sunni area shia area and a kurdish region that would be and i've been in erbil as well middle of january i was there and i agree with his analysis of history when you look at these situations and you take a big military apparatus off the top of a place like the former yugoslavia or now in iraq and then you have all the ancient hatreds that set there how do you deal with them and that's why i think that this is a political solution that is right and i agree because what we're going to need to have is a period of time to get that political machinations in place we're going to need some time and space for kurds to be able to talk together to be able to talk  and that these are not mutually exclusive objectives of having a military apparatus in operation going and in place in iraq pushing forward a very sensible and really probably the only political solution  iraqi constitution and they've even taken a first step so then clemente's the kurdish areas being operated by the kurds and the oil revenues which by the last agreement divided up around the country are the glue to hold the system together this can and should take place and i would urge the administration to push this and even to bring these leaders together in country or outside of the country to push this form a political solution but i would add on top of it that political solution would then vote for this resolution that's at the time table under which this must happen because these are things that are going to take some period of time and as my colleague from delaware noted we've been involved in for the last fifteen years putting this in place and holding this in place that's the requirement of this and so that the passions can calm down the sectarian passions can cool is that you're going to need a force in place to see this political solution on through and that's the all long term objective that i think we need to look at is this form that he's on that track to but that would be in opposition to this resolution that sets a timetable and i respect his discourse and i respect my colleagues on the other side of the aisle that may look at it differently but i think we have to look at recent history to tell us that this is a logical way that that would take iraq is more three groups held together by exteriors forces at the present time with pressure from turkey put pressure from the gulf states with pressure and not constructive with a couple of other neighbors particularly iran and syria i think we need to recognize that political solution that's there the exteriors forces and push this political solution in the environment of a more stable military apparatus a military operation this resolution it seems to me is clearly not a call for victory therefore it must be seen as a call for retreat even if supporters do not contend that it's a plan for victory and we need to win and this they talk about the problems we face not the solutions we need but yes there is a middle road here even really engaging the senator from delaware his political solution with this military rationale in the military need that's going to be there that's still in place in bosnia that's going to be in place for some time in iraq we will need a military presence in iraq for some period of time to count even to get to that political solution we cannot predict how long that presence will be necessary or exactly what type of presence will be required at the dayton accords which we did we predict at that point in time that this is going to be for a period of five years and no more no we said we're going to help provide the stability here so that the political solution can take place and we didn't put ok and one year we're going to have this view of troops in two years we're not going to have any of these types of troops three years we're out we didn't say that and we said ok here's a political solution and we're going to help stabilize this militarily or whatever time necessary to be able to do that these solutions need to be brought together not to be argued as separately i am not calling for an open ended commitment to reckon i am suggesting that our commitment be driven by the mission and that we must complete it and we must get this done we can express office ition to the surge which i have certainly done but after doing so i think we should oversee the implementation but not to try to undercut it nor should we had to have to interrupt a mission just getting under way we're looking at this right now i cannot vote for a plan that would begin to withdraw s troops before the surge forces are even fully deployed at this point in time fourth brigade of the first infantry divisions based in fort riley kansas they just recently arrived in baghdad thank you would be wise for us to tell those soldiers they should prepare to leave even before they get their gear unpack mr patten president hollande i believe it's inappropriate for us to legislate a timetable for drug withdrawal i also believe it is bad policy for us to do this in iraq first supporters claim that the resolution continues the fight against the terrorists by leaving a minimal force in place for counterterrorism operations but apparently the terrorists are not getting that message two days ago one of the al qaeda leaders in iraq used a jihad as web site to discuss the very resolution we're not invading in the senate needs said quote democratic majority the american congress announced that the security plan must produce its prudes in the middle of the summer or else they would expedite the departure of the forces at the end of this year end of quote and the very clear evidence that al qaida is ready to in and around baghdad sunni leaders have become so tired of al qaeda violence against their own communities they're turning to u s forces for protection a timetable for withdrawal serves al  for many years now several of my colleagues on the other side of the aisle have rejected the idea that iraq is really a part a central part of the war on terrorism i believe the statements just read another the leaders inspiring violence and  violence should end this discussion iraq is unquestionably a front in the war on terror and it is essential that we prevail against the terrorists in iraq my colleagues are serious about fighting the war on terror should frustrate the voting against against this resolution senator your time has expired then i want to thank you and i would urge for political purposes of stabilizing the senator from washington is recognized as i was like six minutes from the leader's time on our side without objection so ordered first asking him consent that the previous agreement be modified to provide that if any of the resolutions receive the way from when they live to when they train to when they deploy to when they return home tragically this administration has failed our troops every step of the way today democrats are saying enough is enough we are going to give our troops everything they need and we're not just going to be a rubber stamp for the president's war without him and i am very proud today to offer the murry resolution in support of our troops and i'm pleased that our majority leader senator reid strongly supports this resolution that i'm president we have been fighting to finally have a debate here in the senate for months now that we have today we've got to do three things we need to pass the murray resolution that says we support our troops every step of the way we need to reject the great resolution that blindly follows the president and i hope we passed the re a new direction in iraq that a president summary resolution that i offer affirms that we will provide our troops with everything they need to be safe and to complete their mission will provide everything they need in terms of training equipment logistics and funding and will provide everything they need when they return home are some here have a different idea of a great resolution will tie the hands of congress and would have poured only leave all decisions to president you know how that has turned out if congress were elected by our constituents home surrender our voice we could see our troops being stuck with more of the same more americans being stuck in the middle of a civil war and more veterans coming home without the care they need we don't need more of the same in my opinion we need a new direction summary resolution shows that we can have a new direction in iraq and we can give our troops all the support they need so a president shortly will have a choice either you can just blindly follow the president or you can say we here are going to stand up to our own responsibility to support our troops and we can also push for a new direction in iraq now the great resolution says we have to support the president the resolution says we here have to support our troops a great resolution would simply make congress a rubber stamp for a failed policy the resolution that i've offered says that congress those of the last election here in the senate have a voice and we have to use that to help our troops i suggest to my colleagues that if you're happy with the warner go ahead and vote for the gregg resolution it will keep the flocked on the same path if you are ok with returning troops waiting in a crumbling military hold unit are waiting years for their benefit then vote for the great resolution keep us locked on the same path but if you think our troops do deserve our support and do deserve better vote for them or a resolution if you agree that our troops deserve equipment to keep them safe for them or a resolution if you agree that are to preserve the training that will help them succeed in their mission vote for them or a resolution if you believe that our troops deserve better when they come home importantly vote for them or a resolution and if you believe that congress needs to use his voice and power to give our country a direction in iraq for them or a resolution madam president our troops deserve better than what they have been provided so far the president sent our troops into battle without the lifesaving armor and equipment they need this president left our troops on the battlefield without a plan without a clear mission and if out being honest about the cock of the war and this president shortchange health care and benefits for our returning service members leaving brave americans as we now know to languish in squalor at walter reed and facilities across our nation have we had enough of that didn't american send us a clear message last fall that enough is enough it is time i believe for a new direction madam president the resolution that offered recognizes that congress have a role in playing in supporting our troops we have a voice also to push for a new direction and we are going to use our power  vote to tyrone hand use this opportunity today to tell our troops we are here for them and their family from the time they head off to battle for the rest of their lives we are there for them and most of a dangerous piece of legislation it is constitutionally dubious and it would authorize a scattered band of united states senators to literally tie the hands of the commander in chief at a moment of decisive importance in the quiet against terrorism in iraq i would never doubt the patriotism of my colleagues across the aisle but i've become increasingly troubled over the last few weeks as this debate has taken shape when the president prepared a solution to the growing violence in baghdad he had a good reason to expect the support of at least some of our friends on the other side of the aisle the democratic whip senator durbin said it like december and i quote if we need a national a some troops in baghdad to quiet the situation and make it more so that our soldiers start coming home that i would accept that that's the assistant democratic leader not years ago three months ago yet as details of the president proposal just became clear our friends on the other side circle the wagons and senator durbin got in line just two weeks two weeks after saying he'd support reinforcements as a way of stabilizing iraq the senator from illinois said and i quote the proposed surge in troops is a sad ominous echo of something we've lived through in this country and then later on that day he added i don't believe that a surge is the answer to our challenge in iraq that just two weeks after announcing that it might be a good idea what our friend from illinois felt the same way if one of his democratic colleagues had proposed the surge increasingly the troubling answer to this question appears to be yes indeed it i increasingly clear that the only principle guiding our colleagues on the other side is this if the president proposes that we oppose it this is a bad principle and good times it's an outrageous principle in time of war two months after many of democrats said they would support a surge in troops if it meant stabilizing baghdad and incredibly just one month after sending general petraeus on his mission to do so democrats are now calling for the thing they consistently oppose setting a timetable for withdrawal this is really beyond silly it is a chaotic embarrassment that threatens to shake the confidence of our commanders and of our troops and to involve an enemy that predicted and long for nothing left of course at some point it is not enough to simply say if the president proposed it we oppose it the principle begs for a counter proposal what would the democrats propose instead and we're all we all saw the answer seven different proposals many of which contradicting the last and then finally this proposal everyone could get behind a proposal that sets a date certain for america's withdrawal from iraq this resolution is a clear statement of retreat from the support that the senate recently gave to general petraeus and as i've said its passage would be absolutely vital to our mission in iraq senator clinton put it well she said i don't believe it's smart to set a date for withdrawal i don't think you should ever ever telegraph your intentions to the enemy so they can await you that was sen clinton well ever is here and our friends on the other side of the aisle apparently now think it is a good idea to telegraph our intentions to the enemy osama bin ladin and followers have repeatedly said that the us does not have the stomach for a long passage of this resolution will prove osama bin laden regretfully was right this is a vote he's been waiting for setting a date certain for withdrawal will please a vocal group of democratic presidential primary voters but it would discourage many others including many democrats who agree that timetables are foolish and dangerous more importantly it wouldn't it would discourage our own troops and this against a resolution that sets a timetable that actually announces the date for our withdrawal from iraq and i'll do what i do so for the same reason that many prominent democrats opposed it up until the day president bush announced his plan for securing baghdad just two months ago republicans have met for our allies and for our troops and it is this we will continue to fight a timetable for withdrawal that has no connection to events or circumstances on the ground we will give general petraeus mission a chance to succeed we are proud of the work the general has done and we stand with them until the job done and we'll send that message today when we vote in favor of the gregg amendment this amendment pledges us to support the troops and their mission republicans proposed a month ago that we had the allow to vote on this amendment but we were denied we're being allowed that vote today and just as proudly as will vote against s j reznor and will vote in favor of the gregg amendment and one sense this debate has been academic senators will have a chance to show their support for the mission in iraq when we vote on the supplemental appropriations bill later this month that's the bill it matters that's the one that funds the operation in iraq but in another sense this debate was worthwhile because  exposed the principle that appears to be quite the opposite if the president proposed it we will oppose it and this is no principle at all it's just pure politics it's on worthy and good times it's shameful at a time of war meanwhile the fighting in iraq continues and general petraeus mission is showing early signs of success we're told that the bom deaths are down one third in baghdad since the new plan took effect last month execution style sla are down by nearly half traffic has returned to the once empty baghdad streets no one solution up to say this will last and this is not a prediction but it is a sign of hope the kind of sign that everyone in this country democrat and republican has been waiting for and we in this chamber have a choice we can fan the fly him or we can smother it by voting on a timetable for withdrawal we are very decidedly doing the latter protracted war in iraq the senate finally considers important legislation to direct president bush to change course of the civil war as j was nine which is a joint resolution to revise u policy in iraq is one that i offered a second vote will be on the murray resolution expressing the sense of the senate the no action we take to undermine the safety of the armed forces and finally as congress twenty great amendments on funding for american troops in the field i will discuss at some time length at a later time this afternoon the difference between murray and gray but suffice it to say madam president the that takes care of the troops after battle in addition to all their arac it takes care of the situation so that we don't have another walter reed situation the great commandment does members will have to consider a choice we continue to support president bush's failed policy and his our troops bogged down in the middle of a civil war while the enemy is attacked who attacked us on september eleventh grow stronger or will we stand with the american people and the banding a new direction for this war a direction that maximizes our chances for success in iraq in that part of the world a direction that recognizes the current policy has pushed our troops and their families to the breaking point a direction that sends a signal to the president that this congress will hold him accountable and no longer will we rubber stamp his failed policies a direction that restores us standing in the world and refocus our resources on our most the beginning of the fifth year of this war a fifth year of this war the our troops are now mired in a war and is far away country five years a war of the president's approach to iraq and it's clear it's not working the country is in a state of chaos iraq is in a state of chaos there are literally is no stability united states troops are policing a civil war a protracted civil war not hunting and killing the terrorists who attacked us on nine five years five years of war the mission has changed saddam is gone there are no weapons of mass destruction the original mission no longer exists five years of war with thirty two hundred americans twenty five thousand wounded americans hundreds of billions of dollars spent four billion dollars a week couple hundred million dollars a day still no end in sight according to this president the american military the finest in the world cannot and should not please an iraqi civil war general petraeus whose name has been thrown around here as if you would guess is his war it's not his war president bush's war general petraeus the commander in iraq today recently observed there is no military solution in iraq the war muscle only one through diplomacy politically by forcing iraq's political factions to resolve their differences the key to success in iraq is not escalate the conflict by adding tens of thousands of additional troops to march down the same road some of these troops have been now on the same road as many as four in five times it's time to find a new way forward and a new way home that gives our troops strategy complete the mission and i repeat come home the read resolution will give our troops the best chance  seat in the larger war on terror will direct the president to change course in iraq by changing the mission in iraq this resolution really transition the mission to training force protection targeted counter terrorist operations and begins or a deployment of troops in the next hundred twenty days like the bipartisan iraq study group the goal in my resolution is to remove all combat forces not associated with these missions by the spring of two thousand  my resolution also recognizes a comprehensive strategy comprehensive strategy in iraq phased redeployment shall be implemented as part of a comprehensive diplomatic political and economic strategy includes direct neighbors and the international community one zero seven the murray alternative to the great resolution strongly supports our troops but also properly interpret the constitution by stating that the president and the congress have shared responsibility for decisions involving our armed forces quoting from the resolution the president the congress should not take any action that will endanger the armed forces the united states and will provide necessary funds for the training equipment and other support of the troops in the field as such actions will ensure their safety and effectiveness and preparing for and carrying out their assigned missions and additional marry resolution makes it clear that the constitution gives congress the responsibility in addition to the president to take actions that help our troops and veterans the murray resolution says that our responsibility to our troops does not begin and when they are deployed supporting the troops means giving them proper training before they are deployed and ensuring they receive the proper medical and other support when they return home and a president i suggest that voting no on the murray resolution is voting to condone what has taken place murray resolution recognizes that troops must be taking care of not only when they're in battle but when they get out of battle and if there were ever a picture of what's wrong take a look at what happened to wal the department of defense said yesterday in a report that they issued a pentagon issue there is a civil war going on in iraq now as we speak the pentagon in their report yesterday said violence is up not down three soldiers a day are being killed february was the month of more attacks and any time in this going on the five year war when he met with the president face to face said american troops out of baghdad he's the leader of iraq general casey who is a commander of the times of bread suggested the surge said the surge won't this is not general petraeus is war it's president bush's war and we must change course our resolution hundred twenty days redeployment so they'll be count work on counterterrorism force protection training and yes they also do some political economic strategy and certainly diplomacy our goal spring two thousand  it's easy to talk here about sending the troops into battle supporting the troops i support the troops president i support the troops but i don't think that we should build another drop of american blood in iraq not another drop of blood i spoke to the mother of raul bravo a week ago today the mother of a twenty one year old boy killed in iraq his second tour of duty she said he's the only man in our family her and his three sisters she said he was an angel her son did his best to learn to speak the language of the iraqis she said he said prayers with iraqis his blood should not have been left in that faraway place the war has gone on too long we must change direction in iraq we've given the president chance after chance we hear this again things are getting better things are getting better his own town again says it's a civil war his own pentagon says it's getting worse and that madame president what these resolutions are about today read resolution says change direction around summary resolution says support the troops at all times the great resolution takes congress out of the equation and doesn't do a thing for the troops when they come home is there objection without objection so ordered under the previous order the question is on senate joint resolution nine which the clerk will read for the third time number seventy two as j rise nine to revise united states policy on iraq ms collins mr conrad mr corker mr corn mr kennedy mr kerry ms global char mr cole mr kyle ms land mr menendez mr reid of nevada mr roberts mr rockefeller mr salazar mr sanders mr schumer mr sessions mr shall be mr smith ms no mr mr white house mr wyden mr kerry mr kerry  no mr tester mr tester mr stevens mr stevens no mr roberts no mr casey mr casey  mr specter no mr martinez no mr brown mr brown  mr kennedy mr kennedy  mr menendez mr menendez  mr rockefeller mr rockefeller  are there any senators who haven't voted who wish to change their vote any senators who haven't voted to wish to change their vote on this vote the yeas are forty eight the nays are fifty him not to present with the permission of the republican leader i would ask consent that the next two hours be ten minutes in duration is their objection without objection so ordered there will now be two minutes of debate equally divided and senate resolution one o seven the senator from washington is recognized for their pleas a senator from washington is recognized can there be order please the senator from washington is speaking can there please be order in the senate please take their conversations off the floor the senator from washington is recognized presence the senate is about to vote on them or a resolution there should be no question order in the senate please the senator from washington is recognized madam president there should be no question that the members of the senate support our troops we all in this resolution we want to make sure that we go on record saying we support our troops from the time they go to battle and sent on their missions to the time they come home we make very clear in the murray resolution that this senate will go on record saying the support of our troops extends far beyond their mission in the field needs when they come haul and are sent to walter reed or one of our other medical facilities that we will support them with what they need it says we will support their families throughout their lifetime if that's what it takes for their ironically i would agree with the senator from washington and i although i disagree with your characterization of this this resolution first of all the resolution does officially the same thing the gregg resolution does number one it uses the language congress should not take any action that when danger the united states military is in the field to exactly the same language that is in the very resolution congress should not take any action that were endangered our version of course is the gregg resolution talks about article two section two of the constitution that is in terms of the president's powers constitutional powers in article one section eight of the constitution the congress has powers in the very resolution does essentially the same thing except it doesn't cite it it merely says congress and the president should continue to exercise their constitutional responsibility so i'm going to go for the murray resolution and vote for the gregg resolution i don't see any difference and i think we're supporting the president in this is that is the right thing to do the question is on senate resolution one zero seven to johnson mr kennedy m mr robert mr rockefeller is there any senator in the chamber who hasn't voted or wishes to change their vote any senator in the chamber who has been voted who wishes to change their vote on this vote the yeas are ninety six the nays are two the well as you can see there are plenty of senators there on the floor this is a little short time out really we just saw a few moments ago the resolution offered by senator reid that failed the vote was forty eight to fifty under the agreement the senators had reached sixty votes were needed for passage and then just a moment ago the resolution offered by senator murray passing by a vote of ninety six to two weeks packed short bit of debate and then a vote on the resolution offered by senator gregg that's  what is going on at this hour here in the senate waiting for senators to get back under way you can see in the left lower portion of your screen that's kind of the democratic senate caucus on most areas senator reid in the center surrounded by senator kerry there's looks like senator obama there senator boxer i believe that senator murray is standing next to senator reid we are expecting one more vote here a vote on the iraq resolution offered by senator gregg and short time for debate and then that focus should be getting under way shortly is our expectation correct how to present the gregg and then that has been changed that it was originally filed it is still imperfect i still think at the least from my observation is not good especially in light of the fact that the marine so clearly the resolution leaves a lot to be desired i think it can be construed many different ways i think it's wrong we don't take into consideration the injured troops when they come home madame president and they feel appropriate senator from new hampshire's recognize i'm just wondering what parliamentary situation is because i think we do i have a minute it was a minute on the other side just use the senator has a minute it was a minute on the other side just has always that leader us united states military forces in the field including the elimination or reduction of funds for troops in the field as such action with respect to funding would undermine their safety and harm their effectiveness in pursuing their assigned missions  klein told mrs feinstein mr brown and mr lieberman mr pryor are there any senators in the chamber was to vote or change their vote any senators who wish to vote or change their vote on this vote the yeas are eighty two the nays are sixteen the resolution is agreed to under the previous order and the preamble is agreed to remove under the previous order the senate will proceed to executive session to consider and block the following nominations which the clerk will report should i have order please in the chamber the clerk will  nomination nomination john preston bailey of west virginia to the united states district judge for the northern district of west virginia voters do you write the second of california to the united states district judge for the central district of california spending record can we have order in the senate please good people please take their conversations outside senator from pennsylvania has an outstanding record both academically and professionally senator san fact refuse to even consider older half of his nominees have not done this with president bush's so i will  requested that there is sufficient second just over a break so what i will call have judge hardiman has been on the district bench since two thousand and three they received a unanimously well qualified rating from the american bar mr reed of rhode island mr reid of nevada can't well  florida i thomas hardy men of pennsylvania to be the u s circuit court judges confirmed the nomination is confirmed to quality health care in rural america patients have long gone without care and despite the fact that one fifth of the u s population lives in rural america only nine percent of the nation's physicians are practicing in these areas over fifty million of these rural americans live in areas that have a shortage of physicians to meet their basic needs now physician recruitment to rural america is a big problem part of this problem comes about through high student debt which often forces many students away from a rural practice and into urban specialty medicine where they can probably come in and higher salaries i recently held a senate health committee hearing in alaska this was during the february recess i held a field committee hearing on the physician shortage crisis in rural america at that hearing i had a young woman come up and she is a medical student student currently part of the whammy program the western state medical program this young woman melissa how is twenty six years old and she stated that her student debt that she had accumulated is a huge concern that hangs over the decisions that she makes that she decides where she is going to practice and simply put she said that a hundred thousand dollars student debt faces is kind of scary and i have to admit that's kind of scary a dozen states already reports of your physician shortages shortages exist in the areas of cardiology radiology neurology just to name a few but the greatest shortage is first simply have been in primary care in fact the shortage of primary care physicians in rural areas of the us represents one of the most intractable health policy problems of the past century and it will only worsen in just twenty years twenty percent of the us population will be sixty five or older and is the percentage larger than at any other time in our nation's history and just as this aging population places the highest demand on our health care system we have some experts predict a national shortage of close to two hundred thousand physicians if that becomes a reality eighty four million patients could be potentially left without a doctor's care because the question has to be asked where are the doctors gone we're losing some of our doctors through attrition one third of physicians are fifty five years old and older and are likely to retire just as has been the baby boom generation move into its time of greatest medical needs additionally for the last quarter of a century medical students have kept their student enrollment medical schools excuse me have kept their student enrollment virtually flat and we're also losing a lot of our doctors quite simply through frustrating low medicare and medicaid reimbursement rates coupled with complex regulations and paperwork leave the physicians aggravated leave them disappointed with the practice of medicine in alaska we've we've lived with providers shortages and statehood i grew up in a in a part of the state down in southeastern where you just didn't have doctors that were available to deliver babies except on tuesdays and thursdays you hope that you didn't need to deliver on a tuesday or a thursday well in many parts of our state we don't have providers bat that can can deliver if you're out in the aleutian chain  you're told by your the physicians attendant to come to town come to anchorage six hundred miles away to wait out the remaining months of your pregnancy because it was not they did not have the facilities did not have a doctors available to take care of you in the event of an emergency so we've lived with provider shortages for for a long long time because our state is larger than texas and california and montana combined rural brings on a new meaning and the physician shortage crisis is even more amplified as i've given in my two examples here but we've had some recent events in the state that have created a situation far worse than alaska has known in the past currently in the state we have the sixth lowest ratio of physicians to population in the united states and that is when you take into account anchorage which is our largest population center in rural alaska it's the worst position to population situation in the nation alaska needs nearly four hundred more doctors to provide the same level of care as elsewhere in the country one of our problems is we don't have a medical school we're not likely to be getting a medical school in the near future we also have the lowest per capita number of medical school slots in the country and the lowest number of residency slots we have too small but very very successful unit university of washington medical school partnership and the alaska family residency program these two programs help train alaskans as physicians and also to help us bring doctors to alaska but despite the success of these programs each are far too small to meet our populations needs each week without fail i receive  letters e mails from alaska seniors who simply cannot find a doctor to treat them and i'd like to read just a few excerpts from recent emails that we have received the first one is from a gentleman in anchorage and keep in mind anchorage their largest populations that are about half the population of the state is here he writes that my mother's had difficulty in the extreme in getting a doctor who will take her as she is a medicare patient doctors are telling potential patients that they are no longer taking medicaid my mother has made in excess of one hundred calls to physicians in anchorage another constituent right this is also from anchorage during the past year i've tried to find a doctor that accept medicare i use the anchorage yellow pages and called over one hundred doctors only to be told that they won't accept any more medicare patients she then write and say i'll tell you ahead of time we'll be going to the hospital emergency rooms to receive even the basic medical care calls flu and other basic medical care that could have been treated through seeing a doctor practice just doesn't sound like good does this girl management another constituent this was actually in a letter to the anchorage letter to the editor in the anchorage daily news says my friends telephoned more than eighty doctors recently and not one was accepting new medicare patients a third general and from kenai alaska right my mom has medicare and she had to wait five months to be seen by a neurologist because she'd been put on a waiting list to be seen due to the fact that she was a medicare patient another woman from anchorage as i just got through trying to find a physician for an elderly medicare dependent friend at this time i have found no one who will take her most physicians take no medicare patients or have a quota which is called the providence health care provider list has no one to take medicare and the last  email with from anchorage stating almost no family practice office in anchorage is accepting new medicare patients this is just a sample of what we get from constituents around the state of alaska saying i don't have anyone that can see my mother i can't i can't get in to see anyone myself this present i mention in my comment that this a crisis that is growing in alaska we don't often think of it as being a state where we have a large senior population of some of the southern states as being the ones with the tractors seniors but the fact is alaska has the second fastest growing senior population in the nation second only to nevada so again we ask the question why aren't alaska's doctors able to provide our seniors why are they saying no we're not accepting any new medicare patients well a lot of it has to do with the reimbursement rate recent federal reductions in alaska medicare reimbursement rates have been so severe that primary care physicians report that medicare pays them only thirty seven cents is actually between thirty seven cents to forty cents for every dollar that it costs to treat a patient so the doctor is spending a dollar and in the care provided but is getting really remembers just about forty cents of every dollar we have one physician testify at the field hearing he said that in order for him to to basically break even with his medical practice he would have to see one medicare patients every seven minutes in order for him not to lose money within his medical practice and for those of us who go into our doctor's office if we only had seven minutes in there with us with our medical provider i don't think that we'd feel that we were getting the care the attention that our medical issues deserve losing money by seeing medicare patients has meant that many many of our physicians have stopped accepting medicare patients entirely they're making a decision not to accept any new medicare patients or if you've been a if you've been a patient of a particular physician and you turn sixty five you may have had a  good relationship with that position but if he tells you i'm sorry i'm not accepting any new medicare patients that that day to your birthday comes and all of a sudden you don't have the care that you had relied on for some period of time during this this help seal community hearing we had testimony that revealed that only one neighborhood health clinic in the entire city of anchorage and again this is a city that has half a state's population only one neighborhood health clinic is still accepting new medicare patients so if you're lucky enough to find a physician it often takes weeks or months for an appointment and so when you're faced with this kind of a delay you've got one of two options either go to the emergency room if if the conditions are severe enough or they go without care entirely putting that off down the road state and he said that he was willing to fly the five hundred some odd miles from vessel to anchorage if only he could find a primary care doctor that would accept any kind of job because he said  counted himself lucky because he had a heart condition and he was at least able to get in to see a specialist once in a while we have a gentleman from the chairman of the alaska commission on aging mr frank appel he called the lack of access to health care for seniors the most critical problem facing alaska's clean mr president i know that alaska is not alone in this the crisis is not just alaska i nationwide and we as a body as a congress should find this situation intolerable and i haven't been here in the senate for as long as as many of my other colleagues but i've been here long enough to know that we fight a lot about health care we debate the solvency issues the funding issues the insurance the benefit coverage universal coverage health savings accounts a prescription drug benefit we can argue about a lot of these  issues as they relate to health care and each and every one of these issues these items it is certainly worthy of a great debate but i would submit that not one of those very worthy debate matter is in the lead to one of the seniors that i just mentioned in these letters you can't find a primary care doctor after making a hundred phone call so instead of this body debating how health care is delivered it's time we focus on the fact that it's not delivered in much of america we've got a crisis that simply cannot wait we have to get to do two things we've got to help current physicians stay in the practice of medicine and we must vastly increase our health care workforce earlier this year senator stevens and i introduced the rural physician relief ad and this is a bill that provides tax incentives for physicians to practice in our most rural and french air locations in the country and today along with my senator my colleague senator schumer senator stevens and senator sanders will be introducing legislation in title the physician shortage elimination at this legislation will double the funding for the national health service corps this is a program that is dedicated to meeting the needs of the under served and despite its success over the years it's been vastly underfunded we understand that about eighty percent of the applicants to this worthy program have to be turned away each year because we don't w also in this legislation allow her and under served physician residency programs to expand removing barriers that prevent programs from developing rural training programs will also double certain title seven funding to create programs that target disadvantaged youth in rural and under served areas and nurture them to to create a high flying to careers in health care we need to get more people interested in the field and finally we must bolster the cornerstone of rural health care which is the community health center through three additional grants and by allowing them to expand their residency programs you're this present i would suggest that the prognosis for the quality of health care in america is poor fifty million americans in under served areas across the nation already do without care and soon with even greater physicians shortages it could mean that potentially another eighty four million patients will be left without the physicians here in time for congress to act on this is now in fact is half the time i look forward to working with my colleagues on  issues that are bad again not just alaska specific i think the facts on the ground up north perhaps make the argument more  accentuated but i think it points to a situation in this nation that we must deal with now before the crisis is felt throughout the country i appreciate  while we wait for senators to come to the floor to speak a senate update here the senate completed debate today on three iraq war resolutions one proposed by senate majority leader harry reid to limit the mission there and eventually withdraw troops failed the vote was forty eight to fifty eight needed sixty votes senators approved the other two one by democrat patty murray supporting troops abroad and at home that vote ninety six to two and another by republican judd gregg opposing cuts to troop funding that one passed by eighty two to sixteen the senate's completed legislative work for the week when they return on monday debate over a bill giving the senate approval over interim appointments of u s attorneys you can watch live senate coverage here on c span to when we wait for senators to come to the floor to wrap up their work for the week the senate completed debate today on three iraq war resolutions one proposed by senate majority leader harry reid to limit the mission there and eventually  troops failed the vote was forty eight to fifty eight needed sixty votes senators approved the other two one by democrat patty murray supporting troops abroad and at home that vote ninety six to two and another vibe republican judd greg finally finished and made its way through congress that resolution was voted down the other aspect of that resolution was that it said that we should set a goal to withdraw all combat  troops two thousand and eight march in the meantime the mission would be limited to things like counterterror protection of u s assets things that have nothing to do with civil war which is which is the issue th democrats say we're in an anorak and we need to get out of that was voted down forty eight fifty one democrat one republican switched sides the other two resolutions were a little more mild mannered not binding one saying we should support the troops in their funding the other saying we should support the troops that are funding not just when they're in the field but when they return home that was a democratic resolution i was trying to counter that that other resolutions for the republican resolution  by trying to capitalize on some of the issues over walter reed medical center there's also some difference in the language on those two resolution resolutions both passed by wide margins pertaining to how much overall congress so what does it mean then that the resolution which is the one that failed forty eight to fifty what does it mean that didn't do that it didn't pass well they knew it they knew it would pass pretty much on the republican on the democratic side had hopes of getting some republican s and they knew that they would keep most of their most of their team in line what it means is that the senate is pretty closely divided forty fifty is about as close as you can get to fifty one forty nine which is the actual senate margin of control for the  democrats it's one of those things where democrats want to keep putting pressure on republicans to either eventually cave in and support some of the their ideas or make them pay in two thousand and eight when they come up for reelection the iraq force pretty unpopular so they're  trying to put some pressure on them the the republicans reason that this was a step too far that there has been some some some concern on the republican side about supporting the war but this was considered a step too far for them they look at this and call it a retreat and that it's dangerous for national security so is the senate done with iraq not at all they will say we'll see it pretty soon most likely when the supplemental spending bill that funds the war in iraq comes out we'll probably see this read language resurface and come back and maybe be included there that could be a really difficult debate for both sides and then you know let's say that that fails the democrats  said we're going to keep bringing up iraq you bring up a rack keep bringing up iraq so no this isn't gone by a long shot well one behind the scenes question how did the two leaders senator reid senator mcconnell work out their differences these resolutions made it to the floor that there was some it was surprising that and one way that they got there the democrats or republicans have blocked some previous debates they voted essentially to filibuster some resolutions that dealt  with that dealt with the troop surge the increase in troops that the president proposed in his state of the union speech and a little bit before that the idea at the time was the republicans one of their and then once offered there were some people who thought they were merely scared to have a debate and that could see some republicans switching sides the democrats this time decided to let some of those republican amendments blocked for go this time i think the reasoning on the democratic side was we want to have of out on this no matter whether we have other votes on other resolutions that could capture some more of the spotlight the idea was just to get them on the record the republicans have been kind of getting tired at least the rank and file of being labeled as obstruction ts for not letting this debate happen so they had they had told you know media and some some of their leaders that they wanted to have a debate so this time the republicans said let's go for it the democrats said let's go for it and then it was only a matter of find that working sends a message to them that they still have some republican support for their war policy a good amount even at least on the fundamentals of the war it's something that that i think they're going to have to get used to they say that the white house has said will veto anything like this it's going to be a lot of fighting from here to two thousand and eight it looks like tim stark's of congressional quarterly thanks as always thank you and again the revote on iraq war resolutions today in the senate one from senate majority leader harry reid to limit the mission and withdraw troops eventually that's the one that failed then one by democrat patty murray supporting troops abroad in their home past as well as republican judd gregg opposing cuts to troop funding also passed the senate has completed legislative debate for the week we wait for senators to come and wrap up their business here for the week when they return on monday debate over a bill giving the senate approval over interim appointments of u s attorneys this in light over the issues surrounding the firings of eight u s attorneys a lot of coverage here on c span to