Floor Statements

I ask unanimous consent to speak concerning the motion to waive the Budget Act on the Dodd-Stabenow amendment before proceeding with the vote.

Mr. President, I rise to debate that motion and support Senator Dodd in his motion. I am very proud to be joining with him in the Dodd-Stabenow amendment concerning fully providing the resources for our first responders in our communities all across America. I appreciate the constraints our chairman is working under, but I cannot imagine a more important issue for all of us today than this particular amendment.

This is not a partisan amendment. The terrorists who come do not decide who is a Republican or who is a Democrat, where one lives, their age or ethnic background. This is an issue for all of us as Americans, certainly for the people who work in this building who were directly in the line of attack on September 11, certainly for all of those across the country who understand that this is a new world since September 11, 2001.

When it comes to protecting our country from terrorists, we should do whatever it takes, period, to make sure we are safe. We cannot live by artificial limits, by bureaucratic budget procedures. Just as Congress has come together, working with the President, and said whatever our military needs, whatever it takes to prepare our men and women to be successful overseas, to support our military, to support our Department of Defense, we will do, period, to make sure our people are safe abroad as well as at home. We should do no less.

I join with Senator Dodd in saying this should not even be an issue that we are debating once we have seen this report--the emergency responders are drastically underfunded and dangerously unprepared--a report that does not just deal with one department; they look across the range of issues that relate to our folks on the front lines being able to respond, and they have a report about which every single American should be concerned. We should take this as a blueprint and immediately respond to it.

How do we determine what is the right amount to spend to protect our country? I cannot think of a more objective or credible group than the one which put this together. We should listen to the experts, and in this case a bipartisan commission of experts, charged with this task, who determined we need to spend an additional $98.4 billion over 5 years on top of what we are doing today. This is a shocking difference between what the American people need, what we need, and what we are providing as a Congress representing those American people.

This conclusion was reached by an impressive bipartisan commission. As the Senator from Connecticut has already indicated, it is led by former Republican Senator Warren Rudman, former White House cybersecurity chief Richard Clarke, and just to mention a few of those who have put these recommendations together for us and for the American people, a highly respected list of Americans, including the former Chairman of the Joint Chiefs of Staff, ADM William Crowe, former Reagan Secretary of State George Shultz, and former FBI Director William Webster.

When coming up with its conclusions, this distinguished panel consulted with organizations such as the International Association of Chiefs of Police, the International Association of Fire Chiefs, and the International Association of Fire Fighters. After much deliberation, this panel reached a dramatic conclusion, and the title of its press release says it all:

Nearly 2 years after 9/11, the United States is still

dangerously unprepared, and underfunded, for a catastrophic

terrorist attack, warns New Council Task Force.

I read from the summary of this report:

Nearly 2 years after 9/11, the United States is drastically

underfunding local emergency responders--

Police, fire, emergency medical personnel, others--

and remains dangerously unprepared to handle a catastrophic

attack on American soil, particularly one involving chemical,

biological, radiological, nuclear, or high-impact

conventional weapons. If the Nation does not take immediate

steps to better identify and address the urgent needs of

emergency responders, the next terrorist incident could be

even more devastating than 9/11.

Further, the summary reads:

The task force met with emergency responder organizations

across the country and asked them what additional programs

they truly need--not a wish list--to establish a minimum

effective response to a catastrophic terrorist attack. These

presently unbudgeted needs total $9.84 billion, according to

the emergency responder community and budget experts.

Finally:

The . . . Task Force . . . based its analysis on data

provided by frontline emergency responders--firefighters,

policemen, emergency medical personnel, public health

providers and others--whose lives depend upon the adequacy of

their preparedness for a potential terrorist attack.

This report says our local communities need much more than we are currently providing. This is not a critique from me, as the Senator from Michigan, it is not a critique by the distinguished Senator from Connecticut, it is not by any politician or any person right now who would gain from some partisan advantage. This is a group of experts on a bipartisan basis who come together as Americans to say we are not doing enough.

This report reaches the same conclusion I have heard from my own first responders in Michigan. I have spent a great deal of time traveling across Michigan since last fall, and I have done over 11 different townhall meetings in Michigan with police departments, large and small, fire departments, police chiefs, sheriffs--Republican sheriffs, Democratic sheriffs--those at the health department, the folks who run the emergency rooms at the hospitals, all of those involved, and overwhelmingly they have said: We are working very hard. We cannot do it alone. Please get beyond the ideological debate and talk about what we need to prepare us to be safe.

It cannot be done just by asking the local city, township or county to provide additional resources alone. This is a national attack on our country. It needs a partnership from all of us, and they are speaking loudly that they need our help. More importantly, we need to make sure they are prepared and they are stepping up to the effort.

Unfortunately, they are receiving less from our State governments that are uniformly in a budget crisis. In Michigan, we are seeing about 26 percent of their general fund budget lost through the economy, through various decisions made at the State level. They need our help.

This amendment is much more than dollars. It is really not about the dollars. It is about being safe. It is about being prepared. It is about saying, We get it; we understand we have to do whatever it takes to be able to say to our own families: We are prepared in case another attack comes.

I heard from Michigan police and firefighters and emergency responders that the issue of radios is not some theoretical debate. The ability to communicate between the fire department and the police department or the city and the county, to be able to communicate in a way to respond most effectively if there is a message or an attack is not happening because of the lack of radios. They do not have the state-of-art radio technology, interoperability, to be able to communicate with one another. Imagine how difficult it is to coordinate a response after a terrorist attack if the department has only antiquated radio equipment. How basic can you get than being able to make sure people can communicate with each other?

This is not rocket science. We are talking about the ability to communicate, so they can call someone; so when you call 9-1-1 you know the folks on the other end can call the right people and talk to them to give you the help you need, to get the response you need in the community.

The Rudman report concluded, on average, fire departments across the country only have enough radios to equip half the firefighters. Only 33 percent had proper breathing apparatus. So there is a one out of two chance that the fire department will be able to communicate and only one-third of the personnel in the community have breathing apparatus. Furthermore, only 10 percent of United States fire departments have the personnel and equipment to respond to a building collapse. The Rudman report also stated that police departments in cities across

the country do not have the proper protective gear to safely secure a site following a weapons-of-mass-destruction attack. This type of gear, which we have as Senators and for staff, costs money to procure. Tragically, the men and women on the front lines of the war on terror do not have the equipment. They do not have the equipment I have in my office. That does not make sense. That is not fair. It is not right. There is not one American that would think we are doing the job when they look at the facts in this report.

The Rudman report said public health labs in most States still lack basic equipment and expertise to properly respond if there is a chemical or biological attack. In fact, 75 percent of State labs say they are overwhelmed with current testing loads. It is not that folks do not want to be prepared. It is not that they cannot have the expertise. These are competent people. It is a question of training. It is a question of having the right kind of equipment and technology. This is the United States of America. We can do better. We have to do better.

There are many other concerns. I have heard from local safety officials during my 11 town hall meetings. I heard from police chiefs who say they need resources to provide training, not only to have the trainer come in, but when you take an officer off the beat, off their regular assignment, for a week or 2 weeks or longer, we have to replace them or pay overtime to their replacement. That costs resources which are very difficult to come up with. So training becomes a major challenge for them--both in losing their staff to regular assignments, answering those calls in the neighborhoods, as well as the costs of the training and the equipment needed relating to the training. This becomes a major issue.

I believe the U.S. Government needs the flexibility, as well, so we are not tying their hands. We are saying these are the resources available, you decide what you need in training and equipment and make sure you have enough staff. You make those decisions. This is important. This is front-line defense. I trust the men and women in the State of Michigan and across the country to make the right decisions about what they need to be prepared and to keep us safe.

We have a motion challenging this amendment because it costs dollars. I reiterate, we spend resources and we make priorities every day based on what is important, what are our values, what are the most important things that affect Americans, that affect our families, that affect our communities. I cannot imagine something more important than this issue. I cannot imagine saying to families--and God forbid something happens-- we were not willing to commit what was needed to keep you safe.

As my colleague from Connecticut said, we are spending about $4 billion a month, in other words, $1 billion a week in Iraq, almost $50 billion a year. This amendment costs less than a third of that to keep us safe at home. We know the tax cut passed earlier this year is much more than this amendment. The 10-year cost of the tax cut was almost $1 trillion. The total price tag includes $400 billion in tax cuts for those at the very top income bracket, and those with stock dividends and capital gains. In the State of Michigan there is not one person receiving another tax cut who is doing very well in the State of Michigan who would not say to me: Make sure my family is safe, first. I appreciate having another tax cut, but I want to make sure my family is safe. I am willing to wait a little bit. I will delay that because there is a higher value, a higher priority here. That is, making sure we do not lose human life in America on our own soil through another attack.

We can afford this amendment. All we need to do is slightly scale back some of the tax relief--again, to those who do very well in our country. We want everyone to do well in our country. We want everyone to have the opportunity to succeed. But we want to make sure, first, that they and their families are safe.

It does not matter how much you make in this country when it comes to a terrorist attack; we are all the same. We all join in wanting to make sure we are safe. God forbid there is another terrorist attack on our country. I hope and pray there will not be. But we must be fully prepared. We cannot be partially prepared. We cannot be half prepared. We need to do whatever it takes to help our firefighters, police officers, and first responders to protect us from terrorism.

As we watch the television news, we see a world in turmoil. There is violence against our own soldiers in Iraq. We watch Iran and North Korea develop nuclear weapons that could be sold to terrorists. We have not yet found Osama bin Laden. We cringe when we hear about increased nuclear tensions between Pakistan and India. And we are now witnessing chaos in Liberia. Since September 11, we live in a new world. We can no longer sit back and wait.

We must take action now to protect the American people. This amendment will do that. This amendment is based on those who have studied and have expertise and care deeply as Americans about keeping us safe and secure. This is not a political amendment. This is not an amendment designed in some way to split Democrats and Republicans. This is an amendment designed to meet the needs of those who are charged with protecting us.

The Homeland Security bill before the Senate provides the Department of Homeland Security with $28.5 billion for the next fiscal year. While it is a first step, this report makes it clear it is not enough to keep us safe. Protecting our country is not something we should simply squeeze into the normal appropriations limits. We are vulnerable. We must act now, not later. Otherwise, I am concerned that we will be sorry.

When my colleagues vote, I urge you to think of all those unmet needs in your State, in your community. Think of all the critical infrastructure that is barely protected, and consider what a biological attack could do to you and your family and to the people you represent, and then join with us in doing what the experts are telling us to do: Provide what is needed, whatever it takes to keep us safe.

We can do better for the American people. We are America; we can do what it takes to keep us safe. This amendment puts us in the direction of doing that. I urge support for it and support for a motion to waive.

Will my colleague yield for a question?

I wonder if you might respond a little more on how we will be able to find the dollars? Because, as both of us have indicated--I know you have indicated in Connecticut; I have indicated it in Michigan--there are those who are doing very well, certainly in my State. They have the same concerns as everybody else about being safe and secure. If we ask them to be willing to delay receiving a little bit more back in their pockets, those who are doing very well, in order to be able to put it into keeping their families safe, I think they would be willing to do that.

Isn't that what the Senator is suggesting, that we look at our priorities and decide what is most important in terms of safety and security?

I thank my colleague again for his leadership on this issue.

I have had 11 different meetings from Detroit--large urban areas--to Macomb County, all the way up to Marquette in the upper peninsula, and over to the west side of the State. This report talks about only 50 percent of our firefighters having the radio equipment they need.

I heard firsthand from the folks on the ground, and I am not sure it is even 50 percent. They talked about in some cases the fire department could not talk to the police department in the same city, that the city could not talk to the county.

When we call 911, we expect that call is going to lead to a series of other communications, that it is going to get the right people to us, and that we are going to be able to respond quickly. In the case of a bioterrorism attack, the public health department, of course, is very concerned about the inability to communicate with the fire department. And it is not that they do not have radios; it is that they do not have interoperability. They do not have the same frequency. They do not have the same technology. There is newer and newer technology that allows them to communicate ideally all across the whole State.

We hope we will be developing communications equipment that will have everybody in the county being able to talk to each other and able to talk around the entire State. But the radios, the communications systems were a major issue in those meetings.

The second major issue was training, the ability to have the newest training, the newest equipment in case of a bioterrorism attack. And then, of course, the whole question of added personnel.

I might just add, I believe the sense of urgency occurs here because of the lag time it takes when we approve the dollars to do the training, to get the equipment. I know last year, as a border State, in Michigan, this was a major issue for us. In Detroit, we have the largest border crossing of the northern border. We have over $1 billion in goods that come across the border every day.

And when we put in place--thanks to the support of our colleagues on both sides of the aisle--additional resources for Border Patrol and Customs, it has taken almost a year to train those folks. We are just now seeing the increased personnel at the border as a result of decisions made a year ago to increase the dollars.

Even if we do this now, we are talking about months or a year before the training can actually happen and take effect or that the communications equipment can be purchased and put together. I think there is even a greater sense of urgency as a result of the fact that it takes time once we even make the decision.

The Senator makes such an important point. I was thinking, as he was speaking about how we are losing a firefighter a day--I believe he said as a result of not being prepared for the challenges they face--we have people now, unfortunately on a daily basis, who are losing their lives in Iraq. We are deeply concerned about our troops.

But can you imagine if we said that only half of our military men and women in Iraq could talk to each other through their radios, that only half or maybe only 10 percent have the training they need, or that they did not have the equipment they need. Our Commander in Chief, rightly so--our President--has stepped forward and said: Whatever they need to be prepared, we will make sure they have it.

As the Senator has indicated--and as I have as well--the folks on the front lines at home, in their uniforms, should have no less consideration. Why don't we say, whatever you need--if you are wearing a firefighting uniform, a police officer's uniform; if you are emergency medical personnel--you ought to have whatever you need on the frontline fight because it is a war on terrorism. This should not even be a debate. I think when we compare it, it is startling to think about what we are saying to the men and women on the front lines at home.

Mr. President, I thank my colleague and dear friend from Maryland. She has been waiting to speak for a long time. I appreciate her graciousness in allowing me to speak for a moment.

This is a very unfortunate time in the State of Michigan. We have traditionally had bipartisan cooperation on issues that affect our wonderful State and the people we all represent. I cannot think of a time when we have had in previous Congresses Republican colleagues on the House side doing press conferences and attacking the Senators. It is very unfortunate.

Let me speak first to the numbers our distinguished majority leader just used and other Members on the other side of the aisle. It is my understanding those numbers about backlogs were prior to the filling of four vacancies on the Sixth Circuit. So we are looking at a situation where there have been four vacancies already filled. Retired judges are used to hear cases.

We do not hear about the kind of backlog and the concern about the lack of justice going on in the Sixth Circuit. I believe that is absolutely inaccurate. What we do hear is a great concern about playing politics.

There was an effort to hold up all the nominees to the Sixth Circuit under President Clinton. Now, coming into this Senate, Senator Levin and I have attempted to work with the administration to have a bipartisan solution to stop this. That is what we have been about, not going on with partisanship, which is what is happening now. Rather than working with us for a bipartisan solution, we see partisan press conferences. We see our colleagues on the other side of the aisle, and unfortunately our colleagues in the House on the Republican side, holding press conference after press conference attacking us, rather than working things out.

How do we work it out? Well, many States have bipartisan commissions to recommend nominees to the President, working with the Senators. We have put forward the Wisconsin motto which has the Senators from one party placing four people on a commission. The senior Republican in this case, Congressman Sensenbrenner from Wisconsin, who is a part of this process, nominates four. They have two people from the Wisconsin bar, and the heads of the law schools. It works. It has been embraced by the White House.

It is disconcerting to me to see what has been agreed to and worked well in Wisconsin will not be allowed in Michigan. We know that in Washington State there is a commission. We know there are agreements in other States to work together with the Senators. But somehow in Michigan, instead of doing that, so our families, our workers, and our businesses can be represented and know that we will provide mainstream judges in a bipartisan way, we see unfortunate comments on the floor, we see misinformation, we see political press conferences over and over again.

This is how we got to this situation. It was partisanship in the last Senate under President Clinton, holding up the nominees. We are trying to change that and say let's stop this.

Instead of press conferences, I welcome colleagues in the Senate, as well as our House Members, to join us, to sit down and develop a motto such as Wisconsin and other States, where it works in a bipartisan way, to be able to put forward judges to fill these vacancies.

It is important who is on the bench. This is not the President's prerogative alone, nor any individual Senator. It means we need to work together because our families are affected, our business community, issues of privacy, health care, business law, the environment. Many issues are affected, and so it matters who is on the court from Michigan. We simply ask that we be treated with fairness as other Senators in other States have been, and we will continue to work to that end.

I yield back for my colleague from Maryland.

Madam President, I rise to support the Corzine amendment. I think this is an incredibly important amendment to this important bill. In doing so, once again, as I have done before on this floor, I commend our service men and women who have served us so well in Iraq, as well as around the world.

We join in our pride and gratitude for their courage and their service.

However, I must rise today to express my deep concern about revelation after revelation of the fragile nature of the facts presented to the American public and the world about the reasons we had to preemptively, unilaterally attack Iraq.

Those misleading words in the President's State of the Union Address this past January have brought into question the credibility of our Government. This is extremely serious. It hurts our country because Iraq is not the only threat to our Nation, as the Senator from New Jersey indicated. We continue to be threatened by terrorists in emerging nuclear countries such as Iran and North Korea. In order to win the war on terrorism and ultimately disarm Iran and North Korea, we are going to have to work with NATO and other allies to protect American citizens.

Unfortunately, the misleading statements about Iraq attempting to purchase uranium from Niger will make building such coalitions even more difficult. This means our homeland will be less safe and our American citizens less secure. This is a deep concern of mine. I wish the misleading statements about Iraq and Niger were the only statements in question that the President and his administration have made to the American people. Unfortunately, there have been others.

First, let's go through what transpired with the statements on Iraq and Niger. Before the State of the Union referencing Iraqi purchases of uranium from Africa, the administration, at the direction of the CIA, took out a nearly identical line in a speech the President gave in Cincinnati last October justifying the use of force in Iraq. Then, the African uranium purchase was back in the State of the Union Address, although we were told now this was a mistake by the CIA director George Tenet. Then, the African reference was dropped from Secretary of State Powell's presentation on Iraqi weapons capabilities to the United Nations just 8 days later. Then, Saddam's nuclear weapons came back with certainty when Vice President Cheney appeared on Meet the Press in March and said, ``We believe he has, in fact, reconstituted nuclear weapons.''

This was one of the main assertions used that took us to war, and I believe the American people have a right to know which is it. If it was good intelligence, why the constant change of mind? Either Iraq had nuclear weapons or it didn't. If it was bad intelligence, who kept pushing to use it in the administration speeches and interviews? We need to know the answers to these questions. It is important for the credibility of our country and for the trust of the American people in our Government.

It does not end there. We heard much about specially-made aluminum tubes that could be used to build centrifuges to create weapons-grade uranium. In the same State of the Union where he referenced uranium purchases from Africa, President Bush also said: Our intelligence sources tell us that he has attempted to purchase high-strength aluminum tubes suitable for nuclear weapons production.

But, in fact, an unclassified intelligence assessment back in October stated some intelligence specialists ``believe that those tubes are probably intended for conventional weapons programs.''

Last February, Secretary of State Colin Powell told the U.N. Security Council that ``we all know there are differences of opinion,'' and that ``there is controversy about what these tubes are for.''

However, the International Atomic Energy Agency, after conducting its own study, concluded the uranium tubes were not for uranium enrichment.

Which is it? Enough time has gone by; we should have and are entitled to answers. We are entitled to the truth. Most importantly, the American people are entitled to the truth. Although we now have more than 140,000 troops in Iraq, we have not yet found chemical or biological weapons or even the plants needed to make them. We have not found evidence of al-Qaida training camps, although in the runup to the war the administration not only said they were there in Iraq but that they knew precise locations.

Again, this administration has taken us into a new age, an age where we claim the right to unilaterally, preemptively strike another nation because we believe our national survival is at stake. In such a world, the intelligence used as proof for striking first has to be unassailable, has to be totally credible, or the American people and our allies will be deeply suspicious of any future claims.

The claims led to decisions to put American men and women in harm's way and in too many instances have led to the loss of life. We need to find out the truth behind the various claims and questions, legitimate questions that have arisen, questions that have been asked by colleagues on both sides of the aisle, questions that have taken us into the deserts of Iraq and put our men and women in harm's way.

The only way we can get to the bottom of this is to set up an independent commission to get the facts, a bipartisan commission, a way to objectively look at what happened so it does not happen again.

There is nothing more serious than a potential nuclear threat to our people. If there was ever a need for an independent commission, it is now. We now

face potential nuclear threats from Iran, from North Korea. We could face more in the future. American families and our American troops deserve answers to the questions that have been raised. We all deserve answers. We all deserve the truth.

I hope my colleagues will join in support developing this independent commission. I believe nothing less than the credibility of our country is at stake. I hope we all join in supporting the Corzine amendment.

I yield the floor.

Mr. President, I rise today to introduce legislation

along with Mr. Levin, that would stop the implementation of a new

Metropolitan Statistical Area, MSA, in the Michigan counties of Kent,

Ottawa, Muskegon, and Allegan, KOMA.

On June 6, 2003, the Office of Management and Budget issued its

Bulletin No. 03-04 on Revised Definition of Metropolitan Statistical

Areas, New Definitions of Micropolitan Statistical Areas, and Combined

Statistical Areas, and Guidance on the Use of the Statistical

Definitions in These Areas.

This bulletin finalizes a process that began with the last census.

Statistical areas, as explained by the OMB, are designed solely for

statistical purposes. As stated in the bulletin, they are designed to

``provide nationally consistent definitions in collecting, tabulating,

and publishing Federal statistics for a set of geographic areas.'' The

problem is that the are used for much more than that. They are

principal tool for allocating Federal dollars. And, although OMB

recognizes this, it will ``not take into account or attempt to

anticipate any nonstatistical uses that may be made of the MSAs.''

This is a serious problem. On one hand, we are implementing new MSAs

to serve basic statistical purposes. On the other hand, these new MSAs

are critical for the allocation of Federal money and OMB does not

consider, in the least bit, how these new MSAs may negatively or

positively affect communities. It is easy for OMB staff to say that

their hands are tied by rules and strict methodologies, but this is not

about number-crunching. This is about real dollars for Michigan.

I have heard from numerous constituents in West Michigan who are

concerned about how these new statistical, designations will affect

Medicaid and Medicare payments, Housing and Urban Development grants,

Community Development Block Grants, and other important programs in

Michigan. I share these concerns and want to make sure that we do not

allow a new system of Federal dollar allocations to come into effect

that would hurt West Michigan. We need time to study the impact of the

new MSAs. That is why I am offering legislation to stay the

implementation of the new West Michigan MSAs until October 1, 2004,

leaving the current Kent-Ottawa-Muskegon-Allegan, KOMA, MSA in place.

The KOMA region has developed a common identity over the last decade.

It shares regional challenges such as tourism, transportation networks,

environmental protection, and community health. Business leaders have

worked hard to market the region as a common community with much to

offer potential new businesses and families looking to relocate. I do

not want these leaders to lose this marketing tool. By the OMB setting

up a new MSA with no consideration of the economic and social

integration of the existing MSA, we could see the undermining of a

great deal of progress for this part of Michigan.

We, in Congress, should eventually look at this issue of MSAs

comprehensively. We should ensure that communities do not have to fact

this uncertainty every decade with a new census. We should either

ensure that the OMB takes into account economic and other community

concerns when creating MSAs or we should make sure that Federal funding

allocations are not made through MSAs. Regardless, in the short run, it

is essential that the hospitals, the community development

organizations, the business leaders, and the social service providers

of West Michigan who are raising these concerns with me have time to

study the problem and understand the impact of OMB's decision. Once

that has been studied, we can work with OMB and

the interested parties to ensure that there is no loss of Federal money

to West Michigan.

Mr. President, I rise today to introduce legislation

along with Mr. Levin, that would stop the implementation of a new

Metropolitan Statistical Area, MSA, in the Michigan counties of Kent,

Ottawa, Muskegon, and Allegan, KOMA.

On June 6, 2003, the Office of Management and Budget issued its

Bulletin No. 03-04 on Revised Definition of Metropolitan Statistical

Areas, New Definitions of Micropolitan Statistical Areas, and Combined

Statistical Areas, and Guidance on the Use of the Statistical

Definitions in These Areas.

This bulletin finalizes a process that began with the last census.

Statistical areas, as explained by the OMB, are designed solely for

statistical purposes. As stated in the bulletin, they are designed to

``provide nationally consistent definitions in collecting, tabulating,

and publishing Federal statistics for a set of geographic areas.'' The

problem is that the are used for much more than that. They are

principal tool for allocating Federal dollars. And, although OMB

recognizes this, it will ``not take into account or attempt to

anticipate any nonstatistical uses that may be made of the MSAs.''

This is a serious problem. On one hand, we are implementing new MSAs

to serve basic statistical purposes. On the other hand, these new MSAs

are critical for the allocation of Federal money and OMB does not

consider, in the least bit, how these new MSAs may negatively or

positively affect communities. It is easy for OMB staff to say that

their hands are tied by rules and strict methodologies, but this is not

about number-crunching. This is about real dollars for Michigan.

I have heard from numerous constituents in West Michigan who are

concerned about how these new statistical, designations will affect

Medicaid and Medicare payments, Housing and Urban Development grants,

Community Development Block Grants, and other important programs in

Michigan. I share these concerns and want to make sure that we do not

allow a new system of Federal dollar allocations to come into effect

that would hurt West Michigan. We need time to study the impact of the

new MSAs. That is why I am offering legislation to stay the

implementation of the new West Michigan MSAs until October 1, 2004,

leaving the current Kent-Ottawa-Muskegon-Allegan, KOMA, MSA in place.

The KOMA region has developed a common identity over the last decade.

It shares regional challenges such as tourism, transportation networks,

environmental protection, and community health. Business leaders have

worked hard to market the region as a common community with much to

offer potential new businesses and families looking to relocate. I do

not want these leaders to lose this marketing tool. By the OMB setting

up a new MSA with no consideration of the economic and social

integration of the existing MSA, we could see the undermining of a

great deal of progress for this part of Michigan.

We, in Congress, should eventually look at this issue of MSAs

comprehensively. We should ensure that communities do not have to fact

this uncertainty every decade with a new census. We should either

ensure that the OMB takes into account economic and other community

concerns when creating MSAs or we should make sure that Federal funding

allocations are not made through MSAs. Regardless, in the short run, it

is essential that the hospitals, the community development

organizations, the business leaders, and the social service providers

of West Michigan who are raising these concerns with me have time to

study the problem and understand the impact of OMB's decision. Once

that has been studied, we can work with OMB and

the interested parties to ensure that there is no loss of Federal money

to West Michigan.

In May of this year, unusually heavy rainfall occurred in four countries of the Upper Peninsula of Michigan causing rivers and streams throughout the area to swell out of their banks, inflicting severe and widespread damages. The greatest damages occurred in Marquette County where an earthen dike at Silver Lake Basin failed, sending and estimated 8 billion gallons of water cascading downstream through the city of Marquette toward Lake Superior.

The floodwaters destroyed or damaged numerous public and private structures and caused unprecedented environmental and ecological damage within the Dead River Basin and into Lake Superior in Marquette County. Two power generation facilities were damaged. One of the power generation facilities, the Presque Isle plant in the city of Marquette, resulted in shutdown for more than 30 days.

Without power, two iron ore mines, which produce about 20 percent of our Nation's annual iron ore output, were shut down, idling 1,200 workers. Dozens of other area businesses, institutions and private homeowners were also seriously impacted. Three of the four counties affected are impoverished, with a majority of the population over 65 years of age. Local governments simply do not have the capital to pay for the public damages. Without an infusion of Federal aid, Marquette and the other three counties will have a difficult, if not impossible, task of recovering from this disaster.

Mr. President, I take a moment to send my thoughts and prayers to the family of Senator Strom Thurmond of South Carolina, a man of a remarkable career who made his mark in the permanent history books of the Senate and the country. I know he will be remembered at the funeral next week that many colleagues will be attending. We send our thoughts and prayers to his family at what I am sure is a difficult time as they face this loss.

Mr. President, last night's vote on the Medicare prescription drug bill is one of the toughest votes I have cast since becoming Senator in 2001.

As the people of Michigan know, I made the issue of adding a prescription drug benefit to Medicare one of the centerpieces of my 2000 campaign. I told Michiganians that if they sent me to the Senate, I would fight to add a meaningful prescription drug benefit to Medicare. I also said I would do everything within my power to lower prescription drug prices for everyone.

For years, I have crisis-crossed Michigan and listened to seniors who desperately need help with paying for their medicines. I have heard from middle class, retired people who have had to cut pills in half because they could not afford to pay for their full prescriptions. I have gone with seniors to Canada where they could actually afford to buy American-made prescription drugs because they cost so much less north of the border.

Since 2001, I have sponsored and co-sponsored bills that would provide a comprehensive prescription drug benefit in Medicare and lower prices for all Americans. These are the goals that I have fought for and have spoken out for on this Senate floor time and time again.

Specifically, I have cosponsored S. 7, a bill that would provide a meaningful Medicare prescription benefit. And I have co-sponsored bills to open the border to Canada to allow families to purchase low-cost, F.D.A.-approved drugs made in the U.S. that have been sold in Canada for half the price or less.

I have co-sponsored legislation creating more competition to lower prices by allowing more generics, or unadvertised brands on the market and helping States set up bulk purchasing programs to lower prices for those without health insurance to help pay for their prescription drugs.

I have particularly focused on lowering prices for all Americans because the soaring cost of prescription drugs is hurting all of us.

When a brand-name prescription drug goes up in price three times the rate of inflation, everyone is affected by that. It hurts our seniors, many of whom must pay for prescriptions directly out of their pockets. It harms our businesses by dramatically increasing their health care costs. The average small business has seen their health care premiums double in the last 5 years. This affects our ability to grow and to provide new jobs.

The bill that the Senate passed last night only accomplishes some of my goals. It has its strengths and weaknesses. It is a step in the right direction, but only a beginning step.

On a positive note, this bill establishes an outpatient prescription drug benefit for all seniors for the first time since the entire program was created in 1965.

Currently, Medicare only covers prescription drugs for those who are in the hospital. As we all know, this has been a seniors challenge for our seniors.

Unfortunately, the benefit is confusing and will vary depending upon decisions made by insurance companies, but at least this bill establishes for the first time that there should be a benefit.

The bill provides a benefit for low income seniors who make less than 160 percent of poverty. Married couples earning less than $19,392 per year will receive a comprehensive prescription drug plan. This will help approximately 350,000 seniors in Michigan. Again, this is a step in the right direction.

This bill also provides a catastrophic benefit for seniors who have extraordinary prescription drug bills each year. For some seniors, it is not uncommon for them to have monthly prescription drug bills of over $1,000 per month or $12,000 per year. This bill has a catastrophic cap at $5,800 per year. After $5,800, seniors would only have to pay 10 percent of additional out-of-pocket costs in one year. This is a positive step.

This bill also includes several improvements in payments for Medicare providers. Since 1997, many Medicare providers have been underpaid and have been forced to make difficult decisions regarding serving new Medicare patients. Specifically, this bill provides increased payments for rural providers such as hospitals, ambulance services, and home health agencies. This is important to the people of Michigan.

The bill also makes great strides in helping to lower prescription drug prices for all Americans. For the first time, we have closed loopholes in our drug laws that have allowed brand name drug makers to keep lower cost generic drugs off the market. This bill will mean that there will be more competition between similar drugs and thus lower prices for families, for businesses, and for everyone using prescriptions drugs. This is a positive aspect that I have been fighting for, for the last 2\1/2\ years.

It also includes a provision that I have long championed that will allow pharmacies and families to purchase lower priced prescription drugs from Canada. In some cases, the same drugs that are sold in Canada can cost up to 50, 60, or 70 percent less than they cost here in the U.S. That makes absolutely no sense.

Regrettably, opponents of this type of free market competition attached a provision that allows the Secretary of Health and Human Services to stop its implementation. I hope that HHS Secretary Tommy Thompson will not block it and allow U.S. citizens to get lower priced, FDA approved, American made prescription drugs from Canada.

Unfortunately, this bill has serious drawbacks as well which is why it has been such a difficult situation for me. The Republican Congress, along with the President, has not been willing to allocate enough funding to provide a comprehensive benefit to most of our middle class seniors.

They arbitrarily picked a figure of $400 billion in total spending for 10 years even though we know that it would take twice that amount to provide American seniors with the same kind of prescription drug coverage that we in the Congress enjoy. Why was that decision made? I have always said this is a question of values and priorities.

Which is more important, or more effective, putting money in people's pockets and improving the quality of life for Americans, another trillion dollar tax cut for the privileged few, or meaningful prescription drug benefit that will help our seniors and their families afford live saving medicine and put money back in people's pockets through lower prescription drug prices.

The answer to that question, I believe, is very clear. Unfortunately, misplaced priorities have resulted in a prescription drug plan that is much less than American families need and deserve.

There are many short-comings in this plan that I will continue to do everything in my power to correct.

For example, the drudge benefit stops when a senior's drug expenditures are between $4,500 and $5,800. During that period, after seniors have spent $4,500 on their prescription drug costs, and before they reach $5,800, seniors would pay 100 percent of that $1,300 in prescription drug bills. This is a major gap in coverage.

Secondly, the copayments, the deductibles, the premiums are too high and too unpredictable. The $35 premium often quoted is not even guaranteed in the bill. Seniors will be left to the mercy of insurance companies that will decide the premiums and the benefits that will be provided. This is not in the bill. It is up to the insurance companies.

Another very important issue relates to those who already have prescription drug coverage. There is currently not enough incentive in this plan to make sure employers do not drop existing prescription drug coverage for their retirees. This is a very important issue for the retirees in Michigan.

I will continue to fight for changes in this legislation to protect those who currently have coverage, who have worked hard their whole lives, who have retired and have been fortunate enough to have good benefits and are very concerned that they not lose them, as we work to help others who do not have coverage. It makes no sense to set up a system that might actually take away benefits currently being provided to retirees through private insurance.

Furthermore, one of the most negative parts of this bill is the fact that it does not allow seniors to get their prescription drugs through the traditional Medicare system as their first choice. Under the bill passed by the Senate, seniors must pick a private prescription drug plan or enroll in a private PPO or HMO if one is available to them.

Traditional Medicare, that seniors know and depend on, is only available if private plans are not available. Does this make sense? Only if you are a pharmaceutical company or an insurance company. I believe seniors should have many choices, including the choice to stay in the Medicare Program they know and trust.

As I have said so many times before on this Senate floor, when given a choice between traditional Medicare and a Medicare HMO, 89 percent of our American seniors and persons with disabilities have chosen traditional Medicare--89 percent.

This choice is not available to them under this bill. I believe this is a major flaw that I will continue to do everything I can to correct.

During debate on this bill, I sponsored and cosponsored and supported amendments that would have corrected all of these problems. These amendments would have stopped the benefit shutdown, reduced out-of- pocket costs, protected current retiree coverage, and provided a real comprehensive Medicare prescription drug benefit. Regrettably, none of these important amendments received the necessary support from my Republican colleagues to pass.

When deciding how I would cast my vote on this bill, I looked at all of these things: the positive and the negative. I evaluated whether or not this was a step forward for Michigan families, for Michigan workers, for Michigan businesses and, most importantly, for our seniors who have waited too long for help to pay for their medicine.

After many hours of thoughtful review and discussions with those affected by this legislation, I voted in favor of this bill last night, not because it was the best we can do but because it is a first step in the right direction. This direction--the direction in which we need to move--is for a real, meaningful prescription drug benefit for our seniors who have waited too long for their Government to act.

We were successful in improving this bill in some ways during this debate, but much more needs to be done. There will be other opportunities to do so, and I will take them.

This bill does not take effect until 2006. So between now and then I will be fighting hard to provide seniors with the real prescription drug benefit they need and deserve, and I will continue to help lead the fight to lower prescription drug prices for everyone.

As we know, this legislation is not finished. It must now go to a conference committee, a joint committee between the Senate and the House of Representatives, where differences between the Senate and House bills will be addressed. There are critical differences between the two bills.

The House of Representatives passed, by only one vote, a bill that truly begins to unravel Medicare. The House started down the road of privatizing the health care system of senior citizens and the disabled in our country. They voted to begin the process of turning back the clock to the days when too many seniors and families could not find or afford private insurance.

If I had been in the House of Representatives last evening, where I served for 4 years, I would have voted no. If the House bill comes before the Senate as it is currently written, I will vote no. Unlike the Senate, where we worked in a bipartisan way to develop a plan that the majority of Senators could support, the House process was very partisan and polarizing, and it resulted in an extreme plan that could not be supported by my Democratic colleagues who care deeply about strengthening and preserving Medicare for the future.

Our seniors expect and deserve the best plan we can offer. I will continue to work with my colleagues to achieve that goal. And I hope and pray that we will be successful.

Madam President, I yield the floor and suggest the absence of a quorum.

Mr. President, I am very proud to be joining with my colleague on this very critical amendment. Can you imagine, you are someone who has worked hard all of your life, you have been fortunate enough to have a good-paying job with benefits, you are now retired and you are fortunate to have good health benefits and you find yourself in a situation that, as a result of an action taken here--and certainly there is an effort to move forward and provide people with prescription drug coverage--but if those who already have coverage find, as a result of an action we take, there is an incentive for their employer to drop their coverage, how would you feel about that?

I know how I would feel about that. This amendment is about making sure those who have worked hard all of their lives, who have retired and have had the confidence and the security to know that those health care benefits, retirement benefits they have worked so hard to have in their retirement, would be secure--to make sure if someone is covered right now for prescription drugs that he or she not lose the ability to continue, at least to know that if their employer changes their benefit, they would have immediately the security of the backup Medicare prescription drug plan.

This is very critical in a State such as Michigan where we have 37 percent of our retirees who have insurance, who right now are fortunate enough to have health care insurance and prescription drug coverage.

While there are positives in this bill so there are those who will receive help as a result of being low-income seniors, or those with very high prescription drug costs who will receive help under this bill, one of the glaring omissions and great concerns that I have relates to what Senator Levin was just speaking about, the unfairness of saying to a group of people who have been fortunate enough to have insurance and prescription drug coverage that, as a result of something done by the Congress, they would potentially lose that coverage. That makes absolutely no sense.

What our amendment is saying is if, in fact, their employer would have the incentive to change or drop their coverage, they should be guaranteed that something else is right there, that Medicare as a backup should be there.

My preference would be that we change the formulas so there is not the incentive to drop anyone. That was one of the reasons I strongly supported Senator Rockefeller's amendment and other amendments that have been on the floor. Because my first choice is we take away any incentive for anyone to lose their prescription drug coverage. But unfortunately those amendments were not successful. We did not have the support to do that here.

Given that, we are now coming in and saying if, in fact, an employer, because of the incentives, makes a determination to drop coverage, that at a minimum, out of a sense of decency and fairness, at a minimum that retiree needs to know that Medicare prescription drug coverage, through Medicare, is available without wading through tons of insurance forms or picking through plans or going through all the ups and downs that have been described so many times in this Chamber. They need to know, after having coverage, having it available, having it dependable, that another plan is right there for them. That is the least we can do.

I hope we will join together in a bipartisan way this evening to agree to this very important amendment, and let us send a message to those fortunate enough to have health care insurance and prescription drug coverage that we remember them, we care about them, and we are going to make sure no harm is done to them in the process of putting together this prescription drug plan.

I yield the floor.

Five minutes.

Mr. President, I rise also to support and I am pleased to cosponsor the Durbin amendment. But first, I ask unanimous consent to set aside the pending amendment so I may offer three amendments.

I send the amendments to the desk and ask the reading of the amendments be waived.

Mr. President, I believe this is an incredibly important vote. This amendment really is about providing seniors with what they are asking. The seniors of this country, and those who are disabled, deserve our best effort. As we come together we have been spending this time putting together prescription drug coverage for seniors, debating about how to lower prices, and the Durbin amendment-- which I am pleased to cosponsor--does just that. I believe the Durbin amendment is our best effort. That is what seniors are asking for.

They are not asking for more insurance forms to wade through. Most of them are not asking for more choice. They are asking for prescription drug coverage.

I was talking to someone today at lunchtime who is on Medicare. He said to me, Whatever you do, please do not do anything to Medicare. It is simple; it is easy; it is dependable; they handle my secondary insurance.

He said, I actually have a 1-800 number I call and a real person answers the phone.

He was going on and on talking about how successful and how helpful Medicare has been for him.

I said, Boy, I would love to have you come to the floor and share this with my colleagues, because we keep hearing about how awful the traditional Medicare system is.

The conversation I had with the gentleman at noon reflects what I commonly hear at home. As I said before, the seniors of this country consider Medicare--and I wish we would consider Medicare--a great American success story.

Why is the Durbin amendment the best effort we can provide? Why is it the best we can give to our seniors?

First of all, working within the dollars that have been put aside in the budget resolution, this does not require any additional funds. But, by doing this, by putting the priority on our seniors and those receiving the health care, by making that the focus, that the priority, you can create a very different benefit if your priority is to start with: What do our seniors need? What do those who are disabled need? Let's start with a system that is designed for them.

When we do that, we can create a system that does not have any deductible, no deductible at all. We can create a system that guarantees what the premium will be. Not a suggested premium like we have in the underlying bill, but we can say it is $35 a month; it is guaranteed; it is in the law. Seniors will know what to count on and what to claim for.

We can do a better job on cost savings. Instead of saying we will cover 50 percent of the cost, we can cover 70 percent. That is a big difference--70 percent of the cost.

We can make sure there is no coverage gap. In fact, no one will lose their benefits, their help with their medical payments, as they move up with greater and greater bills. The higher the bill, the more they would continue to get help.

One of the reasons this can be done is because there is a real effort to get the best possible price for our seniors. The real issue in all of this debate--and the reason we have all this convoluted, complicated process that has been going on--is the pharmaceutical industry wants to make sure all the seniors are not in one plan where they can negotiate a big group discount as with any other insurance plan. We know the veterans of this country do not pay retail because the VA gets a group discount. Well, the Durbin amendment would give our seniors that group discount. And if you do that, you can lower prices. It is still a fair return, but you can lower prices, and use those savings to provide a better benefit, to make sure there is no deductible, to make sure there is no gap in coverage for our seniors.

We also can deal with a very important issue for many of us; that is the question of employer benefits. We want to make sure our employers do not have the incentive to drop benefits. There are many people in my great State of Michigan who I have worked with in our great auto industry, and other manufacturing industries, and others that have good benefits now. We are grateful to the employers in the industries involved, and they have a history of good benefits, good wages, and good employees, I might add. We are very proud of the work that goes on in Michigan.

Now that many of our Michiganites have retired, we want to make sure we provide incentives for employers to maintain those benefits. Those lifesaving benefits are absolutely critical. And we know that in the underlying bill, unfortunately, the projection is there will be an incentive for many employers to drop or reduce benefits, which is not acceptable.

What we have in this option, in this best offer that is in front of us, is the ability to count the employer benefits toward out-of-pocket spending, which is an encouragement for employers to continue to provide the benefits they currently provide to their retirees.

Under the Durbin amendment, you would have the option of a private plan. If you would like to go into an HMO or PPO, if that is a positive experience for you, you have that choice. But it also makes sure there is a Medicare choice always, that you have an opportunity to stay within Medicare.

Then one of the most important parts of this amendment is the fact that it would take effect as soon as possible. I think one of my concerns is with all of the talk and all the news reports about a new prescription drug benefit, it is not clear to our seniors that, in fact, no help in terms of a benefit is available until 2006. There is a discount card, yes, but nothing in terms of the bill taking full effect until 2006. So this amendment would say ``as soon as possible.'' As soon as possible we want to make sure this takes effect.

The Durbin amendment puts forward our best effort. It is a better benefit. It is a defined benefit so there is dependability. It reduces prescription drug costs. It maintains choice for those who wish to have another choice other than traditional Medicare. It creates a reliable Medicare benefit fallback if you choose private insurance. If your private carrier drops you, such as happened to my mother with her Medicare+Choice plan, you would always be able to have Medicare as a permanent choice for you if that happens. We incentivize employers to maintain benefits. And, finally, the Medicare-delivered benefit can be implemented faster.

There is a lot of good work and good will among all of our colleagues to try to develop and pass a prescription drug benefit here in the Senate. I believe our seniors deserve the very best we can offer, something that is straightforward, is dependable, is reliable--a system that is based on what is best for them, not what is best for insurance companies or pharmaceutical companies or any other interest but what is best for them.

Medicare has been a great American success story. It works. It just needs to be updated. It just needs to be modernized to cover prescription drugs. I believe it also should be modernized to cover more preventive efforts and other kinds of improvements that will continue to strengthen Medicare and allow it to modernize and improve with the times.

We can do that. We can do that without going to a complicated, convoluted system that focuses more and more on efforts that ultimately could privatize Medicare.

I urge my colleagues to join in support of the Durbin amendment. Give our seniors what they are asking for.

I will share with my colleagues a chart I have used many times on this floor. Right now, 89 percent of the seniors of this country are in Medicare. They are asking--I am very confident they are asking--for the Durbin amendment. I encourage my colleagues to support it.

Mr. President, someone once said, ``A smile costs nothing, but gives much. It enriches those who receive, without making poorer those that give.'' I rise today to offer a resolution to congratulate the American Dental Association for establishing the ``Give Kids a Smile'' program.

This program emphasizes the need to improve dental care access for children. Tooth decay is the most common chronic childhood disease. Tooth decay can cause poor eating and sleeping patterns, decreased attention spans at school, and sadly, prevents children from showing their smiles.

Low income children are much more likely to suffer from tooth decay. Children who are eligible for Medicaid and State Children's Health Insurance Program, SCHIP, are 3 to 5 times more likely than other children to have untreated tooth decay. The ``Give Kids a Smile'' program is helping these children.

Along with helping children get the dental care that they need, this program brings attention to the fact that this is a serious issue that children in our nation are facing. This program provides for and promotes education on dental care, good dental hygiene, dental screenings, exams and radiographs, and even gives sealants and fillings.

On February 21st, my State, Michigan, brought healthier teeth and brighter smiles to 12,800 low-income and disadvantage children. Nearly 1 million children were treated nationwide.

Dentists, such as Dr. John Buchheister, Dr. Sara Wassenaar, Dr. Dale Nester, Dr. Martha Bamfield, and Dr. Gary Schluckebier in Michigan, volunteered their time, resources, and services to give children dental screenings, exams, sealants, and fillings.

Nearly 8,300 children in Michigan also listened to dental education presentations by dental professionals.

I am pleased to stand here today and congratulate the American Dental Association for their leadership on this important children's health issue and for establishing the ``Give Kids a Smile'' program.

I also want to thank the Michigan Dental Association for participating in this program and I want to thank all of the dentists in Michigan and across the Nation that took the time to make the inaugural ``Give Kids a Smile'' day a great success. After all, ``A smile can open a heart faster than a key can open a door.''

Mr. President, before my esteemed colleague from New Mexico leaves the floor, I commend him for his leadership on the issues related to mental health and mental health parity. No one has been more of a champion than the Senator from New Mexico on these issues related to mental health. I have been pleased since being in the Senate to cosponsor those efforts. I congratulate the Senator and urge him on as we work to provide mental health parity which is another very important health care issue we need to address in the Senate.

I will speak in general as it relates to this debate regarding prescription drug coverage and Medicare. Seeing my friend from Wyoming, I commend the Senator from Wyoming, Senator Enzi, who spoke on an amendment dealing with community pharmacies which is important to pass. I am supportive of it.

I did not have a chance to say that yesterday and wanted to take a moment today to commend him for his work. Part of providing choice for seniors is to make sure they can have the same choice from their community pharmacy as mail order and a number of other issues dealing with the importance of community pharmacies. Congratulations for his work in this area.

I take a moment to speak about my perspective relating to where we are and the issues of Medicare and many of the comments I have been hearing this morning that I respectfully share a difference on. I believe millions of Americans who have benefitted from Medicare have a different perspective about the choice of traditional Medicare-- dependability, reliability, ability to choose your own doctor, the fact it has been there for our seniors and people with disabilities since 1965--have a different view versus wading through the insurance bureaucracies. There are lots of bureaucracies we can talk about, but certainly Medicare is not alone in having a bureaucracy. Anyone who has had to wade through insurance forms or attempted to wade through questions from our insurance companies certainly would not say that is less bureaucratic or less paperwork. I find it interesting to hear comments lauding

the process of working through insurance companies. If you ask anyone when they have a claim of any kind whether or not that is a streamlined, easy process, usually it is not.

When I hear about how traditional Medicare does not cover preventive services or has not been updated to cover other services, it is very important to note that it could. Traditional Medicare can cover preventive services. Since arriving in the House of Representatives in 1997, we have gone from paying for mammograms every other year to paying for mammograms every year. We have added other screenings. We can continue to do that. There is nothing about prevention that cannot be done through traditional Medicare. There is nothing relating to coordination that cannot be done through traditional Medicare.

I am in a fee-for-service health plan myself through Blue Cross/Blue Shield, an integrated plan. I am able in a fee-for-service plan to have integration. We can do that, if we want to do that, if we want to strengthen Medicare. The question is where we want to go with health care. If we want to strengthen traditional Medicare, we add preventive measures. We do prescription drug benefit within Medicare so it is coordinated. We are certainly not adding to the coordinated nature of Medicare by saying you can receive an integrated health care approach through an HMO or PPO or other plans, but we are going to, instead, offer only private insurance if it is available in your community. You can't have an integrated approach through traditional Medicare.

That is a conscious policy choice. It is not that you can't.

What we are really debating here is the very same debate that we had before Medicare came into being. I urge colleagues to go back and look at the Congressional Record and read the debate about what occurred before 1965. There were two different philosophies. So many years later it is interesting to me the very same two philosophies exist.

One philosophy, at that time, that of my Republican colleagues, is we should not have Medicare. It is a big Government program. What we should have is private insurance. People should buy from private insurance. At that time about half the seniors in the country could not find private insurance. Much like today, in many parts of the country it was not available to them. Certainly, prescription-only policies are difficult to find. Certainly, in Michigan an HMO is hard to find. If you live anywhere but metro Detroit, you don't have an option such as that. So, much like today, it was not available or not affordable. So the decision was made. It was championed by the Democrats in the Congress. I am proud of that. They were joined by, I believe, 12 Republican Members at the time who voted to make the decision, as an American value, that we were going to make sure older Americans and people with disabilities had access to health care they could afford, quality health care, and they would have access to it regardless of where they lived in the United States.

That was an important value statement made in 1965. I think it is fair to say it has radically changed and improved the quality of life for millions, tens of millions of American citizens, that decision in 1965.

Since that time, it is absolutely true that health care has changed. Boy, has it changed. There are exciting new things that have happened. There are new treatments. There are new miracle drugs. You can take a pill instead of having heart surgery. Our esteemed leader of the Senate talked about those changes and certainly we all agree with those changes.

The question is, Do we change and improve and strengthen Medicare to reflect that, or do we move to a different system? That is a conscious choice. We can absolutely do everything that is being talked about here through traditional Medicare if we choose to do that.

Mr. President, 89 percent of the seniors are under traditional Medicare; 11 percent have chosen to go into managed care available in their area. I share the desire to make sure options are available to seniors at their choice.

But to somehow say we have to abandon the insurance system called Medicare that has worked because it is outdated is not accurate. The accurate statement is we choose not to update Medicare. We choose not to strengthen and modernize Medicare because we want to go back to the private sector, private for-profit insurance and managed care. That is a conscious choice. I find it interesting that is the very same debate that took place when Medicare started.

Again, there is a difference in philosophy of different parties. I believe we have seen the philosophy at work back since the mid-1990s to weaken Medicare, so it is easier to criticize. What do I mean by that?

We had a Speaker of the House, a well-known Speaker back in the mid- 1990s, say we cannot eliminate Medicare directly--I am paraphrasing-- but, instead, we will let it wither on the vine.

At that time, there was a lot of strong support for going to managed care, HMOs, under Medicare. At that time the person who now leads the Center for Medicare and Medicaid said there would be a California gold rush into managed care. People would be leaving in droves, going to managed care because it was so much better than traditional Medicare.

In fact, that did not happen. In the areas where it did happen, such as Michigan--which I have talked about many times on the Senate floor-- we have had over 35,000 seniors dropped because the private HMO made the business decision to pull out of the market and not to cover Medicare beneficiaries anymore. Those individuals went back into traditional Medicare.

But what happened in the 1990s? We had a balanced budget agreement. I believed it was important. I supported that in 1997. But since that time, we have seen cuts, very deep cuts, deeper than we were told would happen, to providers who cover Medicare beneficiaries, people who provide critical home health services, people who provide critical nursing home coverage; our hospitals, our teaching hospitals, our doctors, nurses, physical therapists--all of those who provide health care. We have seen deep, deep cuts.

We have seen rural hospitals and urban hospitals closing. We have seen tremendous cutbacks, more paperwork, less funding. We have seen a crisis. Again, this was due to policy decisions to pull money away from Medicare, to underfund Medicare. My concern is that essentially Medicare has been set up by underfunding it, and then those who do not support Medicare saying: See, it doesn't work; not funding preventive care and saying: See, we don't fund preventive care. See, it is too bureaucratic. All those things could be fixed if there was a commitment to Medicare, if there was a commitment to a program that is a great American success story.

Let me just say in conclusion--I see colleagues on the Senate floor I know wish to speak--I think it is important in this debate that we be very honest with the American people about what the real debate is. It is not that Medicare has failed. It is not that Medicare cannot be improved upon and modernized. The debate is a philosophical one, an ideological one. There is a difference in view where those now in the majority believed, before Medicare, and believe now, that we are better off with a private for-profit insurance company model.

I am also deeply concerned when I continue to hear that somehow we cannot afford to continue with Medicare anymore because of the demographics. I have two points about that. I said this before, but the evidence is overwhelming. Medicare's administrative costs are less, and they are growing at a slower rate. Its costs are less right now than those of managed care HMOs. Every independent study shows there is no evidence that when you bring in a private for-profit insurance company that needs to make a profit because they are in the private sector, the for-profit side of the world, that somehow that brings more money for health care--when they have to take a piece of that for administrative costs and for profit, and so on. In fact, it is just the opposite. The majority of health care in this country, the majority of hospitals, the majority of home health agencies and nursing homes are nonprofit so that every dollar goes into health care because health care is not an option. It is a critical necessity for our people. That is really the debate.

The other piece of the debate is another question of values and priorities. We continue to see trillions of dollars

being given in tax cuts as a priority to a privileged few in this country, instead of focusing on shoring up and modernizing health care with a real, comprehensive prescription drug benefit, and instead of investing in education and innovation in our country to grow the economy through greater productivity. These are conscious choices. The fact that this is not a very good benefit and the fact we are limited in scope is a conscious choice by this body, by this Congress, and by this President, which says Medicare and health care is not as important as another round, and what will be coming, another round and another round of tax cuts for the privileged few of this country.

I will just say in conclusion that as we speak I believe we need to talk about the fact that these are conscious choices being made. I for one believe all the evidence shows we can strengthen and modernize and update Medicare in a way that our seniors want, need, and deserve.

I yield the floor.

Mr. President, I thank my friend and colleague from Montana, who is working hard overall on this legislation. We appreciate his work.

I came to the floor today to join with colleagues to support this amendment and to commend the Senator from New Hampshire and the Senator from Massachusetts for their joint leadership on the committee of jurisdiction and on this very important amendment.

I think one of the most important actions we can take to lower prescription drug prices for everyone is this amendment. Making the marketplace work, making competition work, allowing, once a patent is completed, for a generic drug--or, as we say in Michigan, an unadvertised brand--to have the opportunity to go on the market, to be able to manufacture that drug and drop the price, I think is very significant.

It is very important that we adopt the provisions in this amendment that relate to enforcement and the 30-month stay.

We have had in Michigan for the last couple of years a very important coalition with Blue Cross and Blue Shield, the Detroit Regional Chamber, and the Grand Rapids Chamber. I just came from a meeting in my office with representatives from the chambers, with other businesses, and those in the community who understand we have to get a handle on the explosion of prescription drug prices, and it is critically important we have competition to bring those prices down.

We know the average brand-name product is going up about three times the rate of inflation. We also know it is very costly to invest in new breakthrough drugs. We have many policies on the books to support and subsidize, through the taxpayers, new breakthrough lifesaving medication and to get it to market.

There is important research done in my State of Michigan, of which I am very proud, through those working in Ann Arbor and Kalamazoo and many other parts of Michigan, which has made a real difference in our lives.

Also, after we help fund the National Institutes of Health research, we allow companies tax deductions and credits for research, and we give them up to a 20-year patent so they can recover their costs from their investments in critical research and then the opportunity to bring these products to market.

The deal with the American taxpayers is once that process of subsidizing and support is finished, that formula, that information is supposed to be available for companies that do not do research-- companies that have been called generic drug companies--to manufacture that medicine at a cheaper price. They do not do the research so, by definition, it can be done at a cheaper price. We know that anywhere from 30 percent--I have seen prices that were 70 percent lower. There is a wide range in the ability to bring down prices by having this system work.

We also know that, unfortunately, there have been cases where the system has not worked, where companies have gamed the system or manipulated the system to stop these lower-cost medications from going on the market.

This amendment will close the loopholes and hopefully better enable the system to work so we can have the benefit as consumers, as American taxpayers, of the investments we have made in helping to bring new drugs to the market and have the benefit of being able to afford those products once that medicine comes to the market.

I am very pleased and appreciate the hard work everyone on both sides of the aisle has been involved in to bring this legislation forward. I have spoken many times on the floor about what I believe to be the two goals of Medicare prescription drug coverage and lowering prices for everyone. This amendment is part of lowering the prices for everyone.

I commend everyone involved and urge support of the amendment.

Will the Senator yield for a question?

I appreciate that. I wanted first to compliment my friend from North Dakota, who has worked so diligently on this issue. I am very proud to be a cosponsor of the amendment.

I was in the middle of saying I wanted to ask is it not true that even though the report you just indicated made it clear the safety provisions, the oversight, is the same between Canada and the U.S., isn't it true that even in light of that, you have gone the extra mile to put into place basically a 1-year provision for reimportation, and then at the end of that time the program would stay in effect, unless the Secretary submits a certification that in fact there is a problem, that based on experience, based on evidence that the benefits do not outweigh the risks? Isn't that correct that you in fact have gone that extra step, that extra mile to make sure even though we know it is safe, it is the same, that we give a safety valve so that the Secretary in fact could step in and certify if there was a problem?

Mr. President, it is hard to know where to begin. I would like to talk about some of the facts and realities for folks who are struggling to pay for those medications that are being developed or being advertised on television.

I hope we will remember in these debates we are not talking about automobiles or tennis shoes or peanut butter or any other optional product. We are talking about lifesaving medicine.

I celebrate the fact we have lifesaving medicine and that we have those who have dedicated their lives to that research. We have a lot of such individuals in Michigan. I am very proud of them and the work they do.

At the end of the line, if you cannot afford the medicine, it does not matter. So price does matter. Affordability does matter. Competition to bring prices down does matter.

I am very pleased a little earlier this evening we voted together in a bipartisan way to close loopholes the brand-name companies have been using to game the system, to keep competition off the market, and generic drugs. We passed a very important amendment to this bill. I commend, again, all who have worked very hard on that. The system has been out of whack. I suggest it is out of whack in a number of other ways.

First, it is absolutely true that the most profitable, successful industry in this country is the pharmaceutical industry. No question about it. It is great they are doing well. Any other business in this country would love to have their situation. They are, arguably, the most highly subsidized industry by taxpayers in this country. They have a set of rules that up to this point have been highly in their favor to allow them to keep the competition off the market. It is a great deal if you can get it.

I know we have hundreds if not thousands of folks working here, lobbyists, making sure we keep that good deal for them. I appreciate that. Unfortunately, that good deal for them, that great deal for them, has been at the expense of every other business trying to provide health care for their employees, every other employee trying to keep their health care and not lose their job because of rising health care costs, every senior, every family in this country. The debate about pricing is about not only making sure we have a healthy pharmaceutical industry but we have other healthy businesses and consumers who help pay the tab for that research and can afford to buy the product at the end of the line.

What do I mean by that? I have said this before. We start with a lot of the basic research in this country being paid for by American taxpayers through the National Institutes of Health. I am proud we have greatly increased the amount of money going into basic research. We have done that on a bipartisan basis. It makes a difference. We are very close on many different illnesses from Parkinson's to Alzheimer's to diabetes, critical research. We need to be doing more. But that is done by American taxpayers, investing our money. Because we benefit, we understand how critical this is.

That information, that research, is then given to the pharmaceutical companies who then develop it. We give them a writeoff for their research, tax deductions, tax credits for new research, all of which I support, as well as deductions for their advertising, their marketing, their administration, their other business expenses. Tax deductions, tax credits, are subsidies from American taxpayers. So we have a real stake in this operation. We are already helping pay for it.

Once the drug has been developed, because it is very expensive for new breakthrough drugs, because it is very expensive, we have a policy of creating a patent for up to 20 years to limit the competition so that company can, in fact, be covered at cost, because with new lifesaving drugs it is very expensive.

We have a stake in this. We have a stake in it. We helped pay for it. We helped create rules that are favorable to the companies, so that, in fact, they can succeed. The deal, though, I believe, is that at the end of that process the American consumer, the American senior should be able to afford to buy that product that they helped pay to develop, to research, to make happen. That should be the deal.

That is the point. In too many cases right now that is just not happening. We get to the end of the line, and there are many ways in which the companies sue currently to keep generics off the market or keep the border closed so we can't buy them from Canada or do a variety of other things to make it difficult for the competition to come in and to keep the prices low. They make sure Medicare doesn't negotiate on behalf of all the seniors of the country to be able to force a group discount. There are a wide variety of methods to make sure the rules stay the way they are and we are all paying a big price for that, I believe.

We certainly want this industry to be successful. I think it is clear by the rules, the subsidies, the support that has been there and will continue to be there. But this is not a pair of tennis shoes. It is not an automobile, as much as coming from Michigan I want everybody to buy a new automobile every single year, an American-made automobile. But if you don't, you will not

lose your life. But if you don't get your cancer medicine, you might. This is very different.

Let me speak to the issue of advertising. Since 1996, the FDA has taken the cap off of direct consumer advertising, as we know, radio and television, other direct consumer advertising. We know, we have seen advertising skyrocket. We do not have to debate that. All you have to do is turn on your television set. If not every commercial, it is every other commercial--they are very nice commercials--but they are commercials for prescription drugs. We do not have to argue about whether advertising has gone up. Every single person in this country knows that advertising has gone up.

You do not have to tell a doctor that marketing has gone up. My doctor talks to me about the line of drug reps at the door to come in and promote particular medicines.

We know from studies that have been done, and FCC filings, that about 2.5 times more is claimed under the line item for ``advertising, marketing, and administration'' than is claimed under research.

What I find very interesting is that I keep hearing that more is spent on research than on advertising and marketing. Last year, I offered legislation to say OK, if that is true, then let's just cap the amount you can write off for advertising and marketing to the same level you can write off for research on your income tax form. It should not matter to anybody because they spend more on research. You would have thought I had proposed the worst thing you could possibly propose. It was adamantly and is still adamantly opposed by industry. It should not matter if they are spending more on research than on advertising and marketing.

I would like to speak to the business at hand here, the question of allowing Americans to buy American-made drugs, subsidized by Americans, the research funded in part by Americans, at the price they are sold in every other part of the world--half the price we pay here.

This particular amendment is a very conservative, cautious amendment. It focuses only on Canada. We know, in fact, there is importation already back and forth from Canada. Drugs are already frequently imported into this country but predominantly by manufacturers. They are already bringing them back across the border. In fact, according to the International Trade Commission, $14.7 billion in drugs were imported into the United States in the year 2000, and $2.2 billion in drugs sold in Canada were originally made in the United States.

It is ironic that the drugmakers are saying drugs cannot safely move between the border between the two countries. What they are saying is they don't want individuals to be able to do it or pharmacists to be able to do it or wholesalers to be able to do it, but they do it every day.

Also, we hear there is a difference in terms of oversight and inspections. According to the CRS, our Food and Drug Administration already inspects pharmaceutical production lines in Canada for 341 prescription drugs run by about 30 drugmakers. So they are already doing it for the pharmaceutical industry. We pay to send FDA inspectors to Canada to inspect already.

Another report dated September 2001, a report by our Congressional Research Service--again, the nonpartisan Congressional Research Service--confirms that:

The U.S. and Canadian systems for drug approvals,

manufacturing, labeling and distribution are similarly strong

in all respects. Both countries have similar requirements and

processes for reviewing and approving pharmaceuticals,

including ensuring compliance with good manufacturing

practices. Both countries also maintain closed drug

distribution systems [which is very important] under which

wholesalers and pharmacists are licensed and inspected by

Federal and/or local governments. All prescription drugs

shipped in Canada must, by law, include the name and address

of each company involved along the chain of distribution.

So that is the reason this amendment is narrowly focused on Canada because we are talking about a system that is very similar, almost exactly the same in terms of the safety and the rigorous oversight. We are also talking about a process that is already going on, it is just going on by the manufacturers and not by licensed pharmacists or by individuals or by wholesalers.

I think this amendment is very conservative because the amendment not only has Senator Cochran's provisions in terms of certification, but this is an amendment that would affect 1 year. We are going to affect things for a year, to open the border to Canada. After that 1-year period, the program would stay in effect unless the Secretary submits a certification to Congress that, based on substantial evidence and the experience of the 1 year, the benefits of reimportation do not outweigh the risks. So there are multiple protections in this amendment, and strict FDA oversight is in this amendment.

I think this is particularly important to do in the context of the prescription drug legislation that we are working on and that will be passed by this body because the bill in front of us to provide a Medicare prescription drug benefit does not take effect until 2006. So other than a discount card, which is not new to seniors, those who have been listening to the debate we have been having all week and anticipating help right away are going to be sorely disappointed because there will not be a prescription drug benefit until 2006. In the meantime, we can help not only seniors but families and businesses and everyone who is involved in paying for prescription drugs right away, immediately. It doesn't cost anything to open the border to Canada for prescription drugs for pharmacists and for individuals. We can do it now. If there is an evaluation that there is a problem, it can stop. But we know, based on information about the inspection systems, based on what is already occurring, that it is highly unlikely that there would be a problem.

I think it is critically important that we give major help now. We can cut prices in half; in some cases much more. I have had the opportunity to go with a number of different seniors to Canada where they have met with a Canadian physician and received a prescription and gone to a Canadian pharmacy. We have been shocked at the difference in prices for literally the very same drug. It is particularly significant in Michigan where we can look right across the river which you can swim across, and go from Detroit to Windsor and see that kind of a price difference. We have many seniors now looking to Canada for opportunities to see Canadian doctors because they are so desperate to get help.

Let me mention just a couple of things. Again, we are not talking about some optional product where people are advertising and making good profits. We wish them well. That is the American way. That is the capital system. Good for them. But we are talking about a health care system where we are not seeing doctors being reimbursed, nor hospitals, nor nursing homes, nor home health agencies. The only part of the system that is exploding in cost and which is driving up the cost of the health care system is in the area of pharmaceutical drugs. This is not optional. It is medical. It should be viewed as part of the health care system. That is what we are debating today.

Let me mention Tamoxifen. Tamoxifen is a very important drug in battling breast cancer. I had an opportunity to visit with Barbara Morgan from Michigan when she went to Canada and visited a Canadian doctor and going through the process there where she was able to get her monthly Tamoxifen for $15 instead of $136. That is a huge difference for her. She and her husband are retired on average means. She did not expect to get breast cancer after retirement. They had, like many others, been saving up to do things in their retirement. They now find themselves spending money on her treatment and on her prescription drugs. These are not theoretical discussions about people. This is not a theoretical debate about allowing Americans to get American-made, American-subsidized prescription drugs from Canada. This is very real. It can literally make the difference between life and death for people when they are struggling for critical lifesaving medicines.

That is why I feel so strongly about this amendment. That is why I am hopeful the Secretary will look at the evidence, will look at the narrow construct of this amendment and be willing to work with us, be willing to allow the borders to be opened for 1 year. We

are asking for 1 year with all of the safety precautions that are in this amendment--just 1 year to allow our seniors and others to be able to see a dramatic cut in the prices they have to pay for their medicines; 1 year to try this and to evaluate the issues that have been raised by those who are opposed.

I appreciate the time. This is, I believe, a very serious part of this debate. If we want to make the difference right now for people, right now doesn't involve money in the budget resolution. It doesn't involve waiting until 2006. If we want to help folks right now, the way to do that is to give them the opportunity to get their prescription drugs at the lowest possible price. That is what this amendment will do.

Mr. President, I thank my friend from Illinois. I commend the Senator for his substitute. What the Senator is talking about is exactly what the seniors of America are asking us to do to make sure they have a comprehensive prescription drug benefit under Medicare which they know will be there, which is stable, dependable, where you can choose your own doctor no matter where you live in the country; that whether you live in the upper peninsula of Michigan or Chicago, IL, you will have an opportunity to receive the health care you need and deserve under Medicare.

By simply expanding that to include prescription drugs, and then coupling that with the ability to keep prices down, I believe this is the best possible approach to come before the Senate--in fact, the U.S. Congress. I am hopeful that colleagues, when this comes to the floor, will rally around this plan.

What Senator Durbin has done is put together a plan designed for seniors, not designed for pharmaceutical companies or insurance companies, which is, unfortunately, why this process has become so complicated. For example, people look at me with bewilderment when I am explaining that for the private sector plans in their region, if there are two or more, they would have to take one. But if there isn't, they could have a backup, but then they would have to drop it and go back to an insurance plan. When I explain that plan, they scratch their heads and say: Why are you doing that?

Well, unfortunately, we have a plan put forward--and I have to say it is a valiant effort by many people to try to come to some consensus, and I appreciate that--but the reality is, it is designed much more to benefit the pharmaceutical companies in particular than it is our seniors.

Why is our approach not supported by the pharmaceutical industry? For one simple reason: If we have all 40 million seniors and people with disabilities in one insurance plan, they can negotiate a big group discount, which is what they should be able to do. They should be able to come together, as one insurance plan, and negotiate a group discount. As Senator Durbin indicated, when you do that, you are not paying retail. In fact, the Federal Government does that on behalf of our veterans through the VA, and we are able to get about a 40-percent discount, which is a terrific deal for the veterans of this country. I am proud we do that, but why shouldn't that same opportunity be available for every senior, for every person with a disability under Medicare?

So I just wanted to rise to congratulate the Senator's vision on putting forward the right plan that makes sure that, in fact, our seniors know they can count on a $35 premium. They would also not have to have a deductible. Seventy percent, as I understand, of their prescription drug costs would be paid for. There would be no gap in coverage for the last few months of the year. Or if you found yourself getting to a point where you reached the end of your coverage, and then, unfortunately, your doctor indicates you have an even more serious illness to deal with, you would not be left wondering what to do to pay for that treatment and medication.

This plan does what our seniors in this country are asking for. I believe it does what we should be doing for them. It is what they need, and it is what they deserve. It is what they have been waiting for.

I commend the Senator from Illinois for putting forward this option of which I encourage all of our colleagues to come together to embrace, standing together to achieve a bipartisan victory that is in the best interest of our American seniors.

Mr. President, I send an amendment to the desk on behalf of myself, Senators Boxer, Bob Graham, Rockefeller, Harkin, Cantwell, Kerry, Bingaman, Jack Reed, Clinton, and Mikulski. I ask for its immediate consideration.

Mr. President, I ask unanimous consent that reading of the amendment be dispensed with.

Mr. President, first of all, before explaining the amendment, I commend my colleagues for their leadership on the Finance Committee. They have been working very diligently--the chairman, Senator Grassley, and the ranking member, Senator Baucus, and members on both sides of the aisle. I commend them for bringing forward one of the most critical issues affecting American people, American families, American seniors today. While we may disagree on specifics and on what is the best approach, I very much commend them for giving us the opportunity to debate this critical issue and for the hard work that has gone on, on both sides.

My amendment is a simple one. It would provide another choice of prescription drug plans for seniors on Medicare. In fact, it would provide the choice the majority of seniors want to make on Medicare.

The underlying bill allows seniors to choose a prescription drug plan, but only if the plan is one offered by a private insurance company. My amendment simply allows seniors to get their prescription drugs through the Medicare Program. It is creating one more option. The legislation before us tries to expand health care choices for people on Medicare. Regrettably, it does not provide the full range of choices for seniors.

Without my amendment, we are not in fact providing the full range of choices, including the one for which the seniors are asking. My amendment will allow seniors the choice to get their prescriptions filled within traditional Medicare, to choose a private prescription drug plan, or enroll in a PPO or an HMO. This range of choice will foster competition among the different plans and allow our seniors to make the best possible choice for themselves. This amendment puts all of the plans on the same footing and does not favor one over the other.

I think it is also important to note that the private plans described in the bill don't exist today. In fact, Robert Reischauer was quoted recently in the New York Times saying, ``Private drug-only plans don't exist in nature.'' They don't currently exist in nature. So we are designing a system around plans that do not currently exist.

Medicare does exist. A Medicare plan is one that we know we can put together and that seniors can count on, at the same time giving the opportunity for new plans to be created, as

well as the structures of HMOs and PPOs.

I also think this plan could actually save the Federal Government dollars, and certainly the record would reflect that. There is ample objective evidence that providing health care through the Medicare Program is more efficient than through the private sector. This is one area where the evidence is clear, based on various points of information. Let me just share some with you.

On May 5, 2003, the New York Times reported on findings by MedPAC, our own nonpartisan advisory plan. MedPAC discovered that private health plan fees are about 15 percent higher than Medicare. The Center for Studying Health Systems Change has also made similar findings. So we know that if we go to private plans, on average, services will be about 15 percent higher--more costly for fees for services. Surgeries, they found, were about 26 percent more. Radiology was about 19 percent more. Hospital and nursing home visits and consultations were 9 percent more. On average, we know it doesn't in fact cost less to provide services to private plans. Independent, nonpartisan organizations have found that it in fact costs more.

Also, using private plans would likely cost additional dollars. In the year 2000, our own General Accounting Office estimated that payments to Medicare+Choice plans--and those are the Medicare HMOs that were set up in 1997--exceeded the costs that would have been incurred for treating patients directly through traditional Medicare by an annual average of 13.2 percent.

So, again, we have a situation where our own nonpartisan, objective General Accounting Office said that providing services through Medicare HMOs actually cost, on average, 13.2 percent more than the same service offered under traditional Medicare, where seniors get to select their own doctors and have the dependability of knowing that Medicare will be there.

Thirdly, private plans are not necessarily more efficient than Medicare. The inspector general of the Department of Health and Human Services found that HMOs that contract with Medicare, on average, spent 15 percent of their revenue on administrative costs rather than on health care. In fact, we know those numbers can be even higher in other private sector plans. Dollars have been put aside in this plan to cover higher administrative costs. Some managed care systems spend as much as 32 percent of their revenue. That means that for every precious dollar we have that we want to help seniors pay for their medicine, about one- third of that could go to administration.

By contrast, the Medicare plan spends only 2 percent of its budget on administrative overhead. On average, a private HMO--and we realize more plans are being developed under this proposal than just HMOs, but if we look at what we have to go on in terms of the differences, it is 2 percent administrative costs under Medicare and an average of 15 percent for HMOs. And we know that in some areas, in fact, it is even higher administrative costs for other private insurance plans.

Furthermore, the enrollment experience with private plans in Medicare has certainly not been stellar. In the past 5 years, 2.5 million seniors have been dropped by their Medicare HMO. As I have indicated before, one of those in fact was my own mother in Lansing, MI, who had a very positive experience under a Medicare HMO. But the decision was made, for financial reasons, to no longer cover Medicare recipients. She lost her plan and her doctor, and she was left to figure out how else she would be receiving care under Medicare.

In 2002, three plans in Michigan dropped out of Medicare+Choice altogether, while two dropped significant numbers of enrollees. More than 31,000 seniors in Michigan have been dropped just since 2002. What does that mean in real terms for people? It means that they went into a system, they had a doctor, they were within a certain kind of health care system; then the private managed care plan decided to pull out, and they were then left to go find another plan, actually another doctor, and another way of providing health care.

Only 8 of 83 counties in Michigan now have private Medicare HMO plans, and all of them are concentrated in one area, southeastern Michigan, around metro Detroit, which means that those in the Upper Peninsula of our State don't have that choice. I expect it would be very difficult for them to find a private sector plan, even into the future, in northern Michigan, the Upper Peninsula, or the west side of the State. Right now, the only option is obviously around metro Detroit. None of the remaining Medicare HMOs in Michigan is accepting new enrollees.

One Michigan provider even chose to pay a $25,000 fine to get out of Medicare+Choice and stop serving seniors immediately rather than go through the official withdrawal process. That requires more than 3 months of notice of intent to withdraw. By pulling out immediately, this plan left our seniors in the lurch with very little transition time to explore other ways in order to be able to get their health coverage.

Because of the poor records of the Medicare+Choice plan, almost 9 out of 10 seniors--basically 89 percent--have decided to stay in traditional Medicare. I believe they ought to have the choice to do that. That is what my amendment is all about. It is saying to those right now who have had a choice of a private managed care plan or traditional Medicare since 1997, who have chosen to stay with traditional Medicare, to choose their own doctor, to know that regardless of where they live they will have the dependability, the stability of Medicare, it will be there for those individuals who have chosen overwhelmingly to stay in traditional Medicare--89 percent.

Any one of us would love that kind of a percentage when people are choosing in an election. Eighty-nine percent of the seniors today have said they want traditional Medicare. Yet this choice they have made is not available to them if there are two or more private sector plans available in their region. Essentially, unfortunately, what the current plan says is you have made your choice; we do not like your choice; pick again. My amendment would guarantee seniors would be able to have that choice.

I know some colleagues strongly believe that moving seniors into the private sector is the best way to provide them prescription drug coverage. While I respectfully disagree with this premise, I think it is a good idea to provide private sector options for those who desire them.

Back to my own family, I think my mother should have that choice, and she should be able to go into Medicare+Choice or another managed care plan if she so desires. I absolutely agree with that if it works for them.

The question is whether the Federal Government should force seniors into a plan, whether it is a private insurance plan or traditional Medicare. Should we be deciding what our seniors should have for their prescription drug coverage? Should we make that choice or should they make the choice? That is why my amendment is so important. It will allow seniors to choose the appropriate plan for them, not the Federal Government.

I have heard a lot of arguments that we should provide seniors with the same options that Members of Congress and Federal employees have in the Federal Employees Health Benefits Plan. Under that plan, we have several options ranging from fee for service to PPOs to HMOs. If we like one of those options--and we choose that option, by the way--the Federal Government does not come in and say, If you work for the Senate, you cannot have option A, you can only get B, C, D, and only A under certain circumstances. We say here is the range of options; you select the one that works for you. If we like the one we selected, we can stay in that plan as long as we want. As long as we are covered by the Federal employees health plan, we can choose that plan. We are never forced to switch plans.

Mr. President, can you imagine if we were living under the plan we are asking seniors to live under; if every employee had to switch back and forth, potentially, depending on what was offered in the private sector, rather than remaining with the plan they desired? We have never been forced to switch plans ourselves. It should be the same for our seniors. If we do not have to switch plans year to year, then seniors should not have to switch either.

My guess is most of us like the plans we are in and probably want to stay with them. Certainly, if we do not, we have the opportunity to change. But the last thing we want to do is switch health plans every year or every other year and try to leaf through hundreds of pages of brochures to evaluate the benefits of a new plan. I, for one, find it is difficult to find the time to do that. I cannot imagine anyone would want the chore of going through every year or every other year all of the paperwork to figure out what is best for them, particularly if they like the plan they are in.

Many seniors want stability. They seek a good, solid, guaranteed health plan where they can see their own doctors. There are some seniors who prefer to experiment with private plans, and they should be given that option. But all seniors should have all options, and that is what my amendment would do. It would make sure the choice is in the hands of our seniors.

Again, this approach is within the framework of the bill. It is within the $400 billion that has been carved out within the budget resolution. It is within the framework of the benefits structure that has been designed by the committee. This amendment does not change anything other than to say every senior should have the option, as 89 percent of them have chosen to do, to not only have their own doctor under Medicare, but to have a prescription drug plan under Medicare regardless of where they live, and a plan they can count on and depend on.

Again, I commend my colleagues who have been working diligently on this issue. I know it has been a challenge for everyone. I believe this amendment does exactly what the seniors of America want and allows all of us to enthusiastically embrace this proposal as being the right proposal.

I hope my colleagues will support my amendment to offer one more choice to seniors. It builds on the structure of this bipartisan plan and provides more choices.

I know many of us believe this bill can be improved. Outside objective critics have even used stronger language about the way this is restricted in the bill. For example, former CBO Director Robert Reischauer said:

The benefit is rather skimpy and has a bizarre structure.

It is an insurance structure that exists nowhere in the

private sector or in nature.

Through this amendment we will have a structure that makes sense, that is dependable, that is explainable, that is simple and straightforward, that provides all range of options to seniors so they can decide what it is they wish to do in terms of prescription drug coverage.

Mr. President, I have a letter from the National Committee to Preserve Social Security and Medicare. I will read a portion of it:

On behalf of the millions of members and supporters of the

National Committee to Preserve Social Security and Medicare,

I am writing in support of your ``Medicare Guaranteed

Option'' amendment to S. 1. Since the current Senate

prescription drug bill, S. 1, wants to offer seniors choices,

your amendment would offer seniors real choices because they

would have the choice of what they really want, which is a

defined benefit under Medicare.

I ask unanimous consent that this letter be printed in the Record.

I thank the Chair. Mr. President, again, I urge my colleagues to join in this amendment. I am hopeful we can join together enthusiastically in embracing a system that has worked since 1965 for our seniors. I hope also we can join together to improve it, not only prescription drug coverage, but ways to minimize paperwork and focus more on prevention, as the Secretary of HHS has suggested.

There are many opportunities for us to improve within the structure of Medicare a plan that is focused more on prevention, to eliminate the paperwork, and to do it together and still provide our seniors with the choice for which they are asking.

In conclusion, I ask unanimous consent to add Senator Levin, Senator Kohl, and Senator Dodd as cosponsors of my amendment.

I thank the Chair. I yield the floor.

Madam President, I will respond to my colleague, the chairman of the Finance Committee. First, I thank the Senator for his kind words and my esteemed ranking member from Montana, as well, for his kind words. We have different views, different perspectives on how best to provide seniors with prescription drug help, but we all share a common desire to do that and, within the confines we are operating under, to create a way to do that.

First, the Senator from Iowa, the chairman of the committee, is correct: A portion of the individuals who are in traditional Medicare are there because there are not plans available in their area. In Michigan, as I indicated in explaining the amendment, only 2 percent of the people right now in Medicare in Michigan have access to Medicare+Choice. So it is definitely true.

It is my understanding, though, that CBO has said under the new plan only 1 or 2 percent of the folks would go into managed care under this bill. If that is correct, we would not see much of a choice even if it were available.

However, the larger point is whether or not the market has worked as it relates to health care for seniors. In 1965, when Medicare was created, it came about because at that time half the seniors in the country could not find health care insurance or could not afford it. The market was not working for older Americans at that time.

I argue, also, the fact that there are no managed care plans in Iowa, northern Michigan, or other parts of the country. Again, it is a question of whether or not the market works in those circumstances. The reason Medicare came into being is because there were not health care plans in rural America, there were not health care plans available to those who needed them. We decided in one of the best decisions that has been made by the Congress--I was not there at that time--one of the wisest things that was done at that time was to say our value, as Americans, is that older Americans, the disabled in our country, should not have to struggle to find health care. We believe health care should be available to them whether they live in a rural community, whether they live in a city or a suburb, anywhere in the United States. Our priority as Americans is to create a system that, regardless of where you live, health care would be available and affordable for older Americans and disabled.

Many say today we should be going in the exact opposite direction of expanding what we are doing to make sure everyone has the opportunity for the same health care that seniors and the disabled have in our country; that children and families, working hard every day, that individuals working two and three part-time jobs who cannot find health insurance, ought to have the ability to buy into a system of health care coverage.

There is a great need to make sure that health care is available and affordable. Medicare has done that.

I agree there are improvements to be made, such as more focus on prevention. We can certainly streamline the paperwork and bring it into the 21st century as far as technology and other options, to make the system better. From my perspective, here is a plan, unfortunately, that moves away from that stability, the dependability and affordability of Medicare.

I see my esteemed colleague from Iowa, Senator Harkin, and I know he wants to speak. Members feel strongly about this issue. What we are doing with this amendment is the ultimate choice. It is the real choice. It is the choice the majority of seniors have already made, and it is the choice they want. Under the underlying bill, the only way they could get to the place to choose what they want is if private insurance plans were not available in their area. The plan goes through all kinds of changes to try and make that available, even if it costs more.

Ask any small business, any large business in this country today, how fast their private insurance premiums are going up. We have seen small business premiums double in 5 years. We have seen Medicare going up about 5 percent. We see private sector going up 15, 20, 25, 30 percent a year. This says rather than having a plan that goes up 5 percent a year, we are going to design this so it goes up 15 or 20 percent a year.

That does not make sense. In all honesty, the only group this makes sense for are the pharmaceutical companies who do not want folks in one place to be able to bargain and negotiate lower prices, which is what Medicare would be able to do--negotiate lower prices.

For all who want to get this right for our seniors, I urge my colleagues to join in creating real choice for our seniors. Give them the opportunity for the choice they want. If, in fact, someone chooses to go into managed care, an HMO, PPO, or other kinds of private plans, they should have that choice, as

well. This amendment allows them to do that.

I yield the floor.

Mr. President, I ask unanimous consent that the order for the quorum call be rescinded.

Mr. President, I appreciate my colleagues coming to the floor in support of my amendment. I take a moment to reiterate what we are doing in this amendment.

We are indicating in this amendment we want to make sure every senior has the choice of traditional Medicare for prescription drugs as well as a choice of HMOs or PPOs or other private sector plans. We are talking about seniors wanting to have choice or the desire to give seniors choice.

The majority of seniors, as a matter of fact, like traditional Medicare. It is very clear. They either have chosen traditional Medicare or do not have any private options, and 89 percent of our seniors fall in that category. The majority have chosen Medicare or may live in a rural area where they do not have the choice of a private plan but they are in Medicare and they have their coverage, they can choose their doctor, they can live anywhere within their State or anywhere in the country and know the cost will be the same. It is dependable; it is available it them.

That is what we are trying to do, guarantee seniors will be able to continue to have that choice along with new options for those who live in an area where there is a managed care plan and they choose to go into an HMO or PPO, that would be absolutely available to them. If they choose another private insurance plan, assuming there are those available to them, fine, that is certainly an option that we all agree should be available to our seniors.

The question is whether we will shut off the choice the majority of seniors have already selected, the one they say they want. With all of the talk about choices, what I hear from folks is not: Please give me more insurance plans to wade through or to figure out how to get health care; please give me more insurance bureaucracy to wade through each day. Seniors say: Update Medicare and cover prescription drugs.

It is simple. They want their traditional Medicare, choose their own doctor, choose their own pharmacy, to be able to make their own choices and to have them available regardless of where they are in the country, but they want to make sure they have prescription drugs as well.

We know if health care in 1965 were like it is now, prescription drugs would have automatically been covered. We know that. We also know in 1965, as I indicated earlier, Medicare came into being essentially because of a failure in the private market. That is not a criticism; it is a reality that covering older Americans certainly is more costly as we use more health care. As we get up in age, we find we use more health care, we use more prescription drugs. There are fewer carriers wanting to cover. Certainly, way back in 1965, that was the case when half the seniors in the country could not find a private insurance plan or could not afford a private insurance plan available.

Medicare came into being in order to make sure that health care was available for older Americans and for the disabled in our country. It was a value statement about who we are and what we think is important. It was an important value statement just as Social Security coming into being was a value statement about the fact we wanted to make sure there was a basic amount of money for everyone to know there is a certain amount of financial support available to them as they get older, as they retire. It is a value statement. Medicare and Social Security have both been great American success stories.

We are now at a point where medicine has changed, the delivery system, the way we provide care. Most of us go to the doctor's office and walk out with at least one prescription. We have the opportunity to take medicine to keep us well, to manage our high blood pressure, cholesterol, or other issues that allow us to remain healthy and remain out of the hospital. These are all very positive. We also have the opportunity to avoid heart surgery by taking a pill or have other options by taking medications that cause us not to have to go into inpatient care in the hospital.

A lot of good has happened. We are now at a point where it makes sense to update Medicare. The question is how to do that. We really have two different views on how to do that.

One that I share says we should take a system that has worked and we should make sure it is fully funded so our physicians and hospitals and home health care and nursing homes have what they need to provide services. That is another critical issue--the resources being pulled out of Medicare and the underfunding of Medicare which has caused problems. We should provide full funding, and we should make sure it is modernized to cover preventive efforts and that we cover prescription drugs as a part of an integrated, modern health care system under Medicare. We should use more technology so there is less paperwork and more streamlining, which I know is of great concern to health care providers. We can do all that within the framework of Medicare, which has worked so well. Why is that important? Because it is dependable, reliable, affordable, and it is a value statement about who we are as Americans. That is one view.

Another view is we should move back to the model before Medicare came into existence, and that is more of a reliance on private health insurance plans. We hear from many insurance carriers that they are not interested in prescription-only policies. They are not interested. It is different. Insurance usually means you provide insurance to a large number of people assuming only some of them will get sick or some will have automobile crashes or some will have their homes burn down--not everybody.

In the area of prescription drugs for seniors, from an insurance model it is very different. In fact, when you cover people, you can be assured almost all of them, if not all of them, will in fact need your insurance. They will need your coverage. So it is a very different kind of model than traditional insurance, where only some people use the insurance but everybody is paying into a system and spreading the risk.

That is one of the difficulties we have had, trying to fit this model of private insurance into the fact that we are talking about private insurance for health care, prescription drug care, where everyone who is buying the product will be using it. There are a number of questions about how to fit that model in and make it work.

Then there are questions about why. Why do we do that? Why do we propose something that is complicated, that on the one hand provides choice, which is good, from the private sector, but on the other hand is convoluted and complicated for those who want to stay in traditional Medicare and not make them make that choice. That is one of the questions, Why is this happening?

From the pharmaceuticals' standpoint, they are very much opposed to seniors being under one plan, 40 million people in one place, to be able to negotiate large discounts in price. As a result of that, they certainly have lobbied very heavily for a plan that divides seniors into a lot of different places so they have less leverage to be able to lower prices and negotiate discounts. That is also a concern of mine.

We know also that under traditional Medicare, we actually save money. We hear all the talk about market forces and lowering prices. In reality, facts show the opposite. In fact, commonsense I think shows the opposite when we look at what is happening in the private sector today. The average small business has seen its insurance premiums double in the last 5 years. Certainly in Michigan, major high-tech manufacturing in the State has seen 15 or 20 percent or more increases in the cost of private health insurance every year. Yet under Medicare we see the costs going up about 5 percent a year.

We look at this and say: Wait a minute, we are talking about a plan that costs more, not less. How does that make sense?

We also know, when we look at administrative costs, we are told by those who have analyzed it that administrative costs for Medicare to administer the program are about 2 percent. In the private HMOs in place right now under Medicare, their costs are 15 percent for administration. We are told that in the private sector they actually go higher, that in some private plans it has been as high as 31 percent for administrative costs.

We look at that and say, How does this make sense? We don't want 15 percent going into administration when it can be 2 percent so more of those precious dollars that we have can then go into buying medicine. That would seem to make sense.

There are a number of different reasons I believe it makes sense to make sure the real choice seniors want to have, which is traditional Medicare, is one of the choices available to them. I personally believe it will save dollars. It will allow the money we have to be used more for purchasing medicine and for health care rather than for administration or other kinds of costs.

Medicare is a nonprofit system by design. I know there are differences in philosophy about a for-profit system under health care versus a nonprofit system. But the majority of hospitals in this country are nonprofit. The Medicare system itself is set up so that every dollar possible goes into care. I believe that is a model we should continue. I believe it is a model, although it can always be improved--and I would be the first to say we can improve and streamline the Medicare system--fundamentally it has worked for people. It has been there. It has been a system that has held down costs. It has been dependable and reliable for every single person who is an older American, or for a disabled person in our country. I wish we would embrace it rather than talk about dismantling it.

I ask colleagues to come today, as we vote on this amendment, and join together to provide real choice for our seniors, the choice they are asking for as well as every other choice. Let's make sure every choice they might want to have they could have, including traditional Medicare.

Mr. President, I yield the floor. I suggest the absence of a quorum.

Mr. President, my friend from Oregon was speaking about medicine cabinets. On the question of whether you want a for-profit insurance company or a bureaucrat between you and your medicine cabinet, or whether you want Medicare, which we have known and relied upon since 1965, I appreciate that there is a different view and philosophy. I think there is a fundamental difference in ideology that is working here.

It is interesting. I had a chance to go back to the debates when Medicare was first developed. The same kind of differences occurred at that time and the same debate about whether or not we should provide care under one plan under Medicare that is stable and reliable or use the private market private insurance company. The very same kind of debate was going on then that is going on now.

I believe the right choice in 1965 was Medicare. I believe it continues to be one of the choices that makes sense to offer to seniors.

I wish to respond to the Congressional Budget Office estimate. It is disappointing to me to find that they have chosen to score it at $50 billion above the $400 billion. We have worked with them. In fact, we made it clear that the intent of this amendment was not to add $1 to the budget resolution. It is to use the $400 billion and within that to have a carve-out or choice of Medicare. In fact, so as to guarantee that, we included at the end of the bill an authority to prevent increased costs. If the administrator--in this case we are talking about HHS--determines that Federal payments made with respect to eligible beneficiaries enrolled in a contract under this section exceed on average the Federal payments made with respect to eligible beneficiaries enrolled in a Medicare prescription drug plan or MedicareAdvantage, the administrator may adjust the requirement or payment under such a contract to eliminate such excess.

The reason we have included that is to guarantee that it is within the $400 billion parameter. If, in fact, the Congressional Budget Office has not looked at that, it is unfortunate. I would disagree with their analysis.

I indicate again that this is not about changing the budget resolution or the amount of dollars. It is about creating the best choice or one more choice. It may not be the best for an individual. They may decide that going through a PPO or an HMO or some other part of the alphabet might be a better choice for them. The question is whether people will have a full range of choices including the choice that the overwhelming number of seniors have told us they want.

The intent of this amendment is in fact not to add anything to the cost of this particular bill.

I yield the floor. I suggest the absence of a quorum.

First, I thank my colleague for his eloquence. It is true that 89 percent of the seniors in this country are in traditional Medicare. Only 11 percent are currently in managed HMO plans. Since 1997, seniors have been given a choice between what has been called Medicare+Choice and traditional Medicare. Overwhelmingly, they have stayed in Medicare.

Absolutely not.

Absolutely not. What we are doing is saying, instead of two private insurance plans, we add a third, so instead of two choices, you have at least three.

Absolutely. The Senator from Illinois has hit what I think is the most critical point, and the reason there is such opposition, certainly from the pharmaceutical industry, to what we are trying to do through Medicare. They don't want the majority of seniors in one insurance plan together in Medicare where they can force a group discount. They would like to divide seniors up in lots of different insurance plans and not give them the leverage to bring prices down.

I don't see anything in here that brings it down. In fact, what we are doing in the underlying bill is adding the profit. We are putting for-profit business into this process, so you are actually adding to the cost of this system. I don't see anything in here that will bring prices down. I think that is why the pharmaceutical industry is very supportive of this plan because, unfortunately, the average retail price of an advertised brand is going up three times the rate of inflation. This does nothing to address that and bring the prices down.

Madam President, I appreciate those who are cosponsoring my amendment and have joined with me. I ask unanimous consent that Senator Lieberman's name be added as a cosponsor to the amendment.

This amendment is very simple and very straightforward. What we are saying is, seniors ought to have every possible choice for their prescription drugs, and one of those choices should be under traditional Medicare.

Today, 89 percent of seniors and those with disabilities in our country are under the traditional Medicare insurance plan; only 11 percent are not. We want to make sure, in this amendment, those seniors who are under traditional Medicare--choosing their own doctor, having the confidence to know that regardless of where they live they will have the same premium, the same cost, the same benefit, the dependability of Medicare--that they, in fact, will be able to choose traditional Medicare.

Under every cost estimate we have looked at, in terms of administrative costs, the growth in programs, other kinds of costs, Medicare has always come out less expensive than the private plans that have been compared to it. So, in fact, this does not cost more money, it costs less.

In our proposal, we stay within the $400 billion parameters by allowing the Secretary of HHS to actually modify the plan to stay within the $400 billion in the budget resolution. This is no additional cost. This is a question of choice and making sure seniors who, overwhelmingly, choose to stay in traditional Medicare have the opportunity to do so. I ask my colleagues to join with us in creating true choice for our seniors.

Madam President, I reserve the remainder of my time.

Madam President, prior to 1965, seniors had to go to private insurance companies to get their health care. Half could not find or afford private health care. That is why we created Medicare.

Now we are looking at the opportunity to keep that choice for seniors, plus the opportunity to expand. If they want to be in an HMO, if they want to be in a PPO, they can find insurance in their community. That is terrific. That is their choice. But those who have chosen Medicare deserve the right to pick that choice.