Floor Statements

The following Senator is necessarily absent: the Senator from Nevada (Mr. Ensign).

The following Senator is necessarily absent: the Senator from Nevada (Mr. Ensign).

I ask unanimous consent that the order for the quorum call be rescinded.

Mr. President, I have been talking about, over the last several days, health care reform which is urgently needed. No one is satisfied with the status quo. We have all heard unfortunate stories about Americans who cope with health insurance. All Americans deserve access to high-quality health care. In a country as innovative and prosperous as ours, we can achieve that goal. Republicans believe we can do so by putting patients first. We believe Americans should be trusted with their own money to make wise decisions about the health care plan that best fits their family's needs. We do not believe forcing everyone into a one-size-fits-all, Washington-run system, as the President wants, is the solution to our health care problems. Indeed, we believe a Washington takeover would create a whole new set of problems, the likes of which are experienced every day in countries such as Canada and Great Britain.

President Obama often says if you are insured and you like your current health care, you can keep it. But as I pointed out several times, the President's plan would, in fact, force millions of Americans into the government system by providing incentives for their employers to eliminate their coverage. Government-run health care systems in Canada and Great Britain have, over and over, failed the very patients they were created to serve. Access to doctors, tests, treatments, and medications is limited. Patients wait through painful months and years to get the treatment they need. The longer they wait, the more their conditions worsen. Medications are sometimes unavailable or the government may refuse to pay for them, despite the guarantee of universal coverage to all. Innovation and new medical technologies are not encouraged because they would lead to higher costs. Patients deal with bureaucratic hassles as they try to navigate their way through an overly complicated maze of rules. Americans want health care reform, but they don't want to experience the rationing and the ordeals that a government system would create.

As opposition to this public option idea or Washington takeover grows, some Democrats have been trying to disguise this takeover with a new name. They have come up with the idea of calling it a health insurance co-op. This started with a very good idea from the Senator from North Dakota but has evolved into simply another name for a government-run insurance company. As we all know, a co-op in its purest form is a business controlled by its own members. Co-ops form when communities unite to solve a common problem or exchange goods and services. In Arizona, we have more than 100 co-ops all across the State. Some communities use them to get fresh food, electricity, hardware, heating fuel or create credit unions. A bloated, Washington- run health care bureaucracy forced upon the public is not a co-op.

As former Secretary of Health and Human Services Michael Leavitt has written in a soon-to-be-published Fox News article he shared with me:

A co-op that would be federally controlled, federally

funded, and federally staffed sounds like the public option

meets the new General Motors.

In the era of the GM takeover, Washington controls the purse strings, pays the bills, dictates the rules. The same would be true of a Washington health care co-op.

As Leavitt put it in this article:

Washington healthcare would result in Americans being ``co-

opted,'' rather than being given a ``co-op.''

Americans are also concerned about the cost of the bills being proposed on the Democratic side. The nonpartisan Congressional Budget Office's preliminary estimate shows that the bill in the HELP Committee or the draft bill created by the senior Senators from Massachusetts and Connecticut--the piece of legislation I am talking about--would cost a trillion dollars over the course of 10 years but only would reduce the number of uninsured by 16 million. So a trillion dollars to bring 16 million people into insurance status. For those who would be newly covered, the cost would be $65,185 per person for 10 years of coverage. That is

only a preliminary estimate for part of the plan. Of course, the preliminary estimate does not tell the whole story. What would it cost to cover the remaining 31 million who are thought not to have insurance or the millions who would be displaced from current private coverage with their employer into the public plan? Remember, I indicated that private employers would have no incentive to keep those people on their own rolls when it would be much cheaper to have them go to the government option.

The bill also provides subsidies for families whose incomes reach 500 percent of the poverty line which gets you close to $100,000.

The first question one has to ask in these circumstances is, How do we pay for all of this, and who will pay. We are all familiar with the huge expenditures of this government since the beginning of the year on the so-called stimulus package, the so-called omnibus bill, the budget that has been provided, and now the supplemental that we will probably be taking up tomorrow, all of which adds trillions of dollars in more debt, more debt than all the other Presidents and Congresses of the United States put together. In fact, double that, and that is how much debt is created in just one budget of President Obama.

We add on top of all of that a trillion, 2 trillion, who knows how much to try to find coverage for about 45 million people. We have not had the answers to the questions yet of how we would pay for it and who would pay, but we have seen proposals that range from taxes on beer and soda to juice, salty foods, eliminating charitable tax deductions. We even heard about a value-added tax that would tax everyone regardless of income. Would there be anything left that the Federal Government does not tax at the end of this?

The HELP Committee would also establish a new prevention and public health investment fund. We don't know all the details, but what we have heard is that, it would direct billions of dollars to the government to do healthy things. Like what? Like building sidewalks and establishing new government-subsidized farmers markets. The idea is to encourage healthier lifestyles. I suppose that creating sidewalks so people can jog on sidewalks creates healthy lifestyles. I was at a farmers market this weekend. I didn't notice any Federal subsidies. I am sure the vegetables there are good for everybody, and it would be nice to have more farmers markets. But should the government be spending a lot of money on things such as that in the guise of trying to provide healthier Americans so we have less costly insurance? Encouraging healthier life styles is fine, but I don't think this is the kind of reform the American people have in mind. It is also indicative of a very wasteful and inefficient system, whenever it is run by the Federal Government in Washington.

We all believe that families who can afford insurance should be helped. There are ways to do that. The poorest Americans are already eligible for Medicaid, and we should see to it that Medicaid and Medicare are strong and that everyone who is eligible signs up for them. One of the reasons there are so many uninsured is that many of the people who are eligible for private insurance or Medicaid have not signed up. We could get them signed up for that.

That leads to another question about Washington-run health care. Will increased demands for government health care diminish the quality of care that is now received by America's seniors in Medicare? That is an important question for seniors to contemplate. They want Congress to find ways to ensure Medicare is solvent. They don't want us to divert the program's resources into a massive new entitlement for everyone. Yet we all know, as the President himself has said, that Medicare is not solvent. It is not sustainable. Now we are going to add additional burdens and expect that there would not be any negative impacts on America's seniors. I find that hard to believe.

I haven't read anything in the Congressional Budget Office's preliminary report that makes me more optimistic about this. The preliminary numbers should make us even more weary of adding a new government program.

Finally, we are told we must hurry up and pass the health care reform President Obama wants for the sake of the economy. The President pitched this same argument to Congress as he rushed us to pass the stimulus, which was packed with debt and waste, the details of which are now coming to light thanks to a new report by Senator Coburn. The reality is, the bulk of the money we passed for the stimulus should simply not be spent. That will not be efficiently spending taxpayer dollars. I argued at the time that rushing to borrow money to pass such an expensive and complex bill was irresponsible and a disservice to taxpayers. Administration economists insisted that if Congress hurried to pass the stimulus, unemployment would peak at 8 percent. Four months later, unemployment has now reached 9.4 percent, and here we are again being pressured to hurry up and spend another trillion taxpayer dollars.

Republicans will not be rushed into passing the Democrats' health care bill. We are going to ask the tough questions. I think our constituents deserve answers to those questions. Based upon the track record so far, I wouldn't say the experts who have told us don't worry about the cost, everything will be fine, have not guessed right, as the Vice President said last Sunday. I don't think our constituents want us to hurry it. They want us to do it right. We want real reform, not more deficits, government waste, and unsustainable programs.

As we reform health care, we need an approach that makes sure the patients come first and that no government bureaucrat stands in the way of the doctors prescribing treatments and medications their patients need. The success of America is largely due to the individual freedom we all enjoy. Individual freedom triumphs when the doctor-patient relationship remains free of government intervention. We must continue our great tradition as we pursue the health care reforms we all want.

Let me comment on a piece of legislation Senator McConnell and I introduced. I would love to have everyone cosponsor this legislation. I am hoping we can get it adopted soon before we take up health care reform because it will inform us as to how we should deal with health care reform on what could be the most important issue Americans find involved with this. Americans want their fellow citizens to be insured. They wanted costs to be kept in check so they can afford insurance. They want both those things. But they don't want their care, the care they believe in and they like, interfered with in order to achieve these other two goals.

One of the things they are most fearful of is that their care will be rationed. When we talk about saving money in Medicare in order to pay for insuring more Americans, seniors rightly question whether some of the care they have been getting is going to be denied them or that they will be delayed in getting that care.

One of the ways that could be accomplished is by using something the Congress has already passed called comparative effectiveness research. That stimulus bill I talked of earlier appropriated $1.1 billion to conduct comparative effectiveness research. It wasn't necessary because it is done in the private sector all the time. Hospitals, medical schools, associations, groups of people who want to find out which treatment is best for the most people conduct this kind of research all the time. Is drug X or drug Y better to treat people when they have a certain condition? They run tests to see how the different medications perform. They then give those results to physicians who use that information in prescribing to their patients. It is a way we have found that we can provide better quality care for more people. Sometimes, by the way, we can save money as well.

The point is not to try to figure out how to cut costs so we can deny certain care to people and, therefore, not have the cost of providing it. Unfortunately, that is one of the purposes to which this research could be put. It has been acknowledged by people both within the administration and without. The acting head of the National Institutes of Health, for example, talked about using this research for allocation of treatments.

Allocation of treatments is another way of saying rationing. You decide

which treatments to allocate and which ones not to. This is the way it is done in Great Britain and Canada. They do not have enough money to pay for all the health care that physicians prescribe, so they simply delay some of the care until it is not needed anymore or the person dies or they deny it. For example, one of the policies was not to prescribe a drug--well, the doctor prescribes the drug, but not to fill the prescription for an eye condition until the patient was blind in one eye. Then you could get the drug.

Americans do not want that. They do not want to have to suffer in that way when the medicines are available to treat them. What the government agency in Great Britain has said is: Look, we don't have enough money to give you all of the care your doctor says you need. We are going to have to make tough choices. We understand that will not please everyone. But there is no other way to use the limited dollars we have to provide this free care to everybody within the country.

What we are saying is, we do not want America to get to that point where you have to ration the health care. In Great Britain they have a term called ``QALY.'' It stands for Quality Adjusted Life Years: QALY. What they have literally done is to say that a person's life is worth between 20,000 and 30,000 pounds--I gather that is probably about $35,000 or $40,000--and that in a year of your life, I think it comes out to about $125 a day. If the health care the doctor has prescribed costs more than that, then in most cases you do not get it, even though the doctor says you need it, and he is willing to prescribe it and help you with the procedure or treatment or taking the drug.

I would hate to get to that point in the United States where we have an agency that says how much we think your life is worth every day-- $125--and says: Well, if the prescription of the doctor costs more than that, you are out of luck, we are not going to pay for it.

Incidentally, the national health care system in Great Britain has an acronym for that agency; it is NICE. It is the National Institute for Health and Clinical Excellence, N-I-C-E: NICE--not so nice when you do not get the care your doctor says you need.

What Senator McConnell and I have said is that the government cannot use this research, this comparative effectiveness research, for the purpose of denying your care. Obviously, it can be used for the purpose for which it was originally intended; namely, to figure out which treatments and prescriptions are best. But it cannot be used to deny treatment or service.

We obviously make an exception for the FDA, the Federal Food and Drug Administration, which can say a certain drug is dangerous to your health. Obviously, that would be exempted from this prohibition. But otherwise we say you cannot ration health care with comparative effectiveness research.

The bill pending before the HELP Committee actually creates an agency to use this research for that purpose. So there is a blatant attempt in the HELP Committee to use this research to ration care. Our legislation would stop that. We think we ought to pass it now to instruct the HELP Committee that we do not want that to happen.

In the Finance Committee, it is more indirect. A private entity would conduct the research. But there is nothing to prevent the Federal Government from using the results of the research to delay or deny your care, to ration care.

So for the bills that are being written in both committees, our legislation would provide direction that--whatever other reform we have--Americans are not going to have to worry about somebody getting in between their doctor and themselves, when the doctor says: I think you need this particular treatment, if their insurance provides for that. If not, there are other ways you can get the treatment; if it is a government program such as Medicare, you would be able to get the treatment. The government is not going to inject itself between you and your physician and say: You can't have that because it is too expensive.

That is all our legislation does. I would hope my colleagues would be willing to support that legislation to give direction to the two committees to ensure that they do not, in their zeal to cut costs, write legislation that would have the effect of rationing health care.

There are a lot of other concerns we have in putting this legislation together: concerns about a government-run insurance company to compete with the private insurance companies; a requirement that all employers provide health care, which, of course, would substantially add to their costs and might result in their hiring fewer people or paying the people who they do hire less money.

There are a lot of different concerns we have. But, in my mind, the most serious one is this concern about rationing. Everybody wishes to lower costs. But the one way we cannot lower costs is by having the U.S. Government tell you that you cannot get medical care your doctor says you need.

Let me conclude with this point: If you will think back, think back 100 years ago to the year 1908. How much health care could you buy at the turn of the last century, say the year 1900, 1908? The answer is, not very much. Think back about 40 years before that, when President Lincoln was assassinated and the kind of treatment he got. It almost seems barbaric in our modern way of looking at things that there was not anything available to save his life.

Now think of the incredible inventions and breakthroughs in medical science in the last 100 years, in the last 50 years, in the last 10 years. Things have been invented. New medications, new pharmaceutical drugs, medical devices, new kinds of surgery, ways of treating all kinds of conditions have evolved so rapidly that we are extraordinarily fortunate to be able to buy all of this health care.

So when people say we are spending too much on health care, I am not sure that is totally correct. To the extent there are more efficiencies in the system that can be brought to bear, of course we want to do things to incent those incentives. That is what some of the Republican proposals would do. But what we do not want to do is to put a government bureaucrat in between you and this incredible new medicine that is being invented every day.

We should be glad we can spend more on health care if it is much better health care. As one of the experts in this area said: In 1980, if you had a heart attack, after 5 years, your chances of survival are about 60 percent. If you have that same heart attack today, your chance of survival is about 90 percent--so from 60 percent to 90 percent survival in a few years, based upon new medical breakthroughs. It costs a little more money. The question is, would you rather have 1980s health care at 1980s prices, or health care that is available today at today's prices? I submit almost all of us, when we are thinking about a loved one in our family, would say: I want the very best there is, the very best we can get.

That is why Republicans say we want insurance to be affordable for everyone so that at least, if nothing else, for that catastrophic event in your life--such as a heart attack, for example--you will have all of the latest health care that America has available, and it will be paid for so you will have high-quality care.

In some of these other countries, they say: We are sorry. We can't afford that. We can't afford to spend money on all these new breakthroughs. We are basically stuck with what we could afford back in 1980, for example. And good luck. We know that is not going to help you all that much with your illness, but that is all we can afford to pay.

That is what we are trying to avoid. We are trying to take a very small step first and say that, at a minimum, nothing in this legislation would allow the government to use comparative effectiveness research to ration our care. I do not think that is too much to ask. I would ask all of my colleagues to join Senator McConnell and me in sponsoring that legislation and seeing to it we can get it passed for the benefit of our families and our constituents.

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

The following Senators are necessarily absent: the Senator from Nevada (Mr. Ensign) and the Senator from New Hampshire (Mr. Gregg).

Mr. President, the problems with the current state of health care in America are well known. Republicans do not need to be convinced of a case for reform. We hear from our constituents who have concerns about their own health care dilemmas and those of their neighbors and we all agree the millions of uninsured Americans need access to high- quality health care. But though we all agree on the need for reform, we have disagreements on how best to accomplish our goals.

Republicans favor a patient-centered approach that allows individuals to choose their own insurance, keep it if they like it, and never have to get permission from a Washington bureaucrat to get the test or treatment their doctor says they need. President Obama wants Congress to pass a sweeping new Washington-run health care system that we believe would jeopardize the care most Americans already have. Such a system would likely lead to the collapse of private insurance and replace it with an enormous Washington bureaucracy that would ration health care for all Americans.

I have discussed my concerns that Washington-run health care would diminish Americans' access to quality

care, lead to denials, shortages, and long delays for treatment, and would give power to Washington to dictate what medications and procedures Americans could get and when they could get them. It is already in the works.

A recent National Institutes of Health project description states:

Cost-effectiveness research will provide accurate and

objective information to guide future policies that support

the allocation of health resources for the treatment of acute

and chronic conditions.

``Allocation of health resources'' is a euphemism for rationing-- denying care based on cost. To that end, Senator McConnell and I have introduced legislation that would bar the Federal Government from using comparative effective research to delay or deny care to anyone. That is a bare minimum that we should do to prevent rationing of care. Our bill, incidentally, is endorsed by the American Medical Association.

Mr. President, government-run and rationed approaches have caused much pain to people in other countries--in Canada, for example. In an article for the Manhattan Institute's City Journal, Dr. David Gratzer wrote of the long waits that Canadians endure for just about any procedure or diagnostic test: seniors who lay on stretchers for 5 days in a hospital waiting room; a 3-year wait list for a hernia operation; a 2-year delay for sleep apnea treatment; a year-long delay for a hip replacement, and so on.

It is one thing for Washington to take over car companies. Getting it wrong there usually would not lead to life-or-death problems. But it is an entirely different matter to allow Washington to go into business as the Nation's health care provider. Who is going to protect you when they get it wrong? To whom are you going to appeal?

In his health care speeches, President Obama has stressed that if you like your current health care, you can keep it if you don't want to get on the Washington-run plan. That sounds all well and good, but it would not play out that way, according to health experts.

The Lewin Group produced a study that shows, if enacted, the President's public option--the government-run insurance company--would displace 119 million happily insured Americans. Their companies could take the easy route and simply pay a fine, tell their employees to sign up for Washington-run health care, even if they do not want it. How does that square with the President's assurances that patients will get to keep what they have?

Most insured Americans like their coverage. A May 14 Rasmussen poll shows that 70 percent of Americans rated their coverage as excellent-- 70 percent. Another 23 percent rated it as fair. So most folks are happy with their current insurance and would not appreciate being pushed into Washington's health care bureaucracy, with all of its complex rules and hours of waiting on hold and webs of impenetrable bureaucracy.

Then there is the matter of cost. How much will it cost to add 47 million people to the health care rolls? Who will pay? To not know the answers to these questions is to be fiscally irresponsible. Yet we don't even have precise estimates from the Congressional Budget Office whose responsibility it is to tell Congress how much legislation will cost the taxpayers. The preliminary estimate of the Congressional Budget Office shows that only a part of the Health, Education, Labor and Pensions Committee bill will cost $1 trillion, but it only reduces the number of uninsured by 16 million people--$1 trillion for 16 million people. The remainder of the bill, by the way, has not even been scored.

My math shows that is $62,250 per person, and that only covers about one-third of the 47 million who are said to lack insurance. It doesn't take into account the estimated 119 million insureds who will be switched from the private coverage they currently have to the government program. So what will the total cost be?

Mr. President, there is another concern that hasn't been much discussed but needs to be raised. It is a major concern for America's seniors. Over the weekend, the administration proposed trimming Medicare's budget to pay for this new public plan. This is exactly the wrong thing to do and can only mean one thing: rationing and waiting lists for America's seniors. Seniors want Congress to strengthen Medicare, make it more efficient and, importantly, make it solvent. They want it to serve as intended--to pay for the health care of seniors. They do not want its resources drained to pay for a massive new plan for the 47 million uninsured, plus the 119 million currently insured but soon to be displaced into the government system.

Seniors rightly ask: Won't the new demands for care greatly diminish the quality of care seniors now receive and lead to dangerous waits for tests and treatment?

President Obama has acknowledged that Medicare's promises of treatment are financially unsustainable. We learned recently that Medicare's liability; that is, the amount of benefits promised that are not covered by taxes, is $38 trillion over the next 75 years. One lesson we can draw from Medicare's financial troubles--and veterans health care, for that matter--is that health care plans run by Washington bureaucrats are not very efficient or cost effective. They have no incentive to be. In fact, the economic principle of ``the tragedy of the commons'' applies. Since the money doesn't belong to any one individual or group, no incentive exists to be cost efficient, to eliminate waste, or to streamline the bureaucracy.

Another way to say it is: Who washes their rent-a-car?

Mr. President, seniors and veterans, private insurance holders, small businesses, and employers that insure their workers, the uninsured--in fact, all Americans--should be given the chance to review, discuss, and provide feedback on any legislation as important as this health care reform. It will affect the way we all get our health care.

I look forward to an ongoing dialogue about the health care reform that we all want, but we must not rush to churn out and then hastily pass a plan that will lead to rationing and the displacement of millions from the insurance they currently enjoy. It is of paramount importance that the principles of quality care, choice, freedom, and putting patients first triumph in the reform we all want.

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

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

Mr. President, I wish to talk about a bill Senator McConnell and I introduced today. I think a companion bill will also be introduced by some of the leadership in the House of Representatives. The number of the bill is S. 1259, and this bill is called the PATIENTS Act--``patient'' as in doctor-patient. The idea is to focus on health care as it relates to patients.

Health care reform should be patient centered. Nothing should come between the physician and the patient. We are concerned there is something being done that we need to stop because it could, in fact, insert government bureaucracies between the patient and the physician. What has happened is that in the stimulus bill, the Congress appropriated $1.1 billion for something called comparative effectiveness research. Comparative effectiveness research has been used for years by physicians and hospitals. Medical schools do research, and they determine what kinds of treatments are best. For example, if you have two different drugs for the same condition, they will do testing to see which one seems to work the best. It is called clinical trials. They do clinical research, and physicians and hospitals frequently use that research as recommended for the best way to treat a particular condition. It is not mandatory. Obviously, what is good for most patients may not be good for all patients. So it is not something that is obviously forced upon people, but it provides good information. The problem is that too many people now who are proposing health care reform want to use comparative effectiveness research to end up rationing care, to have a Federal entity or even a State entity, or I should say a private entity, use that research in ways that would end up rationing care, to say some care is just too expensive for you to have, and since the government is paying for it, the government is not going to give it to you.

What our bill would do is make it clear that comparative effectiveness research cannot be used to deny coverage of either a health care service or treatment by the Secretary of HHS. And we say the Secretary of Health and Human Services because all of the various entities that might do that in the Federal Government are part of HHS. So we simply prohibit the Secretary of HHS from using this comparative effectiveness research to deny

health care service or treatment. You would think that would be uncontroversial, and I am hoping at the end of the day that it is not controversial. Nobody wants their health care rationed by somebody here in Washington, DC.

It would also require that comparative effectiveness research account for differences in the preference of patients and their treatment response to personalized medicine on something called genomics.

Genomics is the breakdown of the genes in the body into all of the different elements which make us unique as individuals. What genomics research focuses on is, what exactly is it in your gene composition, the human genome, that might be different from someone else's that means that a personalized treatment would work for you whereas it might not work for someone else. They are actually finding that they can tailor specific drugs to treat specific genes in such a way that, if they know your human composition, they can find a way to treat your condition--say, a cancer--potentially slightly differently than they would treat someone else's cancer, whether it is in the dosage of the medicine or in the specific kind of medicine or however it might be-- the point being that not everyone is the same. In fact, we are all different, we are all unique, and one of the things medicine must recognize is our uniqueness as individuals and not get into the habit of saying that there is a sort of a size that fits all here, and we are going to say that if doctors will treat everyone with this particular medical device or drug or treatment, then we will pay for it, but we are not going to pay for it if they do anything else. That would not be good medicine. That inserts the government between the doctor and the patient. So we say that can't be done using this comparative effectiveness research.

By the way, the bill also makes clear that nothing prohibits the FDA Commissioner from responding to drug safety concerns under his authority. Obviously, if a drug is not safe, the FDA needs to say the drug is not safe and the Federal Government is not going to pay for it. That is obvious.

But the point is that this comparative effectiveness research should not be used by the government to deny or delay or to ration care. The reason for it is, obviously, we all want to be in charge of our own health care with our doctor. We want the choice. If a doctor says: We think you need this kind of treatment and we can get coverage for that from our insurance, we want to be able to get that care. If we cannot, we want to try to find insurance that will provide that kind of coverage for us. At least at a minimum, we want to be able to pay for the treatment, if nothing else. What we do not want is for the Federal Government to say that it does not matter if you want to pay for it, it does not matter if you are covered, you cannot get it because the Federal Government says so.

This is especially important if we have a government-run insurance company, which is what many on the other side of the aisle are talking about.

The President has said he wants a so-called public option so there will be a government insurance company that will be a place where everybody could go for coverage if they don't have it. I happen to think there are better ways of getting everybody covered. To the extent we have some people who need help in getting coverage, the government can provide that help without changing the kind of coverage all the rest of us have. Surveys show, by about two to one, Americans believe we should help people get insurance who don't have it. But by the same rough numbers, everybody says: However, you don't need to affect my coverage in order to do that. In other words, I have insurance. I like it. I want to keep it. I don't want to change. I don't want to have to pay through my insurance or through having care rationed in order to make sure somebody else gets care. The bottom line is, we all want that sacred doctor-patient relationship maintained.

One might ask: Why would we be worried that this comparative effectiveness research might be used to ration care? Is there anything in the legislation that suggests this is going to happen? As it turns out, in both the bill that came from the HELP Committee and the legislation that will be drafted in the Finance Committee, there are organizations that are going to do this research that could, in fact, ration care. In the HELP Committee bill, there is a specific provision that a government entity is going to be created to conduct this research and nothing whatsoever prohibits that entity from denying care based upon the application of rationing. The same is true under the plan talked about in the Finance Committee. There a private entity is organized, but there is nothing that would prevent the Federal Government from rationing the care that is researched by the private entity.

The HELP Committee creates what it calls the agency for health care research and quality in the Department of Health and Human Services. In the Finance Committee, it is a private research entity. But in neither case is the Federal Government prohibited from using this comparative effectiveness research in rationing care.

In addition, the HELP Committee bill establishes a medical advisory council. The medical advisory council is specifically given very broad authority to make recommendations on health benefits coverage; in other words, what is covered by the Federal Government. Obviously, when the Federal Government sets rules, insurance companies frequently apply those same kind of rules. We don't want the government, rather than patients and doctors, making decisions about how much health care or what health care one would have.

Another point I have tried to make to colleagues is, if they think the Federal Government isn't considering this, think about what some people have said in the Federal Government about allocating treatment based upon cost. No less than the Acting Director of the National Institutes of Health, Raynard Kington, announced that the NIH could use this stimulus money, money in the so-called stimulus bill that pays for comparative effectiveness research, to ration care just as is done in other countries. The NIH released a list of research topics and called for the inclusion of rigorous cost effectiveness analysis because ``cost effectiveness research will provide accurate and objective information to guide future policies that support the allocation of health resources for the treatment of acute and chronic diseases.'' ``Allocation of resources'' is a euphemism for rationing of health care. Similar statements have been made by Larry Summers. Frankly, the President himself has talked about this, not in those specific terms, but in a recent interview with the New York Times he said:

What I think government can do effectively is to be an

honest broker in assessing and evaluating treatment options.

If the government is going to be a broker in treatment options, that also is a euphemism for deciding what it is going to pay for and what it will not. In other words, what one can and cannot get.

When a former Senator and at one point candidate for HHS Secretary talked about this, he acknowledged in a book he wrote that doctors and patients might resent any encroachment on their ability to use certain treatments, but he called for the same kind of body in his book that would, in effect, allocate treatments based upon this kind of cost research.

There are many others who have spoken about it as well. We know from experience that this hasn't worked out so well in countries that have tried it such as Great Britain and Canada. In fact, I will quote one other individual who has talked about this, a professor at the Harvard Business School. Regina Herzlinger said that the comparative effectiveness research in the stimulus bill could easily morph into what she called ``an instrument of health care rationing by the federal government.''

There are comparisons to what is being done in Great Britain and other European countries and Canada; ironically, at a time when those countries are actually turning away from the federal monopoly or the national monopoly because of the fact that it has resulted in rationing of care that the citizens of those countries don't like.

A former head of the American Medical Association, which has endorsed the legislation Senator McConnell and I are introducing, said in an op- ed in the Chicago Tribune today, talking about the British agency, for which, ironically, the acronym is NICE:

For example, the agency that makes these decisions in the

United Kingdom determined

that we are all worth $22,750 or six months of life or $125 a

day. I'm sorry. But $125 is the cost of a nice date with my

wife, not the value of my life.

What he is talking about is something called quality adjusted life years which is the British definition of the value they are going to place on a life for the purpose of comparing the cost done by this cost effectiveness research to see whether the cost of the treatment outweighs the value of the life. Think about that. Let me quote from the NICE Web site. It stands for National Institute for Health and Clinical Excellence, NICE. Here is what it says on Great Britain's Web site:

With the rapid advances in modern medicine, most people

accept that no publicly funded health care system, including

the NHS, can possibly pay for any new medical treatment that

becomes available.

If the Federal Government has a monopoly, it probably doesn't have enough money to pay for every treatment that becomes available. It goes on to say:

The enormous costs involved mean that choices have to be

made.

That is why they ration care in Great Britain. It goes on:

The QALY [quality-adjusted life year] method helps us

measure these factors so we can compare different treatments

for the same and different conditions.

It is an idea of how much extra months or years of life of reasonable quality a person might gain as a result of the treatment.

Each drug is considered on a case-by-case basis. Generally,

however, if a treatment costs more than 20,000 to 30,000

pounds per [quality-adjusted life year], then it would not be

considered cost effective.

And they don't give it to you.

We have many examples of people in Great Britain who are denied care because the government has decided that the cost of the treatment is more than the quality-adjusted life year. This is adjusted for age so that the older you get, even though the treatment may cost less, you are less likely to get it because of your age. Think about that for a moment. If something costs $20,000 in the United States and you are 65 years of age and they decide that they can't afford to pay for it, is that what the United States of America is all about? Is that what our government should be telling us? Should the government have the right to say: Based on this research we have done, you can't have that treatment?

If you believe that can't happen in the United States, I think it can. It has happened in Great Britain and Canada. Our legislation says it can't. So what is the harm in adopting our legislation? That is the question I will be asking of anyone who says is it not necessary.

I want to put the question: Then what harm does it do to say that this research can't be used by the Federal Government to deny or delay treatment? I hope my colleagues will appreciate that health care is the most important thing to all of us for our families. Whatever else we may think needs to be done to reform health care, the one thing we can all agree on is, it should not result in rationing of health care for Americans. Our legislation is one step in that process. It doesn't preclude rationing of health care in other ways. But at least it says comparative effectiveness research cannot be used in order to ration care. I hope our colleagues will view this legislation as an important step we can take.

Let me give a couple examples I said I would provide. There is a fellow by the name of Rocky Fernandez, a kidney cancer patient in Britain. He was given 2 months to live when the cancer spread to his lungs. His doctor wanted to prescribe a drug called Sutent, a new drug for advanced kidney cancer, but the government said no. He and thousands of other cancer patients protested the government's decision. This is what you would have to do, I gather. The government ultimately reversed its decision and, fortunately, he was able to begin taking the drug. The British health authorities knew this wasn't the end, that as more costly life extending drugs would become available, patients would demand access to the drugs and the government would be faced with increasingly difficult decisions. So faced with a finite pot of resources, the British health authorities decided that expensive drugs like Sutent would only be approved under specific conditions: They must extend life by 3 months, and they must be used for illnesses that affect fewer than 7,000 patients a year.

Is that what we want in the United States? Before you could get a drug that would give you better quality of life or extend your life, the government is going to run through tests like this. And if it doesn't meet the test, you don't get the drug? This is the danger of a government-run system. In effect, bureaucrats in the government become health care cops. We don't want that in America.

In the reform legislation that we end up acting on, I hope we can all agree that one of the things we can do to prevent this rationing is to at least say we will do no harm. We will not allow this comparative effectiveness research to be used by the Federal Government to deny our care.

I ask unanimous consent to print in the Record the op-ed from the Chicago Tribune by Dr. Palmisano from which I quoted earlier.

We have actually seen the danger in using this kind of research for rationing of care in another context. When we created Medicare Part D, which provides drugs to seniors, we saw the danger of rationing of drugs, and so we specifically provided, in the Medicare Modernization Act, an explicit provision that says you can't use cost- effective analysis to allocate the drugs. It is prohibited there. What we should do is take that same policy and apply it to the rest of our health care, to seniors who are on Medicare and to the rest of the population, to the extent the Federal Government will be able to dictate its care. We have not provided that same protection for any other care, and that is what our legislation, the PATIENTS Act, would do.

The final thing I wish to discuss is the notion that we can have a government-run insurance plan and that somehow that will be healthy for Americans. Stop and think, a government-run option or government option would be the Federal Government making decisions about care. So while you may decide it is a lot cheaper because the Federal Government can subsidize the insurance plan, the government will actually be deciding what kind of coverage you get. This is one of the areas we are concerned about in using this comparative effectiveness research. Because clearly the so-called public option, in order to keep costs down, could end up rationing care. That is OK if it is merely an option and people figured out, wait a minute, even though it is cheaper, I don't want this. But what Lewin and Associates, a health care consulting group, says is that unfortunately, because private employers are likely to dump their employees into the government-run system, about two-thirds of the people who have insurance today, 119 million people, would end up with the government-run plan rather than the private insurance they have today. When the President says, if you like your insurance coverage, you get to keep it, I hope what he means is that we won't do anything in our legislation to make that more difficult.

But if, in fact, the predictions of consulting groups such as Lewin come true, what will happen is, employers, faced with the situation where it is much cheaper for them to insure their employees through this government-run plan, will take 119 million people and transfer them from private insurance to government insurance. At that point, you do not have any option. So the government-run plan is not like it is an option for you, unless you want to change jobs to an employer that is willing to maintain the coverage. And those are going to be few and far between. The same thing is true with the individual health care market.

The bottom line is, when people say to you: Well, if you like your coverage, you are going to be able to keep it, that is not true. Incidentally, under the bill that is being written by the Finance Committee, that is explicitly not true either. That is why we are concerned about this. Because even though you may like the insurance you have today and say: The Federal Government can't tell me what care I can get, it will not be too much longer before that may not be true. You will have the government insurance, and it will tell you what care it can give you.

When we talk about the fact that we are eager for health reform, what we are talking about is allowing people to keep their current coverage; allowing them to take their coverage with them; that is to say, it is portable when you leave one job and you go to another job, to make sure you cannot be denied care because you have a preexisting condition; and if you need financial help in getting insurance, to find a way to provide that financial help.

We believe those are better solutions to making sure everyone is insured than providing a public option. It is a little like the government taking over General Motors. The only difference is, it is one thing if the people who are now running General Motors make a mistake. It is usually not going to be a life-or-death situation. But it is a whole new ball game if the government is deciding you cannot get a particular drug or a particular kind of surgery that your doctor says you need.

The bottom line is, Washington-run health care has significant dangers in it--more than if you are going to run the insurance companies or the car companies or the banks. When you have a Medical Advisory Council, as the HELP Committee legislation provides, or a National Institute for Health and Clinical Excellence--NICE--as in Great Britain, it is anything but nice when your health care is denied to you.

What we are trying to prevent by this legislation, for the final time, is a situation where the government is in a position to tell you that you cannot have a certain drug or treatment or device your doctor has said you need because they use this comparative effectiveness research to say: Well, in your case, you are not going to live much longer anyway. It is not cost effective for us to buy that for you.

That is not the American way. As I said, it is ironic countries such as Canada and Great Britain are actually beginning to now provide private alternatives because they know they cannot take care of all their citizens, and they know there is a revolt going on in their countries about people who are not getting the care they need. So the safety valve for that is to provide an option for the private sector to actually provide for this coverage.

Why would we want to replicate their basic mistake in so-called health care reform? There are easier, less costly, and less harmful ways to do that than the legislation that is being proposed that would allow comparative effectiveness research to ration your care.

I hope my colleagues will take a look at our legislation, S. 1259. If they would like to cosponsor it, we would love to have support because when this issue gets to the floor, we will want our colleagues to weigh in and send a very strong message that comparative effectiveness research is great but it is not good if it is used to deny care or to ration care to the American people. That we have to put an absolute stop to right now, and our legislation would do that.

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

Mr. President, I wish to talk about a bill Senator McConnell and I introduced today. I think a companion bill will also be introduced by some of the leadership in the House of Representatives. The number of the bill is S. 1259, and this bill is called the PATIENTS Act--``patient'' as in doctor-patient. The idea is to focus on health care as it relates to patients.

Health care reform should be patient centered. Nothing should come between the physician and the patient. We are concerned there is something being done that we need to stop because it could, in fact, insert government bureaucracies between the patient and the physician. What has happened is that in the stimulus bill, the Congress appropriated $1.1 billion for something called comparative effectiveness research. Comparative effectiveness research has been used for years by physicians and hospitals. Medical schools do research, and they determine what kinds of treatments are best. For example, if you have two different drugs for the same condition, they will do testing to see which one seems to work the best. It is called clinical trials. They do clinical research, and physicians and hospitals frequently use that research as recommended for the best way to treat a particular condition. It is not mandatory. Obviously, what is good for most patients may not be good for all patients. So it is not something that is obviously forced upon people, but it provides good information. The problem is that too many people now who are proposing health care reform want to use comparative effectiveness research to end up rationing care, to have a Federal entity or even a State entity, or I should say a private entity, use that research in ways that would end up rationing care, to say some care is just too expensive for you to have, and since the government is paying for it, the government is not going to give it to you.

What our bill would do is make it clear that comparative effectiveness research cannot be used to deny coverage of either a health care service or treatment by the Secretary of HHS. And we say the Secretary of Health and Human Services because all of the various entities that might do that in the Federal Government are part of HHS. So we simply prohibit the Secretary of HHS from using this comparative effectiveness research to deny

health care service or treatment. You would think that would be uncontroversial, and I am hoping at the end of the day that it is not controversial. Nobody wants their health care rationed by somebody here in Washington, DC.

It would also require that comparative effectiveness research account for differences in the preference of patients and their treatment response to personalized medicine on something called genomics.

Genomics is the breakdown of the genes in the body into all of the different elements which make us unique as individuals. What genomics research focuses on is, what exactly is it in your gene composition, the human genome, that might be different from someone else's that means that a personalized treatment would work for you whereas it might not work for someone else. They are actually finding that they can tailor specific drugs to treat specific genes in such a way that, if they know your human composition, they can find a way to treat your condition--say, a cancer--potentially slightly differently than they would treat someone else's cancer, whether it is in the dosage of the medicine or in the specific kind of medicine or however it might be-- the point being that not everyone is the same. In fact, we are all different, we are all unique, and one of the things medicine must recognize is our uniqueness as individuals and not get into the habit of saying that there is a sort of a size that fits all here, and we are going to say that if doctors will treat everyone with this particular medical device or drug or treatment, then we will pay for it, but we are not going to pay for it if they do anything else. That would not be good medicine. That inserts the government between the doctor and the patient. So we say that can't be done using this comparative effectiveness research.

By the way, the bill also makes clear that nothing prohibits the FDA Commissioner from responding to drug safety concerns under his authority. Obviously, if a drug is not safe, the FDA needs to say the drug is not safe and the Federal Government is not going to pay for it. That is obvious.

But the point is that this comparative effectiveness research should not be used by the government to deny or delay or to ration care. The reason for it is, obviously, we all want to be in charge of our own health care with our doctor. We want the choice. If a doctor says: We think you need this kind of treatment and we can get coverage for that from our insurance, we want to be able to get that care. If we cannot, we want to try to find insurance that will provide that kind of coverage for us. At least at a minimum, we want to be able to pay for the treatment, if nothing else. What we do not want is for the Federal Government to say that it does not matter if you want to pay for it, it does not matter if you are covered, you cannot get it because the Federal Government says so.

This is especially important if we have a government-run insurance company, which is what many on the other side of the aisle are talking about.

The President has said he wants a so-called public option so there will be a government insurance company that will be a place where everybody could go for coverage if they don't have it. I happen to think there are better ways of getting everybody covered. To the extent we have some people who need help in getting coverage, the government can provide that help without changing the kind of coverage all the rest of us have. Surveys show, by about two to one, Americans believe we should help people get insurance who don't have it. But by the same rough numbers, everybody says: However, you don't need to affect my coverage in order to do that. In other words, I have insurance. I like it. I want to keep it. I don't want to change. I don't want to have to pay through my insurance or through having care rationed in order to make sure somebody else gets care. The bottom line is, we all want that sacred doctor-patient relationship maintained.

One might ask: Why would we be worried that this comparative effectiveness research might be used to ration care? Is there anything in the legislation that suggests this is going to happen? As it turns out, in both the bill that came from the HELP Committee and the legislation that will be drafted in the Finance Committee, there are organizations that are going to do this research that could, in fact, ration care. In the HELP Committee bill, there is a specific provision that a government entity is going to be created to conduct this research and nothing whatsoever prohibits that entity from denying care based upon the application of rationing. The same is true under the plan talked about in the Finance Committee. There a private entity is organized, but there is nothing that would prevent the Federal Government from rationing the care that is researched by the private entity.

The HELP Committee creates what it calls the agency for health care research and quality in the Department of Health and Human Services. In the Finance Committee, it is a private research entity. But in neither case is the Federal Government prohibited from using this comparative effectiveness research in rationing care.

In addition, the HELP Committee bill establishes a medical advisory council. The medical advisory council is specifically given very broad authority to make recommendations on health benefits coverage; in other words, what is covered by the Federal Government. Obviously, when the Federal Government sets rules, insurance companies frequently apply those same kind of rules. We don't want the government, rather than patients and doctors, making decisions about how much health care or what health care one would have.

Another point I have tried to make to colleagues is, if they think the Federal Government isn't considering this, think about what some people have said in the Federal Government about allocating treatment based upon cost. No less than the Acting Director of the National Institutes of Health, Raynard Kington, announced that the NIH could use this stimulus money, money in the so-called stimulus bill that pays for comparative effectiveness research, to ration care just as is done in other countries. The NIH released a list of research topics and called for the inclusion of rigorous cost effectiveness analysis because ``cost effectiveness research will provide accurate and objective information to guide future policies that support the allocation of health resources for the treatment of acute and chronic diseases.'' ``Allocation of resources'' is a euphemism for rationing of health care. Similar statements have been made by Larry Summers. Frankly, the President himself has talked about this, not in those specific terms, but in a recent interview with the New York Times he said:

What I think government can do effectively is to be an

honest broker in assessing and evaluating treatment options.

If the government is going to be a broker in treatment options, that also is a euphemism for deciding what it is going to pay for and what it will not. In other words, what one can and cannot get.

When a former Senator and at one point candidate for HHS Secretary talked about this, he acknowledged in a book he wrote that doctors and patients might resent any encroachment on their ability to use certain treatments, but he called for the same kind of body in his book that would, in effect, allocate treatments based upon this kind of cost research.

There are many others who have spoken about it as well. We know from experience that this hasn't worked out so well in countries that have tried it such as Great Britain and Canada. In fact, I will quote one other individual who has talked about this, a professor at the Harvard Business School. Regina Herzlinger said that the comparative effectiveness research in the stimulus bill could easily morph into what she called ``an instrument of health care rationing by the federal government.''

There are comparisons to what is being done in Great Britain and other European countries and Canada; ironically, at a time when those countries are actually turning away from the federal monopoly or the national monopoly because of the fact that it has resulted in rationing of care that the citizens of those countries don't like.

A former head of the American Medical Association, which has endorsed the legislation Senator McConnell and I are introducing, said in an op- ed in the Chicago Tribune today, talking about the British agency, for which, ironically, the acronym is NICE:

For example, the agency that makes these decisions in the

United Kingdom determined

that we are all worth $22,750 or six months of life or $125 a

day. I'm sorry. But $125 is the cost of a nice date with my

wife, not the value of my life.

What he is talking about is something called quality adjusted life years which is the British definition of the value they are going to place on a life for the purpose of comparing the cost done by this cost effectiveness research to see whether the cost of the treatment outweighs the value of the life. Think about that. Let me quote from the NICE Web site. It stands for National Institute for Health and Clinical Excellence, NICE. Here is what it says on Great Britain's Web site:

With the rapid advances in modern medicine, most people

accept that no publicly funded health care system, including

the NHS, can possibly pay for any new medical treatment that

becomes available.

If the Federal Government has a monopoly, it probably doesn't have enough money to pay for every treatment that becomes available. It goes on to say:

The enormous costs involved mean that choices have to be

made.

That is why they ration care in Great Britain. It goes on:

The QALY [quality-adjusted life year] method helps us

measure these factors so we can compare different treatments

for the same and different conditions.

It is an idea of how much extra months or years of life of reasonable quality a person might gain as a result of the treatment.

Each drug is considered on a case-by-case basis. Generally,

however, if a treatment costs more than 20,000 to 30,000

pounds per [quality-adjusted life year], then it would not be

considered cost effective.

And they don't give it to you.

We have many examples of people in Great Britain who are denied care because the government has decided that the cost of the treatment is more than the quality-adjusted life year. This is adjusted for age so that the older you get, even though the treatment may cost less, you are less likely to get it because of your age. Think about that for a moment. If something costs $20,000 in the United States and you are 65 years of age and they decide that they can't afford to pay for it, is that what the United States of America is all about? Is that what our government should be telling us? Should the government have the right to say: Based on this research we have done, you can't have that treatment?

If you believe that can't happen in the United States, I think it can. It has happened in Great Britain and Canada. Our legislation says it can't. So what is the harm in adopting our legislation? That is the question I will be asking of anyone who says is it not necessary.

I want to put the question: Then what harm does it do to say that this research can't be used by the Federal Government to deny or delay treatment? I hope my colleagues will appreciate that health care is the most important thing to all of us for our families. Whatever else we may think needs to be done to reform health care, the one thing we can all agree on is, it should not result in rationing of health care for Americans. Our legislation is one step in that process. It doesn't preclude rationing of health care in other ways. But at least it says comparative effectiveness research cannot be used in order to ration care. I hope our colleagues will view this legislation as an important step we can take.

Let me give a couple examples I said I would provide. There is a fellow by the name of Rocky Fernandez, a kidney cancer patient in Britain. He was given 2 months to live when the cancer spread to his lungs. His doctor wanted to prescribe a drug called Sutent, a new drug for advanced kidney cancer, but the government said no. He and thousands of other cancer patients protested the government's decision. This is what you would have to do, I gather. The government ultimately reversed its decision and, fortunately, he was able to begin taking the drug. The British health authorities knew this wasn't the end, that as more costly life extending drugs would become available, patients would demand access to the drugs and the government would be faced with increasingly difficult decisions. So faced with a finite pot of resources, the British health authorities decided that expensive drugs like Sutent would only be approved under specific conditions: They must extend life by 3 months, and they must be used for illnesses that affect fewer than 7,000 patients a year.

Is that what we want in the United States? Before you could get a drug that would give you better quality of life or extend your life, the government is going to run through tests like this. And if it doesn't meet the test, you don't get the drug? This is the danger of a government-run system. In effect, bureaucrats in the government become health care cops. We don't want that in America.

In the reform legislation that we end up acting on, I hope we can all agree that one of the things we can do to prevent this rationing is to at least say we will do no harm. We will not allow this comparative effectiveness research to be used by the Federal Government to deny our care.

I ask unanimous consent to print in the Record the op-ed from the Chicago Tribune by Dr. Palmisano from which I quoted earlier.

We have actually seen the danger in using this kind of research for rationing of care in another context. When we created Medicare Part D, which provides drugs to seniors, we saw the danger of rationing of drugs, and so we specifically provided, in the Medicare Modernization Act, an explicit provision that says you can't use cost- effective analysis to allocate the drugs. It is prohibited there. What we should do is take that same policy and apply it to the rest of our health care, to seniors who are on Medicare and to the rest of the population, to the extent the Federal Government will be able to dictate its care. We have not provided that same protection for any other care, and that is what our legislation, the PATIENTS Act, would do.

The final thing I wish to discuss is the notion that we can have a government-run insurance plan and that somehow that will be healthy for Americans. Stop and think, a government-run option or government option would be the Federal Government making decisions about care. So while you may decide it is a lot cheaper because the Federal Government can subsidize the insurance plan, the government will actually be deciding what kind of coverage you get. This is one of the areas we are concerned about in using this comparative effectiveness research. Because clearly the so-called public option, in order to keep costs down, could end up rationing care. That is OK if it is merely an option and people figured out, wait a minute, even though it is cheaper, I don't want this. But what Lewin and Associates, a health care consulting group, says is that unfortunately, because private employers are likely to dump their employees into the government-run system, about two-thirds of the people who have insurance today, 119 million people, would end up with the government-run plan rather than the private insurance they have today. When the President says, if you like your insurance coverage, you get to keep it, I hope what he means is that we won't do anything in our legislation to make that more difficult.

But if, in fact, the predictions of consulting groups such as Lewin come true, what will happen is, employers, faced with the situation where it is much cheaper for them to insure their employees through this government-run plan, will take 119 million people and transfer them from private insurance to government insurance. At that point, you do not have any option. So the government-run plan is not like it is an option for you, unless you want to change jobs to an employer that is willing to maintain the coverage. And those are going to be few and far between. The same thing is true with the individual health care market.

The bottom line is, when people say to you: Well, if you like your coverage, you are going to be able to keep it, that is not true. Incidentally, under the bill that is being written by the Finance Committee, that is explicitly not true either. That is why we are concerned about this. Because even though you may like the insurance you have today and say: The Federal Government can't tell me what care I can get, it will not be too much longer before that may not be true. You will have the government insurance, and it will tell you what care it can give you.

When we talk about the fact that we are eager for health reform, what we are talking about is allowing people to keep their current coverage; allowing them to take their coverage with them; that is to say, it is portable when you leave one job and you go to another job, to make sure you cannot be denied care because you have a preexisting condition; and if you need financial help in getting insurance, to find a way to provide that financial help.

We believe those are better solutions to making sure everyone is insured than providing a public option. It is a little like the government taking over General Motors. The only difference is, it is one thing if the people who are now running General Motors make a mistake. It is usually not going to be a life-or-death situation. But it is a whole new ball game if the government is deciding you cannot get a particular drug or a particular kind of surgery that your doctor says you need.

The bottom line is, Washington-run health care has significant dangers in it--more than if you are going to run the insurance companies or the car companies or the banks. When you have a Medical Advisory Council, as the HELP Committee legislation provides, or a National Institute for Health and Clinical Excellence--NICE--as in Great Britain, it is anything but nice when your health care is denied to you.

What we are trying to prevent by this legislation, for the final time, is a situation where the government is in a position to tell you that you cannot have a certain drug or treatment or device your doctor has said you need because they use this comparative effectiveness research to say: Well, in your case, you are not going to live much longer anyway. It is not cost effective for us to buy that for you.

That is not the American way. As I said, it is ironic countries such as Canada and Great Britain are actually beginning to now provide private alternatives because they know they cannot take care of all their citizens, and they know there is a revolt going on in their countries about people who are not getting the care they need. So the safety valve for that is to provide an option for the private sector to actually provide for this coverage.

Why would we want to replicate their basic mistake in so-called health care reform? There are easier, less costly, and less harmful ways to do that than the legislation that is being proposed that would allow comparative effectiveness research to ration your care.

I hope my colleagues will take a look at our legislation, S. 1259. If they would like to cosponsor it, we would love to have support because when this issue gets to the floor, we will want our colleagues to weigh in and send a very strong message that comparative effectiveness research is great but it is not good if it is used to deny care or to ration care to the American people. That we have to put an absolute stop to right now, and our legislation would do that.

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

Madam President, when it comes to health care, Republicans want reform that respects patient freedom and choice. We want to maintain the sanctity of the doctor-patient relationship. We believe doctors, not Washington, should tailor an individual's care. Washington-run health care would delay or deny care and would displace millions of Americans who are happy with their current health insurance. Federal bureaucracies are not known for being efficient, innovative, or hassle-free.

On Wednesday, the majority whip said:

Those who come to the floor of the Senate defending the

health insurance companies and saying they want no change in

the health care system have to defend the indefensible.

Well, who exactly has come to the floor and said that? Who in the Senate has come to the floor and said they want no change? I know of no one who has done that. This is a straw man argument, usually made when you can't win an argument on the merits, but it has become a familiar refrain from some of our friends on the other side of the aisle. They present a false choice between doing what they want and doing nothing. When they don't want to listen to Republican ideas, they accuse us of wanting to do nothing. It happened with the stimulus bill, and it is happening now with health care.

Republicans want health care reform. I have said this repeatedly, and so has Senator McConnell. I have noted that there are abundant problems in our current system, that a routine visit to the doctor can be surprisingly expensive. Too many people have to go without basic care for a host of reasons, whether they are unemployed or work for a business that doesn't have health care or perhaps have a preexisting condition.

The task before us is to ensure that all Americans have access to quality health care without degrading the quality of care for anyone. In other words, those who are happy with their care--and that is the majority of Americans--don't want to have to sacrifice their care in order to take care of the problem of those who are having issues. And by access to care, I don't mean access to a government waiting list.

There are two ways to approach health care reform while trying to keep costs in line. One, which President Obama says he rejects, is to create a competitive marketplace in which consumers get to pick the plan that works the best for their families. Competition helps the consumer. The more competition, the better. And this concept does not include a Washington-run plan.

The other is for the government to ration care by deciding what treatments you can get and which medications you can have. Yes, you can cut costs this way, but it is not right, it is not what Americans want, nor is it what physicians want. The American Medical Association, an organization of 250,000 of America's physicians, said in a recent statement that it does not ``. . . believe that creating a public health insurance option for nondisabled individuals under the age of 65 is the best way to expand health insurance coverage and lower costs.'' I agree. The doctors--those who provide the care--are concerned about what a Washington-run health care would mean for their patients and for the uninsured Americans who need to get in to see them.

Republicans have been discussing the state of health care in Canada and the United Kingdom because those countries have government-run health care and they delay or deny treatment for many of their citizens in order to keep costs under control. The Canadian and British Governments created these systems with the best of intentions, but government-run care is not serving their citizens' needs, and we don't need to replicate their problems here in the United States. In fact, in Canada, Claude Castonguay, chair of the commission which recommended that Quebec establish a government-run system in the 1960s, declared last year that ``the system is in crisis''--his words. Private clinics are opening all over Canada at the rate of one per week to treat those who are on waiting lists at the public hospitals. Many Canadians who have the resources to get out of the bureaucratic government have chosen to do so.

As the Republican leader pointed out today, Britain's National Institute for Health and Clinical Excellence--the entity responsible for setting guidelines on pharmaceuticals and treatments for British patients--last year denied patients in that country access to four kidney cancer drugs that have the potential to elongate patients' lives. The institute explained it this way:

Although these treatments are clinically effective,

regrettably, the cost is such that they are not a cost-

effective use of resources.

A chilling statement, indeed. The stories of patients being denied treatment by their governments are real.

President Obama and some of my colleagues in the Senate have argued-- as the majority whip has--that a public or a government-run option can compete with other insurers and that this government-run option would be only one choice of many. My question is, Why is it needed?

And what will it do? Government-run health care would crowd out other insurers, quickly becoming a monopoly. I have cited these statistics from the Lewin Group, which has made this point. Someone who has insurance through his or her company could be forced into the government's plan if the employer decides it is simpler and cheaper to pay a fine to the government and eliminate its coverage. A company might say: Why bother with the paperwork and administration when we can just pay a fine and tell people to get onto the government insurance rolls? As I said, that is what health experts say will happen. The Lewin Group I cited before has estimated that 119 million people will be shifted from a private plan onto a government plan if it is created. That would affect two-thirds of the 170 million Americans who currently have private insurance, all but ending private insurance in America.

President Obama said recently:

If we don't get this done this year we're not going to get

it done.

Well, why is that? Why does that have to be so? Could it be because the President would prefer that we rush a bill through before Americans get a chance to absorb what Washington-run health care would mean for their families? If this is worth doing, it is worth doing right. It is worth taking the time to do it right.

Americans are compassionate, and we want coverage for our neighbors just as much as we want it for our own families. But I will tell you that my constituents worry about the cost, and they do not want the Federal Government to cover others at their expense, both in cost and in the form of rationed care. So one of the first questions for this program is, How much is it going to cost and who is going to pay it? Another question is, What is going to be the effect on seniors who are in Medicare? Do they have anything to worry about? And my answer to that is, absolutely, because some of the conversation has to do with ``reforming the way our seniors get their health care.''

We haven't heard much about the exact price of government-run health care, but we know the cost will be extremely high. And whatever we spend, it won't be enough to ensure all Americans get the care they need. So when we begin talking about cost and being more concerned about the cost than the quality of care, as was the institute in Britain I just quoted, then we get into a situation where we are going to have to ration care, and that is something neither our seniors nor families with coverage today want at all.

We need a real marketplace of options. Choice, freedom, and competition should be guiding principles for the health care reform we all want.

I reiterate that Republicans as well as Democrats want reforms in our health care system. There are people who need coverage, and we all understand there are ways we can save money. The question is, Do we do this through more government control, more government bureaucracy, government-run insurance companies, fines on employers, and raising taxes in order to add 40 or 50 million more people to insurance rolls or do we try to

achieve the results through removing barriers to competition which currently exist?

Republicans have noted a whole series of laws right now that could either be reformed or repealed in order to allow more competition, in order to reduce prices for those already in the market and give patients more choice. I don't know why the resistance to this insurance reform. I don't know of anybody who likes the way insurance companies always do their business. I know I don't. So why not reform and enable those who would do it the way people want to have products that could be offered to the public and which presumably the public would buy if they are concerned about the way their insurance is currently being offered?

So this is not a matter of one side wanting reform and the other side not; it is a matter of different approaches. And from my constituents, I can tell you they are concerned about what they have and they are concerned about what they are going to have to pay. As much as they want to help other people have the same kind of coverage they do, they don't want it at the expense of their families, by having care rationed to them and their families as a result of the fact that it would cost more money than we are currently paying.

Madam President, I suggest the absence of a quorum.

The following Senator is necessarily absent: the Senator from Missouri (Mr. Bond).

Further, if present and voting, the Senator from Missouri (Mr. Bond) would have voted ``nay.''

Mr. President, I commend my colleague from Nevada for his remarks and I want to associate myself with them.

I want to speak to health care and the reform that we are attempting to achieve here in Washington. Little disagreement exists about the need for health care reform. A routine trip to the doctor's office can be surprisingly expensive, and many fear if they lose their jobs or even if they switch jobs, they will be left without health care. Others who are unemployed may be wondering how they can afford to see a doctor at all. So the question is, How can we reform health care so that everyone has access to high quality care without changing what works for millions of Americans?

President Obama wants to centralize power in Washington, to change the way health care is obtained by all. He would create what he calls a public option. This would not be an insurance program run by the public but one run by the Federal Government; that is to say, bureaucrats here in Washington, and I believe it would result in a one-size-fits-all government system that would depend upon complex rules and financing schemes, some kind of Federal health board and, of course, higher taxes. It would also inevitably create waiting lists for treatment and denial of care for many. Why? Because the Federal Government resources are not unlimited, so health care for some will have to be delayed or denied to keep spending in check.

The plan the senior Senator from Massachusetts has put forward would create a medical advisory council to determine what treatments people should get and when they should be treated. The goal of this medical advisory council, again, would be to control spending, not to ensure that everyone gets care when they need it. It could tell Americans when they can get their treatment and what medications they can and cannot have. The plan of the Senator from Massachusetts would also offer subsidies to those whose incomes reach 500 percent above the poverty line.

President Obama has said that if new government-run health care is created, you won't have to use it if you prefer your current plan. That is not the way the legislation is being written. The way the legislation is being written in the Finance Committee is that after your contract expires--and it is usually an annual contract--your insurance is gone, and your insurance company must begin to abide by a new set of Federal rules and regulations. That means you will not have the same policy you had before.

Moreover, the government-run care would quickly crowd out other insurers. Employees who have insurance through their company could be forced into the government plan if their employer decides it is simpler or cheaper to pay a fine to the Federal Government and eliminate the coverage. The company might reason: Why bother doing the paperwork when we can tell people to get on the government-run plan? That is exactly what the health experts say will happen.

The Lewin Group has estimated that 119 million people will shift from a private plan that they currently have onto this new government-run plan if it is created. That would affect two-thirds of the 170 million Americans who currently have private insurance, all but ending private insurance in this country.

First, we have the takeover of the auto companies and banks and AIG and student loans and now health care. That is apparently the agenda at play here.

Republicans believe that health care reform should make health care affordable and portable and accessible. That last point is often overlooked. Health care needs to be accessible. People need to get the care they need when they need it, and what the doctor prescribes for them rather than what a bureaucrat says they can have. Access to health care does not mean access to a waiting list. Individuals and families, not the Federal Government, should control decisions about their health care. The principles of freedom and choice should apply here. The government should not eliminate your choices and get between you and your doctor.

I am not sure why some are embracing government-run insurance when those programs have created so many problems in Canada and the United Kingdom. Many people think that Canadians and Europeans get the same quality of health care Americans get but pay less. That is not true. The stories you hear from individuals in those

countries about months- and years-long waiting lists and denial of care are not cherry-picked scare stories. They are commonplace. People often have to wait months for an MRI or a dental procedure or a hip replacement that they urgently need.

According to a new study by the Fraser Institute, which is a Canadian-based think tank, the average wait time for treatment from a specialist in Canada is 18.3 weeks. That is the average waiting time. Stop and think for a moment. You may have had your physician say, I think you have something very drastically wrong with you and I think you need to see a specialist to confirm whether that diagnosis is true, but you are going to have to wait on average 18 weeks for the specialist to see you.

Some people then say, well, at least everybody in Canada has a doctor. That is also not true. That same study reports that 1.7 million Canadians--and that is out of a country with a population of 33 million--were unable to see a family physician in the year 2007. Let me repeat: 1.7 million people couldn't even see a family doctor, and that number does not include those who have a doctor and are on a waiting list, so add the wait times. The bottom line is that having a government-run plan does not guarantee that everyone will have access to a doctor or to medical care. Indeed, it chokes access.

There are some Canadian doctors who are taking action because of this. Private hospitals are sprouting up all over Canada. Dr. David Gratzer, who is a physician, recently wrote an article in the Wall Street Journal about the story of another physician, Dr. Brian Day of Vancouver. Dr. Day, who is an orthopedic surgeon, grew tired of the government cutbacks that reduced his access to an operating room, while at the same time increasing the number of people waiting to see him. So he opened a private clinic, the Cambie Surgery Center, which employees more than 100 doctors. Public hospitals send him patients because they are too busy to treat them. The New York Times has reported a private clinic is opening each week in Canada.

Think about that. This is in response to a wonderful health care system? No, it is in response to a health care system that denies care to patients.

Opening a private clinic that gives health care access to more people, of course, is a noble thing to do, and I commend Dr. Day, but the success of these clinics also shows that many people who can get out of government-run health care will do so.

Americans do not deserve or want health care that forces them into a government bureaucracy that will delay or deny their care and force them to navigate a web of complex rules and regulations. They want access to high-quality care for their own families and for their neighbors. They want to pick their own doctors, and they do not want Washington to dictate what care they can and cannot get for their families.

On a personal note, none of us in the Senate or in the gallery or anybody who may be watching us, I suspect, cares more about anything in the world--other than perhaps their own freedom--than the health of their family. If there is a health emergency right now, we will all drop anything we are doing to provide whatever health care is needed for our family. We don't want anybody to stand in the way of that. But the bottom line is that it is inevitable; when government wants to control the cost of providing health care, and it has control, what it will do is to either deny information to people about what options are available, as happens in Germany, for example; delay the care, which is frequently what happens in Canada; or what frequently happens in Great Britain, where they have a board that makes these decisions, they deny the care altogether because it is simply too expensive for what they consider the value you get out of it. For example: If you are over a certain age, then you are not likely to have an operation such as a hip operation or a knee operation. There are other restrictions that apply as well.

We don't want that in America. We don't want the government in Washington saying that because we want to save money, you can't get care. I would also remind folks that the alternative that is being created in Canada--these private clinics--is not available under the one government-run program we have in America--the Medicare system. We also have a veterans' care system. But under Medicare, there is no alternative. You can't have private care. If you are on Medicare, and you go to a doctor who serves Medicare patients, it is against the law for him to treat you and then charge you individually for that. Under Medicare, it is either Medicare or no care. That is the law.

I know because I tried to get it changed. We tried to get something called private contracting, which would be the same as that alternative in Canada--the private clinic. We tried to get that for Medicare, so that if you were not satisfied with what Medicare gave you, and you wanted to speed it up or get a private doctor, even if he charged you whatever amount he charged you, you would have the right to do that. No. What Congress did was to say--in the middle of the night, in a conference committee--that you cannot do that. Only if a doctor says in advance, I will not treat Medicare patients for at least 2 years is he able to provide that care to you.

So we have a perverse incentive. If you want to take care of people outside of Medicare, you have to agree not to treat Medicare patients. And since we have so many physicians deciding not to take Medicare patients, that is the wrong incentive. We should be encouraging them to take more Medicare patients and at least allow the option that people in Canada have.

The bottom line is, Washington-run health care is not a good idea, and Republicans are not going to support legislation that includes Washington-run insurance companies or that gets in between the physician and the patient and interferes with that important relationship to deny or delay care.

Mr. President, will--

Mr. President, first of all, I was going to interrupt and ask a question, but I simply conferred with Senator McConnell--and I will state and the Record can reflect the fact--that I believe Senator McConnell asked the question of where he would be released if he were acquitted. I don't believe he asserted that he would be released in the United States. I just wanted to clear that up. Obviously, we can check the transcript and determine it. I think that was his intent because of the question that Robert Gibbs had posed. At least that is my understanding of it. We can resolve that.

But I would like to say a couple of other things. First of all, it is important to have this debate. The Senate had a debate some weeks ago, and it is true 90 Senators voted against funding a program to close the prison at Guantanamo Bay. Six Senators voted in favor of moving forward with that.

I appreciate the Senator from Illinois staunchly defending the lonely six, but they represented also a minority of American public opinion, which has said, by 2 to 1, according to the USA Gallop poll, that it is against closing the Guantanamo prison, and by 3 to 1 they do not want the prisoners released in the United States.

Both sides have engaged in a little bit of rhetoric. For example, I would respectfully request my colleague from Illinois go back over what he said a moment ago and perhaps come back tomorrow and think about rephrasing it. I don't think it is fair to characterize the position of the Senator from Kentucky as being fearful of trying people in the United States; fearful, for example, that terrorists--or afraid of giving terrorists rights and so on. I don't think that is the issue. I think what is the issue is the question of whether, as a general rule, it is better to keep prisoners in Guantanamo prison than to put them somewhere else.

I, for one, don't fear trying some of these people who are appropriately charged and tried in Federal court in the United States. But I would also say it is loaded with problems and headaches, and I think my colleague from Illinois would have to acknowledge that the trials that have occurred here have produced some real problems. These are hard cases to try in the United States. You start with the proposition that there are huge security concerns.

Now, it can be done. There will be huge security concerns with this alleged terrorist from Tanzania, and it will cost a lot of money in the place where he is tried. It will pose very difficult questions for the judge, for the people within the courtroom, the parties to the case, the lawyers in the case. There are evidentiary questions and other questions that are illustrated by the case of Zacarias Moussaoui, who was tried in Alexandria. I think we can all acknowledge the government would certainly say that was a huge problem for them because it was difficult to use evidence in the case that had been acquired through confidential or classified methods. The case was ping-ponged back and forth several times between the District Court and the court of appeals. It was a difficult, hard thing to do.

Then there are the situations where cases have been tried in American courts and classified information has inadvertently--and in some cases not inadvertently--been released, gotten into the hands of terrorists. Let me just cite a few of these, and not to make the case that it is impossible or a terrible idea but also to refute the notion that it is a piece of cake. It is not. It is really hard. If you could avoid doing this, I think the better practice would be to try to do so. But on an occasional basis, when we have a good Federal charge, we have the evidence that can back it up, and we think we can get a conviction, there is nothing wrong in those few selected cases with doing it. But we can't say all 240 of the terrorists at Guantanamo qualify for that. Very few of them do, as the President said in his remarks.

Let me note some of these cases. The famous trial of Ramzi Yousef. Here is a statement by Michael Mukasey, the former Attorney General. This is a quotation from the Wall Street Journal, again, during the trial of Ramzi

Yousef, the mastermind of the 1993 World Trade Center bombing:

Apparently, an innocuous bit of testimony . . . about

delivery of a cell phone battery was enough to tip off

terrorists still at large that one of their communication

links had been compromised. That link, which in fact had been

monitored by the government and had provided enormously

invaluable intelligence, was immediately shut down, and

further information lost.

I am not going to read the entire quotations but just some headlines. I mentioned the trial of Zacarias Moussaoui. That was a case also in which sensitive material was inadvertently leaked. Here is the headline from a CNBC story:

The Government Went To The Judge And Said, ``Oops, We Gave

Moussaoui Some Documents He Shouldn't Have.'' . . . Documents

That The Government Says Should Have Been Classified.

There is a whole story about how that happened. The East Africa Embassy bombing trials, which occurred after 2001, September 26 is the Star-Ledger story.

The cost of disclosing information unwisely became clear

after the New York trials of bin Laden associates for the

1998 bombings of U.S. embassies in Africa. Some of the

evidence indicated that the National Security Agency, the

U.S. foreign eavesdropping organization, had intercepted cell

phone conversations. Shortly thereafter, bin Laden's

organization stopped using cell phones to discuss sensitive

operational details, U.S. intelligence sources said.

There is another story about the same thing, with a headline in the New York Times. There is another quotation about the trial of the blind sheik, a story we are all familiar with, of Michael Mukasey, the former Attorney General, saying this in the Wall Street Journal:

In the course of prosecuting Omar Abdel Rahman . . . the

government was compelled--as in all cases that charge

conspiracy--to turn over a list of unindicted coconspirators

to the defendants. Within ten days, a copy of that list

reached bin Laden in Khartoum.

There are other cases. Mr. President, I ask unanimous consent to have these articles printed in the Record.

Mr. President, the only point I am making is that while it is possible to try these people in Federal court, it is very difficult. It frequently results in the disclosure of information that we don't want disclosed. I think it would be far better, if we can, to try these people in military commissions. The President has now said he would go forward with military commissions--modified to some extent--and I think that is a good thing for the trial of those who are suitable for that action.

The President also noted, of course, that there are going to be a lot of these terrorists who cannot be tried but are dangerous and need to be held, and the U.S. Supreme Court has affirmed the appropriateness of holding such people until the end of hostilities. The President has indicated that he would, in fact, do that.

I think there is no question, therefore, that we will be holding some of these people. The question is where best to do it. This is the nub of the argument that my colleague and fellow whip, the Senator from Illinois, and I have been having long distance. I relish the opportunity when we can both get our schedules straight to literally have a debate back and forth. I think it is an important topic.

I see now other colleagues are here, and so I will make one final point, and then I hope we can continue in this debate because I think it is a better policy to keep Guantanamo open and keep these prisoners there than to try to find some alternative.

Let me cite one statistic, and then make my primary point. According to the numbers I have--and I would be happy to share these with my colleague from Illinois with respect to the slots available in our supermax facilities, if I can find it--there are about 15 high security facilities which were built to hold 13,448 prisoners. Those facilities currently house more than 20,000 inmates.

The bottom line is that is not necessarily a supersolution either.

Did my colleague have a quick comment? I want to make my main point.

OK, thank you.

Here is my main point. There are those very credible people who say: Well, this is a recruitment symbol. Guantanamo prison is a recruitment symbol. I have no doubt they are right, it is a recruitment symbol. Several questions, however, are raised by that observation.

The first question is, even if it is false that there has been torture at Guantanamo prison--obviously, terrorists can believe falsehoods--should we take action based upon that falsehood?

The next question I think has to be asked is, does this mean, then, that other terrorist recruiting symbols need to be eliminated by the United States?

The third question is, would that eliminate their terrorism?

What is it exactly that animates these terrorists? Gitmo didn't even exist before some of the worst--in fact, before all of the worst terrorist attacks on the United States or U.S. facilities abroad. There was no Gitmo prior to 9/11. Yet we had all of the various attacks that occurred throughout the world leading up to 9/11 and 9/11 itself. They didn't need another reason to hate America. They didn't need another reason to be able to recruit people. They have all the reasons they can dream up.

I think the key reasons are that they fundamentally disagree with our way of life, and they believe they have an obligation, through jihad, to either get the infidels--that is all of us who don't agree with them--to bend to their will or to do away with us because they don't like our way of life. They do not like the fact that we have the culture we have. They do not like the fact that we give equal rights to women or that we have a democracy. There are a lot of things they hate about the Western World generally and about our society in particular.

These are obviously recruiting symbols and recruiting tools. Are we to do away with these things in order to please them? And even if we did, what effect would it have on their recruiting? Do you think they would then say: OK, great. You have closed Guantanamo prison, you have taken away women's rights, you are halfway home to us not recruiting anybody or terrorizing you anymore. If you will only get rid of the vote and institute Sharia law, we can start talking here.

I don't think that is the way they are going to act. They are going to have grievances against us no matter what. For us to assume we have to change our policies, to change what we think is in our best interests, simply to assuage their concerns because maybe they do use this as a recruiting tool, I think is to, in effect, hold our hands up and say: In the war against these Islamist terrorists, we have no real defenses because anything we do is going to make them unhappy. It is going to be a recruiting tool. After all, we wouldn't want to give them a recruiting tool.

I do not think it is too much of an exaggeration to make the point I made. One might say: Obviously, we are not going to give up our way of life. They are going to have to deal with that. Well, then they are going to keep recruiting. But we could at least get rid of Guantanamo prison. That would at least get rid of one thorn. Would it make a difference? Nobody believes it would make a difference.

The key point I make is--and this is just a disagreement reasonable people are going to have, I guess--I think Guantanamo is the best place to keep these people. My friend from Illinois thinks there are alternatives that are better and that, under the circumstances, we should make the change. Again, I observe that the American people seem to be on the side of not closing it down, and I do not think it all has to do with fear. I think it has to do with the commonsense notion that this is not going to remove terrorist recruiting. If it is better for us to keep them there, we might as well do that.

Mr. President, I understand the time for morning business has now reverted to the Republican side; is that correct?

I thank the Chair.

Mr. President, I would like to address two subjects. The first is the subject my colleague from New York was just discussing, and that is what to do about health care issues we have in the United States. Specifically, I would like to refer to some comments that both he made and the assistant majority leader made this morning.

The first point I wish to make is that when the assistant majority leader came to the floor this morning and in effect said: Unless you agree with our solution, you don't believe there is a problem, that is a fallacy, of course. I

think everybody agrees there are lots of problems. The question is, What is the right solution? So we can all agree there are problems, but let's don't suggest that unless you agree with my solution or your solution, somehow or other we don't appreciate that there are problems.

We are frustrated and a lot of Americans are frustrated because they may work for a small business or they are unemployed and therefore they don't have insurance. It is not easy to take your insurance with you. It is hard to find quality, low-cost health care. This has to be a big priority for a lot of Americans. We all understand that.

Health care needs to be portable. It needs to be accessible. It needs to be affordable. I think all Americans want it to be quality care as well. The question is, How do you accomplish these goals?

One of the problems is, what if you have insurance and you like it? The President says, in that case you get to keep it. The problem is, under the bill that is being discussed in the Finance Committee, you do not get to keep it. If you are an employee of a small business, for example, or you are an individual with your own insurance, when your insurance contract runs out--and those contracts are usually 1 year, 2 years, sometimes as long as 3 years; let's say it is 2 years, and you are through the first year of it--the bottom line is, even though you may like it, at the end of next year when the contract runs out, you don't get to keep it.

Under the bill being discussed there is a new regime of regulation for the insurance companies about who they have to cover, how they cover them, what they can charge, and a whole variety of other regulations that mean that the policy you used to have, that you liked, does not exist anymore.

It may be you will be able to find coverage that you like, but it is simply untrue to say that one of the mainstays of the legislation being proposed is that if you like your current plan, you get to keep it. When your current plan expires, it expires, and you don't get to keep it because it cannot be renewed in its current form. That is point No. 1.

Point No. 2. We just had a discussion about government-run insurance. I find it interesting that some on the other side like to call this a public option, as if the public somehow or other is operating its own insurance company. Let's be clear about who would operate this insurance company. It is the U.S. Government. It is not the public; it is the U.S. Government. That is why Senator McConnell has referred to it properly as government-run insurance.

The Senator from New York just got through saying: Who else is going to provide a check on the private insurance companies to make sure they do things right? The President himself has spoken about the need for a government-run plan to keep the other insurance companies ``honest.''

Insurance is one of the most highly regulated enterprises in the United States. Every State in fact regulates health insurance. This is an area that not only has some Federal regulation, but every State regulates health insurance. In fact, one of the reasons you cannot buy a health insurance policy from the State you do not live in--you can't go across State lines and buy a policy in another State--is because we are so jealous of the State regulation of insurance. So to the question of my friend from New York, who is going to provide a check, the answer is, your State. If you do not trust your State to properly regulate health insurance, then I don't know where we are. But you are not going to provide better regulation by commissioning a government insurance company to exist and compete right alongside the private insurance companies. How does that provide a check on the private insurance companies?

It is not as if there are not enough private insurance companies or they are not providing enough different kinds of plans, so that can't be the problem. It is not a matter of a lack of competition in most places. If the question is, who is going to regulate, the answer is, the State is going to regulate. To the extent it does not, the Federal Government is going to regulate. That is why, A, it should not be called a public option if what they are talking about is creating a government-run health insurance company, which is exactly what is being proposed in the only legislation put out there so far, the so-called Kennedy legislation in the HELP Committee. That is precisely what he proposes. Republicans say: No, thank you. We are not for that.

My final point is that the assistant majority leader said there are lots of other government-run plans, and we are not afraid of them. He mentioned Medicare and the Veterans' Administration. First of all, these are not government insurance companies, these are government-run programs. But, second, the President himself said, and everybody I know of who has studied the issue agrees, Medicare is in deep trouble. The President has said its commitments are unsustainable, meaning we cannot keep the promises we have made in Medicare to future generations because it is far too expensive. We have to find a way to get those expenses under control.

How is adding another 15, 20 or 30 million Americans to an existing program that is not sustainable going to make it any better?

My colleague talked about waiting lines. It may well be true we can find an example or two of people who have to wait in line in the United States. That is something we should not permit in the United States. We know that is what exists in other countries, and I will get to that in just a moment. Why does that justify having an expansion of a government program? If we have a government program which causes waiting lines today, does it solve the problem by adding a whole lot more people to the rolls?

What is likely to happen? The waiting lines are going to get longer because more people are going to have to be waiting for care. Is that what we want in the United States of America? I submit not. So far from being a justification for a government-run program, I believe that argues for not having a government-run program, or at least not expanding the government programs we already have. A government takeover is not the answer. No country, even the United States, the most prosperous country on Earth, has unlimited resources to spend on health care.

That brings up the third problem, which is the rationing, the inevitable delay in getting treatment or tests and frequently the denial of care that results from that. When a government takes over health care, as it has, for example, in Britain and Canada and many places in Europe and other places, care inevitably is rationed. We all have heard the stories.

One of the most direct ways we can ration care is one that the White House has already embraced, and it is part of the Kennedy bill that I spoke of earlier.

The White House has said comparative effectiveness research, which would study clinical evidence to decide what works best, will help them eliminate wasteful treatments. Wasteful to whom? A recent National Institutes of Health project has a description of part of their plan that states, and I will quote:

Cost-effectiveness research will provide active and

objective information to guide future policies that support

the allocation of health resources for the treatment of acute

and chronic conditions.

Allocation of health resources is a euphemism for rationing. Allocation means to allocate, and inevitably there will be denial based upon those things which are deemed to be too costly.

As discussions about health care reform have dominated the news recently, stories have trickled out from individuals living in countries that ration care whose medical treatment has been delayed or denied due to rationing, and we are beginning to hear some of those stories. One that I came across was reported in the Wall Street Journal.

It was the story of one Shona Holmes of Ontario, Canada. When Miss Holmes began losing her vision and experiencing headaches, panic attacks, extreme fatigue, and other symptoms, she went to the doctor. An MRI scan revealed a brain tumor, but she was told she would have to wait months to see a specialist.

Think about this. She goes home and tells her family: The MRI said I have a brain tumor. I have all of these symptoms, including losing vision and the rest of it. But I have to wait months to

see a specialist--I gather, to confirm the diagnosis. I don't know. As her symptoms worsened, she decided to visit the Mayo Clinic in Arizona. So she left her home country, paid her way down to Arizona and paid for the diagnosis and treatment that was called for in her case to prevent the permanent vision loss and potentially death that could have ensued had she not been treated in a timely fashion.

A Lindsey McCreith, also of Ontario, was profiled in the same article to which I referred. Mr. McCreith suffered from recurring headaches and seizures. When he went to the doctor, he was told the wait time for an MRI was 4\1/2\ months. Think about this. You are having seizures and the test that will reveal what if anything is wrong is going to be delayed 4\1/2\ months. One of the reasons, I am told, by the way, is that there are very few places in Canada where MRIs are located, where you can actually get the test. In any event, he decided to visit a clinic in Buffalo, NY--fairly nearby--in order to get the MRI. He did and it, too, revealed a brain tumor. Now Mr. McCreith is suing the Canadian Government's health care monopoly for jeopardizing his life.

I wonder if we want lawsuits to be the answer. When you can't get the care you want, you have to file a lawsuit to get it? Is that what we want in America? I don't think so.

There are also people whose care has been flatout denied. Britain's National Health Service has denied smokers treatment for heart disease, and it has denied hip and knee replacements for people who are deemed to be obese. The British Health Secretary, Patricia Hewitt, has said it is fine to deny treatment on the basis of lifestyle.

[Doctors] will say to patients: ``You should not have this

operation until you have lost a bit of weight,'' she said in

2007.

That is easier said than done for some people. In any event, if they need a health treatment and they need it now, there is a real question whether they can accomplish the ``losing a little bit of weight,'' as Ms. Hewitt said. All Americans deserve access to quality care, but government-run insurance does not equate with access. Rationing will hinder access.

As I said, my colleague from Illinois, the distinguished majority assistant leader, says you can actually find some examples in the United States where there are long wait times. If that is true--and I don't doubt what he said--that is not good; it is bad. We should try to fix that so we don't have wait times. We should not justify having more wait times on the fact that we already have some. We should not say because there are some people in America who have to wait, therefore we should make it possible for everybody in America to have to wait; we should be like Canada or Great Britain.

That is not the answer. If we have wait times here, we should stop it, not say that we, therefore, might as well be like Canada or Great Britain. Americans do not deserve or want health care that forces them into a government bureaucracy with its labyrinth of complex rules or regulations.

Think about the hassles of dealing with the IRS or Department of Motor Vehicles or Social Security Administration when you have a problem there and then imagine dealing with the same issues when it comes to getting health care. We can't enable a panel of bureaucrats, through rules and regulations, to put the politicians in charge of deciding who is eligible for a particular treatment or deciding when or where they can get it. It is wrong for America, wrong for the patients in America, and it is the wrong approach to health care reform.

Republicans believe there is a better way for health care reform. Rather than empowering the government, empower patients. Rather than putting bureaucrats in between your doctor and yourself, try to remove the constraints that physicians have and hospitals have for treating people. Try to remove constraints on insurance companies.

One of the things I have asked for, for example, with all of these wonderful ideas about more government regulation of insurance is, how about repealing some laws that currently prevent insurance companies from competing? I mentioned before you can't compete across State lines.

We all know if you want to incorporate as a corporation--why are all the corporations incorporated in Delaware, ``a Delaware corporation''? It doesn't matter whether you are in Illinois or Arizona, corporations are incorporated in Delaware. At least that is the way it used to be. One of the reasons is Delaware had very benign laws regulating the incorporation of businesses. It was cheaper to do it, and there was less regulatory hassle. But if the distinguished Presiding Officer, for example, looked across the river to the west and saw an insurance company in Iowa that could provide him with better coverage at less cost than the company that insures him in Illinois, why should he be restrained from buying the policy from the company in Iowa? You could buy your automobile insurance that way. You could buy your home insurance that way. Why should you not be able to buy your health insurance that way? Well, you can't.

I am going to conclude this discussion, but just one idea is to remove some of the barriers to competition that would make it more likely that insurance companies could expand their coverage by competing, be required to compete with lower premiums and/or provide better access to care. It seems logical, and in this country, where people move around all the time--my family just drove all the way across the country from Washington, DC, out to Arizona to visit friends and family and go on to California. We travel all around this country all the time. We move families, unlike back in the old days. Why can't we have an insurance regime that enables you to buy insurance from another State? It does not make sense; it inhibits competition; it makes prices higher; and it can have the effect of restricting care. Those are the kinds of things we need to do to reform our system, not put more government in charge and not put government between you and what your physician says you need, or even put some time delay between the opportunity to visit your physician when you know you have something wrong with you.

We are going to have more discussion about this in the future, but I want to back up what Senator McConnell from Kentucky has said. Americans don't want government-run insurance companies any more than they want government-run car companies. It seems as though the government is starting to run everything now--from the banks, to the insurance companies, to the car companies. Now we are going to run insurance companies as well for health care. I do not think that is what the American people want.

I think the Senator from Kentucky is exactly right. I think he is right when he says no government-run care and that we should not be rationing care. Those are two of the most critical aspects of the legislation Senator Kennedy has come forth with and among the things being discussed in the Senate Finance Committee as well. We need to draw a line: Put patients first, not put the government first.

(Mrs. GILLIBRAND assumed the Chair.)

Now, Madam President, since I think I have a little bit more time on the Republican side--though if I have colleagues who wish to speak, I will be happy to finish for the moment--I will go for a little bit longer on another subject.

We have had kind of a running debate on the question of closing Guantanamo prison. This is a subject the Senate has spoken on by an overwhelming vote. I think 90-some Senators voted not to close Gitmo. The American people are 3 to 1 opposed to bringing Gitmo prisoners into their State. They are 2 to 1, at least, in opposition to closing Guantanamo prison. This is not something on which there is a little bit of doubt. The American people are very much opposed to closing Guantanamo prison and bringing those people to their own States.

Nevertheless, the assistant majority leader and five other Democrats voted for the appropriation of money--or the authorization of money-- actually, the appropriation of money to close Gitmo and acknowledge that would require bringing many of those people to the United States.

Well, I happen to agree with Senator McConnell that this is a bad idea, and

with the other 89 Senators who agreed it is a bad idea, at least until we have some kind of a plan to do it. So I was a little struck this morning when the Senator from Illinois said: Well, here is the proof of why we should close the Guantanamo prison.

We just have had an announcement we are going to try a terrorist, whose name is Ghailani, in the United States, and that proves we can close Gitmo.

Well, it does not prove that. It does not prove anything. What it proves is, we can try somebody in U.S. courts. We have done that with a few terrorists, and it is not a pleasant experience. The one that most of us recall in the Washington, DC, area was the trial across the river in Alexandria, VA, of Zacarias Moussaoui. That was extraordinarily difficult for the government to do. It was very difficult for at least two main reasons.

First of all, much of the evidence that was gained to try him was classified and could not be shared with him, and there were significant questions of due process as a result. How can we try somebody for a serious crime and not show them the evidence against them? That is one of the main reasons it is very difficult to try these terrorists for crimes.

The second problem is the security issue. The people in Virginia, in Alexandria--in the county there--will tell you, it was a costly and difficult thing for them to be able to conduct this trial of Zacarias Moussaoui there. Nevertheless, it was possible. Although costly, it was possible. It was even possible to get a conviction, I would suggest, primarily because of some decisions Moussaoui made. Nonetheless, it was possible to do so.

Everybody acknowledges there are some people who need to be tried for serious crimes, in effect, such as war crimes, and who should be tried in U.S. courts. It does not make it easy, but it can be done. What it does not prove is that it should be done for all of the people at Gitmo. In fact, not even the President suggests that. The President, in his speech a few weeks ago, acknowledged that many of the prisoners at Gitmo now are never going to have a trial. They are simply being held until the termination of the hostilities that have caused them to be captured and imprisoned in the first place. They are like prisoners of war who can be detained until the war is over.

Here, however, they do not even have the rights of prisoners of war under the Geneva accords because they do not adhere to the rules of war, they do not fight with uniforms for a nation state, and so on. They, in fact, are terrorists. So they are still allowed humane treatment, but they do not have the same rights as prisoners of war.

What that means is--as the President acknowledged, as the U.S. Supreme Court has acknowledged--we have a right to hold them until the cessation of hostilities so they do not kill any more people. We cannot just turn them loose.

The President, in his speech, made the point that at least 60--I think is the number that was used--of these prisoners have been released and that they were released by the Bush administration. That is true. The Bush administration was under a lot of pressure to try to release as many of these people who were being held as possible, and so they held determinations. They have a determination once a year and initially as to what the status of the individual is and whether he is still a danger. Eventually, in many of the cases, they decided the person could be released back to their home country or to a country that would take them and it would not pose a danger to the United States.

The problem is, there is a very high rate of recidivism among these terrorists. One in seven are believed to have returned to the battlefield. We have evidence of many of them, specifically by name, who returned and who caused a lot of death. There are two in particular I recall who both eventually engaged in suicide bombing attacks, killing, I think, 20-some people in one instance and at least a half dozen people in another instance.

So even when we try our best to make a determination that is fair to the individuals, but we do not want to hold people beyond the time they should be held--that they no longer pose a danger--we make mistakes and we release people back to the battlefield who are going to try to kill us, and they are certainly going to try to kill others, including our allies; and, in fact, they do so. That is a risk, but it is not a risk that we should lightly take.

The remaining 240-some prisoners at Guantanamo are the worst of the worst. These are people about whom it is very difficult to say: Well, they do not pose a danger anymore. We have already been through those, and, as I said, one in seven of those people have not only posed a danger, they have actually gone off and killed people.

So we have 240 of the worst of the worst, and the President correctly went through the different things that can happen to them. Some of them--a limited number--will be tried in U.S. courts, such as this terrorist Ghailani whom Senator Durbin spoke of earlier this morning. It is hard to do. There are a lot of issues with it. But we will try to try some of them.

Others can be tried with military commissions. Others will not be able to be tried. They will have to be held. There may be a few whom we deem no longer a threat to us and they will have to be released but to whom nobody knows because nobody appears to want--well, the French will take one of them, and I think there may be another European country that said--maybe the Germans will take one. That still leaves a lot to go.

So the bottom line is, many are going to have to be detained. The question is, Where do we detain them? My colleague from Illinois says: Well, there are other people who agree we should close Gitmo. Even my colleague from Arizona has certainly said that. But what he did not say is, before we have a plan to do so--and he himself has acknowledged this is really hard to do. And while he would like to close it--as he himself has said: I do not know how you do it--we certainly cannot do it without a plan, and we certainly cannot do it based upon the timetable that the President is talking about.

So it is one thing to say it would be nice to close it. It is quite another to figure out how to do it that would be safe for the American people.

Finally, just a point I want to mention--well, two final points. The Senator from Illinois said this is a problem he, meaning the President, inherited. No. The President did not inherit the problem of having to come up with a plan to close Gitmo by next January 20. The President made that problem himself. When he was sworn into office, I think it was within 3 days, he said: And we are going to close Gitmo within 12 months.

That is an arbitrary deadline that I submit he should not have imposed on himself or on the country because it is going to cause bad decisions to be made. We may have to try more people, such as this terrorist Ghailani, in the United States than we want to or than we should. In any event, we are going to have to try to find, I gather, facilities in which these people could be held in the United States.

FBI Director Robert Mueller testified before the House of Representatives that that posed a lot of problems, real risks, for the United States. Nobody is saying it cannot be done. The question is, Should it be done? Most of us believe, no, it should not be done; there are better alternatives.

The final point I want to make is this: What is wrong with the alternative of the prison at Guantanamo? It is a $200 million state-of- the-art facility in which, as I pointed out yesterday, people are very well treated, humanely treated. They have gotten a whole lot better medical and dental care than they ever got or could have hoped to have gotten in their home countries, fighting us on the battlefield of Afghanistan or somewhere else.

The bottom line is, this is a top-rate facility. The people there do not mistreat prisoners. That is the myth. Somehow people conflate what happened at Abu Ghraib with Guantanamo. This brings up the last point. It is argued by my colleague from Illinois and others that, well, terrorists recruit based upon the existence of Guantanamo prison.

Think about that for a moment. Are we going to say because terrorists accuse us of doing something wrong--even though we did not--we are going to stop any activity in that area because we want to take away that as a recruitment tool? We would have to basically go out of business as the United

States of America if we are going to take away all that terrorists use to recruit people to fight the West. They do not like the way we treat women with equality in the United States. They do not like a lot of our social values and mores. They do not even like the fact that we hold elections.

So because that is used as a recruitment tool, we are going to stop doing all of that? What sense does this make? We treat people humanely and properly at Guantanamo. People were mistreated in another prison called Abu Ghraib. They are not the same. Abu Ghraib, therefore, does not represent the example of what we should be doing with respect to Guantanamo.

We will have more debate on this subject. I note the time is very short, and I meant to leave a little time for my colleague from Texas. I hope to engage my colleagues in further conversation about this issue. The American people do not want people from Gitmo put into their home States.

Mr. President, I wish to join the ranking member of the committee on which I sit, as well as the distinguished minority leader, in asking the question of why we have to set a date right now on the hearing for Judge Sotomayor. There is no reason for us to do that because there is no way to know at this point whether we will have our work done by that time.

Historically--and it is for good reason--you want to have the review completed before you question the witness about the matters under review. That makes sense. So there is no reason to set that date today, and that is troublesome. We don't know if we will be ready by July 13, but there is a lot of history to suggest it is going to be very difficult to be ready by that time.

The leader just pointed out the fact that if you compare the work required to consider the nomination of the now-Chief Justice John Roberts as opposed to this nominee, you have more than 10 times as many cases to look at with Judge Sotomayor as you had with Justice Roberts. That takes a lot of time. And even with 20-some staffers reading these 4,000-plus decisions, it is not just a matter of reading the cases; it is a matter of then looking to see what the precedents cited were to determine whether you think the judge was right in the decision that was rendered, to look at the other references in the case to see how closely this followed existing law, and whether it appears the judge might be trying to make law as opposed to deciding law.

That is important in this particular case because of the standard the President laid down for his nominees which strongly suggests something beyond deciding the law. In 5 percent of the cases, as he said, there is no precedent, there is no legal mechanism for deciding how the case should come out. You have to base it on other factors. Everybody is well aware of some of the factors this particular nominee has talked about and the President has talked about--the empathy, the background, the experience in other matters.

The question is, in reading these opinions, do you find a trend of deciding cases on something other than the law, potentially the making of law in this particular case? And even if, as the leader said, you have to review 76 cases a day, that is only the decisions she has participated in or the opinions she has written or joined in.

How about the other writings--her law review writings, her speeches she has given, the FBI report, the ABA report, which we do not have yet, the questionnaire which has not been completed; in other words, a variety of things that have been reviewed and read. And then you discuss the nomination with witnesses to say this matter has been raised, this matter has been raised, what do you think about that?

She will have a variety of people who will be writing to the committee on her behalf. We will receive reams of letters and comments from people who think she is a good nominee, and we will receive a lot of comments, I suspect, from people who think she is not a good nominee. We need to go through all of that. When people write to us

about these nominees, for or against, we don't ignore what they say; we take it to heart. That is part of our job. All of this takes a great deal of time and effort.

Final point, Mr. President. We don't want to leave this to staff. We are going to read those opinions. I have instructed my staff on the opinions I want to read. I am used to reading court opinions, but not everybody has done that fairly recently in their career, and that takes a lot of time as well, considering all the other work we have to do.

To do this right, to conduct the kind of fair and thorough hearing that Senator Sessions talked about, and to follow the kind of precedents and tradition that the minority leader talked about, I think it is important for us to do it right, to get it right, to take the time that requires. And if that means going beyond July 13, then do that.

Senator Specter, when he was chairman of the committee, worked in a bipartisan way with Senator Leahy. Senator Leahy can certainly work in a bipartisan way with us to ensure there is an adequate amount of time.

At the end of the day, what we want is a hearing that everyone can say was fair, was thorough, resulted in a good decision and, hopefully and presumably, will allow this nominee, if she is confirmed, to take her position prior to the beginning of the October term. Justice Roberts was confirmed, I believe, on the 29th of September, and that was 4 days ahead of the time, I think--or 2 days. The Court reconvenes on October 5. Therefore, I see no reason why, if we do this right, we cannot have the nominee--if this nominee is confirmed--confirmed by the time the October term begins.

I say to my colleagues, let's do this right and not try to push things beyond the point that is appropriate under the circumstances.