Richard Burr

Mr. BURR

Mr. BURR. Mr. President, some in this institution suggest that there is no liability crisis in health care in America. I am here today to say that I don't think anyone in America believes that. They may believe it in this institution. As a Senator from North Carolina, I can state no one from North Carolina believes it. Not only has the out-of-control litigation in health care over the last decade inflated the cost for every American, it has now begun to affect the access we have to health care services. Doctors across the State in North Carolina report they have been forced to reduce the coverage of critical medical services, especially in obstetrics, neurosurgery, orthopedics, plastic surgery, and primary care because of the sharp increase in the cost of medical malpractice insurance coverage. It has gotten so high they cannot afford the coverage. Hospitals are concerned about the potential reduction in their services to their communities in the future as a result of the current crisis in medical liability insurance where premium increases and declining reimbursements continue. Hospitals report that the insurance crisis is making it increasingly more difficult for their medical staff to obtain adequate insurance coverage, and more importantly, at affordable prices. The crisis is real. We can no longer in this institution act like an ostrich, put our head in a hole in the ground, and believe because we cannot see it, it does not exist. Some nursing homes in North Carolina this year have no choice but to operate without liability insurance in order to stay open. The oldest and the frail in this country would not have the facilities to live in but for the brave decision of some owners that forego the insurance they can't afford. Other long-term care facilities, faced with the huge increase in premiums, have been forced to reduce staff hours, freeze wages and reduce residents' activities. Those are things we do not want to see happen to that population. North Carolina faces a medical liability insurance crisis. I had a friend who graduated from Wake Forest with me and was lucky enough to go to medical school. Today he is a nephrologist. I don't even know what a nephrologist is. I am not sure that too many people in America know what a nephrologist is. But I can tell you that he tells me nephrologists rarely get sued. In the last 3 years, his liability insurance has increased 300 percent. He has had a 300-percent increase in his cost to continue to practice medicine in a specialty that rarely sees lawsuits. North Carolina hospitals have experienced medical liability insurance premiums increasing from 400 to 500 percent for the past 3 years, with small rural hospitals experiencing the greatest increases. According to two recent studies, North Carolina's nursing homes are experiencing a tremendous increase in their medical liability premiums. Premiums for some nursing homes in North Carolina have skyrocketed by as much as 1,800 percent since 1995. But some in this institution suggest there is not a liability crisis in health care in America. The U.S. Department of Health and Human Services has concluded that the leading cause of the national liability insurance crisis is the recent explosion in multimillion dollar litigation awards and the resulting instability this creates in the medical liability insurance market. The U.S. Department of Health and Human Services cited that North Carolina is tied with Nevada for the most mega malpractice awards in recent years. But some in this institution suggest that there is not a medical liability crisis in America. Not only is it a crisis, health care services are out of the realm of the average American. It is driving doctors out of the profession of delivering medical services. In medical schools across the country this year, just as last year and the year before, many students will make a decision as to the specialties they choose for their entire medical profession based upon the likelihood of being sued in a court versus where their interests and their love might exist in health care. But some suggest there is not a liability crisis in America. In North Carolina today we have a shortage of OB/GYNs, we have a shortage of neurosurgeons, we have a shortage of thoracic surgeons. When you look at the demographic shift that is happening in America, the Census Bureau projects that in North Carolina alone we will have a 53-percent increase in the State's population over the next 20 years. We will be the seventh most populated State. The OB/GYNs better move there because without OB/GYNs we are not going to deliver new babies. If they move there for retirement, which is probably our largest growth area, they may find out that they are moving to a State that has a tremendous health care infrastructure but the state does not have the specialists in neurology, in neurosurgery, and thoracic surgery available for their age group, and then they will have not made the wisest decision. But some suggest there is no crisis. Lawsuits today are the leading cause of liability insurance increases. Changes are needed to protect patient access to health care. States that have enacted comprehensive common sense liability reforms have experienced much lower increases in medical liability insurance premiums compared to States such as North Carolina and Nevada because we have yet to adopt such reforms. It is imperative this institution accept the national responsibility to end this crisis in health care, to make sure that the next students in our medical schools make decisions based upon where they want to practice and who, in fact, they want to help and not based upon where their fear exists of where the trial bar is most likely to target for the next lawsuit. Over the years, I have heard from a lot of folks in North Carolina. I received this letter from a doctor in Greensboro, NC, in the month of April. It says: As an orthopaedic trauma surgeon, I urge you to pass medical liability reform this year. Each year, reform legislation passes the House of Representatives, but stalls in the Senate. Special interests are standing in the way of reform. I can say that special interests are not the patients across this country, it is not the patient who is looking for the specialist in North Carolina. The letter goes on to say: I can tell you from the point of view of someone on the front line of medicine that America's (and North Carolina's) medical liability crisis has to be solved. Medical lawsuit abuse and unpredictable and huge verdicts are forcing good doctors out of practice. Fewer young doctors are entering important, but high risk specialties, including orthopedics, obstetrics, and emergency medicine. Others are cutting back on critical, but risky procedures, leaving patients to wonder where they will get care when they most need it. The cost of defensive medicine alone is staggering. I see it all the time: doctors ordering tests and referring patients to specialists more out of fear of lawsuits than because doctors believe the tests or extra visits are medically indicated. These costs are dragging down our health care system and our economy, and they ultimately increase out- of-pocket patient costs. It is time we fix this broken system. I am not sure that anyone summed up the crisis in America in a one- page letter better than this doctor, this doctor who said that he is on the front line of medicine in America and in North Carolina. He put his finger on the point that if we don't solve it today, fewer young doctors will be entering the profession. That means less choice. Fewer doctors doing high-risk procedures in trauma care, something that doctors perform because they are trying to save a life. Others are cutting back on critical but risky procedures, leaving patients to wonder who will be there to do these procedures. In this institution, we fight cost and access. In America, we fight cost and access. Many times the decisions we make as Americans, such as choosing to move to a particular area because the schools are good, also includes the big component that there is a major medical facility available for us and our family. The realities are, as this goes on, those major medical areas are going to be more and more important because in rural America there will not be doctors. And if there are no doctors, we know today, based upon what doctors tell us, there won't be OB/GYNs. We will have to tell pregnant women, let us know when you think you are going to go in labor because it is a 2-hour drive to the nearest facility that delivers babies. Or, as we have seen in some places, no natural child births, only Caesarian, because there is a risk of litigation to natural delivery that does not exist with the procedure of Caesarian birth. But some suggest in this institution that the liability crisis does not exist in America. We come to the Senate to debate how we change health care policy so that health care is accessible and affordable for all Americans. We understand today how many Americans, or we think we do, go without insurance, without coverage, without the security at night of knowing that whatever happens to them, they have a policy to take care of. If we did not solve this problem, it does not matter what the policy says. If the doctor is not there, where is our level of security? Where is the level of security of an American today that lives in a rural market where their hospital is closed? Not just their doctor left, but because of an 1,800-percent increase in the cost of liability insurance, they have decided to close the doors. The burden falls on the payer--us--on insurance companies to try to raise the reimbursements big enough to make the payments for liability coverage. Why? Because of mega-awards, because of the influence those mega-awards have, in fact, had on the insurance product itself. Dr. Handy was not the only one who wrote me. I had an interesting note from a doctor in Fayetteville, a member of a four-person neurology practice that cannot attract physicians to join the practice because of the inhospitable liability environment that exists. She and her husband are both neurosurgeons. They want to stay in North Carolina, but they may need to move and are actively looking elsewhere because they cannot even attract a neurologist to come into an existing practice. They realize, as two neurosurgeons, if your practice cannot grow based on today's reimbursement structure, there is no way they can survive. Increases in their costs of insurance have limited their ability to deliver charity care. They have also decreased their participation in workers' comp. Their practice writes off more than $1 million a year in uncollectible accounts. There are currently only four neurosurgeons in Fayetteville, NC--the pentagon of the Army, Fort Bragg, NC, where over 55,000 men and women in the U.S. Army call home. But some still suggest there is not a crisis. You see, it is easy to suggest that something does not exist because I think there is a tendency in our system that until it directly affects us, it really does not exist. The reality is that every day we meet in this incredible, historic institution, there are people across this country who do not have access to a doctor, who cannot afford the services, who have been affected by the fact that the liability crisis in America is, in fact, real and has affected them. Well, the challenge for this Senate, as we move forward, is to make sure our voices are louder than those who suggest there is not a crisis, to make sure the human face of those around America--who are affected directly and indirectly by the liability crisis that exists in medicine today--to make sure their voice is heard, their face is seen, that in this institution, as we talk about solutions, we look around the country and say: What have others done? Well, that is what we are getting ready to do next week. We have looked around the country and seen who has been successful. And we are going to adopt a model that exists in Texas. It is not one that tightens as much as California. California, usually not necessarily the one that looks at Washington and says: Limit something for us-- California woke up and said: There may not be a liabilities crisis in America, but there is a liability crisis in California, and we are going to put caps in, we are going to bring some sanity to the system, we are going to bring in the parameters that drive price's down and encourage doctors to practice here in, yes, obstetrics, in neurology, in neurosurgery, and thoracic surgery. California thrives today. What was California's comment about what we might do in Washington? It was: My gosh, don't make us raise our caps to what you are going to establish in all the States. We are below that today. I never thought I would say: California does something right. Let's mirror it. But that day has come in the Senate but at a time where some still suggest there is not a crisis. What do we want to do? Replicate what, in fact, States have replicated to address the high cost of health care, the lack of access, the flight of doctors, the need for specialists. We want to adopt that nationally. It is as simple as that. Next week, people will come to the floor of the Senate and they will, in an incredible way, suggest there is not a crisis in America. I want those in the Chamber today to remember next week not just the doctors who say there is a crisis, and it is real, but to remember the patients out there who are directly affected by our inability to solve this problem. They are the ones for which the safety net is supposed to be there to protect them. But the safety net only works if the infrastructure is there. This is not about cost by itself today. This is about access. And when access goes away, our ability to address it with a safety net is gone. I urge my colleagues to stay engaged. I look forward to next week's debate. I thank the Presiding Officer for the time, and I yield back.

Mr. BURR

Mr. BURR. Mr. President, I thank my colleagues.

Mr. BURR. I understand that Senator Lieberman has an amendment related to GAINS.

Mr. BURR. The Smithsonian has agreed to provide the samples and the data it collects to United States agency partners without delay. In turn, we will count on the DOI, USDA, HHS, and any other agencies to negotiate the full coordination and integration of the Smithsonian domestic component, the GAINS network, and any other ongoing effort into a public database. This way we know samples will be stored and shared between governmental and nongovernmental organizations and that data will work with additional efforts in the future.

Mr. BURR. I agree that avian flu surveillance is critical to our ability to protect public health. Mr. President, I ask Senator Lieberman, is the global program he supported in the fiscal year 2006 appropriations process for international surveillance currently up and running? The Smithsonian Institute and the domestic surveillance program they are working on and his international surveillance program will be important partners. We urge all parties to begin their activities immediately.

Mr. BURR. Mr. President, my amendment builds upon work Senator Lieberman and Senator Brownback undertook last year in the fiscal year 2006 Defense appropriations bill, which also included the first avian flu supplemental. It enhances our domestic capacity to undertake wild bird surveillance coming into and across the United States by utilizing the expertise of the Smithsonian Institute to support our Federal agencies.

Mr. BURR. An international avian flu surveillance component is an important investment and I hope HHS and CDC recognize the need to enhance our surveillance capabilities. I encourage the Appropriations Committee and Chairman Cochran to give it full consideration.

Mr. BURR

Mr. BURR. I thank the chairman and recognize there might be an individual who wants to speak in opposition. I suggest the absence of a quorum.

Mr. BURR. Mr. President, would the Senator from Colorado yield for a question? If the Senator would allow me, it is my understanding we would be able to voice vote my amendment that is pending right now. If the Senator would allow me to do that, we could dispose of this amendment in 30--I have been told I am incorrect.

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

Mr. BURR. Mr. President, I ask unanimous consent to set the pending amendment aside and call up amendment No. 3713.

Mr. BURR. Mr. President, I will be brief because I know we are in debate on another amendment. Avian flu is the concern of not just this Congress but of this country and the rest of the world. As it has spread by migratory birds--and in some instances around the world--it has infected humans. It is the responsible thing on the part of this country to prepare for that. Part of preparation is not only being prepared for the human side, it is being prepared to track its entry and possible migration through the United States. Today we have devoted, with the leadership of the chairman of the Appropriations Committee, moneys to the Fish and Wildlife Service to successfully do that, and we do it between Russia and Alaska. Unfortunately, there is a lot of geography in North America that goes uncovered and has routes for migratory birds. My amendment is simple. We would like to reprogram $5 million of surveillance money that is in this emergency spending bill to the Smithsonian, directed to work with all of their nonprofit affiliates to set up a migratory bird surveillance program. This Congress has committed a tremendous amount of dollars to be prepared and to respond if bird flu becomes a human-to-human transmission. If we look around the world at successes, one would look at Taiwan and Japan specifically, where their migratory birds surveillance program detected, contained, and eliminated on their islands the infection. That is not to say that they are home free, but they certainly have a track record of eliminating the threat, even before it hit in total their domestic population of poultry. We are concerned about the human-to-human transmission. With that concern has come a tremendous amount of resources from the Federal Government. It deserves us spending as much time focused on the economic impact before human-to-human transmission. I think it is safe to say that a majority of this country can be affected with our poultry flocks, and we have an opportunity, with a successful surveillance program, to make sure that we do what Japan and Taiwan did, and that is detect its entry, try to contain it, try to eliminate it when it first enters. I am not sure that we have an entity that has a track record of doing what we are asking the Smithsonian. In the past, the Appropriations Committee has devoted some funds to some entities that suggested they could do it. The reality is they are not doing it today. This effort is to take an agency, a Federal arm, and to try to extend to them the resources to do what they say they can do and that is a successful migratory bird surveillance program. I ask my colleagues to support the amendment. Without it, we have no hope of a surveillance program for migratory birds, with the exception of what we currently do in Alaska with Fish and Wildlife. We have a commitment to make sure that the efforts of the Smithsonian and their successes are integrated into the database of Fish and Wildlife. This is not to duplicate. It is not to create something that might be a threat to the existing program we have under way. It is to complement it. It is to say that we understand this is a large continent and that we have to tap the pool of people who are in nonprofits across the country and across the continent, if we want to be successful with a surveillance program. I ask my colleagues to support reprogramming $5 million for this year. It is not new money. It is reprogrammed money. It is money that we had devoted to surveillance. It is shifted from human surveillance to migratory bird surveillance. I thank the Chair and yield the floor.

Mr. BURR

Mr. BURR. I yield the floor.

Mr. BURR. Mr. President, I ask unanimous consent to set the pending amendment, and I call up my amendment, which is at the desk.

Mr. BURR. Mr. President, if it helps my colleagues, it will take me 20 seconds to offer this amendment.

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

Mr. BURR. I call up my amendment which is at the desk.

Mr. BURR

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

Mr. BURR

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

Mr. BURR

Mr. BURR. Mr. President, I ask for the yeas and nays.

Mr. BURR

Mr. BURR. Mr. President, I rise on the Senate floor today to not only offer this amendment and talk about it, but to speak on an amendment of another Member of the Senate, an amendment that also focuses on the avian flu. Our country faces threats, some of which we know and some of which we don't know today. One real threat is the threat of pandemic bird flu. The President of the United States was ahead of the curve on this with a proposal to the Congress of over $7 billion for advanced development of vaccines, for the preparation the country needs to go through, and for the stockpiles of antivirals and countermeasures. The fact is that Congress has responded to his request. This year the budget resolution highlights the fact that the President's request of $2.3 billion of taxpayers' money is in this budget resolution. My colleague from North Dakota, for whom I have a tremendous amount of respect and who has helped, along with Senator Gregg, to move this budget resolution through this body, has asked we increase that amount by $5 billion. If for 1 minute I thought $5 billion would make America safer, I would be on the floor as a cosponsor of that amendment. But the reality is, we are at a point where we are absorbing all the money we can, given where we are in this process. I just left a hearing with the Secretary of Health and Human Services. My direct question to him was: The President's budget asked for $2.3 billion. Is that sufficient for 2007? He looked at me and said: Senator, where we are in the development of vaccines, where we are in our need for stockpiles, that amount fulfills everything we can do in preparation. So I urge my colleagues not to support the amendment for an additional $5 billion of taxpayers' money to potentially go into a black hole. I remind my colleagues that the way this is funded is to raise taxes on the American people. We have used tax loopholes for corporations to fund many items suggested in amendments on this floor. The fact is, once again, the American people realize this is a covert way of raising taxes on them. My amendment does something very simple. It creates a reserve fund. It has been described as hollow because it has no money. I believe the American people demand that we bring fiscal responsibility to this institution, to the Congress of the United States. I don't want to tie the hands of individuals within the agencies if they see a need for something, but the creation of this reserve fund allows them to do it in a budget-neutral way. I believe this will be overwhelmingly supported because, in fact, it doesn't spend any new money, but it provides the flexibility and authority to those who are charged with addressing this threat. The amendment establishes a reserve fund, and that can help to rebuild our domestic vaccine industry, support advanced development and acquisition of needed drugs and vaccines, strengthen the public health infrastructure, and increase surveillance and outbreak containment. We are at a point in this Congress where we have the opportunity to reauthorize the Public Health Security and Bioterrorism Preparedness and Response Act, and we are considering legislation on advanced development of vaccines and countermeasures against chemical, biological, or radiological and natural threats. There are many issues that we have to decide exactly how we are going to handle. But to throw money at them is, in fact, not the answer today. Those who are charged with the responsibility of making sure this country is prepared, in fact, have sufficient funding today. I urge my colleagues to vote against the Conrad amendment, to vote for the Burr amendment, and to make sure this administration is able to carry out what has been a well-planned preparation for a known threat to this country and, I might add, to the world. I yield the floor.

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

Mr. BURR. Mr. President, I send an amendment No. 3114 to the desk and ask for its immediate consideration.

Mr. BURR. Mr. President, I ask unanimous consent to set the pending amendment aside.

Mr. BURR

Mr. BURR. Mr. President, I rise today to introduce legislation that would provide an above-the-line tax deduction for individuals who purchase their own health insurance and are not receiving it through their employer. An above-the-line tax deduction would allow a taxpayer to take the deduction even if they don't itemize their taxes. Current law allows those individuals who are self-employed and purchase health insurance to take an above-the-line tax deduction. My legislation would make the tax code fairer by allowing those people who are not self- employed to take the same deduction. An estimated 17.4 million Americans in 2005 were covered by individually purchased health insurance policies. Some of these people are self-employed and can currently take this deduction. However, based upon these statistics, I estimate that up to 2 million families who have purchased health insurance do not have access to this deduction. My legislation seeks to correct that. Additionally, the legislation will make it cheaper for uninsured people to purchase their own health insurance policies. Health care costs in general are expected to rise 7.2 percent per year for the next ten years, so it is important for Congress to pursue steps to attempt to rein in this inflation and also to try to make health care and health insurance more accessible and affordable. This legislation is a part of those efforts. Another important aspect of the legislation is that it would also allow individuals to take an above-the-line deduction for the purchase of long-term-care insurance. Most employers do not offer any subsidized long-term-care insurance to their employees, so those who need this protection often have to purchase it in the individual market. It is very important for Americans to purchase this insurance, since many people assume that Medicare covers long-term-care costs when people turn age 65. However, this is not true. Often, seniors will find themselves on Medicaid, the low-income federal health care program, when they have long stays in nursing homes that they cannot pay for. Long-term-care insurance is a far better alternative to having seniors go onto Medicaid. It is important for Congress to incentivize people to purchase this insurance, and my legislation is a step in the right direction. I want to urge my colleagues to look at this legislation. It is short and to the point, but helping people to have private health insurance and long-term-care insurance is an important part of improving our health care system.