know in the State of Oklahoma, the hospitals there last year billed over $5 billion in revenue, made over $5 billion in profit, and out of that they billed another $400-some-odd million in care that was uncollectible to people who did not have insurance or couldn't pay. That was not really their cost. That was their billed price. Remember, we give this nonprofit status to all these entities, this $500 million worth of profit in Oklahoma, for example, and they pay no taxes on that. They pay no real estate taxes. In essence, they offer about $100 million worth of charitable care. What this bill does is it takes away all the cost shifting. What are the other things we do? We incentivize high-risk pools. What about the person who gets a chronic illness and they say all of a sudden their insurance company drops them. We have incentivized so the insurance company is not going to do that. In every State we give a bonus if they set up a high-risk pool and then the high-risk pool is funded out of everybody who is insured in that State. So if you have an insurer insuring someone with complications from diabetes and they say we will drop this person because it is too costly, they go to the high- risk pool. Guess what. That insurance company is going to pay for them anyway. There is no benefit for them to drop them. There is all the benefit then for that insurance company to get busy and involved in managing the chronic disease, where we know we can eliminate complications, we can improve the quality of life, and we can also increase life expectancy by managing the chronic disease. Here is what we do for Medicaid patients. They get a $2,000 check from the Federal Government plus from their State. They can go into whatever plan they want. If their State says we want to stay with Medicaid and take that in enhanced Medicaid, the State gets to do that. There is not a mandate in anything. What it says is: If you think a State Medicaid Program is better for your State, without choice, then you can do it. But all the rest of the States are going to say I think I would rather have our Medicaid patients have a true insurance, a real card where they have the same access, the same equality of access as anybody else. All of a sudden you have everybody in the marketplace compete. They can stay in a State-run system. They get to save what they don't spend on their health care for future health care needs. One of our problems is savings in this country. It is important. How do we fix our health care system? We know that, if we look at the liability costs that showed 10 percent of the health insurance dollar going for liability insurance, that is an underestimate. The American Hospital Association found, recently reestablished by another organization, I can't remember who, that repeated the study--what we know is each year, today, besides that 10 percent, providers order another 8 percent of the cost of health care for tests that patients do not need. Why do they do that? They do that because they perceive they need to have everything on the books to defend themselves that they can have, so they fire a shotgun at it. We will get this test, this test, this test--knowing they don't need it but they operate under the ``what if'' scenario, this adversary system that we have. Finally, we address liability. We give another percentage bonus to the States that will set up what is called a ``health court'' system. It is a real simple system. If you have a complaint against a provider, a hospital or a doctor, you can go to the health court. You don't have to go to the health court. But you can go to the health court and you can be seen in front of three lawyers, three doctors, and a judge who have their own expert witnesses. This judge is schooled in medical malpractice. They can make a decision for you right then. If you accept the decision, then you give up your right to go to court. If you don't accept the decision, you can't ever come back to that court on that particular issue, but everything you do in court is admissible. We do not take away anybody's right to go to court. But what we do accomplish is making sure people get made whole quicker and cheaper--40 percent now doesn't go to the trial lawyer for you to get made whole. There is no question we make mistakes in medicine every year. But why should we drag it out for 3 to 5 years, No. 1. Why should we pay 40 percent of whatever the ultimate award is to somebody who helped us accomplish that, where we can set up a system that will arbitrate that in front of a nonbiased group of peers, lawyers and doctors who say: Here is the right thing, here is the medical case, the legal case, let's make a decision and send it on. What it does is it saves tons of money directly, but what will it do? As soon as you create confidence on the part of providers that they do not have to order this other 8 percent of tests, you are going to see that dropping about half. So we can gain 4 percent in this cost of health care by setting up health courts, by changing the dynamic under which we make sure people are made whole when something happens to them in the medical malpractice area. Not every State has to do this. But if your State decides to do this, you get a 1-percent bonus on your Medicaid money--out of a large pool. We have lots of ways in which we do not say we want the States to do this and now we are going to tell you how to do it. We are saying here are some ways we think you can also do it. Go figure out the best way for you, and by the way, if you do some of the things that we think will save some money, here is some extra money for you. Ultimately, if we do not fix health care--everybody in this Chamber knows we are going to go the way of Western Europe and that is the following: We are going to decide that we are going to have a single- payer system run by the Government. As P.J. O'Rourke says: ``If you think medicine is expensive now, wait until it is free.'' We are going to control costs. We are going to do it the same way we are trying to control costs with CMS. What happens? What happens is we are going to start rationing care. Let's take some real statistics. In England, diagnosis? Cancer. In England, if you get a diagnosis of cancer right now, the average starting time for your chemotherapy is 10 months after your diagnosis. Anybody here who wants that kind of medicine will vote against this bill. That is exactly what we get. We get rationing. What it means is people with great potential will not get the treatment in time to capture that great potential. What it means is great suffering. What it means is loss of innovation. What it means is a lack of available, fair access. It is everything in England in their health care system takes away all freedom. It is also interesting to know this past year in Canada there was a lawsuit filed, which was won. What this individual said is the Canadian law says I can't go to anybody except a Canadian doctor who is owned and run by the Government. They challenged that. The Canadian supreme court ruled on the side of the patient: You ought to have the right and freedom to go wherever you want, to whomever you want if you are willing to pay the bill. Paying the bill is the insurance part of this. If you want to be able to have that access, then you are going to want to be able to buy a policy that allows you to have it. If you don't want that access, you can buy a policy that says here is a straight HMO, here are the only four doctors you can go to, and here is the hospital you are going to get to go to. We are talking about freedom in health care. How do we get to the bottom line, away from 16 percent of our GDP, down to 10 percent of our GDP? More importantly, how do we create a system that gives us better quality, at lower cost, with better value. That is what we are talking about. I yield to the Senator from North Carolina.