Floor Statements

Mr. President, I spoke yesterday about the Morocco free- trade agreement and its benefits for both the United States and Morocco.

I hope and expect that when we vote on the Morocco implementing bill, the bill will pass by an overwhelming margin.

That is a fitting way to cap a busy month on trade and head into the summer recess.

As I look back at the accomplishments on trade since the beginning of the year, I am pleased at how much we have done. It would be considered a full plate in any year, but in an election year, it is especially gratifying to have achieved so much.

We passed the JOBS Bill, a complex tax measure that will help create jobs in America and bring the United States into compliance with the WTO. That bill passed the Senate overwhelmingly with 92 votes.

We extended and enhanced an important trade and development program for Africa--the Africa Growth and Opportunity Act through a unanimous vote.

We created a different trade and development program for Haiti, also through a unanimous vote.

And of course, just last week, we passed the Australia free-trade agreement implementing bill with 80 votes.

It has been a busy year.

I am heartened by the strong votes all these measures attracted. No victory is ever easy. They are hard fought by people working every day to do the right thing.

I want to congratulate Senator Grassley and his staff for their leadership, and Ambassador Zoellick and his excellent negotiating team for all their hard work.

As I look ahead, there will be some difficult issues to confront. I believe we have more work to do to rebuild a strong consensus on trade. We could do better on both the substance of trade agreements and on the process of considering them.

I also believe we should be devoting more of our resources toward enforcing trade agreements we already have.

But today, I would like to focus on our successes on all we have already accomplished, and on what we are about to do.

When we vote to approve the Morocco legislation, we will be solidifying our oldest diplomatic relationship in the world.

We will be giving reform-minded governments in developing countries around the world incentive to redouble their efforts to modernize their economies.

We will also be setting a new standard for agreements with developing countries in a variety of important areas. These include intellectual property, market access, and even agriculture.

The Morocco agreement is a good agreement. I urge my colleagues to vote for it.

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

Mr. President, I rise in support of the legislation to implement the U.S.-Morocco free trade agreement. By voting to approve the Morocco implementing legislation, we can confirm our close and longstanding ties with Morocco.

In 1777, soon after a breakaway British colony calling itself the United States of America declared independence from Britain, Morocco was the first country in the world to recognize the new government.

In 1787, the two nations negotiated a Treaty of Peace and Friendship that is still in force, representing the longest unbroken treaty relationship in U.S. history.

Soon thereafter, Morocco's rule wrote to President Washington to ask for help in protecting Morocco's shipping fleet from marauding bandits.

Washington wrote back, apologizing that the United States was too poor and too weak from the recent American Revolution to help Morocco. But Washington said that perhaps someday, the United States would be strong enough to help its friends. For Morocco, that day has now come.

So there are strong foreign policy reasons to vote for the Morocco implementing legislation. But I have often said that foreign policy concerns alone should not control our trade policy. I have argued that we should negotiate free trade agreements with countries that offer real economic advantages for U.S. farmers, workers, and businesses.

I am happy to report that while Morocco has a relatively small economy, the agreement with Morocco is a

strong agreement that offers significant opportunities for American exporters. In many ways, it sets a new standard for U.S. free trade agreements with developing countries.

Take, for instance, the provisions regarding intellectual property. Morocco has agreed to a high level of protection for intellectual property rights. The agreement includes state-of-the-art protections for digital copyrights and trademarks, expands protection for patents, and mandates tough penalties for piracy and counterfeiting.

Morocco has also agreed to the best market access package to date of any U.S. free trade agreement with a developing country.

Over 95 percent of our trade with Morocco in consumer and industrial products will become duty-free immediately upon the entry into force of the agreement. All remaining tariffs will be eliminated within 9 years.

The agreement is also good for U.S. agricultural producers. Wheat was a sensitive issue for the Moroccan negotiators. They initially resisted attempts to increase access to U.S. wheat exports. Morocco purchased most of the wheat it needed to import from the European Union. They did not want to open it up to America, but I fought hard to ensure that U.S. wheat producers would not be left out of the agreement. I made it clear that I could not--and would not--support any agreement with Morocco that excluded wheat. Wheat is an important export crop for many U.S. States, including my home State of Montana.

In the end, Morocco agreed to open up its market to U.S. wheat. The agreement creates new tariff rate quotas for wheat that could lead to a 5-fold increase in U.S. exports to Morocco. Most importantly, it will allow U.S. wheat producers to compete in Morocco on a level playing field with their European competitors.

Beef was another sensitive issue for Moroccans. Again, I made clear how important beef exports were to me and to others in the Congress. In the end, the agreement gives U.S. beef producers new access to Morocco for their high-quality beef exports.

The agreement is good for the United States, but it is also good for Morocco. It will help update and modernize Morocco's economy and attract investment to Morocco.

Morocco has used the free trade agreement negotiations to consolidate significant domestic reforms. For example Morocco recently enacted a new labor law and a new law on child labor, both of which were drafted with the help of the International Labor Organization.

Also, during the course of the negotiations, Morocco agreed to accede to the World Trade Organization Agreement on the Expansion of Trade in Information Technology.

As a result, Morocco recently eliminated tariffs on a number of information technology products. That could help increase Morocco's productivity as Moroccan businesspeople gain easier access to high-tech products.

By voting to approve Morocco implementing legislation, we can support reformers in Morocco who seek to modernize its economy. We can also send a signal to other developing countries with reform-minded governments that opening up their economies can lead to closer economic relations with the United States and new opportunities for their citizens.

I urge my colleagues to support this legislation.

Before I conclude, I would like to take a moment to thank my good friend, the chairman of the committee, Senator Charles Grassley, for his leadership not only on this legislation but on every piece of legislation we have dealt with in this Congress. The chairman and I have worked with other members of the Finance Committee to address their concerns. I must say, there were several on this implementing legislation with Morocco. We worked with those Senators, with their concerns. I compliment the chairman for his leadership in working all that out, and I believe he has successfully addressed all those concerns.

I appreciate the willingness of the members of the committee to work cooperatively to get this legislation done in a timely manner.

I yield the floor, I suggest the absence of a quorum, and ask unanimous consent that time under the quorum call be charged equally against both sides.

Mr. President, I rise to call my colleagues' attention to a very important matter--the safety of America's hospitals. This is an issue that affects every State and people of all political beliefs. In an effort to keep American hospitals safe and ensure they provide quality health care, Chairman Grassley and I are introducing the Medicare Hospital Accreditation Act of 2004, which is simultaneously being introduced by our colleagues in the House of Representatives.

As I can attest through personal experience, America's hospitals provide outstanding health care. Every day, thousands of people receive the treatment they need from dedicated and highly competent hospital staffs working in well-run hospitals across the country.

But confidence in our hospitals should not be confused with complacency. Every so often, someone from outside a hospital must come in to each facility and look under the hood, so to speak, to read through patient charts, check clinical practices and to make sure that sprinklers are working and stairways are sound. We have put our trust in accrediting organizations to identify problems in hospitals so that they may be corrected and quality and safety improved.

Most hospitals are accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), which has been accrediting hospitals for over 50 years. When JCAHO accredits a hospital, that hospital is deemed to be in compliance with the conditions of participation for Medicare. As today's report by the Government Accountability Office (GAO) shows us, JCAHO's record of identifying problems in hospitals is far from perfect. Furthermore, the GAO points out that government has little oversight authority over JCAHO's hospital accreditation process. Less oversight authority, in fact, compared to accrediting organizations for other kinds of healthcare facilities.

While the GAO's findings are a reason for concern, the report does not mean that American hospitals are unsafe. But it does send a clear message--one that the Congress and the Administration should heed--that there is room for improvement in identifying problems at hospitals. Given my commitment to keep hospitals as safe as possible, I view the GAO's recommendations as a call to action.

Therefore, I am pleased to join Chairman Grassley in introducing legislation to remove JCAHO's unique status as an accreditation body and to give the Centers for Medicare & Medicaid Services (CMS) the same authority over JCAHO's hospital accreditation that it already has with respect to the accreditation of other healthcare facilities. Putting all accrediting organizations on equal footing will result in better accreditation and better healthcare facilities for everyone. Expanding oversight by CMS of JCAHO's hospital accreditation will help improve the process, keep patients safe and ensure that hospitals continue to perform to our expectations.

The legislation we're introducing today is bipartisan and bicameral. I urge my colleagues to join us in co-sponsoring this bill and working together to get it passed.

Mr. President, I rise to call my colleagues' attention to a very important matter--the safety of America's hospitals. This is an issue that affects every State and people of all political beliefs. In an effort to keep American hospitals safe and ensure they provide quality health care, Chairman Grassley and I are introducing the Medicare Hospital Accreditation Act of 2004, which is simultaneously being introduced by our colleagues in the House of Representatives.

As I can attest through personal experience, America's hospitals provide outstanding health care. Every day, thousands of people receive the treatment they need from dedicated and highly competent hospital staffs working in well-run hospitals across the country.

But confidence in our hospitals should not be confused with complacency. Every so often, someone from outside a hospital must come in to each facility and look under the hood, so to speak, to read through patient charts, check clinical practices and to make sure that sprinklers are working and stairways are sound. We have put our trust in accrediting organizations to identify problems in hospitals so that they may be corrected and quality and safety improved.

Most hospitals are accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), which has been accrediting hospitals for over 50 years. When JCAHO accredits a hospital, that hospital is deemed to be in compliance with the conditions of participation for Medicare. As today's report by the Government Accountability Office (GAO) shows us, JCAHO's record of identifying problems in hospitals is far from perfect. Furthermore, the GAO points out that government has little oversight authority over JCAHO's hospital accreditation process. Less oversight authority, in fact, compared to accrediting organizations for other kinds of healthcare facilities.

While the GAO's findings are a reason for concern, the report does not mean that American hospitals are unsafe. But it does send a clear message--one that the Congress and the Administration should heed--that there is room for improvement in identifying problems at hospitals. Given my commitment to keep hospitals as safe as possible, I view the GAO's recommendations as a call to action.

Therefore, I am pleased to join Chairman Grassley in introducing legislation to remove JCAHO's unique status as an accreditation body and to give the Centers for Medicare & Medicaid Services (CMS) the same authority over JCAHO's hospital accreditation that it already has with respect to the accreditation of other healthcare facilities. Putting all accrediting organizations on equal footing will result in better accreditation and better healthcare facilities for everyone. Expanding oversight by CMS of JCAHO's hospital accreditation will help improve the process, keep patients safe and ensure that hospitals continue to perform to our expectations.

The legislation we're introducing today is bipartisan and bicameral. I urge my colleagues to join us in co-sponsoring this bill and working together to get it passed.

Mr. President, I ask unanimous consent that the following fellows and interns be granted the privilege of the floor during consideration of the Morocco bill: Sarah Hagigh, Molly Bell, Tony Cerise, Ashley Griffith, Ade Ifelayo, Kellen Moriarty, Scott Richardson, Alex Robles, Ben Sather, John Van Atta, Chris Wardell, Steve Beasley, Jodi George, Scott Landes, Pascal Niedermann, and Matt Stokes.

Mr. President, I support the Kennedy-DeWine tobacco amendment to the JOBS bill. I believe that FDA authority must go hand-in-hand with any tobacco buy-out. I am pleased that we were able to reach this compromise. Although I was unable to cast my vote for this important amendment, I did want to be on the record in support of the amendment.

Mr. President, today the Senate begins consideration of the U.S.-Australia Free Trade Agreement. I support this agreement for one simple reason: Trade means jobs.

The U.S. economy is the most flexible, vibrant, and dynamic in the world. We owe that to the ingenuity of the American people and their relentless thirst to create and to innovate.

We also owe it to the policies we have put in place to support the innovation that keeps our economy growing and creating jobs. That includes embracing open trade.

Twelve million Americans--1 out of every 10 workers--depend on exports for their jobs. And these jobs pay thousands of dollars more than jobs unrelated to trade.

Now, some think of trade as helping only big multinational companies. In reality, trade helps companies of all sizes. Firms with fewer than 20 workers

make up two-thirds of American exporters.

Trade also creates benefits for communities across the country. In Montana, nearly 6,000 jobs depend on manufacturing exports. And more than 730 Montana companies, mostly small and medium-sized businesses, export products overseas.

Despite the well-known benefits of trade and the vibrancy of the U.S. economy, the last few years have been difficult ones.

Since January 2001, the American private sector has lost nearly 2 million jobs--mainly in manufacturing. And service-sector jobs--once virtually immune to international competition--have begun to move offshore in increasing numbers.

When people talk about jobs moving overseas, they frequently talk about trade. Too often, the proposed solution is to retreat into isolationism and raise barriers to trade. In my view, that's exactly the wrong approach. We should engage in more trade, not less.

But we must be smart about trade. We must enforce our trade laws and our trade agreements. We must ensure that markets remain open to U.S. companies, and that U.S. companies can compete on a level playing field.

We should reject the notion that we must lower standards in this country to compete. Instead, we must look to raise standards in the countries we trade with. The Trade Act of 2002 made tremendous progress in this regard, but we must continue to ``race to the top.''

The free trade agreement with Australia is the kind of agreement we should be negotiating. It offers both broad commercial benefits and high standards.

Australia is one of the few countries with whom the U.S. enjoys a trade surplus, with the bulk of this surplus in manufactured goods.

With this agreement, U.S. manufacturers predict that U.S. exports will grow by an additional 20 percent--$2 billion per year. Montana already exports $3.4 million per year in industrial goods to Australia. And these exports will grow with this agreement.

This is great news to manufacturing workers who have been hard hit by massive job losses. It is especially important in a State like Montana, where we have lost 3,300 manufacturing jobs in the past 4 years. These losses represented 15 percent of the Montana manufacturing workforce.

But it's not just about manufacturing. This agreement will also benefit U.S. service providers. Australia will expand access for cross- border services, and to enhance regulatory transparency. That will mean greater opportunities in financial services as well as those services provided through new and innovative technology.

Beyond these benefits, the agreement also increases protections for intellectual property. And it requires Australia to offer greater opportunities to U.S. bidders in government procurement.

All of these improvements will translate into a more fair and open market for U.S. producers. That will mean more jobs and higher wages for U.S. workers.

At the same time, this agreement opens the door to a greater relationship with one of the most vibrant and promising economies in the world. Australia stands as a gateway to the fast growing markets of Southeast Asia. This agreement will help U.S. companies further develop their export potential.

Now, some have expressed concerns regarding agriculture. Australia exports many of the same commodities that the U.S. produces--most notably, beef, dairy, and sugar. Yet Australia offers a much smaller consumer market in return.

Those of us from States that produce these commodities were concerned. However, given the close relationship between the U.S. and Australia, and given the substantial benefits to the manufacturing and service sectors, it was clear to me that Congress would approve an Australia agreement.

The only solution to this challenge for U.S. agriculture was good, old-fashioned tough negotiating. I urged Ambassador Zoellick to work hard to preserve the interests of rural America, by treating U.S. commodities sensitively.

I pushed him to ensure a long transition period, and to provide strong safeguards where necessary. I am pleased to report that U.S. negotiators responded to these concerns and met me more than half way.

For beef, there is an 18-year transition period and two automatic safeguards. As we drafted the implementing legislation for this agreement, I worked hard to ensure that there were significant protections for Montana's ranchers.

For dairy, the agreement ensures a slow pace for increased market access, while maintaining over-quota tariffs--a chief priority for U.S. producers.

Finally, U.S. negotiators preserved current sugar policy, in order to enhance our prospects to achieve global reform in the WTO.

These protections help shape an agreement that is balanced and sound. It enhances opportunities for U.S. companies and workers, while also being sensitive to the interests of our farmers and ranchers.

Let me turn to one final issue that has been receiving attention lately. In the last couple of days, some Members have questioned whether this agreement affects U.S. government regulation of prescription drugs.

These concerns involve the potential impact of trade agreements on U.S. healthcare programs, including Medicare, Medicaid and the VA and DOD programs, and the implications of the agreement on the adoption of drug reimportation legislation in the future.

USTR has assured Congress that the provisions in the agreement will not require any changes to the administration of U.S. health programs. And that no changes to current U.S. law or administrative practice are necessary to implement the agreement.

Furthermore, because Australia itself does not permit most pharmaceuticals to be exported, we are assured that this agreement will not impede Congress from considering and enacting reimportation legislation.

My own view is that the concerns raised by these provisions are more hypothetical in nature than concrete. Nonetheless, this is an issue that Congress--and the Finance Committee--should explore more thoroughly as we move forward on trade negotiations in the future.

I urge my colleagues to vote for this agreement. This is an agreement that will help our long-term competitiveness. This is an agreement that will create jobs. This is an agreement that is good for Montana and good for America. I hope it will receive strong support.

Mr. President, I appreciate the comments by my colleagues on the importance of U.S. beef and the impact upon it by this Agreement. The U.S. cattle industry is a cornerstone of rural America. Virtually every rural community in America is supported, in some way, by domestic beef production. This is especially true in Montana, where cattle and beef account for 25 percent of our State's economy. Nearly half of our State's economy depends on agriculture, overall. Since it's pretty tough to survive on one-half of an economy, it's easy to see how important this industry is to Montana. The cattle industry creates thousands of jobs and supports thousands of families.

This is why I fought so hard to ensure that this agreement reflected the particular needs and interests of Montana and U.S. cattlemen. When the administration first indicated their intention to negotiate an agreement with Australia, I was frankly concerned. Australia is one of the world's largest exporters of beef, offering a relatively small consumer market in exchange for access to ours.

I was faced with a choice. I could oppose the agreement from the beginning, or I could engage the process and try to forge as strong an agreement as possible. Opposing the agreement from the beginning would mean taking myself out of the process. At that point, I would be unable to best defend the interests of my constituents who had much at stake in the negotiations. Engaging the process would allow me a seat at the table, and an opportunity to insist on provisions that preserve the interests of Montana's cattlemen. Thus, engagement was the better choice.

After nearly a year and a half of tough negotiations, including countless meetings and conversations with U.S. negotiators, and Australian officials, as well, I am satisfied that we got as good a deal as we could. The agreement treats beef as a particularly sensitive product, taking into account the loss of U.S. global exports due to the discovery last year of BSE. It provides a long transition period for duty phase-out, and a slow, gradual increase in beef access to Australia. Most importantly, the agreement creates two safeguards that are triggered automatically whenever the volume or price-based conditions are met.

While the administration is given authority to waive the application of a safeguard--if certain, rare conditions are met--I also worked with Ambassador Zoellick and his staff to establish procedural requirements that must be met before a safeguard could be waived.

All in all, I am confident that the provisions in the agreement are strong and adequate. Still, our efforts illustrate the importance of these issues, not just for this FTA but for future agreements, as well. The United States traditionally exports 10 percent of its beef production, and this figure was growing until our export markets were blocked in the wake of last December's discovery of a single dairy cow infected with BSE.

Clearly, expanded trade is important to the U.S. cattle industry. Yet, extreme distortions in global beef markets pose a serious threat to the future of U.S. ranchers. All the hard work in the world won't amount to a hill of beans if we don't tackle the sources of these distortions--such as massive subsidies, high tariffs, and the like. I ask that a position paper, describing distortions in the global cattle and beef markets, be printed in the Record.

Mr. President, this position paper has been prepared by R-CALF USA, an industry association representing ranchers across the country including Montana.

Future trade agreements must seek to eliminate the distortions that undermine the prosperity of U.S. producers. That means the U.S. should negotiate agreements that offer real and substantial opportunities. That also means the U.S. must take a hard-nosed approach in the Doha Round of WTO negotiations.

This matter is crucial to the future of rural America. It is worth every ounce of effort we can pour into it, and I--for one--pledge to press this fight.

Mr. President, before we conclude today's debate, I just take a minute to thank some of the staff who have worked very hard on this agreement.

I first thank Ambassador Zoellick's team, particularly Ralph Ives, Matt Niemeyer, Lisa Coen, and Ted Posner. We worked closely with them for nearly 2 years, and I have appreciated their dedication to getting a good agreement.

I also thank the staff of the Senate Finance Committee. On the Republican side, Everett Eissenstat, Stephen Schaefer, and David Johanson.

And finally I thank my own staff on the Finance Committee, Russ Sullivan and Bill Dauster, who head up our Committee staff. Our trade team: Tim Punke, Shara Aranoff, Brian Pomper, and Sara Andrews. Liz Fowler, who worked on the pharmaceutical provisions. And I especially thank John Gilliland, one of our International Trade Counsels who has done a tremendous job, particularly on the difficult and sensitive agriculture issues.

Mr. President, it has taken us too long to reach this point. Frankly, we are doing today what should have been done last fall. We are finally moving forward with the Jumpstart Our Business Strength--the JOBS bill.

I commend the Majority Leader and the Democratic Leader for reaching the agreement that allows this bill to move forward. I commend, as well, the Chairman of the Finance Committee, Senator Grassley, who has been so instrumental in bringing us to this point.

There is a reason why we call this bill the JOBS bill. This bill will help create and keep good, high-paying manufacturing jobs right here in America. And this bill will help remove crippling European tariffs that rob American firms of business. Every month that goes by without enactment of the JOBS bill results in more tariffs on our American companies. We need to enact this bill.

So, as we go forward to conference, it is critical that we adhere to the following 5 principles.

First, we should preserve our bipartisan support for this bill. The Senate-passed JOBS Bill had strong bipartisan support. It passed by a vote of 92 to 5 on May 11. To preserve this bipartisan support we need to ensure that any significant change from the Senate-passed bill be limited, germane, and agreed to on a broadly supported bipartisan basis.

Second, any conference agreement should be budget neutral. The government is running record budget deficits. Gone are the surpluses of just a few years ago. We should show fiscal discipline and responsibility. The conference agreement should be budget neutral. And the conference agreement should not employ budget gimmicks.

Third, we should protect our Nation's manufacturing jobs. Since January 2001, America has lost more than 2.7 million manufacturing jobs. In my home state of Montana, we have lost 2,700 jobs in that time, over 12 percent of our manufacturing jobs. Therefore, savings from repeal of the Foreign Sales Corporation/Extraterritorial Income, FSC/ETI, regime should go to domestic manufacturing. The conference agreement should devote the preponderance of its total cost to the centerpiece of this bill: a domestic manufacturing tax benefit.

Fourth, the conference agreement should incorporate the important tax shelter reforms that the Senate has repeatedly passed. It has been nearly 3 years since Enron and other corporate scandals. Yet Congress still has not enacted any meaningful tax legislation to close the corporate abuses of the tax code. The Congress should retain the package of the Senate-passed tax shelter provisions, including the provisions ensuring that business transactions are undertaken for economic, and not tax avoidance purposes, and requiring CEO signatures.

Finally, an important part of the Senate bill is its coverage of all types of businesses. The conference agreement should provide a domestic manufacturing tax benefit to all domestic manufacturers, regardless of choice of business entity. It should cover not just C corporations, but also S corporations, partnerships, and sole proprietorships.

Mr. President, I will fight to ensure the conference agreement adheres to these principles. I will fight for the Senate's position across the board, including on overtime rules and on energy tax provisions.

Here is the bottom line: The Senate passed the JOBS bill with a wide, bipartisan majority. The conferees have to work together, across political differences, to move this important bill forward. We need to continue our fight for good jobs, here in America.

Mr. President, I rise to address the value of free trade, and of the process by which we get it.

From ancient times, people have learned that trade among nations means more economic growth and higher incomes. People have better standards of living, thanks to trade.

Free trade allows each nation to devote more resources and energy to those things for which it has a comparative advantage. Partners to free trade thereby get goods and services at lower cost than they would in isolation.

Conversely, protectionism stunts growth and reduces income. Tariffs are taxes. And like other taxes, they can impede the efficient allocation of resources. Where nations impose quotas and tariffs, goods and services cost more. People live less well than they would with free trade.

But you don't have to take my word for it. Look at the record. Take America's two biggest recent trade agreements.

America entered into the North American Free Trade Agreement, NAFTA, in 1993, and the Uruguay Round Agreements, the WTO, in 1994. In the years following those major trade agreements, America experienced one of its strongest economic expansions.

Yes, balancing the budget and funding education also had something to do with it. But trade helped.

America experienced 8 years of economic growth. The American economy created more than 20 million new jobs. The average household's real income rose 15 percent. Americans' standard of living improved.

Put the other way around: The opponents of free trade have a difficult job to explain how those major trade agreements hurt the American economy in the 1990s.

I am a proud advocate of trade. I am an advocate of stronger economic growth and higher incomes. I want a better standard of living for Americans.

So how can we achieve freer trade? How do we lower barriers to trade? That brings us to a discussion of trade procedures.

The Senate considers trade agreements under somewhat unique procedures. These special procedures go by several names: fast-track, trade negotiating authority, or trade promotion authority.

Under these procedures, legislation to implement a trade agreement gets an up-or-down vote within a limited time. Debate is limited to 20 hours. No amendments. No filibusters.

The Senate is about to consider legislation under these procedures to implement the United States-Australia Free Trade Agreement. We may also soon consider legislation under these procedures to implement the United States-Morocco Free Trade Agreement.

Two other agreements with six Central American countries and Bahrain are signed and ready for us to consider whenever the administration chooses to move them.

With so much trade activity, it is a good time to review the applicable procedures.

It all begins with the Constitution. Article I, section 8, clause 3 says that: ``The Congress shall have the power . . . to regulate Commerce with foreign Nations.'' Since the founding of our Country, it is, and has always been, Congress that holds primary responsibility for trade.

Now, 535 Members of Congress cannot negotiate trade agreements. The logistics are unimaginable. So our predecessors figured out fairly early that the actual negotiating would have to be delegated to the executive branch.

But that does not mean that Congress has delegated its Constitutional responsibilities. To the contrary, under United States law no trade agreement is self-executing. It has no effect on domestic law until Congress passes implementing legislation.

A system where one branch of government negotiates trade agreements and another must accept them and turn them into domestic law presents challenges.

The system worked well enough in the early days of the General Agreement on Tariffs and Trade. Back then, the executive branch was negotiating agreements to reduce tariffs. Congress would delegate authority to the President to agree to cuts within a specific range. All the President had to do was proclaim those changes once agreed to.

In the 1960s, however, the United States and its trading partners in the GATT began to expand the scope of trade negotiations to non-tariff measures. Without any advance authorization from Congress, the administration negotiated several deals on non-tariff measures in the GATT's Kennedy Round.

It brought those agreements back to Congress. Congress rejected the agreements, refusing to implement them into domestic law. This embarrassed the administration. And it frustrated our trading partners. They learned that negotiating with the executive branch is not enough. The final word lies with Congress.

Our trading partners became wary. They didn't want to devote years of effort to another round of trade negotiations in the GATT if American negotiators could not keep the promises they made. The executive branch wanted advance authorization from Congress to negotiate non-tariff trade agreements.

The administration proposed treating tariff and non-tariff agreements the same. The executive branch said: Congress should simply authorize the President in advance to negotiate and implement the deals that the President makes.

The Finance Committee resisted. Yes, tariff deals are easy to approve in advance. All Congress has to do for a tariff deal is to tell the Executive how low the negotiators can go.

But non-tariff deals are more complicated. They can cover things like Customs rules, trade remedies, food safety rules, and intellectual property rights. It would be too difficult for Congress to approve parameters for these kinds of agreements in advance. Congress would want to see the details before deciding to approve and implement these deals.

Congress and the President reached a compromise and enacted it in the Trade Act of 1974. That Act created the so-called ``fast-track'' process.

Fast-track has something for everyone. It gives the Executive express authority to negotiate tariff and non-tariff agreements, so long as our trade representatives meet general negotiating objectives set out by Congress. And it guarantees our trade partners that any agreement will receive an up-or-down vote by a date certain. That way, when they negotiate with the United States, they know that Congress cannot later amend the agreement or kill it with a filibuster.

But, most importantly, fast-track preserves Congress's Constitutional primacy on trade. No agreement gets implemented unless a majority of Congress approves.

Fast-track procedures require close collaboration between the Executive and Congress at every stage. The President must notify committees of jurisdiction and consult with them before a negotiation begins and regularly throughout the negotiations. Once talks are complete, the President must notify Congress 90 days before signing the agreement, to permit Congress time to review the terms of the deal.

Once the agreement is signed, the President must submit it to Congress, along with a draft implementing bill, for approval. Congress has no more than 90 days in which the Congress is in session to act. And amendments are not in order.

But the time when close coordination between the Executive and Congress is most critical is the period between when the agreement is signed and when the President submits the agreement to Congress.

This is the time when the administration and the trade committees sit down together to craft an implementing bill. The law requires the Executive to consult with the committees of jurisdiction. But because the details of this consultative process are not spelled out by law, some call this stage the ``informal process'' or the ``mock process.''

No one should be fooled by these titles. This cooperative drafting venture--while not spelled out in the law--is the centerpiece of the fast-track process.

It is at this stage--before the implementing bill becomes unamendable--that the trade committees can weigh in and bring their own ideas to the table.

Congress and the President first used the procedures adopted in the Trade Act of 1974 to implement the GATT Tokyo Round agreements in 1979. The Government has since used these procedures to implement the WTO Uruguay Round Agreements, as well as free trade agreements with Israel, Canada, Mexico, Singapore, and Chile.

From the beginning, the Finance Committee has strived to make the informal process operate as much as possible like the normal legislative process.

For that reason, the Finance Committee always holds a mock markup of the draft implementing bill. Like any markup, this event is open to the public. And Members are free to offer amendments to the draft bill that has been developed by the administration and committee staff.

The committee holds a recorded vote on each amendment offered. It then votes on whether to approve the draft bill, as amended, in a recorded vote.

Amendments are common events at mock markups. When the Committee considered the United States-Israel Free Trade Agreement in 1984, committee members offered 13 amendments, and the Committee adopted 3. In 1988, when the committee considered the Canada-United States Free Trade Agreement, members offered 9 amendments, all of which were adopted. When the Finance Committee considered draft implementing legislation for the North American Free Trade Agreement in 1993, members offered at least 15 amendments, of which 14 were adopted. There were more than 30 differences between the Senate and House versions of the bill at the end of the mock markups.

By contrast, no amendments were offered last year when the committee considered the Singapore and Chile implementing bills. That was unusual.

In each of these cases, consideration of amendments was followed by a committee vote to approve the draft bill, as amended.

In every case except Singapore and Chile, amendments added in the mock markup led to differences between the versions of the draft bill approved by the Finance Committee and the bill approved by the Ways and Means Committee.

Consistent with normal legislative practice, the two committees resolved these differences in an informal or ``mock'' conference. Each House appointed conferees to participate.

To begin the conference process, staff from both parties and both Houses jointly prepared a document identifying all the differences between the two versions of the draft bill. Where agreement was possible, staff recommended a resolution.

Typically, the House and Senate exchanged offers on more difficult issues, which were then resolved at the Member level. In each case, Members and staff were able to resolve all or virtually all conflicts. Both committees could then recommend identical draft bills to the administration for formal submission.

This time-tested process really works. It allows Congress to exercise its Constitutional prerogatives in full, while still guaranteeing the President and our trading partners a timely vote on trade agreements.

Although these informal procedures are not statutory, they were certainly on my mind when I worked to secure a renewal of the President's trade negotiating authority in the Trade Act of 2002. I firmly believe that Congress should continue to insist on a meaningful and robust informal process.

One of the keys to a meaningful informal process is time. In the case of the U.S.-Canada Free Trade Agreement, the informal process took 7 months. That is how much time elapsed between when the U.S. signed the agreement and when the President formally submitted the implementing bill to Congress. During that time, the

Finance Committee held hearings, conducted several weeks of informal drafting, and held four mock markup sessions. The informal conference alone included 3 days of Member-level meetings and took close to 2 months to complete.

The informal process for NAFTA lasted a full year. It included five hearings in the Finance Committee as well as hearings in five other committees. The Finance Committee staff worked with the administration for months on legislative drafting. The Finance Committee's markup involved 3 sessions over 2 weeks, followed by a conference.

The informal process for the Uruguay Round Agreements Act took about 9 months.

The Singapore and Chile FTAs took less time. That makes sense. The agreements required many fewer changes to U.S. law than those that came before.

After walking through the draft bills in detail with the administration, with Committee staff, and with legislative counsel, Members were satisfied. They chose not to offer any amendments at the mock markups. No conference was necessary.

Affording sufficient time to the process pays off. After the President formally submits an implementing bill, the fast-track procedures allow Congress up to 90 days to complete action. That is 90 days on which Congress is in session not calendar days.

But nowhere near that much time has ever been used. The formal process took 56 calendar days for the U.S.-Canada Agreement--including the August recess. NAFTA, Singapore, and Chile took a mere 16 days each.

What lesson can we learn from all this experience? Process matters.

Congress needs to be engaged throughout the negotiations. The trade committees need to play an active role in drafting implementing legislation. Committee members need to have enough time to give meaningful consideration to amendments and to resolve any differences between the Houses before the Government completes an implementing bill. When that happens, the formal fast-track process goes quite smoothly.

What does this mean for the future? First, we should not get overconfident. Just because the process works smoothly and quickly for some agreements, like Singapore and Chile, doesn't mean we can start skipping steps. In fact, with a vote on whether to extend the President's trade promotion authority for an additional 2 years possible next summer, now is no time to get sloppy.

More complex agreements may be ahead. CAFTA involves six countries and could raise controversial new issues. Any agreements that come out of the WTO Doha Round or the FTAA talks could require extensive new implementing legislation. In sum, we would be foolish to assume the process of developing implementing bills will always be as easy in future as our recent experience with Singapore and Chile.

Second, timing should always be Member-driven. Members should have the time that they need to review the relevant materials and participate in the informal process. We should never cut that time short just to meet artificial deadlines.

When we shortchange the process, we shortchange the Constitution. When we start cutting corners on process, we begin to abdicate Congress's constitutional role in making trade law.

A good agreement is no excuse for bad process. A good agreement is no excuse for Congress to surrender its Constitutional role. The ends do not justify the means.

Let us work together to advance the process of free trade. Let us ensure a fair process for reaching our trade agreements, and thereby make future trade agreements easier to achieve. And by advancing those agreements, let us work together to earn those benefits of free trade of greater economic growth and higher standards of living for generations of Americans yet to come.

Mr. President, I rise with my colleague and friend Chairman Chuck Grassley to introduce The Qualifying Individuals' Program Extension Act. This bill would extend avery important program that provides assistance to low-income Medicare beneficiaries. The so- called QI-1 program, which will expire at the end of

this fiscal year, currently pays Part B premiums for Medicare beneficiaries earning less than $12,570 this year. That's about $1,050 a month. Medicare Part B premiums are expected to increase to $75 next year. That's a substantial sum for beneficiaries living on a fixed income of $1,000 a month. 7.5 percent of their total income, in fact, and that's just for premiums for one part of the Medicare program--they must still pay coinsurance and the deductible for Parts A and B.

In enacting the Medicare prescription drug benefit last year, Congress acknowledged that seniors with incomes up to 150 percent of the Federal Poverty Line--in 2004, that's about $14,000 a year, or $17,000 per couple--need some additional help in paying their drug bills. I viewed the low-income drug assistance provisions as one of the great successes of the prescription drug bill. We should not give with one hand and take away with another by allowing the QI-1 program to expire--hurting the very same people that we tried to help in the Medicare prescription drug bill.

The QI-1 bill is a truly bipartisan effort. Democrats, particularly my colleague Senator Bingaman from New Mexico, have long championed the QI-1 program. And the Administration's budget for Fiscal Year 2005 includes an extension for QI-1s. I urge my colleagues to support this important program and work with me to get it passed as quickly as possible.

Mr. President, I rise with my colleague and friend Chairman Chuck Grassley to introduce The Qualifying Individuals' Program Extension Act. This bill would extend avery important program that provides assistance to low-income Medicare beneficiaries. The so- called QI-1 program, which will expire at the end of

this fiscal year, currently pays Part B premiums for Medicare beneficiaries earning less than $12,570 this year. That's about $1,050 a month. Medicare Part B premiums are expected to increase to $75 next year. That's a substantial sum for beneficiaries living on a fixed income of $1,000 a month. 7.5 percent of their total income, in fact, and that's just for premiums for one part of the Medicare program--they must still pay coinsurance and the deductible for Parts A and B.

In enacting the Medicare prescription drug benefit last year, Congress acknowledged that seniors with incomes up to 150 percent of the Federal Poverty Line--in 2004, that's about $14,000 a year, or $17,000 per couple--need some additional help in paying their drug bills. I viewed the low-income drug assistance provisions as one of the great successes of the prescription drug bill. We should not give with one hand and take away with another by allowing the QI-1 program to expire--hurting the very same people that we tried to help in the Medicare prescription drug bill.

The QI-1 bill is a truly bipartisan effort. Democrats, particularly my colleague Senator Bingaman from New Mexico, have long championed the QI-1 program. And the Administration's budget for Fiscal Year 2005 includes an extension for QI-1s. I urge my colleagues to support this important program and work with me to get it passed as quickly as possible.

Mr. President, I speak about Burma and U.S. sanctions policy. Last year, thugs working for the illegitimate Burmese government attacked opposition leader Aung San Suu Kyi and her supporters with clubs and sharpened sticks, killing as many as 70 pro- democracy activists.

The government then held Suu Kyi in what it cynically called ``protective custody.'' Those events prompted international outrage and led the United States to pass the Burmese Freedom and Democracy Act of 2003.

That Act banned all imports to the United States from Burma. Chairman Grassley and I worked hard to ensure that these sanctions would be effective--and that Congress would continue to play a key role in their implementation.

I did not want Congress to impose trade sanctions on Burma without any opportunity to review the policy and revise it if it wasn't working. So the act requires that Congress debate and vote on whether to renew the import ban every year. That is why we are here today.

What has the import ban accomplished? In 2002, the last full year without a ban, Burma exported $356 million to the United States, mainly in garments and apparel products.

Since the U.S. blocked all imports from Burma, more than 100 garment and apparel factories have closed, throwing 50,000 to 60,000 people, mainly young women, out of work.

And according to the State Department, many of these young women, lacking jobs and opportunities are, in desperation, quote, ``turning to work in the sex industry or being forced or duped into prostitution by traffickers.''

On the other hand, Burma's military rulers are doing just fine. The State Department notes that ``the military leaders personal power and wealth have little connection to the well-being of the country. The country's economic and military elite derives its greatest earning power from the trade of natural resources with neighboring states and countries in the region.''

I have long been critical of unilateral sanctions. They almost never work. They may be an effective expression of our rage, but as a rule, they do not destabilize oppressive regimes, and they often hurt the unfortunate people they are intended to help.

The ban on imports from Burma is no exception to this rule. Multilateral sanctions can be effective. That's why I insisted that the act require the administration to work toward making the sanctions multilateral. But to date, no country in the world has joined the United States in banning imports from Burma--not one.

Now, let me emphasize that Burma's government is despicable by any measure. Security forces commit murder, use rape as a weapon of war against ethnic minorities, and utilize forced labor. Democracy activists are arrested and dissent punished. Conscription of child soldiers is widespread.

There is no dispute that Burma's actions require a response. The question is whether unilateral trade sanctions are the proper response.

This is not an easy question. I hope that my colleagues have thought hard about the consequences. I hope they have made an honest assessment of the merits of maintaining the import ban.

We cannot forget that the votes we cast have real consequences. Those thousands of young women being forced into prostitution should serve as a harsh reminder.

After struggling with the issue for some time, I decided to support renewing the import ban for another year.

On balance, I believe we should allow the administration more time to try to convince other countries to join in sanctioning the outlaw regime in Burma. But I would urge the administration to make this more of a priority. Their efforts so far have produced little result.

If I am to find any consolation in this state of affairs, it comes from the fact that Congress has a say in whether the trade sanctions on Burma continue. We have retained our Constitutional authority over international commerce.

This is consolation to me because it is hard to evaluate any unilateral sanctions program without looking back on our failed sanctions against Cuba.

Since 1960, when the Cuban embargo was first put in place, the United States has pursued a unilateral policy of driving the Castro regime out of power. Even as the rest of the Soviet bloc collapsed, the Castro regime has retained its control on the Cuban island.

The U.S. embargo has failed. In fact, it is obvious to me that the embargo actually shelters Castro, and has directly contributed to the strength of his regime.

But the unilateral embargo has remained in place for more than forty years. Had Congress originally required an annual vote on the Cuban embargo, as we have now done with the Burma sanctions, the embargo would have been eliminated long ago.

Instead, the Cuban sanctions were created without any end in sight, without any exit strategy, without any plan for its removal. So, here we are, thirteen years beyond the fall of the Soviet Union, with the last vestige of the Cold War alive and well 90 miles from our shores.

That's why Senators Roberts, Enzi and I have introduced legislation to give Congress a voice on Cuba sanctions. This legislation mirrors the legislation on Burma that we are discussing today.

It would allow sanctions against Cuba to continue--but would require both Houses of Congress to vote annually to renew the sanctions. Absent such a vote, the sanctions would end.

This is a reasonable approach to Cuba, and to sanctions more generally. Of course, that's also why this legislation won't pass this year. The Administration and Congressional leadership are well aware that Cuba sanctions would not survive a Senate vote.

In fact, last year, overwhelming majorities in the Senate and House voted to suspend enforcement of the travel ban. Everyone here remembers that those votes were ignored by the leadership in both chambers, and the travel ban remained in place.

I hope that Congress can learn from the mistakes we have made--and are still making--in Cuba. I hope that Congress will work toward a more responsible sanctions regime. I stand ready to work with my colleagues to make that happen.

Let me close by thanking Senators McConnell, Feinstein, and Grassley for their work on the Burma legislation. Senators McConnell and Feinstein have been tireless advocates for democracy in Burma. They deserve to be commended.

I would also like to acknowledge some of the staff who have worked hard on this issue--Paul Grove, Michael Schiffer, Everett Eissenstat, and Stephen Schaeffer.

As a member of the Senate Committee on Agriculture, Nutrition, and Forestry, but also as the ranking Democrat on the Senate Finance Committee, I would like to thank Agriculture Committee Chairman Cochran and Ranking Member Harkin for their clarification on this point.

The Senate Finance Committee has long grappled with the challenges of allowing sensitive program information to be shared. While there are many cases where it is in the public good to share limited amounts of information, such as in this case, it is important that we take such steps carefully and that we not inadvertently or unintentionally allow more information to be shared than is absolutely necessary to accomplish our goals.

The amendment to the Social Security Act that is under consideration ensures that only certain Medicaid information can be shared with local educational authorities for the purpose of verifying eligibility and income with respect to the School Lunch and School Breakfast Programs. Information about a child's health or disability status or medical expenses would not be relevant to verifying eligibility for school breakfast and lunch programs, which is based only on the child's family income. Accordingly, information

about a child's health or disability status or medical expenses could not be shared with local educational agencies under the authority of this Medicaid amendment. I thank the chairman and the ranking member for clarifying the narrow goals of the amendment and look forward to its implementation in a manner that is consistent with the committee intent.

Mr. President, today I honor and congratulate my friend MG Prendergast.

After 46 years of loyal military service to Montana and our Nation, the top officer of the Montana National Guard will step down from his post August 1, as age prevents Major General Prendergast from serving beyond his 64th birthday.

Some call him general, some call him husband, father, son. I call this outstanding individual, my friend. I have known Gene since the early years in our hometown of Helena, MT, where we both lived and played, studied and worked. In 1958, when Dwight Eisenhouser was President, Major General Prendergast volunteered for his first of many military positions in the Montana Air National Guard while also working a civilian job at a local bank. I worked with him at the Union Bank during the summer months away from school. In 1960, he transferred into the Montana National Guard and received his commission in 1967 as an ordnance officer.

Major General Prendergast worked his way up through the ranks, and held various titles, including automotive platoon leader, instructor at the Montana Military Academy, assistant commandant and chief of staff of the Montana National Guard. He graduated from the Regents College of the State University of New York in 1993.

For his outstanding service and many years of commitment to our Nation, Major General Prendergast has been awarded the Meritorious Service Medal with two oak leaf clusters, Army Commendation Medal, Armed Forces Reserve Medal, and the Army Reserve Components Overseas Training Ribbon, among other medals.

Major General Prendergast is known among his colleagues, his friends, and all Montanans for his commitment to the American Nation. In his own words, ``There is no higher calling than serving your country in uniform. What it's all about is the soldier in uniform.''

Today I honor both the soldier and the man. I have been so fortunate to have this man as my friend over many years. In fact, my good friend shares with me a love for long-distance running, and I have enjoyed running many

miles with the general under Montana's big sky. We run and talk, laugh and share family stories.

As I reflect on the years I have been fortunate to know MG Gene Prendergast, I am reminded of the plaque which hangs in his office that his wife, Kathy, had made for him, the long-distance runner:

``The race is not always to the swift, but those who keep

on running.'' Around the world in 22 years--running 25,000

miles--June 1978-August 2000.

For my friend, MG Gene Prendergast, the race has only just begun. You are a soldier's soldier. I salute you for your outstanding service to our State and to this Nation.

Mr. President, I rise today to introduce the ``Medicare Quality Improvement Act of 2004.''

This bill will establish a new payment incentive structure for quality health care, starting with the Medicare Advantage and End Stage Renal Disease programs. Under this policy, Medicare would give a financial boost to plans and renal care providers demonstrating the highest quality care and a bonus to those that are working hard to improve.

Why focus on quality? I hear from all corners that the U.S. health care system is unsustainable in its current form. Costs are rising, and the care provided is not always appropriate or necessary. Not to mention that 43 million Americans lack health insurance.

As I travel around Montana, I hear so much from so many constituents about the rising cost of health care. Countless parents tell me they are struggling to pay for health care for their families, afraid that one more illness will force them into bankruptcy. Working people tell me they fear their employers will raise their premiums or drop

coverage altogether due to rising health care costs. And employers, both large industries and small enterprises, tell me they face competition from companies in countries where healthcare is significantly less expensive. While these employers are trying to keep jobs at home, health care costs are pushing them abroad.

And most recently, my personal experience with the health care system has brought the issue of health costs and quality even closer to home.

A few weeks ago, I chose to have an elective procedure to keep my heart healthy. I have excellent health care coverage, and I was able to seek out excellent doctors and nurses at the Mayo Clinic. In short, I am fortunate that the care I received was high-quality care. The doctors and nurses who took care of me were on the ball--making sure I got the right medications with no dangerous interactions, using proper surgical safety so I wouldn't get an infection, and providing good follow-up care so I could get back to my family and back to work.

My experience with the health system was a positive one. Unfortunately, not everyone is as lucky. Ninety-eight thousand people die every year in this country as a result of medical errors. That's 270 people each day. An appalling statistic. Many of these deaths can be prevented, and we must work to make sure that they are.

In addition to the cases of medical error we know about, there are many that go unreported and even undetected. Studies have shown that patients in the U.S. receive recommended care and treatment when they visit the doctor or hospital only about half of the time. Failure to follow proper patterns of care or recommended guidelines can lead to poor outcomes, and it is also more expensive in the short and long run.

Errors can mean more trips to the hospital or to the doctor, more drugs, and sometimes even additional surgeries. Each preventable medication error costs about $4,700 in added hospital costs alone, not to mention the personal costs of childcare and lost wages, and the societal costs of lost productivity.

While not as fatal as actual errors, missed health care opportunities also carry a cost. Each year, missed health care opportunities-- inappropriate care and generally poor quality care costs the U.S. health system more than $1 billion dollars in avoidable hospital bills and 41 million lost work days, which costs American businesses about $11.5 billion. Improving the quality of health care can reduce health care costs and stimulate our economy. In a time of slow economic growth and large deficits, health care is a compelling place to start.

Last year's Medicare Modernization Act got the ball rolling. The Medicare bill ties hospital reimbursement to reporting data on specific quality indicators. And hospitals are responding. Today, almost 2,000 hospitals are sharing data with the Centers for Medicare and Medicaid on at least one of the quality measures. Knowing more about the care that is delivered across the country should help us target incentives and resources to improve quality. It also provides employers and patients with new information about where to find the best deal for their health care dollar. And it also provides hospitals a way to compare their performance to other hospitals.

The bill I am introducing today builds on this strong start. It would establish a mechanism to pay for quality in the Medicare Advantage and End Stage Renal Disease Programs, through bonus payments for the best quality nationwide and bonuses for improving from one year to the next. Rewards for improvement are an important piece of my proposal--last year, the top ten percent of health plans in the country reported perfect scores on a set of quality indicators. There is no doubt that they deserve recognition. But we don't want to leave behind smaller or historically poorer-performing organizations that are making major strides to improve.

Medicare Advantage plans, which tend to utilize a coordinated model of care, have a unique opportunity to impact a patient's health outcomes--plans have access to information about a patient's medical history, and can follow patients more closely to ensure that they are receiving appropriate preventive, acute, and follow-up care. Medicare Advantage plans can translate their own payments into quality incentives downstream. They can reward providers for performing certain procedures known to be effective, or for prescribing drugs known to have equal or greater effectiveness at a reduced cost. And they can improve a beneficiary's preventive and wellness benefits.

Dialysis clinics that participate in Medicare through the program for patients with End Stage Renal Disease have a momentous mission, helping these patients enjoy life for years longer than we might have thought possible just a few decades ago. Because dialysis is such a complex operation, quality of care is extremely important.

Plans and providers in the Medicare Advantage and ESRD programs have already started measuring and reporting on quality, which makes them an excellent place to start. But I want to be clear these programs should not be singled out simply because they are ahead of the game. Working with ESRD providers and Medicare Advantage plans heralds the beginning of a longer journey, and we need to stay the course.

First, we need to monitor this quality incentive program and ensure that the methods used to measure health care quality and evaluate performance are evidence-based and valid.

Second, we should evaluate the impact of a pay-for-performance program on health plans and providers--particularly small organizations and those that are just entering the market. Additionally, because last year's Medicare legislation made payment and policy changes to these providers--for example, a short-term payment increase for ESRD and a new payment policy and the addition of regional plans for Medicare Advantage--we would need to keep a close eye on the consequences of these changes and the interaction with the pay-for-performance quality initiative and take action where necessary.

Third, we should look with a wide lens and move forward with quality initiatives in all government health care programs. It is our responsibility to set an example for the industry through quality improvement programs in Medicare and Medicaid, including traditional fee-for-service Medicare.

As I mentioned, the National Voluntary Hospital Reporting Initiative is a groundbreaking program, but we need to do more in traditional Medicare to encourage high quality care. My bill sketches out a roadmap that will lead us toward expanding the quality measures currently collected for fee-for-service providers, and ultimately toward additional Medicare payment systems that promote quality improvement.

We can also do more to focus on quality care in Medicaid. Today, there are a number of people at the Centers for Medicare and Medicaid Services whose responsibility it is to improve the quality of care in Medicare. On the Medicaid side, there is one person--one person who, while given the responsibility for quality, has no resources or authority to develop program innovations.

You might say that quality is already addressed in Medicaid. I applaud my colleague and Chairman of the Finance Committee, Senator Grassley, for encouraging CMS to increase its quality improvement activities for home and community-based services in Medicaid. We should build on this foundation and broaden the effort. We need to identify barriers to quality improvement throughout the Medicaid program, and take steps toward removing those barriers.

The bill I introduce today would target a few of those barriers, and it would require further studies to identify others. It authorizes money to hire new staff--experienced health professionals--to improve the quality and coordination of care delivered to Medicaid beneficiaries. It explores ways to integrate data on Medicaid beneficiaries who are also enrolled in Medicare--the dual-eligibles and coordinate the care they receive from both programs. Many dual- eligibles are among the sickest and costliest beneficiaries. By better coordinating their care we can improve health outcomes and save money in both programs at once.

As you can tell, I have a lot of ideas. But I have only scratched the surface of this issue and am deeply committed to working with my colleagues in the

Senate to move forward. This bill is a good start, but it is just that--a start. We must do more.

Many of my colleagues in the Senate also care deeply about improving the health care system, and I commend their efforts to develop courageous proposals that will spark change. Senator Clinton introduced a bill last year, the Health Information for Quality Improvement Act. More recently, Senator Kennedy Introduced the Health Care Modernization, Cost Reduction, and Quality Improvement Act.

These bills lay out a comprehensive array of policies to improve health care quality and reduce costs, and my bill focuses on one piece of that picture--paying for quality. They represent the gold standard toward which we should all be working. But we share a common goal to make the most of the American health care dollar, so that we can provide better care to more people.

As I mentioned, health care in this country is more expensive than it is elsewhere. But we don't necessarily get more for our money. The United States spends twice as much on health care than any other country, but studies have shown that quality is about the same. Better in some areas, worse in others, but all in all about the same. No matter how you cut it, that means that the value of our health care-- what we are getting for each dollar is less in the United States than in other developed countries.

I've always believed that Americans were all about value. We are the country of start-up companies and the home of Wal-Mart. We know about good business, and we know about hard work. We should know more--and do more--about health care.

We are an amazing country, but today our health care system is sick. Why? It is not the fault of hard-working doctors and nurses who put in long hours to make their patients healthy. It is our fault. We need to support the work of health care professionals by providing the right resources and designing payment systems to promote quality. Today, it takes an average 17 years for a new discovery in medical care to move from the lab bench into regular clinical practice. And for providers working in settings without regular Internet access or without the luxury of time to peruse medical journals, it may take even longer. As Members of Congress, we have the opportunity to change the system, to provide incentives for good care, funding for research into best medical practices, and to require the development and reporting of quality measures.

The road to this goal is long and difficult. I call on my colleagues for their energy and support, and I call on health care professionals and the health insurance industry to work with us. This is challenging work, and involves many difficult decisions. But I've never been one to shirk a challenge, and I hope you will join me. This bill is the beginning of what must be a strong bipartisan push to improve our health care system--to increase quality of care, to reduce costs, and to strengthen the American spirit.

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