Speeches & Floor Statements
Colloquy Remarks of U.S. Senator Lamar Alexander (R-Tenn.) and Republican Colleagues -- Health Care Reform
Posted on November 20, 2009
Mr. ALEXANDER. Mr. President, the debate has begun. The debate is about reducing health care costs -- the cost of premiums every American has or the cost to the government that every American has to be responsible for. The bill we have been presented goes in the opposite direction. It raises taxes. It means higher premiums. It cuts Medicare. It transfers major new costs to States which, in turn, will damage higher education and/or increase taxes or both. Our purpose on the Republican side is to take this next hour, as we intend to take several hours, all the hours allocated to us today and tomorrow, and help the American people have a chance to read the bill section by section, to understand what it costs and to understand how it affects them. In this next hour, the Senators from Georgia, Mr. Chambliss and Mr. Isakson, and the Senator from Kansas Mr. Brownback, will be focusing on tax increases. We will be referring specifically to page 348, title I, subtitle (f), part 2 of this 2,074-page bill, which has to do with the tax on employers. We believe a great many employers will look at this big bill, look at the tax on them, if they don't pay insurance, look at the new government program and say: It is going to be a lot easier for me to pay the fine and write a letter to the employees and say: Congratulations, I have written a check to the government. You are on the government plan. Then we will go to page 2,040 of the bill, which is the new Medicare payroll tax. That is a tax on hiring. You heard that right, a tax on hiring in the middle of a 10-percent unemployment situation. How is that going to create any jobs? We don't think it will. Then Senator Chambliss, especially, and Senator Isakson, because of his background as a small businessperson, will talk about what Republicans want to accomplish. If you are waiting for the Republican leader to roll in a wheelbarrow with a 2,074-page Republican version of health care reform, you will never see it. We don't believe in that. What we do believe in is identifying a goal -- reducing the cost of your premium, reducing the cost to the government, and then going step by step toward that goal; for example, by reducing junk lawsuits, by allowing small businesses to pool their resources to purchase insurance, which we have offered but the Democrats will not allow to come forward, and by allowing people to purchase health insurance across State lines. Senator Chambliss and others of us will talk about this during the next hour. That is the Republican plan, to do what most Americans want done, to reduce the cost of premiums, and to not increase premiums and taxes, or cut Medicare. There is one hidden tax I wish to talk about because it is in the bill, and it is in the news. Most Americans may have seen that the University of California yesterday raised tuition 32 percent. There are, in our country, around 18 million students who are in higher education. What I wish to say to them is, if this bill passes, their tuition is going up. California's tuition is going up again. It is going up in Tennessee. It is going up in North Dakota, in Nebraska, in Georgia, everywhere there is a public college, university, or community college there are going to be new taxes or higher tuition or both. In California right now, they are pointing fingers at each other about the 32-percent tuition increase. But they should be pointing the finger at us, Washington, DC, Congress, because it is we who have allowed the Medicaid Program, the largest government-run program we have in the country, to go year after year with increases of 7 or 8 percent. We require every State, if it opts in, to have a government-approved Medicaid Program. In our State, it is called TennCare. That Medicaid Program is helping bankrupt the States. Here is a State of Tennessee headline: "State looks at $1 billion in cuts." Part of that is from the recession. But part of that is because of the increased cost of Medicaid. What does this bill do? It sends to the States another $25 billion in increased Medicaid costs. What will that mean? Higher tuition rates, higher taxes, or both. The University of California has the reputation as the best public university in the world. It will not be that very long if the Congress of the United States doesn't rein in Medicaid and reduce its cost so Californians can afford to have both a health program and a fine university system. The Governor of Tennessee has said the same thing. He has been outspoken about this. He has talked about exactly the dollars it will cost us. In the House bill, it is $1.4 billion over 5 years. In my view, I don't see how the State of Tennessee can pay that without a big State tax increase or without damaging higher education or both. Someone might look at this and say: What does health care have to do with a 32-percent tuition increase in California? It has everything to do with it. Instead of reining in Medicaid, we are expanding Medicaid. By doing that, we are making it impossible for virtually every State to properly support higher education. The only choice they have, other than taxes, is raising tuition for 18 or 20 million students across the country. Californians, if this bill passes, your tuition is going up one more time. I call on the Senator from Georgia, Mr. Isakson. He spent a number of years as the leader of the Republicans in the Senate. He dealt with the Medicaid question. He dealt with the question of taxes. As a small businessman for most of his life, he understands well the impact of new taxes on hiring and mandates on businesses. Mr. ISAKSON. I thank the Senator from Tennessee. Mr. President, I am delighted to be a part of the debate for all the right reasons, to talk about things we can do but also talk about things that the proposed legislation, in fact, does do to the American people, to small business, and to our future. When I end my speeches in Georgia, I always end with the same line. I say: I am 65 years old. I have nine grandchildren; in fact, No. 9 was just born. His name is Hunter. He is 5 weeks old. I always say my life is about their lives. The rest of my life is about making their lives as rich, as prosperous, as safe, and as free as the one my parents left to me. Legislation such as this severely threatens that. I wish to talk about two ways in which it does. The heart and soul of America is the small businessman, as 73 percent of our employees are employed by small business. I ran one. I had 200 employees and 800 independent contractors. By law, I could provide health insurance to the 200 employees, and I did. But contractors, because they are independent, the IRS will not let an employer provide that benefit. That is one of the reasons you have a large number of uninsured who are actually working -- real estate agents, sole proprietors, contractors. The Senator from Tennessee and I and the Senator from Wyoming, Mr. Enzi, then as chairman of the HELP Committee, proposed a small business health care reform act, a Republican act proposed in this body to cover one-third of the uninsured without raising rates or without raising premiums or without raising taxes. We had to get to a cloture vote of 60, and we only got to 57. So 3 years ago we missed a chance to cover one-third of the uninsured by a change in our law which would make it more affordable and accessible for independent contractors. That is what we were for. Let me tell you what this bill does to a small businessperson. No. 1, if you have 50 or more employees and you do not offer them health insurance, you have to pay a fine of $750 per employee for ad infinitum. If it is 500 or 50 or 1, you have to pay a $750 fine. I ran a company for 20 years. When I ran that company, I did provide insurance to 200 employees. I paid about $3,200 a year for the company's expense of their group health insurance. They paid the balance. If this offer were before me as a small businessman, then I would have said: Well, I have a $750 fine if I don't insure them and a $3,200 cost if I do. What should I do? Well, as a businessman, you are going to elect not to provide insurance, to pay the less expensive cost, which is the $750-per-person fine, and drive them into a public option. This is not about a public option, it is about a public ultimatum, because as you look at the revenue-raising procedures, the tax-raising procedures, and the policy procedures, it basically drives people to a public option and drives small business away from providing that insurance. There is another way it hurts small business. It also says, if you do provide health insurance to an employee and the cost of their part of the premium exceeds 9.8 percent of their annual income, then you have to move them to the public option, and they get subsidized. But you get fined $300,000 a year for the rest of the number of years that person works for you because their cost to their insurance was more than 9.8 percent of their income. You might say: Well, whose insurance would be more than that? Well, if you take a receptionist or someone like that today in a business, who may be making $25,000 or $30,000 -- an entry-level job -- 9.8 percent of that is only $2,800, $2,900. It would be more than easy for their share of their premium to exceed 9.8 percent. So the company gets fined, the employee gets driven to a public plan, and more revenue goes to the government through an indirect tax of a fine. Mr. ALEXANDER. I wonder if the Senator would yield for a question? Mr. ISAKSON. Absolutely. Mr. ALEXANDER. If the employee were eligible for the Medicaid Program in Georgia and lost employer insurance and went into the Medicaid Program, isn't it true that the employee who went into the new government plan under this bill is likely to pay a higher premium and have a harder time finding a doctor? Mr. ISAKSON. There is no question. I say to the Senator, you are exactly right. To think that it actually benefits the employee by doing that is wrong. They will have fewer doctors providing the coverage, and their cost might, in fact, be higher. But I want to talk about one other thing on the small businessman before I yield to one of my other colleagues. There is another tax -- and we have heard the business about taxing the rich. This bill provides a surtax on payroll -- a payroll Medicare tax -- on any employer who makes more than $200,000 if they are an individual or $250,000 if they are a couple. The Medicare tax goes from 1.25 percent -- your share; the company matches it -- to 1.95 percent. Now, $200,000 is a lot of money, and so is $250,000. But to a small business incorporated as an LLC, a sub S, or something like that, that pays taxes as an individual, that is 1.95 percent doubled, which is actually a 3.9-percent increase on every dollar that company makes on gross, not profit, above $200,000 or $250,000. It is a tax on their business for Medicare to pay for a public option, not for Medicare. And Medicare goes broke in 2017. So we are raising taxes on Medicare for the alleged rich, which really is most small businesspersons, all to pay for a program that does not benefit Medicare. The unintended consequences of this legislation are disastrous to small business, it is inappropriate in the way they are handled, and it is directed to drive people to an inevitable option to where there is no option at all. I thank the Senator from Tennessee for giving me the time. I know my colleague from Georgia, Senator Chambliss, has a few facts to add as well. Mr. CHAMBLISS. Mr. President, I thank my colleagues from both Tennessee and Georgia. I want to talk just for a minute about what Republicans are for. We have been criticized by the folks on the other side of the aisle for being just against what they are for, and that is not at all true. There are actually four other plans that were filed in both the HELP Committee and the Finance Committee, three of which were strictly Republican plans, one was a bipartisan plan, that never saw the light of day, simply because the folks on the other side of the aisle had their minds made up they were going to have their plan with a government option, and they were going to do whatever they could to move us toward universal health care coverage. I want to say to those folks on the other side of the aisle who have stood up and said on the floor of this Senate: Yes, by putting a government option in place, our intention is for the government to take over health care -- some of them have been very straightforward about that, and they have been honest. There have been others who have been not so honest about that. But that truly is the reason there is a government option in the plan we have up for a vote tomorrow night. But what are Republicans for? First of all, everybody in this body is in agreement that we want to drive down the cost of health care and we want to drive down the cost of insurance, and those are integrally linked. If you drive down the cost of health delivery, then you will drive down the cost of health insurance. There are a number of ways we can agree today to enact legislation that will help drive down the cost of health care. What are those things? Preventive health care. Well, there is some mention of preventive health care in Senator Reid's bill somewhere in these 2,074 pages. There is the mention of preventive health care, but there is not the incentive in place to encourage people to move toward preventive health care as was done in the private sector with Safeway, a grocery store chain where the CEO has visited both Republicans and Democrats and talked about the way Safeway was successful in doing that. We all want to make sure those who do not have insurance today are covered. We want to cover preexisting conditions. We want to make sure we put competition into the insurance market by allowing policies to be sold across State lines. All of those things will work in concert to drive down the cost of delivery, as well as the cost of insurance policies per se. There is another measure that will significantly improve the cost of delivery; that is, putting in some measure of tort re form. In this bill, with these 2,074 pages, that seeks to totally reform the health care industry in America today, there is not one mention of reforming the tort system in this country, the malpractice reform area. If you go to any doctor and you ask him what is the No. 1 issue on his mind when it comes to reducing the costs in his office, I bet in 99 percent of the cases -- maybe 100 percent -- they are going to tell you that tort reform must be implemented if we are ever going to hope to drive down the cost of the delivery of health insurance in this country. Senator Graham and I have an amendment we will be talking about that is a tort reform measure that is a loser-pays style of tort reform. It does not take away the right from anybody who is injured. Anybody who is injured ought to have the right to have their day in court. But it does eliminate the potential for the extensive, frivolous lawsuits that our docs and our hospitals have to deal with every single day that drive up the cost of health care. I want to talk, too, about one other measure we are for that has been talked about a lot today; that is, covering the uninsured. I think, without question, if you want to drive down the cost of delivery and the cost of health insurance, you need to cover those people in this country who need to be covered. We have a little disagreement with folks on the other side of the aisle as to the exact number they seek to cover with this 2,074-page bill. But there is one area where we do agree; that is, there are somewhere between 47 million and 50 million people in America today who are truly in that uninsured category whom we all, as a body of 100, would like to see have affordable insurance available to them. Now, who are these uninsured? First of all, there are about 6 million people in this country today who are uninsured who are here illegally, and they are illegal, undocumented aliens. Folks on the other side -- and there is some question about this when you look at the language in this 2,074-page bill, whether they cover those illegal aliens -- but let's assume we all agree they ought not to be covered. There are another 14 million people in America today who have health insurance available to them from the Federal Government in one form or another. Either they are Medicaid eligible or they are eligible for some form of SCHIP, the State Children's Health Insurance Program. In Georgia, it is called PeachCare. For whatever reason, these 14 million people have not taken the initiative to go out and sign up, for example, in Georgia in the Department of Family and Children Services. I do not know what it is in Tennessee, I say to Senator Alexander, but there is a comparable office in all 50 States for that to be done. What do these 2,074 pages seek to promote as to the 14 million people who have insurance available to them today to go in and take that insurance? Nothing. So these 14 million people are not even addressed. Then there are another 15 million people to whom Senator Isakson just referred. They are people who are either those independent contractors or they are employees who work for employers who do not provide health insurance, but all of them are gainfully employed, and they have the ability to purchase health insurance. Some of these people are dealt with in this 2,074-page bill. Some of them are not because if you are an employer with 50 or fewer employees, then you are exempt, you would not be covered, still, as a part of that 15 million. Then there are about another 12 million to 15 million whom I refer to as the hard-core uninsured. Those are the folks whom we really ought to try to reach, and those are the folks whom the bulk of the $2.5 trillion this bill is going to cost during the 10 years when it becomes fully implemented seeks to reach. I would simply say, if we are going to truly have a health reform bill, we need to start and take it step by step. If the folks on the other side of the aisle are serious about health care reform, we can get the appropriate committee chairmen together this afternoon, tomorrow, or whenever, and begin work on these issues I have just laid out about which there should be no disagreement. We could move forward with developing a true and meaningful health insurance reform package. I want to come back in a minute and talk about Medicare taxes and the way Medicare is going to be dealt with here. But I would simply throw it back to the Senator from Tennessee, as well as to my colleague from Georgia, because they have both been involved in a very honorable way at the State level. Senator Alexander is a former Governor of Tennessee. Senator Isakson was an elected member of our State house, as well as our State senate. I say to the Senators, you gentlemen have experience dealing with Medicaid, and you know what the taxation side of Medicaid does from a State level. I would like to ask for your thoughts on what this 2,074-page bill is going to do to Medicaid in this country as we know it today. Mr. ALEXANDER. Mr. President, I thank the Senator from Georgia. I am going to throw the question right back to Senator Isakson in just a minute. I appreciate Senator Chambliss taking time to point out what Republicans are for because it seems as if no matter how many times a day we say it, our Democratic friends do not hear it. Let me put it this way: Let's say Senator Isakson, who has been a small businessman, buys a new small business. He takes it over, and he sees that generally it is working pretty well but it has some problems with it. I wonder if the first thing he would do is come in and say, I tell you what, let's just turn it all upside down and change it all, or would he say, let's identify the problem, and let's take a few steps in the direction of fixing that problem. What Republicans are saying is, we have a big health care system that in general works pretty well. Mr. President, 250 million of us have health insurance plans; 47 million do not. Senator Chambliss has just pointed out who those people are. Thirteen million or 14 million are already eligible for plans and for one reason or another do not sign up. A few million are illegally here. Some others are young and think they are invulnerable and do not sign up. But we are saying the problem is the cost, people cannot afford to buy their own insurance, the government cannot afford its health care costs, and people are going broke over this. So we want to reduce the cost. Senator Chambliss identified this step-by-step approach. He mentioned reducing junk lawsuits against doctors. We have proposals for that. Combating waste, fraud, and abuse -- we have introduced legislation for that. Senator Isakson talked about allowing small businesses to pool their resources. Additional ways to reduce cost is allowing people to purchase insurance across State lines, so you can shop for more insurance and reduce your cost through competition, and amending the health savings account laws so you can withdraw your money in a tax-free way to pay for your insurance premium, and encouraging wellness and prevention. We could take those six steps, reduce costs, and then take six more. I wonder, Senator Isakson, with your experience in business, if you think it makes any sense for us to just come in here and say: OK, we are really smart here in the U.S. Congress. This is a big country, with 300 million people. We are just going to turn the whole health care system upside down, write a 2,074-page bill, change the premiums, raise the taxes -- do all these things -- or would you go step by step in the right direction and try to re-earn the confidence of the American people who have lost a lot of confidence in Washington, DC? Mr. ISAKSON. I think it is an excellent question, because every year in my company we have an annual planning retreat at the end of the year for the next year, and ironically -- and I didn't know we were going to get into this discussion -- but our No. 1 topic that I would send out to all of my management team is: What is the No. 1 thing we need to correct or do in our company? We would spend the entire retreat talking about that one thing. If that one thing was the uninsured, then what we would have talked about is what do you do to insure that 14 to 15 percent who don't have coverage. Senator Chambliss hit the nail on the head: Small businesses with health plans that allow independent contractors and contractors to be covered; that is one. Have an immediate identification and registration system for government people who are eligible for Medicare, Medicaid, or SCHIP so that when they come to a provider or a doctor they end up getting covered. Then, third, come up with a program that meets that last third, which Senator Chambliss referred to as hard core, but at least those who by choice or by chance are not covered. The last thing I would have done is said, We are going to throw out the 85 percent of this that works in order to fix the 15 percent that doesn't, and that, in effect, is what this bill does. Mr. ALEXANDER. Senator Chambliss, one of the most difficult issues I think for many Americans who are watching what we are doing is the plan to cut Medicare. The new bill goes a step further. The way I read it -- and I indicated the sections in the bill a moment ago -- we are not only cutting Medicare, we are going to tax Medicare. Then we are not even going to spend the money on Medicare. In other words, we are going to cut grandma's Medicare, tax grandma's Medicare, then spend grandma's money on somebody else, and grandma's Medicare is going broke in 3 or 4 years, according to the Medicare trustees. Mr. CHAMBLISS. In addition to that, we are going to continue to tax young people who are in the workplace for additional Medicare taxes that are intended to be used by them in what is called the CLASS Act, which is another part of this monstrous bill, and chances are those people are never going to see those benefits. There is one tax after another in this bill that applies to Medicare. One other aspect of Medicare that is of such critical importance here is that they have an $850 billion pricetag, according to the Democrats. According to the numbers and the figures that Senator Gregg, the ranking member of the Budget Committee, came down here this morning and talked about, is that that $850 billion is for the first 10 years. The taxes begin next year. The benefits don't begin until 2014. When you look at 2014 to 2025, the first 10 years of full implementation, the cost of this bill is actually $2.5 trillion, not $849 billion. Why is it $2.5 trillion? Well, it is because the scope of government has broadened to such an extent that the expense of providing the services is going to be greater. We are going to have more people coming onto Medicare. We know now, as Senator Alexander said, according to the bipartisan Medicare Commission, we will be paying out more in Medicare benefits than we receive in Medicare taxes in the year 2017. There are only two ways to fix that: either raise taxes or decrease benefits. The majority that is in power in Congress today has a habit of not seeing a tax they don't love, so my guess is that is the direction in which they are going to want to go: Raise taxes on Medicare beneficiaries and those in the workplace again to ultimately pay for Medicare benefits down the road. The other part of this I wish to address with respect to Medicare is the Senator from Florida got up as we were coming on the floor and talked about this so-called deficit reduction. What do they mean when they say we are going to have a $32 billion deficit reduction over 10 years? Well, here is how it works. The deficit reduction is brought about primarily by the addition of a program in this bill to Medicare, what is called the CLASS Act. The CLASS Act is a long-term policy of insurance to take care of long-term health care needs. Young people are going to be required -- young people in the 20, 30, 40-year age bracket will pay into the so-called Medicare trust fund that will be used to pay benefits for long-term care for those individuals when they start reaching the age where they need long-term care. So CBO has said that because these folks are 20, 30, and 40 years old and they are going to be buying these policies, they are not going to be getting any benefits for another 20, 30, or 40 years. So we are going to take the position that all of those premiums, which go into the general fund, by coincidence, will go to reduce the deficit. But guess what is going to happen, even according to CBO, when all of these young people who have been paying into the CLASS Act start getting benefits. All of a sudden we are going to start seeing deficits in the outyears, and our children and our grandchildren are going to have an additional debt put on them because of the way this particular provision is scored -- and it is being touted as a deficit-reducing provision right now -- that truly is going to be a provision that adds to the deficit and the debt our children and grandchildren are going to have to pay. Mr. ALEXANDER. It must be a little confusing to the American people. I mean, one day Senator Reid comes out and, a big hurrah, we are going to reduce the deficit and we are only going to spend $800 billion, and then the next day Republicans come out and say, No, when the program gets going, it is $2.5 trillion over 10 years. I wonder if I could say to the Senator from Georgia, while we have heard you talk about these projections, the senior Republican on the Joint Economic Committee has come to the floor, the Senator from Kansas. How do you explain this to people in Kansas, Senator Brownback, who must be very confused by this back and forth? Mr. BROWNBACK. I don't think they are particularly confused. I think they smell a rat in this and they know if you are going to add this big of a program, somebody is going to tax me somewhere here. The interesting way this is actually scored in the bill is the government uses the old heavy hand of inflation. As we have heard, many economists have spoken in the past about how inflation is the most cruel tax of all, particularly for the people on a fixed income, because then the base of the dollars they have doesn't go as far as they used to. What is scored in this bill -- and we have seen this time and time again -- is what you have is an inflation factor that is not indexed. It is not indexed. I wish to show these charts here to prove it. At the end of how this is scored, we will end up having people who have subsidized insurance when they start out, but that in the outyears in the scoring will be taxed for having subsidized insurance. So we will be both taxing them at the same time as we are subsidizing their insurance. And we are also -- and I will show a chart here in a minute -- where we will be taxing their insurance plan that we are subsidizing at the same time, and that is built into the base score. So then that is how you get to a CBO score that, presto chango, we don't have any -- the budget is balanced; we are even producing a surplus. It is this cruelty of inflation. People can remember back to the Jimmy Carter days with 10 percent inflation. They know what that did to them. Look at this. This is all in the CBO scoring. This is from the Joint Economic Committee staff who have been working through these calculations to see, How do you come up with adding a multitrillion-dollar entitlement program and come to a budget deficit-neutral facet to it? What we see here is surtax levels -- and this is kind of a busy chart -- but this red line is 100 percent of poverty in 2009 and 100 percent of poverty built out over 100 years, which is also -- this is part of the scoring system, and then the median income of married households. What you see is families receiving subsidies beginning to pay the surtax in the scoring of this. That is all due to the cruelty of inflation. Mr. ALEXANDER. I wonder if I could ask the Senator from Kansas, haven't we heard this story somewhere before? As I remember, back in the late 1960s there was a so-called millionaires tax. We were going after 155 very rich people in America who weren't paying any taxes and now we call it the alternative minimum tax, and if we don't fix it every year more and more people will end up paying this tax. I think last year there were 28 million Americans who would have had to pay the tax. Mr. BROWNBACK. That is absolutely correct, and it is the same technique. This is the alternative minimum tax on steroids in the insurance industry and in the insurance field. It is the same thing. We fix it every year. That is why this is such a fraud. Do you really think we are going to tax people for their health insurance at the same time we are subsidizing their purchase of health insurance? That isn't going to happen, so those dollars aren't going to arrive. So where are those dollars going to come from? It will be from deficit and debt, or you are going to have this cruelty of inflation taking place. The bill funds health care reform with increased Medicare taxes. We are going to see that taking place in this as well. Here is the chart I like that I will show. It demonstrates how we are going to have these Chevrolet plans -- you have heard of these health insurance plans. Let me put this chart up. We are going to tax the Cadillac plans, all right? Well, it turns out under this bill, the Chevy becomes a Cadillac. So you are going to tax the Cadillac when it is still a Chevy. That is because of inflation. Most people know their health insurance premiums have been going up pretty consistently over time. Well, it turns out that the Chevy will metamorphose into a Cadillac and it gets taxed and that is in the scoring of the CBO scoring of this bill, and that is how you come out with balancing the cost of the bill. None of this is going to happen. You will have some sort of AMT-type fix that will take place on an annual basis, and at the end of the day you get a big debt and deficit you are going to have with it, or horribly cruel high levels of inflation, or maybe both. Mr. CHAMBLISS. I would ask the Senator from Kansas if he would yield for a question. The question is: The Senator from Kansas and I were elected to Congress in the same year. This is our 15th year, I believe, of serving. You have been over here longer than any of us have, and you were involved in State government as well. Have you ever seen a Federal program that was projected to be at X number of dollars of expenditure which came in on time and on budget? Mr. BROWNBACK. No, I haven't seen that take place. Mr. CHAMBLISS. Do you think that when Senator Reid comes down here and says this bill is going to cost $849 billion over 10 years, that is a correct figure for a massive reform of health care? Mr. BROWNBACK. No, and I don't know that there would be 5 percent of the public in my State who would believe that, because their experience tells them different. Their experience tells them: Look, I know you guys make these great promises and everything, but I also know the further out you make this promise, the less reliable your data is, and I have seen that whenever the government gets into things, it always costs a lot more and it seems as though our debt and deficit always keeps growing and it is way too big. What is troubling is that this is built into the base of how we get to the numbers of getting this as a budget-neutral matter. This isn't going to happen. On top of all of that, you say we are going to save $400 billion in Medicare. We have now voted four times for the so-called doctor fix, which was a slight reduction in Medicare spending for providers, and I voted for it three times, to fix it, on an annual basis. Do you possibly think -- possibly think -- that the Congress is going to cut Medicare $400 billion, that people are going to come back here and say, You can't do that, you are going to be ruining Medicare and that Congress will fix it? I said this to Treasury Secretary Geithner yesterday: Our experience has never been to do something like that. So where does the money go? It goes right on the deficit and the debt and you are going to add to that $12 trillion estimate. We are hemorrhaging Federal money and, at the same time, the global community is saying, you have to get your fiscal house in order. We just had our President over in China, hat in hand, with our bankers saying, OK, we think human rights is pretty important, but we need that loan. What we are going to see take place, because this is a fiscally irresponsible package, I think we are going to see the international community saying words are one thing, but action is what talk, and we are going to start pulling capital out of the U.S. marketplace. It is going to drive up interest rates, it is going to drive up inflation. So maybe this scenario happens, but it is cruelly done through inflation, and it is not fair to the American public. Mr. ALEXANDER. I wonder if I might ask Senator Isakson from Georgia, we talked a little bit about his experience as a small businessman. Senator Brownback has talked about taxes and how they are going to go up. According to the Republican Budget Committee analysis, the new taxes in this bill that we have on our desks would be about $850 billion over a 10-year period of time. Senator Isakson has been a small businessperson. Some of those taxes would be on you. Who is going to pay the taxes? Mr. ISAKSON. My customer. You know, the thing is, business is the collector of taxes for the government. Government imposes a fee, a fine, a cost to business, and it rolls into the base of what that business has to pay to produce its product and it is upon that which they make a profit. So this business of taxing business, they are getting business to collect a tax from the ultimate consumer. That is all it is. I want to throw something else in. I appreciate Senator Brownback very much. I was in Georgia a few weeks ago, Albany, near where Senator Chambliss raised his family, at a Rotary Club. I was asked by a fellow: You keep talking about a trillion. How much is that? I babbled and fumbled, and I really -- have you ever tried to explain that number and quantify that? It is a huge number. We are talking about $2.5 trillion in the first full 10 years. I got so frustrated that I got on the calculator to figure out an analogy as to how much it is. I decided, I wonder how many years would go by for a trillion seconds to pass. I got on the calculator and worked it out. It is 31,709 years for a trillion seconds to go by. That gives you some proportion of the volume of dollars we are talking about in taxes and costs and, as the Senator said so rightly, debt. That is a lot of money, and the American taxpayer ultimately is on the bill for every dime of it. Mr. CHAMBLISS. I ask my colleague from Georgia, we talked about this, and he has had extensive experience at the State level with respect to Medicaid. Take our State -- and I think we are representative of all 50 States. We have a Medicaid Program now that provides for coverage or eligibility at 100 percent of the poverty level. This bill takes that to 133 percent of the poverty level. Talk for a minute about the impact of going from 100 to 133 percent to cover some of those uninsured I referred to earlier. What is the impact on our State? Mr. ISAKSON. Right now, Georgia's current year budget for the cost of Medicaid is $2.150 billion, or about 12 percent of the State appropriations. This bill, as currently configured, raises that eligibility by 3 percent. But the Feds hold harmless the States for the first 3 years of that increase, and then it is a 90/10 split for the next 3 years, and then it is silent. To give everybody the benefit of the doubt, say States only have to pay 10 percent more. That is one-quarter of $1 billion more in Georgia -- from $2.15 billion to $2.4 billion in the State budget. We all know what is going to happen -- what happened with the first Medicaid. The State will have to pay the full 35 percent, which would mean that over time, at the end of the 10 years, using today's numbers without inflation, Medicaid costs in Georgia for about 12 percent of the population would go from $2.15 billion to $3.4 billion a year for Medicaid. Mr. CHAMBLISS. Whether it is paid by the Federal Government after that 3 years or by the State of Georgia, whose pocket will it come out of? Mr. ISAKSON. The taxpayers of the United States of America. Mr. ALEXANDER. As we were discussing earlier, it could be paid out of the pockets of the 18 million or 20 million students who go to, for instance, the University of Kansas and Kansas State. We began this discussion by pointing out that California raised tuition yesterday 32 percent for its students. They are pointing fingers at each other, but they should be pointing at us for not reining in Medicaid because over time that is the biggest reason. Mr. BROWNBACK. In my State of Kansas, a huge budget debate is going on about where we are going to come up with the shortfall this year in the State budget. People can save in some places, but you have to do this on Medicaid. It ends up, in all probability, that a disproportionate share will come out of the schools for the schoolchildren. Is that what we at the Federal level want to see take place? No. That is one of the reasons I am voting against this bill. You are dictating a State budget. Initially the Feds are putting in the full amount, but I have seen this before too. You start with the Federal Government wiggling the carrot, saying: Take a bite. You can do it. Then once you get hooked, you say: OK, we are going to reel it in now, and you will pay more of it. It will be the Federal Government dictating the State budget, putting it into Medicaid and taking it away from schools. That is what will take place. That is what is happening in my State now. It is not fair to do that. It is not right for us to do that. Most of the people across Kansas think this whole issue is fiscal insanity -- literally fiscal insanity -- what we are looking at doing with that level of debt, $12 trillion a year. With my State having the level of debt it has, making this requirement -- a multi-trillion-dollar entitlement expansion when the Federal Government is hemorrhaging money, as well as State governments -- is fiscal insanity. The world community is saying: Get your fiscal house in order. This makes no sense. Mr. CHAMBLISS. I don't think we can overstate what the Senator has said. Not only is the Federal Government looking at the largest deficit we have ever seen, by three times, in the history of our country -- just this past year, $1.3 trillion -- but every State is having the same problem. That is trickling down. In Georgia, for example, we have one county that has run into these education reductions that Senator Alexander is talking about, which universities are facing. That one school system reduced the days the children are going to school from 5 to 4 days to save the cost of buses running and other bills, for heating and whatnot, for that extra day. That is not what we need to be doing as Americans. We need to figure out a way to struggle through this. Instead of struggling through it, now we are, in the toughest times we have ever seen, as Senator Brownback said, we are adding this huge, massive debt on top, and the huge taxes that will stifle the small business community on top of the debt that we have seen created in this country just in the past 12 months. Mr. ALEXANDER. I have a question I will ask any of the Senators who want to comment. Someone asked me yesterday: Where is all this opposition to these health care bills coming from? We have seen the Gallup poll and the Pew poll. These are not Republican Polls. They are well-respected polls in this country that are showing that independent voters, by 2 to 1, say they don't want this bill. I have been in and out of politics for many years. I have never had as many people stop me on the street or in the airport or wherever, and say, "Please don't do this." Somebody asked me yesterday: Why is there that much opposition? My answer was -- and this is what I would appreciate comments on -- this is not just about health care. This is, as President Obama said one time, a proxy for a national debate about the role of government in Washington and in everyday American life. This is about the stimulus package, about the Washington takeover of car companies. This is about the growing debt; this is about the takeover of student loans; this is about every Washington takeover, and every increase in debt. That is what this debate is about. I think that is why we are seeing such intensive opposition. I wonder if you have any reflection? Mr. BROWNBACK. I certainly think it is. What I observe, too, is people coming up to me in large numbers and very passionately saying they are both mad and scared. They are mad about this taking place, and they are scared it is going to actually happen to them. They feel like, how can this happen to them in this country? They look at that huge debt and at our President over in China talking as if he is going to see the banker, and they don't like it. This isn't their country the way they want it to be. They want our country to be fiscally sound instead of going to beg hat-in-hand to the "banker" in a foreign country. Then you are going to add another big entitlement on top of that? They are saying: Don't ask me, the taxpayer, for more money because I don't have it. They are mad and scared about this. It is very disconcerting for people in the country. Mr. ISAKSON. I agree with Senator Brownback. I guess I could sum it up in four phrases. There will be less access, seniors fear, because of cuts in Medicare. They will have less access. There will be higher costs because of the bending of the way in which they calculate premiums and the additional taxes. Everybody knows that will be a higher cost. There is a great fear of rationing, which is a component part of almost every plan to get from where we are to where they want to take us. Lastly, I hear a lot from young people who are considering a medical career either in research or in applied medicine. They fear that medicine will not be the practice in this country in the future that it has been in the past. If that is true, if they leave and go to other fields, we will have less innovation and research and development and, in the end, less quality health care for the American people. Mr. CHAMBLISS. These are not people who are on the extreme right or extreme left who are bombarding us with phone calls, e-mails, and letters as all of us get on airplanes, as I did Monday. I had people come up as I walked through the airport and as I was on the airplane and when I got off the airplane, saying: Please stop this bill. Don't pass this foolish bill that you all are talking about up there now. It is amazing, the type of folks who will come up and say that. I have two quick anecdotes I would like to read. One is a letter I got from a doctor. It reads: Dear Senator: I am a vascular surgeon in Rome, GA, with a patient population that is 70 percent Medicare. I am deeply concerned about the proposed Medicare cuts. After 8 years of college and medical school, and 7 years of training, I have accumulated a large debt in loans and interest. Plus there is the huge administrative burden of a large Medicare population in my practice. I don't know how I and other physicians are going to be able to afford to continue to see Medicare patients if these cuts go through. As it stands now, I am paid only 23 cents on every dollar charged. I would appreciate help in staving off these cuts. The other one is an e-mail I got in the last few days about a good friend of Senator Isakson and mine, Bob Lovein, a funeral director in Nashville, GA, which is close to my hometown. It says this: A lady walked into the funeral home and gave him a letter from the VA. The letter stated that they (the VA) owed her $307 on her husband's death benefits. Bob pulls her husband's file and he had buried him 10 years ago...and we trust the government to run health care? That is how ridiculous it is in the minds of people in this country who are calling and writing our offices -- certainly the offices of every one of the Members of this body -- because they don't understand why we are mortgaging and sacrificing our children's future, or why, as Senator Brownback says, when the President goes to China to see our banker -- which China owns almost $1 trillion worth of our debt -- and the Chinese Premier asked the President about the health care bill because he is concerned about the way we are spending money here. I can never remember any foreign leader ever asking the President of our country about anything to do with the financial condition, particularly a program like this, which would affect us. Mr. ALEXANDER. I am afraid our time is almost up. Mr. BROWNBACK. Yes, our President got lectured by the Chinese regulator about our financial system. This is unbelievable. This exacerbates it, if we pass this bill. Mr. ALEXANDER. I thank Senators Brownback, Chambliss, and Isakson. I think all four of us want the American people to know above all that we have repeatedly said that instead of 2,000-page bills that raise taxes, raise premiums, cut Medicare, and transfer costs to States, we would rather identify the goal of reducing costs and go step by step toward that goal. We have introduced specific legislation to take those steps, which could be bipartisan, such as allowing small businesses to pool their resources to purchase insurance, that Senator Isakson talked about, and reducing junk lawsuits, as Senator Chambliss talked about, and allowing competition across State lines. We have our step-by-step plan. We believe the American people have lost confidence in Washington and that they would prefer that we go step by step in the right direction to reduce costs and re-earn their trust rather than pass a 2,074-page bill that will bankrupt the country. I yield the floor. Mr. BROWNBACK. Mr. President, I suggest the absence of a quorum.