Floor Statements

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 President, I ask unanimous consent that the order for the quorum call be rescinded.

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 President, I ask unanimous consent that the order for the quorum call be rescinded.

Mr. President, I yield myself 5 minutes.

I rise to discuss the pending nomination of Dr. Lester Crawford to be the Commissioner of Food and Drugs. I particularly thank all of the people who have been involved in this nomination process. It has been a great bipartisan effort. It has been thoroughly explored and we finally are at a point where we can have an actual FDA Commissioner approved. It will be a tremendous relief to me and to the Nation, I am sure.

I particularly want to thank Senator Kennedy for his efforts in proceeding through the different hearings that we have had and all of the other work that we have had to do. The Food and Drug Administration is tasked with the broad and critical mission of protecting public health. The FDA Commissioner is in charge of an agency that regulates $1 trillion worth of products a year.

The agency ensures the safety and effectiveness of all drugs and biological products like vaccines, medical devices, and animal drugs and feed. It also oversees the safety of a vast variety of food products as well as medical and consumer products, including cosmetics.

In addition, the Commissioner is responsible for advancing the public health by helping to speed innovations in its mission areas and by helping the public get accurate, science-based information on medicines and foods. The FDA has been without a confirmed Commissioner for more than a year.

In January of this year, 17 members of the Senate Committee on Health, Education, Labor and Pensions sent a bipartisan letter to the President urging him to nominate a Commissioner to provide the agency with greater clarity and certainty in its mission to protect our food and drug supplies. Recent breakthroughs in medical science and technology show how quickly science and technology are changing our lives each and every day.

The FDA is at a critical point in its history. The potential benefits from our medical research are staggering. A fully confirmed FDA Commissioner is essential to ensuring that these medical breakthroughs can be brought to the market safely and effectively. Consumers deserve to have a fully functional FDA that can oversee the industry with confidence and authority and harness the technical achievements that can improve and save lives.

I believe the President's nominee, Dr. Lester Crawford, has the right qualifications to lead the FDA and to bring about the necessary reforms to maintain consumer confidence in our Nation's drug safety. Clearly we need someone at the helm of the FDA who can direct the agency and work with Congress to find the answers to these and many other difficult issues that will continue to come before us.

Dr. Crawford has been Acting Commissioner of FDA since March of 2004. He has a long and distinguished career in private and public service. He worked at the FDA in other capabilities before joining the agency again in 2002.

The show of support for Dr. Crawford's nomination has been strong. In the runup to Dr. Crawford's confirmation hearing in March, my committee received letters of support from more than 100 individuals and organizations. It is high time we had this debate and this vote. We waited many months for President Bush to send us a qualified nominee for the post.

In response to our bipartisan letter to the President, the President nominated Dr. Crawford. We have waited long enough. I think we can all agree that we need a strong leader at the FDA right now and one who has a mandate to act. We must be forward looking. There are many items before the FDA that require the immediate attention of an FDA Commissioner vested with full authority.

The authority flows directly from the act of Senate confirmation. Without a Senate-confirmed leader, we cannot expect the FDA to be as effective as we need it to be.

Dr. Crawford's nomination was reported favorably out of the Committee on Health, Education, Labor and Pensions on June 15. So I am pleased that we are now ready to confirm Dr. Crawford so that he can take charge, take action, and take responsibility for leading the FDA in the best interests of the public health.

I yield the floor and reserve the remainder of my time.

Mr. President, I yield 5 minutes to the Senator from Utah, Mr. Hatch, a former chairman of the committee that handles this. He has handled these confirmations before.

Mr. President, I yield 2 minutes to the Senator from Iowa, Mr. Grassley.

Mr. President, I yield myself 2 minutes.

I thank everybody who has made comments today. I wish to address the last few comments that were made because our committee has oversight over the Food and Drug Administration. We are concerned about any situation that would give people less than full confidence in the medicines they are taking.

What we have been faced with for the last 18 months, which has been mentioned, is kind of giving a person a job. We have not given him the job, we have kind of given him the job. Anybody who has read transcripts from previous confirmation hearings would know that this is an extremely difficult position to ever get confirmed from. There are a lot of viewpoints from both sides. We have to have somebody in charge who has full authority, who has the right to look at the science and make decisions, who has full authority to make structural changes. I would say that Senator Kennedy and I have been looking at that, doing the oversight.

With respect to drug safety, I want my colleagues to know that I take the recent drug safety concerns seriously. Senator Kennedy and I are working together with our fellow committee members to develop comprehensive FDA drug safety legislation in this Congress and to bring that bill before the Senate so there can be those changes.

We will act, but we will act in a way that is mindful of the importance of weighing the risks of drugs and the benefits of the drugs on the same scale. Every drug has risks, and we would do the American people a grave disservice if we overreact to recent controversies.

Mr. President, as we move to a vote on the nomination of Dr. Lester Crawford to serve as Commissioner of Food and Drugs, I want to remind my colleagues of the important role the Food and Drug Administration plays in protecting and promoting the public health.

The FDA's mission is broad. The FDA regulates food, drugs, biologics, medical devices, animal feed, and cosmetics. The FDA regulates everything from cellular phones to cell tissue and gene therapies. In fact, Americans spend more than 25 cents of every dollar on products regulated by the FDA.

And as science progresses, the challenges of regulation grow. For instance, the FDA regulates a host of new products that blur the FDA's traditional boundaries. Today, the FDA is charged with regulating drug- delivery devices, such as coronary stents coated with drugs that contribute to keeping arteries open. Then there are next- generation orthopedic implants with biologic products built into them to stimulate tissue growth.

All of these new innovations require a nimble and responsive agency to regulate them, and they require resources to match. Today, in fact, Senator Kennedy and I are introducing legislation to protect and strengthen a critical user-fee program. This program provides FDA with a stable stream of revenues to support the agency's mission to review and approve new medical devices. Without our action, that program would expire at the end of this fiscal year.

I believe that is just one expression of bipartisan support for FDA. Is FDA perfect? Of course not. FDA is staffed by human beings, and from time to time they make mistakes--as do we all.

But the FDA plays a critical role in our Nation's public health, and an important agency such as FDA needs to

have a strong leader with the power vested in him by Presidential nomination and Senate confirmation.

So I urge my colleagues to accept the President's nominee, Dr. Lester Crawford, and to vote to confirm him as the next Commissioner of Food and Drugs.

Yes.

The Senator is absolutely correct. The Presiding Officer is chairing that subcommittee and holding extensive hearings on that and bringing together some great experts to help us resolve that.

Mr. President, I yield any remaining time we have. I ask for the yeas and nays.

Mr. President, I yield myself 5 minutes.

I rise to discuss the pending nomination of Dr. Lester Crawford to be the Commissioner of Food and Drugs. I particularly thank all of the people who have been involved in this nomination process. It has been a great bipartisan effort. It has been thoroughly explored and we finally are at a point where we can have an actual FDA Commissioner approved. It will be a tremendous relief to me and to the Nation, I am sure.

I particularly want to thank Senator Kennedy for his efforts in proceeding through the different hearings that we have had and all of the other work that we have had to do. The Food and Drug Administration is tasked with the broad and critical mission of protecting public health. The FDA Commissioner is in charge of an agency that regulates $1 trillion worth of products a year.

The agency ensures the safety and effectiveness of all drugs and biological products like vaccines, medical devices, and animal drugs and feed. It also oversees the safety of a vast variety of food products as well as medical and consumer products, including cosmetics.

In addition, the Commissioner is responsible for advancing the public health by helping to speed innovations in its mission areas and by helping the public get accurate, science-based information on medicines and foods. The FDA has been without a confirmed Commissioner for more than a year.

In January of this year, 17 members of the Senate Committee on Health, Education, Labor and Pensions sent a bipartisan letter to the President urging him to nominate a Commissioner to provide the agency with greater clarity and certainty in its mission to protect our food and drug supplies. Recent breakthroughs in medical science and technology show how quickly science and technology are changing our lives each and every day.

The FDA is at a critical point in its history. The potential benefits from our medical research are staggering. A fully confirmed FDA Commissioner is essential to ensuring that these medical breakthroughs can be brought to the market safely and effectively. Consumers deserve to have a fully functional FDA that can oversee the industry with confidence and authority and harness the technical achievements that can improve and save lives.

I believe the President's nominee, Dr. Lester Crawford, has the right qualifications to lead the FDA and to bring about the necessary reforms to maintain consumer confidence in our Nation's drug safety. Clearly we need someone at the helm of the FDA who can direct the agency and work with Congress to find the answers to these and many other difficult issues that will continue to come before us.

Dr. Crawford has been Acting Commissioner of FDA since March of 2004. He has a long and distinguished career in private and public service. He worked at the FDA in other capabilities before joining the agency again in 2002.

The show of support for Dr. Crawford's nomination has been strong. In the runup to Dr. Crawford's confirmation hearing in March, my committee received letters of support from more than 100 individuals and organizations. It is high time we had this debate and this vote. We waited many months for President Bush to send us a qualified nominee for the post.

In response to our bipartisan letter to the President, the President nominated Dr. Crawford. We have waited long enough. I think we can all agree that we need a strong leader at the FDA right now and one who has a mandate to act. We must be forward looking. There are many items before the FDA that require the immediate attention of an FDA Commissioner vested with full authority.

The authority flows directly from the act of Senate confirmation. Without a Senate-confirmed leader, we cannot expect the FDA to be as effective as we need it to be.

Dr. Crawford's nomination was reported favorably out of the Committee on Health, Education, Labor and Pensions on June 15. So I am pleased that we are now ready to confirm Dr. Crawford so that he can take charge, take action, and take responsibility for leading the FDA in the best interests of the public health.

I yield the floor and reserve the remainder of my time.

Mr. President, I yield 5 minutes to the Senator from Utah, Mr. Hatch, a former chairman of the committee that handles this. He has handled these confirmations before.

Mr. President, I yield 2 minutes to the Senator from Iowa, Mr. Grassley.

Mr. President, I yield myself 2 minutes.

I thank everybody who has made comments today. I wish to address the last few comments that were made because our committee has oversight over the Food and Drug Administration. We are concerned about any situation that would give people less than full confidence in the medicines they are taking.

What we have been faced with for the last 18 months, which has been mentioned, is kind of giving a person a job. We have not given him the job, we have kind of given him the job. Anybody who has read transcripts from previous confirmation hearings would know that this is an extremely difficult position to ever get confirmed from. There are a lot of viewpoints from both sides. We have to have somebody in charge who has full authority, who has the right to look at the science and make decisions, who has full authority to make structural changes. I would say that Senator Kennedy and I have been looking at that, doing the oversight.

With respect to drug safety, I want my colleagues to know that I take the recent drug safety concerns seriously. Senator Kennedy and I are working together with our fellow committee members to develop comprehensive FDA drug safety legislation in this Congress and to bring that bill before the Senate so there can be those changes.

We will act, but we will act in a way that is mindful of the importance of weighing the risks of drugs and the benefits of the drugs on the same scale. Every drug has risks, and we would do the American people a grave disservice if we overreact to recent controversies.

Mr. President, as we move to a vote on the nomination of Dr. Lester Crawford to serve as Commissioner of Food and Drugs, I want to remind my colleagues of the important role the Food and Drug Administration plays in protecting and promoting the public health.

The FDA's mission is broad. The FDA regulates food, drugs, biologics, medical devices, animal feed, and cosmetics. The FDA regulates everything from cellular phones to cell tissue and gene therapies. In fact, Americans spend more than 25 cents of every dollar on products regulated by the FDA.

And as science progresses, the challenges of regulation grow. For instance, the FDA regulates a host of new products that blur the FDA's traditional boundaries. Today, the FDA is charged with regulating drug- delivery devices, such as coronary stents coated with drugs that contribute to keeping arteries open. Then there are next- generation orthopedic implants with biologic products built into them to stimulate tissue growth.

All of these new innovations require a nimble and responsive agency to regulate them, and they require resources to match. Today, in fact, Senator Kennedy and I are introducing legislation to protect and strengthen a critical user-fee program. This program provides FDA with a stable stream of revenues to support the agency's mission to review and approve new medical devices. Without our action, that program would expire at the end of this fiscal year.

I believe that is just one expression of bipartisan support for FDA. Is FDA perfect? Of course not. FDA is staffed by human beings, and from time to time they make mistakes--as do we all.

But the FDA plays a critical role in our Nation's public health, and an important agency such as FDA needs to

have a strong leader with the power vested in him by Presidential nomination and Senate confirmation.

So I urge my colleagues to accept the President's nominee, Dr. Lester Crawford, and to vote to confirm him as the next Commissioner of Food and Drugs.

Yes.

The Senator is absolutely correct. The Presiding Officer is chairing that subcommittee and holding extensive hearings on that and bringing together some great experts to help us resolve that.

Mr. President, I yield any remaining time we have. I ask for the yeas and nays.

Mr. President, I rise today to introduce a bipartisan bill to improve the quality and efficiency of health care by harnessing the potential of information technology. I am joined in this effort by Senators Kennedy, Frist and Clinton.

In recent weeks, Senator Kennedy and I introduced legislation to move our health care system into the electronic information age to serve patients better. Separately, Senators Frist and Clinton also introduced a bill to spur the adoption of health information technology to improve health care quality.

Both of our bills were referred to the Committee on Health, Education, Labor, and Pensions, which I chair and on which we all serve. All of us put a lot of time and effort into crafting our bills, and we quickly realized that if we took the best of both of our bills and combined them into one, the whole would be much more than the sum of its parts.

All of us believe that if we move from a paper-based health care system to secure electronic medical records, we will reduce mistakes and save lives, time and money. And because we share this goal, we worked together to combine our bills into one piece of legislation that will bring the government and the private sector together to make healthcare better, safer and more efficient by accelerating the adoption of interoperable information technology across our healthcare system.

The sponsors of this bill span the political spectrum, but we still have many things in common. One of our common bonds--in fact, one of the things we have in common with all Americans--is that all of us are, or have been, or will someday be patients. And all of us either have stories to tell about frustrating experiences we've had, or that our family or friends have had, with navigating our health care system.

We have an outstanding health care system in the United States. That's doesn't mean there isn't room for improvement, though. And one of the most important things we need to do in healthcare is to put information technology to work for patients, improving quality while reducing costs.

I want to thank Senators Kennedy, Frist and Clinton for working together in a spirit of bipartisan compromise to mold our separate bills into one measure that will advance our vision of the future of health care. We know President Bush shares our commitment, because he has called for every American to have his or her own electronic health record by the middle of the next decade, and he has his Secretary of Health and Human Services, Michael Leavitt, working assiduously toward this objective.

So I look forward to working with Senators Kennedy, Frist, and Clinton and the rest of my fellow Senators in the coming weeks and months to send this legislation to the President so that we can meet the ambitious goals that we all share.

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

Mr. President, I rise today to introduce a bipartisan bill to improve the quality and efficiency of health care by harnessing the potential of information technology. I am joined in this effort by Senators Kennedy, Frist and Clinton.

In recent weeks, Senator Kennedy and I introduced legislation to move our health care system into the electronic information age to serve patients better. Separately, Senators Frist and Clinton also introduced a bill to spur the adoption of health information technology to improve health care quality.

Both of our bills were referred to the Committee on Health, Education, Labor, and Pensions, which I chair and on which we all serve. All of us put a lot of time and effort into crafting our bills, and we quickly realized that if we took the best of both of our bills and combined them into one, the whole would be much more than the sum of its parts.

All of us believe that if we move from a paper-based health care system to secure electronic medical records, we will reduce mistakes and save lives, time and money. And because we share this goal, we worked together to combine our bills into one piece of legislation that will bring the government and the private sector together to make healthcare better, safer and more efficient by accelerating the adoption of interoperable information technology across our healthcare system.

The sponsors of this bill span the political spectrum, but we still have many things in common. One of our common bonds--in fact, one of the things we have in common with all Americans--is that all of us are, or have been, or will someday be patients. And all of us either have stories to tell about frustrating experiences we've had, or that our family or friends have had, with navigating our health care system.

We have an outstanding health care system in the United States. That's doesn't mean there isn't room for improvement, though. And one of the most important things we need to do in healthcare is to put information technology to work for patients, improving quality while reducing costs.

I want to thank Senators Kennedy, Frist and Clinton for working together in a spirit of bipartisan compromise to mold our separate bills into one measure that will advance our vision of the future of health care. We know President Bush shares our commitment, because he has called for every American to have his or her own electronic health record by the middle of the next decade, and he has his Secretary of Health and Human Services, Michael Leavitt, working assiduously toward this objective.

So I look forward to working with Senators Kennedy, Frist, and Clinton and the rest of my fellow Senators in the coming weeks and months to send this legislation to the President so that we can meet the ambitious goals that we all share.

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

Mr. President, I rise today to introduce a bipartisan bill to improve the quality and efficiency of health care by harnessing the potential of information technology. I am joined in this effort by Senators Kennedy, Frist and Clinton.

In recent weeks, Senator Kennedy and I introduced legislation to move our health care system into the electronic information age to serve patients better. Separately, Senators Frist and Clinton also introduced a bill to spur the adoption of health information technology to improve health care quality.

Both of our bills were referred to the Committee on Health, Education, Labor, and Pensions, which I chair and on which we all serve. All of us put a lot of time and effort into crafting our bills, and we quickly realized that if we took the best of both of our bills and combined them into one, the whole would be much more than the sum of its parts.

All of us believe that if we move from a paper-based health care system to secure electronic medical records, we will reduce mistakes and save lives, time and money. And because we share this goal, we worked together to combine our bills into one piece of legislation that will bring the government and the private sector together to make healthcare better, safer and more efficient by accelerating the adoption of interoperable information technology across our healthcare system.

The sponsors of this bill span the political spectrum, but we still have many things in common. One of our common bonds--in fact, one of the things we have in common with all Americans--is that all of us are, or have been, or will someday be patients. And all of us either have stories to tell about frustrating experiences we've had, or that our family or friends have had, with navigating our health care system.

We have an outstanding health care system in the United States. That's doesn't mean there isn't room for improvement, though. And one of the most important things we need to do in healthcare is to put information technology to work for patients, improving quality while reducing costs.

I want to thank Senators Kennedy, Frist and Clinton for working together in a spirit of bipartisan compromise to mold our separate bills into one measure that will advance our vision of the future of health care. We know President Bush shares our commitment, because he has called for every American to have his or her own electronic health record by the middle of the next decade, and he has his Secretary of Health and Human Services, Michael Leavitt, working assiduously toward this objective.

So I look forward to working with Senators Kennedy, Frist, and Clinton and the rest of my fellow Senators in the coming weeks and months to send this legislation to the President so that we can meet the ambitious goals that we all share.

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

Mr. President, I rise today to introduce a bipartisan bill to improve the quality and efficiency of health care by harnessing the potential of information technology. I am joined in this effort by Senators Kennedy, Frist and Clinton.

In recent weeks, Senator Kennedy and I introduced legislation to move our health care system into the electronic information age to serve patients better. Separately, Senators Frist and Clinton also introduced a bill to spur the adoption of health information technology to improve health care quality.

Both of our bills were referred to the Committee on Health, Education, Labor, and Pensions, which I chair and on which we all serve. All of us put a lot of time and effort into crafting our bills, and we quickly realized that if we took the best of both of our bills and combined them into one, the whole would be much more than the sum of its parts.

All of us believe that if we move from a paper-based health care system to secure electronic medical records, we will reduce mistakes and save lives, time and money. And because we share this goal, we worked together to combine our bills into one piece of legislation that will bring the government and the private sector together to make healthcare better, safer and more efficient by accelerating the adoption of interoperable information technology across our healthcare system.

The sponsors of this bill span the political spectrum, but we still have many things in common. One of our common bonds--in fact, one of the things we have in common with all Americans--is that all of us are, or have been, or will someday be patients. And all of us either have stories to tell about frustrating experiences we've had, or that our family or friends have had, with navigating our health care system.

We have an outstanding health care system in the United States. That's doesn't mean there isn't room for improvement, though. And one of the most important things we need to do in healthcare is to put information technology to work for patients, improving quality while reducing costs.

I want to thank Senators Kennedy, Frist and Clinton for working together in a spirit of bipartisan compromise to mold our separate bills into one measure that will advance our vision of the future of health care. We know President Bush shares our commitment, because he has called for every American to have his or her own electronic health record by the middle of the next decade, and he has his Secretary of Health and Human Services, Michael Leavitt, working assiduously toward this objective.

So I look forward to working with Senators Kennedy, Frist, and Clinton and the rest of my fellow Senators in the coming weeks and months to send this legislation to the President so that we can meet the ambitious goals that we all share.

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

Mr. President, I rise today to express my opposition to the Dominican Republic-Central American-United States free trade agreement, known as CAFTA. I am opposing the implementing legislation before the Senate today due to the negative impact that passage of the agreement will have on the domestic sugar industry. I also believe mandatory country of origin labeling should be implemented before we sign trade agreements that will bring in additional meat products.

The production of sugar is vitally important in Wyoming. Behind hay, which is fed to our livestock, sugar beets is the No. 1 cash crop in Wyoming. So small sugar beet farms in Wyoming have a big impact on my State's economy. For example, my office received calls from bankers and local economic development agencies in towns that depend upon the viability of the sugar beet industry. They were concerned about the impact of CAFTA on the health of their local economies--the economies of my home State.

In addition, the sugar industry is vertically integrated. Sugar beet farmers are invested in their land and specialized farming equipment. However, across the Nation, sugar beet farmers have also banded together to purchase the processing plants that add value to their crop. So their investment in sugar is higher than the investments of other farmers in their crops. Many of these plants have been purchased in recent years with a long-term debt load. Wyoming sugar beet farmers have a special interest in ensuring that their industry has long-term viability. The sugar that would be imported from CAFTA countries under this agreement, in addition to the sugar expected to be imported from Mexico under NAFTA, would have a detrimental impact on the sugar beet industry in the near and distant future.

President, I rise today to speak to the ever worsening crisis of cost, coverage, and confidence in our health insurance system, but, more importantly, to outline what I believe to be several positive steps we can take in the near term toward relieving an impasse that has long stalled progress toward relief.

As I speak today. we are nearing almost 5 years of double-digit growth in health insurance premiums--increases that have repeatedly exceeded more than five times the rate of inflation. Since 2000, for example, group premiums for family coverage have grown nearly 60 percent, compared to an underlying inflation rate of 9.7 percent over the same period.

Not surprisingly, those hardest hit are America's small businesses and those individuals outside of employer-provided insurance. These are the ones with the least market leverage and the weakest ability to pool risk. Already, among the very smallest of our businesses, those with fewer than 10 employees, only 52 percent offer coverage to their employees.

Mr. President, I am a realist. The most fundamental drivers of health care costs are ones that defy near-term solutions. These drivers include advances in costly medical treatments, Americans' continuing appetite for such treatments, lack of transparency in pricing, and an antiquated third-party payment system that insulates consumers from seeing the true cost of care they receive.

To take just one example, I--like many of my colleagues--would strongly support shifting much of our current tax subsidy of health insurance away from the employer and toward the individual. However, I fully recognize that any change on such a scale is, at best, years away.

And yet, like most Members in this body, I am hearing an ever growing chorus of concern from my constituents about health insurance--and most especially from small businesses.

America's families and small businesses don't want us to wait for the perfect solution or the perfect moment. They need real help, and they need it now.

Recognizing this increasing concern, and as the new Chairman of the Senate's Health, Education, Labor and Pensions Committee, I have made it a priority in recent months to seek the counsel of stakeholders, citizens, experts, and fellow Members of Congress on how we might come together on a package of insurance reforms we can realistically hope to enact in this Congress.

The most visible proposal now on the table--at least for the small group market--is the approach known as association health plans, or AHPs. Under this proposal, which was introduced in this Congress by Senators Snowe and Talent, qualifying trade associations would be permitted to band together their members for purposes of offering health coverage.

Association health plans hold significant promise--particularly in the pooling of risk, economies of scale, and market clout they could lend to thousands of small businesses.

At the same time, however, the AHP bills in their current form may also go too far in allowing some association plans to play by a separate set of rules than those governing the rest of the small group insurance marketplace, thereby tempting adverse selection and market disruption. Another concern is the fact that the current AHP proposals would shift primary oversight over many association plans away from States and move it to the Federal Government.

Regrettably, debate over these AHP pros and cons has hardened into a political and stakeholder stalemate--a stalemate that has helped block constructive action on new insurance reform for nearly a decade.

It is time we reached an end to this impasse.

Toward this end, I appreciate the hard work of Senators Snowe and Talent and other AHP proponents in working with me on possible compromise approaches. And similarly, I am encouraged by what appears to be a growing pragmatic spirit amng traditional AHP critics such as insurers and State regulators.

Meanwhile, other of my colleagues, such as Senator DeMint and Senators

Durbin and Lincoln, have also come forward with serious contributions to the discussion.

I look forward to working with my colleagues of both parties, as well as with key stakeholders, in putting forward a full proposal for consideration by the HELP Committee and by the Senate.

However, as we move forward with this process, I want to pause today to identify certain foundation principles and reform components I believe should guide the direction we pursue:

No. 1, association-based plans should have the opportunity to harness the advantage of independent pooling and play a commercially meaningful role in the coverage marketplace--and if that puts market pressure on insurers, so much the better. At the same time, however, the coverage provided to association members should be subject to underlying regulatory and consumer protection requirements substantially comparable to those applicable to all entities offering similar coverage. In short, associations deserve a real seat at the coverage table, but that table should not have a substantial tilt one way or the other.

No. 2, the current hodgepodge of varying state health insurance regulation should be streamlined, thereby easing administrative and regulatory costs, and facilitating a larger number of plans in more states. Such ``harmonization'' was among the options put forward last year by the Senate's Republican Task Force on Health Care Costs and the Uninsured. Under such an approach, states would be encouraged or required to adopt common sets of rules in targeted areas of health insurance regulation, such as rating and underwriting, though State oversight and enforcement authority would remain.

No. 3, individuals and businesses should have the opportunity to purchase lower-cost plans free or largely free of state benefit mandates. Though most purchasers will likely choose fuller coverage, it is important to assure that lower-cost alternatives exist as a safeguard for those who are struggling at the margin. Not everyone needs or wants the same degree of coverage, and where possible, our insurance laws should accommodate this reality.

No. 4, primary responsibility for most insurance oversight and consumer protection should remain with the state insurance commissions--including the right to assess health plans, including association plans. Although some degree of new Federal involvement will likely be necessary, it should be kept to a minimum. Though far from perfect, our State insurance commissions are much closer to the real problems confronted by purchasers of insurance in their communities than would be a federal agency in Washington.

No. 5, the focus of our immediate effort should be on policies that do not require significant Federal outlays. Many laudable proposals have been put forward by the President and others for tax-based and other financial assistance for the purchase of insurance, and many of these should be pursued with vigor. We should not, however, allow the fiscal challenge of enacting such policies to sidetrack our efforts to advance less costly improvements.

I am open to suggestions, and I am open to compromise--but I am not open to continued inaction.

My intention is for these principles to serve as a foundation for the swift finalization and passage of a health insurance reform package that will deliver real relief to America's small businesses and struggling families.

I ask unanimous consent that a summary overview of these principles be printed in the Record.

Mr. President, no matter who we are, where we live or which Party we belong to, one thing we have in common is that all of us have been and will again be patients under the care of a health professional who we may, or may not, have visited before for treatment.

If we have already established a relationship with the doctor who is about to treat us, our problems will either be minimized, or will not exist. But, if this is our first experience with a physician or a specialist, how can we be certain that he or she has all the information that is necessary to prescribe a course of treatment and begin our care?

These are the kind of thoughts that run through every patient's mind as we sit in the waiting room, wondering if the high tech equipment that surrounds us is also reflected in our physician's access to our lab reports and previous examinations. In other words, is there any way for our doctors to get to know us, before we've even set foot in their examining room?

It's ironic that we live in a world where the latest news, sports and weather can make their way from the either side of the world to our computers and television sets as it happens. Our financial information is kept by our banks and is updated continuously throughout the day and is available to us almost instantaneously. Our medical records, however, are still kept the old fashioned way, on paper, and filed away. It is a tedious system, built the old fashioned way, because that's the way it was always done. Well, I am here to announce that the time has come to move to a newer, faster and more reliable system. Imagine a medical network that will reduce errors, help to lower costs and improve the quality of care we receive, all at the same time, by providing a treating physician with the information he needs immediately at the point of care. Is it possible--yes! Then why hasn't it happened yet?

Why is our medical system surging ahead in the kinds of technology that are available to diagnose and treat disease, when, at the same time, it is falling further and further behind in the creation of electronic medical records and the ability to share that information with health care providers who need that material to make what can all too often be life and death decisions?

Clearly, something has to change when I can carry a fob on my key chain that provides my local gas station owner with instant access to my credit information so I can buy fuel for my car, but providing access to my medical records to my doctor is a much longer and tedious process. This needs to change and it needs to change now.

We can all see how the information revolution has had a dramatic impact on virtually every industry in the United States. Its ability to promote efficiency has helped to reduce costs and increase effectiveness wherever it has been applied. It is now time to bring that technology to bear on our healthcare system.

At present, healthcare expenditures are growing faster than the overall economy. In 2003, we spent more than $1.7 trillion on healthcare. By 2014, that number is expected to reach $3.1 trillion. Clearly we need to find ways to increase the efficiency of our health care system and reduce the costs associated with it.

We have all heard it said that, when it comes to our health care system, you can't maintain the current standards of quality and control or reduce costs at the same time. While the implementation of a health information technology system may not dramatically reduce costs, it will help move us further down the road of controlling costs.

If we could manage a quick trip to the future, and pay a visit to the doctor's office when a health information technology system is put in place, we would see some dramatic changes have been made in the ability of our doctor to diagnose, treat and provide warnings of current and future medical problems.

In that future, when I arrived at my new doctor's office I gave the nurse at the front desk my key fob. She took a moment to swipe it past their computer access link. It is soon downloading my medical information and compiling a ``health report'' that focuses on any trends that are developing as the previous results of my examinations are charted and compared.

Then, as I sit in the waiting room, my physician is already consulting those records and monitoring my current and previous test results which are presented to him in the form of a graph that he has pulled up on his computer screen. With the simple swipe of a mechanical key my future doctor has

been able to unlock my complete medical history, and examined the results of all the tests I had taken over the years, regardless of where I had received care.

If my doctor was concerned about my cholesterol level, for example, he or she could pull up a complete history of blood tests that will enable my physician to track my blood chemistry and note any changes in my cholesterol level over the years.

Later, if my doctor considers writing a prescription for a new drug or medication, he will have the ability to first view all medications I am currently taking in order to make an informed decision regarding any potentially dangerous interactions or adverse side effects that might occur as a result of the new prescription.

Such a system will enable doctors to spend less time gathering information and quizzing patients about past health problems and spend more time listening to patients and ensuring their health care needs are met.

President Bush and Secretary of the Department of Health and Human Services Michael Leavitt have made their support for this clear. They recognize that the increased use of health information technology has the potential of saving this country billions of dollars that are now spent on duplicative tests, unnecessary inpatient admissions, and the costs associated with adverse drug effects. Some estimates suggest that, when an information technology system is established and put into operation, for each dollar we spend on this new technology we will save as much as four dollars in reduced costs. In a system with such high, increasing costs every dollar we can save is magnified.

Fortunately, this is not something that will have to wait for someday until it is technologically possible and practical. There are already medical pioneers in the field who are putting the tools together and working on the network that will be needed to provide for rapid and complete transmission of our medical history when it is needed. One of these innovators currently lives in my home State of Wyoming, in Big Piney, in fact.

The story of Dr. William Close is quite a remarkable one. With a wide and varied background that includes his love for the outdoors and a taste for classical music, Dr. Close has spent his life ensuring that the latest possible technologies were being used to address the health care needs of people all over the world.

Prior to settling down in Wyoming, Dr. Close spent 16 years in Africa battling the illnesses and dealing with the medical problems faced by a nation with a large population of patients, and not enough doctors to go around. His first year there he was one of only three doctors in a 2,000-bed hospital.

It was during those days that Dr. Close determined to find a way to bring the tools of modern technology to the diagnosis and treatment of disease. Faced with such a huge patient population, he needed a tool that would make the compiling of information and its interpretation easier.

His work led to the creation of a unique software that enabled a doctor to input a series of symptoms and come up with a possible diagnosis. It turned out to be such a valuable tool that it was able to be used on Palm Pilots, which made it an invaluable program for use on our Navy subs.

Upon his return to the United States he continued to work on the development of his computer application so he could track a patient's medical history over several visits, rather than focus on each appointment as a unique set of data. That enabled Dr. Close to spot problems before they became serious and to treat trends before they became life threatening.

Dr. Close has now logged more than 50 years of medical practice and, although he's officially retired, he still finds time to see patients in his office. He still makes house calls, too. That's a rare thing in most States, but a welcome part of life in Wyoming. He continues to work at what he calls his ``gentle, limited practice'' as he continues to provide an example for other health care providers and health information systems on how to maximize health care choices and treatments for his patients by getting to know the needs of his patients, by tracking their past history so he can help create a plan that will minimize a patient's risk for future health problems.

These are the kinds of things that are possible, if we commit to working together with our nation's health care providers to establish a network of information that will address the needs of the people of our country. I have been pleased to work with my ranking member on the HELP Committee, Senator Kennedy, and the chair and ranking member of the Finance Committee, Senators Grassley and Baucus, on this and other complementary legislation that will promote the use of health information technology today, not tomorrow. We have been putting a considerable amount of time and effort into the crafting of these bills to ensure that they will increase efficiencies, make our health care system more effective and responsive, and provide better care to us all as patients.

I mention the effect our bills will have on individuals because, as with most changes to our health care system, how well the system will work is ultimately determined by how well it works for those who rely on it.

For most Americans, their first and primary concern is the privacy of their records. That is an important provision of the bill and we have included strong language to ensure the privacy and security protection patients were guaranteed under HIPAA, the Health Insurance Portability and Accountability Act, are preserved. As that medical oath says so well, first, do no harm.

At present, most of our medical records are kept by well meaning physicians who, unfortunately, are known for having illegible handwriting. Some of their handwriting is worse than my own. A computerized record will eliminate that problem and provide clear, easily read and interpreted medical data to those who will need it to prescribe a course of treatment.

As with most things, there will be a great deal of concern about the system's cost and the availability of funds to pay for it. Our legislation will award competitive, matching grants to healthcare providers, states and academic programs to facilitate the purchase and enhance the utilization of qualified health information technology.

In the months to come, we will continue to encourage the participation of the private sector in this effort. They have asked for, and I believe they deserve, a seat at the table when standards are being determined and policies are being implemented. There is no question that some of them are closest to the problem at hand and their experience, ideas, and suggestions for innovation will be invaluable as we pursue the implementation of this new technology nationwide.

Secretary Leavitt recently announced the formation of what he is calling the American Health Information Community. He will chair this 17-member public-private collaborative that will help facilitate a nationwide transition to electronic health records, including common standards and interoperability, in a smooth, market-led way. I share his support for such an approach and his efforts to make it a reality.

The implementation of this new technology will make the sharing of health information more efficient between doctors and health professionals. And, most importantly, it will help to make our health care system more effective and provide better care to those who make use of it. It will also help to begin the vital process of controlling health care costs, something we must set as a goal and begin to achieve in the time before us.

This is a vital step in that process. With it, we can continue to make health care services more affordable and available. Without it we run the risk of having the best health care system in the world, with few among us able to afford taking full advantage of it.

I look forward to working with all my colleagues in the months ahead to ensure that meaningful health information technology legislation is signed into law later this year.

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

Mr. President, I rise today along with my colleague Senator Baucus from Montana to introduce a bill that will help bring about a more reliable system of medical justice for all Americans.

In the last Congress, we had three robust debates on a critical issue--medical liability reform. Though a majority of the Members of this body wanted to begin working to pass legislation, we didn't have the 60 Senators necessary to invoke cloture and begin the real work on the bills. That was disappointing, because skyrocketing medical liability insurance premiums are forcing doctors to move their practices to States with better legal environments and lower premiums. This is endangering the availability of critical healthcare services in many areas of Wyoming and other states.

Throughout our debate, I heard many of my colleagues say that they wanted to work on this issue, but that they simply could not support the bill as it stood. While I disagreed with their positions then, I respected their opposition. I also trust that they sincerely wanted to help solve our Nation's medical liability and litigation crisis.

During those debates, I noticed something interesting. While we argued the ``pros and cons'' of the bills, no one stood up to defend our current system of medical litigation. In fact, even some of the lawyers in this body agreed that our medical litigation system needs reform.

Why didn't we hear anyone defend the merits of our current medical litigation system? It's because our system doesn't work. It simply doesn't work for patients or for healthcare providers.

Compensation to patients injured by healthcare errors is neither prompt nor fair. The randomness and delay associated with medical litigation does not contribute to timely, reasonable compensation for most injured patients. Some injured patients get huge jury awards, while many others get nothing at all.

Let's look at the facts. In 1991, a group of researchers published a study in the New England Journal of Medicine. The study, known as the Harvard Medical Practice Study, was the basis for the Institute of Medicine's estimate that nearly 100,000 people die every year from healthcare errors.

As part of their study, the researchers reviewed the medical records of a random sample of more than 31,000 patients in New York State. They matched those records with statewide data on medical malpractice claims. The researchers found that nearly 30 percent of injuries caused by medical negligence resulted in temporary disability, permanent disability or death. However, less than 2 percent of those who were injured by medical negligence filed a claim. These figures suggest that most people who suffer negligent injuries don't receive any compensation.

When a patient does decide to litigate, only a few recover anything. Only one of every ten medical malpractice cases actually goes to trial, and of those cases, plaintiffs win less than one of every five. In addition, patients who file suit and are ultimately successful must wait a long time for their compensation--the average length of a medical malpractice action filed in state court is about 30 months.

While the vast majority of malpractice cases that go to trial are settled before the court hands down a verdict, the settlements even then don't guarantee that patients are compensated fairly, particularly after legal fees are subtracted. Research shows that for every dollar paid in malpractice insurance premiums, about 40 cents in compensation is actually paid to the plaintiff--the rest goes for legal fees, court costs, and other administrative expenditures.

To sum up: most patients injured by negligence don't file claims or receive compensation. Few of those that do file claims and go to court recover anything, and those who are successful wait a long time for their compensation. And those who settle out of court end up receiving only 40 cents for every dollar that healthcare providers pay in liability insurance premiums.

It's hard to say that our medical litigation system does right by patients in light of those facts. Unfortunately, our system doesn't work for healthcare providers either.

Earlier, I spoke about those Harvard researchers who found that fewer than 2 percent of those who were injured by medical negligence even filed a claim. As they reviewed the medical records for their study, the researchers also found another interesting fact--most of the providers against whom claims were eventually filed were not negligent at all.

That's right--most providers who were sued had not committed a negligent act.

In matching the records they reviewed to data on malpractice claims, the Harvard researchers found 47 actual malpractice claims. In only 8 of the 47 claims did they find evidence that medical malpractice had caused an injury. Even more amazingly, the physician reviewers found no evidence of any medical injury, negligent or not, in 26 of the 47 claims. However, 40 percent of these cases where they found no evidence of negligence nonetheless resulted in a payment by the provider. Basically, the researchers found no positive relationship between medical negligence and compensation.

That study was based on 1984 data. The same group of researchers conducted another study in Colorado and Utah in 1992, and they found the same thing. As in the 1984 study, they found that only 3 percent of patients who suffered an injury as a result of negligence actually sued. And again, physician reviewers could not find negligence in most of the cases in which lawsuits were filed.

Now, I assume that the patients who sued had either an adverse medical outcome, or at least an outcome that was less satisfactory than the patient expected. But our medical litigation system is not supposed to compensate patients for adverse outcomes or dissatisfaction--it's supposed to compensate patients who are victims of negligent behavior. It's supposed to be a deterrent to substandard medical care.

It's not fair to doctors and hospitals that they must pay to defend against meritless lawsuits. Nor is it fair that they must face a choice between settling for a small sum, even if they aren't at fault, so that they avoid getting sucked into the whirlpool of our medical litigation system.

It's not hard to understand why physicians and hospitals and their insurers want to stay out of court. When they lose, the decisions are increasingly resulting in mega-awards based on subjective ``non- economic'' damages. The number of awards exceeding $1 million grew by 50 percent between the periods of 1994-1996 and 1999-2000. Today, more than half of all jury awards exceed $1 million.

As a result, when a patient suffers a bad outcome and sues, providers have an incentive to settle the case out of court, even if the provider isn't at fault. But is this how our medical litigation system is supposed to work--as a tool for shaking down our healthcare providers?

Let's face it--our medical litigation system is broken. It doesn't work for

patients or providers. Even worse, it replaces the trust in the provider-patient relationship with distrust.

Then, when courts and juries render verdicts with huge awards that bear no relation to the conduct of the defendants, this destabilizes the insurance markets and sends premiums skyrocketing. This forces many physicians to curtail, move or drop their practices, leaving patients without access to necessary medical care. This is a particular problem in states like Wyoming, where we traditionally struggle with recruiting doctors and other healthcare providers.

Perhaps we could live with this flawed system if litigation served to improve quality or safety, but it doesn't. Litigation discourages the exchange of critical information that could be used to improve the quality and safety of patient care. The constant threat of litigation also drives the inefficient, costly and even dangerous practice of ``defensive medicine.''

Yes, indeed, defensive medicine is dangerous. A recent study found that one of every 1200 children who receive a CAT scan may die later in life from radiation-induced cancer. Knowing this puts a physician faced with anxious parents in a difficult situation. Does the doctor use his or her professional judgment and tell the parents of a sick child not to worry, or does the doctor order the CAT scan and subject the child to radiation that is probably unnecessary, just to provide some protection against a possible lawsuit?

We have a medical litigation system in which many patients who are hurt by negligent actions receive no compensation for their loss. Those who do receive compensation end up with about 40 cents of every premium dollar after legal fees and other costs are subtracted. And the likelihood and the outcomes of lawsuits and settlements bear little relation to whether or not a healthcare provider was at fault.

We like to say that justice is blind. With respect to our medical litigation system, I would say that justice is absent and nowhere to be found.

During our debates in the last Congress, I said that the current medical liability crisis and the shortcomings of our medical litigation system make it clear that it is time for a major change. I also said that regardless of how we voted, we all should work toward replacing the current medical tort liability scheme with a more reliable and predictable system of medical justice.

Today, Senator Baucus and I are introducing a bill that would help achieve that goal.

Most of us are familiar with the report on medical errors from the Institute of Medicine, also known as the IOM. Many of us may be less familiar with another report that the IOM published in 2003. That report is called ``Fostering Rapid Advances in Healthcare: Learning from System Demonstrations.''

Our Secretary of Health and Human Services at that time, Tommy Thompson, challenged the IOM to identify bold ideas that would challenge conventional thinking about some of the most vexing problems facing our healthcare system. In response, an IOM committee developed this report, which identified a set of demonstration projects that committee members felt would break new ground and yield a very high return-on-investment in terms of dollars and health.

Medical liability was one of the areas upon which the IOM committee focused. The IOM suggested that the federal government should support demonstration projects in the states. These demonstrations should be based on ``replacing tort liability with a system of patient-centered and safety-focused non-judicial compensation.''

The bill we are introducing today is in the spirit of this IOM report. This bill, the Fair and Reliable Medical Justice Act, would authorize funding for States to create demonstration programs to test alternatives to current medical tort litigation.

The funding to States under this bill would cover planning grants for developing proposals based on the models or other innovative ideas. Funding to States would also include the initial costs of getting the alternatives up and running.

The Fair and Reliable Medical Justice Act would require participating states and the Federal Government to collaborate in continuous evaluations of the results of the alternatives as compared to traditional tort litigation. This way, all States and the federal government can learn from new approaches.

By funding demonstration projects, I believe Congress could enable States to experiment with and learn from ideas that could provide long- term solutions to the current medical liability and litigation crisis.

In introducing this bill, I wanted to provide some alternative ideas that would contribute to the debate. As a result, the bill describes three models to which states could look in designing their alternatives.

For instance, a State could provide healthcare providers and organizations with immunity from lawsuits if they disclose an error that results in an injury and make a timely offer to compensate an injured patient for his or her actual net economic loss, plus a payment for pain and suffering if experts deem such a payment to be appropriate. This could give a healthcare provider who makes an honest mistake the chance to make amends financially with a patient, without the provider fearing that their honesty would land them in a lawsuit.

Another idea would be for a state to set up classes of avoidable injuries and a schedule of compensation for them, and then establish an administrative board to resolve claims related to those injuries. A scientifically rigorous process of identifying preventable injuries and setting appropriate compensation would be preferable to the randomness of the current system.

Still another option would be for a state to establish a special healthcare court for adjudicating medical malpractice cases. For this idea to work, the State would need to ensure that the presiding judges have expertise in and an understanding of healthcare, and allow them to make binding rulings on issues like causation compensation, and standards of care.

We already have specialized courts for complicated issues like taxes and highly charged issues like substance abuse and domestic violence. With all the flaws in our current medical litigation system, perhaps we should consider special courts for the complex and emotional issue of medical malpractice.

I believe one thing in our medical liability debate is absolutely clear--people are demanding change. The States are debating liability reform, and a number of states have enacted new laws. States are heeding this call for change, and Congress should support those efforts.

My own State, Wyoming, had had a number of lively legislative debates on medical liability reform over the past few years, but we have a constitutional amendment that prohibits limits on the amounts that can be recovered through lawsuits. The Wyoming Senate has considered bills recently to amend our State's constitution to create a commission on healthcare errors. That commission would have the power to review claims, decide if healthcare negligence had occurred, and determine the compensation for the death or injury according to a schedule or formula provided by law.

According to the key sponsor of these bills, Senator Charlie Scott, one of the biggest obstacles to passage is the uncertainty surrounding this new idea. No one has any basis for knowing what a proper schedule or formula for compensation would be. No one knows how much the system might cost, or how much injured patients would recover compared to what they recover now.

Senator Scott wrote me to say that federal support for finding answers to these questions might help the bill's sponsors sufficiently respond to the legitimate concerns of their fellow Wyoming legislators. We should be helping state legislators like Senator Scott develop thoughtful and innovative ideas such as the one he has proposed. That's one of the reasons I am offering this bill.

Clearly, the American people and their elected representatives have identified the need to reform our current medical litigation system. There is a real medical liability crisis, and Congress needs to act sooner rather than later.

My cosponsor Senator Baucus and I voted differently on medical liability reform in the last Congress, but we

both agree that we ought to lend a hand to States that are working to change their current medical litigation systems and to develop creative alternatives that could work much better for patients and providers. The States have been policy pioneers in many areas--workers' compensation, welfare reform, and electricity deregulation, to name three. Medical litigation should be the next item on the agenda of the laboratories of democracy that are our 50 States.

No one questions the need to restore reliability to our medical justice system. But how do we begin the process? One way is to foster innovation by encouraging States to develop more rational and predictable methods for resolving healthcare injury claims. And that is what the Fair and Reliable Medical Justice Act aims to do.

In the long run, we would all be better off with a more reliable system of medical justice than we have today. I know that my fellow Senators recognize this, so I hope my colleagues on both sides of the aisle will work with me and Senator Baucus on this legislation.

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

Mr. President, I rise today along with my colleague Senator Baucus from Montana to introduce a bill that will help bring about a more reliable system of medical justice for all Americans.

In the last Congress, we had three robust debates on a critical issue--medical liability reform. Though a majority of the Members of this body wanted to begin working to pass legislation, we didn't have the 60 Senators necessary to invoke cloture and begin the real work on the bills. That was disappointing, because skyrocketing medical liability insurance premiums are forcing doctors to move their practices to States with better legal environments and lower premiums. This is endangering the availability of critical healthcare services in many areas of Wyoming and other states.

Throughout our debate, I heard many of my colleagues say that they wanted to work on this issue, but that they simply could not support the bill as it stood. While I disagreed with their positions then, I respected their opposition. I also trust that they sincerely wanted to help solve our Nation's medical liability and litigation crisis.

During those debates, I noticed something interesting. While we argued the ``pros and cons'' of the bills, no one stood up to defend our current system of medical litigation. In fact, even some of the lawyers in this body agreed that our medical litigation system needs reform.

Why didn't we hear anyone defend the merits of our current medical litigation system? It's because our system doesn't work. It simply doesn't work for patients or for healthcare providers.

Compensation to patients injured by healthcare errors is neither prompt nor fair. The randomness and delay associated with medical litigation does not contribute to timely, reasonable compensation for most injured patients. Some injured patients get huge jury awards, while many others get nothing at all.

Let's look at the facts. In 1991, a group of researchers published a study in the New England Journal of Medicine. The study, known as the Harvard Medical Practice Study, was the basis for the Institute of Medicine's estimate that nearly 100,000 people die every year from healthcare errors.

As part of their study, the researchers reviewed the medical records of a random sample of more than 31,000 patients in New York State. They matched those records with statewide data on medical malpractice claims. The researchers found that nearly 30 percent of injuries caused by medical negligence resulted in temporary disability, permanent disability or death. However, less than 2 percent of those who were injured by medical negligence filed a claim. These figures suggest that most people who suffer negligent injuries don't receive any compensation.

When a patient does decide to litigate, only a few recover anything. Only one of every ten medical malpractice cases actually goes to trial, and of those cases, plaintiffs win less than one of every five. In addition, patients who file suit and are ultimately successful must wait a long time for their compensation--the average length of a medical malpractice action filed in state court is about 30 months.

While the vast majority of malpractice cases that go to trial are settled before the court hands down a verdict, the settlements even then don't guarantee that patients are compensated fairly, particularly after legal fees are subtracted. Research shows that for every dollar paid in malpractice insurance premiums, about 40 cents in compensation is actually paid to the plaintiff--the rest goes for legal fees, court costs, and other administrative expenditures.

To sum up: most patients injured by negligence don't file claims or receive compensation. Few of those that do file claims and go to court recover anything, and those who are successful wait a long time for their compensation. And those who settle out of court end up receiving only 40 cents for every dollar that healthcare providers pay in liability insurance premiums.

It's hard to say that our medical litigation system does right by patients in light of those facts. Unfortunately, our system doesn't work for healthcare providers either.

Earlier, I spoke about those Harvard researchers who found that fewer than 2 percent of those who were injured by medical negligence even filed a claim. As they reviewed the medical records for their study, the researchers also found another interesting fact--most of the providers against whom claims were eventually filed were not negligent at all.

That's right--most providers who were sued had not committed a negligent act.

In matching the records they reviewed to data on malpractice claims, the Harvard researchers found 47 actual malpractice claims. In only 8 of the 47 claims did they find evidence that medical malpractice had caused an injury. Even more amazingly, the physician reviewers found no evidence of any medical injury, negligent or not, in 26 of the 47 claims. However, 40 percent of these cases where they found no evidence of negligence nonetheless resulted in a payment by the provider. Basically, the researchers found no positive relationship between medical negligence and compensation.

That study was based on 1984 data. The same group of researchers conducted another study in Colorado and Utah in 1992, and they found the same thing. As in the 1984 study, they found that only 3 percent of patients who suffered an injury as a result of negligence actually sued. And again, physician reviewers could not find negligence in most of the cases in which lawsuits were filed.

Now, I assume that the patients who sued had either an adverse medical outcome, or at least an outcome that was less satisfactory than the patient expected. But our medical litigation system is not supposed to compensate patients for adverse outcomes or dissatisfaction--it's supposed to compensate patients who are victims of negligent behavior. It's supposed to be a deterrent to substandard medical care.

It's not fair to doctors and hospitals that they must pay to defend against meritless lawsuits. Nor is it fair that they must face a choice between settling for a small sum, even if they aren't at fault, so that they avoid getting sucked into the whirlpool of our medical litigation system.

It's not hard to understand why physicians and hospitals and their insurers want to stay out of court. When they lose, the decisions are increasingly resulting in mega-awards based on subjective ``non- economic'' damages. The number of awards exceeding $1 million grew by 50 percent between the periods of 1994-1996 and 1999-2000. Today, more than half of all jury awards exceed $1 million.

As a result, when a patient suffers a bad outcome and sues, providers have an incentive to settle the case out of court, even if the provider isn't at fault. But is this how our medical litigation system is supposed to work--as a tool for shaking down our healthcare providers?

Let's face it--our medical litigation system is broken. It doesn't work for

patients or providers. Even worse, it replaces the trust in the provider-patient relationship with distrust.

Then, when courts and juries render verdicts with huge awards that bear no relation to the conduct of the defendants, this destabilizes the insurance markets and sends premiums skyrocketing. This forces many physicians to curtail, move or drop their practices, leaving patients without access to necessary medical care. This is a particular problem in states like Wyoming, where we traditionally struggle with recruiting doctors and other healthcare providers.

Perhaps we could live with this flawed system if litigation served to improve quality or safety, but it doesn't. Litigation discourages the exchange of critical information that could be used to improve the quality and safety of patient care. The constant threat of litigation also drives the inefficient, costly and even dangerous practice of ``defensive medicine.''

Yes, indeed, defensive medicine is dangerous. A recent study found that one of every 1200 children who receive a CAT scan may die later in life from radiation-induced cancer. Knowing this puts a physician faced with anxious parents in a difficult situation. Does the doctor use his or her professional judgment and tell the parents of a sick child not to worry, or does the doctor order the CAT scan and subject the child to radiation that is probably unnecessary, just to provide some protection against a possible lawsuit?

We have a medical litigation system in which many patients who are hurt by negligent actions receive no compensation for their loss. Those who do receive compensation end up with about 40 cents of every premium dollar after legal fees and other costs are subtracted. And the likelihood and the outcomes of lawsuits and settlements bear little relation to whether or not a healthcare provider was at fault.

We like to say that justice is blind. With respect to our medical litigation system, I would say that justice is absent and nowhere to be found.

During our debates in the last Congress, I said that the current medical liability crisis and the shortcomings of our medical litigation system make it clear that it is time for a major change. I also said that regardless of how we voted, we all should work toward replacing the current medical tort liability scheme with a more reliable and predictable system of medical justice.

Today, Senator Baucus and I are introducing a bill that would help achieve that goal.

Most of us are familiar with the report on medical errors from the Institute of Medicine, also known as the IOM. Many of us may be less familiar with another report that the IOM published in 2003. That report is called ``Fostering Rapid Advances in Healthcare: Learning from System Demonstrations.''

Our Secretary of Health and Human Services at that time, Tommy Thompson, challenged the IOM to identify bold ideas that would challenge conventional thinking about some of the most vexing problems facing our healthcare system. In response, an IOM committee developed this report, which identified a set of demonstration projects that committee members felt would break new ground and yield a very high return-on-investment in terms of dollars and health.

Medical liability was one of the areas upon which the IOM committee focused. The IOM suggested that the federal government should support demonstration projects in the states. These demonstrations should be based on ``replacing tort liability with a system of patient-centered and safety-focused non-judicial compensation.''

The bill we are introducing today is in the spirit of this IOM report. This bill, the Fair and Reliable Medical Justice Act, would authorize funding for States to create demonstration programs to test alternatives to current medical tort litigation.

The funding to States under this bill would cover planning grants for developing proposals based on the models or other innovative ideas. Funding to States would also include the initial costs of getting the alternatives up and running.

The Fair and Reliable Medical Justice Act would require participating states and the Federal Government to collaborate in continuous evaluations of the results of the alternatives as compared to traditional tort litigation. This way, all States and the federal government can learn from new approaches.

By funding demonstration projects, I believe Congress could enable States to experiment with and learn from ideas that could provide long- term solutions to the current medical liability and litigation crisis.

In introducing this bill, I wanted to provide some alternative ideas that would contribute to the debate. As a result, the bill describes three models to which states could look in designing their alternatives.

For instance, a State could provide healthcare providers and organizations with immunity from lawsuits if they disclose an error that results in an injury and make a timely offer to compensate an injured patient for his or her actual net economic loss, plus a payment for pain and suffering if experts deem such a payment to be appropriate. This could give a healthcare provider who makes an honest mistake the chance to make amends financially with a patient, without the provider fearing that their honesty would land them in a lawsuit.

Another idea would be for a state to set up classes of avoidable injuries and a schedule of compensation for them, and then establish an administrative board to resolve claims related to those injuries. A scientifically rigorous process of identifying preventable injuries and setting appropriate compensation would be preferable to the randomness of the current system.

Still another option would be for a state to establish a special healthcare court for adjudicating medical malpractice cases. For this idea to work, the State would need to ensure that the presiding judges have expertise in and an understanding of healthcare, and allow them to make binding rulings on issues like causation compensation, and standards of care.

We already have specialized courts for complicated issues like taxes and highly charged issues like substance abuse and domestic violence. With all the flaws in our current medical litigation system, perhaps we should consider special courts for the complex and emotional issue of medical malpractice.

I believe one thing in our medical liability debate is absolutely clear--people are demanding change. The States are debating liability reform, and a number of states have enacted new laws. States are heeding this call for change, and Congress should support those efforts.

My own State, Wyoming, had had a number of lively legislative debates on medical liability reform over the past few years, but we have a constitutional amendment that prohibits limits on the amounts that can be recovered through lawsuits. The Wyoming Senate has considered bills recently to amend our State's constitution to create a commission on healthcare errors. That commission would have the power to review claims, decide if healthcare negligence had occurred, and determine the compensation for the death or injury according to a schedule or formula provided by law.

According to the key sponsor of these bills, Senator Charlie Scott, one of the biggest obstacles to passage is the uncertainty surrounding this new idea. No one has any basis for knowing what a proper schedule or formula for compensation would be. No one knows how much the system might cost, or how much injured patients would recover compared to what they recover now.

Senator Scott wrote me to say that federal support for finding answers to these questions might help the bill's sponsors sufficiently respond to the legitimate concerns of their fellow Wyoming legislators. We should be helping state legislators like Senator Scott develop thoughtful and innovative ideas such as the one he has proposed. That's one of the reasons I am offering this bill.

Clearly, the American people and their elected representatives have identified the need to reform our current medical litigation system. There is a real medical liability crisis, and Congress needs to act sooner rather than later.

My cosponsor Senator Baucus and I voted differently on medical liability reform in the last Congress, but we

both agree that we ought to lend a hand to States that are working to change their current medical litigation systems and to develop creative alternatives that could work much better for patients and providers. The States have been policy pioneers in many areas--workers' compensation, welfare reform, and electricity deregulation, to name three. Medical litigation should be the next item on the agenda of the laboratories of democracy that are our 50 States.

No one questions the need to restore reliability to our medical justice system. But how do we begin the process? One way is to foster innovation by encouraging States to develop more rational and predictable methods for resolving healthcare injury claims. And that is what the Fair and Reliable Medical Justice Act aims to do.

In the long run, we would all be better off with a more reliable system of medical justice than we have today. I know that my fellow Senators recognize this, so I hope my colleagues on both sides of the aisle will work with me and Senator Baucus on this legislation.

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

Mr. President, it gives me a great deal of pleasure to bring before the Senate a resolution honoring Sigma Chi on the occasion of its 150th anniversary.

I am especially pleased to do so because I am a member of that organization. I am very proud of that, and of my association with the people who have made Sigma Chi what it is today and has been for 150 years.

Pay a quick visit to any college campus in the country and you will see a number of fraternities in residence that are working to help support their members and be a force for change in the world. They are good organizations, and they offer a lot to those who enroll, but, even given my bias in favor of Sigma Chi, I don't think there is any question that Sigma Chi has been one of the best of the bunch for many, many years.

Sigma Chi was founded in 1855 at Miami University in Ohio by seven friends who wanted to provide a better fraternity experience at their school. The seven joined together to pursue their dream of a fraternity that would be an ``association for the development of the nobler powers of the mind, the finer feelings of the heart, and for the promotion of friendship and congeniality of feeling.''

That effort succeeded beyond their wildest dreams and today, that one chapter has grown to more than 200 with over 200,000 active members across the United States and Canada. Each chapter exists to promote each member's active pursuit of an education on campus and, off campus, it encourages them to get involved in the day to day life of the community that surrounds their school. That has enabled Sigma Chi to produce leaders committed to making a difference in the world using their God-given talents and abilities and the education they have received in college. Simply put, Sigma Chi people are committed to making the world a better place for us all to live by encouraging everyone to get involved.

Fraternities have traditionally provided an important source of support for many people who are away from home for an extended period of time--some for the first time in their lives. Sigma Chi has a 150- year history of being an important part of the social network that exists to make campus life better. Thanks to Sigma Chi, the friends you make, the support you receive, and the camaraderie you develop lasts a lifetime.

Congratulations, Sigma Chi. You have a history of helping to develop leaders who have produced results that have changed the world. Your future is bright and full of promise. The roster of those who have belonged to Sigma Chi is long and impressive. I know I'm in good company with my Sigma Chi brothers and I'm proud to be a part of it all.

I ask unanimous consent to print the following in the Record.

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

Mr. President, I am here to speak on the importance of a national energy policy and to express my staunch opposition to the inclusion of an amendment offered by my colleagues from Arizona and Connecticut that creates a mandatory carbon cap and trade program.

Before doing so, however, I want to take a moment to thank the chairman of the Energy and Natural Resources Committee, Senator Domenici, for his hard work on the bill. Senator Domenici has worked exceedingly hard to craft truly bipartisan consensus legislation. I commend him for that work. I commend everyone that has worked on this bill under his direction. It is extremely important we have an energy policy.

I remember 1973 when OPEC shut off the supply. We had gas lines for what little natural gas there was. At that time, the seat I now hold was held by Senator Cliff Hansen from Wyoming. He expressed the need for an energy policy. Ever since that time we have been talking about the need for an energy policy. Now is the time we can have an energy policy. Let's finish the job.

From the time I was first elected to be the mayor of Gillette, WY, during the energy boom years of the 1980s, I have advocated the need for a comprehensive national energy policy. I come to the Senate today as a strong advocate for such a policy and to share my support for the version of the bill pending before the Senate. We have debated the merits of a comprehensive Energy bill for years. We have come close to passing an Energy bill on a number of occasions. At the end of the day, however, the Congress has not made those discussions a reality and our inaction has caused the energy situation in our Nation to worsen.

Oil prices have reached nearly $60 a barrel, more than double what they were in 2000. Unfortunately, as our demand for gasoline has increased, our Nation's refining capacity has not. This has led to record-high gasoline prices, and while high natural gas prices have helped my State, they continue to have damaging effects on consumers across the Nation.

Without a comprehensive national energy strategy, there is no end in sight for the problems we see. The high energy prices that are hurting small business will continue to make increased investment in those businesses difficult. The high energy prices that limit the ability of families to go on vacations will continue to make those trips more and more rare. The high energy prices that make it difficult for lower income people to pay their bills each month will continue to price them out of proper heating in the winter and proper cooling in the summer.

Never before has there been a time when it is more appropriate for Congress to act. Before the Senate, we have a comprehensive Energy bill that is a step in the right direction. This bill balances the need for increased domestic production while maintaining a commitment to environmental protection and energy conservation. It will help reduce our dependence on foreign sources of oil and will enhance our energy security.

This bill provides a blueprint for future energy production. At the same time, it addresses our energy needs of today. In its current form, the bill recognizes that the production of energy and the protection of environment are not mutually exclusive. It recognizes we can grow our economy and conserve energy.

Specifically, I am pleased this bill includes a number of important provisions that support and promote clean coal development. Coal is an extremely important resource in Wyoming and throughout our Nation. We have as many Btu's in coal in Wyoming as the Middle East has in oil. Wyoming has the largest coal reserves in our Nation. In fact, the county in which I served as a mayor has more coal than most foreign countries. Thus, any comprehensive energy solution that seeks to lessen our dependence on foreign energy sources must make coal a central part of the discussion.

Recognizing this, H.R. 6 authorizes $200 million per year for fiscal years 2006 through 2014 to be spent on clean coal technologies. It also incorporates a number of necessary changes to the Mineral Leasing Act to promote the development of our Federal coal resources.

The bill also repeals the Public Utility Holding Company Act of 1935, also known as PUHCA. PUHCA was enacted to eliminate unfair practices and other abuses by electricity and gas holding companies by requiring Federal control and regulation of interstate public utility holding companies. In 1935, that made sense. But today, with the oversight by the Federal Energy Regulatory Commission, by State public utility commissions, by the Department of Justice, and by the Federal Trade Commission, what was once a useful and necessary tool now unnecessarily stands as a barrier to increased investment in transmission capacity.

I am pleased that the tax title of the bill includes a provision to address our Nation's need for increased refinery capacity. I am pleased that it promotes increased investment in renewable technologies, such as wind power and hydrogen. There is no question that we need to pass the energy bill we are debating because it will truly benefit our nation.

While I support this bill as it is currently written, the amendment that is currently pending would have a disastrous effect on our economy and would ignore principles that the Senate laid out in previous debates dealing with the issue of climate change. Passage of an amendment like the one before us, that would implement a mandatory carbon cap-and-trade program, would jeopardize my support of the overall bill. I want to take a moment to share my staunch opposition to that amendment.

Climate change is a topic that we have debated for years. This topic should be familiar to us. Nonetheless, it is important to share a historical

perspective about where the Senate stands on climate change and to make clear that the proposal we are discussing, which implements a mandatory carbon cap-and-trade program, flies in the face of the Senate's stated position on global climate change.

I took advantage of the opportunity to go to Kyoto for the global climate change conference that was held there. At that conference, the Kyoto Protocol was drafted. One of the things I noticed when I got to the conference was that the United States was the only country there that thought it was an environmental conference. The rest of the world approached it as an economic conference, one where they had an opportunity to slow down the U.S. economy and allow for growth in their nations.

On the other hand, we approached it as an environmental conference. In doing so, we laid out some strict guidelines for our delegation to work within as they tried to reach an agreement. Unfortunately, on the last night some of those were compromised. The United States made some agreements that would be impossible for us to ever meet.

Before the debate first began in Kyoto about the need to control carbon emissions--that was in 1997--the Senate made a clear and direct statement of principle on that subject. When it came to negotiations on climate, we stated that any agreement that did not treat all nations, both developed and developing, equally was unacceptable. We also made it clear that we would not support an agreement that would cause serious harm to our economy. By a vote of 95 to 0, on July 25, 1997, the Senate approved the Byrd-Hagel resolution that explicitly stated the Senate's position.

The Byrd-Hagel resolution addressed the concerns of those who believe that a global climate change policy would ``result in serious harm to the United States economy, including significant job loss, trade disadvantages, and increased energy and consumer costs.''

It also addressed concerns that any effort to reduce global emissions would be imposed only on developed nations, ignoring developing nations where emissions would continue to rise without any effective controls. Let me repeat that again. We would oppose any efforts to reduce global emissions that would be imposed only on developed nations, ignoring the developing world where emissions would continue to rise without any effective controls.

Now, the Senate agreed to take this position in the 105th Congress. Since that time, nothing has changed. The science behind global climate change remains uncertain. The modeling that many used to ``prove'' that climate change exists remains fatally flawed. Yet we continue to have the same debate year after year.

We ignore the fact that the Bush administration has taken steps to reduce our carbon emissions. We ignore the fact that as a nation we are doing better than nearly every European signatory of the Kyoto Protocol when comparing greenhouse gas intensity reductions.

We also ignore the fact that climate change is a global problem. Unless we engage the developing world, whatever reductions we have in the United States will not improve the situation on a global scale.

We are just a couple of years from having China exceed the emissions that we have in the United States. They will do so without any of the environmental safeguards that we have already put in place.

When I was at the Kyoto conference, I had an opportunity to meet with the Chinese delegation. I had a couple things that I was interested in: One, why they thought, as a developing nation, they should not have to do anything to address climate change; and, just as importantly, at what point they thought they would no longer be a developing nation so they could participate in this.

They let me know they expected to always be a developing nation and to never have a part in the Kyoto Protocol. It is pretty easy to sign something that you do not have to do anything on, especially when it will force one of your main economic competitors to comply and reduce their production.

Then, I even asked: Is there any time at some future, unspecified date that you would be willing to participate? They said no. That is as loose as you can make it: some future, unspecified date. And they are not interested in participating.

Not only is the rest of the developing world not participating. The biggest polluter--in a couple of years--is not going to be a part of any of the action to reduce carbon emissions in the world.

Now, instead of working to improve the science and to improve technologies that will inevitably reduce the amount of carbon released into the atmosphere, a number of my colleagues focus on the need for a mandatory carbon cap-and-trade system. They focus on implementing what can only be described as another energy tax. Such a tax will cause the United States to lose jobs and will shift production to other parts of the world where the environmental standards are not as strict. Instead of having the effect of lowering the amount of carbon that seeps into our atmosphere, the effect will be the opposite as those developing nations allow for production without any environmental controls.

Yet, without sound science, without sound economics, and without the developing world, some Senators continue to insist that we must implement a cap-and-trade system in the United States.

As stated by the Cooler Heads Coalition:

The risks of global warming are speculative; the risks of

global warming policy are all too real.

The proposal offered by my colleagues from Arizona and Connecticut ignores the principles expressed in the Byrd-Hagel resolution. Passage of their mandatory cap-and-trade proposal will dramatically harm our economy at home without incorporating the developing world. It would lead to a drastic increase in transportation costs and home electricity costs. It would be costly for small business owners, and it would cause manufacturers to pay even more than they already do for natural gas.

Overall, according to the Independent Energy Information Administration, the Nation's energy costs would increase between $64 billion and $92 billion in 2010, between $152 billion and $214 billion by 2020, and between $220 billion and $274 billion in 2025.

My constituents simply cannot afford to have us enact such legislation. If we, as a Senate, really want to stand for improving global conditions, then we need to stand behind the principles of the Byrd-Hagel Resolution, as we did earlier this afternoon when we voted in favor of an amendment offered by the Senator from Nebraska. His legislation took a technology-based approach at home and encouraged the spread of the technology to the developing world. It made sound environmental and economic sense, and I voted in favor of that proposal.

While I oppose the pending amendment on policy alone, I think it is important for my colleagues to recognize the overall impact of including the current amendment in the Energy bill. Passage of this proposal has the potential to derail this important legislation. The Senate and House versions of the Energy bill are very different, and even without a climate change amendment, the conference with the House will be difficult. The addition of a mandatory carbon cap and trade program could be the poison pill that brings this Energy bill to a halt.

Why are we going to risk derailing a comprehensive Energy bill to implement a system that will harm our economy and will have little effect on the amount of carbon emissions released into the atmosphere? Why are we moving forward with something when the science behind the proposals remains unproven and the models used to prove that science remain flawed?

We must consider all of these issues as we cast our vote on this amendment. I will be opposing it, and I will urge other Members to do the same.

It is important to note, that although I oppose any attempt to include a mandatory carbon cap-and-trade program in the Energy bill, I strongly support the overall Energy bill. Comprehensive energy policy will undoubtedly benefit our Nation, and I look forward to working with my colleagues to finally make this legislation a reality.

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