Floor Statements

Mr. President, I ask unanimous consent that the Committee on Agriculture be discharged from further consideration of S. 33 and that the Senate proceed to its immediate consideration.

Mr. President, I ask unanimous consent that the bill be read three times and passed; that the motion to reconsider be laid upon the table, with no intervening action or debate; and that any statements relating to this measure be printed in the Record.

Mr. President, I ask unanimous consent that the Agriculture Committee be discharged from further consideration of S. 1499 and that the Senate proceed to its immediate consideration.

Mr. President, I ask unanimous consent that the bill be read three times and passed; that the motion to reconsider be laid upon the table; and that any statements relating to the bill be printed in the Record.

Mr. President, I ask unanimous consent that the Agriculture Committee be discharged from further consideration of H.R. 1367 and that the Senate proceed to its immediate consideration.

Mr. President, this is legislation that I authored and was very proud to have authored. This is the bill that is going to help protect large cats from being owned in a place such as New York and kept in apartments.

Mr. President, I ask unanimous consent that the bill be read three times and passed, the motion to reconsider be laid upon the table, and that any statements relating to the bill be printed in the Record.

Mr. President, I ask unanimous consent that it be in order for the Senate to proceed en bloc to the consideration of the following calendar items: Calendar No. 41, S. 425; Calendar No. 255, S. 391; Calendar No. 256, S. 434; Calendar No. 257, S. 435; Calendar No. 258, S. 452; Calendar No. 259, S. 714; Calendar No. 260, S. 1003; Calendar No. 261, H.R. 622; and Calendar No. 262, H.R. 1012.

I ask unanimous consent that any amendments, where applicable, be agreed to, the bills, as amended, if amended, be read three times, passed, and the motions to reconsider be laid upon the table en bloc; the consideration of these items appear separately in the Record and that any statements related thereto be printed in the Record, without intervening action or debate.

Mr. President, I ask unanimous consent that the Senate now proceed to the immediate consideration of H.R. 1006, which is at the desk.

I ask unanimous consent that the Inhofe amendment at the desk be adopted, the bill, as amended, be read the third time and passed, the motions to reconsider be laid upon the table en bloc, and that nay statements relating to the bill be printed in the Record.

Mr. President, I ask unanimous consent that the Senate proceed to the immediate consideration of S. 1947, which was introduced earlier today.

Mr. President, I further ask unanimous consent that the bill be read three times and passed, the motion to reconsider be laid upon the table, with no intervening action or debate; and that any statements relating to this measure be printed in the Record.

Mr. President, I ask unanimous consent that the Banking Committee be discharged from further consideration of S. 811 and the Senate now proceed to its immediate consideration.

I ask unanimous consent that the substitute amendment at the desk be agreed to, the bill, as amended, be read the third time and passed, the motion to reconsider be laid upon the table, and any statements related to the bill be printed in the Record.

I ask that the Chair now lay before the Senate the House message to accompany S. 1768.

The Presiding Officer laid before the Senate the following message:

Resolved, That the bill from the Senate (S. 1768) entitled

``An Act to extend the national flood insurance program'', do

pass with the following amendment:

Strike out all after the enacting clause and insert:

I ask unanimous consent that the Senate concur in the House amendment, the motion to reconsider be laid upon the table, and that any statements related to the bill be printed in the Record.

Mr. President, I ask unanimous consent that the Senate proceed to the immediate consideration of Calendar No. 407, S. 1522.

I ask unanimous consent that the committee amendments be agreed to en bloc, the bill, as amended, be read the third time and passed, the motions to reconsider be laid upon the table en bloc, and that any statements related to the bill be printed in the Record.

Mr. President, as in executive session, I ask unanimous consent that the injunction of secrecy be removed from the following treaty transmitted to the Senate on November 24, 2003, by the President of the United States:

Mutual Legal Assistance Treaty With Japan, Treaty Document

108-12.

I further ask unanimous consent that the treaty be considered as having been read the first time; that it be referred, with accompanying papers, to the Committee on Foreign Relations and ordered to be printed; and that the President's message be printed in the Record.

Mr. President, I want to talk about one Senator's journey through this bill, trying to make a decision based on the facts and trying to get through the rhetoric, because there is a lot of that going on in any piece of legislation. So I am trying to write down the pros and the cons of this legislation and go through them in a systematic fashion and try to make a decision based on policy and not based on politics, a decision based on what is in the bill, not on what people are saying is in the bill.

As I have gone through this, I have a whole list of general principles that I believe are good. I have still not made up my mind on this final piece of legislation because it is really a balancing act. There are good things and there are things that are not so good. Just to mention a few of the things that I believe are good in this bill, probably the best thing is something called the health savings account, which has nothing to do with Medicare today. It has to do with reforming the overall insurance system in our country for health care. It is something I have been fighting for, for many years and introduced legislation on when I was in the House of Representatives on the Ways and Means Committee.

We passed it several times, but unfortunately, when we passed the final version, we had to water it down so

much that we enacted a piece of legislation that did not work. So the health savings accounts in this piece of legislation, I believe, are going to be one of the most significant reforms we can possibly enact for the future of bringing the patient back into the accountability loop. When you have a third-party payer system--what I mean by that is the person receiving the care doesn't directly pay for the care; it is a third-party payer system.

So when you walk into a doctor and the doctor says we need to run this test and that test, the person doesn't even say how much do those tests cost or is there a cheaper place to go get an MRI, for instance, or is one place better or cheaper or is a certain specialist better than others or is one cheaper than others, and maybe of the same quality--none of those kinds of discussions happens because they are not paying the bill. The health savings account allows them to put money into an account tax free. It builds up in the account tax free, and when it is taken out for health care expenses, it is taken out tax free. Then that person directly pays the doctor.

Now, why is that significant? It is significant because in our current system, whether it is traditional Medicare fee for service, or even the HMOs or the PPOs, all the payments go through some kind of bureaucracy, whether it is a Government bureaucracy or a private one. Anybody that has experienced our health care system today knows that maybe companies are not trying to deny payment but it certainly seems like that in a lot of cases.

My in-laws are dealing with this right now. My father-in-law had cancer last year. They have been battling for almost a year now on whether the insurance company should pay for a large part of their coverage or not. That takes a lot of time for people to process, to answer phones, go through the whole process. If somebody is paying out of their own pocket to the doctor, none of these conversations has to take place, and that money that is saved through the bureaucratic process can go directly to health care. I believe health savings accounts are one of the most positive things in this bill.

Mr. President, will the Chair please notify me when there is 1 minute remaining?

Second is the means testing idea of Part B, the affluence testing, as it is being called. I think it is wrong. This is not a part of Medicare where people are paid in their taxes over the year. Part B is something that younger generations--such as the pages we have here-- people paying taxes out there are paying for seniors, and we should, at least for those wealthy seniors, have them pay for that benefit they are getting, instead of shifting the benefit on to middle-class taxpayers. That is also very good.

Another part that is good in the bill is this idea of a disease management pilot project. Right now in Medicare, you go to one doctor and Medicare pays, and maybe you have diabetes and you have to go to several specialists, internists, or whatever; there is nothing really coordinating care. So you get different prescriptions and different doctors. There is no real coordination of care and also not a lot is being done preventively. So we end up with poor-quality care, poor outcomes, and we spend more money.

We have a great demonstration project, a pilot project that Republicans and Democrats actually should like in this bill on the disease management part of it. In the future, I believe it will improve outcomes for seniors healthwise, and it will also save costs.

As to some of the negative parts of the bill, first of all, it does not kick in right away. A bill that I introduced would have kicked in as soon as the drug discount card kicks in. That is the only thing that really kicks in, in the next 5 or 6 months--the drug discount card. The legislation I had introduced actually would have fully kicked in. The Democrat bill and Republican bill we had debated, none of those kicked in right away, and neither does this bill.

The other problem with this bill is there is a cliff at 150 percent of poverty. After that, you kind of drop right off the cliff. So for those below 150 percent of poverty, this is too generous. With a $1 and $3 copay, we are going to incentivize people to overutilize drugs, pure and simple. You are going to see overutilization of drugs. We see it in Medicaid today because of the low copays and we are going to see it here. That was a huge mistake that we didn't once again have people receiving the drugs having anything financial at stake. And $1 and $3 copays will not change behavior in any way whatsoever.

The other thing that actually we have to consider--and we should at least go into this with open eyes--this is the largest wealth transfer since Medicare was first put into effect. We just have to know that. The $400 billion is being taken from younger people and given to older people. The older people didn't pay for it. We are giving that. So we have to go into this with open eyes.

The other thing I believe is a problem with the drug benefit we have in Medicare is that it is giving it to the wealthy. I don't believe we should be. We should be helping and putting almost all the benefit into the people who are literally having to choose between prescription drugs and rent and maybe whether they are going to eat that month or what kind of food they are going to eat that month.

Instead, this bill gives coverage for everybody on Medicare. I don't believe that is right. When Bill Gates turns 65, I don't believe he should be getting a prescription drug benefit that is paid for by some union worker who worked hard all of their life and paid taxes. I don't believe that is right. So I believe the prescription drug benefit should be means tested. That is another negative in this particular piece of legislation.

Just mentioning a couple of the things, there are some really good pieces of this bill, but there are some major negatives in this bill.

When we are going through all of the rhetoric, I think all of us have to be honest. The supporters of the bill should be honest that there are some problems with it, but the people who are against the bill should also be honest. This does not end Medicare as we know it. This is a bill incredibly generous to low-income seniors. Even if I vote against this bill, I have to say this is incredibly generous to low- income seniors. That is just being honest. All seniors pay out of pocket is a $1 copay for generics and a $3 copay for brand name prescription drugs. That is an incredibly generous benefit.

In conclusion, as I go through this next 24 to 48 hours--whenever we are going to vote on final passage of the bill--it is a 700-page document we got a couple of days ago. I think we have to take our time to go through the bill.

Taking our time to go through the bill is very wise to do because my biggest fear--and we see this happen with legislation all the time--when we have this kind of complexity in a document is the law of unintended consequences.

We enact bills all the time. When we enacted HIPAA--and the majority leader is on the floor and he knows better than anybody--the HIPAA law is a terrible piece of legislation, and we are suffering consequences today. We are driving up health care costs unnecessarily because of that legislation. That is why I am still trying to go through this legislation to make up my mind.

I thank my colleague, the senior Senator from Nevada, Mr. Reid, for yielding me the time to speak tonight. I look forward to hearing the majority leader's comments on this legislation as I am still battling through what I am going to do on it.

I thank the Chair. I yield the floor.

Reserving the right to object, and I will object, very simply put, when the Democrats were in control of the House of Representatives, the Senate, and the Presidency back in 1993, the unemployment rate, when they terminated the program, was 6.4 percent nationally. It is now 6.0 percent, lower than it was in 1993 when every Democrat voted to terminate the program. So with that, I object.

Mr. President, I rise today to introduce, with my distinguished colleague from Maryland, Senator Mikulski, the Mammography Quality Standards Reauthorization Act of 2003. The purpose of this legislation is to reauthorize the Mammography Quality Standards Act in order to maintain access to high quality mammography services for every woman in America.

Breast cancer is the second leading cause of cancer deaths among American women. An estimated 211,300 new cases of invasive breast cancer are expected to occur among women in the United States in 2003. In my home State of Nevada alone, 1,400 new cases of breast cancer will be diagnosed in women, and an estimated 300 women in Nevada will die of breast cancer next year.

The MQSA was originally passed in 1992 to ensure that all women have access to quality mammography for the detection of breast cancer in its earliest, most treatable stages. Congress re-authorized MQSA in 1998, extending the program through 2002. Although MQSA was scheduled for reauthorization last Congress, we unfortunately failed to act.

The MQSA has had a positive impact on mammography quality. FDA inspection data continues to show overall facility compliance with the national standards to ensure the quality of x-ray images. Currently, over 98 percent of all mammography facilities pass the phantom image test during their facility inspection. MQSA remains as essential tool for early detection and for combating mortality associated with breast cancer.

The legislation I introduce today would reauthorize MQSA for 2 years, signifying Congress' commitment to extending the life of this important program. Reauthorizing the act for a shorter amount of time than previously done will allow Congress the time it needs to examine some serious issues facing the long-term effectiveness of the act while still maintaining vital quality standards in the interim.

In addition, this legislation would permit the Secretary of the Department of Health and Human Services to issue two additional and temporary certificates that will allow facilities who offer mammography services to continue to provide uninterrupted care while they go through the process of reaccredidation. This is important as we encourage more and more women to seek screening services each year.

With these significant changes, MQSA, I believe, will be more effective than ever. While we are improving the act with this bill, we need to tread carefully as we look to make further changes. Mammography, like every health discipline, is an imperfect science. On average, radiologists estimate that somewhere around 75 percent of cancer can be found through mammography. Thus, until the technology improves, the quality of the reading is limited.

We have to remember that in the medical field, human error is unavoidable. Most doctors practicing today are excellent at what they do, and placing additional regulations on them, especially in an already highly-regulated subspecialty, can often times do more harm than good. Congress needs to be increasingly vigilant in making sure that practices below acceptable standards are eliminated. To that end, one of the real benefits of MQSA is its required medical audit procedure which mandates that each FDA-approved facility has a system for following up on mammograms that reveal problems. In

other words, each facility performs a self-check on itself, helping to ensure quality care is being given.

The impact of medical liability on the radiological profession has been immense, leading to a shortage of quality doctors. As bad as it has been for the profession itself, the adverse effect it has had on patient access to care is intolerable. In places across the country, women are having to wait weeks, even months, to get a mammography screening. In a speech this February in Florida, the president of the American Medical Association stated that in a recent survey of Palm Beach, Miami Dade and Broward Counties, 7 of the 29 radiologists said they had stopped reading mammograms--and 8 others are considering that possibility. In addition, Orlando Regional Hospital reports that the average wait time for women seeking mammography rose from 20 days in 2000--to 150 days in 2002. The cause of all this is that many radiologists can't find or afford the necessary liability insurance.

The bottom line is that at a time when the medical liability crisis is hitting the industry harder than ever, the last thing the Federal Government should be doing is creating more avenues for abusive lawsuits. That is why Congress must balance the need to find ways to improve the quality and delivery of women's health, while at the same time preserving a positive and equitable medical environment for well- intentioned professionals to practice.

The MQSA has been an important program in increasing the quality of mammography services for women. I thank Senator Mikulski and HELP Committee Chairman Gregg for all of their hard work on this issue, and I look forward to seeing this legislation through to passage by the Senate and ultimately signed into law.

Mr. President, I rise today to introduce, with my distinguished colleague from Maryland, Senator Mikulski, the Mammography Quality Standards Reauthorization Act of 2003. The purpose of this legislation is to reauthorize the Mammography Quality Standards Act in order to maintain access to high quality mammography services for every woman in America.

Breast cancer is the second leading cause of cancer deaths among American women. An estimated 211,300 new cases of invasive breast cancer are expected to occur among women in the United States in 2003. In my home State of Nevada alone, 1,400 new cases of breast cancer will be diagnosed in women, and an estimated 300 women in Nevada will die of breast cancer next year.

The MQSA was originally passed in 1992 to ensure that all women have access to quality mammography for the detection of breast cancer in its earliest, most treatable stages. Congress re-authorized MQSA in 1998, extending the program through 2002. Although MQSA was scheduled for reauthorization last Congress, we unfortunately failed to act.

The MQSA has had a positive impact on mammography quality. FDA inspection data continues to show overall facility compliance with the national standards to ensure the quality of x-ray images. Currently, over 98 percent of all mammography facilities pass the phantom image test during their facility inspection. MQSA remains as essential tool for early detection and for combating mortality associated with breast cancer.

The legislation I introduce today would reauthorize MQSA for 2 years, signifying Congress' commitment to extending the life of this important program. Reauthorizing the act for a shorter amount of time than previously done will allow Congress the time it needs to examine some serious issues facing the long-term effectiveness of the act while still maintaining vital quality standards in the interim.

In addition, this legislation would permit the Secretary of the Department of Health and Human Services to issue two additional and temporary certificates that will allow facilities who offer mammography services to continue to provide uninterrupted care while they go through the process of reaccredidation. This is important as we encourage more and more women to seek screening services each year.

With these significant changes, MQSA, I believe, will be more effective than ever. While we are improving the act with this bill, we need to tread carefully as we look to make further changes. Mammography, like every health discipline, is an imperfect science. On average, radiologists estimate that somewhere around 75 percent of cancer can be found through mammography. Thus, until the technology improves, the quality of the reading is limited.

We have to remember that in the medical field, human error is unavoidable. Most doctors practicing today are excellent at what they do, and placing additional regulations on them, especially in an already highly-regulated subspecialty, can often times do more harm than good. Congress needs to be increasingly vigilant in making sure that practices below acceptable standards are eliminated. To that end, one of the real benefits of MQSA is its required medical audit procedure which mandates that each FDA-approved facility has a system for following up on mammograms that reveal problems. In

other words, each facility performs a self-check on itself, helping to ensure quality care is being given.

The impact of medical liability on the radiological profession has been immense, leading to a shortage of quality doctors. As bad as it has been for the profession itself, the adverse effect it has had on patient access to care is intolerable. In places across the country, women are having to wait weeks, even months, to get a mammography screening. In a speech this February in Florida, the president of the American Medical Association stated that in a recent survey of Palm Beach, Miami Dade and Broward Counties, 7 of the 29 radiologists said they had stopped reading mammograms--and 8 others are considering that possibility. In addition, Orlando Regional Hospital reports that the average wait time for women seeking mammography rose from 20 days in 2000--to 150 days in 2002. The cause of all this is that many radiologists can't find or afford the necessary liability insurance.

The bottom line is that at a time when the medical liability crisis is hitting the industry harder than ever, the last thing the Federal Government should be doing is creating more avenues for abusive lawsuits. That is why Congress must balance the need to find ways to improve the quality and delivery of women's health, while at the same time preserving a positive and equitable medical environment for well- intentioned professionals to practice.

The MQSA has been an important program in increasing the quality of mammography services for women. I thank Senator Mikulski and HELP Committee Chairman Gregg for all of their hard work on this issue, and I look forward to seeing this legislation through to passage by the Senate and ultimately signed into law.

Madam President, I rise today to make some brief comments about the Defense authorization bill.

First, I compliment the chairman and ranking member for working hard on this legislation. I also thank the professional staff, both on the committee as well as the personal staffs. It was my first year on the committee, and it was an incredible process. There were many controversial and complex issues on which we worked together.

In the end, we have done a lot for the members of our military, our Armed Forces serving in this country and around the world. With the global war on terrorism, these issues have become more important than ever: To make sure they have the resources to fight the global war on terrorism and to ensure a quality of life so we can maintain the all- volunteer professional armed services we have.

Several issues covered in my subcommittee, the Readiness Subcommittee, were very important. We have a problem with our ranges. Dealing with readiness, we have to have the proper training facilities. This bill helps us address some of those issues. The military does such a fabulous job protecting the environment on its training ranges that the use of those ranges almost became threatened. This bill makes sure that the training ranges and the environment are protected, while the military can still use the training ranges. That was a very important part of this Defense authorization bill.

I also think about what we have done for military families. That cannot be overemphasized because of the sacrifices they make for this country. It is not just the people in uniform, but it is the families and the sacrifices they make for the country. It is important that we take care of their quality of life. I am very proud of the work we have done in this Defense authorization bill.

I hope next year we can complete this bill earlier in the year, before Defense appropriations is done, because it is a better way to do it. The issues are complex. Many times they are controversial. But we have to be willing to put our personal interests, our party's interests behind the interests of our

Nation and the interests of our military.

The Defense authorization bill is one place where we can join hands across the aisle, as we have done on so many issues this year, and continue to work to make sure our military is so far superior to any other military in the world that if there is ever a question whether we go into battle, we know we have the upper hand.

Madam President, I thank the chairman for all the great work he has done.

I yield the floor.