Madam President, we are on the Gulf of Mexico energy security bill, a bill that has been very carefully crafted in a bipartisan way. It has been our approach from the outset. One of the real…
Madam President, we are on the Gulf of Mexico energy security bill, a bill that has been very carefully crafted in a bipartisan way. It has been our approach from the outset. One of the real challenges we have is taking a bill which is delicate, in the sense that it has been carefully crafted, vetted, and addressed for the last year--and there are many other people who would like to add other energy amendments or bills to this single, focused step, this being built upon the comprehensive energy bill, a bipartisan bill that was passed a year ago this week. So it is a challenge to keep the body focused on this issue. In doing so, there are procedures here shortly that are important to accomplish delivering as many as a billion barrels of oil to the American people and over 5 trillion cubic feet of natural gas, enough gas to heat or cool 6 million homes for 15 years. We have it within our grasp.
We had a good vote yesterday morning in terms of getting on the legislation, which we are on, and now, from a leadership standpoint, we have to stay focused on this bill, even though there are a lot of other good ideas out there, and complete this step and our action in the Senate. Thus, I will go through a series of steps here, and we will have comments on that.
Amendment No. 4713
Madam President, I send an amendment to the desk.
Madam President, I ask unanimous consent that reading of the amendment be dispensed with.
Madam President, I ask for the yeas and nays on the amendment.
Madam President, I send a second-degree amendment to the desk.
Madam President, I send a cloture motion to the desk.
Madam President, I ask unanimous consent that the live quorum be waived.
Madam President, this cloture vote will occur on Monday. We have not set the specific timing, but I anticipate that vote would be at 5:30. We will set the exact time later today.
This will be a very important vote, and it is critical that Senators be here, and they should prepare to be here at 5:30. We will announce the specific time later today. I ask them to adjust their schedules accordingly. In all likelihood, we will be voting on Monday. I hope they have adjusted their schedules accordingly.
Madam President, reserving the right to object, filling the tree is the procedure I have used in order to accomplish what is a very important next step in building on, as I said, the comprehensive Energy bill the managers worked for last year, which has been tremendously successful as we look at alternative energy, such as ethanol or, in the future, nuclear and biomass, looking at the supply side and the consumption side of the equation. What is challenging in floor management is being able to now build upon that bill from last year and take one step at a time.
As we are commenting on this now, there are so many good proposals, substantive proposals, that would help our dependence on foreign sources of oil. We are 60 percent dependent today on foreign sources of oil. We have to change that by lessening our energy dependence with homegrown energy. That is what we will be able to do on the floor today in this carefully crafted, focused, very discrete bill that looks at the Gulf of Mexico, which has revenue sharing that has been carefully worked out with Members in this body for the last 6 to 7 months in terms of the specifics. With that, we will be able to deliver this bill to the American people and address the squeeze we know they are feeling today when they are filling up the tractor or the car or preparing to go on vacation or air-conditioning their homes or heating their homes at other times of the year.
With that being the approach, I will object to setting aside the amendments because it would mean actually trying to decide among many good proposals that would come to the floor--and it is not that they are not good or they won't be addressed in the future. We are going to keep this bill focused, tight, and clean.
I object.
Mr. President, while my distinguished colleague from Alabama is on the floor, I thank him for his leadership on this particular issue because it gives us that opportunity to act with meaningful solutions to problems everyone is feeling. So many things that we do here are issues that seem so macro, so big. I am sure when people are watching C-SPAN or television or they even read about what we do, they wonder, are those people up in Washington doing anything to address the issues that affect me, the squeeze that I feel, the cost of living that we know has to be addressed?
Then you say, What are those things? Where is that squeeze coming from, despite the record low unemployment rate of 4.6 or 4.7 percent and the creation of 5 million jobs?
It comes back again and again--those energy costs, filling up that gasoline tank, getting ready to go on vacation, or altering your vacation, or paying that heating bill, or this time of year that air conditioning bill. And it comes back to energy.
Now we are acting and we are acting in a way that in the past has been stopped--and that is by looking right here at home at the good old American homegrown supply.
Everybody knows that ultimately in the market-based system there is supply and demand. Now we are addressing supply directly, as my colleague mentioned, in a way that is very protective of our environment, of our coastlines, that is environmentally sensitive but in a way that we know will open as much as a million or more barrels.
I thank my colleague for his leadership and also for his explanation so people fully understand the impact of that legislation which is now on the floor.
There is a lot going on. I want to make a couple of comments because there are some things going on right now. The House of Representatives will probably be out tomorrow. We will be in session tomorrow. We are working on a whole range of issues in conference and in our discussions as we look ahead for the next week that we will be here, and then the 4 weeks in September when we come back. I am very hopeful that the House will pass the pensions conference report and sometime here in the next 24 hours. I know our colleagues from the Senate
who are on the conference are working very hard to get the House Members to move ahead on the issue that we know is very important to the American people. Individual retirement security. Again, it goes back to this cost of living and the squeeze that people feel. That is what this pensions bill is all about.
Other issues that are being addressed are so-called tax extenders because we have to act now every year. We would like to make these tax cuts permanent, but we have to act every year and extend them for 1 year or 2 years.
What is also interesting in terms of message is the great impact that tax cuts put forward by this body under the leadership of President Bush have had--a huge impact on individuals and families.
One of interesting things that I find when you say we are going to make the tax cuts permanent and extend them for 3 or 4 years, people do not understand fully what that means and how it affects them as individuals. But 3\1/2\ years from now for a family of four making a median income of $62,000 or $63,000, what percentage of this Federal tax will go up if we don't act to make these tax cuts permanent? Usually, when I ask a crowd of people if the Bush tax cuts are not made permanent, if the Senate doesn't act for whatever reason, or it is obstructed from acting, they say, Maybe my taxes will go up 10 percent or 20 percent, or 30 percent. Not many people say 30 percent. But the fact is, if we don't act in this Senate to make those tax cuts permanent, for a family of four, their Federal taxes will go up, 3\1/2\ years from now, 58 percent. And now people say: I see the importance of what you are doing in Washington, DC, why you are following President Bush in terms of his tremendous leadership in cutting taxes, keeping taxes low, and working hard to make those tax cuts permanent. Then it comes together.
We are looking at a tax extender package, and we are also looking at what my colleagues feel strongly about--a permanent solution to the death tax.
First of all, the death tax does not make sense. It is not fair. It discourages savings and discourages thrift. Therefore, we need to have a permanent solution. I say bury it forever, but the will of the Senate is not to bury it forever and eliminate it totally. Therefore, we are working with what is a very reasonable compromise position. So there is a lot of discussion on that underway.
What we have is crazy. We have a death tax. It used to be high and is coming down. In 2010 it disappears, and in 2011 it goes back up to 55 percent. Talk about things that do not make sense, that does not make sense. We need to fix that. I hope we can do that in the next 6 to 8 weeks.
One last thing I comment on because there has been huge progress today in the House of Representatives which allows us to move forward on an issue that will affect just about everyone listening to me now, an issue we have acted on with meaningful solutions to a real problem, is health information technology. The House today passed a health information technology bill. We have passed one in the past. Now we can marry those two in conference. And we will save lives.
Medicines cure, but medicines can also kill. Last week, the National Academy Institute of Medicine, which we all respect, we all look to, which looks at things very objectively--the committees they put together are experienced, have broad expertise, and take current issues that are challenging and address them in an environment that is very constructive. They released the most extensive report ever done on drug or medication, medicine errors, mistakes that are made, whether they are inadvertent or mistakes just made. The report is fascinating.
Why do I say it affects everyone? Right now, four out of five American adults today--so in all likelihood, everyone listening to me-- take one medicine, at least one medicine over the counter or a prescription. One out of three adults listening to me now take five medicines. That is amazing. Being a physician, it wasn't true 10 years ago, it wasn't true 20 years ago. When my dad began to practice medicine 70 years ago, no one would believe the power we have in medicines today--the power to cure but, if misused or mishandled, the power to kill.
This report just came out last week, and it is fascinating. The report addresses lots of things. I will come back and cite some of them. I will look at findings. How these medicines are administered, if not done correctly, with real care, can result in serious injury, hurt the patient, can cause death--all related to how they are administered, the dosage they are administered in.
Before coming to the Senate, I spent 18 years in hospitals, always 5 days a week and 95 percent of the time 6 days a week, working in hospitals, taking care of people. There you see it all. You see doctors inadvertently writing prescriptions for drugs that interact and are not compatible with certain drugs. Maybe they didn't know the patient was on that particular drug or they just didn't know there would be an interaction of the two drugs, and it hurts the patients. Nurses or health care providers mistakenly put the wrong medication in the IV bag, the intravenous bag that runs into your hand, or administer the wrong blood type. A pharmacist might dispense a 100-milligram pill instead of a 50-milligram pill. These errors are wasteful, obviously, but can also be harmful and can be deadly.
The Institutes of Medicine found that at least 1.5 million Americans are sickened, injured, or killed each year by errors in either processing, dispensing, or taking medications. These errors are widespread. The IOM report found on average a hospital patient is subjected to one medication error every day they are in the hospital. That is pretty amazing. A hospital patient is subjected to one medication error each day he or she occupies a hospital bed.
That is costly. Not only does it occur, and it occurs frequently, it costs a lot. The IOM report estimates the extra expense of treating drug-related injuries in hospitals alone is $3.5 billion a year.
The report--again, it just came out last week--is the most comprehensive report today. It sends a very clear signal; that is, we need to act.
The good news is that we have acted with a first step in this Senate, and as I mentioned earlier the House acted today, which means together we can produce a bill, and have the President sign it, which will make a difference.
The IOM report offered several recommendations to prevent these errors. In many ways, the recommendations they put forward reinforce my vision or a vision I believe is very important as to where we need to be in health care in the future. We have to start today in that direction. That is what the recommendations do.
That vision is really pretty simple. It is a vision of a health care system that is not centered on HMOs, bureaucrats, Washington, or hospitals or clinics. It is centered on the patient. The patient is in the middle of the system.
In this system also is the importance of having the driving force of the consumer. You have the patient, and it is driven by decisions being made by consumers all over the country.
The third component is that it needs to be provider friendly. You need physicians participating, nurse practitioners participating, nurses and other health care providers, technicians, the people who draw the blood, and the lab technicians all participating in a way that there is a comfortable exchange of both information services as well as trust. So it is a patient-centered, consumer-driven, provider-friendly system.
Now, the engine to that system has got to be value, has got to be outcome, has got to be results. When I say ``value,'' I really mean almost in simple terms of the product, the outcome, in terms of value, divided by how many dollars you put in. So you want as much health produced per dollar injected into the system. That has to be the engine of this system, and it has to be fueled by three things.
That is where the exciting part comes in. That is where this health information technology plays such an important role. It has to be driven by information, 21st-century information that simply was not around the last century. It really was not around when I was doing heart transplants every week 10 years ago, 12 years ago. You just didn't have that sort of information generated. It was the knowledge revolution, the explosion of information, computers, the Internet. That knowledge is out there today.
The second fuel has to be choice. You have to have people out there making prudent decisions for themselves each and every day. Obviously, that is very consistent with my principles as a Republican in terms of maximizing choice. The 21st-century information, with empowerment of the consumer by choice, and third, some element of control.
The control really comes in if people have to have resources to make those decisions or, if not, need to be assisted. You have to have a strong safety net for a patient-centered, consumer-driven, provider- friendly system based on values, driven by information and choice and technology. You have to have a seamless flow of information which is privacy-protected and which is secure.
No single piece of legislation incorporates all of that, and no single piece of legislation incorporates all the IOM recommendations. But there are things we can do to move in the direction toward that vision.
I have sponsored bills in this Senate and urged industry-wide changes that made considerable progress that caused us to move toward achieving that.
Last summer, on this floor, I publicly called on the pharmaceutical companies to implement a voluntary 2-year restriction on direct-to- consumer advertising for newly released drugs. What is direct-to- consumer advertising? It is what you see on television each night or over the course of today in terms of the drug ads, in magazines. It is the full-blown pictures you see every day--newspaper ads--where the advertising is directly to the consumer, to the individual, to the patient.
What I called upon the pharmaceutical companies to do is to review their procedures and on a voluntary basis give a 2-year restriction on direct-to-consumer advertising for lots of reasons. I will come back do that.
I also publicly asked the GAO, the Government Accountability Office, to analyze the Food and Drug Administration oversight of such advertising. Are we doing enough to make sure that information which comes out to the consumer is filtered appropriately, to make sure it is accurate, that it is honest, that it shows the pluses but also shows the dangers and the weaknesses as well?
Spending on direct-to-consumer advertising and prescription drugs was steady over the years. In recent years, it has skyrocketed. Why? Because you put advertisements out there and people buy the drugs. The problem is, and the reason I brought it up in the Senate and made this public call, this advertising can lead to inappropriate use of drugs using too many of these drugs, using them for the wrong indications, overuse and underuse of the drugs. It could be an underselling of the risks that are actually in a drug. You see all the good things and the beautiful pictures and people running through fields, but at the same time you really do not see the dangers, the side effects that could be harmful, that could compromise your safety, the patient's safety and care.
The good news, based on that call, at least in part, is the pharmaceutical industry responded and I would say responded fairly aggressively. They soon after issued a set of guidelines for prescription drug advertising on newly released drugs. They got together and talked about the importance of their responsibility in this direct-to-consumer advertising, the fact that it is not just to improve their bottom line but it is health care, it is patient- centered, that you have to have the strengths but you have to give weaknesses of these drugs when you put them forward. So I applaud them. And that response is making a difference. That is one example. That is sort of a first step in guaranteeing patient safety and care.
I mentioned the GAO report. It has not come back yet. I look forward to receiving their findings, their results on the FDA's oversight, to come soon.
Other progress: Last summer, we passed the Patient Safety and Quality Improvement Act. It became law July 29, exactly a year ago, 2005. It also contributed to this patient-centered system which is consumer driven. It helps improve the quality and gets rid of the waste. When I say value, that is results, as I said, per dollar of input. You want to maximize that. So you want to get rid of the waste. You want to get rid of the abuse. You want to get rid of inefficiency. And we did a lot in that regard.
What this Patient Safety and Quality Improvement Act did was to help both improve quality and weed out waste by minimizing the fear of litigation. Now, why does that matter? It really comes down to--and I oversimplified it a little bit, but if you are a physician or you are a nurse and you are in a hospital and you make a mistake, and you feel bad about it, you should be able to share that information with other people so they can learn from your mistakes.
Quality improvement: We see it in airlines. We see it in general aviation. But we do not see it in health care--or we didn't before passing this particular bill. What we have been able to do in that particular bill is basically ease--without fear of a lawsuit coming after you. The reason it is not shared is because you know some greedy, predatory trial lawyer is out there and saying: Oh, there is a mistake. Let's go after them. What it does is put a barrier up there so no longer does that individual practitioner, doctor, or nurse have to have the fear of sharing information of an inadvertent mistake so others can learn.
The IOM report's most striking finding was that many providers do fail to report these medication errors that ultimately don't result in an injury. They fear these lawsuits. But without reporting this information, clearly, we cannot learn from our mistakes. That is what the Patient Safety and Quality Improvement Act addressed.
That brings me, finally, to information technology. The Senate passed a health information technology bill. It was bipartisan. I thank Senators Kennedy and Enzi and Clinton, all of whom worked with me and all of our colleagues in producing this bill--a bill called the Wired for Health Care Quality Act. What it does is it promotes the use of electronic medical records. It jump-starts America's transition to this 21st century system based on choice and based on value and based on outcomes by having a seamless network that is fully interoperable in terms of the transmission of health information, so doctor can communicate with hospital, can communicate with pharmacy, can communicate with patient in a seamless way, where records can be stored electronically. They can be transmitted electronically. If you are in Nashville, TN, and you live in Princeton, NJ, and you have an automobile accident as you are on I-41 through Nashville and you are taken to Vanderbilt Hospital, they can push a button, and in a secure, privacy-protected way, your record instantaneously shows up at the Vanderbilt emergency room and they can see what allergies you have, what medicines you have, whether you had previous heart disease, whether you can tolerate anesthesia--instantaneously; otherwise, they would have to repeat all those tests. They might not even be able to get that information.
That is the power. What it does is it builds a platform for the interoperable transfer of information--interoperability standards--that has the ability to transform the practice of medicine. That is how big these bills potentially are.
Doctors write about 2 billion prescriptions each year. We still write them, for the most part, by hand. And that spelling, what you look at, unfortunately, is misinterpreted. And as the IOM report documents, a lot of errors are still being made in that transmission of reading what a doctor had written at the pharmacy or at wherever the hospital might be distributing those drugs and then delivering it to the nurse and having the nurse give it to the patient. You get rid of all that--not all of it but most of it--by having that seamless flow of electronic information.
I think back to transplantation. I would have a patient. I would transplant the heart in Nashville and take care of them and have them on a drug called cyclosporine. And they would go back home, maybe 2 or 3 hours away, where another doctor would take care of them. If they got a cold, the local family doctor might put them on erythromycin, not knowing--because transplants were so new at the time--that if you put somebody on cyclosporine on erythromycin, their liver would fail. But it happened. They
may not know that cyclosporine was there. Well, with the electronic transfer of information, that physician would know that patient is on cyclosporine, and it would be instantaneous and immediate. If he wanted to put a patient on erythromycin and tried to prescribe it, a red flag would come up and say: No, you can't do that because the patient is on cyclosporine.
All this makes so much sense. Medical records today are stuck in the stone age. But every other sector of our economy has information presented in what is the information age. It is now time to bring medicine--it is amazing that medicine is still stuck in the stone age-- into this information age.
I will close on all this, but, as you can see, I am very excited about it. This particular bill which we passed and which will be married with the House bill helps fix all of that. It is going to go a long way to addressing the concerns that were in this IOM report last week.
Electronic medical records will improve health care. They will promote the secure exchange of privacy-protected information, and they will seamlessly integrate quality standards with information technology, all of which means to say better care, lower costs, greater accessibility, the elimination of waste, elimination of inefficiency as well as the medical errors themselves.
So the House has moved. We have moved. Now it is time to get to conference as soon as we possibly can. And if we do that, we will move our system toward that vision of the patient-centered system which is driven by consumers and 21st century information. It will save lives.