quorum call:

a senator: mr. president? the presiding officer: the senator from rhode island. mr. whitehouse: are we in a quorum call? the presiding officer: we are. mr. whitehouse: may i ask that the pending quorum call be vitiated.

the presiding officer: yes. mr. whitehouse: we are embarked on one of the most important challenges that our country faces. we will begin to reform our tragically flawed and broken health care system. to bring down its skyrocketing costs, to cover its tens of millions of americans left uninsured, and to improve its way below average results. so the high-quality health care comes within reach for every american family. the stakes are high. this week in a speech before the american medical association president obama said this: the cost of our health care is a threat to our economy. it is an escalating burden on our families an businesses. it is a ticking time bomb for the federal budget. and it is unsustainable for the united states of america. the president said health care reform is the single most important thing we can do for america's long-term fiscal

health. savings in waste, confusion, unnecessary or defective care and illness prevention could well exceed $700 billion a year eventually. it's not going to happen like that. but it's a goal we can shoot for. i applaud president obama's commitment and leadership and i commend my senate colleagues for their tireless efforts in the pursuit of meaningful comprehensive reform. in the new energy and focus we have seen in this debate isn't limited to us here in washington. in recent months doctors and hospitals, patients and insurance companies, labor unions and drug companies have all come together in support of the need for restructuring of our system. amidst all of this it has been my great honor to join the ranking member from oregon, the

presiding officer from oregon, i mean on the "help" committee where he serves with such distinction an where much of the legislation to repair our broken health care system is being debated, written, and refined. in that capacity i was recently invited to the white house to meet with president obama, his health care time, and all of our colleagues on the "help" and finance committees. we discussed our reform and reported on the progress each committee made in the past several weeks. in the coming weeks we'll hear a lot about the details of health care reform legislation and those details are very important. but even more important are the hundreds of millions of american families in each of our states, all over the country, who have experienced real anguish, coverage, lost or denied, hospital stays extended due to

complications or errors, prescription drug bills rising and rising with no end in sight, even losing everything because a loved one fell ill. a few months ago i launched a page on my website for rhode islands to share their experiences with our broken health care system. and hundreds of people have written in from all over the state. anita is a social worker and mental health professional in providence. she shares what she described as the sad and rude awakening she experienced after opening her own practice last. as a provider, like all providers, she takes great pride in the quality of care and attention that she gives to her patients. and, yet, she often found herself burdenedded with an endless trail of paperwork and the time consuming task of battling insurance companies and

tracking down claims. like so many of her colleagues, anita is frustrated that she must spend so much time fighting administrative hurdles and navigating bureaucratic red tape. after years of training to become a health professional anita wishes she had more time to do just that, provide care to her patients. she writes: i would much rather spend the time seeing clients than negotiating automated telephone systems and waiting to speak to a person several hours per week. it is a total waste of human time and talent. i heard from melissa, a self-employed writer from newport, whose unpredictable income leaves her unable to afford health insurance. without coverage melissa knows she risks being one serious illness away from what she calls the brink of disaster.

though the stress -- through the stress and fear of not having insurance, through that brink that she lives on of disaster, melissa waits and hopes that she doesn't get sick because that is the only option she has in this, our great country. rhonda is a mother in koffingtry. she told me about her struggle to get health care coverage for her family. as if raising her two sons wasn't enough work, this single mother works two jobs to make ends meet. although her employer offered health coverage at an affordable price, rhonda's limited income could not be stretched to cover the additional cost of coverage for her children. so her sons went without insurance for three years. rhonda, like so many hard-working americans, was call the between a rock and a hard place, making slightly more than the eligible income to qualify

for health coverage through state assisted plans, but not making enough money to afford health care coverage on her own. she prayed every day that her children would be spared from sickness or injury. i also received a story from richard in providence who told me about his father, a hard-working man, who left work for six months to concentrate on fighting a battle against cancer. sadly, just when richard's father needed the support the most, his company dropped him from their health plan. without coverage, and unable to pay the costs out-of-pocket, his father was forced off his chemotherapy treatment. richard's father was very lucky. the doctors cleared him of cancer, however, the medical bills were so high that richard's parents lost their home. remarkably after all of his family has been through, richard

feels fortunate that at least his father was covered for part of his treatment. but he udged us to fix this old and broken system. for these rhode islanders and for millions more americans silently suffering through their own personal catastrophes all over the country, we now have to be a voice. we must improve the quality of our health care. we must develop our nation's health information infrastructure. and we must invest in preventing disease. we must protect existing coverage where it is good and improve it when it is not. as the president said, if you like your health plan, you get to keep. it we -- keep it. we must dial down the paperwork wars an dial up better information for american health care consumers. and we must speak for the

46 million americans, 9 million of whom are children, who right now as i stand here on the senate floor have no health insurance at all. and as families u.s.a. reports, 47 million actually understates the problem. because during the course of this year, nearly 90 million americans will at one point or another go without health insurance. we look around at dark and tumultuous economic times, yet looking beyond the immediate economic perils that we face, a $35 trillion unfunded liability for medicare, not' penny -- not a penny set against it, is bearing down on us. as the president told the a.m.a. earlier this week, if we fail to act, federal spending on medicaid and medicare will grow over the coming decades by an amount almost equal to the amount our government currently

spends on our nation's defense. in fact, it will event ually grow larger than -- eventually grow larger than what our government spends on anything else today. it's a scenario that will swamp our federal and state budgets and impose a vicious choice of either unprecedented tax hikes, overwhelming deficits, or drastic cuts in our federal and state budgets. mr. president, question only avoid that vicious choice by reforming the health care system. we are committed to making sure that every american has health insurance coverage, but meaningful reform will take more than that think of it this way. if you had a boat out in the ocean and people overboard around it in danger of drowning, surely you would try to bring them all into the boat. but if the boat itself was sinking, if the boat itself was

on fire, surely you would know that had you to do more than just bring them onboard. you have to repair the boat. you have to get it floating and moving forward. and that's what we have to do with our health care system. it's not enough just to provide coverage for all americans. we also have to right this ship. this means improving the quality of health care and investing in prevention, especially in those areas where proved quality of care and investment in prevention means lower cost. so that, for instance, 100,000 americans will no longer die each and every year because of entirely avoidable medical errors. this also means reforming how we pay for health care so that what we pay for is what we want from health care. mr. president, government must

act. at least, government must act. the problems of health care in america are rooted in market failures. we can't wait for the market to curiae problem rooted in market failure. it is nonsense. we've got to change the rules of the game. we also can't pay for one thing and expect another. we've got to change the incentives. we don't expect americans to go out and build our highway infrastructure for us. we do that through government. we can't sit around and wait for our health information infrastructure to build itself either. and we cannot expect quality improvement and prevention of illness to flourish when we make it a money losing proposition for the people who have to make it work. we have to change those

incentives too. now, opponents of reform are arguing that this process is going too quickly, that we need to slow down, wait, pause. they're loading down this bill with hundreds of amendments. 170 amendments alone on the section that deals with preventive care. but haven't we waited long enough? slow is what we've done for years, even decades. when i hear from rhode islanders like the stories that i reported here, like richard and rhonda and melissa and anita, i think not that we're going too fast, i think we are irresponsibly, even frighteningly late in getting after this problem and taking up this charge. and if we wait much longer, we may be too late to avoid that tidal wave of costs that

threatens to swamp our ship of state. to those who say "slow down," i say "keep up." opponents of reform want people to believe that a system that costs too much, that lets insurance company bureaucrats make decisions about our health care, that is riddled with error, duplication and waste, that leaves nearly 50 million americans without any health insurance is acceptable. everybody says they want reform, but unless we get moving, all we'll end up with is more of the same. as president obama said this week, the status quo is unsustainable. some opponents want to slow this down because they know if they slow it down, they can kill it. we can't let that happen. the stakes are way too high. mr. president, the anguish out there, as you know in oregon, as

i see in rhode island, as all of our colleagues see across the country, is real. and it is everywhere. and now at least we can do something about it. now is the time. this is the moment. let us make this work. let us together find a way to make this work. i thank the chair, and i yield the floor. i note the absence of a quorum. the presiding officer: the clerk will call the roll. quorum call:

mr. roberts: mr. president? the presiding officer: the senator from kansas. mr. roberts: thank you for that very profound greeting. i'm assuming we're in a quorum call, mr. president. the presiding officer: the senator is correct. mr. roberts: i ask unanimous consent that the quorum call be dispensed with. the presiding officer: without objection. mr. roberts: i ask unanimous consent that i may proceed as if we're in morning business for approximately 15 minutes. the presiding officer: without objection. mr. roberts: mr. president, and

to all present in terms of staff, i apologize. this is friday. here we are at, what, 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 and so i'll quit apologizing. but there's been some things happening in regards to health care. the distinguished senator from rhode island indicated the need to move forward on health care. everybody agrees to that. but the pace of it and what's going on is of real concern. so i do have some remarks to make, and i'll try to make this as quickly as possible and succinct as possible so that everybody here can go about their business. i see smiles from the pages in regards if i can just hurry up and get through this comment -- or my comments. mr. president, 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. now, i know that's getting in the weeds in regards to health care language and health care acronyms. it's called c.e.r. -- remember that term, c.e.r., it's going to be around for a long time because it's become quite controversial in regards to our health care discussion and what eventually passes. c.e.r. is research that compares the relative outcomes of two medical treatments for the same condition to determine which one is better. that's a good thing. it's a good thing to disseminate and to inform doctors, and everybody in the health care delivery system -- nurses, health care providers, pharmacists, et cetera, et cetera -- it's a good thing. but the first problem with c.e.r. 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 c.e.r., or a master plan, or a master evaluation that could come out of washington from an outfit called c.m.s. under the department of health and human services. this is -- the situation is that the patients must be able to deviate from the results of this and make treatment decisions on a case-by-case individualized basis. that's what we want want in terms of our -- that's what we all want in terms of our treatment with our doctors. now, it is other major problem, i would submit, is that c.e.r. has been used by other governments, such as the united kingdom, to base treatment decisions not just on relative effectiveness but on relative cost. and there's the rub. if c.e.r. is going to inform doctors and everybody in the medical community that this kind of treatment or this kind of

best practices, this is the arena in which you should operate or pasture you should operate in, that's okay. but if it's used in regards to control costs as opposed to care, then we've got 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 pseudo science under the guise of c.e.r. which brings me back to yesterday's discussion on c.e.r. in the "help" committee markup. the kennedy-dodd bill includes a section that establishes a new center for health outcomes, research and evaluation. and this outfit is to conduct and support comparative effectiveness research. section 219-h-1 -- now, if that consistent getting into the weeds, i don't know what is -- but that section includes the following language relating to

the practical effect of c.e.r., or comparative effectiveness research. that would, again, be conducted by the center. and the center reports and recommendations shall not be construed as mandates for payment, coverage or treatment. so that language was in there to get at this problem of those of us who worry that c.e.r. will be used by c.m.s. -- that's another acronym. that's the outfit that runs medicaid and medicare in terms of services. these are the people who count the beans. these are the people that want to turn the red beans into black beans. these are the people that are into cost containment. these are the people that many times drive hospital administrators and board members in small hospitals crazy. but at any rate, to worry abou about -- or to take away the worry, that language was put in there, senate reports and recommendations shall not be construed as mandates for payment coverage or treatment. and they thought that was enough to protect us in regards to

c.e.r. dictating medical care and stepping inbetween you and your dock tear. -- you and your doctor. let's go back to those words: shall not be construed as man daissmentmandates. what does that mean? the word "mandate" means to force and combine. this should not be interpreted as to forcing c.r.er.s. railroad the veterans administration or department to restrict payments to doctors based on its results. senator mikulski and and i dr. coburn as well had a very lively discussion about the intent of this language. senator mikulski said that 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. and senator mikulski has worked long and hard on this bill and i respect her for that. she is a good expleeg a good friend -- good colleague and a good friend, and 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.