Floor Statements

Mr. President, a good measure of the strength of a community is how they come together in a crisis. From June 4 to June 18, 2010, Fremont County, WY, experienced a 100-year flood. The spring runoff from the snowpack in the Wind River Mountains was heavier than usual, causing the Big Wind, Little Wind and Popo Agie Rivers to reach flood stages. Just when the citizens didn't think it could get worse, a cold front passed through, with rain and hail in lower elevations, and three to 6 feet of snow in the mountains. Lander, Riverton, Hudson, and the Wind River Indian Reservation were all threatened.

As the flood waters rose, the Fremont County commissioners led by Chairman Doug Thompson and Vice Chairman Pat Hickerson along with the Joint Tribal Councils chaired by Ivan Posey and Harvey Spoonhunter came together to request a disaster designation from Wyoming's Governor Dave Freudenthal.

As the 32 square miles of Fremont County were threatened by flood, the citizens rolled up their sleeves and worked together to protect life, livestock, and property. Under the steady guidance of incident commander, Craig Haslam, along with Joe Moore from Wyoming Homeland Security, 52 local, county, State and Federal agencies coordinated flood mitigation efforts. According to Fremont County resident Bill Sniffin, it was the biggest disaster effort of its type in Wyoming's history.

It was inspiring to see Wyoming's National Guard working side-by-side with the Fremont County folks. The 400 soldiers, under the command of General Edward Wright and Colonel Luke Reiner, bagged sand, transported folks from houses, and were at the ready for whatever the community needed. Christian Venhuizen, at the Wyoming National Guard Public Affairs, served as information officer keeping the public and media informed throughout the entire flood.

Kathi Metzler, director of Fremont County Emergency Management, and her assistant Vonda Huish opened a temporary office so they could manage the logistics that is part and parcel with coordinating so many different agencies. It was comforting having Kathi and Vonda close by to orchestrate the flurry of activity.

We can only estimate the number of hours volunteers devoted to keeping the flood waters at bay. Some estimate 35,000 hours, others say it might be up to 50,000 hours. Almost a half million sandbags were filled. Folks donated their pickups and trailers to haul property and livestock to higher ground. This is quite an investment for a county with only 36,000 people.

While the help of the government agencies was so important, neighbors helping neighbors kept damage to a minimum. Jim Buline and his son Robert, Lee Hansen and his son Jace, Travis Becker and his son Lars are a few of the many neighbors and friends who helped Charlie and Linda Griffin save their home on their historic ranch. Students from Wyoming Catholic College devoted all their time to help anyone in need. Jeri Trebelock and her staff from the Popo Agie Conservation District organized and worked with volunteers for bank stabilization to protect the Hunhke and Guschewsky homes as well as a mobile home park. In addition, all the Popo Estates landowners came together helping each other with sandbagging to protect their homes. These are just a few examples of the community spirit demonstrated by the folks in Fremont County.

On Thursday, August 5, 2010, folks from Fremont County will gather at Mr. D's Grocery Store for a ``We Survived the Flood of 2010'' party. I ask my colleagues to join me in congratulating the citizens of Fremont County and the 52 local, State, and Federal agencies for a job well done.

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

Mr. President, I ask unanimous consent to speak as in morning business for up to 15 minutes.

Mr. President, I come to the Senate floor again today as someone who has practiced medicine in Casper, WY, taking care of families there since 1983. I come also as the medical director of the Wyoming Health Fair and someone who has brought low-cost blood screening to people, looking for ways to help with early detection of medical problems, whether it is high blood pressure or diabetes or cancer because so often early detection means early treatment and, as a result, longer survivability and better care.

So I come to the floor of the Senate today with a doctor's second opinion about the health care law that was signed by the President a little over 100 days ago. The goal, of course, of health care reform was to lower the cost of care, to increase the quality of care, and to increase the access to care around the country. Since this bill was signed into law, we have heard week after week of new unintended consequences. We hear the personal stories of people whose lives have been affected because of the law, whose lives have been impacted by the unintended consequences of the law.

During the entire debate, I was concerned if the legislation passed and became law that it would be bad for patients relying on our health care system, bad for providers--the nurses and the doctors in this country who take care of patients--and bad for payers because I believed the law would drive up the cost of care, making insurance more expensive, and also have an impact on the taxes people would pay. So I have come each week, as I do today, with this doctor's second opinion of things that have happened during the past week; new things that we have learned about the health care law and what is happening with trying to provide health care to so many Americans but also people worldwide.

As part of the discussion of this health care law, there was a discussion about the Canadian health care system and the British health care system. We now have in charge of Medicare and Medicaid in this country someone who has said he is in love with the National Health Service, which is the British health care system. So, Mr. President, I come to the Senate floor today having come across an article in a British paper--the Sunday Telegraph--about their National Health System--a system who some in this country have held up as a model. It is a system I look to as one that results in people having care delayed and care denied.

When I look at the survivability of patients after, say, cancer in the United States, we know patients with cancer survive longer in the United States than in Britain or in Canada, and not because our doctors are better but just because people receive more timely care.

Mr. President, I am going to quote from this article, but I ask unanimous consent to have printed in the Record the entire article.

Mr. President, this article, as I said, is from the Sunday Telegraph, and the headline is ``Axe falls on NHS services.'' This is dated July 24, and it talks about some of the most common operations performed in England, including hip replacements and cataract surgery. I am an orthopedic surgeon, so I have done many hip operations, but this is what the article says:

Many of the most common operations--hip replacements and

cataract surgery--will be rationed as part of attempts to

save billions of pounds, despite government promises that

front-line services would be protected. Patients' groups have

described the measures as ``astonishingly brutal.'' An

investigation by The Sunday Telegraph has uncovered

widespread cuts planned across the National Health Service,

many of which have already been agreed by senior health

service officials. They include: Restrictions on some of the

most basic and common operations, including hip and knee

replacements, cataract surgery, and orthodontic procedures.

Plans to cut hundreds of thousands of pounds from budgets for

the terminally ill, . . . the closure of nursing homes for

the elderly . . . a reduction in acute hospital beds,

including those for the mentally ill.

The article goes on:

Thousands of job losses at NHS hospitals, including 500

staff to go at a trust where cancer patients recently

suffered delays in diagnosis and treatment because of staff

shortages.

They are cutting 500 more staff positions there. The article continues:

The Sunday Telegraph found the details of hundreds of cuts

buried in obscure appendices to lengthy policy and strategy

documents published by the trusts. In most cases, local

communities appear to be unaware of the plans.

When we read on in this article, it is very disturbing. If I were living in Britain, I would be very disturbed. As someone living in the United States, with a new person now in charge of Medicare and Medicaid who has said he loves what is happening in the British health care system, I have great concerns.

The article also says:

As well as sending more patients home to die, the paper

said the savings would be made by admitting fewer terminally

ill cancer patients to hospital because they were struggling

to cope with symptoms such as pain. Instead, more patients

would be given advice on ``self management'' of their

condition.

In other words, essentially telling them to go it alone. These are very disturbing words and a very disturbing situation now occurring in Britain.

Next, there is an article that appeared in Tuesday's New York Times-- yesterday's New York Times--entitled ``Settling Down to a New Job, but Hampered by Old Words.'' This is an article about the new Director of Medicare and Medicaid. This article by Robert Pear talks about the fact that the new administrator has never had a confirmation hearing, never had a confirmation hearing and never had to respond to the American people through Congress to the questions that the American people have about the person who is newly in charge of Medicare or Medicaid, especially when we see the hundreds and hundreds and hundreds of billions of dollars spent every year by Medicare and Medicaid.

The article says he never had a confirmation hearing and has not responded publicly to critics. It goes on to say:

The White House has declined to make him available for an

interview.

Amazingly, the budget--we hear so much about the Pentagon and the military budget--but, amazingly, the budget of Medicare and Medicaid is larger than the budget for the Pentagon. Here we have someone newly appointed, in a recess appointment, someone in charge of Medicare and Medicaid at a time when this Congress, through its action and the laws signed by the President, cuts $500 billion from our seniors on Medicare and does it without having someone come and explain to Congress how he plans to keep the quality of care up or try to keep the quality of care up at a time with such cuts--not to save Medicare but to start a whole new government program.

Dr. Berwick, it goes on to say, ``has received an honorary knighthood from Queen Elizabeth II in 2005,'' because of his love of the British health care system. In fact, they quote him here in this article saying, ``I am romantic about the National Health Service.'' He says, ``I love it.''

The other thing so interesting, at this time in the history of the United States, is we now have someone in charge of Medicare and Medicaid who says that ``any health care funding plan that is just, equitable, civilized and humane must--'' and he repeats the word ``must''--``must redistribute wealth from the richer among us to the poorer. . . .''

It is no surprise that this week in a report out Monday, 58 percent of Americans, in a Rasmussen poll, favor repeal of the health care law. Fifty-eight percent of Americans favor repeal of a law that was forced down their throats, with people around the country saying no, don't do this to us, we do not want to go in that direction. But this Congress, this body, felt it knew more than the American people.

I talked a little bit about the British health care system. People also look to

Canada where, as the President said to us when we had our roundtable discussion in January, the summit at the White House, he said: Everybody in Canada gets coverage.

There is a big difference between coverage and care. It is interesting where things are turning in Canada. It is in Regina, which is the birthplace of Canada's socialized health care system. That is where, in 1962, the bill was passed and the law was signed for a government-run health care system. Now the health care plan there is contracting out CT scans to the private sector. They are contemplating private reforms because the government system is failing.

Some people say: But in Canada everybody has a doctor. According to the Canadian Medical Association, this report shows 4 million to 5 million people still do not have a family physician.

By the government's own standards in Canada--and that is a government and those are standards where they are used to waiting in line, where they expect long delays--even according to their own standards they are saying the Canadians are now waiting too long for care. This is even after massive increases in spending.

They go on to talk about how much better the care is in the United States, in terms of surviving cancer, surviving heart attacks, surviving transplants--because in America there is greater access to preventive screening tests and higher treatment rates for chronic illnesses. So Canada is rethinking their system. Britain has announced they are rethinking their system under the new Prime Minister there, and the new government. They are cutting significantly more.

That brings us back to Dr. Berwick, who said ``the decision is not whether or not we will ration care, the decision is whether we will ration with our eyes open.''

It is no surprise that many people across this country view this nominee the same way that a former nominee who received a recess appointment was viewed. I will quote at the time Senator Obama when he was talking about a recess appointment made by then President Bush. He talked about the appointee, saying, ``He's damaged goods. He'll have less credibility.''

That gets back to the New York Times headline, ``Settling Down to a New Job But Hampered By Old Words.''

Does the public deserve a hearing for this Medicare appointee? Does the public deserve a hearing? Do they have a right to hear what this man has to say? According to the Washington Post, in a headline of their July 23 editorial, ``The public deserves a hearing for a Medicare appointee.''

This goes on and says, in explaining his move to sidestep the Senate:

President Obama said in explaining his move to sidestep the

Senate and use a recess appointment to install Donald Berwick

to run Medicare and Medicaid--they had some reasons.

But they go on to say:

Mr. Obama's hurry would have been more understandable had

he not waited for more than a year to select an

administrator. . . .

Now the President has resubmitted Dr. Berwick's nomination, as is the general practice here, and those Members of this body and specifically those on the Senate Finance Committee, want and have made a reasonable request for a confirmation hearing. Still, none has been planned.

It is interesting because the American people still want to know more about this nominee, what his beliefs are, and what we have to go by are the quotes. I have gone through a number of them now.

The question comes also to what questions does Dr. Berwick not want to answer. When one looks into the past, you say: He is a doctor, he is going to be involved with health care, he is going to likely have to live under the system with Medicare and Medicaid. I am sure he is not going to establish something that is going to impact his health personally. But that gets back to the source, where Dr. Berwick has come from. It turns out Dr. Berwick does not need to worry about those things. He does not have to deal with the anxieties the rest of America deals with, created by limited access to care and the extent of coverage. I am reading now from an article from Washington, from the Examiner:

As it turns out, Berwick himself does not have to deal with

the anxieties created by limited access to care and the

extent of coverage.

It goes on to talk about a ``special benefit conferred on him by the board of directors of the Institute for Health Care Improvement,'' where he came from, ``a nonprofit health care charitable organization that he created and which he served as chief executive officer.''

He and his wife will have health coverage ``from retirement until death.'' He has now retired to come work for the government, to be the head of Medicare and Medicaid. According to page 17 of his employment contract, under postretirement health benefits, ``health care coverage from retirement until death.''

How many others can look for that sort of benefit who are working for nonprofit charitable organizations? Maybe he does not want to answer those questions. The Senate has a right and the American people have a right to ask the questions.

I also found it interesting that for somebody at a nonprofit charitable organization, that that benefit of health care from retirement until death went along with the salary he earned. His compensation in 2008--$2.3 million, in a nonprofit charitable organization. I think it is reasonable for people to want to ask the questions, where does the $12 million in contributions come from? Where are the grants? How did it come in? What impact are those people going to have and try to have on you as you work on rules and regulations in Medicare and Medicaid? Those are reasonable questions that the American people would want to have answered, yet we do not have the answers.

As a doctor, I go home every week, visit the people in Wyoming, and visit with doctors and nurses and patients. One of the things that strikes me is the last report--they talk about side effects. ``Obamacare,'' it says, ``Could Punish Docs for Better Quality Care.''

That is what I hear about the most at home from doctors who are taking care of their patients, saying: I do a good job, I do everything I can. Yet the rules and regulations are going to punish me for doing what I know is right for my patients.

Part of that is rules and regulations that are coming out of Medicare and Medicaid and the Secretary of Health and Human Services who is developing these with financial incentives dealing with patient outcomes. One of the things they want to do is punish people, punish physicians and hospitals by penalizing them if a patient returns to the hospital after they have been discharged within a certain number of days.

One of the finest hospitals in this country is the Cleveland Clinic, specifically relating to heart conditions. People from around the world--kings, sultans, queens--come to the Cleveland Clinic. Some fly in in their private jets. Why? Because of the quality of care at the Cleveland Clinic--very understandable.

It is interesting, when the Cleveland Clinic took a look at their numbers, seeing how they are likely to do under the scenario that the Secretary of Health and Human Services says is the way to improve care in this country, the clinic found--it has to do with people with heart failure, people who are being readmitted to the hospital, patients with heart failure. It is considered to be a sign of poor quality care when a heart patient must be readmitted for further treatment.

What the clinic did is they studied their readmission rates and they found that their readmission rate, in a 30-day period, was actually much higher than the national average. So they must not be a very good hospital, according to the Secretary of Health and Human Services, because that is how they are being judged.

But when you look at the Cleveland Clinic in terms of how the patients do, how many live for much longer, what we find out is that the survivability of the patients at the Cleveland Clinic is also much longer. More people survive. The results are better. So if you are a patient with heart failure, you want to go to the Cleveland Clinic. If, on the other hand, you are somebody who works at Health and Human Services and are just keeping the records, they are going to say: You don't want to go there because some people come back into the hospital.

Once again, we have a situation where government is saying one thing

and people--doctors, nurses, patients, families--know that the government is wrong and we should trust the doctors to make the right decision.

That is why I return to the floor today to say it is time to repeal and to replace this health care law. We need a patient-centered health care bill. We need to replace anything that is either insurance company centered or government centered, and be patient centered. We can do that by allowing patients to buy insurance across State lines, to give people who buy their own health insurance the same tax breaks that the big companies get; by providing individual incentives for people who stay healthy, take preventive measures, lose weight, get their diabetes under control, get their blood pressure down, quit smoking--provide those incentives because that will lower the cost of care.

We need to deal with lawsuit abuse and the expenses of unnecessary tests provided by doctors practicing defensive medicine. We also need to allow small businesses to join together to buy health insurance much more effectively.

Those are the things that will work to get down the cost of care, increase the quality and increase the access. That is why today I offer my second opinion: It is time to repeal and replace this health care law.

Exhibit 1

Axe Falls on NHS Services

(By Laura Donnelly, July 24, 2010)

NHS bosses have drawn up secret plans for sweeping cuts to

services, with restrictions on the most basic treatments for

the sick and injured.

Some of the most common operations--including hip

replacements and cataract surgery--will be rationed as part

of attempts to save billions of pounds, despite government

promises that front-line services would be protected.

Patients' groups have described the measures as

``astonishingly brutal''.

An investigation by The Sunday Telegraph has uncovered

widespread cuts planned across the NHS, many of which have

already been agreed by senior health service officials. They

include:

Restrictions on some of the most basic and common

operations, including hip and knee 7 replacements, cataract

surgery and orthodontic procedures.

Plans to cut hundreds of thousands of pounds from budgets

for the terminally ill, with dying cancer patients to be told

to manage their own symptoms if their condition worsens at

evenings or weekends.

The closure of nursing homes for the elderly.

A reduction in acute hospital beds, including those for the

mentally ill, with targets to discourage GPs from sending

patients to hospitals and reduce the number of people using

accident and emergency departments.

Tighter rationing of NHS funding for IVF treatment, and for

surgery for obesity.

Thousands of job losses at NHS hospitals, including 500

staff to go at a trust where cancer patients recently

suffered delays in diagnosis and treatment because of staff

shortages.

Cost-cutting programmes in paediatric and maternity

services, care of the elderly and services that provide

respite breaks to long-term carers.

The Sunday Telegraph found the details of hundreds of cuts

buried in obscure appendices to lengthy policy and strategy

documents published by trusts. In most cases, local

communities appear to be unaware of the plans.

Dr. Peter Carter, the head of the Royal College of Nursing,

said he was ``incredibly worried'' about the disclosures.

He urged Andrew Lansley, the Health Secretary, to ``get a

grip'' on the reality of what was going on in the NHS.

The Government has promised to protect the overall budget

of the NHS, which will continue to receive above-inflation

increases, but said the service must make ``efficiency

savings'' of up to K20 billion by 2014, which would be

diverted back to the front line.

Mr. Lansley said last month: ``This protection for the NHS

is protection for patients--to ensure that the sick do not

pay for the debt crisis.''

Dr. Carter said: ``Andrew Lansley keeps saying that the

Government will protect the front line from cuts--but the

reality appears to be quite the opposite. We are seeing

trusts making job cuts even when they have already admitted

to being short staffed.

``The statements he makes may be well intentioned--but we

would implore him to get a grip on the reality, because these

kinds of cuts are incredibly worrying.''

Katherine Murphy, of the Patients Association, said the

cuts were ``astonishingly brutal'' and expressed particular

concern at moves to ration operations such as hip and knee

operations.

``These are not unusual procedures, this is a really

blatant attempt to save money by leaving people in pain,''

she said.

``Looking at these kinds of cuts, which trusts have drawn

up in such secrecy, it particularly worries me how far they

disadvantage the elderly and the vulnerable.

``We cannot return to the days of people waiting in pain

for years for a hip operation or having to pay for operations

privately.''

She added that it was ``incredibly cruel'' to draw up

savings plans based on denying care to the dying.

On Thursday, the board of Sutton and Merton primary care

trust (PCT) in London agreed more than K50 million of savings

in two years. The plan included more than K400,000 to be

saved by ``reducing length of stay'' in hospital for the

terminally ill.

As well as sending more patients home to die, the paper

said the savings would be made by admitting fewer terminally

ill cancer patients to hospital because they were struggling

to cope with symptoms such as pain. Instead, more patients

would be given advice on ``self management'' of their

condition.

Bill Gillespie, the trust's chief executive, said patients

would stay at home, or be discharged from hospital only if

that was their choice, and would be given support in their

homes.

This week, Hertfordshire PCT plans to discuss attempts to

reduce spending by rationing more than 50 common procedures,

including hip and knee replacements, cataract surgery and

orthodontic treatment.

Doctors across the county have already been told that their

patients can have the operations only if they are given

``prior approval'' by the PCT, with each authorisation made

on a ``case by case'' basis.

Elsewhere, new restrictions have been introduced to limit

funding of IVF.

While many infertile couples living in Yorkshire had

previously been allowed two cycles of treatment--still short

of national guidance to fund three cycles--all the primary

care trusts in the county are now restricting treatment to

one cycle per couple.

A ``turnaround'' plan drawn up by Peterborough PCT intends

to make almost K100 million of savings by 2013.

Its cuts include closing nursing and residential homes and

services for the mentally ill, sending 500 fewer patients to

hospital each month, and cutting K17 million from acute and

accident and emergency services.

Two weeks ago, Mid Yorkshire Hospitals trust agreed plans

to save K55 million in two years, with K20 million coming

from about 500 job losses.

Yet, a month before the decision was taken, senior managers

at a board meeting described how staff shortages were already

causing delays for patients being diagnosed and treated for

breast cancer.

Mr Lansley said any trusts that interpreted the

Government's demands for efficiency savings as budget or

service cuts were wrong to do so, and were ``living in the

past''.

I ask unanimous consent to speak as in morning business.

Mr. President, I rise today to talk about the oilspill in the Gulf of Mexico and energy legislation that may be on the floor this week.

For more than 3 months, the American people have watched our Nation's greatest environmental disaster unfold. This tragic accident has cost lives. It still threatens jobs and communities throughout the region. The shrimpers, fishermen, small business owners, restaurant and hotel workers, rig workers--everyone has been impacted.

In the last couple of weeks, we have gotten some rare good news. First, the new containment cap has temporarily plugged the hole. Second, the new cap survived the recent storm in the gulf. Hopefully, next week BP will finish drilling two relief wells and permanently plug the leak.

From this disaster we have learned that our country and the Federal Government were not prepared to deal with an emergency of this magnitude. Now we have an opportunity to fix the system. We need to implement reforms that prevent these accidents in the future and improve the ability to respond.

A tragedy of this magnitude merits a serious, bipartisan response from this body and from this country. The Congress has two options: No. 1 is to fix the problem; the second is to score political victories that don't help the gulf. My friends on the other side of the aisle appear committed to using this crisis to try to score political points.

The majority leader announced that he plans to unveil his energy legislation later today. It reportedly will contain oilspill provisions as well as broader energy legislation. The bill is being written behind closed doors--not in a committee, not in front of the American people, not on C-SPAN, but behind closed doors--and it will likely come directly to the floor later this week without ever going to a Senate committee. I think a fair question to ask right now is, What is going to be in the bill? Why can't we address the oilspill in an open way, in a transparent way? Are Senators going to be allowed to offer amendments, amendments that would improve the bill and increase bipartisan support?

Republicans have introduced an oilspill alternative. The Republican bill includes several important provisions:

First, the Republican bill reforms the system for managing offshore oil and gas exploration. It enhances safety requirements, and it improves spill response capacity. The Republican bill requires that our national oilspill contingency plan include a clear, accountable chain of command. That way, the American people know who is in charge and who is making decisions on the ground and on the water.

Next, the Republican bill reforms oilspill liability. The bill increases liability limits based on risk factors such as water depth and a company's previous history. It also sets up a system where claims beyond the liability cap are paid for by all of the companies drilling offshore. This liability system ensures those impacted are compensated. Unlike some other proposals out there, this proposal does not unfairly discriminate against small and medium-sized companies that are exploring for energy in the gulf.

The Republican bill also lifts the overly broad drilling moratorium that has been imposed by the Obama administration. Rather than imposing a blanket moratorium that threatens thousands of jobs in the gulf, the Republican bill would lift the moratorium for companies that have complied with the new safety and inspection requirements. This provision stops the administration from compounding the economic damage that is currently occurring in the gulf.

Importantly, the Republican bill also establishes a truly unbiased, bipartisan oilspill commission to investigate the spill. The oilspill commission that was appointed by the President is stacked--stacked with people who philosophically oppose offshore exploration.

Ideology aside, the members of the President's oilspill commission lack the essential technical expertise on offshore drilling. There is no expert on petroleum engineering on his commission. There is no expert on rig safety on the President's commission. Having this sort of expertise will help the factfinding mission. It will also strengthen-- it will strengthen the quality of the commission's recommendations. It is imperative that the oilspill commission has credibility.

The Republican bill helps those in the gulf. It will save much needed jobs, and it will improve our ability to explore for offshore oil and gas well into the future.

It is unfortunate that the majority is only spending a few days on the situation in the gulf. The text of the bill that this body is supposed to be debating later this week, that the American people should have an ability to see and to comment on, is not yet publicly available. How can this body, how can the American people have a serious debate on a bill in less than a week, especially if no one yet knows what happens to be in the bill? This is a crisis that has lasted for almost 100 days, the greatest environmental disaster in the history of our country. Yet the Senate is rushing to complete a bill that no one has seen, that continues to be written behind closed doors, and expects to complete it by the end of the week.

Sadly, the majority lacks transparency, and this lack of transparency by the majority follows months of poor response efforts by BP and by this administration. The companies involved in the spill played the blame game. While oil executives pointed fingers at one another, the administration struggled to get a handle on the situation.

The response was delayed, and the response was disorganized. The response lacked direction, and the response lacked decisiveness. There was no clear chain of command. State and local officials have repeatedly expressed frustration with the cleanup effort. And it is not just a lack of resources; in some cases, Federal approval stands in the way of local cleanup efforts.

Newsweek magazine had a recent article entitled ``The Mire Next Time.'' It says:

BP and federal officials have conjured parts of their oil

spill response plan from scratch and changed them by the day,

often failing to act with the speed and decisiveness an

emergency demands.

Over the weekend, Politico reported that ``the White House dispatched political and communications aides to the Gulf Coast states.''

Let me repeat that. Over the weekend, Politico reported that ``the White House dispatched political and communications aides to the Gulf Coast states.''

According to Politico:

The effort came about after the White House grew concerned

over political damage--

Not environmental damage--

from not having a permanent presence in the Gulf Coast

states.

Campaign staffers might help the White House contain its political disaster, but they are not going to solve the actual environmental and economic disaster.

Instead of worrying about political problems, the White House should be encouraging the Senate to work in a bipartisan way on legislation that will help prevent future accidents and to improve our Federal response capacity. Our top priority should be stopping the leak and containing the spill.

We must also make sure those impacted are compensated, and the claims process must be fair and fast. The majority should devote more than a few days to fixing the problems in the Gulf of Mexico. I urge colleagues on the other side of the aisle to work with us. Let us come together to pass bipartisan oilspill legislation. That is what the American people want. That is what the American people deserve.

I yield the floor.

Mr. President, I ask unanimous consent that the Senate proceed to the immediate consideration of H.R. 4853; that all after the enacting clause be stricken and the substitute amendment at the desk, which would add the previously requested lawsuit settlement language, modified with a rescission of unobligated stimulus funds to cover the costs and modified to reflect Barrasso amendment No. 4313, be agreed to; that the bill, as amended, be read a third time and passed, and the motion to reconsider be laid upon the table.

Mr. President, I rise today to pay tribute to 1LT Vernon Baker, a native of Cheyenne, WY. Our Nation has lost a son of Wyoming and hero of World War II.

First Lieutenant Baker not only fought the fascist Axis powers but he also fought to serve in a segregated U.S. Army. Vernon Baker's life story is a testament to no door or opportunity can be permanently shut in the United States.

As a young man, Mr. Baker made the decision to serve his country in World War II by joining the U.S. Army. He was initially told by Army recruiters he could not sign up because he was Black. His determination to serve his country was not deterred. Vernon returned to the Cheyenne recruiting office and found a recruiter who would sign him up.

First Lieutenant Baker went on to serve with the 92nd Infantry Division's 370th Regiment, an all Black unit in Italy. Throughout his World War II service, Mr. Baker was awarded the Bronze Star, Purple Heart, and the Distinguished Service Cross. Fifty years later, First Lieutenant Baker was awarded the Medal of Honor for his leadership and bravery in destroying a number of German positions near Viareggio, Italy, almost single handedly.

I thank Mr. Baker for his service. Mr. Baker is survived by wife Heidy, four children, and a grandson.

Mr. President, I ask unanimous consent to have printed in the Record First Lieutenant Baker's Medal of Honor citation and an article that appeared in the Casper Star Tribune.

Madam President, I come to the floor to visit about the continuation of revelations to the American people about the health bill that has been signed into law by the President. I come as someone who has practiced medicine in Wyoming, taking care of the families of Wyoming for the last 25 years. I come as someone who is the medical director of the Wyoming Health Fair, offering low-cost blood screens, low-cost preventive services to let people identify health problems early so they can get early treatment, keep down the cost of their medical care. This is something we have done all around the State of Wyoming for almost a quarter of a century now.

I come today to offer a doctor's second opinion. I have done this every week since the health care bill became law because every week there is a new revelation, a new finding, something that once again affirms what those of us who opposed this health care bill and this law had said would happen if this actually became law.

I come to the floor to tell my colleagues what I have found in the last week. After all, the goal of health care reform was to lower costs, to increase quality, and to improve access for patients around the country. I continue to believe week after week, as Americans learn more and more about this law, that this is a law that is going to be bad for patients--I heard that as I traveled the State of Wyoming this past weekend talking to folks; bad for providers, nurses and doctors taking care of patients; and something that is going to be bad for payers, people who are going to have to pay the bills for their own health care, because costs are going up, people paying for their own health insurance because costs are going up, taxpayers who are going to have to pay for this because those costs continue to go up.

I come to the floor having just taken a look at the Sunday New York Times, an article by Robert Pear: ``Changing Stance, the Administration now Defends Insurance Mandate as a Tax.'' I stood on this floor week after week hearing people on the other side of the aisle say: No, this isn't a tax. Now, all of a sudden the administration says differently. But then who can forget Nancy Pelosi, Speaker of the House, who said: You don't get to find out what is in the bill until the bill is passed.

There have been so many broken promises made by this administration and this President to the American people. It is no surprise that a majority of the American people continue to want to have this law repealed and replaced.

Well, let's review a couple of those promises. One is the President said:

The plan I'm announcing tonight--

and he said this to a joint session of Congress, with those

of us here attending--

The plan I'm announcing tonight. . . .will slow the growth

of health care costs for our families, our businesses, and

our government.

Well, the Chief Actuary for Medicare and Medicaid said, of course, the President is wrong.

Then the President said: If you like your health care plan, you will be able to keep your health care plan, period. He said: No one will take it away, period. He said: No matter what, period.

But then the Chief Actuary of Medicare and Medicaid said 14 million Americans would lose their employer-sponsored health coverage under the law. And when the White House came out with its own recommendations and rules and regulations, even they have said a majority of Americans who receive their health coverage through work will not be able to keep the coverage the President of the United States promised them they could keep.

And now the one where the President said: I can make a firm pledge. Under my plan, no family making less than $250,000 a year will see any form of tax increase.

He went on to be specific. He said: not your income taxes, not your payroll taxes, not your capital gains taxes, not any of your taxes.

That is what the President happened to say.

Well, that was not just a candidate speaking that way. Even as President, in September of 2009, in a speech before Congress, President Obama again promised the American people:

The middle class will realize greater security, not higher

taxes.

What a difference a year makes. The President's new health care law does contain tax hikes--lots of them. In fact, there are at least 18 new taxes in the health care law, and it raises approximately $500 billion over a 10-year period.

Here are a couple of examples: new taxes on medical devices and supplies, new taxes on brandname prescription drugs, new taxes on health insurance providers, increased Medicare payroll taxes on employers. But the most egregious is the individual mandate tax. That is the one that the American people are so concerned about right now. The new health care law requires all Americans to buy Washington- approved health insurance, and they have to do it by the year 2014. If they do not, they have to pay. Some call it a penalty, others call it a fine. For the first time in our Nation's history, the Federal Government is ordering the American people to use their own hard-earned money to buy a specific good or service.

Most people I talk to, who see through all of the games and the wording, say this is a tax. Even ABC News's George Stephanopoulos clearly pointed this out during a September 2009 interview with then President Obama. In that interview, Mr. Stephanopoulos pressed President Obama, pressed him to admit that the individual mandate is a tax. He asked President Obama:

But you reject that it's a tax increase?

And the President responded:

I absolutely reject that notion.

Well, Mr. President, apparently your own administration disagrees with you. And clearly your Justice Department disagrees with you. Because as the New York Times reported, on July 16--just this past Sunday--it said:

Administration officials say the tax argument is a linchpin

of their legal case in defense of the health care overhaul

and its individual mandate, now being challenged in court by

more than 20 states and several private organizations.

It is so interesting. Just the first paragraph:

When Congress required most Americans to obtain health

insurance or pay a penalty, Democrats--

In this very Chamber--

denied that they were creating a new tax. But in court, the

Obama administration and its allies now defend the

requirement as an exercise of the government's ``power to lay

and collect taxes.''

So there you have it. The article says the Justice Department now believes--the Justice Department takes direction from the President-- the Justice Department believes the individual mandate penalty is a tax precisely because it generates money, $4 billion per year through 2017. That is according to the Congressional Budget Office. So you have the President promising the American people one thing and directing his Justice Department to say exactly the opposite.

Well, you might say, is this partisan? No. We are talking about a New York Times article. The New York Times goes on to quote Jack Balkin, who is a professor of law at the Yale Law School. This is somebody who actually supports the health care law. This is a supporter of the health care law. What does he say about President Obama? He said he ``has not been honest with the American people about the nature of this bill.'' He says: ``This bill is a tax.''

So here you have a supporter of the health care law, a supporter--a Yale Law School professor--who goes on to say of President Obama, he ``has not been honest with the American people about the nature of this bill.'' He said: ``This bill is a tax.''

We have President Obama's own administration now admitting the individual mandate to buy health insurance is a tax increase. Well, this clearly violates the President's repeated promises that no one--no one--making less than $250,000 a year would see a tax increase.

Congress's Joint Committee on Taxation confirms the tax hikes in the health care law absolutely will hit millions of middle-class, working- class families struggling in this economy.

Once again, we see and hear the President of the United States promising the American people one thing and delivering something entirely different.

The President went on national TV and said his individual mandate was not a tax. Now the President's administration says it is.

So I come to the floor again today with a doctor's second opinion, outlining the broken promises of this health care law--the broken promises made by this President and this administration to the American people, and forcing through, cramming down their throats, against the wishes of the American people, a law the American people did not want, and still do not want. Because if you go to any senior center, if you go to any civic organization, if you travel around this country and you ask the question: Under this law, do you believe the cost of health care will go up, all the hands will go up. And if you ask the question: Do you think the quality of your own care under this new law will go down, the same number of hands continue to go up.

That is why it is important we repeal and replace this health care law with something that is patient centered, with something that focuses on patients, not Washington bureaucrats and not insurance company bureaucrats. There is no reason to not allow Americans to buy insurance across State lines. There is no reason not to allow Americans who want to buy individual insurance to get the same tax breaks. They should be able to get the same tax breaks as those who get their insurance through work from the big companies with those tax breaks.

We have to allow people to have individual incentives if they stay healthy and take measures to keep down the cost of their own care. We have to deal with lawsuit abuse, which was essentially neglected in this over 2,000-page health care law. We need to encourage and allow small businesses to join together to get the cost of their health care down and the cost of their insurance down.

Those are the things that will get the cost of care down--not this monstrous bill that is bad for patients, bad for providers, and bad for the payers of health care. That is why week after week I continue to come to the Senate floor to once again go over what we have learned in the past week. This week we have learned the President of the United States, who promised there would be no increased taxes, has now changed the tune of his entire administration and his Justice Department by saying: Oh, no, we are changing our stance. Now the insurance mandate is a tax.

I offer my second opinion, and it is time to repeal and replace this health care law.

Madam President, I yield the floor.

I suggest the absence of a quorum.

Mr. President, West Virginia, the U.S. Senate, and our Nation have experienced an incredible loss. Over the last few weeks, this Chamber witnessed poignant eulogies and remembrances of the legendary Senator Robert Byrd. Much has been said and written since Senator Byrd's death on June 28, 2010.

Those who have so eloquently written and spoken knew the Senator much better than I--Presidents, Senators, world leaders, dignitaries, as well as members of his family and friends in West Virginia.

He will be remembered as an intelligent, compassionate and illustrious figure. A giant.

Many people have recalled his historic milestones, distinguished career and legendary speeches. I first met Senator Byrd when I arrived in the Senate in 2007. I introduced myself and told him about a friend and patient of mine from Wyoming who had told me that Robert Byrd was his favorite senator. Like Senator Byrd, my friend uses a wheelchair. Senator Byrd asked me why my friend liked him so much. I told him it was because of their mutual commitment to the Constitution.

I went on to say that he thought Senator Byrd was ``the best thing since sliced bread.'' Senator Byrd's eyes brightened and widened with the reference to sliced bread. He then gave me a complete history of sliced bread in America and the date when the first mechanical bread slicer was used in the United States. As a true man of the people, Senator Byrd also sent a note and a copy of the Constitution to my friend in Wyoming.

When former Wyoming Senator Cliff Hanson died late last year, I shared the news with Senator Byrd. Senator Byrd said, ``I liked Cliff Hansen. Cliff Hansen was a friend of mine. Cliff Hansen knew what he stood for.'' The same can be said for Senator Byrd.

As a public servant, he had few equals. As a parliamentary expert, he had none. Every day, Senator Byrd showed his enduring dedication to his family, the people of West Virginia, the United States Constitution, and our Nation.

Senator Byrd leaves us with a memory of the man--the memory of his kindness, grace, and passion. He had a depth of institutional understanding and knowledge of the traditions of the U.S. Senate that will never be replaced. While many of us are students of history, Senator Byrd truly lived this Nation's history. His strength, determination, and unyielding pursuit of knowledge serve as a model for all of us.

To his daughters Mona Byrd Fatemi and Marjorie Byrd Moore, his grandchildren, and family, I extend my family's sympathy and hope the coming days are filled with love, enduring strength, and God's grace.

Bobbi and I wish the Byrd family our best and our prayers are with you.

Thank you very much, Mr. President.

I come to the floor today with my friend and colleague because I have just gotten back from a week of traveling all across the State of Wyoming, a beautiful State this time of year. People are out and at parades. I had a chance to visit at several senior centers. The question that continued to come up was, Can the government force me to buy health insurance?

A lot of people in Wyoming carry their copy of the Constitution with them. They carry it in their breast pocket. They carry it with them. It is in the pickup truck. It is with them all the time. They continue to look to the 10th amendment, which says:

The powers not delegated to the United States by the

Constitution, nor prohibited by it to the States, are

reserved to the States respectively, or to the people.

The people quote that. It just makes sense to the people of Wyoming that Washington should not be able to come into their communities, into our State, into their homes, and say: You must buy this product.

So when I see the number of States--20 now--that have filed suit against the Federal Government because of a new health care law, a law that I think is going to end up, if it is not repealed and replaced, being bad for patients, bad for payers, the taxpayers in the country and the people who pay their own health care bills as well, and bad for providers--it is a bill that I think is bad medicine, to the point that Senator Tom Coburn and I, the other physician--there are only two physicians who practice medicine in the U.S. Senate, and I have been taking care of people and their families in the State of Wyoming since 1983--we have come up with a report called ``Bad Medicine: A Checkup on the New Federal Health Care Law.''

There are people who say: I don't like this. Now we have a nominee to the Supreme Court who is very likely, if this works its way to the Supreme Court, to have an opportunity to make a ruling, a ruling for the people of the United States, on whether this body--this Senate, this House--has a right to tell the American people what product they must buy, whether it is health insurance, whether it is cars, whether it is the kind of cereal they eat for breakfast in the morning. The American people are very concerned.

So I come to the floor also with this editorial from Tuesday, July 13, this editorial entitled ``Kagan and ObamaCare,'' because the fundamental question is, Should this nominee recuse herself if she is, in fact, confirmed by this body? One might say: Well, when would someone recuse themselves from making a decision? Because, after all, she has been serving in this administration, serving this President, serving the President who has promoted such a piece of legislation that forces American citizens, forces the citizens of this country to buy a product.

The editorial says:

Recusal arises as a matter of judicial ethics if as a

government official she expressed an opinion on the merits of

the health-care litigation. This is what she would have to

render a judgment on were she to be confirmed for the High

Court.

It goes on:

It is also the question on which she is likely to have

participated given her role at the Justice Department.

I would have to turn to my colleague who is the ranking member of the Judiciary Committee.

It says as well that:

The Solicitor General is the third ranking official at

Justice, its senior expert on Constitutional issues, so it's

hard to believe she wouldn't have been asked at least in

passing about a Constitutional challenge brought by so many

states. The debate about the suit was well underway in the

papers and on TV. The matter surely must have come up at

Attorney General Eric Holder's senior staff meetings, which

the Solicitor General typically attends.

The editorial goes on to say:

We doubt Ms. Kagan would have stayed mum about the cases in

internal Justice councils on grounds that Mr. Obama might

later nominate her to the Court. At the time the Florida suit

was filed on March 23, she was only one of several potential

nominees whose names were being floated by the White House.

So here we have this, and that is when you get back to that opening

paragraph I read: ``Recusal arises as a matter of judicial ethics.''

So I say to my friend and colleague from Alabama, is this not a legitimate area of concern, especially in light of the fact that across this great country people are offended by this law? I just saw a poll that came out today. The popularity of this new law, which has never been very popular and which was forced down the throats of the American people, is now 7 percentage points less popular now than it was even 2 months ago. So something exceptionally unpopular is getting even more unpopular. By a ratio of 2 to 1, people think it is going to raise their costs and lessen their quality of care.

Mr. President, I spent Friday visiting with colleagues, friends, patients at the Wyoming Medical Center. Across the board, after talking to physicians, talking to patients, talking to others in the hospital as well as around the State of Wyoming, people believe it is going to be bad for patients, those waiting to get their care; bad for payers, the taxpayers of this country, the individuals who are paying for their insurance as well; and bad for providers, the nurses and the doctors whom I talked to. They have incredible concerns about what the impact is going to be on nurses and doctors when taking care of patients. The patients' concerns are, are they going to get the kind of care they want, the kind they are accustomed to, because no matter where I go in Wyoming, I hear people saying: This is a bill that wasn't passed to help me; it was passed and forced down our throats to help someone else, and they are going to make me buy a product that I might not want to buy, according to a number of criteria the government puts forward.

They may not want what the government says they have to buy, and then you get back to the Constitution. Does this government and does Congress have a right to tell the American people what they must purchase?

The whole health care law makes me nervous. I look at this and say that the underpinning of this law--the thing that holds it together--is the mandate on the American people that everyone buy insurance, that everyone has to have insurance at work or through Medicare or Medicaid, but if none of those work, you have to buy insurance. It is the government telling someone they have to buy it.

So I have great concerns when a government thinks it is so powerful, and this body thinks it is so powerful--more powerful than the American people. I reject that, and I want to make sure that, as it gets to the Supreme Court, there are people on the Court who side with the American people and, most importantly, with the Constitution--what to me the tenth amendment means--and the people of Wyoming, which is that the government cannot come into our homes and say you must do this--you must buy this product.

I ask my colleague this, as he participated in the hearings and the questioning. Apparently, Ms. Kagan says she will recuse herself from participating in a number of cases--I think 11--on which she represented the government in her current job as Solicitor General.

It seems that in a case such as this--the area that the President of the United States put all of his credibility and effort into forcing through this body and through the House and, in my opinion, jamming down the throats of the American people--if she is already going to recuse herself on 11 other issues, it seems to me that we should also get that sort of a commitment on this issue.

As the Senator has said--and he has practiced law--recusal arises as a matter of judicial ethics. Now we are talking about the ethics of the individual involved, and the decisions that person would then make based on the position to which they are nominated.

If I can ask a final question. The final paragraph of this editorial that the Senator will introduce into the Record says:

As someone who hopes to influence the Court and the law for

decades--

We are talking about an appointment that could last a lifetime, 30 or 40 years.

Ms. Kagan should not undermine public confidence in her fair-

mindedness by sitting in judgment on such a controversial

case that began when she was a senior government legal

official.

It seems to me--and I ask the Senator at this time--where someone may be embarking on a long career on the Court, wanting to do the right thing and head in the right direction, that the best decision would be to recuse herself from this case as well, if she is confirmed, rather than get involved in it and potentially have an impact on her reputation for decades to come.

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

I ask unanimous consent to speak for up to 30 minutes in a colloquy with a number of colleagues.

Madam President, I rise to discuss a recess appointment made last week when many of us were traveling to visit with constituents to talk about the issues of the day.

During that time, I was in Wyoming, and one of the main issues brought up at senior centers was the appointment by the President of Dr. Donald Berwick to be the head of Medicare and Medicaid. I heard the concerns of these folks because of statements Dr. Berwick had made about the British health care system and his love of the National Health Service in England. They are concerned as to how this gentleman, who has taken positions and made a number of statements, would run Medicare and Medicaid. Specifically, they had concerns because they had heard his statement:

The decision is not whether or not we will ration. The

decision is whether we will ration with our eyes open.

Seniors around the State were concerned about what this means. Then to hear that the President made a decision to do a recess appointment of this very individual, without hearings in the Congress, without an opportunity for the American people to hear specifically his response to questions we might have--is this what the American people want? Absolutely not. We have a President who campaigned on a pledge of accountability and transparency. To me, this makes a mockery of that pledge because this nominee will not have to answer questions about statements he has made.

I see my colleague from Arizona, a State where people on Medicare are concerned, where we have many seniors, a State with a Medicaid population that will be impacted. Yet we now have a director of Medicaid and Medicare, finally named by the President after a full year of debate on a health care law that cut $500 billion from seniors on Medicare and crammed 16 million more Americans onto Medicaid, a program that is currently very broken. I say to my colleague from Arizona, my goodness, the impact on the folks in Arizona is astonishing.

There was an article today in one of the papers that talks about a Medicaid stalemate. They talk about his home State of Arizona. They say Arizona has had to cut about a dozen benefits from its Medicaid Program, including hearing aids, podiatrist services, capped physical therapy visits. Yet there was nobody in charge of Medicaid when the President and the Democrats in this body said: Hey, don't worry. We are going the cram another 16 million more Americans onto Medicaid--a system we know is broken.

So I turn to my colleague from Arizona and ask him his thoughts on this recess appointment at a time when seniors and folks around the country are concerned about the debt, the deficit, the economy, and now we are seeing the President making a mockery of his previous comments about accountability and transparency.

Madam President, I believe the President of the United States, I say to my colleague and friend, now has what he wants: his health care rationing czar--not someone approved by the Senate but someone he has appointed and put into place without an open hearing.

It is so interesting, as my colleagues from Arizona and South Dakota talk about, that the failings of the British health care system--a system that Dr. Berwick says, ``I am romantic about; I love it; it is a national treasure, a global treasure,'' but then the headline today is: ``U.K. Will Revamp Its Health Service.'' It says: Health care experts called the plan one of the biggest shakeups in the national health service's 62-year history. Its new coalition government in Britain, grappling with weak public finances and rising health care costs, announced an overhaul of the state-funded health system that it said would put more power in the hands of the doctors and involves cutting huge swaths of bureaucracy.

This is at a time when we have just in this country passed not what we voted for but what the Democrats and the President voted for: a bill that increases the bureaucracy, including $10 billion for Internal Revenue Service agents and higher and higher numbers of government workers and bureaucrats taking power away from the doctors, away from the patients. Now it is government-centered health care at a time when Britain is moving away from it, and the person the President of the United States has put in as his health care rationing czar is someone who calls that approach a national treasure; cutting $500 billion from our seniors depending on that for Medicare, not to save Medicare but to start a whole new government program.

Britain is trying to revamp because they know that someone with cancer in the United States has a much better chance of survival than somebody in Britain. It is not because our doctors are better in the United States--and I have practiced medicine in Wyoming for 25 years-- it is because people get care in the United States that is delayed and therefore denied in Britain. But Dr. Berwick is romantic. He has fallen in love with that national health service, a service that is not good for patients, and it is not good for providers.

I see my friend from South Dakota, another rural community and State. I am sure he is seeing and hearing the same things from his seniors there, their concerns about what is going to happen to the cost of their care, the quality of their care, and the availability of the care, especially with Dr. Berwick now in charge.

Madam President, if I could just ask my colleague, talking about the Constitution and how we as Americans see ourselves, Senator McCain just quoted a comment made by Dr. Berwick about the darkness of private enterprise. Dr. Berwick coauthored a book called ``New Rules.'' In it, he argues that one of the primary functions of health regulation is to constrain decentralized, individual decisionmaking--constrain individual decisionmaking--and to weigh public welfare against the choices of private consumers. I mean, could anything fly further in the face of what Americans believe? The decisions, the choices of private consumers--that is how we make decisions in America. That is what I recommend for patients: Make your individual choice. What is best for you? How to help keep down the cost of your care; prevention, coordinating care; working and making smart choices for you as an individual. Who knows better? Who knows better how to spend your money? You do. Who knows better how to make choices for your life? You do.

That is not what Dr. Berwick is saying in this book, ``New Rules.'' It is to weigh public welfare against the choices of private consumers.

So I inquire of my colleague from South Dakota, what would people from South Dakota think about that? This is somebody who is saying: Government knows better than you do. People of Wyoming have never felt that way, and I would imagine the people from South Dakota have never felt that way either.

It was interesting, on this floor someone on the other side of the aisle stood and said: If you are against Dr. Berwick, then whose side are you on? As I see my colleague from South Dakota, I can answer that question, and he can answer that question. If you are against Dr. Berwick, then whose side are you on? I am on the side of the American people--the American people who are concerned about $500 billion in cuts to their Medicare, not to help Medicare, not to strengthen Medicare, but to start a whole new government program.

I am on the side of the people who believe we should not redistribute wealth in this country. I am on the side of my patients and friends in Wyoming who do not want the rationing of care. I am on the side of my friends and patients in Wyoming who do not want government-run health care. But that is what we have now.

We have a President-appointed czar, essentially--a czar--to ration health care. That is not what the American people want. It may be what the Democrats in Congress want. It may be what the President of the United States wants. I view this as an arrogant use of Presidential power at a time when I think the American people were intentionally misled all during the fall because the President refused to appoint somebody, would not name anybody to be in charge of Medicare and Medicaid when the whole debate was going on. Only after the bill was signed into law--only then--would he announce to the country his choice was somebody way outside the mainstream of how we in America deliver health care, want our health care, how we care as patients, how we care as physicians--way out of that mainstream, someone whose approach is a very different one, who loves a system where we know people with diseases are denied care, where care is delayed, and where today the whole country is saying: I think we got it wrong. We need to relook at this. They see what is happening, and I think the American people will know what will happen to us as a nation if we go down the path of a nationalized health system where we redistribute wealth, ration care, and government runs the health care system of our Nation.

It is the wrong decision by the President. It is the wrong direction to go. The American people know it, and they do not like it.

Once again, the American people are not going to have their voices heard because the American people are going to be denied an opportunity to voice their opposition to this nominee to their elected representatives because the President decided he knew better than this Congress and made a decision to appoint someone at a time when the American people wanted their voices heard.

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

Mr. President, I come to the floor today, having just returned from spending a wonderful week over the Fourth of July in Wyoming, visiting with people across the Cowboy State at senior centers, Kiwanis clubs, Rotary clubs, and repeatedly the issue came up of this appointment of Dr. Berwick to head Medicare and Medicaid.

My colleague who just left the floor talked about the playbook of delay and obstruction. I will tell you that this recess appointment and the overall appointment of Donald Berwick is absolutely a page out of the playbook of the U.S. President of delay and obstruction.

Last year I came to this floor and said we should have somebody in charge of Medicare and Medicaid. When this body is talking about cutting $500 billion from our seniors on Medicare, not to save Medicare but to start a whole new government program, there ought to be somebody in charge of Medicare in this country who can answer the questions about what are the impacts going to be. But the President of the United States refused to name anyone.

At a time when this body was debating how to handle 16 million more Americans jammed and crammed into Medicaid, a program where half the doctors in the country will not see those patients, it is like giving somebody a bus ticket when a bus isn't coming. Those people may have coverage but they are not able to get care. There should have been somebody in charge of Medicaid. I came to this floor and said: Mr. President, it is time to make someone take over the responsibilities, to be in charge of Medicare and Medicaid so they can come and explain to this Senate and this country what the impacts are going to be of the cuts in Medicare and the cramming of more and more people into Medicaid. But the President of the United States refused.

The playbook of delay and obstruction belongs to this administration. The playbook of delay and obstruction is what led us here today, to a situation where no one was even named to be in charge of Medicare and Medicaid for the United States until after an extremely unpopular and unwise health care bill was signed by the President of the United States. Then and only then did the President of the United States decide who he would want to put in charge of Medicare and Medicaid. To me, this is an insult to the American people, an insult that the American people would never ever have an opportunity of having open congressional hearings to have explained to them the positions of this man nominated to head Medicare and Medicaid for this country.

I think the President of the United States has made a mockery of his pledge to be accountable as an administration, to be transparent as an administration. That is what I heard at senior centers in Rock Springs, WY, and in Riverton, WY, at a Kiwanis club, people there as well as at a meeting in Powell, WY, at the Rotary club. People all across Wyoming and all across the country are very concerned, saying how is this going to affect me personally. Seniors know if you take $500 billion away from their Medicare, not to help seniors, not to help Medicare, but to start a whole new government program--they are very interested how that is going to work because that affects each and every one of them personally.

I heard my colleague from Rhode Island talk about coordinated care. I am with him. We need to coordinate care. That is why I was surprised to see Members of the Democratic side of this Senate vote to kill the program of Medicare Advantage for 10 million Americans. These are individuals who signed up for Medicare Advantage because there is an advantage. It actually helps with preventive medicine and it helps with coordinated care. That is going away. Yet the President of the United States did not have anybody in charge of Medicare or Medicaid to explain what would be the impact of getting rid of Medicare Advantage on those 10 million people who need coordinated care and needed preventive medicine.

When I hear my colleague from Rhode Island say if you are against Dr. Berwick, then whose side are you on, I would say I am on the side of the people of Wyoming, the seniors of this country, the people who are seeing $500 billion of Medicare cut from them to start a whole new government program. They realize it is not going to help them. That is why at town meetings and visits around the State of Wyoming people believe ultimately they are going to end up paying more for their care and are going to have less care available to them because of this very unpopular health care law. That is why, week after week, I come to the Senate floor to talk as a practicing physician, someone who has taken care of patients for 25 years around the State of Wyoming, to give a doctor's second opinion, to talk about what I see, as a physician, with this health care law that ultimately I believe is going to be bad for patients, bad for payers--the people across this country who are going to pay the bill for this--and bad for providers, the nurses and doctors who take care of the patients.

Here we now have appointed, without a hearing, without a debate, without this Senate having had a chance to vote, a Director of Medicare and Medicaid who has expressed many opinions that do fly in the face of and are way out of line with the opinions of the American people. So it is not a surprise you see headlines in places such as the New York Times that say ``Tough Confirmation Battle Looming For Medicare Nominee.'' That is in the New York Times.

The Boston Globe, the hometown paper where the nominee has been known to practice, ``Dangerous To Your Health,'' of Dr. Berwick.

What is this administration trying to hide? Why is this administration unwilling to have hearings? Why is the administration not allowing Dr. Berwick to come to Congress to explain to

the American people his opinions and his views? All we know is what we have read, what we have seen from his speeches, the things he has written. Likely, it is because if those things were heard by the American people this man may absolutely be unconfirmable.

If that is what the President wants, that is what the President got. Because right now I will tell you the President of the United States has his own health care rationing czar.

You say how can you imagine that sort of thing? Let's look at some of these quotes from Dr. Berwick.

The decision is not whether or not we will ration care--the

decision is whether we will ration with our eyes open.

This is not some long-ago quote. This is last year:

The decision is not whether or not we will ration care--the

decision is whether we will ration with our eyes open.

This is what he says about the British health care system. He says:

I fell in love with the [national health system] . . . to

an American observer, the [National Health Service] is such a

seductress.

Who talks like that? He said:

The [National Health Service] is not just a national

treasure, it is a global treasure. As unabashed fans, we urge

a dialogue on possible forms of stabilization to better

provide NHS with the time, space, and constancy of purpose to

realize its enormous promise.

I will tell you as a practicing physician that the rates of cancer survival in the United States are much higher than in Britain. It is not that our doctors are better, it is that people get care sooner-- early detection, prevention, early treatment. Those are the keys to cancer survivability. So what we know is that it is not that the doctors in the United States are better than those in England, it is that the patients in the United States get care where they do not in England. But, then again, Dr. Berwick loves the British health care system. He actually says:

I am romantic about the National Health Service; I love it.

That is what we have. We have a recess appointee who also went on to have some ideas about wealth in the United States. He said:

Any health care funding plan that is just, equitable,

civilized and humane must redistribute wealth from the richer

among us to the poorer and less fortunate.

Here we have a recess appointee who will make decisions for hundreds and hundreds of billions of dollars, that impact the lives of the American people, without ever having a Senate debate, without ever having a Senate hearing, without us ever having one word of testimony because the President of the United States believes that he knows better than the people of this country.

Dr. Berwick coauthored a book. He talked about one of the primary functions of health regulation is to ``constrain decentralized individual decisionmaking.'' Let me say that again: ``Constrain decentralized individual decisionmaking.'' Individuals? Humans? People around the communities. People in our home States. He says we want to constrain local people making local decisions. And he says to weigh public welfare against the choices of private consumers. For a consumer, what is more important to them than their health?

This is not a one-party-only situation. Even Max Baucus, Senate Finance chairman, issued a statement critical of this end-around decisionmaking by the President.

It is interesting how things change. When Barack Obama was a Member of the U.S. Senate, as he was not that long ago, the President at the time, George W. Bush, made a recess appointment. This is what President, then Senator Obama, had to say of John Bolton. He said, ``He's damaged goods.'' He said, ``He'll have less credibility.''

Don Berwick is damaged goods. He will have less credibility. I am not talking about that with a couple of Senators, I am talking about it from the standpoint of the American people. The American people know and understand that the President of the United States is trying to hide something. That is why there has not been an open hearing. The Republicans have been asking for an open hearing. The Republicans have been asking for a number of weeks for an open hearing. I have been asking that the President name somebody to this position since last year but, no, in the playbook of delay and obstruction, the administration has decided not to do that--don't name anybody until well after the bill is signed into law and then don't allow that person to come to the Senate for a confirmation hearing.

What are they trying to hide from the American people? That is where we are today. We are in a situation where the President of the United States has made an appointment, a recess appointment without hearings, without the American people knowing or being able to ask the questions. What exactly are you going to do here, Dr. Berwick, when you cut $500 billion from our seniors on Medicare? What is that impact going to be on their lives when you cut money from hospice, when you cut money from nursing homes, when you cut from physical therapy, when you cut from rehab, when you cut money from hospitals, when you cut money from physicians? We have more and more people becoming Medicare age every year. Why is the President of the United States unwilling to have that individual come to the Senate and explain to the American people how it is going to work? The people have a right to know.

That is why I am not surprised and was not surprised this past week in Wyoming--in Riverton, in Rock Springs, in Powell, as I traveled around the State--to have people coming up to me saying: What is going to happen to my Medicare, now that the President has made this recess appointment over the Fourth of July, when the Members of Congress are not in Washington but are at home, visiting with the folks in their districts?

What is this going to mean for my health care or, as many others say, what does this mean for my mom or my dad? Those are questions that are not going to be answered because the President of the United States has decided to make a recess appointment at a time the American people have the right to expect and deserve to know from a President who has campaigned and promised, promised the American people, transparency and openness and accountability, and now the American people realize they have received none of those things.

So, again, as a physician I come to the Senate floor. I spent all day Friday at a Wyoming Medical Center visiting with people in Casper. Senators around the country went home and talked to people, in fact, many back to where they worked. I went back to where I worked at the hospital, visited with doctors and nurses and patients as well. All are concerned, concerned about this health care law that they believe is going to raise the cost of their health care, lower the quality; concerned about a health care law that they believe is going to be bad for them as patients, bad for the taxpayer because the costs are going to go up; bad for the providers, the nurses and doctors who take care of them; bad for the American people.

That is why so many of them, still today, believe this health care bill should be repealed and replaced with things that put patients in charge, not insurance company bureaucracies, not Washington, DC bureaucrats; that would put patients in charge. That is what we need in this country. That is the kind of health care the American people need. That is what they are asking for. And when my colleague says: If you are against Dr. Berwick, then whose side are you on? I am on the side of the people I have taken care of all around the State of Wyoming for the last 25 years.

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

Mr. President, I rise today to pay tribute to a close friend of the Senate, COL Phil Skuta. Over the past 2 years, Colonel Skuta has served as the Director of the Marine Corps Liaison Office to the U.S. Senate.

Throughout Colonel Skuta's service in the Senate he has escorted 14 CODELs to 27 countries. I have traveled with Phil to visit our troops in Kuwait, Iraq, and Afghanistan.

Last year, I had the privilege of spending Thanksgiving with the Wyoming Army National Guard 115th Fires Brigade in Kuwait. With only 2 weeks' notice, Colonel Skuta and his team provided the support to execute this trip. As a selfless leader, he did not task a junior officer to take on the trip. He postponed his Thanksgiving plans with family to be with our troops in the Middle East.

Throughout these travels I got to know Colonel Skuta very well. Colonel Skuta is a native of Williamsport, PA. Phil joined the Marine Corps in 1984 through the Platoon Leader's Class program while studying at the University of Pittsburgh at Johnstown.

From Operations Desert Shield and Desert Storm to Joint Guardian and Iraqi Freedom, Colonel Skuta has led his marines through many trying and dangerous situations. On his most recent deployment, he led the Second Battalion, Seventh Marines into Iraq to train and conduct operations with the Iraqi Security Forces. The 2d Battalion, seventh Marines' primary area of operations was Ramadi and west of the Euphrates River in Al Anbar province.

Throughout his career he has handed down from one marine to the next his excellent leadership skills. Colonel Skuta's example will teach the next generation that will come to know the Marine Corps. Under Phil's leadership, steady hand and sharp instincts, the USMC Senate liaison team has well served General Conway and all marines. The USMC liaison office has provided invaluable support for the Senate.

While the U.S. Senate and Marine Corps are losing a valuable and trusted ally in this body, we wish Colonel Skuta well on his next assignment to be Director of the USMC Strategic Initiatives Group.

Mr. President, I come to the floor today, as I have each week since the health care bill became signed into law, to visit with Members of this Chamber about experiences I have had, having practiced medicine in Casper, WY, since 1983. For a long time, I was an orthopedic surgeon taking care of families across the Cowboy State. I come today, as I have week after week, to offer a doctor's second opinion about the health care law because it seems every week since this bill has become law there is some new, unintended consequence, some new development, some new sharing of information that the American people seem to say: That is not what I want for my health care. It is not what I want for my family.

During the debate of the health care bill, it was the Speaker of the House, Nancy Pelosi, who said: First you must pass the bill to find out what is in it. Well, as the American people continue to learn about what is in this new health care law, they continue to be disappointed with so many broken promises that were made by Members on the Democratic side of this body and by the President of the United States.

The initial goal of the health care bill, which is now law, was to lower the cost of care, to increase the quality of care, and increase the access to care. Yet in the weeks that have gone by--and the President of the United States had a press conference last week, 90 days into the process--it seems to me this law is going to be bad for patients, those who need medical care in this country; it is going to be bad for payers, the patients who pay for their care, the businesses that pay for the insurance, the taxpayers who are going to be burdened additionally; and it is bad for providers, the nurses and the doctors who try to take care of these patients.

So as I look at this, it seems to me this health care law is going to result in higher costs for patients and less access and less quality. That is why across the board still a majority of Americans want this bill repealed, want the law repealed and replaced because, basically and fundamentally, they do not believe this was a law that was passed for them. They believe it was a law that was passed for somebody else. They think, as a result, they are going to end up paying more and getting less.

That is why today I come to the Senate floor to talk about an additional broken promise and why the American people continue to be so very skeptical about this new health care law.

We have heard the promises in the past by the President. He said: If you like your health care plan, you will be able to keep your health care plan. Period. He said: No one will take it away. Period.

Last week I came to the floor to talk about the fact that over half of the people in this country who receive health care through where they work--half of them--will lose the coverage they have, and it may be within the next 4 years. Those are not my statistics. That is the report that came right out of the White House just a little over a week ago.

So the public is skeptical. I come to you as someone who has worked with preventive medicine, who has worked as the medical director of Wyoming Health Fairs that have provided low-cost health screenings for people all across the Cowboy State, where thousands of people show up at health fairs on weekends to learn what their blood sugar is and how to help get that down; to help people with diabetes, where they get to learn what their cholesterol levels are and how to get that better controlled, to learn if they have thyroid problems and do screenings for cancer as well.

So people all across this country are concerned with their care and the quality of their care and the cost of their care.

The President has made a number of promises, and there is another one he made that I wish to talk about today, and that is a promise the President made to small businesses. On May 7, President Obama, on his monthly job numbers, said:

Four million small businesses recently received a postcard

in their mailbox telling them that they are eligible for a

health care tax cut this year.

That is what the President said. He said:

Four million small businesses recently received a postcard

in their mailbox telling them that they are eligible for a

health care tax cut this year.

He went on to say:

It's worth perhaps tens of thousands of dollars to each of

these companies.

Well, on face value, that sounds pretty good. Small business owners all across the country would welcome that sort of help. Yet I wish to bring to the floor today an article written by one small business owner, Charles Arp. The title of his column is ``ObamaCare's Broken Promise: One Company's Experience.''

I talked with Mr. Arp yesterday by phone. He is in Illinois. He said this is absolutely what has happened to his business, and he knows I am going to be sharing it on the floor of the Senate today, because he has concerns. He got that postcard. He was at first encouraged by the President's words, the President's promise, but, again, it is another broken promise to the American people. This is a letter dated June 18 of this year. He says:

A few months after the passage of President Obama's health

care overhaul, a postcard arrived which led me to believe

there may be a benefit coming to my small firm. The mailing

from the Treasury Department touted a generous 35 percent tax

credit to firms with less than 25 full-time employees

averaging less than $50,000 per year in wages, a category

which includes my company. In fact, I thought we were right

in the sweet

spot, with 17 full-time employees averaging slightly more

than $42,000 per year.

Well, small business needs relief. He goes on to explain about his company:

I manage Pinney Printing Company in Sterling, Illinois. I

am the president of the firm which our family has owned for

100 years. Health care expenses are a major obstacle to

Pinney's long-term prosperity. Each year in May, our policy

renews and we are faced with double-digit premium increases--

20 to 40 percent in recent years.

Some of the increase is absorbed by the company, and some

gets passed on to the employees through higher premiums,

deductibles, and copays. We have experimented with self-

funding and high-deductible health plans. Last year we were

forced to downgrade to an HMO plan.

We are nearing the end of our rope, so I was hopeful to

learn there could be some benefit for us in the new law.

And what small business owner wouldn't?

He goes on to say:

Postcard in hand, I did a quick calculation and figured our

tax credit should be about $28,000. That is 35 percent of the

$80,000 we expect to spend this year on employee health care

premiums. I phoned our health insurance broker and inquired

whether anything special had to be done, not wanting to be

excluded by some technicality. He reported there was no

special requirement--more good news.

Aha, the next section: ``Barrier to Tax Credit.'' He said:

But there was a problem. A few weeks later I received an e-

mail with a link to the National Federation of Independent

Business's online calculator. This is a calculator designed

to help firms determine their qualifications for the tax

credit. I plugged in our numbers, and pressed ``update'' to

yield a calculation of . . . zero-zip, nada!

Double-checking, I tried again and again, finally concluded

that the 35 percent tax credit will be available only to

firms with ten or fewer employees averaging $25,000 or less

per year. Increasing either factor--either the number of

employees or the average salary--greatly diminishes the

magnitude of the tax credit. Increasing both factors yields a

parabolic reduction in the result.

Being in the graphic arts industry, I decided to create a

chart diagramming the limits of this ``generous'' tax break.

I have the chart here.

He goes on:

Not one to give up easily, I continued my pursuit--

because he had the postcard, of course.

He said:

Surely, there was some benefit in this for me, after years

and years of paying the toll for big-government programs and

receiving nothing.

The vague language on the postcard instructed readers to

learn more at www.irs.gov. There it said to exclude owners,

those having a stake of 5 percent or more, from all the input

values. I eagerly entered new numbers--subtracting myself, my

annual premium, and my salary. This brought our head count

down to 16 employees and dropped the average salary to

$40,000.

I entered the numbers, and the NFIB calculator displayed

the same result--another big goose egg.

He goes on:

Talk about unintended consequences! My firm would have to

reduce its workforce and cut employee wages to benefit from

this newly enacted Patient Protection and Affordable Care

Act. Is this what the objective should be?

I would never consider taking such an action. Most of the

employees have worked at Pinney for twenty years or more. It

did get me thinking, though: Maybe we could divide Pinney

Printing Company into two smaller firms. While I'm no expert

at gaming the government, like some people, it's certainly a

possibility many will consider.

I feel foolish now, after getting my hopes up for a

government solution to our problem. Our firm is running out

of affordable options.

It is my belief that health insurance should be decoupled

from employment and bought by individuals and families in the

same way automobile insurance is purchased. It is my fear

that ObamaCare is a step in the wrong direction and matters

will get worse, not better, for Pinney Printing Company and

others like us.

So there you have it. It is a heartfelt letter written by someone who got the postcard from the IRS, from the President, listened to the President's statement that said you will be eligible, but what he found out, as did many small business owners all around the country who received this postcard, is that it doesn't apply to them, and if they want to make it apply to them, what they are going to need to do is actually fire employees and lower the wages of the other employees. It makes no sense at all, and that is why I talked to Mr. Arp yesterday, the owner of the company, who said he found this deceiving.

So that is why I come week after week to the Senate floor to say it is time to repeal this legislation and replace it with legislation that delivers more personal responsibility, puts patients in charge; a patient-centered health care plan that allows Americans to buy insurance across State lines; one that gives individuals the same tax relief as the big companies when they buy their own personal health insurance; one that provides individual incentives like the people who attend the Wyoming health fairs--people who take responsibility for their health and who try to find and detect problems early to get down the cost of care. We need to replace it with something that deals with lawsuit abuse and the expense of unnecessary tests due to doctors practicing defensive medicine. We need one that allows small businesses to join together to find less expensive insurance to their employees.

These are the things I will continue to work on. These are the things I will continue to come to the Senate floor and share with the Members of this body and the American public. Today, that is why I offer this second opinion, and another reason to repeal and replace this health care law.

Thank you, Mr. President. I yield the floor.

Mr. President, this weekend, the citizens of Greybull, WY gather to dedicate a monument at the Donald J. Ruhl Memorial Cemetery. This monument is the culmination of the hopes, dreams and hard work of dozens of people in the community. A true American hero was laid to rest in their cemetery, and these committed individuals wanted his memory to be honored forever. Donald served our Nation during World War II as a marine. His bravery and ultimate sacrifice earned him our Nation's most distinguished recognition, the Medal of Honor.

Donald J. ``Johnny'' Ruhl, enlisted in the Marine Corps Reserve on September 12, 1942. Immediately going on active duty, the new recruit used his lifelong experience with firearms to qualify as a sharpshooter, and demonstrated his endurance by becoming a combat swimmer. Following his exemplary performance at boot camp, Private Ruhl volunteered for Parachute Training School. At the conclusion of this 5- week training, Ruhl was promoted to private first class and assigned to further training in New Caledonia.

He first saw combat at Bougainville, but it was his actions at Iwo Jima that truly demonstrated his heroism. In February 1945, Johnny departed from

Saipan aboard the USS LST 481, headed for the shores of Iwo Jima. Private First Class Ruhl displayed his courage from the onset of D-day at Iwo Jima on February 19, 1945. Johnny recognized his role early on in the battle attacking a group of eight Japanese soldiers single- handedly. Private First Class Ruhl confirmed his valor and bravery by risking his own life to rescue a marine wounded ahead of the front line--ensuring that the man was transported to an aid station, regardless of the threat to Ruhl.

Ruhl continued to establish his commitment to the cause by returning from the aid station to voluntarily investigate an abandoned Japanese gun emplacement. With boundless courage, he prevented the enemy from regaining possession of the valuable site by occupying the position throughout the night. On February 21, Johnny demonstrated his true selfless nature. As Company E, 2nd Battalion, 28th Marines, 5th Marine Division pushed forward on their quest to capture Mount Suribachi, Private First Class Ruhl along with his platoon guide, pressed their position to the top of a Japanese bunker. As the marines prepared to fire upon the enemy troops, a grenade landed between them. While notifying the platoon guide, Ruhl dove onto the grenade, absorbing the full detonation with his body. This sacrifice saved the lives of all of the nearby marines. Thanks in great part to this selfless act, Company E was able to raise an American flag on the top of Mount Suribachi.

In awarding Private First Class Ruhl the Medal of Honor posthumously, President Truman recognized Johnny's efforts, stating ``An indomitable fighter, PFC Ruhl rendered heroic service toward the defeat of a ruthless enemy.'' . . . Certainly Truman was correct when he continued praising Ruhl's dedication to our Nation and his fellow marines, ``. . . his valor, initiative and unfaltering spirit of self-sacrifice in the face of almost certain death sustained and enhanced the highest traditions of the United States Naval Service.''

PFC Donald J. Ruhl embodied the Marine Corps motto, Semper Fidelis, committing his life, and his death, to loyalty to the Corps and his country. The community of Greybull has done well to recognize this hero. They have demonstrated their faithfulness to his memory by renaming his eternal resting place. His gift to our country will never be forgotten--in passing his memorial, we will forever know that Donald J. Ruhl gave all so our country could remain free.