the results of this comparative effectiveness research to make payment decisions, whether you're paid or not in regards to medicare, or, for that matter, medicaid, is not the same thing as prohibiting or preventing c.m.s. from doing so. in order to vigorously protect e right of patients and doctors to make treatment decisions against the danger the government will interfere i believe the bill must prohibit the government from using the results of c.e. exprvment making payment coverage or treatment decisions. sorry you can't have that treatment, you have to have this treatment because it is a best-medicine practice regardless of the fact that you and your doctor have had that treatment and the doctor thinks that's the best treatment for you. i offer new language and the new language would have placed a clear bright line firewall between the conduct of

comparative research which is essential to advancing medical science. it's a good thing. and the use of its results to restrict your doctor if using his or her best judgment when treating you. my language which i further modified at suggestion of accept mikulski read "senator roars and recommendations are prohibited from being used by a government entity for payment or treatment decisions." and senator mikulski agreed to consider the suggestion last night and i appreciate that. but, today, when the help committee reconvened our markup, senator mikulski and the majority refused to accept my language and offered counter language that would basically put us back to square one doing nothing to protecting patients and doctors from government agency interfering in their treatment decisions. when i asked why my language was unacceptable, which i thought was acceptable for much when we left yesterday, i was told that

the decision to say my language was not acceptable was based on concerns by -- quote -- "washington policy experts." and i said, who's that? which "washington policy expert" said my language was not acceptable. and when pressed on which "policy experts" we learned that the directive had come straight down if the white house. now, why would the white house be so concerned about prohibiting federal government from using comparative effective research to restrict payments to doctors or to direct doctors to follow specific treatment orders? why would the white house do this on this proposal, which is a proposal that really affects 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 c.e.r. as the golden reign for cost containment. the president said when asked how on earth will you pay for the health care bill he said we're going to cut medicare patients. how are you going to do that? if you have a comparative effective research golden reign that. cans from c.m.s. or national institutes of health you can see the research says you should follow these practices, not those practices and those practices, or these practices would certainly cost less. and i don't think that's a go thing. and from the o.m.b. director, peter orszag to n.i.h. director to national economic council director larry summers and indications from our new secretary of health and human services, kathleen sebelius, all have pointed to the huge potential of c.e.r. to be used

to contain costs -- not to recommend procedures best for the patient, as determined by the patient and doctor but by c.e.r. to control cost. that is why the white house does not want to prohibit a government agency if using the results to deny you and your doctor the right to choose the treatment that is best for you. now, after all 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 preferred to as a "scare tactic." and they indicated that i was using the word "rationing" as a scare tactic to scare people to say that we don't want health care reform.

and i find that rather condescending and demeaning. and it certainly is not accurate. you tell me when medicare fuses to pay your doctor if he or she decides you need a particular course of treatment that definite eights from the government standard -- deviates from the government standard what do you call snit i call it rationing and it is happening right now this this country. we may not have explicit rationing like 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 -- i am not making that up -- or refuses kidney cancer drugs for temple natural patients because it's not worth the money to extend their life by six months -- that's really 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, same thing for pharmacists and the same thing for home health care and the same thing for all the providers of the provider health care. so those doctors can't afford to take medicare and medicaid patientpatients and they make te decisions and those individuals do not have access to care and that's rationing. i'm talking about a doctor who makes a decision, you know i'm only getting paid 70 cent on the dollar in terms cost on medicare patient and i have to hire extra people to keep up with all the paperwork and regulations. those people don't exist in the rural health care delivery system and we have to train them, find them, and it is a lot easier if i drop the medicare program. now, that comes as a sudden jolt and a sudden decision that is just not fair in regard to the patients that were being treated by that doctor in terms of

medicare and that's what we call rationing right now in regard to the united states of america. we know that the administration wants to use c.e.r. to contain cost. we know c.m.s. has a history of denying full payment based on cost. i'm not going to take the time on the senate floor right now to go into all of the problem c.m.s. has posed for the health care delivery system. again, these are the folks that have a difficult task. they're trying to change the red beans and the black beans so health care doesn't cost so much but in terms of their decision here in washington in regard to what care is going to be paid for and what isn't, they are an absolute nightmare to every hospital administrator, every hospital board member in the 350-some hospitals i have in kansas, in the 83 critical access hospitals i have in kansas. we don't have a very good relationship with c.m.s.

what we have is a meaningful dialogue when yet another regulation comes down the pike to contain costs. most of which the doctors have never heard of not to mention everybody else in the health care delivery system. so i can go into quite a rant as you can expect from my comments in regard to c.m.s. and what they do and what they don't do. why are the democrats resisting my 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 this could lead to the rationing of health care? it boils down to the fact they don't want the american people to know what their true plans could actually be. that's why they're shoving this massive health care reform bill through congress at warp speed having markups before we have complete language or cost st.s. now, we just heard from the

distinguished senator from rhode island about the need for health care reform and the fact he was complaining over 100 amendments in the help committee. my goness, almost every major bill i have been associated with we have literally, hundreds of ams and many fall by the wayside, many are withdrawn. we dealt with 17 or 18 of them as of today and senator mikulski and senator dodd did a good job along with our ranking member, senator enzi, from wyoming. but it would be helpful if we're going to manufacture forward with health care reform if we had the bill. we don't have the bill in the help committee but one sixth of the bill and then we have a congressional budget office score on one-sixth of the bill and that's $1 trillion and boy did that shock everybody. $1 trillion for one-sixth of the bill? what is the whole bill going to cost? that estimate is some the neighborhoods of $4 trillion. how will you pay in the finance

committee, $4 trillion for health care reform and take it from the health care delivery system. i don't think you can. but we don't know because we haven't seep the legislation. we're being asked to go on a deadline schedule to produce amendments -- things like c.e.r. that worry people in regard to possible rationing by a date certain, or a time certain -- and we haven't even seen the bill we're amending. i've never been through a situation like that not to mention the specific cost estimates by c.b.o. this is in the right. that is request 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. and that's why slowing down doesn't necessarily mean everyone is opposed to health care reform it means we ought to get it right and we at least ought to have a bill to read to know what we're dealing with.

i think it's because they know if americans knew what they were doing they would never stand for it. i think we need to get this to the public and the public hopefully can fully understand. i am not going to allow this. personally, i'm going to continue to shout it from the rooftops, beware of what lurks under the banner of "reform," and to tell every doctor and hospital add minute streart, every -- administrator, every hospital board member and everyone who has anything to do with the health care dleferry system, watch out in regard to c.e.c. it could put you out of business. it could put you out of business. we have examples of c.m.s. doing exactly that. do back up one difficult and realize, mr. president, that the government has tken over your health care the same way they have taken over the banks and auto industry. don't let them ration your health care. rationing is not what we need. it would be terribly

counterproductive. i hope that we can do a better job in the future. i yield back. and i suggest the absence of a quorum. the presiding officer: the clerk will call the roll. quorum call: quorum call: