Floor Statements

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 President, I ask unanimous consent that the order for the quorum call be rescinded.

Thank you very much, Mr. President.

Mr. President, today I come to the floor to tell the Nation a story, and it is the story of a Wyoming doctor, a doctor by the name of Randy Johnston. He is an ophthalmologist who practices in Cheyenne, WY. He is very qualified. He is very capable. He is also a good friend.

The reason I come to tell you this story is because, like many doctors across the country, Randy takes care of people on Medicare, and occasionally in his practice as an ophthalmologist he gives shots to people on Medicare. As a matter of fact, there is a picture of Dr. Johnston on the front page of the American Medical News. This is an article dated November 10, written by Jane Cys, and it shows Dr. Johnston in his office in Cheyenne getting ready to give a shot.

Well, in the past, Randy would buy the drugs that his practice uses and then bill the patients for the treatment. The drugs that Randy uses are typically injected, but under this Part B Medicare drug program some are infused through a patient intravenously right into the vein.

Two years ago, Randy enrolled in a new program created by the 2003 Medicare Modernization Act. This Medicare Part B program was called the Competitive Acquisition Program--CAP is the phrase they use. It was designed to give doctors a choice in the way they administer the drugs.

Under the program, the doctor would first see the patient, then order the medicine from a Government vendor, then get the medicine, and then give the injection.

Well, the way it worked is, Medicare would then pay the vendor for the drugs. Medicare also would bill the patient if there was a copay or a premium the patient owed. Randy was only responsible to bill Medicare for the actual treatment of the patient, not for the medicines.

Congress and the Centers for Medicare and Medicaid Services hailed this new program as a way to alleviate administrative burdens and reduce Medicare costs--a good idea. Doctors could now spend more of their time with their patients rather than serving as drug purchasers and bill collectors.

Randy signed up for the program early, and the program that was passed as part of the 2003 bill finally got started in 2006. Randy thought it made good sense for him, good sense for his patients. Some of his Medicare patients could not afford to pay for their office- administered drugs, and Randy saw great potential in this new program. He could transfer the Medicare billing part of it to someone equipped to handle the administrative redtape, and this freedom would leave him more time to focus on practicing medicine.

The program has now been in place for 3 years. What are the results? Well, only 4,200 doctors signed up for the program. You may ask, why is that? Dr. Johnston can tell you, and this article in the American Medical News explains it very well. Administrative hassles, burdensome drug transportation and storage rules, and vendor delivery problems-- and that is just to name a few.

For example, the Government rules require doctors to give patients the drugs only in the facility where the vendor delivered the medicine--no exceptions, none. This requirement prevented doctors from moving drugs between their main office and a part-time satellite office they may have in another community.

Washington bureaucrats simply do not understand what a burden this policy can be in rural and frontier communities. Seniors living in rural States such as Wyoming often have to travel great distances-- hundreds of miles--to see a specialist like Dr. Randy Johnston. This program, with good intentions, clearly was not designed to meet the unique needs facing rural patients and health care providers who work tirelessly to serve their patients.

Dr. Johnston was also required to order the drugs for a specific individual patient by name. He was not allowed to restock a general office supply to use on multiple patients.

I understand the Government is trying to prevent drug stockpiling. But this rigid program requirement does not give doctors the flexibility they need to practice medicine. This is especially true in emergency situations.

So who is liable when a patient comes to the doctor's office needing immediate treatment but the doctor cannot help because he has to call the Government to send the medicine in the first place, even if he has a supply on hand for another patient? The program's current design has turned out to be a bureaucratic nightmare.

After only 3 months in the program, Randy Johnston wrote Medicare a letter begging--I say begging--to be let out of the program. Why? Well, it was not just the excessive paperwork and the excessive phone calls to get the medication; Randy saw how absolutely wasteful this Government program had become.

When Dr. Johnston purchased Medicaid vials himself from a local pharmacy, the local pharmacy would divide it into multiple doses that could be used for different patients. Using the new Medicare program, Dr. Johnston had to order an entire vial for each patient, use the one dose the patient needed, and then throw the rest away.

Why would Medicare force seniors and taxpayers to foot the bill for an entire vial of medication containing 400 doses when the patient only needed 1 dose? At a time when Americans are facing such painful financial times, this wasteful Government spending is appalling. We are talking about lifesaving medicine, expensive medicine. I do not know anyone who buys a loaf of bread, takes out one piece and eats it, and throws away the rest of the loaf. This makes no sense to anyone.

It is well past the time that Washington bureaucrats start treating taxpayer dollars like the money in their own personal checkbooks. When emergencies, illnesses, or major household repairs occur in our families, we find a way to pay the bill. We look at our budgets, we tighten our belts, and we find alternative places to save. We eliminate luxury items. We stop wasteful spending.

Dr. Johnston was absolutely right to try to get out of this absolutely wrong, wasteful program. Washington bureaucrats who have never been on the front lines treating Medicare patients developed this program. They do not understand the practical applications. So I was not surprised when Medicare announced in September of this year they were putting the entire program on hold starting in January 2009. Washington bureaucrats claim they are considering alternative ways-- alternative ways--to improve the program because they want it to succeed.

The new administration has a tremendous opportunity to learn from Randy Johnston and from the 4,200 other participating doctors. Rather than hamstring providers, perhaps Washington should start to focus its efforts on eliminating waste, eliminating fraud, and eliminating abuse in the Medicare system.

This year alone, we have seen one news report after another uncovering Medicare wasting money. These news reports sound the alarm to every hard-working taxpayer in the sound of my voice and all hard- working taxpayers across America.

Who is holding these bureaucrats accountable? Just this week, the Department of Health and Human Services issued the Agency Financial Report. This document shows that in fiscal year 2008, these Government check writers made $10.4 billion--$10.4 billion--in improper Medicare fee-for-service payments. We can do better. We can do much better than this.

Wasteful spending strips Medicare of the vital resources that are needed to care for our elderly, to care for our frail, to care for the vulnerable. The new administration has a real opportunity to show leadership. Working together, we can fix this flawed policy. Medicare patients, doctors who take care of Medicare patients, and the American taxpayers deserve nothing less.

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

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

Madam President, I suggest the absence of a quorum.

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

Mr. President, this morning I would like to speak about medical safety, about patient care, about the cost of that care, and about how Medicare is dealing with this.

In 1999, the Institute of Medicine issued a groundbreaking report on medical errors. The report was called ``To Err Is Human: Building a Safer Health System.'' The Institute of Medicine findings provoked heated and extensive professional and public dialog. The report left few doubting that preventable medical injuries occur and continue to be a serious problem in America.

It identified a number of solutions, solutions to stop hospitals and physicians from performing unsafe practices. It also asked lawmakers to partner with health care providers to create and to adhere to strict, ambitious, quantitative and well-tracked national goals.

The National Quality Forum Set out to do just that. The forum's mission is to bring people together to create health care quality initiatives that are safe, effective, and patient-centered.

In 2001, the former National Quality Forum CEO first coined the term ``never event.'' Well, he was referring to particularly shocking medical errors that really should never happen, medical errors such as surgery performed on the wrong body part, surgery performed on the wrong patient, or the wrong surgical procedure performed on a patient.

By 2002, the National Quality Forum had identified 27 so-called never events. Now, the ``group'' is listed in six different categories: surgical, product or device, patient protection, care management, environmental, and criminal.

The Agency for Healthcare Research and Quality says that most never events are very rare. They estimate that a typical hospital might have a wrong-site surgery case once every 5 or 10 years.

As public reporting on health care quality gained momentum, lawmakers focused on eliminating never events. They did it as a way to increase accountability as well as to contain costs. More and more surgeons began physically signing the surgical site with a marking pen in the pre-op holding area. Now, they did this while the patient was still awake just to make sure everyone agreed what operation was being done on what body part.

The Deficit Reduction Act of 2005 required the Secretary of Health and Human Services to select at least two conditions that could be reasonably prevented. This is where Washington went too far. The Washington bureaucrats identified eight conditions as never events. Here is the list: object left in during surgery; air embolism; blood incompatibility; pressure ulcers; falls and trauma; catheter-associated urinary tract infections; vascular catheter-associated infections; and surgical-site infection. Why is this important, this list of eight? Well, it is important because some of this list of eight conditions really should never happen. Some of these eight conditions, though, can and do occur with regularity, even under the best of circumstances.

Well, what is the impact of the rules on patients and the medical profession? Medicare says it will pay to treat the underlying diagnosis but will not pay the hospital to treat complications from any of these eight conditions if the medical problem develops during the patient's hospital stay. For example, the patient is treated for a stroke, has no other complications during the hospital stay, and the hospital is paid a little over $5,000 by Medicare. If the same patient was to have a severe pressure ulcer when they arrived at the hospital in addition to the stroke, Medicare pays about $3,000 more for the treatment of both the stroke and the ulcers. But Medicare says: If the pressure ulcers developed after the patient arrived at the hospital, then Medicare will only reimburse to treat the stroke, not to treat the pressure ulcer.

The problem with pressure ulcers is they will not show up until the patient has usually been in the hospital for awhile. The damage to the tissue occurs at the time the patient with the stroke or with a broken hip lies motionless at home waiting until someone finds them, as often happens with somebody who lives alone. The damage occurs before the patient is even taken to the hospital, but the hospital is going to lose up to $3,000 to treat the pressure ulcer regardless of the medical condition that caused the problem in the first place. The bureaucrats are saying it should never happen, yet it happens all the time.

Although the never events program is in its infancy, I am troubled by the direction these Washington bureaucrats are headed. I believe the negative long-term impact on patient care is going to be significant. This year, Washington bureaucrats expanded the never events. They expanded the list to include even more conditions: surgical-site infections following elective procedures, blood sugar control, and deep-vein thrombosis/pulmonary embolism.

When you take a closer look at the entire process, it does show a disturbing trend. I agree that a foreign object left behind inside a patient after surgery is an event that should never occur. The fact is that most of the never events on the Government's list, selected and targeted in the rulemaking process, are impossible to eliminate.

These bureaucrats clearly did not fulfill their requirement in the Deficit Reduction Act, a requirement to choose never events that are reasonably preventable by applying evidence-based guidelines. To be reasonably preventable, the Washington bureaucrats must have peer- reviewed, published literature showing clinicians can reduce the incidence of the chosen never event to zero or near zero. Current data shows that even when all appropriate care is administered, we do not know how to reduce the rates to zero or near zero of many of the conditions now on the list. Some patients, particularly high-risk folks, will develop conditions on the list regardless of how good the care is that they receive at the hospital.

Here is an example. The bureaucrats have listed deep-vein thrombosis/ pulmonary embolism as a never event. Well, the best scientific studies on large numbers of total hip and total knee procedures--and this is from the time I started in medical school and we were trying to lower the risk of those blood clots--showed that under no circumstances, no matter what different treatments the best scientists have come up with, there is no current treatment available today worldwide that would decrease the blood clot risk to zero.

Now, I want to tell you about a patient who had a broken hip, a broken hip on the left side, and at the same time of the injury, she bruised her right hip but did not break it. We know that patients with either a broken hip or who have received an artificial hip,

that right after surgery, for the first couple of weeks, they have an increased risk of getting a blood clot. We treat them with blood thinners. Still, blood clots happen.

So this is a patient who was given a blood thinner. We were trying to find out what the right delicate balance was. We worked with an internist and others. We thought we had the right delicate balance for the right dose of medication. On her right side where she had the bruise, she bled into that wound, and that bruise got more blood accumulated, a hematoma. On the left side, the side with the broken hip, she got a blood clot. She was on the blood thinners and bled into the one side, had a blood clot on the other side, and yet they call it a never event. How can Washington bureaucrats say that this is a never event?

Let's look at another so called never event that made the list. Many of the ventilator-assisted pneumonia cases I saw practicing medicine in Casper, WY, occurred in trauma patients. The Wyoming Medical Center is a centrally located trauma facility. I saw patients brought in from accidents that occurred around all the State.

Many of the patients are treated and stabilized at a local hospital 100 to 250 miles away. They are transferred to the Wyoming Medical Center. Trauma physicians have no way to determine whether the pneumonia is secondary to aspiration that occurred right there at the site of the accident or whether it occurred as a result of something that happened at the first hospital. In the physician's initial assessment, a pneumonia has not yet developed. It takes time before it shows signs. Even the Washington bureaucrats that wrote the proposed rule agree. The rule is clear and scientific evidence is clear that 60 to 80 percent of ventilator-assisted pneumonia cases cannot be prevented. How can they call that a never event?

I have been a doctor for 30 years. I can share lots of similar examples with Members. Each example begs the following question: So what if the never event occurs in one hospital and then the patient needs to be transferred to another medical facility for advanced specialty care? Medicare says they are not going to pay for that treatment. Does that mean the second physician in the second hospital will not get paid? If the receiving hospital will get paid but the first one will not, isn't that surely going to lead to more transfers from one hospital to another, moving the patient from a hospital where the hospital will not get paid to the hospital where payment will occur?

Look at it on the other side. If the receiving hospital will not get paid for a complication that occurred at the first hospital, then why should they accept the patient in transfer for the care they need? Is there any way for hospitals to appeal the decision of the Washington bureaucrats? What impact will this whole process have on medical liability? Will this list of so-called never events lead to increased litigation? After all, if something is never supposed to happen because the Government list says it doesn't but then it happens, does that mean someone is at fault?

Where guidelines and proven medical strategies exist, doctors and hospitals strive every day to make sure serious adverse events do not ever occur. Never events should never occur.

It is important to remember that the 1999 Institute of Medicine report which called attention to medical errors in the first place said bad systems and not bad people lead to most errors. As an orthopedic surgeon, I have spent my entire professional career trying to make people better. I have been on call in the middle of the night when folks have been involved in traumatic accidents. There are people with incredible talents practicing medicine, trying to do their best, but government policies continue to needlessly hamstring the ability to help their patients. The health care of this Nation is going to be hurt by the direction that Washington bureaucrats are headed.

``Never events'' should never happen. When Washington bureaucrats stretch the meaning of the word ``never'' to keep from paying hospitals, they mislead the public and cheat our Nation's hospitals and health care providers. Perhaps Washington should start to focus its regulatory efforts on eliminating waste, fraud, and abuse in the Medicare system. This year alone we have seen one news report after another uncovering Medicare wasting American tax dollars. Medicare is paying billions for wheelchairs, prosthetics, canes, prescription drugs, and other medical supplies, as the report shows, all prescribed by doctors who are dead, some who died 10 years ago. The Washington check writers honored hundreds of thousands of these fraudulent claims. I wonder who is holding these bureaucrats accountable.

In 2001, they pledged to fix the problem identified by the Health and Human Services Office of the Inspector General. That was 7 years ago. Recent reports estimate Medicare loses approximately $70 to $90 billion each year to waste, fraud, and abuse. This strips our health care system of vital resources, resources we should be devoting to care for the elderly, the frail, the vulnerable. Federal officials have an opportunity to show leadership. They could have chosen to work with hospitals and physicians to develop evidence-based guidelines. Instead they have decided to issue a rule aimed at withholding money from hospitals, not improving patient care.

It is time to rethink this flawed policy. Policies must work to improve patient care, not to punish hospitals. Hospital doors must remain open.

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

Madam President, I rise today to pay tribute and express our Nation's sincere gratitude to a remarkable young soldier and his family. I was saddened to receive word that on September 17, 2008, Army CPT Bruce E. Hays of Cheyenne, WY, was killed in the line of duty while serving our country in the war on terrorism. Captain Hays died from injuries he sustained while supporting Operation Enduring Freedom when an improvised explosive device detonated near his vehicle in Gerdia Seria, Afghanistan.

Captain Hays first enlisted in the Army in 1984, and joined the Wyoming National Guard in 2000. He received his commission and became an officer later that year. He was a versatile soldier, commanding units ranging from field artillery to information technology. Captain Hays is remembered by his fellow Wyoming soldiers as an outstanding officer, commander and leader who was both loved and respected by his troops.

It is because of Bruce Hays and the blanket of freedom that he fought to provide that we sleep safely in our beds at night. The brave men and women of this Nation who answer the call to service and wear the uniform of the Armed Forces deserve respect and recognition for the enormous burden that they willingly bear. They put their very lives on the line every day for their fellow countrymen. And because of them and their families, our Nation remains safe and free in the face of danger and those who seek to harm us.

Captain Hays represents the epitome of this selfless service to a cause greater than one's self. He was deployed as chief of an Embedded Training Team, charged with mentoring the Afghan police forces to defend the people of Afghanistan against terrorism. Laying aside his own self interest, Captain Hays gave his life in a far off land helping a fledgling democracy and a newly freed people to live the dreams that freedom and liberty bring.

In the book of John, Jesus said that, ``Greater love has no man than this, that he lay his life down for his friend.'' CPT Bruce Hays gave his life, that last full measure of devotion, for you, me, and every single American. He gave his life defending his country and its people, and we honor him for this selfless sacrifice. And there are no words to express the profound gratitude that our Nation owes this brave solder and his family.

Captain Hays is survived by a loving family including his wife Marie and their children, Bethany, Eleanor, John, Alfonso, and Genevieve, and his parents Barbara and Leonard. He is also survived by his brothers and sisters in arms of the Wyoming National Guard and the U.S. Army. We say goodbye to a devoted family man and an American citizen soldier. Our Nation pays its deepest respect to CPT Bruce E. Hays for his courage, his love of country and his sacrifice, so that we may remain free. He was a hero in life and will remain so in death. All of Wyoming, and indeed the entire Nation, is proud of him. May God bless him and his family, and greet him with open arms.

Staff Sergeant Nathan M. Cox.

Mr. President, the debate over the legal drinking age has continued for decades.

As a physician and surgeon, I have repeatedly dealt firsthand with the traumatic results of underage drinking.

Recently, a number of college presidents from across the country signed a public statement petitioning that the current legal drinking age be lowered to age 18.

I believe changing this law would pose a danger to our youth and communities.

Wyoming's First Lady, Nancy Freudenthal, wrote an important editorial addressing drinking on college campuses. It was printed in the Wyoming Tribune Eagle and the Casper Star Tribune. I believe Mrs. Freudenthal presents a compelling argument for keeping the minimum drinking age at 21.

I ask unanimous consent to have the editorial to which I referred printed in the Record. There being no objection, the material was

Madam President, this act has opened the door to hundreds of thousands of individuals to actively participate and contribute to our great Nation. It has raised the conscience of our Nation regarding disabilities and the impact they have on their lives. The fair treatment of the citizens of the United States is paramount. Every citizen, regardless of the obstacles in their lives, should have the opportunity to work, live and fully participate in our society.

There are many individuals with disabilities who are exceptional physicians and professionals. It is clear that situations will arise in which an individual desiring to become a licensed physician has a legitimate disability and a reasonable accommodation can be made during standardized testing.

Licensing boards have the responsibility to accurately measure an applicant's skills and abilities to practice in a professional field. The purpose of standardized examinations is to create a set environment in which to carefully determine and ensure that applicants have the knowledge, skill, and ability to perform in the real world. Certain performance measurements can only be evaluated under set parameters. It is vital that standardized testing organizations not be required to fundamentally alter key performance measurements when providing reasonable accommodations to students with disabilities.

As a doctor, I understand the need to ensure that future physicians have the ability to safely and skillfully provide medical care. Patients should not have to worry about whether their treating physician is qualified.

Public health and safety is based on the ability of these physicians to work under pressure, respond quickly, and do so in a manner that protects the well-being of the patient. The real world requires a physician to concentrate and think clearly, often within a very small timeframe.

Licensed physicians throughout the country are required to take a standardized test to meet the requirements expected of the profession. Determining whether an accommodation is reasonable should be left to the licensing board. When a testing organization or a licensing board has made a decision in good faith about an appropriate accommodation, the decision should be given great deference. This is particularly true in light of the important role these examinations play in the licensing process and the safety of the general public.

It is important that the integrity of standardized tests for the licensing of professionals in the field of medicine is maintained. The legislation does not require accommodations which would alter key performance measurements. There is no record that this legislation would require standardized testing organizations, such as the State Boards of Medicine, to fundamentally alter their examinations with accommodations that will undermine the essential purpose of their exam.

Mr. President, I thank my colleague from Colorado. He is absolutely right, Wyoming is a State which has been very blessed-- blessed with abundant sources of energy, and certainly coal, natural gas, oil, uranium for our nuclear power, and also wind, a renewable source of energy. So we have lots of different resources with which we have been blessed.

But in terms of coal--and we know half the electricity in the United States comes from coal--what we know is that there is enough coal in Wyoming to power this country for centuries--not decades but centuries. There is that much coal in Wyoming. Coal is available, affordable, reliable, and a secure source of energy for our Nation.

To me, this is about being self-sufficient in terms of our own energy. We are sending so much of the wealth of this great country overseas. Every time we buy another barrel of oil overseas. Whether it is $120, $130, $140 per barrel, that is a transfer of the wealth of our Nation to people who are not necessarily our friends.

And we have the source of energy here, with the coal, and the technology is incredible. There are ways to use the coal to convert it to electricity and there are other ways to use the coal to convert it to liquids. Aviation fuel. The military uses an incredible amount of fuel. I have amendments I have introduced and am trying to have debated on this floor that deal specifically with converting coal to liquids, to allow us to use that liquid for our aviation.

There is another technology, coal to gas. There is a true visionary in Wyoming. His name is John Wold, 91 years old, and he is here today to visit. His granddaughter works in my office. I

have talked to him for years about the technology of coal to gas, and it is ready to go and available in Wyoming. It is being done in other places around the world, but not yet here. So it is incredible in terms of the available resources we have. But it is not only one source of energy. We need it all. We need the coal, we need the natural gas, we need the uranium, we need the oil, and certainly we need to be more efficient, as my colleague from Colorado has talked about. We need to be energy efficient, but we need the renewables. So we need the transmission lines, but we have plenty of wind in Wyoming.

Look at oil shale. The Senator from Colorado is familiar with that, because Colorado, as well as Wyoming, as well as Utah, is blessed with oil shale. Perhaps I could ask my colleague from Colorado to discuss some of the issues related to that.

The people in Wyoming clearly are affected the same way folks in Colorado are in terms of the large distances they have to drive, whether going to see the doctor, or taking the kids to school, or going to shop for groceries. I think statistically, when they look at how many miles on average people drive a year, Wyoming is No. 1 in terms of the longest distances. So when the price of fuel goes up, the price of gas at the pump, the people of Wyoming feel it the greatest because they are driving that many more miles. Many of them have pickup trucks or utility vehicles, because when you are that far away from home during the winter, you need to have those higher profile, larger vehicles. It is a matter of personal safety. It is what we want our kids to be in as well.

So the inflation is there at the pump, but it is not only that. There was an article in the Wall Street Journal this past week about a woman in Casper, WY, who runs a bakery. It is a great bakery, down on First Street, and sheoes a nice job. But the supplies, the cooking things she buys to put in the bagels--whether it is the canned apples or the sugar--everything is up pricewise because it has to be shipped in to be used. So it is the fuel we use in our own vehicles but it is also the fuel that is being used to ship products.

The people of Wyoming are smart. At all these town meetings I have, they get it. They understand there is going to be a change in the energy we use in this Nation, a change in the different sources of energy. The people in Wyoming know we would be wise to be conserving, and we are, and they know we would be wise to be using the renewables that we have a lot of, but they are also wise in knowing we do need to find more and use less; that it is a matter of supply and demand. And until

you can deal with both sides of that equation--not just one side but deal with both sides--people are going to continue to feel the pain not only at the pump but also at the grocery store. So the people of Wyoming get it. They know the importance of the work we are doing here in trying to find solutions that will help America become energy self- sufficient by developing American coal, American oil, American natural gas, American uranium, and American renewable energy sources.

Interstate 80, which runs west to east across the lower part of the State of Wyoming, is a national transportation route where people are taking products from the coastal areas, the ports in California or Oregon, and they come to a pinch point in Utah and then they all get onto I-80, west of the Wyoming border at Evanston, and they come all the way across the State. Fuel prices are high, and the miles are long. People who talk about a 55-mile-an-hour speed limit in this body clearly have not driven across I-80, where a speed limit like that didn't work before when they tried it, and it won't work now.

I served in the State Senate in Wyoming, a great place. On the third floor of the capital building, there is a large mural on the wall which sort of depicts the State of Wyoming. There is a part of the bottom where I-80 is running across it. Even back when this was painted, years ago, if you count the vehicles on the mural, half of them are trucks. Half of them. And I think the proportion now is even greater than half of them being trucks.

Think about all the product that is being moved east and west on I- 80, and I am sure you are seeing it in Colorado as well, with people awaiting the delivery of those products across this Nation and paying higher prices for those products because of the fuel it takes to fill the trucks in order for them to deliver the product. So we are seeing that not just at the pump but also in the pockets of consumers.

Mr. President, we started talking a little bit about coal. I wish to say it is not just Wyoming and Montana, coal is abundant throughout the United States. Whether it is Pennsylvania--I see our colleague from Pennsylvania is here. Actually, the whole region of Pennsylvania is called the coal region. He made mention of that. But in West Virginia and Illinois, coal is abundant, it is affordable, it is reliable and secure.

I appreciate the efforts my colleague from Colorado is engaged in, in terms of oil shale--another abundant source of energy that is not being utilized. It is American energy that can be used for the betterment and future of our great Nation.

Mr. President, I wish to speak on S. Res. 482, a resolution designating July 26, 2008, as ``National Day of the American Cowboy.''

The cowboy is the icon of Wyoming, representing our history and way of life. Wyoming's cowboy spirit and western values embodies all aspects of our lives. Independence, courage, family values, and good stewardship of the land are all virtues that every Wyomingite holds dear. The people of Wyoming are proud of our cowboys and cowgirls. They carry on our strong traditions and western values.

The National Day of the American Cowboy also holds a special place in Wyoming's heart as we remember our dear friend, Senator Craig Thomas. As many know, this day of recognition initially came about through the efforts of Senator Thomas.

Senator Thomas was a genuine cowboy. He led by example instead of seeking the spotlight. He was a dedicated public servant, a powerful leader, and a straight shooter. He was a loyal family man. He was a beloved role model. All who knew Senator Thomas will remember the humble cowboy who was unwavering in his dedication to God, Wyoming, and his country.

Senator Mike Enzi and I have continued this effort to honor our American cowboys and cowgirls across the country. I am pleased that the Senate agreed to the resolution. I look forward to celebrating this special day with Wyoming.

Mr. President, it gives me great pleasure to recognize the accomplishments of Del Tinsley; the 2008 inductee into the Wyoming Agricultural Hall of Fame.

Del's fascination with agriculture began as a small boy. He spent his summers helping ranchers in the community of Guernsey, WY. As the director of the Wyoming Office of USDA Rural Development, Del's enthusiasm for agriculture has become a lifelong career dedicated to Wyoming's farmers and ranchers.

Del's boyhood summers on the ranch soon developed into a successful tenure selling advertising for the Wyoming Stockman-Farmer. In 1990, Del went to work building the newly established Wyoming Livestock Roundup from a little known publication to the must-have newspaper for every major implement dealer and livestock auction in the State.

As director of the Rural Development office of the USDA, Del has successfully encouraged renewable energy development and business diversification within Wyoming's agricultural industry.

Over the years, Del has been a voice of wisdom for Wyoming's farming and ranching communities.

I am pleased to honor Mr. Del Tinsley on the Senate floor today. Del is a true steward of the land. Del continues to uphold the Wyoming heritage of farming and ranching.

Mr. President, I am pleased to recognize the accomplishments of Jim Magagna, 2008 inductee into the Wyoming Agricultural Hall of Fame.

Jim Magagna has spent much of his life fighting for Wyoming agriculture interests at the local, regional and national level. A third generation sheep rancher from southwest Wyoming, Jim is the president and manager of Magagna Bros, Inc.

Jim has a long history of service to Wyoming's ranchers and farmers. He has served as president for agricultural groups including the Wyoming Wool Growers Association and the National

Public Lands Council. He now serves as the executive vice president of the 135-year-old Wyoming Stock Growers Association.

One of many noteworthy efforts, Jim directed the implementation of the Wyoming Stock Growers Agricultural Land Trust. The trust provides farmers and ranchers with conservation opportunities to remain productive and independent. Jim's dedication to the interests of Wyoming agriculture has created a legacy that will serve Wyoming well for decades to come.

It gives me great pleasure to honor Jim Magagna, a true Wyoming cowboy. He continues to uphold one of the most trusted, respected, and revered ways of life in America.

I have heard it time and time again. We are ready to vote and to offer amendments. Clearly, we need to deal with this issue of supply and demand. We need to find more and use less. The people of Wyoming get it. The people of my neighbors to the east in South Dakota know it. The people from Utah understand it completely. The people at home get it.

There is a story in the Wall Street Journal from Thursday, ``Want to See Inflation Pressures? Try Wyoming.'' People drive great distances in these Western States, but they are also paying not just the price at the pump but also at the grocery store when they have to buy things shipped in because of transportation costs. They say: Hey, you are sending all of this money overseas to foreign countries, people who are not our friends. We need to be energy self-sufficient. We need to do it at home, which is exactly what we are trying to do with these seven amendments. Wyoming is an energy State--oil, natural gas, uranium for nuclear, and coal. The technology now with coal is there for clean coal technology, coal to liquids. That is energy that can be used for our military airplanes.

They have said that because it is the most available, affordable, secure, reliable source of energy we have. We have enough coal to last this country hundreds of years. We have ways to capture the carbon and pump it into the ground of old oil wells and get more oil and leave some of the carbon down below.

And we could do it all with an environmental safety net. The opportunity has been blocked step by step.

Mr. President, I rise today to speak about the extraordinary impact of rising gasoline prices, the extraordinary impact it is having on all Americans, and the parliamentary games of those on the other side of the aisle.

The airline industry, truckers, ranchers, families who must travel to and from work and school, families going to buy groceries, all of them are experiencing dramatic increases in the cost of energy. These soaring gasoline prices offer a glimpse at the effect home heating costs will have on the American family budget this coming winter.

Today's energy crisis is focused on prices at the pump. But the Nation's energy concerns stretch well beyond the pump. In the coming weeks and months, rising energy prices will be seen in the monthly bills for home heating, natural gas, electricity, and heating oil. In fact, this month, in Washington, DC, right here in this Capitol Building, we are operating our own Senate offices under an electric brownout advisory. This is recent evidence that our electric grid is stressed. When it comes to energy, we need it all.

We need to develop domestic supplies of oil and gas. We need to develop nuclear energy. We need to develop renewable energy, such as wind and solar. We need to develop America's most affordable, secure, and abundant energy supply, and that is coal. In fact, coal to liquid offers great promise in reducing America's reliance on foreign oil imports.

We must also develop concerted policies to promote increased efficiencies, to promote increased conservation, and to reduce waste. In summary, we must find more and use less.

On the subject of soaring gasoline prices, I must ask my colleagues: When is enough enough? When will this body be willing to address the underlying issue of both supply and demand. Many are calling for change. Few are offering meaningful solutions. Here are a few examples.

Some on the other side of the aisle want to tax their way to lower oil prices. Increased taxes will result in higher prices and less oil and gas production, not more. Taxes will stifle our economic security. Taxes will not encourage economic security.

Many on the other side of the aisle think litigation is the way to bring down prices at the pump. The proposals I am cosponsoring choose innovation over litigation.

Some on the other side of the aisle claim we can regulate our way to lower prices at the pump. They want to do it by penalizing oil and gas leaseholders. This approach shows very little understanding of the energy development process. This approach offers no help, no help at all with the bureaucratic maze and roadblocks to finding more energy.

Some propose restrictions on price gouging by gas station owners, but those same individuals fail to show any actual evidence of price gouging. In fact, the margins for the gas station retailers in this country are being squeezed. Rather than increased regulation, I support proposals that invest in inspiration, in ingenuity, and in productivity gains. I support technology gains that unleash the power of the private sector to develop short- and long-term energy solutions.

Some want to impose heavy-handed Government mandates to nationalize the speed limit. Some are suggesting 55 miles an hour. I bring along a copy of a newspaper that hardly ever makes it to the streets of Wyoming. It is the New York Times, and this is this morning's paper. While the people of Wyoming do not read it, reporters from that paper actually went to Wyoming and covered Sheridan, WY.

There are five wonderful colored pictures of Wyoming and there is a nice map and it talks about Wyoming. On the front page of today's New York Times, it talks about the Kerns family, a wonderful family in the Sheridan, WY, area. They were at a town meeting I recently had and they were talking about ranching. This summarizes it. When I hear people propose a 55-mile-an-hour limit, talk about ranch families such as the Kerns--conservative, self-sufficient, and wanting mostly to be left alone.

That is what it is all about in Wyoming--conservative, self- sufficient, and wanting to be left alone. We do not need Washington telling us how to drive and how fast. We can make those decisions for ourselves.

I have the belief in the ability of Americans to choose for themselves. I am confident the people of America, not Washington, will make the right decisions. History has proven that American's self- reliance is an effective tool against rising energy prices.

American families right now are conserving in record numbers. They are carpooling, they are cutting back on the miles they drive, and they are purchasing more fuel-efficient vehicles. Statistics show that this year the year-over-year gasoline use is down roughly 2 percent. It is the steepest drop in demand in the last 17 years. American families are responding and they are responding without being told by the Federal Government to inflate their tires. Yes, that is what I heard yesterday in an Energy Committee hearing from an official: It is time to inflate your tires.

American families are conserving. They are doing so without far- reaching Government mandates. American families are demanding and purchasing more fuel-efficient cars regardless of any timeline for energy efficiency standards Congress may impose.

In fact, American families have done much more than simply conserve on energy in the past several months. Some have dealt with serious job losses. Many have struggled with housing deflation. We are all facing inflation at the grocery store.

You say: Is that happening everywhere? Wyoming has been in the news today. First, a front-page story in the New York Times and now a large story in the Wall Street Journal today; the headline: ``Want to See Inflation's Pressures? Try Wyoming, and Its $1.14 Bagels.''

There is a nice picture of a friend of mine, a bakery owner, Marsha Asbury, in Casper, and first it talks about this city. It talks about ``this wind-raked city on the plains.'' It tells you we are committed to renewable sources of energy because we have a lot of wind in Wyoming. But they talk about gasoline prices.

Gasoline prices, too, have risen sharply as they have

across the country. But it is the price of--

Actually it is what Ms. Asbury puts into her bagels that is causing her the trouble because it is causing the inflation. It says:

Most of her ingredients are shipped in from nearby states.

The prices have jumped dramatically this past year, as

suppliers struggle to recoup the high cost of trucking items

to Wyoming.

Heavy items have increased in price the most. The canned

jalapenos and pumpkin that Ms. Asbury uses for her specialty

bagels; the canned apples, for strudel; the sugar and flour--

all are up 35 percent in the past year. Butter and milk are

up 25 percent.

All because of the cost of energy and transportation fuels.

As it says:

Still, the rising cost at the pump hits hard, because

Wyoming drivers put an awful lot of miles on their pickups

and sport utility vehicles as they traverse this sparsely

populated state.

Yes, American families have moved beyond simply conserving. Now many are sacrificing. Despite the resilient response of the American people, there is still no meaningful action from this Congress to address the fundamental supply and demand for foreign oil. The Senate leadership on the other side of

the aisle will not allow a debate on bills that will actually increase American energy supplies. Each of the provisions to increase American energy offered by this side would be coupled with measures to improve conservation, to promote energy-efficient measures.

To be very clear, I agree with some of the components of the speculation bill before us. In fact, several of these provisions were included in legislation I have cosponsored. Yet, as a matter of principle, I believe the Senate must act on a set of solutions rather than pursue a piecemeal approach. It is not simply the soaring prices, but it is America's reliance, America's dependency on foreign imports. Congressional leadership is opposed to even debating increasing American exploration and production. With more American supply, there is a more secure energy future.

We have seen the same old responses from the other side of the aisle. They approach the current energy crisis, such as nearly every other policy challenge, with more taxation, with more regulation, and with more litigation. Rural States such as Wyoming are especially hit hard by soaring prices. Mass transit is not an option. Prices are high and the hundreds and hundreds of letters I received on this issue are a testament to the real pain. Wyoming does contribute greatly to America's energy needs. We are the largest producer of coal in the country; the largest producer of uranium; the second largest source of onshore natural gas; and we have world-class wind resources.

The citizens of Wyoming get it. We have been involved in domestic energy production and transmission for decades.

The other side of the aisle simply says no to domestic energy exploration; no to American energy. America faces an energy crisis and an economic crisis. Continuing to rely on increasing amounts of foreign oil leverages our country's future. It is time to focus on an American response: American energy efficiencies, American conservation, and, yes, American energy exploration. Our country deserves better and our children deserve better.

The massive transfer of wealth that is happening every day, from our country to overseas, is putting our children and our grandchildren's future at risk.

When is enough enough? I am asking those opposing American development, how much transfer of wealth is enough? How many hundreds of billions of American dollars must we send to foreign nations to buy their oil? How much of our Nation's great wealth must we transfer before it is acceptable to develop American resources? Is it $100 billion? Is it $200 billion? Is it $300 billion? Apparently not.

Some on the other side of the aisle do not want to allow American energy production through deep sea exploration, through oil shale development, through streamlined permitting. Their so-called responses leave America more and more reliant on foreign countries to provide for America's energy. We can do better and we can do so in an environmentally sensitive manner, as we have done for the 118 years we have been a State in Wyoming.

There have been extraordinary technological developments in oil and gas exploration and development. Provisions to address excess speculation must be coupled with added supply and added conservation. We must find more and use less. The rhetoric from the other side is all about change. I think those blocking American solutions to foreign energy dependence would do well to change their minds, change their policy prescriptions, and change their approach on energy policy; otherwise, this Congress will only be leaving American families with change in their pockets at the end of each month.

I believe Americans want meaningful solutions, not merely change.

There is a difference. American energy is the most important issue facing the American people today. American families are sacrificing. At a minimum, at an absolute minimum, those same families deserve real action from this Congress.

Most certainly it would be very important to turn that coal into liquid fuel for aviation. If you take a look at this morning's Politico, an issue of the Pentagon, the Department of Defense is the Nation's biggest oil consumer, burning 395,000 barrels per day, about as much as the country of Greece.

The Air Force's thirsty planes burn more than half the fuel supplied for the entire U.S. military. It did receive $1.5 billion in new relief from Congress for fuel and still has $400 million left to go.

When you look at that and say: What else could we do to help lower that cost, not just for the consumer who fills their tank at home but also for your military, it is converting coal to liquid. The technology is there. People ask: Is there enough coal and how would you do it?

There is an incredibly abundant supply of coal in this Nation. To me, coal is the most available, affordable, reliable, and secure source of energy we have in this Nation. Wyoming is the No. 1 coal producer in the United States. There is enough coal in Wyoming alone to help our Nation for centuries, for hundreds of years. Coal is there and the technology is there.

Right now under the law, the military is not allowed to make a contract long term to put that coal into liquid. But the technology is there. We have an exciting company in Wyoming, near Medicine Bow, building a plant to do this, to convert the coal to liquid. But it is not only Wyoming

As the Presiding Officer knows, and the Senator from Tennessee knows, there is coal all around the United States--coal in West Virginia, coal in Kentucky, coal in Pennsylvania, coal in Illinois, coal in Wyoming, coal in Montana. Everyplace we need energy we have coal.

Some folks are saying: What about the carbon dioxide? But the technology is there to get the carbon dioxide, to sequester it, and actually to use it for more oil development.

You take an old burned-out oil well where there is not a lot of oil coming out. There is a way to inject the carbon dioxide and get out more oil. So it is not only good because you can use the coal for the liquids, you can also use this carbon dioxide to get even more oil. By that, you are certainly finding more, with something we have here.

To me, this is so much about becoming, as a nation, energy self- sufficient. The only way we can do that is to rely on American sources of energy. We are sending hundreds of millions of dollars overseas to people who are not our friends--hundreds of billions of dollars.

This is America's treasure going overseas. Why? Because we are not energy self-sufficient. But with all the coal resources we have all across this country, and the technology, we can today start converting the coal to liquids to be used for aviation, to be used for our military. The No. 1 user is our military in terms of the largest user of our energy.

It seems to me, to the Senator from Tennessee, that when we have this discussion--and I hear Senator Isakson talking about nuclear, finding more energy that way, I hear Senator Hatch talking about the cars and using less energy that way--this is one more way in this whole portfolio of different ways to use energy as we find more and use less.

Because the American people are going to continue to use all the energy, we need all the sources of energy. That is the way we can keep down the price at the pump for people all across our country.

Mr. President, I rise today to speak about the price of gasoline and diesel fuel, a price that is affecting all Americans. High prices at the pump challenge many Americans who travel great distances for work, for school, or to shop for groceries. This is especially acute in sparsely populated States such as Wyoming.

These prices are resulting in dramatic impacts to our economy. America is now importing more than 65 percent of the oil we consume. We are sending hundreds of billions of dollars overseas to foreign nations that are not necessarily our friends.

It is well beyond time for Congress to act and to adopt meaningful short-term, medium-term, and long-term solutions. As a matter of principle, I believe the Senate must act on a set of solutions rather than pursue a piecemeal approach.

I am an original cosponsor of two pieces of legislation that include a range of solutions--S. 2958, the American Energy Production Act, and S. 3202, the Gas Price Reduction Act. Combined, these bills include provisions on advanced technology, on speculation, and on added supply. The bottom line is, we need to find more and use less.

Today, I wish to speak on two points. One is limiting market speculation, and the other is increasing domestic production.

Based on a range of testimony, it is clear to me that there is dramatic disagreement on the extent to which excessive speculation contributes to the runup in oil prices. As a physician, I am quite concerned that some may have misdiagnosed the energy crisis. In my view, it is a classic misdiagnosis where policymakers focus too much attention on the symptoms of the predicament rather than the underlying causes of the problem.

I am absolutely convinced that the fundamental issue here is one of supply and demand. Simply because market speculation is a symptom of that larger problem does not mean we should shy away from addressing it head-on. Dealing with speculation, however, is not the full answer. We must combine these efforts with meaningful action to expand domestic supplies and to encourage conservation and energy efficiencies.

On the issue of market speculation, I have concluded three fundamental points: One, American consumers should not bear the burden of those who seek to manipulate markets. Two, the United States should not push our financial services trading to foreign countries. We should not replace excessive speculation with excessive regulation. And three, we should strengthen the futures trading markets. This can be done through investing in additional research, requiring transparency, putting more cops on the beat, and strengthening requirements on foreign boards of trade.

Efforts to address market manipulation require a careful balance. Increased visibility into transactions must not turn into onerous regulations.

More importantly, steps to curtail speculation must be combined with real solutions to address the underlying fundamental of domestic supply and demand. We must insist on efforts to increase our energy supplies, promote conservation, and encourage energy efficiencies. We would be failing the American people if we did not talk about increasing the domestic supply of energy.

I must comment on proposals to punish companies that some believe are not developing leases as quickly as they should. This is a ludicrous argument. Frivolous lawsuits and substantial administrative hoops dramatically delay oil and gas exploration and production even on valid existing leases. These punishing tactics being proposed are akin to leasing an apartment, only to have your landlord withhold the keys and complain about why you haven't moved in yet. Rather than punishing existing operators, we can and should streamline the permitting process.

Recently, I was in the part of Wyoming known as the Powder River Basin. It is in the northeastern part of the State. I heard firsthand about the obstacles people are facing when they try to find more oil and gas. American producers are routinely faced with rules and regulations that limit drilling for one reason or the other.

Typical restrictions are related to both occupancy of the land and the time during the year American producers can operate. Examples of prohibitions include extensive restrictions for bird roosting, for bird nesting, for migration, and for wildlife feeding.

The seasonal prohibitions currently limit exploration to a small fraction of the year in many areas. As we can see from this chart, some areas are off limits to produce for all but 10 weeks of the year, from August 16 through October. This is the only time of the year they can produce. If this calendar represented the blackout dates for using our frequent flier miles rather than the dates blacked out for finding the energy that powers our airlines, I guarantee you that outraged citizens all across this country would be pounding down the doors. Let's take a look. January blacked out. February blacked out. March blacked out, April--go through the calendar--May blacked out, June, July. And the charge from the other side of the aisle is that companies are not producing on their leases fast enough.

The bottom line is, there are many reasons why there may not be active exploration and production on lands already under lease. If Congress is serious about producing oil on existing leases, then Congress needs to critically review the process needed to develop oil and gas wells.

As of late June in Wyoming's Powder River Basin, there were 2,589 applications to drill that were awaiting approval by Federal bureaucrats. These are on land where the company has already paid for the lease but is not yet permitted to drill. They have paid the rent, but they have not yet been given the keys to move in.

The vast majority of the applications face extensive administrative delays. What is the current law? The current Federal law requires that permits be either issued or deferred within 30 days of the day the Government receives the completed application. That is right, the law says Federal bureaucrats must give an answer in 30 days. Well, there are many instances where there is not even the acknowledgment that the submitted application was received. Moreover, the applications sit for months and months, in some cases even over a year, and still Federal bureaucrats have not processed the application to drill.

In a small provision that was slipped into this year's consolidated appropriations act, these production companies now have to, in addition to all the paperwork, pay $4,000 every time they request a permit to drill--a permit that is on land that they have already leased and paid for, a permit that is not being processed in a reasonable, timely manner, and a permit that may not be processed for months or even years.

There are over 850 drilling permits, just in Wyoming, that have been specifically delayed due to policy development, environmental delays, and even litigation. For people to say that oil and gas operators are sitting on leases without any intent to drill is intentionally misleading. In my State, the producers want to drill and they are waiting to drill. They are simply waiting for the Government traffic cops to give them the green light.

For people who claim they want to increase domestic supply of energy on leases that have already been paid for, there is a place you can focus your effort. Focus on the thousands of permits nationwide, and especially in my home State--permits that have not yet been granted, permits that are being held up while waiting for the Government bureaucrats to act. The leases have been paid for, the workers are ready, and literally, today, standing by ready to work. All we are waiting for now is for the Government paperwork.

This is no way to run a country.

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

I will withhold the request.