Floor Statements

Mr. President, I ask unanimous consent to proceed as in morning business to speak about the health care deliberations we are undertaking. I know we are under the Defense authorization bill. My remarks should not take that long.

Mr. President, as I indicated, I rise today to talk about health care reform and the hard truths that have so far been not hidden but I do not think have been very much aware to many Americans.

I was inspired to come to the Senate floor today because we are holding hearings in the HELP Committee--and we are holding hearings in the Finance Committee--and a series of events in the Health, Education, Labor, and Pensions Committee made me recall the observations of a well-respected public opinion analyst, pollster Daniel Yankelovich, founder of the New York Times/Yankelovich Poll.

The HELP Committee has been struggling--well, we have been working hard; ``struggling'' probably is not the right word; and many thanks to the chairman, Chris Dodd, our ranking member, Mike Enzi, and the members of the HELP Committee--but we have been going through a multiweek markup that I think has been characterized by some very wishful thinking on the part of the majority members of that committee; namely, the hope or the wish that they can somehow not reveal the very real costs and tradeoffs raised by their health care reform bill. I think the American people ought to become more and more aware of this.

The bill the HELP Committee is marking up establishes all sorts of new government programs, all sorts of new government mandates and controls--all justified by the need to ``rein in health care costs'' and ``increase health insurance coverage.'' I know those are two very good and noble pursuits, which I support wholeheartedly. As a matter of fact, I think Republicans now have about six bills to do the same thing. They do not get much attention, but we have six bills.

But there is a big problem with this bill. It does neither of these things, in my opinion. It neither reduces costs, nor does it significantly increase coverage. In fact, it significantly increases costs for very little gain--``costs,'' c-o-s-t-s. Remember that word. But my colleagues on the HELP Committee continue to wish and to hope they can obscure this reality through a barrage, really, of speeches and rhetoric and what I call misleading figures.

It has been this behavior that has caused me to recall Mr. Yankelovich's observations on something called the evolution of opinion. I am going to use that as the basis of my remarks--the evolution of opinion. The article was in Fortune magazine, and it jogged my memory in this regard. But, in any event, I think it serves as an important illustration of the health care reform process so far. Mr. Yankelovich observed that the evolution of a person's opinion could be traced through a continuum of seven stages. That is a fancy way of saying there are steps you go through when you are trying to think something through.

First, we have had daunting awareness: the realization that our health care system was not working for every American and needed to be addressed. I think everybody understands that.

The second stage, greater urgency: the economy began to go south and people who used to rely on their employer for health insurance began losing their jobs.

Then there is the third stage: reaching for solutions. Our committee has held hearings and began to meet with stakeholders. The administration met with stakeholders. The stakeholders, I think, probably met in good faith. And it has only been recently they have discovered they may have signed on to something that is very illusory, to say the least.

Fourth, the stage where many on the HELP Committee and elsewhere have arrived at today: the wishful thinking stage, the well-intentioned, romantic, simplistic, perhaps naive moment where all one sees are the benefits, without considering the consequences--the law of unintended effects. For example: the totally misleading claim by the majority that the new data from the Congressional Budget Office revealed a much lower score for this bill, $597 billion--a lot of money--while still expanding health insurance coverage to 97 percent of Americans. This claim is the very definition of ``wishful thinking.'' But facts are stubborn things. The actual CBO numbers say this bill leaves 34 million people still uninsured. That is not 97 percent coverage. In order to gain anywhere near 97 percent coverage, we would have to significantly expand Medicaid--a very expensive proposition which, according to CBO, adds about $500 billion or more to the cost of this bill.

More wishful thinking: The $597 billion cost was further artificially lowered through several budget maneuvers, such as a multiyear phase-in and a long-term care insurance program that will increase costs significantly outside the 10-year budget window CBO is required to use. Here we are passing a long-term insurance bill that goes beyond 10 years that CBO cannot even score.

After taking these realities into account, a more accurate 10-year score of this bill is closer to $2 trillion. I said that right: not $1 trillion--$2 trillion.

This is when we should arrive at the fifth stage of opinion making: weighing the choices. Since the true cost of this bill is approximately $2 trillion, we must own up to the American public about the tradeoffs. We must finally understand that the tradeoffs threaten a health care system that polls tell us has a 77-percent satisfaction rate.

This is not to say we should not undertake any reforms, but we need to honestly discuss the costs and benefits of reform proposals. And the majority's proposal is high on cost and low on benefits.

The No. 1 tradeoff that Americans need to know is, higher taxes. Remember when the President promised: If you make under $250,000, you will not see your taxes increased, that you would actually see a tax cut. Well, like so many other pledges, those promises had an expiration date, and that date is rapidly approaching.

The bill raises $36 billion in the first 10 years in new taxes on individuals who do not purchase health insurance. That is a penalty. It raises another $52 billion in new taxes on employers who do not offer their employees health insurance.

As an aside, guess who suffers when the employer's taxes get raised? It certainly is not the employer. It is the employee who gets laid off or does not get a raise. It is the applicant who does not get hired. Even President Obama's own Budget Director admits this fact.

At least one economic survey estimates that an employer mandate to provide health insurance, such as the

one in the Kennedy-Dodd bill, would put 33 percent of uninsured workers at risk for being laid off--33 percent of uninsured workers. The study went on to say that ``workers who would lose their jobs are disproportionately likely to be high school dropouts, minority, and female.'' It is a job killer for the very people whom the bill ostensibly seeks to help.

These new taxes do not come close to paying for this bill, and the ideas that have been coming out of the Finance Committee, on which I am also privileged to serve, the House of Representatives--the so-called people's body--and the administration prove that these new taxes will be just the first of many.

One option: a new and higher income tax on taxpayers with earnings in the top income tax brackets--there is some press on that as of now-- including small businesses--essentially a small business surtax--to pay for government-run health care. Keep in mind that this surtax is in addition to the higher income taxes the President is already calling for in his budget.

The President's budget proposal calls for raising the top two individual tax rates in 2011. Many small businesses file their tax returns as individual returns, and the National Federation of Independent Businesses, NFIB, estimates that 50 percent of the small business owners who employ 20 to 249 workers fall into the top two brackets. When these higher income taxes are combined with the proposed surtax to pay for the government-run health care, it means that a small business could see its tax bills go up by as much as 11 percent--11 percent--when this health care reform bill finally takes effect--an income tax rate increase of about 33 percent over what they pay today.

But it does not stop there. Under the proposal the House is expected to unveil, possibly today, they leave the door open for even more tax increases on small businesses. That proposal is expected to allow, in 2013, for the small business surtax to be raised by several additional percentage points if health care costs are higher than expected, which is likely.

These higher income taxes would be a devastating hit on our Nation's small businesses--the same small businesses that create roughly 70 percent of the jobs in this country and are the backbone of our economy. We should not be raising taxes on these job creators if we want our economy to rebound and grow and expand.

Small businesses in Kansas tell me they feel they are already stretched to the limit, and they worry that to pay the additional taxes called for in the President's budget, not to mention an additional small business surtax to pay for a government-run health care program, they will have to cut back elsewhere--``cut back,'' meaning layoffs; cutbacks, meaning really it is the worst thing you could do for the economic catalyst of our country, the small business community. Make no mistake, these will be difficult choices. They will have to reduce the wages and benefits of current employees. They will have to pass their costs on to their customers. They will have to lay off workers or not hire new employees. None of these are good options for workers, small businesses, or our economy.

But higher taxes are just one of the ways the majority wants to pay for this massive expansion of government. The other method? The other method will be cuts to Medicare. You heard me right: Medicare, cuts to Medicare, cuts to the reimbursements to providers to our senior citizens, cuts we have been trying to prevent, where we have added money in almost every session we have been in.

There would be $150 billion from the hospitals. The hospitals have agreed to this with their national organizations but funny thing: The hospitals from Kansas came back to me and said: Not on your life. For a person who has worked hard to prevent cuts in that market basket of provider reimbursements to keep our rural health care delivery system whole, it comes to me as a great surprise that their national organizations would sit down and say: OK, we are going to give up $150 billion, only to learn a couple days or weeks later that some in the House say: That is not enough. So they didn't have a deal--and another few hundred billion from the physicians. I haven't heard any agreement on that from the physicians.

Tens of billions from home health care agencies and radiology and home oxygen and PhRMA. Let's don't forget PhRMA, who agreed to a certain amount of cuts--I think it was $80 billion--but now they have learned that figure isn't firm. So whoever else gets strong-armed or weak-kneed into making a deal with this administration, you better be careful.

Again, when doctors and hospitals and pharmacists and home health agencies get their reimbursements slashed by Medicare or Medicaid, who pays the price? It is not the provider, at least not at first. It is the people with private insurance who pay a hidden tax to make up the difference--some $88.8 billion per year, according to a recent Milliman study. Once the provider runs out of private payers to shift this cost deficiency onto, who pays? It is the patients who lose access to a doctor or a hospital or a pharmacist or a home health agency.

In addition to cutting Medicare payments, this bill will dump, by some estimates, well over a million new people onto a government-run health care plan which will never pay providers enough to cover their costs, despite any rhetoric otherwise. As this number grows and the private market shrinks, the decrease in the number of doctors and hospitals and other providers will be inevitable. We see that already. We already have rationing. We already have shortages. We already have doctors and providers who say: I am sorry, I am not reimbursed to the extent I can stay in business and offer you Medicare. So rationing is not a scare word, it is something that is happening now. It will simply not be possible for them to keep their doors open on the margins that the government will pay them. And that is when rationing of health care will become a way of life in this country.

Oh, I can see it now. It will either be by age or by test or by the comparative effectiveness research golden ring that CMS--that is another acronym--an outfit that works for the Department of Health and Human Services. These are the bean counters who look in this way at health care and don't look at the real effects, and I see what can happen.

These are the tradeoffs the American people need to know about in this bill. Yep, $2 trillion in new spending, higher taxes, job-killing employer mandates, and rationed health care. And for what? To overhaul a system with which 77 percent of Americans are satisfied.

I offered several amendments in the HELP markup just this morning, attempting to force the committee to face stage 5--remember my Fortune magazine and my stages of evolution of thought--to truly weigh the choices, that is the next stage. My amendments would have prevented Federal health subsidies from being funded through higher taxes on employers, higher taxes on individuals and families or through cuts to Medicare. All three were defeated in a party-line vote. I wasn't alone in trying to get the committee to weigh the choices in this bill. Senator Alexander spoke very credibly as a former State governor about the fiscal catastrophe that expanding Medicaid eligibility will cause for the States. Again, he was defeated by a party-line vote.

How can we ignore the very real consequences of raising taxes on individuals and employers in a recession--some say the worst recession since in the 1930s? How can we deny that further cutting Medicare will increase costs for everyone else and possibly eliminate access to health care for our seniors? How can we turn a blind eye to all the States that are already facing a financial meltdown and force them to take on billions of dollars of new Medicaid obligations?

Some are still stuck in stage 4, still hanging on to their wishful thinking.

Well, I am ready to move on to stage 6, and probably everybody else is as well here on the floor. It is called taking a stand. I hope we can all take a stand to preserve the system that works well for the vast majority of Americans and to consider a more cost-conscious, realistic, and patient-friendly approach to greater health care reform.

By far the most important stage for us is--yes, the final stage-- stage 7:

making a responsible judgment. The policies in this bill are very expensive, and the American people need to know that someway, somehow they will have to pay for them. So we must thoroughly examine the cost and the tradeoffs in health care reform. We cannot simply engage in wishful thinking. The American people expect us to make responsible judgments. There is simply too much at stake.

I understand the leadership of this body is in a dash, a rush to finish the hearings in the HELP Committee to produce a bill, as well as to force the Finance Committee to come up with a markup of a bill to pay for all this. I don't know how you pay for $2 trillion while the Finance Committee is talking about $350 billion and those are very controversial. I have a suggestion. I think we ought to put a big banner right up here where the President is not, right over there. I don't think the President would mind very much, and it could just say, ``Do No Harm.'' Then maybe we could put something underneath that and say: ``Slow Down'' or maybe in the language of my State ``Whoa.'' And then put that in the back of the HELP Committee, put in the back of the Finance Committee, and let's do the job right.

I am delighted to yield.

If my distinguished colleague--well, I will take back my time and yield back for any comments he may want to make. The person on the other end of the phone call, was he for the health care bill or was he against it?

Whether for or against, I hope the Senator from Mississippi would have explained that we both have some real concerns, and we hope we can get real health care reform.

I also thank the Senator.

Let me just give one quick example of what I am talking about with regard to Medicare. The President of the Kansas Pharmacists Association is from a very small town out West. We conduct a lot of listening tours, and we go into the pharmacy. The pharmacists, we ought to give them a GS-15 salary because they are the people who deal with Medicare Part D. That is the prescription drug program we give to seniors; it is very popular.

Let's say a lady named Mildred came in to see her pharmacist there and Mildred talked to Tom, the pharmacist, and said: What is this doughnut hole? And Tom says: Well, that is where you have to pay a bigger copayment. And she says: Well, can't I get a new kind of program or something else that will help me out here? He said: Yes, there are 47 new programs you can choose from. Mildred, the one that you want is right here. She says: Good. Then I am not going to get hurt with the cost of the prescriptions I need. He says: But I can't offer it to you? Why? Because I only get reimbursed 71 percent.

That is about the national average. How on Earth can we expect every pharmacist all around the country to administer--and they are the ones doing the administering; it isn't the Area Agency on Aging or the 1- 800-Medicare. So he had to tell her that the program in Medicare Part D that would cover the doughnut hole, he didn't get reimbursed enough and couldn't offer it. Well, he helped her out. All pharmacists try to do that. That is where we are.

Or if Mildred goes to the doctor and the doctor says: I am sorry, I can't take any more Medicare patients--that is happening. It is real. This bill exacerbates that--exacerbates it. That is why I am so upset and why I came to the floor today.

I will go back to the HELP Committee in good faith to work with my colleagues and we will try to make it bipartisan. I know on Thursday we are supposed to have a markup in the Finance Committee--marching orders from the leadership around here, right in the middle of a Defense authorization bill. We don't need marching orders. We need to slow down. We need to slow down and get this right.

Thank you, Mr. President. I yield back the remainder of my time.

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

I ask unanimous consent I may proceed as if in morning business for approximately 15 minutes.

Mr. President, and to all present in terms of staff, this is Friday, and here we are at 1:25. I apologize to the doorkeepers, I apologize to the elevator operators, I don't want to keep you here for a long time, so I will quit apologizing, but there have been some things happening with regard to health care.

The distinguished Senator from Rhode Island indicated the need to move forward on health care. Everybody agrees to that. The pace of it, what is going on, is a real concern, so I do have some remarks to make. I will try to make this as quickly and succinctly as possible so everybody can go about their business. I see smiles from the pages, in regards if I can just hurry up and get through my comments.

Yesterday, in the HELP Committee's markup of the Kennedy-Dodd health care reform bill, we had a very good discussion about the proper use and the objectives of something called government-conducted comparative effectiveness research.

I know that is getting into the weeds in regard to health care language and health care acronyms. It is called CER; remember that term, ``CER.'' It is going to be around for a long time because it has become quite controversial in regard to our health care discussion and what eventually passes. CER is research that compares the relative outcomes of two medical treatments for the same condition to determine which one is better. That is a good thing. It is a good thing to disseminate and to inform doctors and everybody in the health care delivery system--nurses, health care providers, pharmacists, et cetera--it is a good thing. But the first problem with CER is that not every patient is the same. What is better for one patient may not be better, or could actually be worse, for another. For this reason doctors and patients must be able to deviate from the results of something called CER, or a master plan or a master evaluation that could come out of Washington from an outfit called CMS, under the Department of Health and Human Services.

The situation is patients must be able to deviate from the results and make treatment decisions on a case-by-case individualized basis. That is what we all want in terms of our treatment with our doctors.

The other major problem, I submit, is that CER has been used by other governments, such as the United Kingdom, to base treatment decisions not just on relative effectiveness but on relative cost. There is the rub. If CER is going to inform doctors and everybody in the medical community that this kind of treatment or this kind of best practice is the arena in which you should operate or pasture you should operate in, that is OK. But if it is used to control costs as opposed to care, then we have a problem.

By giving priority to the relative costs of the treatments being compared, the government can deny access to health care based on what I would call pseudoscience, under the guise of CER. That brings me back to yesterday's discussion on CER on the health care markup. The Kennedy-Dodd bill includes a section that establishes a new Center for Health Outcomes Research and Evaluation. This outfit is to conduct and support comparative effectiveness research.

Section 219(h)(1)--if that isn't getting into the weeds, I don't know what is--includes the following language relating to the practical effect of CER, or comparative effectiveness research. That would, again, be conducted by the center.

Center reports and recommendations shall not be construed

as mandates for payment, coverage and treatment.

That language was in there to get at this problem for those of us who worry that CER will be used by CMS--that is another acronym. That is the outfit that runs Medicaid and Medicare, in terms of services. These are the people who count the beans, these are the people who want to turn the red beans into black beans. These are the people into cost containment. These are the people who many times drive board members in small hospitals crazy.

At any rate, to take away the worry, that language was put in there: Senate reports and recommendations shall not be construed as mandates for payments, coverage and treatment. They thought that was enough to protect us in regard to CER dictating medical care and stepping in between you and your doctor.

Let's go back to those words ``shall not be construed as mandates.'' What does that mean? ``Mandate'' means to force, compel, bind. This language says the CER shall not be interpreted as forcing CMS, Veterans' Administration or the Department of Defense to restrict payments to doctors based on its results.

Senator Mikulski and I and Dr. Coburn as well had a very lively discussion about the intent of this language. Senator Mikulski said the intent of the language was to keep the right to make treatment decisions with the doctor and the patient, not with the government. I certainly agree with that.

Senator Mikulski has worked long and hard on this bill, and I respect her for that. She is a good colleague and a good friend. I agree with this intent.

But as I pointed out to the Senator, the language in the Kennedy-Dodd bill does not accomplish our common intent of saying the government is not mandated or forced to use the results of this comparative effectiveness research to make payment decisions. Whether you are paid or not in regard to Medicare or, for that matter, Medicaid is not the same thing as prohibiting or preventing CMS from doing so.

In order to vigorously protect the rights of patients and doctors to make treatment decisions against the danger that the government will interfere in that process, I believe the bill must prohibit the government from using the results of CER in making payment, coverage, or treatment decisions. Sorry, you cannot have that, you have got to have this treatment, because it is a best medicine practice, regardless of the fact that maybe you and your doctor have had that treatment before and the doctor thinks that treatment is the best treatment for you.

I offered new language, and the new language would have placed a clear, bright-line firewall between the conduct of CER--which, by the way, I think is essential to advancing medical science; it is a good thing--and the use of its results to restrict your doctor from using his or her best judgment when treating you.

My language, which I further modified at the suggestion of Senator Mikulski, read: ``Center reports and recommendations are prohibited from being used by any government entity for payment, coverage, or treatment decisions.''

Senator Mikulski agreed to consider my suggestion over last night, along with Senator Dodd. I appreciate that. But today when the HELP Committee reconvened in our markup, Senator Mikulski and the majority refused to accept my language and offered counterlanguage that would basically put us back to square one and, in my view, would do nothing to protect patients and doctors from CMS or any other government agency interfering in their treatment decisions.

When I asked why my language was unacceptable, which I thought was acceptable for everybody when we left yesterday, I was told that the decision

to say my language was not acceptable was based on concerns by ``Washington policy experts.''

I said: Who is that? Which Washington policy expert said my language was not acceptable?

When pressed on which policy experts, we learned that the directive came straight down from the White House. Why would the White House be so concerned about prohibiting the Federal Government from using CER to restrict payments to doctors or to direct doctors to follow specific treatment orders? Why would the White House do this on this in-the- weeds proposal, which is not an in-the-weeds proposal at all, it is about what the government is going to do or tell doctors and patients what they can expect.

It is clear from statements made by this administration that they see CER as the golden ring for cost containment. The President said when asked, how on Earth are you going to pay for the health care bill, We are going to cut Medicare payments.

How are you going to do that?

Well, if you have a CER golden ring that comes down from CMS or the National Institutes of Health for cost containment, you can see: This research says that you should follow these practices, not those practices and those practices, or, these practices would certainly cost less.

I do not think that is a good thing. From OMB Director Peter Orszag, to the NIH Director, going on to the National Economic Council Director, Larry Summers, and indications from our new Secretary of Health and Human Services, Kathleen Sebelius, a good friend, former Governor of Kansas, all have pointed to the huge potential of CER to be used to contain costs, not to recommend procedures best for patients and the doctors as determined by the patient and the doctor, but by CER to control costs.

That is why the White House does not want to prohibit CMS or any government agency from using the results of CER to deny you and your doctor the right to choose the treatment that is best for you.

After all of that was said and done, and a lot was said and not much done, I got quite a lecture this morning in regard to my use of the word ``rationing'' to describe what this could lead to. This lecture was referred to as a scare tactic. They indicated that I was using the word ``rationing'' out there as a scare tactic to scare people to say we do not want health care reform.

I find that rather condescending. I find that demeaning. And it is certainly not accurate. You tell me, when Medicare refuses to pay your doctor if he or she decides you need a particular course of treatment that deviates from the government standard, what would you call it? I would call it rationing.

That is the danger. It is not a scare tactic. Health care rationing is happening right now in this country. We may not have explicit rationing such as in the United Kingdom where the government refuses to give elderly people drugs to treat their macular degeneration until they have already gone blind in one eye--not making that up--or refuses kidney cancer drugs for terminal patients because it is not worth the money to extend their life by 6 months. That is rationing.

But we do have de facto rationing, because Medicare and Medicaid refuse to pay doctors anything close to what their costs are. By the way, it's the same thing for pharmacists, the same thing for home health care, and for all of the providers who provide our health care treatment. This means those doctors cannot afford to take Medicare and Medicaid patients--they make the decision then--and it means that those individuals do not have access to care. That is rationing I am talking about.

I am talking about a doctor who makes a decision: I am only getting paid about 70 cents in terms of the dollar in regard to my cost in regard to Medicare patients. I have to hire extra people to keep up with paperwork and regulations. Those people do not exist in the rural health care system. We have to try to find them. So it is a lot easier if I drop the Medicare Program.

That comes as a sudden jolt and a sudden decision that is not fair in regard to the patients who were being treated by that doctor in terms of Medicare. That is what we call rationing right now in regard to the United States of America.

We know the administration wants to use CER to contain costs. We know CMS has a history of denying full payment based on cost. I am not going to take the time on the Senate floor right now to go into all of the problems that CMS has posed for the health care delivery system. Again, these are folks who have a difficult task. They are trying to change the red beans into black beans so that health care does not cost so much. But in terms of their decisions here in Washington in regard to what care is going to be paid for and what is not, they are an absolute nightmare to every hospital administrator, every hospital board member in the 350 or so hospitals I have in Kansas, and the 83 critical access hospitals I have in Kansas.

We do not have a very good relationship with CMS. What we have is a meaningful dialog, most of the time, when yet another regulation comes down the pike to contain cost, most of which the doctors have never heard of, not to mention everybody else in the health care delivery system. I can go into quite a rant, as you can expect from my comments in regard to CMS and what they do and what they do not do.

Why is the majority, why are the Democrats, resisting any language to protect patients and their doctors, you and your doctor, and your right to make the right treatment decision for you? Why are they trying to muzzle my warnings that this could lead to the rationing of health care? It boils down to the fact that they do not want the American people to know what their true plans could actually be. That is why they are shoving this massive health care reform bill through Congress at warp speed, having markups before we even have complete language or cost estimates.

We heard from the distinguished Senator from Rhode Island about the need for health care reform, and the fact that he was complaining about over 100 amendments in the HELP Committee. My goodness. Almost every major bill I have been associated with, you have literally hundreds of amendments. Many fall by the wayside, many are withdrawn. We have dealt with 17, 18 of them as of today.

Senator Mikulski and Senator Dodd did a very good job in that respect, along with our ranking member, Senator Enzi from Wyoming. But it would be helpful, if we are going to move forward with the health care reform, if we had the bill. We do not have the bill in the HELP Committee. We have one section of the bill, and then we have a Congressional Budget Office score on one-sixth of the bill that is $1 trillion. And, boy, did that shock everybody. Say $1 trillion for one- sixth of the bill. What is the whole bill going to cost? That estimate is somewhere in the neighborhood of $4 trillion. How on Earth are you going to pay, in the Finance Committee, the pay-for committee, $4 trillion for health care reform, and take it out of the health care delivery system?

I do not think you can do it. But we do not know, because we have not seen the legislation. We are being asked to go on a deadline schedule to produce amendments on things such as CER that worry people in regard to possible rationing by a date certain or a time certain, and we have not even seen the bill we are amending.

I have never been through a situation like that. Not to mention the specific cost estimates by CBO. This is not right. That is why Chairman Baucus in the Finance Committee had at least the good sense to postpone the markup of his bill until we could work this out. That is why slowing down does not necessarily mean that everybody is opposed to health care reform. It means we ought to get it right.

We at least ought to have a bill to read, to know what we are dealing with. I think it is because they know that if Americans knew what they were doing, they would never stand for it. I think we need to get this out to the public, and the public will hopefully fully understand it. I am not going to allow this. Personally, I am going to continue to shout it from the rooftops and beware of what lurks under the banner of ``reform'' to tell every doctor, every hospital administrator, every hospital board member, anybody who has anything to do with the health care delivery system, watch out in regard to CER.

It could be the golden ring of cost containment, and it could put you out of business. It could put you out of business. We have examples of CMS doing exactly that. So do not wake up one day and realize that the government has taken over your health care the same way they have taken over the banks and the auto industry. Do not let them ration your health care. Rationing is not what we need. It can be terribly counterproductive, and I hope we can do a better job in the future.

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

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

Mr. President, I ask unanimous consent that I may proceed for approximately 16 minutes as in morning business.

I thank the distinguished Acting President pro tempore.

Health Care Reform

Mr. President, last week, I came to the Senate floor to talk about the flawed process of our current attempts to reform the health care system in this country and the urgent need to fix those flaws.

Those efforts included a letter--my letter--which every Republican member of the Finance Committee and the HELP Committee--Health, Education, Labor, and Pensions Committee--signed requesting some very reasonable steps to be taken by Chairman Baucus, Chairman Kennedy, and Senator Dodd, who is standing in for our friend and colleague, Senator Kennedy.

We asked the chairmen to release the details of their plans to reform health care. We asked them to do so in a timely manner to allow us time to read and understand the policies and to get reactions from our constituents, i.e., the people who will benefit or will not benefit, not to mention the providers of health care. We asked them to give us the estimates of how much their plans would cost and how it would impact everyday Americans. Finally, we asked them to identify how they intended to pay for these plans.

It was my sincere hope that by receiving this information we could better participate in the quest to ensure that every American--every American--has meaningful access to health care, not to mention patient choice.

Well, unfortunately, the health care reform process has been so corrupted by artificial timelines and a ``hurry up'' and a ``riding hell for leather'' mentality that it threatens to destroy a health care system that has served most Americans very well.

The American health care system represents one-sixth of our economy, which has been repeated many times on this Senate floor, offers health insurance coverage to 250 million Americans, and employs over 16 million people. It leads the world in medical innovations that save lives inside as well as far outside our borders. So this actually is an international health care bill.

President Obama has recognized that most people are happy with their health care. Obviously, they would like some changes, some reforms. But he has repeatedly assured them: If you like what you have, you can keep it.

Well, because changes to this system have the potential to impact every single American citizen and citizens of other nations, it seems to me we must ensure we protect the best of its features when we consider changes to shore up its deficiencies.

Careful consideration is required. That is why we ask for more details. That is why we ask for more time. To date, our requests for more information have not been met, and I think I am starting to understand why.

Yesterday afternoon, the Congressional Budget Office, the CBO, released its first preliminary analysis of the bill we are scheduled to begin marking up in the HELP Committee tomorrow. Let me repeat this: Yesterday afternoon--less than 24 hours--if you are a HELP Committee staffer, you are looking at your watch, and you are wondering how come you do not have more time--the Congressional Budget Office released its first preliminary analysis of the bill that we are scheduled to begin marking up tomorrow.

I said in my previous speech, maybe we need a ``process czar,'' a ``fair play czar'' around here. We have 25 czars in the Obama administration. Maybe we need a czar around here to at least be fair, give us more time, give us more consideration, let us know what we are going to be voting on.

Before I talk about the results of the CBO's analysis of the Kennedy- Dodd legislation, I need to point out this analysis is incomplete. It is incomplete because, despite our persistent requests for more information from our Democratic colleagues and friends, one day before the markup of possibly the most important health care bill ever to cross the Senate floor, they have not released the complete legislation.

In fact, even when the HELP Committee begins our markup tomorrow, we will not have a complete picture of what we are marking up. The most contentious components of the bill will not be released until sometime on Thursday morning--leaving us around 30 hours to digest these significant policies, vet them with our people back home, take the specifics back home to the health care providers and every constituent who certainly is interested and wants to know the details, and then file amendments to see if we can do better, see if we can actually correct some things we think are headed in the wrong direction.

I said it is hard to digest all of this in 30 hours. This is not digestion, this is not indigestion--this is heartburn. It may develop into a malady much more serious than that.

Most egregious perhaps is the fact that we will most likely be considering these major reforms without any idea of how much they will cost or how they will affect the current system. But, as I said, I am starting to wonder whether that is not part of the plan, which leads me back to yesterday's CBO release analyzing the cost and effect of just one of the six titles to the Kennedy-Dodd health care reform bill--and an incomplete title at that.

According to CBO, the incomplete sections of title I will cost $1 trillion--$1 trillion. That is just for one incomplete title of this bill. What will we get for this staggering investment, for a title with a purpose ostensibly to expand health care coverage to the estimated 47 million Americans currently lacking insurance?

According to CBO, we will only cover 16 million more Americans. Let me say that again. According to CBO, we will only cover 16 million more Americans. That does not seem like a very good return for a bill that seeks to cover three times that many people.

Instead of extending health insurance to 47 million uninsured, we are leaving tens of millions still uncovered. And the CBO says that figure is around 37 million people. So you can see we have some flaws in this approach on this bill.

In addition, CBO says that 15 million people would lose their employer-sponsored insurance and another 8 million--again, this is the CBO analysis--would lose coverage from their current source.

Whom are we going to trust around here? At least when we asked the CBO to give some specifics, they are providing some specifics; that is, 15 million people would lose their employer-sponsored insurance and another 8 million would lose coverage from their current source. That is 23 million people. That is a lot of folks. As I said, President Obama has consistently promised: If you like the health insurance plan you have, you can keep it. Not those 23 million.

Under the Kennedy-Dodd bill, 23 million Americans who may like what they have cannot, in fact, keep it--again, according to the CBO, nonpartisan.

I cannot even imagine how much more this bill will cost taxpayers when CBO figures in the rest of the initiatives my friends across the aisle wish to add. I am positive, under the complete plan by my colleagues, millions more Americans will not be able to keep the insurance they like.

That is because in addition to the plans that have already been released, they want to establish a new government-run, taxpayer- financed insurance plan that is estimated to replace private insurance for over 100 million Americans. They want an expansion of Medicaid for everyone up to 150 percent of the Federal poverty level. They want to enact dozens upon dozens of new programs.

For example, title III of this bill includes--listen to this--a $10 billion per-year-cost in mandatory spending--mandatory spending; this is on the appropriators' side--for something called a Prevention and Public Health trust fund for the Appropriations Subcommittee on Health, with very little, if any, direction on what the money would be used for.

This is unprecedented and amounts, in my view, to a slush fund, regardless of any description.

Another section provides an unknown amount of money--``such sums as may be necessary''--to fund something called a community makeover-- excuse me--a community transformation grant to build grocery stores, sidewalks, and jungle gyms.

Sidewalks, jungle gyms, grocery stores? This is a health care bill, not a rural development bill. I am shocked by the numbers that have come out so far, and they are just the beginning.

Well, come to think of it, maybe it is related to health care. Maybe if you build a better sidewalk, people could walk on that sidewalk, pass the jungle gym, exercise on the jungle gym, go to the grocery store, have mandates to buy nothing but fruits and vegetables, come back past the jungle gym, exercise some more, and since the sidewalk is fixed, they could go home, and we would help cure the obesity factor we face today. Maybe that is the tie. Maybe that is the tie.

I am shocked, as I said, by the numbers.

One independent group--now listen again to this; you have to listen to this--the group called HSI Network in Minnesota has estimated that the cost of the Kennedy-Dodd bill in its entirety could be $4 trillion--$4 trillion. The Lewin Group has estimated that up to 119 million Americans could lose their private insurance coverage under a government-run plan.

I am willing to bet the American public will be as shocked as I am once they understand what has been lurking, lurking, lurking under the banner of reform. The refusal to release information such as this until the very last possible minute, under an unjustifiably accelerated timeline, leaving no time for Senators, let alone the American public, to examine the merits of this plan, makes me think the ``health care emperor has no clothes.''

Let me repeat what the CBO has said. Sixteen million Americans newly insured--a good thing--but 37 million Americans still not insured. Twenty-three million Americans lose what they have for $1 trillion. This is the wrong direction. This is the wrong direction. We ought to say: ``Whoa.'' Put a sign up in both committee rooms that says: ``Whoa,'' and put a sign underneath it that says: ``Do no harm.''

To add to this concern I have and the frustration I have in regard to health care reform, CongressDaily reported Tuesday, June 16--that is today--that CBO scored a recent version of the Senate Finance Committee--this is Finance, this is not Health. This is not the one I am talking about; this is the Finance Committee, and I have the privilege of serving on both--that their overall proposal is at $1.5 trillion over 10 years, not $1 trillion, according to several sources. This is a typical news story. The committee's timeline to release and mark up the legislation could slip on the news. Senate Finance Chairman Max Baucus cautioned today the CBO numbers, which he did not confirm, were on a bill that is about 2 weeks old and the bill has evolved since then. The chairman indicated it is unlikely he will release a draft of his committee's bill Wednesday, as he previously estimated--that is tomorrow. The high score could add more credence to an insurance co-op proposal offered by Senate Budget Chairman Kent Conrad as an alternative.

So we don't know. Is it $1.5 trillion or is it $1 trillion? We don't know. And if an offhand comment, which may or may not be private, but I don't think anymore anything should be private in regard to health care reform--the chairman indicated, I think, it was a comment in response to Senator Snowe, who said, How do we vote for this bill in committee if we don't know how much it costs and how it is going to merge with the Health Committee's bill. Basically the answer coming back, as everybody knows is, This bill isn't going to be written here, this bill isn't going to be written in committee; it is going to be written in conference. It is called ``trust me.''

I don't see how we can have much trust when ``the emperor has no clothes.''

I yield the floor.

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

Madam President, I understand we are in morning business, and I ask unanimous consent that I be recognized for about 12 minutes.

Madam President, I rise today to discuss an issue that is one of these ``believe it or not'' issues of waste and abuse concerning billions of tax dollars and stimulus funding. I have some good news and then I have some bad news to report.

First the good news. In the last 24 hours, we have been able to reverse a policy that would have used stimulus money to pave the same road twice within a matter of months. I said yesterday that did not pass the Kansas commonsense test or, for that matter, any State's commonsense test, and would be a huge abuse of taxpayer dollars. We have reversed this plan, this silly plan, in a bipartisan way.

I wish to personally thank Vice President Biden, the man charged with overseeing all of the stimulus spending, for taking action to correct this abuse after I contacted him. I really thank the Vice President because the White House moved and the Vice President moved in an expeditious fashion, and I, quite frankly, didn't expect they could move that fast, but they got the job done.

The Vice President will be in Kansas today, and I asked him to review this rather ridiculous example of wasteful spending occurring in Cherokee County, KS, just a short 2-hour drive south on U.S. Highway 96 from where the Vice President will be. You see, a section of old Highway 96 would have been

resurfaced with stimulus funds. Then portions of an EPA Superfund site would have been cleaned up with stimulus funds, and the heavy equipment used for the cleanup would have damaged the newly resurfaced highway, so they would have to go back in and do the highway again. Once this cleanup was complete, additional stimulus funds would have gone to repair the road damage caused by the heavy trucks. Taxpayers would have paid almost $1 million to fix this road twice.

Fortunately, in working with the Vice President, we now have media reports that the Superfund cleanup will occur prior to any roadwork. That is the good news. Again, I credit the Vice President and his staff and his team.

Now for the bad news. While this spending issue has been fixed, there is a much larger spending issue affecting dozens of Kansas families in Cherokee County, KS, and that is still a major problem. I am going to urge the Vice President to again provide leadership. He is the self- proclaimed new sheriff in town. I am an honorary sheriff of Dodge City, KS, my hometown. So from one sheriff to another, I would simply say to the Vice President: Sheriff, I will ride shotgun or you can ride shotgun. We have the problem only half solved.

You see, in April, EPA Region 7 issued a press release saying Cherokee County would receive up to $25 million from the stimulus. According to the press release:

By starting or speeding up cleanup at Superfund sites, the

[stimulus] funding is also increasing the speed with which

these sites are returned to productive use. When a Superfund

site is redeveloped, it can offer significant economic

benefits to local communities, including future job creation.

Unfortunately, for fewer than 100 residents living in the city of Treece, the stimulus funding for this project is literally going down a sinking hole. The city of Treece, KS, sits on the Kansas-Oklahoma border. This small, rural community was once a world leader in lead and zinc mining, mining that lasted for nearly 100 years. As the mining companies shut down in the 1970s, the groundwater began to rise and the pillars that supported the soil above the mine shafts began to collapse and you had a giant sinkhole. Shortly thereafter--in 1983, to be exact--the EPA placed over 500 square miles in southeast Kansas, northeast Oklahoma, and southwest Missouri on the National Priorities List of the Superfund list, including the city of Treece. In total, Cherokee County, KS, where Treece is located, has 115 square miles in the Superfund Program.

Last summer, during a listening tour of this part of Kansas, I saw firsthand how 100 men and women and children are living in absolute blight. They live day by day not knowing when--and I mean when, not if--their homes will collapse into the earth below into a giant sinkhole. They remain there despite the loss of businesses and infrastructure because their homes have no market value and they cannot sell them to fund a new home or even rent one.

As parts of Cherokee County have been on the Superfund list for the last 26 years, the EPA has removed and replaced contaminated topsoil. According to their stimulus press release, the EPA will continue to remove lead-contaminated residential soil at more than 380 acres in Baxter Springs and Treece. That probably sounds like an admirable thing to do, but as the ground below it caves in, the exposed soil that has not been cleaned up will rise, so essentially this is a never-ending process. You are cleaning up topsoil on a single home, and after the sinkhole sinks, obviously the topsoil is going to be contaminated with the contaminated soil underneath the new topsoil. If you get all that, I think you got the problem. This is a never-ending process.

I have worked very long and hard with other members of the Kansas delegation to determine how best to address this situation. The only satisfactory answer anyone has been able to give me is to relocate the town to protect the residents from a complete cave-in. The Federal Government needs to buy out the land from the remaining homes and business owners and then prohibit any future construction on the property affected by the contamination. This is exactly what we did with Pitcher, OK, on the other side of the State line, just a few years ago. Most estimates indicate we could relocate the entire town with $3 million in Federal funding and $500,000 in State funding--funding the State of Kansas has already set aside. During the previous Congress, I introduced legislation to address the Federal portion of this funding.

Fast forward to today, with an economy experiencing a lot of turbulence and a so-called stimulus bill that everyone in this body heard was an absolute necessity and not only a job maintainer but a job creator. So I asked the EPA to use $3 million of already allocated stimulus funding to relocate the community--$3 million. I was told no.

Instead of solving this problem and relocating the families of Treece to a safe facility, the EPA, with the assistance of the stimulus package, continues to spend even more money, $25 million--eight times the amount needed to relocate the community, the 100 people who live in blight and fear that their homes will sink into a sinkhole--to put new soil--this is what they are currently going to do--onto contaminated soil, which is then going to collapse and recontaminate all the soil. This doesn't make sense.

I have had an ongoing dialog with EPA, and they have told me:

The wastes are causing great environmental harm to

southeast Kansas--

We, of course, knew that--

as evidenced by the documented impacts to birds, fish,

mussels, macro-invertebrates, and horses. There is also

evidence of harm to humans as it is related to elevated blood

lead levels.

The letter went on to say:

EPA Region 7 believes the situation at the adjacent Region

6 Tar Creek Superfund site in Oklahoma materially differs

from the Cherokee County Superfund site, and that is what

drives different decisions for the Tar Creek Site.

I am going to refer to a couple of charts here.

This is a picture of Treece, KS, located right here. You can see all of these white objects here. Basically, that is the chat material that has come out of many mines over 100 years.

Here is Treece, KS, and here is Pitcher, OK. Here is a giant chat pile in between. I have been there. You see many little ponds and winding roads, and I advise you not to go fishing in any of those ponds. You might catch a three-eyed fish. At any rate, it is all contaminated, all a sinkhole, whether it is from Treece, KS, in Region 7 with the EPA or whether it is Pitcher, OK, in Region 6 in Dallas. I don't know what the difference is. If this is contaminated, and it is, and this is contaminated and looks the same, and it is, what the heck is the difference?

Let me show another angle so you can appreciate what I am talking about. This is what the people of Treece see every day as the Sun rises and sets. This is a giant chat mountain--all of this contaminated soil. This side of the chat mountain is Treece, the other side is Oklahoma-- the same situation, same problem, same contaminated soil, same sinkhole, and the same thing on the other side, except EPA 7 in Kansas City can't get it through their heads that this is identical to the same problem over here.

Instead of spending $25 million to clean up and put topsoil on contaminated soil that will sink, why can't we spend $3 million to save the community of Treece and relocate these people? Basically, EPA Region 7 does not have a factual basis, according to them, ``that would allow the use of regular or [stimulus] funds for a residential buy-out at the Treece subsite.'' Why? We were going to spend money for a road to be built twice. We are spending $25 million to put topsoil on a sinkhole. Why can't we put $3 million to relocate this town?

Here is my question. EPA acknowledged there is evidence of harm to humans. They listed a whole series of other animals and wildlife, and so on and so forth, that they are worried about. I understand that. But why not provide assistance to relocate fewer than 100 people from harm's way?

Furthermore, EPA told me that ``a 10-year timeframe is estimated for complete waste remediation.'' Due to the continual mine collapses, I wonder if the environmental cleanup will ever be completed.

I think it is in the best interests of all taxpayers to quit throwing money down sinkholes and provide an opportunity for 100 folks who have no other

options to move, as their homes are worth nothing. We do not need to spend, again, $25 million on a problem that will not be solved--topsoil on top of the sinkhole. We need to take care of these people and spend $3 million to let them get on with their lives. While American taxpayers are spending untold millions to prevent mortgage collapses, I can see no better use for the stimulus plan than to get the residents of Treece into safe homes.

I said once before, I am an honorary sheriff of Dodge City. I have a badge. You can go to Dodge City and you can meet the marshal, you can see Miss Kitty. You can go down to the Long Branch. We are used to taking care of problems ourselves. Kansas has appropriated $500,000 to do this. All we are asking for is $3 million, not the $25 million that I don't think is going to ever really result in any long-term cleanup.

You have to be there to realize just how bad this is, the pools of water and all. People will tell you: Senator, we are going to take you around this way. Don't walk this way.

So I would just ask Sheriff Joe, who is the self-declared sheriff on stimulus money, help me out here. Ride sidesaddle or you can drive the stage. Help me get $3 million. You have already stopped the ridiculous situation of building the road twice after we had destroyed it with stimulus money. That is the good news. But the rest of the story is that the citizens of Treece need to be relocated. We can do this for $3 million.

This remains an awful way to treat any community. I think it is not a wise use of taxpayer money. It does not pass the Kansas commonsense smell test.

I yield the floor.

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

I ask unanimous consent that I may proceed for about 12 or 13 minutes as in morning business.

Mr. President, I rise today to talk about health care reform. What else in regard to the interests of the American people and what we are doing here?

As the Republican leader, Senator McConnell, has pointed out in several floor speeches over the past week or so, the desire for health care reform on both sides of the aisle is one that unites this Chamber across both political and geographic boundaries.

Our system of health care produces some of the best care in the world and it is the driver of a substantial share of the medical innovations that have wiped out diseases, improved our comfort, and extended our time on this Earth.

However, this system is not truly accessible to everybody, and that is the problem. That is what this entire debate boils down to: your ability to have access to a doctor, to go see the doctor of your choice when you need to see that doctor.

Solving this problem of access is exceedingly complicated, partly because it evidences itself in so many diverse ways all across the country, so many geographical areas. For example, in our rural areas in Kansas, we are struggling with attracting and retaining doctors and keeping the doors open to our hospitals, to our pharmacies, and clinics. We talk about recruiting athletes. My goodness, the business of recruiting doctors and health care professionals is equally as competitive.

In our urban areas such as Kansas City and Wichita, our providers face very different challenges which are just as daunting and which threaten a patient's ability to access health care.

On top of that, although some 250 million Americans have health insurance, somewhere in the neighborhood of 27 to 47 million, depending on who you are counting and who is talking, do not. That makes accessing health care expensive and very challenging for them.

In addition, the government-run Medicare Program, which is on the verge of bankruptcy, by the way, does not pay doctors and pharmacists and ambulance drivers and nurse clinicians--pardon me, clinical lab folks and home health care providers and almost every health care provider that you can name--they do not pay them enough to cover their cost. Unless these providers have a non-Medicare population to recoup their losses, they cannot stay in business and their patients lose out--a de facto rationing of health care.

As a member of both the Finance and HELP Committees, and the cochair of the Senate Rural Health Care Caucus, I am able to participate and have been participating, along with staff, in this complex and very difficult effort. We must reform our health care system into one that guarantees meaningful access for all Americans, and guarantees that patient-doctor relationship. However, this effort to date has been a tale of rhetoric versus that of reality, the promise of cooperation contrasted with the unfortunate but real fact of partisanship, something I do not like to say.

Let me explain. President Obama, who ran as a ``postpartisan'' candidate, has made many overtures to Republicans indicating a desire for this process to be bipartisan. He just met with some members of our leadership and obviously the leadership on the other side of the aisle as of today.

Others in the Senate have declared their goal to be a bill that attracts upward of 70 votes. Is that possible? I would hope so. It could be. That would be a tremendous victory for the Senate of the United States and the American people.

But the reality is something very different. Today in the HELP Committee, the Health, Education, Labor and Pensions Committee, we have just begun the process of walking through a 615-page bill that we are scheduled to mark up next Tuesday.

This bill does not have one single Republican contribution, as far as I can tell. Moreover, it is incomplete, with many details missing. For example, the small detail of how much it will cost. There is no cost estimate to this bill of 615 pages, just going through it as of today, going to try to mark it up next Tuesday.

Come on. That is not the way we should be doing business. The Finance Committee has conducted a parallel and I think, quite frankly, a better process so far, and I wish to thank Chairman Baucus and Ranking Member Grassley and their staffs for their efforts. But we still have not seen a detailed proposal or cost estimate, and we are being pushed to mark something up in the next few weeks as well.

I want everyone to understand why process is important. Health care reform is important, to be sure. Getting things done obviously is important. But so is process. It is not because I do not want health care reform, nor is any Member in this body in a position to say they do not want health care reform. I want every single Kansan, every single American, to be able to see the doctor of their choice when they want to, especially when they have to.

I speak today because this health care reform bill will likely involve one of the biggest, most important votes that I or any one of my colleagues will cast during the time we are privileged to serve in the Senate of the United States. This health care reform bill will affect the lives of every single American. It will reform a system that drives one-sixth of our economy, over 16 million American jobs. It will have consequences for medical science and innovation that improve the lives of not only those of us in this great country but all across the world. When people are really sick, they come to the United States.

This bill will spend upwards of $2 trillion--$2 trillion--our children and grandchildren will have to some day repay. If we are going to do this, we cannot afford to get it wrong. For this reason, I initiated a letter about a week ago on behalf of all of my Republican colleagues on the Senate Finance Committee and on the HELP Committee. I asked the chairmen of those respective committees, the distinguished chairman, Senator Dodd, who is now serving in Senator Kennedy's absence, to give this process the time and the careful consideration it deserves. That was the message of the letter: Give us the time and the very careful consideration this vital issue deserves.

It seems to me our requests have been extremely reasonable. First, please provide us with your detailed plan with enough time for us to read it, to understand it, and get feedback from our constituents back home, the people the bill will affect.

We have done this in the Finance Committee. Goodness knows, I do not know how many panels we have had, how many walk-throughs, how many slide presentations. Boy, that is tough in the afternoon to turn the lights off as Senators and try to pay attention to fact after fact after fact and suggestion after suggestion after suggestion and policy objective after policy objective on each day as we go through the legislative swamp, to try to get this from here.

Our requests, again, I think--I want to say it again. First, you should provide us with your detailed plan with enough time for us to read it, understand it, get feedback from our constituents back home, the people the bill will affect. The reason I said that twice is that every day we had one of these slide shows, every day we had a

PowerPoint, every day we got more information, our office would send it back to the providers of health care in Kansas, much in the same fashion as members of the committee would send to it their people, and say: Hey, is this going to work? These are the people who actually do provide the health care.

I know the arguments that say: Well, now, wait a minute. We need to cut out fraud, waste, and abuse, and we need to be much more cost conscious. We need better practices in regard to better medical practices. We need a lot of things to either suggest or to incentivize or to maintain what the health care providers do.

But in the end result, if that person is sick, they are going to have to see a doctor, and they are going to have to see a nurse or some health care provider. So in the end result, we better at least be doing something that the providers say, yes, this makes common sense or you are going to see either one of two things: You are going to see a political revolt when they say, no, we are not going to go down that road or else you are going to see a continuation of rationing where providers say: No, I am not going to take part anymore in the Medicare Program, because I am not getting reimbursed up to cost.

You can have the best government program in the world, you can have the best government card in the world. But if you cannot find a doctor who provides service or a home health care provider who will provide service, or any provider who will provide that service well, where are you?

Second, I would like to see provided the cost estimates from the Congressional Budget Office and the Joint Tax Committee. Let us know how much all of this is going to cost. That is extremely important. We are hearing anything from $1 to $2 trillion.

Then, lastly, how will it be paid for? I know we are into an era now where basically we have the printing presses rolling, and we have an Economic Recovery Act and we have many facets of that, we have the stimulus, the omnibus, we had the President's budget and we had TARP, and we had four different other acronyms under TARP, and we did not worry too much about the pay-fors and who was going to pay for it. We let the printing presses roll, because nobody wanted to see economic Armageddon.

Could we have done it better? I think so. But that is yesterday's decision. So we should identify how this will be paid for or are we not going to pay for it. Are we simply going to go ahead--there has been some discussion about some aspects of it that you would not pay for. There are other aspects that we need to go into, because they involve probable tax increases, and now is not the time to be increasing taxes, especially on the small business community, despite the need for health care reform.

I think asking for these details is absolutely fair. I think it is necessary under the circumstances. In fact, I would be ignoring my responsibilities to my constituents in Kansas if I did not demand these conditions be met.

Every single Republican member of the Finance Committee and HELP Committee signed the letter. Every single one expressed a desire to work with our colleagues to achieve bipartisan health care reform.

That brings me back to today's HELP Committee walk-through of 615 pages of an incomplete draft, the rushed HELP and Finance markup schedule, Tuesday, and then in about a week or two, the arbitrary floor debate deadlines that we hear from leadership. I hope our letter will slow this hurried dash to an imaginary finish line. Slow it down. Slow it down. I know it is extremely important that we pass good health care reform legislation. It is also extremely important to prevent bad legislation from passing and get America saddled with it for about 20 or 25 years. I wish at the end of every committee room, if in fact the bill gets to committee, the committee of jurisdiction, that we can hold appropriate hearings, we would have a sign that says, ``Do no harm.'' And then right below it perhaps we could put ``whoa,'' until everybody can slow down and read it in regard to process, and cost, and specifics of the bill, and trying to work together to get a good product.

There is no reason why the Senate should rush through a bill that has this much at stake. So time out. Time out. Time. Slow down. Give us the details. That is all we are asking for. The people of this great Nation deserve nothing less. Let's get health care reform and let's get it right.

I yield the floor.

I suggest the absence of a quorum.

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

Mr. President, I rise today to again pay tribute to one of the Senate's finest: our colleague, the late Craig Thomas from Wyoming. Two years ago this week, the Senate lost a steady hand and a man who did much for his State of Wyoming. Craig was dependable in the finest sense of the word. He defined the word ``dependable.'' He was the epitome of a workhorse, not a show horse.

On a personal note, for many Senators, why, Craig was not only a colleague but a dear friend. I will cherish that always. Craig was also a fellow marine. In this case, Semper Fidelis--always faithful--is most appropriate. If anyone faced trouble in their life, the one person you would want by your side would be Craig Thomas.

This is why I am proud and honored again to join with my colleagues Kent Conrad and Tom Harkin, and with the new Senator from Wyoming, John Barrasso, and the distinguished Senator from Utah, Orrin Hatch, to introduce the Senate Rural Health Caucus bill in honor of Senator Thomas. The bill we are introducing is the Craig Thomas Rural Hospital and Provider Equity Act, with emphasis on the ``equity.''

The people of Wyoming and all of Craig's colleagues knew he fought for rural America and always put the needs of his State above all else. On the health care front, why, Craig was truly

a champion for strengthening our rural health care delivery system and providing relief to our hospitals and other providers in our rural areas.

He served for 10 years as the cochair of the Senate Rural Health Caucus. He actually took over the reins as cochair after my fellow Kansan, Bob Dole, retired from the Senate. And as I know personally, it is hard to follow in the footsteps of Senator Dole--for that matter, Senator Thomas.

However, Craig did this with great ease and great pride. His steady leadership put the caucus on the map, and he made great strides in showing all of our colleagues the true needs of rural health care. We will truly miss him during the current health care debate. I and the members of the caucus miss him and his leadership greatly.

One of the biggest accomplishments for Craig in the Rural Health Caucus was passage of the Medicare Modernization Act in 2003, which provided a big boost to our rural hospitals and providers. There was recognition and support from our colleagues from all of our geographical areas, large and small, for including these badly needed rural health provisions.

These provisions included in the Medicare bill provided much needed relief to rural health providers, enhanced beneficiary access to quality health care services, and improved provider payments in our rural areas. So many times those payments simply do not even come close to the costs of the provider and the service they provide to our rural citizens.

However, you would never know that it was Craig Thomas behind the scenes working to get these rural health provisions included in the Medicare bill. Craig was more concerned with getting the work done rather than taking the credit. So instead of taking individual credit for his hard work and his dedication on the Medicare bill, he applauded the entire Rural Health Caucus and patted everybody else on the back. It is this kind of leadership that set Craig Thomas apart from his colleagues.

However, Craig knew that while passage of the Medicare bill was a giant step for rural health, we still had much work to do to ensure our rural system can continue to survive. Sometimes when they ask me about health care reform--``they'' meaning most of the people interested in health care reform: the media, others, the health care providers--I simply say one of the things we want to do is to make sure we preserve what we have. This is why we were proud and honored to carry on his legacy by introducing the Craig Thomas Rural Hospital and Provider Equity Act in the 110th Congress, and again in this Congress. We can enhance Craig's legacy certainly in this way.

I wish to especially recognize a member of Craig's former staff who has always worked extremely hard to advance rural health care causes and who has remained a champion for Wyoming as a member of Senator John Barrasso's staff: Erin Dempsey. I know my staff has worked very closely with Erin over the years, and I have a great amount of respect for her hard work. We always have an expression: We are only as good as our staff here--or at least some of us do actually admit to that. Erin, thank you for being such a hero alongside Craig, and now Senator Barrasso. We are proud of you for everything you have done on behalf of rural health care.

This Congress, with health care reform at the front and center, Senators Barrasso, Conrad, Harkin, Hatch, and I will do our very best to lead in Craig's absence and to ensure that rural health does not get left behind. I have made a personal commitment to make sure we get this bill done and ultimately provide the much needed relief to our rural communities.

The Craig Thomas Rural Hospital and Provider Equity Act recognizes that rural health care providers have very different needs than their urban counterparts and that health care is not one size fits all.

The Craig Thomas Rural Hospital and Provider Equity Act--and the acronym of that, by the way--everything has to be an acronym in Washington--is R-HoPE--so the R-HoPE Act of 2009 makes changes to Medicare regulations for rural hospitals and providers. It recognizes the difficulty in achieving the same economies of scale as large urban facilities. This legislation equalizes Medicare's disproportionate share of hospital payments to bring the rural hospitals in line with our urban hospitals. This bill also provides additional assistance for small rural hospitals that have a very low volume of patients. Often these hospitals have trouble making ends meet under the Medicare payment system.

The Craig Thomas Rural Hospital and Provider Equity Act, R-HoPE Act, also provides a Capital Infrastructure Loan Program to make loans available to help rural facilities improve crumbling buildings and infrastructure. In addition, rural providers can apply to receive planning grants to help assess capital and infrastructure needs.

The bill extends to January 1, 2011, two incentive programs aimed at improving the quality of care by attracting health care providers to health professional shortage areas. The first is the Medicare Incentive Payment Program, which provides a 10-percent bonus payment to physicians who will practice in shortage areas. The second is the Physician Fee Schedule Work Geographic Adjustment--that is a mouthful-- but it simply means it will bring rural doctors' Medicare fee schedules for wages more in line with urban doctors.

The bill also recognizes that other providers do play a great role in the rural health care delivery system. Our bill increases the payment cap for rural health clinics to keep them in line with community health centers. It provides a 5-percent add-on payment for rural home health services. And it provides a 5-percent add-on payment for ground ambulance services in our rural areas.

One of the provisions in the bill--and this is the one that Craig Thomas certainly championed--is a provision to allow marriage and family therapists and licensed professional counselors to bill Medicare for their services and be paid the rate of social workers.

Currently, the Medicare program only permits psychiatrists, psychologists, social workers, and clinical nurse specialists to bill Medicare for mental health services that are provided to our seniors. However, most rural counties--most rural counties--simply do not have a psychiatrist or a psychologist. Marriage and family therapists, however, and licensed professional counselors are much more likely to practice in a rural setting and are often the only mental health professionals available.

Finally, this bill uses technology to improve home health services and quality of care by creating a pilot program providing incentives for home health agencies to purchase and utilize home monitoring and also communication technologies and facilitates telehealth services across State lines.

Today I am proud and honored to introduce this bill on behalf of our former Senator and colleague, Craig Thomas. We miss him greatly as a personal friend, a confidante and colleague. Our thoughts and prayers are with his wife Susan, his sons Peter, Patrick, and Greg, and his daughter Lexie.

Mr. President, it is time to pass this bill.

Mr. President, I yield the floor.

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

Mr. President, today, those of us who have strongly insisted that no terrorist currently in Guantanamo Bay should or will be transferred to the United States, I think, have won a big victory.

I am going to be very frank about it. Faced with an embarrassing defeat, and listening to the American people, the Democratic leadership has accepted an amendment offered by Senator Jim Inhofe of Oklahoma, myself, and many others that prohibits the use of Federal funds to transfer or locate any Gitmo terrorist to the United States.

This is an important, commonsense victory for the security of our country and more especially for Fort Leavenworth, KS. Following President Obama's decision to close Gitmo at the end of this year, there has been much speculation about moving terrorists to Leavenworth, especially in the press, and even on the Senate floor. I responded with remarks several weeks ago: ``Not on my watch.''

The problem is that while we have prohibited the use of funds to transfer terrorists to the United States, the Obama administration still has proposed no plan to meet their own January deadline. That does remain a challenge, and it means that while we won a victory today--no funds--it seems to me we must remain vigilant to make sure future plans do not include locations in the United States, including Leavenworth.

There are simply too many security risks and the possibility of negative impacts on our Kansas citizens and the Intellectual Center of the Army at Fort Leavenworth to even consider moving terrorists to Kansas.

I hope President Obama and his team designated to come up with a plan can come to the realization that closing Gitmo actually poses new problems in terms of security and logistics and legal issues.

Now that we are all on the same page, let's find a better answer and one that does not endanger Leavenworth, KS, or any other community in the United States.

I also wish to associate myself with the remarks of the distinguished Senator from Nebraska, Mike Johanns, who I think summarized the whole situation very well. I wish to thank Senator Inhofe for persevering. I wish to thank my dear friend and colleague, the distinguished Senator from Hawaii, Mr. Inouye, for his leadership in this regard.

But during this debate, and for some time, it seems to me we have seen a change in how those who are incarcerated at Gitmo are now being defined and described in the media, in the administration and, as a consequence, by some Americans.

I understand there is a poor perception of Guantanamo Bay. I think that is a fact we all realize. We heard another Senator from the other side of the aisle describe that in detail--as a matter of fact, ascribed all the problems to the Bush administration. But I do not think that is relevant. To say there are no terrorists there, to say there are not even enemy combatants there, is doing a disservice to us all by trivializing the crimes committed by the men at Guantanamo Bay.

I ask you, when did we start making terror politically correct? This same question was asked by Daniel Pearl's father, Judea Pearl, in an article that ran in the Wall Street Journal this past February. It is called: ``Daniel Pearl and the Normalization of Evil.'' I think every Senator and every American should read it, more especially in regard to this debate on where we locate these terrorists.

As you may know, and we should all remember, Daniel Pearl was the American journalist who was captured and beheaded--beheaded--on a video by the ``nonterrorist, nonenemy combatant'' Khalid Shaikh Mohammed in 2002--beheaded by Khalid Shaikh Mohammed, who is actually sitting at Guantanamo Bay right now.

Listen to what Judea Pearl, a respected professor at UCLA, has to say about that act of terror on his son:

Those around the world who mourned for Danny in 2002

genuinely hoped that Danny's murder would be a turning point

in the history of man's inhumanity to man, and that the

targeting of innocents to transmit political messages would

quickly become, like slavery and human sacrifice, an

embarrassing relic of a bygone era.

But somehow, barbarism, often cloaked in the language of

resistance, has gained acceptance in the most elite circles

of our society. The words ``war on terror'' cannot be uttered

today without fear of offense. Civilized society, so it

seems, is so numbed by violence that it has lost its gift to

be disgusted by evil.

Well, this Senator remains disgusted by evil. I am disgusted by those who target innocent civilians as they spew their hatred. I refuse to adopt what Danny's father calls ``the mentality of surrender.'' And that is weaved throughout this debate in regard to what happens to these terrorists.

It is not too late. We can all refuse to surrender to the idea that terrorism is somehow a tactic, to refuse to believe it is an acceptable tool of resistance.

There is still time for Americans to remember that there are men at Guantanamo who cannot be released and most certainly should not be on American soil.

Mr. President, I yield back.

Mr. President, I rise today to offer a special tribute to Kent Wells, a Kansan and longtime friend, who has turned his own battle with multiple myeloma into a fight for continued research to benefit the Multiple Myeloma Research Foundation, MMRF.

Multiple myeloma is an incurable cancer of the plasma cell. It is the second most common blood cancer. There are approximately 50,000 people in the United States living with multiple myeloma and an estimated 15,000 new cases of the disease are diagnosed each year.

The Multiple Myeloma Research Foundation, which was established in 1998 as a nonprofit organization, has a unique mission to urgently and aggressively invest in research that will result in the development of effective treatments and, ultimately, a cure.

Today, MMRF has raised over $100 million to support the world's most cutting-edge myeloma research. The foundation is widely recognized as the driving force behind progress made against the disease and one of the Nation's most groundbreaking cancer research organizations.

When Kent received his diagnosis in 2007, he began working with the foundation, personally benefiting from the research and the clinical drugs that have been established. But he understands all too well that much more must be done, and Kent has chosen to fight for his own health and for the health of others by further supporting the work of MMFR.

This week, on Kent's behalf, dozens of his friends and colleagues are sponsoring an event that will raise money for the Multiple Myeloma Research Foundation so that it can continue the efforts to develop the necessary research to conquer this disease.

It should come as no surprise to Kent that his friends and colleagues from all walks of life have come together to share this fight with him and his wife Debbie and their sons, Trevor and Bryan.

I first met Kent in 1975. Kent was a young man from Garden City, KS, interning in Washington for my predecessor, Congressman Keith Sebelius. I was the Congressman's chief of staff at that time.

I would like to take a little credit for giving Kent his start in public service, hiring him for that internship. ``Potomac Fever'' must have bit Kent because after he finished law school at George Washington University, he became a legislative assistant for Senator Nancy Kassebaum. And our friendship continued.

Yes, I admit to omitting one small part of his biography here. Kent did receive his undergraduate degree from the University of Kansas in Lawrence. He is a proud Jayhawk, something that he never lets this Wildcat forget.

Truth be told, I think that Kent would have chosen Jayhawk basketball over Washington internships, but he didn't make the team. Kent, I never told you that we would have welcomed you with open arms to the K-State team. Instead, Kent had to settle for pickup games in Washington when he came to work for Senator Kassebaum.

One of the genuinely nice things about working in Washington is that staff for the Kansas delegation get to know one another and actually become family--not on every occasion or in every instance--but often in sharing a common experience.

I could get into quite a laundry list of mutual experiences I have enjoyed with Kent, his brother Kim, and the Wells family, great supporters and friends. Not to embarrass Kent, but with his smile and personality he could brighten up any room regardless of the occasion. Kent Wells is just one of those people you like to be around, and that genuine personality plus a lot of talent has served him, and those he has worked for, well.

That is, of course, with the exception of the pickup basketball games I mentioned before. It was at a local gym that the Dole, Kassebaum, Roberts staffers and other hangers-on would play Saturday mornings.

My role, given my athletic career had sunset years previous, was to pass the ball to the players like Kent and set blind-side picks. Kent is a slasher but really prefers an outside set shot. Somehow, we ended up on opposing teams.

My team would be composed of big Bill Taggart, who simply walked around the gym for exercise and would occasionally kick the out of bounds ball back; Rich, ``The Mule'' Armitage--enough said; a couple of pickup players who simply ran with the ball as fast as they could.

Kent and Randy Miller, another staffer and good basketball player, had their own handpicked team that, for the most part, scored at will with absolutely no respect for an elder Member of Congress except to call fouls.

The trash talk would go something like:

``All he does is foul people, stay at one end of the court and try that old flat hook shot.''

``I know, but we have to have five people, just stay out of his way or if we get him, tell him to pass you the ball.''

You would think one would expect a little more respect, especially since I would bring my young son David to shoot baskets on another court. But not these guys. The Jayhawk crimson and blue was running in their veins and they pretty much ran me off the court. But I did set some hellish blind side picks, hit 1 out of every 10 flat hook shots, and had great times that are wonderful memories.

Kent's career goes well beyond Capitol Hill. Today he is a successful telecommunications executive, but one of his joys is that he has passed the love of KU basketball to Trevor and Bryan, both of whom proudly sport KU attire on campus at USC and Wisconsin.

Now we have come full circle with the Wells family. Thanks to his Dad's passion for public service, Bryan Wells begins an internship with my office this summer. He is clearly a chip off the old block.

I stand today with all of the Wells family and friends in support of Kent's efforts to promote increased awareness and research for the Multiple Myeloma Foundation. He and others facing this disease are not alone.

Madam President, I ask unanimous consent to speak as in morning business--in fact, I think we are in morning business. I ask unanimous consent to be recognized for 20 minutes.

Madam President, I wish to thank our Republican leader for so succinctly summing up the issue we face in regards to the terrorists--and, yes, they are terrorists--who are at Guantanamo Bay and for what I think is the almost unbelievable suggestion that we move these folks to a homeland, USA, and my remarks will continue in that regard. I thank the leader for raising the subject.

I rise today to speak about Guantanamo Bay, but I wish to point out that I am speaking about a Guantanamo Bay that some of my colleagues and some citizens of our great country might not recognize.

Obviously, the Guantanamo Bay I am speaking of houses ``terrorists.'' I have been there, and there are terrorists at Gitmo. I have seen them. As a matter of fact, I have seen interrogation procedures with the terrorists. They are not ``enemy combatants'' fighting an ``overseas contingency operation,'' but terrorists whom we must wage a war on terror against because they continually plan to launch attacks against us.

Senator McConnell spoke of the 10 percent who have been released and who have shown back up on the battlefield. There is a wonderful picture--well, it isn't a wonderful picture; it is a very telling picture--of one of these terrorists who was incarcerated at Gitmo and whom we released. He was treated and fitted with a prosthesis--with health care better than many of my small communities get.

There is a picture of him back on the battlefield waving his prosthesis in one hand and with an AK-47 in the other. If that doesn't tell the story, I don't know what would.

The reason I explain this is because we have seen a change in how those who are incarcerated at Gitmo are now being defined and described both in the media and in the administration, and as a consequence, by some Americans. I understand there is a poor perception of Guantanamo Bay, but to say there are no terrorists there, to say that there are not even enemy combatants there is doing a disservice to us all by trivializing the crimes committed by those who are incarcerated there.

I ask my colleagues: When did we start making terror politically correct? And why?

I understand this administration has great feelings about these issues, and many Americans have great feelings about these issues. Many Americans disagree very strongly with the past administration. I know this administration wants to draw a line of demarcation and say: This is not our policy, whether it is the war in Iraq, whether it is our operations in Afghanistan, whether it is our foreign policy, our national security policy, or whether it is intelligence. These are all very legitimate topics for debate and discussion, but in the process of this debate and this discourse, we should not ignore reality.

This same question as to why we would do this was asked by Daniel Pearl's father, Judea Pearl, in an article that ran in the Wall Street Journal this past February. I have the article here. It is called ``Daniel Pearl and the Normalization of Evil.'' Every Senator and every American should read this article and should take it to heart.

As I think most people know--and we should all remember--Daniel Pearl was the American journalist captured and beheaded--beheaded on video-- by the ``nonterrorist, nonenemy combatant'' Khalid Sheikh Mohammed in 2002. He was beheaded by Khalid Sheikh Mohammed, who is actually sitting at Guantanamo Bay right now.

Listen to what Professor Judea Pearl, who is a respected professor at UCLA, has to say about that act of terror when he and Danny's mother looked at a picture of their son, Daniel:

Those around the world who mourned for Danny--

His son--

in 2002 genuinely hoped that Danny's murder would be a

turning point in the history of man's inhumanity to man, and

that the targeting of innocents to transmit any political

message would quickly become, like slavery and human

sacrifice, an embarrassing relic of a bygone era.

But somehow,--

And I continue to quote Professor Pearl--

barbarism, often cloaked in the language of resistance, has

gained acceptance in the most elite circles of our society.

The words ``war on terror'' cannot be uttered today without

fear of offense. Civilized society, so it seems, is so numbed

by violence that it has lost its gift to be disgusted by

evil.

Well, I remain disgusted by evil, and more than that, I am fatigued by those who seemingly ignore it. I am disgusted by those who target innocent civilians as they spew their hatred, and I refuse to adopt what Danny's father called ``the mentality of surrender.'' I think it is not too late. It is not too late for a wake-up call. We can all refuse to surrender to the idea that terrorism is somehow a tactic. To refuse to believe it is an acceptable tool of resistance.

There is still time for Americans to remember that there are men at Guantanamo Bay who cannot be released and most certainly should not be on American soil. In fact, Americans must remember there are men at Gitmo who planned the September 11 attacks, the USS Cole attack prior to that--this was before we even connected the dots--and the attacks on American Embassies in Africa, causing great loss of human life. There are men at Gitmo who have perpetuated horrible crimes against humanity and would like to do so again because they don't like who we are or the way we live.

Terrorist detainees should be held, as they are now, at Gitmo, in compliance with international law. That should be respected, of course.

Ask the Red Cross or our new Attorney General, Eric Holder. Guantanamo, despite what some might think, is a first-rate facility that safely keeps these men out of civilized societies, affords them human treatment, and gives them religious respect. Again, I know. I was there.

Certainly, Khalid Sheikh Mohammed did not afford Daniel Pearl those courtesies. No, Khalid Sheikh Mohammed and others like him were--and still are--on a jihad against every man, woman, and child in our country. Yet we should bring these terrorists to American soil? Not only is that just plain wrong, it is logistically a situation that will not work. We can't do it without a tremendous infusion of funds and a lot of other problems.

In Dodge City, KS, at the coffee clatch that I attend, they call that flatout dumb. In fact, for those who would like to bring these nonterrorists, nonenemy combatants to hometown, USA, let me paint a picture.

Fort Leavenworth, KS, has been mentioned many times as a possible location for the 100 or so terrorists whom Defense Secretary Gates says can't be released but can't be tried. Leavenworth: where we educate all future Army officers, where we host foreign military officers every year to build relationships and foster military cooperation. Leavenworth: the intellectual center of the Army.

Do my colleagues think Army officers want to study at Fort Leavenworth if terrorists are there? Do they think they want to send their kids to school on the base minutes away from the most dangerous men in the world? Do they think foreign countries, especially friendly Muslim nations, will want to send their best and brightest officers to a place that houses men who we all agree are not appropriate for a

civilized society? I don't think so. Not a chance.

Even worse, I can't believe we are asking the people of Leavenworth to hang out with the ``welcome terrorists'' banner or put out the welcome mat to terrorists or to share their community not only with terrorists but with every protestor who will inevitably show up or with every terrorist who will view a facility on the mainland as a target, as they do. And before someone says Fort Leavenworth is secure, let me tell you it is secure all right; but for military prisoners who are compliant and for civilian prisoners who are not on a jihad against America.

Guantanamo Bay is a fortress, a humane, Red Cross-approved fortress, but a fortress nonetheless. Moving such a facility to hometown, USA, will require security beyond reality. I can't even begin to imagine what it would look like at Leavenworth, but I do know it is unrealistic to think a place such as Leavenworth, which has a railroad running through it and a river running next to it and highways all around it, would not be secure. No, it is not secure enough. In fact, the only place that is would have to be a fortress in the middle of nowhere--or Guantanamo Bay.

Let's also not forget the cost to taxpayers if such a thing would actually happen. We would not be able to mix these prisoners with the general prison population there, let alone the public. We would have to build a hospital and medical facilities, exercise and eating facilities, places for religious worship, and the list goes on and on and on. We have that at Gitmo. If anyone thinks that is crazy, I recommend they travel to Gitmo and take a look. They already have all of those facilities there. In fact, the medical facilities I saw are better than most in most of our small rural communities in this country.

Why we keep coming back to this ridiculous argument, why we keep trivializing the crimes committed by those at Gitmo, and why we keep offering up our American communities as a reasonable alternative is beyond me.

But I will say this: not in our backyard, not in Kansas, not on this Senator's watch, not on my watch. I don't know how many times I have to say or shout this on the Senate floor before this misbegotten idea is put to rest. But trust me--trust me--I will continue to do it until we come to our senses or until one of my colleagues who wants to close Gitmo offers a site in their State as a reasonable alternative.

One Senator has a lot of tools in his toolbox for keeping the Senate tied up in knots. If someone gets the bright idea of moving these prisoners to Kansas, we can all cancel our summer travel plans because we are going to be spending a lot of time here doing nothing. Come to think of it, that might be a better alternative as to where we are headed.

Thank you, Madam President. I yield the floor.

Madam President, it has come to my attention that I don't think we have a quorum, so I suggest the absence of a quorum.

I thank the distinguished Senator and nattily dressed chairman of the Budget Committee.

Mr. President, on rollcall vote 136, I voted ``nay.'' It was my intention to vote ``yea.'' Therefore, I ask unanimous consent that I be permitted to change my vote, since it will not affect the outcome.

Madam President, I rise today as a cosponsor and in support of the amendment offered by my friend from Arizona, Senator Kyl. I thank the Senator for introducing the amendment on behalf of health care providers not only in Arizona and Kansas but all across the country, and, as a result, the patients they serve.

I think we all know we have marching orders, if I can describe it that way, from the administration and from others to complete health care reform this year. But the President has been a little vague about what he envisions, stating that he will leave the details to the Congress, and the devil is, indeed, in those details. Senator Kyl has certainly pointed out one of the details that has to be fixed.

Let me be clear. I am not opposed to health care reform. I don't know who would be opposed to health care reform. But we must beware of what lurks under the banner of reform. I do support, as do many others, a system of affordable, accessible health care for all Americans. But I do not support a system that replaces the judgment of your doctor with that of a government agency, as described so ably by Senator Kyl. For this reason I share the concern of the Senator regarding the implementation of something called comparative effectiveness research. I wish more of my colleagues were in the Chamber to listen to this-- listen to the description of what could happen in regards to something called comparative effectiveness research. The acronym for that, by the way, is CER.

This gets in the woods of health care reform. Comparative effectiveness research, or CER, is simply research that compares the effectiveness of two or more health care services or treatments. CER is not necessarily a bad thing. In fact, it has the potential to provide benefits to medical science and also, obviously, to patients. However, with CER policy--again, the devil is in the details. When discussing the details of comparative effectiveness research, we need to focus on another term, ``least costly alternative.'' This is where comparative effectiveness research has the potential to have a huge and negative impact on patient and doctor choice.

If comparative effectiveness research is used to deem two health care services or treatments to be interchangeable, then CMS, within the Department of Health and Human Services, will be able to invoke the least costly alternative to only reimburse the health care provider based on the cost of the cheapest treatment.

One need not look any further than the Congressional Budget Office's Budget Options, Volume I, Health Care, written under the direction of OMB Director Orszag, to see that the use of least costly alternative authority to restrict doctors' decisions and ration health care is clearly on the table.

Here is a good example. One of the CBO health care budget options discussed the savings that could be realized if CMS applied Medicare's least costly alternative policy to include something called viscosupplements. You use viscosupplements to treat a degenerative joint disease of the knees called osteoarthritis. A lot of Senators have knee problems--not only weak knees but sometimes knees that need a little help. So even though CBO recognizes that there may be justifiable reasons your doctor would choose to provide one viscosupplement over another to help your knees, this option would allow the Government to use least costly alternative authority to interfere with and restrict your doctors's decision. This is very dangerous territory.

Rather than having to depend on the rigorous clinical trials conducted by the Food and Drug Administration, the CMS could use the much lower bar of comparative effectiveness research to declare that the two treatments are interchangeable and thus can be subject to the least costly alternative policy.

This type of Government interference in the doctor-patient decisionmaking process ignores the very large and important differences that exist among people, among patients--I think that should be obvious--in favor of a one-size-fits-all health care solution that could and would lead to rationing of health care.

Let this be a warning to all patients, all doctors, all hospitals, all nurses, all ambulance providers, all pharmacists, all home health care providers--all of the people who provide health care throughout America, rural and urban. You are on notice that this policy combination--comparative effectiveness research and least costly alternative--may be the Holy Grail of cost containment at the expense of patient care. That is what Senator Kyl's amendment gets at.

My colleague's amendment prohibits the use of comparative effectiveness research to deny coverage of health care treatments under a Federal health program. It requires that comparative effectiveness research take into account

the individuals and their treatment responses and their preferences, and it does protect doctor and patient sovereignty over health care decisions.

For these reasons I urge my colleagues to vote yes on the Kyl amendment.

I yield the floor.

I thank the Presiding Officer and ask that I be recognized for 15 minutes, and I ask unanimous consent that Senator Vitter be recognized to speak following me, after my 15 minutes.

Madam President, in the midst of this debate on the $410 billion omnibus spending package, the Finance Committee heard from Treasury Secretary Geithner as part of the committee's annual review of the President's budget. This is a very ambitious budget, particularly, coming on the heels of this omnibus package. It seems as if we have one huge bill after another--TARP, omnibus, stimulus, and now budget.

For the first time we are looking at a budget that tops $3.6 trillion. At a time when many families are struggling, this budget asks them, to support Federal spending on new and very questionable programs and higher taxes to support those programs. We ought to be concentrating instead on the scope of the economic recovery package, not on these other programs--which I will go into in just a moment.

I also want to help set the record straight with regard to the Federal deficit. If we are ever going to achieve any progress, and with some bipartisan support, then we ought to quit looking in the rear-view mirror and citing some statistics that do not add up. Facts are stubborn. Since the new administration took office, we have heard a persistent drumbeat from the majority about the legacy of debt that they say they have inherited from the previous administration. The President did inherit a significant debt, but to say it was solely a result of Republican policies and those of the previous administration is simply not telling the full story to the American people Or, as the late great Paul Harvey would say: ``Now the rest of the story.''

I borrowed this chart from Senator Grassley, the ranking member and previous chairman of the Finance Committee. It shows the deficit as a percentage of GDP over the past 8 years. It begins with the economy that the previous administration inherited. The deficit levels for those earlier years of the decade reflect the downturn in the economy, the burst of the tech and the impact of the 9/11 terrorist attacks on

the economy. However, the deficit levels came down when we had bipartisan support for tax relief--not tax cuts, tax relief--that was passed in 2001, 2003.

Look at what happened. The deficit shrank noticeably between 2004 and 2007, from $413 billion in 2004 to $163 billion in 2007. Nobody ever talks about that.

If you really wanted to get somewhat partisan, you could point to the fact that we were not in power then in 2007. That is when the majority took over. But I am not into that. It doesn't make much difference. It seems to me we should quit looking in the rear-view mirror and look on down the road with what we do for economic recovery.

In other words, under the policy of the previous administration, the deficit shrank by more than half during this period from 2004 to 2007. Those are the facts. It was not until 2 years ago, when Democrats came to power in Congress, that the deficits began to increase again. The spending spree over the past 2 years was led by the majority who wrote and pushed through a $700 billion financial bailout bill that has contributed significantly to the deficit the country now faces.

This bill, I will be very fair about it--this bill was bipartisan. It had the support of both Democrats and Republicans in the Congress, and a Republican President. As a Member of the Senate at that time President Obama supported the bill. When we talk about the deficit that the country is facing, let's keep this in mind. Again, we cannot keep looking in the rear-view mirror with facts that are misleading if we wish to achieve bipartisan progress in addressing the deficit.

The American people are very fearful, if not fed up, with the current rampant and unceasing spending that is going on in Washington--$700 billion to bail out financial firms that are too big to fail--with more requests for assistance expected; a $250 billion placeholder is provided in the President's budget; a questionable stimulus bill that will cost $787 billion--more than $1 trillion, when you add in interest; and there is a $410 billion omnibus bill and a $3.6 billion budget proposal. They simply want to know, and I think every Senator here wants to know as well, where does it end? When will we have spent enough and how on Earth are we going to pay for it? Is it going to work? Those are the questions.

At least a partial downpayment for this spending is included in the budget. The President has returned to the tried and true majority playbook to pay for more spending by simply raising taxes.

I take issue with the statement that the tax increases in the President's budget will be borne primarily by those families who earn over $250,000--the ``not one dime'' argument. This budget raises taxes on small businesses, the Nation's job creators. It passes on the cost of a cap-and-trade--or as I see it a cap-and-tax--system, not only to businesses but to consumers in the form of higher prices for energy. To my way of thinking, nobody has explained to this Senator how that is going to work or if we have the technology to make it work. It may be desirable, but I have yet to see how it is going to work or the technology.

The budget raises taxes on domestic energy producers. It raises taxes on investments. American consumers and families will pay higher taxes under this cap-and-trade proposal.

The counter argument is that they are targeting what they have determined are the wealthy to pay for their spending priorities. I always said I wonder when it would be time for those in Congress who believe this is the way to do things to determine who is rich or who is not. That is called class warfare in my view, but that is another speech and another story.

In other words, most Americans do not need to worry about these tax increases because it will not affect them, it will only affect their neighbor. I have yet to see a tax imposed on one set of taxpayers where the cost was not ultimately passed on to someone else. We are all in this economy together, and a tax increase on one neighbor is likely to be felt by the guy next-door.

The President's budget includes several of what I call anthill issues. These were the issues I discussed with Secretary Geithner.

The reason I call them anthill issues is you do not want to be giving a speech, or standing on an anthill--and I have had that experience, with a fellow Senator in Kansas, where she was standing on an anthill. I suggested she move. She said she was happy where she was. And I said: I don't think you will be in about 2 or 3 minutes. That was the case and she moved.

I have read with interest over the past few days the comments from several of my Democrat colleagues who have expressed the same concerns I have about these so-called anthill issues, those that bite, and that is a good sign. One anthill issue proposal would increase revenue by reducing the amount of mortgage interest that homeowners who pay taxes in the top brackets can deduct. At a time when the Federal Government is taking unprecedented steps to shore up the housing market and make home ownership possible for qualified homeowners, it seems counterintuitive. That is a Senate word, ``counterintuitive.'' ``It seems like we shouldn't be doing this.'' Those are the real words. It seems counterintuitive, to say the least, to reduce an inherent incentive in the Tax Code to own a home.

Does it make sense to tell these families who have lived in their home for 10 to 20 years that they can no longer deduct their mortgage interest? And what does reducing the mortgage interest deduction mean for the value of their home? We have already heard concerns that limiting the deduction would further depress home prices. What message does it send to families who may be looking to purchase a home right now, which I thought was the goal.

I do not know how the administration can, on one hand, provide billions of dollars to aid housing, including a $75 billion plan that Secretary Geithner announced a few weeks ago, to help those who have bought homes they can no longer afford and aid homeowners who are underwater in their mortgages but, on the other hand, reduce the tax incentive for those earning over a certain amount and who own or are looking to buy.

The second anthill proposal targets contributions to charitable organizations. I don't know who thought this up. In this economic climate, many charitable organizations are being asked to do more with less while donors tighten their belts, while at the same time more people are turning to charities for assistance. Yet this budget not only raises income taxes on those in the top two tax brackets, reducing their discretionary income from which they can make charitable contributions, it also reduces the value of the deduction for charitable contributions for these taxpayers. Clearly, these changes will not bring a halt to charitable giving. I know that. But won't it reduce contributions to charities when more Americans are relying more on charitable assistance? Won't the cost of a decline in charitable giving be borne by those most in need of assistance?

Secretary Geithner, in testimony, says an estimated $4 billion loss is ``modest.'' I do not agree with that. I suggest that a $4 billion loss to charitable organizations around the country is not modest. Why would the administration create any disincentive that will reduce donations to charity?

Finally, the third anthill issue targets certain small businesses for tax increases. This is a point I want to underscore. In Kansas, we have over 60,000 small businesses which make up 97 percent of the State employers.

They are the leading job creators.

The budget reinstates the 36 percent and 39.6 percent--might as well make it 40 and 41 when you count the deductions that will not be included--in income tax rates for individuals earning over $200,000 and for families earning over $250,000, reinstates the personal exemption phaseout, and limits the benefits of itemized deductions for these taxpayers.

These increases will result in higher taxes on many small businesses. I know supporters of the wealth redistribution in the budget say it does not raise taxes on that many small business owners. But the National Federation of Independent Business data shows differently. The data shows that 50 percent of the small business owners who employ 20 to 249 workers would fall into the top two brackets. And over half of the Nation's private sector workers are employed by small businesses with 20 to 500 employees.

Small businesses in Kansas feel they are stressed to the limit and they worry that to pay the additional taxes proposed in this budget-- and this is the real world, this is the reality, this is the law of unintended effects that we always fall into--means they are going to have to lay off workers, reduce wages or benefits, or pass these costs on to their customers. None of those are good options.

Let me say that tomorrow we are set to pass this $410 billion omnibus spending bill. I am going to oppose this bill. I do not like doing so, but I am going to oppose this bill. There are a lot of things wrong with this bill. And it is clear, it seems to me, that we must--we must--get a grip on Federal spending because in a few weeks we will take up the budget proposal for next year.

If there is a silver lining in the President's $3.6 trillion budget, it is that the tax increases would not take effect until 2011, reflecting the administration's acknowledgment that raising taxes when the economy is in crisis is not a good idea.

Thus, it appears that the administration expects that the economy will be recovering by 2011. I hope so. And that certainly would be good news. I hope the administration will use caution when determining if the economy is sufficiently recovered to withstand nearly $1 trillion in new taxes in 2011.

I hope they will consider stepping off the anthills I have mentioned: limiting deductions for charitable giving, mortgage interest, and tax increases on small businesses. I hope they will not insist on pursuing their spending agenda at the expense of economic recovery. To forestall recovery in order to pursue their tax and spending agenda is simply not right.

As the eminent columnist Charles Krauthammer wrote in the Washington Post last week with regard to the President's proposed budget:

The day of reckoning has arrived. President Obama has come

to redeem us with his far-seeing program of universal,

heavily nationalized health care; a cap and trade tax on

energy; and a major federalization of education with

universal access to college as the goal.

Wow, that is an ambitious agenda. However, pursuing this through higher taxes and bigger Government is not a legacy I think the administration will want to pass on to future Presidents or to future generations.

That is the rest of the story.

I yield the floor.

Mr. President, if the Chair could let me know when I have about a minute remaining, I would appreciate it.

Mr. President, our economy needs a stimulus; there is no question about it. Senator Cardin certainly illustrated that in his remarks. Americans are worried, very worried about job security and how they will support their families and stay in their homes if they lose their jobs. The Senator mentioned businesses in Maryland. I know businesses in Kansas are the same way. All over the country, our Nation's businesses are struggling. Not a day seems to pass without another major U.S. employer announcing stunning layoffs. However, this conference report--this didn't get here until 12 last night. You talk about transparency. I defy any Senator to say he has been through every page of this in terms of transparency.

This conference report is a missed opportunity. We had an opportunity to provide pro-growth policies that put money directly into the pockets of families and businesses. When they have more money in their pocket, they can spend it as they see fit rather than handing the money over to the Government to redistribute elsewhere. Instead the conference report further reduces the tax relief that will go to workers from $500 to $400 per individual, from $1,000 to $800 per couple. Estimates are that this tax relief will add about $13 more per week in the worker's paycheck this year. Next year it will add only about $8 a week. How will $8 a week stimulate the economy? It won't even buy a family of four dinner at McDonald's off the dollar menu. They will probably have to split the hamburger.

We also had an opportunity to fix housing first--that is the Gordian knot of what faces us in terms of an economic stimulus--to address the core problem in our economy. Unfortunately, our colleagues across the aisle rejected meaningful housing relief during Senate debate. Now the conference report dramatically cuts the tax relief to encourage qualified home buyers to purchase a home, one of the very few things in the stimulus that would have done us some good.

Most Americans are clearly opposed to the spending in this bill. A bill negotiated in a back-room deal without the transparency we were promised by the new administration. A bill that increases spending at the expense of putting money directly in the pockets of families and businesses.

This bill remains a honey pot for too many special interests. It reinforces a growing and dangerous mindset that the Government--not private enterprise, personal responsibility and hard work--is the creator of wealth and prosperity. It reinforces for individuals, businesses, and State and local governments that the Federal Government is the source for funding for--the honey pot--for whatever they need.

I have here the ``Berenstein Bears,'' a little book I read to first, second, and third graders. It should have been required reading prior to the stimulus. ``The Trouble With Money, With the Berenstein Bears.'' Open the book and it reads: When little bears spend every nickel and penny, the trouble with money is they never have any. And then after learning their lesson, the cub asked Momma bear: What about the money we earned?

You earned it and it is yours, said Momma.

No more, not with this conference report. It borrows money for programs that, in many cases, should be funded by local or State investments and that won't create jobs now, such as $300 million for new cars for Federal employees. The problem with $300 million for new cars is that somebody is going to drive them. Rather than focusing on practical and comprehensive approaches to fixing housing first, this bill diverts Federal funds to controversial and politically skewed groups that will do nothing to address interest rates, availability of credit, or declining home values that are at the root of the housing and mortgage crisis.

Two infrastructure provisions have miraculously grown during this conference. First, the Senate bill provided the highest level of funding for Amtrak at $850 million. The House had $800 million. The conference report includes $1.3 billion for the rail company. Does this mean Amtrak will stop in Dodge City, KS at some time other than 4 a.m. which they do today?

Second, the high speed rail earmark that is not an earmark, that received $2 billion in the Senate bill and zero in the House, has somehow grown by 400 percent overnight. I know some of my colleagues will come up and say this is not an earmark to the tune of $8 billion in taxpayer money. But press reports have already questioned this definition since it appears the rail link between Los Angeles and Las Vegas will be the major beneficiary. I guess they hit the jackpot.

I want to be clear as well that the health care provisions in this bill are not stimulative. Instead they represent major policy changes that should have gone through the regular order.

The most egregious example of this stealth maneuvering is $1.1 billion for the establishment of a new Federal board to conduct comparative effectiveness research. The majority is aiming, bluntly put, for research that justifies restricting access for Medicare patients to medical treatments that the Government deems to be not cost effective. That is an extremely dangerous path to be on. One need look no further than Canada and the United Kingdom for examples of comparative effectiveness research being used to deny access for treatments for breast cancer, Alzheimer's disease, rheumatoid arthritis, and much more.

I also want to highlight the inequitable increases to Federal Medicaid funding for States. I have heard arguments from my friends from States that reap large windfalls under the regular Medicaid formula as well as under the special bonus formula in this bill. But you cannot tell me with a straight face that the State of New York deserves $12.2 billion more than the State of Kansas.

Under this bill, the State of Kansas is estimated to receive an additional $450 million, while the State of New York will receive an additional $12.65 billion. That is nearly 28 times more than what my State will receive. When CBO estimates that total enrollment-driven State Medicaid increases are only expected to be $10.8 billion, well anything

more than that is an earmark in my book.

So I want everyone to understand the State of New York is getting an earmark that is 28 times what the State of Kansas is getting, 23 times what the State of Iowa is getting, and 41 times what the State of Nebraska is getting. That is not fair.

Americans do not want us to place greater debt on future generations by supporting a bill that doesn't provide the right incentives to stimulate the economy and create private sector jobs. The American public does not want the Government determining what is and what is not a beneficial health care treatment.

This is not our finest hour as a Congress. We had a real opportunity to stimulate our economy, create jobs, and put money back in families' wallets through common sense tax relief.

There is an old story that says you can't kill a frog by dropping him in boiling water. He reacts so quickly to the sudden heat that he jumps out before he is hurt. But if you put him in cold water and warm it up gradually, he never decides to jump until it is too late. He is cooked. Men are just as foolish.

I thank the Chair.

If you take away their freedom overnight, you have a violent revolution on your hands. But steal it from them gradually under the guise of security or stimulus or recovery, and you can paralyze an entire generation. I think we failed on that front. We are not stimulating the economy. We are creating a nanny state based upon a new form of American socialism. The lure of that is especially dangerous, as many people I would have never suspected will be coming to Washington, coming to the honey pot, not doing things for themselves at home but coming to Washington expecting some kind of a stimulus or money or grant. That is not right. It tears at the fabric of what America is all about.

I yield the floor.