Washington -LRB- CNN -RRB- -- The U.S. Senate on Monday opened what is expected to be a lengthy and rancorous debate on a sweeping bill to overhaul the nation 's health care system . In statements laced with heated and conflicting rhetoric , Senate Democrats and Republicans outlined opposing positions on the 2,074-page Democratic measure that would provide health insurance to an additional 31 million people at a cost of almost $ 850 billion . Democrats led by Senate Majority Leader Harry Reid of Nevada framed the debate as historic and said the bill would provide vital health insurance for almost all Americans , hold down spiraling costs that threaten the U.S. economy and instill needed reforms to ensure the long-term solvency of the government-run Medicare health program for senior citizens . `` In the greatest country on Earth , no American should die simply because they do n't have health insurance , '' said Sen. Max Baucus of Montana , one of the bill 's architects , while Reid said the bill `` saves money , saves lives and saves Medicare . '' Republicans countered that the bill was too big , too expensive and would cause more harm than good . Sen. John McCain of Arizona called it a `` sham '' and a `` 2,074-page monstrosity full of measures that would impair the abilities , particularly of our senior citizens , to keep the benefits they 've been promised . '' McCain immediately proposed sending the bill back to committee to remove all provisions intended to bring down the costs of Medicare . He cited proposed cuts to Medicare , including $ 118 billion in subsidies provided to private insurers for Medicare Advantage -- an enhanced benefits program for senior citizens . `` There is no math , old or new , that gets you to no change in the benefits they have under Medicare Advantage and yet cuts $ 120 billion , '' McCain said . A vote on McCain 's proposal was likely on Tuesday . The House has passed its version of a health care bill , and if the Senate passes its bill , the two measures would be merged by a congressional conference committee . Both chambers then would have to approve the revised bill before it could go to President Obama 's desk . On Monday , debate quickly bogged down in Republican procedural objections , causing Reid to lament : `` This is not a good way to start this debate . '' Republican Sen. Mike Enzi of Wyoming challenged a motion by Reid that he said would unfairly cut off the proposal of amendments , including McCain 's planned Republican amendment to prevent cuts to Medicare . While Reid 's motion failed , Enzi labeled it a stunt . So far , Republicans unanimously oppose the health care bill . The Senate voted 60-39 to launch debate on the measure , overcoming a Republican filibuster through support from every member of the Democratic caucus . Reid also will need 60 votes to eventually close the debate , and his ability to secure that support remains uncertain . The debate will feature amendments intended to delete or change controversial provisions , including creation of a government-run public health insurance option to compete against private insurers , tax increases and provisions intended to prevent federal tax dollars from paying for abortion except in cases of rape , incest or danger to the mother 's life . For the most part , battle lines are clearly drawn . Liberal-minded senators such as Bernie Sanders of Vermont , an independent who sits with the Democratic caucus , favor a public option as the best way to force competition on private insurers to bring down costs , while fiscally conservative Democrats such as Nebraska 's Ben Nelson are concerned about the cost and scope of a government-run alternative . Nelson has said he would join a Republican filibuster against closing debate on the bill if it retains the current public option provision , which allows states to opt out of a national plan . Another Democratic caucus member , independent Joe Lieberman of Connecticut , says he also will prevent a final vote if the bill contains any form of public option . On the Republican side , none of the 40 senators supports a public option , but one -- moderate Olympia Snowe of Maine -- has discussed a trigger mechanism that would automatically bring a public option if thresholds for expanded coverage and lower costs go unmet . The trigger idea is considered the lone chance of a compromise that could gain the support of any Republicans . For Democrats , each vote is crucial . Overcoming a filibuster requires support every member of the Democratic caucus , so if Lieberman or others oppose a public option , Reid would need a GOP senator to switch sides on the bill . Senate Democrats concede that some changes are necessary to get the health care bill passed . They contend their comprehensive approach is necessary to reform a system in which higher costs are draining the national economy and harming businesses and individuals . Republicans call for an incremental approach that they say would reduce the costs of health care without needing to create bureaucracies and raise taxes in a huge overhaul . Other risky issues for Senate Democrats include abortion and tax increases to pay for health care reform . The bill includes tax increases aimed at those earning more than $ 200,000 a year and insurers providing so-called `` Cadillac '' health plans worth more than $ 8,500 a year for individuals or $ 23,000 for families . It also would set a 5 percent tax on elective cosmetic surgery . In contrast , a separate health care bill narrowly passed by the House of Representatives earlier this month includes an income tax surcharge on individuals earning more than $ 500,000 a year and couples making more than $ 1 million . Republicans say any tax increase is bad in a struggling economy because it hinders growth and gets passed on to consumers , while Democrats argue the bill 's tax provisions would n't hit the lower or middle class and would create incentive for private insurers to lower the cost of policies . However , a key Democratic constituency -- organized labor -- opposes taxing the `` Cadillac '' health plans negotiated for workers in lieu of wage increases . On abortion , the House bill has more restrictive language regarding the use of federal funding , and some Senate Democrats say they oppose adding it to their chamber 's proposal . According to the nonpartisan Congressional Budget Office , the Senate health care bill would reduce the federal deficit by about $ 130 billion over the next 10 years , through 2019 . Any effect on the deficit in the following decade would be `` subject to substantial uncertainty , '' but probably would result in `` small reductions in federal budget deficits , '' the budget office report said . It also reported that health insurance premiums would remain roughly the same for most people , with costs for lower-income Americans reduced due to subsidies under the plan . According to the budget office , more than 80 percent of Americans would remain in employer-based health plans . Both the Senate and House bills would require individuals to buy health insurance , with penalties for noncompliance . Unlike the House version , the Senate bill does not mandate that all employers offer health care . The two bills are virtually identical on a broad range of changes , including creating health insurance exchanges , expanding Medicaid , subsidizing insurance for low - and some middle-income families , and capping out-of-pocket medical expenses , while preventing insurance companies from denying coverage for pre-existing conditions . CNN 's Ted Barrett , Alan Silverleib and Tom Cohen contributed to this report