Louisiana Road Home Act

Mr. President, a month ago I outlined an important issue affecting all Americans who take prescription drugs or use medical devices--the need for greater transparency in the money that drug and device companies hand out to doctors. Today, I am pleased to introduce the Physician Payments Sunshine Act, along with Senator Kohl, chairman of the Special Committee on Aging. This legislation will bring much needed transparency to the financial relationships that exist between the drug and device industries and doctors.

There is no question that the drug and device industries have an intricate network of financial ties with practicing physicians. These financial relationships can take many forms. They can include speaking honoraria, consulting fees, free travel to exotic locations for conferences, or funding for research. Drug and device companies spend billions and billions of dollars every year marketing their products. A good amount of this money goes directly to doctors in the form of these payments.

This practice, and the lack of transparency around it, can obscure the most important question that exists between doctor and patient: What is best for the patient?

As the editorial board of the Des Moines Register wrote recently, and I quote, ``Your doctor's hands may be in the till of a drug company. So how can you know whether the prescription he or she writes is in your best interest, or the best interest of a drug company?'' That is an excellent question. Currently, the public has no way of knowing whether their doctor has taken payments from the drug and device industries, and I intend to change that--not just for Iowans but for all Americans.

Payments to a doctor can be big or small. They can be a simple dinner after work or they can add up to tens of thousands and even hundreds of thousands of dollars each year. That is right--hundreds of thousands of dollars for one doctor. It is really pretty shocking.

Companies wouldn't be paying this money unless it had a direct effect on the prescriptions doctors write, and the medical devices they use. Patients, of course, are in the dark about whether their doctor is receiving this money.

The Physician Payments Sunshine Act sheds light on these hidden payments and obscured interests through the best disinfectant of all: sunshine. This is a short bill, and a simple one. This bill requires drug and device manufacturers to disclose to the Secretary of Health and Human Services, on a quarterly basis, anything of value given to doctors, such as payments, gifts, honoraria, or travel. Along with the money, these companies will have to report the name of the physician, the value and the date of the payment or gift, its purpose, and what, if anything, was received in exchange. This bill then requires the Department of Health and Human Services to make the information available to the public through a searchable web site.

And this bill has some teeth, too. If a company fails to report, the Physician Payments Sunshine Act imposes a penalty ranging from $10,000 to $100,000 for each violation.

Many States are ahead of the curve on this and have passed, or are currently considering, similar measures. In 1993, Minnesota required the Nation's first public disclosure of gifts and payments from wholesale drug distributors. Vermont passed a similar law in 2003, although much of the information is not publicly available. More recently, the District of Columbia, Maine, and West Virginia have followed suit in requiring disclosure, though not all make the information available to the public through a web site. The General Assembly in my home State of Iowa may soon be requiring disclosure as well.

But this kind of information shouldn't be available only to Americans who happen to be lucky enough to live in a State already addressing this problem. On the contrary, this information should be accessible to all Americans across the country and it should be updated in a timely manner. I propose to my colleagues that now is the time to act.

I realize that some critics, including many of the drug and device companies, are going to say that creating this sort of national database is too time consuming and too expensive. I can hear the complaints already. But let me remind you again--the drug companies are already reporting their payments to doctors in Minnesota and other States. Companies already have this information available. We aren't requiring them to go out and obtain it--we are just asking them to share it with the American people.

Perhaps even more telling is that at least one industry leader has taken the goal of increased transparency into its own hands. Although it is not making its payments to doctors publicly available, Eli Lilly has taken important steps to meet the public's demand for increased sunshine. In response to my investigation of drug company payments for continuing medical education, Eli v Lilly voluntarily created a web site that details payments they make to organizations like patient groups and hospitals. I commend Eli Lilly for taking the lead on that issue, and I look forward to working with them on my latest effort.

This bill is careful not to burden small businesses--it applies only to companies with annual revenues over $100 million. It is the largest companies who are driving this practice, and for whom disclosure would be least burdensome.

Further, during a meeting on a separate matter with officials from Glaxo Smith Kline in early August, my staff brought up the idea of drug companies reporting payments to physicians. I am happy to say that Dr. Moncef Slaoui, the chairman of research and evelopment for Glaxo Smith Kline, said that he was also interested in a little sunshine. In fact, here are his exact words: ``We're happy for transparency.'' I would like to commend Dr. Slaoui for his comments and I look forward to working with him and leaders at other companies on this bill.

It is not only industry leaders who are leading the way on the issue of increased transparency--some of America's best medical schools are taking steps to prevent conflicts of interest among their physicians. In fact, the Yale University School of Medicine, the University of Pennsylvania, and the Stanford University Medical School have gone so far as to prohibit certain gifts and payments altogether.

So let me be clear. This bill does not regulate the business of the drug and device industries. I say, let the people in the industry do their business. After all, they have the training and the skill to get that job done. Just keep the American people apprised of the business you are doing and how you are doing it. Let a little bit of sunshine in to this world of financial relationships--it is, after all, the best disinfectant.

Mr. President, I am proposing today and will file legislation to create a comprehensive and nationwide process for voters to select nominees every 4 years for President of the United States. This legislation will establish six Presidential primary dates--the first one in March of a Presidential election year, two in April, two in May, and one in June.

Each of these contests would feature at least one State from six different regions, six geographic regions around the country. The order of States within each region would rotate every 4 years--every Presidential election. That order would be determined at the beginning by lot in order to determine the sequence. And then the next Presidential election, the ones who had gone first in March would then go to the end of the line and they would be in June, and the list would move up.

It would give voters in the larger States a strong voice in selecting the nominees over that 4-month period while also giving the citizens in the smaller States a fair say, instead of the present system we have now where the small States are the ones that have an inordinate influence in selecting the nominees of the two great parties.

So in this legislation, by featuring States from each of the six regions, there will be racial, ethnic, economic, and regional diversity on each of the primary dates. And, of course, it has a much more rational proposal for an agenda, in that you start in March and it concludes in June of the Presidential election year, instead of this chaotic situation we have now with States trying to get ahead of each other, with them starting now as early as the early part of January and with it being frontloaded so that, in effect, we may find the Presidential nominee decided by the middle of February.

I am introducing this legislation with my colleague Senator Levin of Michigan. It is our experience as Senators from Florida and Michigan that we have seen firsthand how unfair and undemocratic our Presidential primary system has become. I might say this legislation tracks Senator Levin's brother's legislation filed in the House of Representatives, Congressman Sandy Levin. Our bill is going to try to approach a rational way of selecting the nominees for President of the United States instead of this chaotic system we have now.

Now, neither bill is going to fix the current controversy we have over the sequence of the contest in Iowa, Nevada, New Hampshire, and South Carolina. For that, a short-term fix is certainly needed. What we have now is this chaotic situation where all the small States are trying to get ahead of each other. This certainty is needed to resolve the fix created by several States moving their 2008 primaries ahead of some of the other States. In my State, the Republican legislature of Florida--signed into law by a Republican Governor--moved the Florida primary from March to January 29. In Senator Levin's State, a Democratic legislature--signed into law by a Democratic Governor--moved its primary to January 15. What we may find is that other States may follow suit with a big jump.

I have proposed to the Democratic National Committee that it allow, for this particular Presidential cycle, the traditional first-in-the- Nation States to move ahead of my State on January 29; and, instead, the party leaders have decided that Florida's votes are not going to count in the 2008 Presidential primary. The DNC said Florida's earlier primary, which was signed into law by our Governor, would alter the sequence of Iowa, Nevada, New Hampshire, and South Carolina. So last month, the party officials decided to strip Florida of its 210 delegates to the national convention. That means that this country's fourth largest State will have no say in picking the Democratic Presidential nominee. Well, that is simply unacceptable.

Florida still has several weeks to find a solution for the DNC that it will accept; or, as I have suggested, legal action may be necessary. It is a case of fundamental rights versus the rules of a political party. And as to our right to vote, and to have that vote count, there can be no debate. I want to say that again. As to our right to vote, and to have that vote count, there can be no debate.

Senator Levin and I will work hard to ensure that the controversy over the respective positions of Florida and Michigan in the primary schedule are resolved; and, for the long term, our legislation would bring order to the next and all future Presidential primary seasons. It would ensure that no one State has a disproportionate influence on the selection of the nominees. By introducing this bill today, we want to begin a broader discussion about achieving lasting reform.

With the experience we have had in Florida, in the disputed Presidential election in 2000, and again 6 years later, with there having been an ``undervote'' of 18,000 votes in a congressional election in one county in Florida, Sarasota County, the sensitivity in Florida of having the right to vote and to have that ballot count, and to have that ballot count as intended, is paramount, and it is highly sensitive in the State of Florida. For a political party to punish a State for stepping out of line is the height of insensitivity in understanding that those votes are critical and that people know their sacred right of the ballot is protected. We

intend to see that the right to have their votes counted, and counted as they intend, is preserved.

In the meantime, we have to bring rationality to this process. The regional primary system set up in this legislation Senator Levin and I are introducing today is a suggested approach so that by the year 2012 we will have order in selecting our Presidential nominees instead of the chaos we find ourselves in now.

Mr. President, I ask unanimous consent that the text of the bill be

Mr. President, despite the record transportation funding that Congress provided in the 2005 Transportation Reauthorization bill, SAFETEA-LU, our Nation's infrastructure is being stressed to the breaking point. Our ports and rail lines are at or near capacity. Our highways are clogged. The tragedy in Minneapolis last month showed the entire country that our bridges are in desperate need of repair.

The American Society of Civil Engineers has noted that over the next 5 years $1.6 trillion in investment is needed from all levels of government to keep our Nation's current transportation system up to date. To put that into perspective, our Nation's infrastructure needs roughly six times as much funding as was included in SAFETEA-LU.

The question is ``Where do we find the transportation funding that our country needs to meet our transportation and our economic needs?''

Senator Thune's and my answer is to invest in America.

Everyone agrees that our country's infrastructure needs are tremendous. Everyone agrees that our country needs to invest more in transportation. What Congress hasn't been able to agree on is where to find the money. Gas taxes just don't generate enough revenues to even begin to satisfy highway and transit needs.

In this budget climate, pots of extra Federal money are not just sitting around waiting to be used, and States surely don't have any extra money either. Most have budget deficits. All the conventional funding sources are coming up short, so Senator Thune and I think it is time to think outside the box and outside the trust funds. The Federal Government is about the only entity in the country that does not borrow money for capital projects, but in this climate it should and it must.

Senator Thune and I have come up with a creative approach to provide $50 billion of additional new funding for transportation projects our country desperately needs by issuing Build America Bonds. Our country's needs are so great that we think funding should be made available that is in addition to SAFETEA-LU.

Our legislation is not a substitute for fixing the transportation trust fund. We still must address that problem, and next year we must start on a new transportation bill. Our legislation is meant to provide extra money on top of regular transportation funding.

This money could not be earmarked by Congress. This will not fund any Senator's pet project. This money will be controlled by the States, and used for the projects they think are most critical.

An annual amount of approximately $500 million from trade fees will be placed in an Infrastructure Finance Account and invested for the life of the bonds, which will generate more than enough to repay the entire $50 billion principal amount.

That means the only cost to the Government is the ``interest portion'' on the bonds, which is in the form of tax credits. With this funding mechanism, as little as $2 billion a year could generate the $50 billion in funding for transportation infrastructure. I call that a very smart investment in our country's infrastructure.

This investment is badly needed.

Citizens stuck in traffic choking on exhaust need relief. Truckers who need to detour miles out of their way to avoid weight-limited bridges need relief. As our economy struggles with stagnating wages, the loss of even basic health benefits for many, and a mortgage market that is spiraling downward, the American worker needs relief.

The U.S. Department of Transportation estimates that each $1 billion of funding for transportation directly produces nearly 50,000 jobs. So under the Wyden/Thune proposal the $50 billion of new transportation funding will provide critical economic stimulus that will create up to 2.5 million family wage jobs.

This is an economic stimulus idea that will generate more funding for the economy now. It will create jobs. It is a chance for the Federal Government to hold up its end of the bargain with our States.

Mr. President, I come to the floor today to speak about an important issue that will determine the success of long-term recovery efforts in the gulf coast. As you know gulf coast was devastated in 2005 by two of the most powerful storms to ever hit the U.S. in recorded history Hurricanes Katrina and Rita. We also experienced the unprecedented disaster of having a major metropolitan city, the city of New Orleans, under up to 20 feet of water for 2 weeks when there were 28 separate levee failures which flooded 12,000 acres, or 80 percent of New Orleans following Katrina.

I strongly believe that the Congress can provide vast amounts of tax credits, grants, loans, and waivers but all these benefits will not spur recovery if we cannot get people back into their homes. That is where recovery must start and end. In Louisiana alone, for example, we had over 20,000 businesses destroyed. However, businesses cannot open their doors if their workers have nowhere to live. Louisiana also had 875 schools destroyed. Again, teachers cannot come back to school and teach our children if they do not have a roof over their heads. So a fundamental piece of recovery in the gulf coast is to allow disaster victims to return home and rebuild.

Today, I am proud to introduce legislation which is extremely important to the recovery in the State of Louisiana. This is because, over the past few months, we have learned that the Road Home is facing a shortfall of billions of dollars due to various reasons. There is certainly more than enough blame to go around for the mistakes in the creation and management of the Road Home program, and fixing them will be a shared responsibility. But a significant initial flaw can be found in the inadequate and unfairly distributed funding which represented all the administration was willing to commit towards Louisiana recovery. At this stage, the funding shortfall threatens to stall recovery in Louisiana and leave homeowners without the vital funds they need to rebuild their homes. To address this important issue, the bill we introduce today includes an authorization of funds so that if the State of Louisiana puts up $1 billion towards the Road Home shortfall, additional funds necessary to shore up the program would be available. I strongly believe this bill will serve as a hand up, not a hand out. The State of Louisiana shares a financial obligation to address the shortfall and this bill would hold it accountable, but with the State meeting their obligation the Federal Government also would step in to help.

In closing, let me reiterate that this bill addresses one of the most fundamental needs following a disaster: the need to return home. Whether residents live in million dollar mansions, rental housing, or public housing they all share a desire to return to their communities and, in particular, their homes. I urge my colleagues to support this important legislation as now these disaster victims are counting on the Congress for action.

I ask unanimous consent that the text of the bill be printed in the Record.

Mr. President, I come to the floor today to speak about an important issue that will determine the success of long-term recovery efforts in the gulf coast. As you know gulf coast was devastated in 2005 by two of the most powerful storms to ever hit the U.S. in recorded history Hurricanes Katrina and Rita. We also experienced the unprecedented disaster of having a major metropolitan city, the city of New Orleans, under up to 20 feet of water for 2 weeks when there were 28 separate levee failures which flooded 12,000 acres, or 80 percent of New Orleans following Katrina.

I strongly believe that the Congress can provide vast amounts of tax credits, grants, loans, and waivers but all these benefits will not spur recovery if we cannot get people back into their homes. That is where recovery must start and end. In Louisiana alone, for example, we had over 20,000 businesses destroyed. However, businesses cannot open their doors if their workers have nowhere to live. Louisiana also had 875 schools destroyed. Again, teachers cannot come back to school and teach our children if they do not have a roof over their heads. So a fundamental piece of recovery in the gulf coast is to allow disaster victims to return home and rebuild.

Today, I am proud to introduce legislation which is extremely important to the recovery in the State of Louisiana. This is because, over the past few months, we have learned that the Road Home is facing a shortfall of billions of dollars due to various reasons. There is certainly more than enough blame to go around for the mistakes in the creation and management of the Road Home program, and fixing them will be a shared responsibility. But a significant initial flaw can be found in the inadequate and unfairly distributed funding which represented all the administration was willing to commit towards Louisiana recovery. At this stage, the funding shortfall threatens to stall recovery in Louisiana and leave homeowners without the vital funds they need to rebuild their homes. To address this important issue, the bill we introduce today includes an authorization of funds so that if the State of Louisiana puts up $1 billion towards the Road Home shortfall, additional funds necessary to shore up the program would be available. I strongly believe this bill will serve as a hand up, not a hand out. The State of Louisiana shares a financial obligation to address the shortfall and this bill would hold it accountable, but with the State meeting their obligation the Federal Government also would step in to help.

In closing, let me reiterate that this bill addresses one of the most fundamental needs following a disaster: the need to return home. Whether residents live in million dollar mansions, rental housing, or public housing they all share a desire to return to their communities and, in particular, their homes. I urge my colleagues to support this important legislation as now these disaster victims are counting on the Congress for action.

I ask unanimous consent that the text of the bill be printed in the Record.