Floor Statements

Mr. President, last year, America spent $2.4 trillion on health care. That is 1/6 of our economy. Yet we ranked last among major industrialized nations in the Commonwealth Fund's National Scorecard on Health System Performance, which ranks the number of deaths that could be prevented before age 75 through effective health care.

Some analysts estimate that as much as 30 percent of our spending is for ineffective, redundant, or inappropriate care. That's care that does nothing to improve the health of Americans.

Our system also leaves nearly 50 million Americans without health coverage and 25 million more with inadequate coverage. Most bankruptcies and foreclosures in America are related to medical costs.

Our system needs reform.

Today, along with Senator Conrad, the Chairman of the Budget Committee, I am proud to introduce a bill that would improve health care in America by helping doctors and patients to make better, more- informed health care decisions.

This legislation would increase the chances that Americans receive the right care. This bill would provide for research that can help physicians and patients know more about what works best in medicine, and what does not.

Some patients, receive medical treatments that work well. Some patients receive treatments that do not. In many cases, doctors simply don't have enough reliable evidence to decide which treatments are best for which patients.

Rapid innovation and advancements in medicine have led to an ever- changing array of new and sometimes expensive technologies. The age of personalized medicine and genetic engineering will provide even more choices for patients and their physicians. Indeed, both patients and physicians can face great difficulty in choosing among treatment options.

Patients and physicians need more credible information about how treatments for a specific condition compare to each other. Today, the vast majority of medical information shows how treatments work compared to placebos. Most medical information does not show how treatments work compared to each other.

For example, men with prostate cancer have a choice among 3 common treatments surgery, radiation, and chemotherapy. Each approach yields different outcomes in terms of survival, ability to return to work, and other measures of quality of life.

Comparative effectiveness research would compare each approach in a systematic way. That way, doctors and patients would have more information about how options work, and for whom. The bill that I introduce today would do just that.

This bill would facilitate comparisons across a broad spectrum of health care interventions and health care strategies that are used to prevent, treat, diagnose and manage health conditions. By evaluating and comparing what works best, patients and providers can make more informed decisions about care.

More specifically, this bill would create a nonprofit institute that would be responsible for setting national health care research priorities. The institute, called the Patient-Centered Outcomes Research Institute, would be a private

entity. It would be governed by a multi-stakeholder, public-private sector Board of Governors. It would not be an agency of the Federal Government.

Keeping the Institute a private, nonprofit entity would shelter it from potential political influence from both the executive and legislative branches of Government. The independence and expertise of the Institute would result in more credible and more useful research for Americans.

The Institute would set national priorities for comparative effectiveness research and facilitate studies that would help to answer the most pressing questions about what works, and what doesn't.

The Institute would have the authority to contract with experienced Federal agencies--such as the National Institutes of Health and the Agency for Health Care Research and Quality, or with private researchers--to carry out the actual research. The Institute would also be responsible for disseminating the findings of the research in ways that make sense to both patients and providers.

The Institute's work would not happen behind closed doors. The bill would provide opportunities for public input and scientific review of the integrity of the research being conducted. The Institute's meetings would be accessible to the public, and open forums would help to solicit and obtain input on the Institute's activities and agenda. Also, public comment periods would be made available to discuss research findings.

The Institute's work would benefit all Americans who receive health care. So both public and private payers would fund the Institute. After an initial investment from general revenues, the Institute would be funded by an all-payer system, drawing from both public and private sources.

Comparative effectiveness research would not be the ultimate decision maker. Instead, it would provide an additional tool to improve health quality. The Institute would be a health care resource, a scientific entity, a source of knowledge, and a provider of information.

According to the Institute of Medicine, this research would provide better evidence--objective information--so that doctors and patients could make better decisions.

If we are truly to reform our health care system, then we must get more evidence into the hands of the people making medical decisions. This research is not only about reducing health care costs. It is focused on addressing significant gaps in knowledge.

It is not just the academics and economists who agree. Patient advocates like the National Breast Cancer Coalition, provider groups like the American Medical Association, and consumer groups like AARP can see the benefits of this research quite clearly. They have all extended their support.

The American Recovery and Reinvestment Act made a significant investment towards this type of research. But that was just a first step. We must ensure that this research will be sustained in the years to come.

From cars to toasters, Americans are able to readily view and evaluate information about the quality and effectiveness of so many of the items that they buy. It seems only logical that they should have information on what works and what does not when it comes to their health, especially with one in every 6 of this country's dollars leing spent on health care.

It is time for Americans and their doctors to be wield the world's most advanced science, so that the most personal health care decisions, like so many of the other decisions we make, are made with access to the best available information.

I urge my colleagues to support this common-sense measure.

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

Mr. President, this Nation and this body have debated divisive trade issues for more than a century. In the 1820s, the cotton, indigo, and rice exporting southern States quarreled with northern States intent on protecting nascent manufacturing In the 1930s, President Hoover's appeals to save American jobs brought the Smoot-Hawley tariff.

Since the Second World War, America has moved to open the world's markets and our own. We are better for it. But divisive trade debates do and will continue. Few debates have been as long and contentious as those regarding our economic sanctions on Cuba.

I am introducing legislation today to bring this divisive debate to an end. I do so not as an ideologue or a partisan. I am neither the Cuban government's friend nor its staunchest enemy. I instead am a Montanan. Like most Montanans, I take no pleasure in disagreement. Like most Montanans, I try to make a deal when I can. Like most Montanans, I stick to the facts.

Here is how I see the facts. Opening Cuba to our exports means money in the pockets of farmers and ranchers across America. Lifting financing and other restrictions on U.S. agriculture could increase U.S. beef exports from states like Montana and Colorado from $1 million to as much as $13 million. Lifting these restrictions could allow agricultural exporters in States like North Dakota and Arkansas to obtain nearly 70 percent of Cuba's wheat market, nearly 40 percent of its rice market, and more than 90 percent of its poultry market. Lifting these restrictions could allow America's farmers and ranchers to export as much as $1.2 billion in total agricultural goods to Cuba.

The facts also show that European and other exporters already reap these benefits. Europe has scrapped its Cuba sanctions. Just last week, EU officials were in Havana calling for full normalization of ties. Those officials made no secret of wanting to solidify ties with Cuba now to get the jump on the U.S.

Those are the facts as I see them. But that is not all I see. I am not blind to the Cuban people's suffering or the crimes of their government. I am not deaf to the calls for political and religious freedom just 90 miles off our shores. But I also see that increased trade ties historically have led to improved political ties, whether between Argentina and Brazil in this hemisphere or between former rival nations in Europe.

Am I certain that increased trade will improve our political ties with Cuba? I am not. But I am certain that we have had these sanctions in place for over 5 decades. I am certain that five decades of sanctions have made no Cuban freer, no nation more prosperous, and no government more democratic. I am certain that one side has gotten its chance and its way. I am certain that the status quo must now change.

Here is how I propose to change our status quo with Cuba. My bill, which 15 other Democratic and Republic Senators have joined, would help U.S. farmers and ranchers sell their products to Cuba by facilitating cash payment for agricultural goods, authorizing direct transfers between U.S. and Cuban banks, and creating a U.S. agricultural export promotion fund. This bill also eases restrictions on exports of medicines and medical devices. It allows all Americans to travel to Cuba--not just one particular group.

John Stuart Mill wrote that ``Commerce first taught nations to see with goodwill the wealth and prosperity of one another. Before, the patriot . . . wished all countries weak, poor, and ill-governed but his own . . .'' For too long, America has stood atop our barricade of sanctions and looked down upon a weak, poor, and ill-governed Cuba. Let us now open our commerce with Cuba. Let us wish them wealth, prosperity, and an abundance of all that we value and hold dear in America.

Mr. President, this Nation and this body have debated divisive trade issues for more than a century. In the 1820s, the cotton, indigo, and rice exporting southern States quarreled with northern States intent on protecting nascent manufacturing In the 1930s, President Hoover's appeals to save American jobs brought the Smoot-Hawley tariff.

Since the Second World War, America has moved to open the world's markets and our own. We are better for it. But divisive trade debates do and will continue. Few debates have been as long and contentious as those regarding our economic sanctions on Cuba.

I am introducing legislation today to bring this divisive debate to an end. I do so not as an ideologue or a partisan. I am neither the Cuban government's friend nor its staunchest enemy. I instead am a Montanan. Like most Montanans, I take no pleasure in disagreement. Like most Montanans, I try to make a deal when I can. Like most Montanans, I stick to the facts.

Here is how I see the facts. Opening Cuba to our exports means money in the pockets of farmers and ranchers across America. Lifting financing and other restrictions on U.S. agriculture could increase U.S. beef exports from states like Montana and Colorado from $1 million to as much as $13 million. Lifting these restrictions could allow agricultural exporters in States like North Dakota and Arkansas to obtain nearly 70 percent of Cuba's wheat market, nearly 40 percent of its rice market, and more than 90 percent of its poultry market. Lifting these restrictions could allow America's farmers and ranchers to export as much as $1.2 billion in total agricultural goods to Cuba.

The facts also show that European and other exporters already reap these benefits. Europe has scrapped its Cuba sanctions. Just last week, EU officials were in Havana calling for full normalization of ties. Those officials made no secret of wanting to solidify ties with Cuba now to get the jump on the U.S.

Those are the facts as I see them. But that is not all I see. I am not blind to the Cuban people's suffering or the crimes of their government. I am not deaf to the calls for political and religious freedom just 90 miles off our shores. But I also see that increased trade ties historically have led to improved political ties, whether between Argentina and Brazil in this hemisphere or between former rival nations in Europe.

Am I certain that increased trade will improve our political ties with Cuba? I am not. But I am certain that we have had these sanctions in place for over 5 decades. I am certain that five decades of sanctions have made no Cuban freer, no nation more prosperous, and no government more democratic. I am certain that one side has gotten its chance and its way. I am certain that the status quo must now change.

Here is how I propose to change our status quo with Cuba. My bill, which 15 other Democratic and Republic Senators have joined, would help U.S. farmers and ranchers sell their products to Cuba by facilitating cash payment for agricultural goods, authorizing direct transfers between U.S. and Cuban banks, and creating a U.S. agricultural export promotion fund. This bill also eases restrictions on exports of medicines and medical devices. It allows all Americans to travel to Cuba--not just one particular group.

John Stuart Mill wrote that ``Commerce first taught nations to see with goodwill the wealth and prosperity of one another. Before, the patriot . . . wished all countries weak, poor, and ill-governed but his own . . .'' For too long, America has stood atop our barricade of sanctions and looked down upon a weak, poor, and ill-governed Cuba. Let us now open our commerce with Cuba. Let us wish them wealth, prosperity, and an abundance of all that we value and hold dear in America.

Madam President, today I would like to recognize one of the finest members of my staff to ever work for me, the State of Montana, and the U.S. Senate. Demetrios James Marantis has served in the Senate since 2005, and on Wednesday, the Senate approved his nomination to be Deputy U.S. Trade Representative.

When Demetrios first joined my staff more than 4 years ago, he came with a chorus of support and an impressive set of skills and experience. This week, he leaves the Senate for his next challenge with an even larger group of supporters and another impressive list of accomplishments.

Demetrios was at the center of the largest expansion and reform of trade adjustment assistance since its creation four decades ago. He was critical to our granting permanent normal trade relations to Vietnam, and instrumental in keeping U.S.-China economic ties on track in challenging times. Demetrios helped me and the Senate extend trade preference programs to the world's poorest nations, and worked to lay the groundwork for the important pending trade agreements that I hope that the Senate will consider in the coming months.

He did all of this with an unwavering commitment to this country, and an unassailable reputation for fairness and openness to supporters and opponents alike. And as many of my colleagues and their staff will always remember, Demetrios never failed to bring a little bit of fun and a good sense of humor to even the hardest job.

But what I will remember most about Demetrios is his commitment to the people that our economic policies affect. In Montana, Demetrios made a point to know the ranchers in Molt, the seed potato farmers in Manhattan, and the wheat farmers in Three Forks. Demetrios's intelligence and experience helped guide me and the Senate through the letter of our trade laws. But his good character and heart reminded us what those trade laws are really about America's workers, farmers, ranchers, and families.

I congratulate Demetrios on his nomination, thank him for his good work, and wish him the best of luck as Deputy U.S. Trade Representative.

I ask unanimous consent that the following Finance Committee staff be granted floor privileges during consideration of the Sebelius nomination: Kelly Whitener, William Martinez, and Michael London.

Madam President, this amendment sounds good on the surface, but, frankly, it will make health care reform more difficult. It is difficult enough as it is. This amendment will make it much more difficult.

Some suggest that wealthier Americans should be ``means tested;'' that is, they should not get the same benefit under the Part D drug benefit as others. That is a policy that needs to be debated. I personally think that is something we should consider. After all, as the Senator from Nevada said, it is in the President's budget to means test Part D drug benefits.

But that is not the point here. The point here is, do we want to help make health care reform easier or more difficult? The effect of the amendment is to reduce the Finance Committee's allocation in health care reform. That is going to make the Finance Committee's effort to get meaningful health care reform more difficult.

I suggest we take up that issue--whether to means test Medicare or not--in the context of health care reform. Then the savings that would be achieved by means testing--if we enacted it--would go toward health care reform.

The effect of the Senator's amendment is twofold. One is to suggest means testing Medicare Part D, which is in the President's budget, but the President doesn't want to use means testing to reduce spending on health care. He doesn't want that. So it would accomplish both purposes; that is, to be sure we meaningfully address means testing but in a way that doesn't hurt the efforts of health care reform.

It makes much more sense to not adopt this amendment but take up the question of means testing in the context of health care reform, where it is part of many other components of health care reform, where the pieces will fit together in a way that makes more sense.

I respectfully say this is not the place to consider means testing. It should be done in the context of health care reform. If we don't approve this amendment, then we can deal with this issue on health care reform.

There are a lot of arguments for and against this. I take no firm position as chairman of the Finance Committee, but I believe the Senator's concept has merit. After all, it is in the President's budget, but it should not be done here, which has the effect of taking it out of the Finance Committee's allocation, which makes it more difficult for the Finance Committee to do its work on health care reform.

I respectfully urge Senators to not support this amendment so we can make it easier to take up health care reform in a way that we can consider this policy as one of the many we take up on health care reform.

Again, I urge that the amendment not be adopted so we can do our job.

I yield the floor.

Mr. President, I have lined up to speak. So many of us want to congratulate the esteemed Senator from Iowa. I congratulate him on his 10,000th vote.

Many of you know Chuck and I get together once a week. We started this practice at least 8 or 9 years ago, and sometimes he is chairman, sometimes I am chairman; chairman or ranking member, vice versa, back and forth. We meet every Tuesday at 5 o'clock in the afternoon, and we have done this for 8 years. Maybe we have missed five or six or seven times, but constantly, consistently we get together to go over matters, minimize misunderstandings, and so forth. Lately, the last couple, 3 years, the meetings have been in my office. I have a little bit bigger conference room. That is not the real reason, though. The real reason is, as Chuck always reminds me, in my office the coffee is free, so it is much better to meet in my office.

All of you who know Chuck know he passes the airport test; that is, if you are ever stranded in an airport for 10 or 12 hours and you are sitting next to somebody, you get to like the person or you do not get to like the person. Chuck more than passes the airport test. The more you get to know Chuck Grassley, the more you will like him. It is his decency, his honesty. He is unpretentious. It is his basic Iowa grassroots personality. It means so much to me, in spending so much time with him. The only time our meetings are cut short, I might say, is when Chuck has to dash out and get on the radio and talk to people back home in Iowa; otherwise, Chuck stays throughout the meeting. The people in Iowa mean so much to him.

I might also say that we know how much he protects taxpayers' interests. It has been mentioned--whistleblower legislation, which he promotes so aggressively. He is also downright parsimonious himself. He turns the balance of his office budget back to the taxpayers. Every year, he returns a good portion back to the taxpayers. He also, I might say, promotes ethanol for several reasons. One, it is good for Iowa. But he also contributes to the reduction of fossil fuel consumption. When he comes back home from plowing his field, he is on his tractor, and he coasts downhill the last mile to save a few pennies of diesel fuel. He does. I checked that out a short while ago. Yes, he does that just to save a few pennies of diesel fuel.

Anyway, I want to tell you how much I appreciate him. He is one of my very best friends.

I think the measure of a Senator really is whether he or she is popular in two different areas, with two different audiences. First is the people back home--how popular is a Senator back home? The second is, how popular is he or she with his or her colleagues? There are two separate audiences. There are two separate criteria. Clearly, Chuck is popular in both areas. He is very popular in Iowa. The people of Iowa love him. The people, Members of the Senate love him. He is one heck of a guy, and I just feel so honored to be able to serve with Chuck on the Finance Committee, but also, more importantly, he is a very good friend here in the Senate.

So I congratulate you, Chuck.

(Applause, Senators rising.)

Mr. President, the Bennett amendment would express the importance of taxpayers' ability to take deductions for contributions to charity. It is also important to recognize that this amendment is not inconsistent with either current law or the President's budget.

This amendment is also consistent with the votes that we took last week when we affirmed our support for charitable contributions.

I urge the Senate to adopt the amendment.

Amendment No. 949

Mr. President, this is not an insignificant amendment. It is not small change. It has very significant consequences to all States. A very small number of States, a handful, will

get a big windfall. All of the rest of the States will have money otherwise raised from OCS--raised from revenues from mineral leasing royalties not go to them at all.

Currently, revenue goes to all 50 States. There is a small carving out for some of the coastal States and Florida. This amendment says: All the revenue raised, all the coastal revenue goes to only those few coastal States, which means revenue would not go to the other States that benefit currently from oil and gas leasing revenue.

The other big consequence is, this is a big tax increase. It is a revenue-neutral provision. That means it is $110 billion, conservatively, over 10 years, which means we have to raise taxes $110 billion to pay for giving money to a small handful of States and take it away from the majority of the States.

I strongly urge members not to support this amendment.

Mr. President, I oppose this amendment for a lot of reasons. No. 1, this is an unfunded mandate. The TANF program, the low- income program, the welfare program, is a block grant program. We give to all the States and the States set up their own systems under TANF. This is an unfunded mandate. It tells States they have to test all low- income people for drugs.

I think, frankly, it is a mean-spirited amendment. I believe we should not equate all low-income families with drug addiction. States can decide for themselves if they want to drug test. My State of Montana does. TANF, again, is a block grant program. States can decide for themselves what they want to do. We should not equate all low- income families with drug addiction, and I strongly encourage this amendment be soundly defeated.

Mr. President, the chairman of the committee and the ranking member did such a wonderful job. I think we should all express our appreciation.

(Applause, Senators rising.)

Mr. President, I rise today to introduce the Rural Heritage Conservation Extension Act of 2009, along with my good friend, Senator Grassley from Iowa.

As we all know, the country, including my home State of Montana, is losing precious agricultural and ranch lands at a record pace. While providing Montana and the Nation with the highest quality food and fiber, these farms and ranches also provide habitat for wildlife and the open spaces, land that many of us take for granted and assume will always be there. Conservation easements have been tremendously successful in preserving open space and wildlife habitat. Montana has begun to recognize the importance of using conservation easements to preserve these lands. We currently have more than 1.5 million acres covered by conservation easements. To some, that may seem like a large amount, but this is Montana, a State that covers 93,583,532 acres.

To assure that open space and habitat will be there for future generations, we must help our hardworking farmers and ranchers preserve this precious heritage and their way-of-life. The Congress recognized this by providing targeted income tax relief to small farmers and ranchers who wish to make a charitable contribution of a qualified conservation easement. The provision allows eligible farmers and ranchers to increase the amounts of deduction that may be taken currently for charitable contributions of qualified conservation easements by raising the Adjusted Gross Income, AGI, limitations to 100 percent and extending the carryover period from 5 years to 15 years. In the case of all landowners, the AGI limitation was raised from 30 percent to 50 percent. This provision will expire at the end of this year.

The number of acres protected and easements held by state and local land trusts has grown as a result of this incentive. According to the Land Trust Alliance, America's Land Trusts protected 535,000 more acres with conservation easements in the first two years with the new tax incentive than in the previous two years, a 36 percent increase. In 2006 and 2007, land trusts added over 6,000 easements, about 2,000 more than the 2 years before the incentive.

The Rural Heritage Conservation Extension Act of 2009 would make this allowable deduction permanent, building on the success of conservation easements. Our farmers and ranchers will be able to preserve their important agricultural and ranching lands for future generations, while continuing to operate their businesses. Landowners, conservationists, the Federal Government, and local communities are working together to preserve our precious natural resources.

This legislation is vitally important to Montana, and to every other State in the Nation.

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

Mr. President, I rise today to introduce the Rural Heritage Conservation Extension Act of 2009, along with my good friend, Senator Grassley from Iowa.

As we all know, the country, including my home State of Montana, is losing precious agricultural and ranch lands at a record pace. While providing Montana and the Nation with the highest quality food and fiber, these farms and ranches also provide habitat for wildlife and the open spaces, land that many of us take for granted and assume will always be there. Conservation easements have been tremendously successful in preserving open space and wildlife habitat. Montana has begun to recognize the importance of using conservation easements to preserve these lands. We currently have more than 1.5 million acres covered by conservation easements. To some, that may seem like a large amount, but this is Montana, a State that covers 93,583,532 acres.

To assure that open space and habitat will be there for future generations, we must help our hardworking farmers and ranchers preserve this precious heritage and their way-of-life. The Congress recognized this by providing targeted income tax relief to small farmers and ranchers who wish to make a charitable contribution of a qualified conservation easement. The provision allows eligible farmers and ranchers to increase the amounts of deduction that may be taken currently for charitable contributions of qualified conservation easements by raising the Adjusted Gross Income, AGI, limitations to 100 percent and extending the carryover period from 5 years to 15 years. In the case of all landowners, the AGI limitation was raised from 30 percent to 50 percent. This provision will expire at the end of this year.

The number of acres protected and easements held by state and local land trusts has grown as a result of this incentive. According to the Land Trust Alliance, America's Land Trusts protected 535,000 more acres with conservation easements in the first two years with the new tax incentive than in the previous two years, a 36 percent increase. In 2006 and 2007, land trusts added over 6,000 easements, about 2,000 more than the 2 years before the incentive.

The Rural Heritage Conservation Extension Act of 2009 would make this allowable deduction permanent, building on the success of conservation easements. Our farmers and ranchers will be able to preserve their important agricultural and ranching lands for future generations, while continuing to operate their businesses. Landowners, conservationists, the Federal Government, and local communities are working together to preserve our precious natural resources.

This legislation is vitally important to Montana, and to every other State in the Nation.

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

Madam President, we in Congress this year are embarked on major efforts to enact health care reform. It is very much in the President's budget. President Obama very much wants to enact health care reform this year. There are provisions in the budget resolution to encourage us as a body, a Congress, to enact health care reform.

The basic reason is because it is so needed. It is incredibly important that our Nation enact health care reform this year. I am not going to get into all the details and the various provisions that we must enact in order to get meaningful health care reform. By meaningful health care reform, I mean controlling costs. I remind my colleague, we in America spend about $2.5, $2.6 trillion on health care. That is this year. If we do not do anything, those costs are going to almost double in 6 to 8 years.

We can't continue to spend what we do on health care. We spend almost twice as much as the next most expensive country. It is a huge cost of business. It is a very big cost to American business. American companies are becoming less competitive. Why? Because health care costs are too high; business costs are too high.

In addition, look at our Medicare budget. It is going out of sight. If we do nothing, if we don't curb our underlying Medicare budget costs, our budget, along with Medicaid, will probably double in another 8 or 9 or 10 years. That is unsustainable, to say nothing about individual costs to individual Americans, the personal costs, the family costs, the premium costs. We don't have a system in this country. We have a hodgepodge of lots of different functions--doctors, nurses, insurance companies, medical equipment suppliers, PMDs-- everything is part of the system, and they are all trying to help supply health care, but because it is so disjointed we have a nonsystem where costs are just rising exponentially. We also have a nonsystem where 46 million Americans don't have health insurance, and about 25 million additional Americans are underinsured. It is ridiculous. This is the only industrialized country without health insurance. What we need is a solution which is uniquely an American solution.

We are not Canada, we are not Great Britain, we are not France, we are not Sweden, we are the United States of America. By ``uniquely American,'' I mean it should be a combination of public and private. That $2.6 trillion we spend today is divided half in private and half in public. We must find a way to curb costs, to get coverage to Americans retaining that uniquely American approach of private and public coverage.

We are working hard to try to find that solution. Part of the solution is reducing unnecessary costs and waste in our system. There is immense waste in the American health care system--immense waste. Basically, it is because of practice patterns, it is because of the way we reimburse on volume and quantity, not quality.

We have to move much more toward reimbursement; that is, paying doctors and hospitals on the basis of quality, not volume, and concepts such as bundling and medical home and health IT, which is in the budget, so we have information technology assistance to help, in several years, get to the point where we reduce health care cost.

But another is, frankly, comparative effectiveness. We need to know the comparative effectiveness of drugs, procedures, medical equipment, et cetera, so we get the best, highest quality, and we, therefore, will probably know which ones will tend to cost more than others. Doctors can make choices, patients can make choices, and insurance companies can make choices as to which procedure, which drug makes more sense. Basically, it is up to the doctor to decide which way makes the most sense.

Now, the effect of the Kyl amendment, as I understand, is, frankly, to say that you have to pay for a very costly procedure that somebody deems to be not only ineffective, it may be harmful, and you have to pay for it. That does not make sense. Rather, I think the Senator from Arizona agrees with me, we are trying to figure out a way to use comparative effectiveness to help doctors have more information, and hospitals more information, as to which works better, has higher quality, and works better when compared to something else.

We are going to have to get into issues such as evidence-based medicine to help determine quality. Lots of concepts here that make a lot of sense. But I wished to say that whereas the intention--I somewhat understand the intention of the amendment, somewhat. I do not entirely understand the intention of the amendment.

But the effect of the amendment is to say that a procedure--let me get this straight. The language does not curb growth in health care spending by using data obtained by comparative effectiveness. It says there can be a procedure determined to be totally ineffective or may be harmful, but it has to be used. The doctor has to use it. That does not make sense.

I think it is a doctor's choice as to whether, by looking at the various procedures, what makes more sense compared to something else, using the data we provide by this process. But that is still a doctor's choice. That doctor, he or she, that doctor should decide which of these makes the most sense.

Therefore, I think it makes much more sense, frankly, that this not be approved. It is not necessary. It kind of gets in the way.

Senator Hatch and I and Senators Grassley and Enzi are introducing a comparative effectiveness amendment. It gets to what I think the Senator from Arizona wants us to move toward; that is, comparative effectiveness, where we look at comparative quality of procedures, which is what we are trying to do--not cost but quality.

There was a big dustup in the stimulus debate about comparative effectiveness because somebody thought we were putting a cost-benefit analysis in it. We are not. We took that out. I must say to my friends, I went to the mat, frankly, to make sure cost was taken out. We took it out. It is just comparing quality.

The bill I hope to introduce--working to get support from Senators Grassley, Hatch, and Enzi--would take cost out. It is just looking at quality. That is what we want to do. It is based on quality.

I think the Senator from Arizona will be very happy with that bill we are going to be introducing because it gets

at what I think the Senator wants: Let's compare quality, but let's not put the cost component into it because that would not be appropriate at this time.

No.

Madam President, this is a rather remarkable amendment. It basically says we cannot pay any attention to the fruits of clinical research in making decisions about what is covered under health care reform. I find that pretty amazing.

For example, let's say that clinical research shows a certain procedure is not only not good but it is harmful, such as Vioxx, which caused problems for seniors. This amendment says we cannot use that evidence. We cannot use that information. We can't do that because it might suggest we can't use a certain procedure--Vioxx.

This is an ostrich amendment. This is a head-in-the-sand amendment. We want to have the benefits of clinical research so that doctors can make up their own minds what is the best procedure. We want the fruits and the benefit of clinical research to address the quality of health care.

I urge Members to vote for health care and vote against this amendment.

I might say, too, Madam President, that I misspoke earlier when I said who is a cosponsor of the bill. We are urging Senators Enzi and Hatch to cosponsor the bill. They haven't quite done that yet, but I think it is going to happen.

Mr. President, I would like to recognize Tessa Shumway of Terry, MT--this year's winner of the National Disaster Response Preparedness Award from the American Red Cross. Tessa is from Terry, a small town in eastern Montana.

In Montana, we are proud of our open spaces, of our outdoor heritage and our rural landscape. We didn't get the title ``Big Sky Country'' by filling our land with skyscrapers or high rises or byways. We are hard working, quiet people with the grit to build our lives on some of the most beautiful and rugged land on Earth. We are Montanans.

Of course, living in Montana's rural communities can create some challenges. For folks in places like Ismay or Brockaway, when disaster strikes, the nearest help may be miles away. And that is where Tessa Shumway comes in. Tessa is the face of the Red Cross across 10 counties in eastern Montana. Her territory is larger than the entire State of Indiana.

She is on call 24 hours a day, every day of the week. She is the local disaster chair, disaster instructor, preparedness trainer, volunteer recruiter and statewide disaster committee cochair. In addition to all this, Tessa holds a regular day job as a bartender at the American Legion in Terry.

Tessa received the Disaster Response Preparedness Award not only for her years spent helping the folks of eastern Montana, but also for the new volunteers and Red Cross workers she has trained. It is impossible to know how many lives she has touched, how many people she has helped, simply by passing her knowledge on to others.

I would like to congratulate Tessa, her husband Zane and two children, Josh and Katrina--as well as the folks of Terry, who have a true hero in their community.

March of 2009 was a difficult month for Montanans. Several tragedies shook our State, from a deadly explosion in Bozeman to the tragic plane crash in Butte. Montana's Red Cross stepped up to help folks recover and rebuild. Tessa herself was on hand to help victims of the fire in Miles City and find shelter for folks displaced by dangerous winter storms.

I believe service is one of the most honorable things a person can do. Whether it is service to one's community, State or country--service is the most noble of all human endeavors. That is why I would like to recognize Tessa Shumway as a Montana hero--a woman who has given so much of herself to her neighbors and to the people of our State. We are lucky to have her under the Big Sky and I am proud to call her a fellow Montanan.

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

Madam President, the amendment offered by the Senator from South Dakota would state the sense of the Senate that the tax law should not be changed in any way that would discourage taxpayers from making charitable contributions and gifts.

This country has a proud tradition of charitable giving. We are proud of that tradition. We are proud that we give to those in need, and we should encourage people to keep on giving. One of the best ways to do that is through the itemized deduction for charitable giving.

We very much support the itemized deduction for charitable giving. But the Senator's amendment is overbroad. It would put the Senate on record as favoring the preservation of incentives for charitable giving over all other priorities.

Let me talk about a few other priorities the Senate might want to consider.

What about cracking down on tax cheats? What about balancing the budget? What about repealing the so-called death tax? The Senator's amendment could be read as conflicting with each of those other priorities.

Let me explain. Let's say a tax cheat sets up a charity that is really a scam. Should the IRS be able to crack down on that scam? Of course it should. But the Senator's amendment says we should preserve the full income tax deduction.

Let's say we want to repeal the estate tax--some call it the death tax. There is pretty wide agreement that it is a disagreeable tax. But studies have also shown that repeal of that death tax would decrease charitable giving. Should we not scale back the estate tax anyway? Of course we should. But the Senator's amendment would put the Senate on record that we always want to encourage charitable giving rather than discourage it, which would put a big limitation on reducing the death tax.

What if we reach a bipartisan budget agreement to limit the deficit and help balance the budget? Might we want to consider limiting the ability of upper income taxpayers to take their full deductions?

This is not so farfetched an idea. Under current law, itemized deductions are already limited for high-income givers--taxpayers with more than $166,800 in income. Congress enacted that change as part of a bipartisan budget agreement, negotiated by OMB Director Dick Darman, and signed into law by the first President Bush. Yet these Americans still give. Americans who itemize deductions, as well as those who don't itemize deductions, continue to give.

According to the CRS, only 30 percent of taxpayers claim a deduction for charitable giving. Yet we know many more give to charity. The group Independent Sector found that 70 percent of households give.

Thankfully, many taxpayers make charitable contributions, even though they are not getting any tax benefit at all. Indeed, one might say the greatest charity is when someone gives from the heart rather than just when it is tax deductible. So we do not need the extreme statement in the Senator's sense-of-the-Senate amendment.

I have offered a side-by-side amendment that emphasizes Congress's continued support of tax incentives for giving. Let's show our support for charitable giving without making the categorical statement in the Thune amendment.

I urge my colleagues to oppose the Thune amendment and support the Baucus amendment.

Amendment No. 721 to Amendment No. 687

Madam President, I ask unanimous consent that all pending amendments be temporarily laid aside so that I may call up amendment No. 721.

Madam President, I ask unanimous consent that reading of the amendment be dispensed with.

Madam President, I yield the floor.

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

Mr. President, the Senate is about to vote on two amendments on the tax treatment of charitable giving. The first is my amendment. My amendment would put the Senate on record supporting charities. It says Congress should look for ways to encourage charitable giving. I hope my colleagues can support it.

The second amendment is the Thune amendment. The Thune amendment favors preservation of full taxing incentives for charitable giving, over all other priorities. That is overbroad. That is extreme. I will have more to say about that in a few minutes.

But the first vote is now on my amendment to state that the Senate's strong support for charitable giving. I encourage my colleagues to support that amendment.

I encourage all time to be yielded back.

Mr. President, the Thune amendment says: Preserve full tax incentives for charitable giving, over all other priorities.

This is a shot at President Obama's proposal to limit deductions for those making more than a quarter of a million dollars a year.

But the Senator's amendment is broader than that. It is overbroad.

Should the tax law be able to crack down on charities that are actually scams? Of course, it should.

But the Thune amendment says: Preserve the full income tax deduction, no matter what.

Should we scale back the estate tax, even if it would decrease charitable giving? Of course, we should.

But the Thune amendment says: Don't discourage charitable giving.

This amendment is overbroad. I urge my colleagues to oppose the amendment.

I ask for the yeas and nays.

I thank my colleague from New Mexico, the chairman of the Energy and Natural Resources Committee, for his dedication to this issue. I am pleased to have worked with Senator Bingaman, the chairman of the Finance Subcommittee on Energy, Natural Resources, and Infrastructure, on this new incentive. And I wholeheartedly agree with Senator Bingaman that we cannot allow the United States to miss the opportunity to add thousands of green manufacturing jobs. This new tax credit for investment in advanced energy facilities will level the playing field so that the U.S. can compete for these jobs, and I was pleased to include it in my chairman's mark when the Finance Committee considered this legislation.

Under section 1302 of ARRA, the Treasury Secretary is authorized to award total credits of up to $2.3 billion for qualifying projects. Within 180 days of enactment, the Treasury Secretary, in consultation with the Secretary of Energy, is required to establish a program to consider and award certifications for projects that qualify for the credit. The bill enumerates selection criteria that the Treasury Secretary shall take into consideration. The Finance Committee developed these criteria with the Energy and Natural Resources Committee, and through the Chair, I would like to ask Senator Bingaman to explain the criteria and clarify how Congress intends the administration to implement this credit.

I most certainly agree with the Senator's description and I thank him for his collaboration in developing this robust new tax credit.

Mr. President, there is a storm brewing. This storm is not an act of God. It is man-made. It is coming to a head next year.

The 2001 tax cut law gave much-needed tax relief to families with children. It gave much-needed tax relief to families with college students. It gave much-needed relief to family-owned businesses.

I worked on those tax cuts. I believed in them.

But the provisions in that bill expire on December 31, 2010.

Since the day that we passed that bill, we have passed others. These other bills expanded and enhanced some of the 2001 provisions that help America's families.

Next year, all that we have done disappears. American families are left in a state of uncertainty. This uncertainty undermines confidence in the Government and the future.

That is why, today, I am introducing the Taxpayer Certainty and Relief Act of 2009.

This bill would make permanent several expiring provisions that help families.

This bill would make permanent the tax cuts for the 10 percent, 15 percent, 25 percent, and 25 percent tax brackets. Without this change, taxpayers would experience up to a $5,000 tax increase. This bill would make permanent the lower capital gains rates for taxpayers in these brackets.

This bill would makes permanent the marriage penalty relief enacted in 2001. This would guaranty that married couples would not be penalized when they take their wedding vows.

This bill would also make permanent the $1,000 child tax credit. It would also make permanent the refundable child tax credit, with a threshold of $3,000, that was recently passed as part of the American Recovery and Reinvestment Act.

This is important because prior to the 2001 bill, this credit was $500 and not refundable.

This bill would make permanent the expansion of the earned income tax credit. As a result, married couples would get more relief and families with three or more children would get a larger credit.

The bill would help working men and women by making permanent the changes to the dependent and child care credit. This credit helps cover the increased expenses of providing child care during a time when everyone is struggling to stay employed and weather this economic downturn.

This bill would also make permanent the increased credit for adoption. Giving a child a home and love is expensive. Families that adopt children have a lot of expenses. This bill would continue to give a $10,000 credit for adoption expenses.

These provisions recognize the increased cost of raising children. Congress values families and wants every family to succeed.

Another problem that Congress has to tackle every year is the Alternative Minimum Tax, or the AMT. This tax creeps up on millions of taxpayers every year. Every year, Congress holds this monster at bay, making sure no new taxpayers pay this horrible tax.

As a result, the number of taxpayers paying the AMT remains at just over 4 million. Without Congress's action, 26 million people would have to pay this tax.

This bill would permanently fix the AMT. It sets the exemption at 2009 levels and indexes it for future years. It also allows the AMT against the nonrefundable credits.

Finally, this bill would offer certainty on the estate tax. This is something that I have tried to get done over and over again. The Finance Committee held several hearings discussing this tax. This bill makes permanent current law. This bill would set the exemption at $3.5 million, or $7 million for married couples. It would also set the tax rate at 45 percent.

We have also made some other needed fixes. This bill would unify the gift and estate taxes. This bill would also allow a decedent spouse to transfer any unused exemption to the surviving spouse. This is known as portability.

I believe that this bill is just the beginning. I realize there are other tax cuts that need to be made permanent. For example, I hope to address education issues later this year.

But today, let us begin to give working families some shelter from the coming storm.

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

Mr. President, there is a storm brewing. This storm is not an act of God. It is man-made. It is coming to a head next year.

The 2001 tax cut law gave much-needed tax relief to families with children. It gave much-needed tax relief to families with college students. It gave much-needed relief to family-owned businesses.

I worked on those tax cuts. I believed in them.

But the provisions in that bill expire on December 31, 2010.

Since the day that we passed that bill, we have passed others. These other bills expanded and enhanced some of the 2001 provisions that help America's families.

Next year, all that we have done disappears. American families are left in a state of uncertainty. This uncertainty undermines confidence in the Government and the future.

That is why, today, I am introducing the Taxpayer Certainty and Relief Act of 2009.

This bill would make permanent several expiring provisions that help families.

This bill would make permanent the tax cuts for the 10 percent, 15 percent, 25 percent, and 25 percent tax brackets. Without this change, taxpayers would experience up to a $5,000 tax increase. This bill would make permanent the lower capital gains rates for taxpayers in these brackets.

This bill would makes permanent the marriage penalty relief enacted in 2001. This would guaranty that married couples would not be penalized when they take their wedding vows.

This bill would also make permanent the $1,000 child tax credit. It would also make permanent the refundable child tax credit, with a threshold of $3,000, that was recently passed as part of the American Recovery and Reinvestment Act.

This is important because prior to the 2001 bill, this credit was $500 and not refundable.

This bill would make permanent the expansion of the earned income tax credit. As a result, married couples would get more relief and families with three or more children would get a larger credit.

The bill would help working men and women by making permanent the changes to the dependent and child care credit. This credit helps cover the increased expenses of providing child care during a time when everyone is struggling to stay employed and weather this economic downturn.

This bill would also make permanent the increased credit for adoption. Giving a child a home and love is expensive. Families that adopt children have a lot of expenses. This bill would continue to give a $10,000 credit for adoption expenses.

These provisions recognize the increased cost of raising children. Congress values families and wants every family to succeed.

Another problem that Congress has to tackle every year is the Alternative Minimum Tax, or the AMT. This tax creeps up on millions of taxpayers every year. Every year, Congress holds this monster at bay, making sure no new taxpayers pay this horrible tax.

As a result, the number of taxpayers paying the AMT remains at just over 4 million. Without Congress's action, 26 million people would have to pay this tax.

This bill would permanently fix the AMT. It sets the exemption at 2009 levels and indexes it for future years. It also allows the AMT against the nonrefundable credits.

Finally, this bill would offer certainty on the estate tax. This is something that I have tried to get done over and over again. The Finance Committee held several hearings discussing this tax. This bill makes permanent current law. This bill would set the exemption at $3.5 million, or $7 million for married couples. It would also set the tax rate at 45 percent.

We have also made some other needed fixes. This bill would unify the gift and estate taxes. This bill would also allow a decedent spouse to transfer any unused exemption to the surviving spouse. This is known as portability.

I believe that this bill is just the beginning. I realize there are other tax cuts that need to be made permanent. For example, I hope to address education issues later this year.

But today, let us begin to give working families some shelter from the coming storm.

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