Hillary Clinton

Mrs. CLINTON

Mrs. CLINTON. Mr. President, I rise to introduce the Protecting American Democracy Act of 2003, legislation that is vital to ensuring that the voting systems used in our Federal elections are as secure as possible while also ensuring that each and every voter in our Nation has an equal opportunity to verify his or her vote before that vote is cast and permanently recorded. At its core, this legislation will ensure that every vote is properly counted, ensuring the integrity of each vote, which is at the heart of our democracy. In recent months, there has been discussion about the increasing use of electronic voting systems such as direct recording electronic systems (DREs), the first completely computerized voting systems. Computerized voting systems can have many advantages. As the Congressional Research Service has reported, they are arguably the most user-friendly and versatile of any current voting system. Among many features, such voting machines can be easily programmed to display ballots in different languages and can be made fully accessible for persons with disabilities, including the visually impaired. They can also prevent overvotes and spoilage of ballots due to extraneous marks since no document ballot is involved. In addition, fully computerized systems have the ability to notify voters of undervotes. Presently, no other kind of voting system possesses so many features. For this reason, it is expected that within the next two years, with funding authorized under the Help America Vote Act of 2002 (``HAVA''), state and local jurisdictions across the country will begin purchasing fully computerized systems. One of the disadvantages of these electronic voting systems, however, is that they do not give voters an opportunity to verify their votes-- to confirm that the voting machinery is registering the vote that the voter intended to cast--before the vote is cast and permanently recorded. In addition, electronic voting systems raise other concerns because of the ability of the software in the voting system to be compromised, or worse, maliciously attacked, by someone who may want to alter the voting results. Indeed, a number of recent studies, including the July 2001 study by Caltech/MIT, the July 2003 study by Johns Hopkins and Rice universities, the September 2003 study by the Science Applications International Corporation, requested by the Governor of Maryland, and the two November 2003 studies conducted by Compuware Corporation and InfoSENTRY, requested by the Ohio Secretary of State, pointed to significant and disturbing security risks in electronic voting systems and related administrative procedures and processes. That is why in addition to ensuring that voters have an opportunity to verify their vote, it is vital that we improve the security of voting system technology, and that means not only the kind of software that is used but also how, for example, that software is designed, stored, disseminated, updated, field tested, and used in an actual election. This is a developing consensus among computer security experts that not only is the security of electronic voting systems wholly inadequate, but that the security policies and procedures that State and local election officials, voting system vendors, and others use are non-existent, inadequate, or, if they exist, are not followed, which is the same as having no policy at all. Our Nation is the greatest Nation on earth and it is the leading democracy in the world. Central to that democracy is ability of Americans to have confidence in the voting system used to register and record their votes. This is a fundamental standard that must be met. I have concerns, however, that our Nation is falling short of that standard. That is why I am today introducing the ``Protecting American Democracy Act of 2003,'' which amends by adding a voter verification requirement for voting systems to give each voter an opportunity to verify his or her vote at the time the vote is cast. Voters will be given an opportunity to correct any error made by the voting system before the permanent voting record is preserved. While requiring that all election jurisdictions give voters the ability to verify their votes, this legislation also gives States and local jurisdictions the flexibility to employ the most appropriate, accurate, and secure voter verification technologies, which may include voter-verifiable paper ballots, votemeters, modular voting architecture, and/or encrypted votes, for their State or jurisdiction in a uniform and nondiscriminatory manner. Any voter verification method used must ensure that voters with disabilities and other affected voters have the ability to cast their vote in private, and language minorities must have equal access in verifying their vote. This is important if we are to ensure that all Americans--including the more than 20 million voters who are visually impaired, the more than 40 million Americans who lack basic literacy skills, and millions of language minorities--will be able to exercise their constitutional right to vote. To address critical security issues, the ``Protecting American Democracy Act of 2003'' also amends HAVA by adding a security requirement for voting systems to ensure that voting systems are as secure as possible. Specifically, voting systems must adhere to the security requirements for Federal computer systems as required under current law or, alternatively, more stringent requirements adopted by the Election Assistance Commission. Currently no such requirement exists. I believe that, at minimum, the systems used by the people of the United States to exercise their constitutional right to vote, the hallmark of our democracy, should be at least as secure as the computer systems used by the Federal Government. The security requirements must also provide that no voting system shall contain any wireless device, which reduces the risk that hackers will be able to attack any electronic voting system. In addition, all software and hardware used in any electronic voting system must be certified by laboratories accredited by the Commission as meeting all security requirements. The Act also requires the Election Assistance Commission to report to Congress within 6 months of enactment regarding a proposed security review and certification process for all voting systems. Within 3 months of enactment, the Government Accounting Office, unless the Commission has already completed the following report, must issue a report to Congress on the operational and management systems that should be employed to safeguard the security of voting systems, together with a schedule for how quickly each such measure should be implemented. Lastly, immediately upon enactment, the National Institute of Standards and technology (NIST) must provide security consultation services to State and local jurisdiction. Two million dollars in Fiscal Years 2004 through 2006 are authorized to be appropriated to assist NIST in providing these security consultation services. I cannot think of a more significant risk to our democracy than for Americans to lack complete confidence in the voting systems used to cast and count their votes in Federal elections. For all those who believe that in a democracy, there is no more important task than assuring the sanctity of votes, this should be an easy step to take to assure it. For this reason, I urge all of my colleagues to support this legislation. I ask unanimous consent that the text of this bill be printed in the Record.

Mrs. CLINTON

Mrs. CLINTON. Mr. President, today, I am introducing a bill that seeks to begin a dialogue on one of the most important yet neglected aspects of our health care system--health care quality. this is an enormous issue that affects every single one of us who has ever needed medical care, and it affects all taxpayers because quality care has such potential to avoid waste and save millions of dollars in health care costs. I have raised many of these ideas as amendments in other contexts, such as the Medicare debate on S. 1, and the debate over S. 720, the Patient Safety and Quality Improvement Act of 2003. I intend to continue working with my colleagues on improving these ideas and proposing additional concepts. But with this bill today, I seek to put forward a package of ideas, provoke conversation, and present this as a first step in making quality a focus of my health care efforts next year. My goal with these efforts is to both improve quality and outcomes, and reduce costs by encouraging care that is more effective. There is no reason why we cannot achieve this. We have the most advanced medical system in human history--the finest medical institutions, the newest treatments, the best trained health care professionals. But in spite of the best intentions of clinicians and patients, our health care system is plagued with underuse, overuse, and misuse. currently, only about 50 percent of care that is known to be effective is provided, and the care given is supported by solid scientific evidence, and the pace of dissemination of new evidence is painfully slow. It may take up to 17 years for treatments found to be effective to become common practice. Much of the overuse or misuse of health services stems from the fragmentation of our system. In a recent study in Santa Barbara, CA, 20 percent of lab tests and x-rays were conducted solely because previous results were unavailable. One in seven hospitalizations occurs because information is unavailable, and a shocking percentage of the time, physicians do not find patient information that had previously been recorded in a paper-based medical record. Despite all of our Nation's medical advances, health quality is becoming even more endangered in some respects. Nursing care which is often shown to be a decisive factor for hospital patient outcomes, its in grave shortage, and a majority of U.S. physicians surveyed by the Commonwealth Fund perceive their ability to provide quality care as having worsened over the last 5 years. Additionally, even as the quality of health care we purchase lags, our spending on inadequate and wasteful care is spiraling out of control. Premiums increased 13 percent last year, and health care costs are increasing at nearly 10 times the rate of inflation. To make matters worse, the public health system is straining to meet the challenges of bioterrorism or emerging infections, the number of uninsured Americans is rising, clinicians are leaving practice, and the older adult population is set to double by 2040. The reason is not because doctors aren't trying hard enough, or hospitals are at fault. That we're able to get good health care at all is testament to the genius and heroism of doctors and nurses who deliver care, despite all the obstacles, despite every effort of the system to hinder them. But what our medical system requires of providers is a little like asking pilots to routinely land planes without any information from the control tower. The best of them can do it--they could land a plane with one arm around their backs missing key information and confirmations, but why force them to do it? Why deny them critical information when it could be easily available? There is no plausible reason for denying needed information, especially when life and death are at stake. That's unfortunately exactly what our health care system says to doctors, nurses, and hospitals. Physicians for example spend four years in medical school, and then several years more in their residency training, cramming medical information into their heads. Then we expect them to look at a patient taking four different drugs, with a heart condition, and immediately remember any drug-drug interactions that could occur. We ask them to do it without looking up any reference materials. We ask them to do it in the few minutes that they have with each patient given the ever-shorter visits, and ever-increasing patient and paperwork load. Moreover, in their free time, they are expected to keep up with all the new journal articles and learn about every new drug. Yet hand-held computers can now allow the doctor to pull up up-to- date information immediately, right at the bedside, if he or she has any question. And NIH spends billions of dollars in research to generate that information. Shouldn't that investment reap results for the patient as quickly as possible? This bill seeks to provide the direction that would support such technology and make it widely available to physicians. Right now, doctors, nurses, and hospitals are holding the health care system up, preventing utter collapse by sheer, heroic, force of will. Instead of the clinicians supporting the system, we should build a system that supports clinicians instead. The premise of this legislation is that information, in the hands of the right people at the right time, drives quality and value. We need to empower patients and health care providers to make the right choices. And to do that, health care decisionsmakers--providers, payers, and patients--need to have access to the right information, where and when it is needed, securely and privately. This legislation seeks to: 1. Generate information about health quality through increased research, increased public reporting along key quality measures, and standardization of those measures to assure comparability and usability of reported information; 2. Ensure that payers, providers and patients get information in a usable form so they can make effective decisions; and 3. Reduce barriers to the development of an IT infrastructure that is so critical to achieving those first 2 goals. Eighty percent of the care delivered today is not backed by sound clinical research. That is why we need to do more research, and see if the care we provide today has sound justification in science. But even where we know what to do, we don't always do it because the information is insufficiently disseminated and utilized. Studies have shown some procedures being performed even when they have not met accepted criteria for appropriateness: In one study, of all the non-emergent, noncancerous hysterectomies performed, only 30 percent had been properly worked up and met the full medical criteria for necessity. In another study, about one-fourth of coronary angiographies and upper gastrointestinal endoscopies did not meet standards of medical appropriateness. On the flip side, in situations where the benefits of an intervention are clear, many patients do not receive the indicated care: Very few hospitalized patients at-risk for pneumococcal pneumonia who had not been previously vaccinated end up being vaccinated during their hospital stay. Routine peak flow measurements are conducted in only 28 percent of pediatric patients with asthma. And only one-half of diabetics receive an annual eye exam. We know what good health care means in these areas, but we don't practice it, in part because that information may not be readily available, and regardless, there is no incentive for quality. We are suggesting--track the outcomes, share that information with patients, providers, and insurers, and ultimately, pay for performance. This bill will help us become better purchasers of care, and help us take the first steps toward aligning the incentives so that higher quality is rewarded. I ask unanimous consent that the attached article from last week's New York Times be printed in the Record showing how our current reimbursement system is gravely misaligned. Under the current system, higher quality can be penalized, while worse care can ironically be more profitable. Today, by introducing these ideas for the purpose of seeking feedback from my colleagues and experts in the field, I am taking the first step toward improving our health care system for everyone and saving money. I invite interested colleagues to join me in partnership on this important venture and look forward to taking strong, positive action next year to improve health quality for all Americans.

Mrs. CLINTON

Mrs. CLINTON. Mr. President, this is a sad day for seniors and a sad day for America. I have long fought for a prescription drug benefit, and I am truly disappointed that this bill fails to adequately address this need. Seniors deserve a comprehensive, reliable prescription drug plan. This is no such bill. It is a weak benefit meant to cover the true intentions of its authors--privatizing Medicare. In short, the bill Republicans are passing today is a wolf in sheep's clothing. This bill, over time, will bring about the unraveling of the Medicare system, breaking a promise we made to our seniors. It does all this under the cloak of a prescription drug benefit that is far too small and far too weak to justify the negative side effects. To illustrate how this bill begins the demise of Medicare and sets our Nation back in its effort to care for seniors, we need only to look at the years before Medicare, when the private market failed to adequately serve the elderly. This sicker, costlier population was an unprofitable group for private insurers to cover. It was impossible to take care of this pool and still keep premiums affordable. Before we passed Medicare in 1965, 44 percent of seniors were uninsured. Now 1 percent of seniors are uninsured--a lower rate than any other age group. Medicare does this by being able to spread the per-person costs across a large number of people to pool the risk. This bill, however, fragments the risk pool and allows private plans to ``cherry-pick'' the healthiest seniors. Left behind will be a group of Medicare applicants that are far more expensive per person. This will create a two-tiered system and start an insurance cost death spiral that will unravel Medicare's financing. Medicare is a promise we made as a nation to guarantee seniors the health care they need in their golden years. This bill betrays that promise. And it does so under the false pretense of a prescription drug benefit. While promising negligible prescription drug coverage, this bill immediately puts benefits at risk for millions of seniors, including retirees, members of state prescription plans and those who are dual-eligible for Medicare and Medicaid--the poorest and the sickest. I voted against this bill for these reasons, and because these flaws will particularly harm New Yorkers. This bill contains little to prevent employers from dropping retiree coverage. That will disproportionately affect New York, which has a higher percentage of seniors with retiree health than other States. In New York State, 36.5 percent of Medicare beneficiaries have retiree coverage compared to a national average rate of 31.8 percent. Over 200,000 Medicare beneficiaries in New York will lose their retiree health benefits under this bill. This bill will also reduce drug coverage for the lowest-income and sickest Medicare beneficiaries--those dually eligible for Medicare and Medicaid. In a cost-savings provision, this bill will ban Medicaid from filling in the gaps in coverage by prohibiting Medicaid dollars from covering prescription drugs not covered by the new Medicare drug plan. This could hurt 6 million nursing home residents, people with disabilities, and truly indigent seniors nationwide, and over 400,000 in New York alone. This bill also fails to protect seniors who hope to stay in state prescription drug plans, like New York's EPIC. Unless corrected, this bill will force EPIC to comply with private drug plans preferred drug list, hampering EPIC's ability to ``wrap around'' Medicare and supplement the drug coverage. The state legislature will be forced to change the law and the design of EPIC to continue to program. Retirees, dual-eligible and state plan participants are not the only losers in this bill. The premium support provision will also hurt seniors in various regions selected for this experiment. These seniors will incur a surcharge in their Medicare premiums others will not have to pay. The seniors who want to stay in traditional Medicare but fall in a metropolitan area chosen for the premium support ``demonstration'' will have a 5 percent surcharge over their counterparts in other States. In the future that surcharge could spike to 88 percent if the ``demonstration'' is expanded to a full-premium support privatization effort. New York seniors in Rochester and Buffalo are at risk of being treated in that discriminatory manner. New York State also has two other Metropolitan Statistical Areas--Albany-Schenectady-Troy, and Glen Falls--that face the possibility of being chosen and whose seniors are therefore at risk of having to pay more in Medicare part B premiums than other seniors in the U.S. The bill also hurts seniors and individuals with disabilities by raising every Medicare beneficiary's deductible for physician services immediately, before seniors and people with disabilities even receive any benefits. Yet it fails to deal with the rising price of prescription drugs. It guts re-importation, weakens the generic provisions, and goes through the most unimaginable contortions to undermine government bargaining power, or any other checks on skyrocketing prescription drug prices. At the same time it places a 45 percent general revenue trigger on overall Medicare spending. This puts existing non-drug benefits in jeopardy by placing an arbitrary lid on spending and allowing drug-related spending to grow uncontrollably. That means other Medicare benefits will get squeezed into tighter and tighter fiscal constraints. If they can't fit those constraints, this bill forces those existing benefits onto the chopping block year after year. I and many of my colleagues have expressed concerns, not just with aspects of this bill, but with the appalling process with which it was thrust upon us. As complex and confusing as this bill is, the senate discussed it for less than a week now. We have not been given ample time to understand this bill, and our constituents have not been given adequate time to discern how it will affect their lives. Fortunately, there are some provisions included that I support. I am very glad to see that this bill stops the damaging cuts to physician payments and provides a small increase to physicians instead. I am pleased that the bill includes between $300 and $400 million for rural and small community hospitals and health providers in New York, while also providing additional funds for public and other hospitals who serve a disproportionate number of uninsured or Medicaid patients. And while I would have liked to see all teaching hospital cuts averted, I am pleased that at least some improvements were made for graduate medical education, since New York State trains many of the graduate physicians in the nation. This bill also includes a version of Senator Schumer's proposal, which provides greater market competition for generic drugs. And finally, this bill contains a proposal that I offered as an amendment on the Senate floor--the comparative effectiveness research provision. This will assure that we spend money on drugs that are most effective, not just the ones that are most advertised. These positive provisions, however, should have been attached to a good bill. They are not enough to justify undermining the promise of Medicare. I believe New York deserves a better bipartisan alternative than the one that passed today, and I will continue fighting this year, as well as in years to come, to correct the deficiencies I've described today so that Congress might deliver on the long-awaited promise of a simple, affordable, comprehensive prescription drug benefit for all seniors. Like so many other pieces of legislation we have witnessed in the past two and a half years, this bill is designed to please special interest and not the public. It will be a benefit to drug manufacturers. And it will be an benefit to private insurance providers. They are the big winners here, and that's not right. We need a bill that will benefit seniors. They deserve a benefit that is comprehensive, wide-ranging, and reliable. Today's bill is mainly a bill to privatization of Medicare. And it's not only seniors who will be harmed. All Americans, young and old, will deal with the financial and medical consequences of this bill for years to come. This is a bad bill for seniors and a bad bill for America.

Mrs. CLINTON

Mrs. CLINTON. Mr. President, I believe we are to go back on the schedule for the postcloture Medicare debate; is that correct?

Mrs. CLINTON. Mr. President, there are a number of significant issues that have been raised in this debate over the last 48 hours. I remind our colleagues and our seniors who may be following this debate with some interest that we have had this bill--this gigantic bill--for 4 days. This is one of the most significant pieces of legislation that will come before this Congress certainly this year, but I would argue for many years to come. It is a wolf in sheep's clothing. We remember the old fairy tale about the wolf that couldn't get into the hen house or into the shepherd's enclosure to try to go after the hens and go after the sheep and kept trying and trying. Finally, the wolf figured out that a frontal assault was just not going to work. People would see the wolf sneaking up on the hen house, sneaking up behind the sheep, and they would scare them off and try to get him before he got the hens and the sheep. The wolf got really smart. The wolf found some poor old sheep that hadn't quite made it back from the hills and, unfortunately, killed that sheep, got that sheepskin, and snuck in. When people saw it moving across the ground, they thought: That's just an old sheep. Lo and behold, the wolf got to the hen house and the sheep, and that poor old farmer didn't have any hens or sheep left by the time the wolf got done. Make no mistake, that is what is going on here. You can dress it up, you can talk about how significant a benefit it is going to turn out to be, how we are modernizing and changing Medicare for the 21st century, but remember that fairy tale. Fairy tales are rooted in ancient folk wisdom and experience, and what we have here is just a classic wolf in sheep's clothing. There are many reasons to oppose this bill, and my colleagues have been going through them one after another. I think the bottom line is, No. 1, this bill does very little of what it actually advertises doing. It advertises it is going to be a sea change--a positive sea change-- for seniors, and that is not the case. We have been fighting over prescription drug benefits for seniors for years. A decade ago, when I was working on behalf of the Clinton administration with respect to health care, we included a drug benefit. Some of you may remember that debate. That debate went down, and it went down for many reasons, but one was that it was a 1,300-page bill-- a bill that would guarantee health insurance to every American, a bill that would control prices so that we could actually afford health care for every American, and people said: Oh, my goodness, that is such a long bill; why, look at what the Clintons are trying to do. They are trying to change health care with that gigantic bill. Remember, we produced that bill with a thousand people involved in the process. We vetted it with everybody. We brought it to the Capitol. It was done in the light of day. We produced a bill and then, of course, all the special interests got everybody confused about what was in the bill, and the bill went down even though, as it was going down, public opinion surveys were asking Americans: What is it you want in a bill? They said: We want guaranteed affordable health care coverage and the ability to pick our doctor--all of which was in the bill. It didn't do me any good to keep saying it because $300 million had been spent by the special interests for TV ads, radio ads, and newspaper ads--the whole 9 yards. Oh, my goodness, the bill was so big and so confusing and all these terrible things were going to happen. Four days ago--4 days ago--we got this bill. I am looking through this bill trying to figure out, my goodness, how long it is. I know it is awfully heavy. I think it is about 1,200 pages. That is just to do something to Medicare. It is not to guarantee health insurance for children and working people. It is not to guarantee health insurance for people 55 to 65, who retired and who start, as you do when you get to 55, to have health kinks and problems and are not eligible for Medicare. It doesn't do anything for that. It is a 1,200-page bill which we received 4 days ago, and I can guarantee you there are disputes on the floor of the Senate as to what is in it and what it means. Why is that? Because we haven't had a chance to examine and analyze it, and if we haven't, with our staff and our efforts over the last 4 days, I know the American people, particularly our seniors, haven't either. There are many provisions in this bill that really need to be brought into the light of day. I will be voting against cloture, which is a parliamentary term to try to cut off debate, because I don't think we have had enough debate yet. I don't want anybody being surprised about what is really in this bill because there are going to be a lot of surprises. The promise of reimporting drugs from Canada--which is really important in a place such as New York because we border Canada. A lot of my seniors from Watertown, Massena, or Plattsburgh go across the border and get those cheaper drugs. In this bill, that is going to continue to be a problem and a prohibition in reality, if not legally, because drug companies are going to be given the go-ahead to basically violate antitrust rules so they can cut back on the amount of drugs they send to Canada. I don't blame the drug companies. They have a captive market in our country. Our tax dollars do the research at our great universities and research labs. Our tax dollars support the National Institutes of Health. Our tax dollars create the conditions in which drugs are given clinical trials to determine whether they help or hurt. We do all the work for the entire world for determining the efficacy of drugs, quality, and safety, and then other countries, such as Canada, Europe, and other places, bargain with the drug companies. They say, OK, we have a big market. We have millions of people. It is kind of like Sam's Club, only think of it as the Canadian club or the European Union club. They bargain with these drug companies and they drive the prices down because they are going to buy in volume. Should we not have an Uncle Sam's Club? Should not Uncle Sam be able to bargain with these drug companies? Apparently that is not what the backroom negotiators and writers of this legislation wanted because in the most wonderful example of Orwellian language, on page 53 of this bill, under a title called noninterference--I love that--it says in order to promote competition--there are magic words around here. It is said that competition is going to be promoted, while they create a monopoly, while they end antitrust, because they are setting up all kinds of special privileges for special interests. Nevertheless, we just hope nobody notices that. So in order to promote competition under this part and in carrying out this part, the Secretary, No. 1, may not interfere with the negotiations between drug manufacturers and pharmacies and PDP sponsors--those are drug plans--and may not require a particular formulary--that is the list of the drugs one can get--or institute a price structure for the reimbursement of covered drugs. Basically, what this means is the lid is off. Not only can we not get the drugs from Canada anymore because our drug companies will say to the poor Canadians, keep letting your pharmacists send them across the border and we are going to not send the drugs for the Canadian people. But we cannot even bargain. We cannot have an Uncle Sam's Club. We cannot get the volume discounts. We have to look at who is doing what in this debate to figure out where the sheep are, where the hens are, and where the wolves are. One of the biggest wolves who has been after Medicare for as long as he has been in public life is our old friend, Newt Gingrich, former Speaker of the House, when he called for Medicare to wither on the vine. Well, guess who showed up to try to whip those House Republicans in line to vote for this bill, which is why they had to leave the vote open for more than 3 hours, the longest time they had ever had to leave a vote open because basically, there was the wolf in sheep's clothing going up to the House Republicans and saying: Do not worry, we are going to say all of these good things about this bill, but just wait until we get our hands on it; just wait until we get into that hen house. I do not blame them if that is what they believe. Nevertheless, we are the ones who are going to be paying the price. I ask unanimous consent for an additional 2 minutes.

Mrs. CLINTON. I will put a chart up that gives a short summary for any American, and particularly for any senior citizen, watching. This bill sacrifices seniors' interest to special interests. Seniors need lower drug prices. Forget it. The drug industry wants higher profits. Seniors need predictable premiums. Forget it. Managed care wants the flexibility to raise their rates even in the middle of the year. Seniors need a choice of drugs. Forget it. The drug industry wants a restrictive formulary that pushes their brands. Seniors need to keep their retirement benefits. Forget it. The private plans want a $12 billion slush fund so we are going to lose retiree health care. Seniors want to stay in Medicare. Forget it because what is going to happen is that Medicare is going to get increasingly the health care plan for the sickest and the oldest of our seniors, which will make it more expensive. In this bill we are going to even see a constriction on the nondrug benefits for Medicare. So one has to really watch what goes on around here. They have to follow it carefully. This is a bill that is bad for seniors, bad for America, and I hope my colleagues will stand against it.

Mrs. CLINTON. Mr. President, I am very pleased that my colleague Senator Smith has taken the lead in asking for an extension of the Temporary Extended Unemployment Compensation Program. One might wonder why we are having to do this, but the simple explanation is that once again we have run out of time. People will run out of their benefits by the end of this year. If we go home for the Thanksgiving and Christmas holidays without acting, there will be many Americans and a lot of people in Oregon and in New York who are not going to have the continuing help they deserve in these times. We have extended unemployment insurance with bipartisan support in the Senate three times in the last 2 years. I am very proud of that because I think it shows how we can work together to help those who deserve our assistance. Because we are not coming back in, as I understand it, until January 20, we won't be able to do that if we don't act now on the Senator's proposal. If we do act now, the House, which is coming back in early December, will be able to similarly act and the benefits will flow. It is significant, too, that Senator Smith and I are in the Chamber asking our colleagues to join us because the State of Oregon and New York City have the highest unemployment rates in the entire country. New York City has an unemployment rate of 8.2 percent. We have never recovered from the effects of September 11. Oregon has an unemployment rate of 7.6 percent. So both the Senator and I are very concerned about the good people we represent on opposite ends of our country who have been out of work for a long time. We know long-term unemployment is at the highest level it has been in 20 years. We need to give them some additional time. This extension would provide another 13-week extension until June. I would urge support of Senator Smith's proposal. If I am not already listed as an original cosponsor, I ask unanimous consent that I be so.

Mrs. CLINTON. I yield back to the Senator from Oregon.

Mrs. CLINTON. Mr. President, I will say a few words and then yield to my good friend from New Jersey. Before I get into the Medicare debate, I wish to say some concluding remarks in response to my colleague from Nevada. At the rate that job creation is going under this current administration, we have one job opening for every three applicants, and it will take the next 19 months to get to the level of jobs we had before the March 2001 recession started. So I think we are mixing apples and oranges here. This has been a jobless period. One can argue about whether or not there has been any kind of recovery. I would take issue with people suggesting it, but if they do, then they need to use that oxymoron ``it is a jobless recovery,'' because the economy sure is not creating jobs. In addition, we have places such as the one my friend, the Senator from Oregon, represents, and my State, where the unemployment rate is far above the national average. There is no way to say New York City, with an 8.2-percent unemployment rate, is creating jobs again. It is not happening. I have a little problem with this idea that we are comparing welfare recipients with people who lost their jobs. Welfare recipients didn't have jobs, by definition. The whole effort in the 1990s was to create circumstances in which people could move from welfare to work. What we have now are people moving from work to nothing. We have no safety net. So we are telling people who have worked hard, done what they were supposed to do, been laid off from airlines, or telecommunications, or financial services, whose jobs have gone to India or China, and there are no jobs to replace them, we are telling them: Tough luck, happy Thanksgiving, Merry Christmas, Happy New Year. If that is what the other party wants to send as their Christmas greetings to their constituents, that is certainly their right. It certainly seems not to be in the spirit of the holiday we are about to celebrate. It is factually inaccurate to say there are jobs being created, and all we have to do is really put the pressure on these people and make it impossible for them to do anything other than go get a job. That would be great if there were jobs to be gotten. Given the combination of the economic and budget policies of this administration, I don't think we are going to have those jobs available. I predict to you that even if we have an unemployment rate nationally of 6 percent, or 6.1 percent, or 6.2 percent, we are not going to have the jobs coming back because this administration has presided over the largest job loss in American history since Herbert Hoover. If I were on the other end of Pennsylvania Avenue, I would not want to be reminded of that, either. I would not want there to be an up-or-down vote on whether or not to extend unemployment insurance because, if do you that, you admit the obvious: You know what, we are not creating jobs and we have to do something to help people. I regret that the effort my friend, Senator Smith, and I have joined together in trying to accomplish has been objected to; namely, to bring about an extension of unemployment benefits, which strikes me as not only the right thing to do but the smart thing to do, because every time we extend unemployment benefits to the people who truly need them, you pump more money into the economy, which may create a job or two and obviate the need for uninsurance benefits in the future. We will be back, as we were last year. We are not going away, obviously. This is something about which we care deeply. It is the right thing to do. If I thought we were having the kind of economy in the future that we had starting in 1993, I might have a different idea, but that is not what is going to happen. All the happy talk notwithstanding, that is not going to happen. Mr. President, I will now move to the Medicare conference report. I have to tell you that the more I learn about this proposal, the less I like it, the less fair I think it is, the less useful for our seniors. Just recently, because we got this 1,200 page bill 4 days ago, including a weekend, when people were combing through it, our experts were trying to read it. I can guarantee you that if you put two Senators up in the well of the Senate on opposite sides of the bill, or even on the same side of this bill, they would not agree on every provision because there is not anybody who fully understands what is in this bill. But what I just learned is that three important items from the Senate bill were changed in conference, in addition to everything else we know that was changed--all the big things, including the reimportation of drugs, the limitation on premium support, the lack of any kind of support for HSAs, all of those things which changed. Here are some additional changes which are now coming to light as people comb through the fine print of the bill. First, we thought seniors would know at the time of their enrollment in these private plans what drugs would be on the list. That is called a formulary. It is kind of a fancy term. There are lots of fancy, confusing terms in this bill. My colleague, Senator Boxer from California, has a mind-boggling chart, where she and her good staff have pulled out all kinds of words that no normal human being understands. Heaven forbid, I don't think abnormal people understand them. They are made-up words that describe these processes and events, and nobody understands what they really mean. So we now found out that these formularies--the list of drugs that would be offered by a plan--are not necessarily going to be available to a senior when that senior signs up. Now, imagine that. Think about my 84-year-old mother, who takes a number of prescription drugs that are very specific and assigned to her by her physician to meet her needs. Her doctor says: This is what you need, and here is your prescription. So in 2006 or 2007, when she signs up for one of these plans, she is not going to know whether the plan includes a particular drug that she needs. I find that a big problem, because how can you buy something when you don't know what it is you are buying? This is supposed to be a prescription drug plan. Therefore, prescription drugs are at the heart of it. If you don't even know which drugs you are supposed to get on your plan, that is not much of a plan. This is another typical example of the old bait and switch--maybe it is better to call it buying a pig in a poke. You don't know really what you are buying but you have to go out and buy it. Second, when the Senate sent the bill to conference, the Senate required that the 10 regions determined by the Secretary of Health and Human Services would be larger than a State. Now, that was supposed to assure that we avoid the problem we now have with Medicare+Choice, where HMOs serve some counties but withdraw from or refuse to serve other counties. I have that problem all over my State. The most intensely organized seniors in my State are seniors who have had a bad experience with HMOs--HMOs that came into their county and left them high and dry at the end of the year; HMOs that came in and, when they found they had no competition, raised the costs right in the middle of the year. Or at the end of the year, when it came time to change and they were the only game in town, they really increased costs to our seniors. But the conference report, instead of taking the Senate requirements, eliminates it--eliminates the requirement that the insurers must serve an entire State or a large region. I also know that as a Senator from New York, I have a special obligation toward the people of Puerto Rico. We have a lot of Puerto Ricans in New York. We are very proud and I am very honored to represent a large Puerto Rican population in New York. But the conference report has less money than the Senate bill for prescription drugs for Puerto Ricans. I know it always comes as a surprise to some people to learn that Puerto Ricans are American citizens. They are not some alien group over here. They are American citizens. They don't live in a State, but neither do the people who live in the District of Columbia, but they are American citizens, too. For some reason, we are not providing adequate funding for the people of Puerto Rico to get the prescription drugs to which American citizens under this bill are entitled. Those are three hidden provisions in the fine print that we just discovered today. Now we are going to have to vote on this bill today or tomorrow, and we are going to be setting ourselves on a course that will radically change Medicare. Why should people care? If you are not 65 or older, if you are not my mother's age, if you are not even closing in on Medicare, as I am, why should you care if you are my daughter's age or one of these young people working in the Senate in their thirties or forties? Why should you care? I would argue you should care because, No. 1, in our country we try to keep faith with each other by providing a safety net for seniors, for people who fought the wars, raised their families, built their businesses, and served their communities. We thought ever since 1965, when Medicare was passed, that it was really good for America to make that commitment to our parents and our grandparents. It was the right thing to do. It was the moral thing to do. It was the smart thing to do. Before 1965, the poorest people in America were people over 65. Now there are poor children. We have had a massive transfer of wealth to take care of our parents and grandparents through Social Security and Medicare. I believe we have neglected our children. We have about 22 percent of our children living in poverty. I am not proud of that, but I am proud of what we have done through Social Security and Medicare. If we are starting to unravel that now, that says something about who we are as a people. It says something about this generation of American leadership compared to previous generations. Why else should you care if you are not a Medicare beneficiary? Maybe you are the son, the daughter, or a grandchild of a Medicare beneficiary and maybe you will want to do the right thing if your grandparent or your parent has some kind of medical problem and they cannot afford to pay for it themselves, and you want to step in and help because that is the kind of person you are. And I hope that describes the vast majority of our young people in our country today. That may be tough because maybe you are saving to send your own child to college or maybe you are saving to buy your first house. Then all of a sudden, a medical catastrophe strikes, and what used to be Medicare to provide that safety net is just not there anymore in 2010 or 2012. All of a sudden, the burden falls back on you. Why else should you care? Because in this bill it is not only about undermining Medicare, it is about undermining health insurance in general. We already have an increasing number of uninsured people, and we are going to have even more of them in the future because we have a totally dysfunctional system for financing health care that certainly does take care of insurance companies and their executives and pharmaceuticals and their executives but doesn't do a great job for the average person. This bill will undermine insurance for everyone, not just for Medicare recipients. Why do I say that? Because there are no cost controls to keep the price of a prescription drug down. There is no bargaining power for the Governor to try to hold the pharmaceutical companies in line to prevent them from just blowing the top off whatever the price structure is. There is a really insidious provision that puts a limit on how much money we can spend on overall Medicare if the prices of Medicare go up--that is, hospitals, doctors, and drugs now--which means you have to cut back on everything, not just prescription drugs. So we are going to have Medicare recipients squeezed even more. There is such a thing called cross subsidization. What that means is, if you have insurance and you go to the hospital, you are not just paying for your services that you get, you are, in effect, paying for people who couldn't pay. For example, maybe the day before you showed up in the emergency room, Mrs. Smith came in after a terrible car accident or maybe some kind of acute asthmatic attack or other kind of serious problem, and she didn't have any insurance. The hospital takes care of her, but then they have to charge you, your employer and your insurance company more to pay their bills. Anytime you transfer money away from direct care, you are forcing more people to pay more for the same care. Some of them will be unable to afford it, but the cost to the providers of that uncompensated care will, in turn, raise the price which, in turn, has employers dropping people which, in turn, creates more uninsured individuals. It is a closed system. It is a circuit. The circle should not be stressed. This breaks that circle. This takes the security of Medicare and pulls it right out, causing all sorts of effects throughout the circle. The reason we created Medicare in the first place was that insuring older people who might be more sick and more frail is not a profitable enterprise. There are people who retire and go to some beautiful place and play golf all the time. They are physically fit and they look great when they are 75, but now they may live to be 100, 25 more years. At some point, the body starts breaking down no matter how well you take care of yourself. Medicare was the idea that we needed to provide a product because the marketplace would not provide it, and this bill proves the wisdom of that because the only way you are going to provide these benefits is basically by subsidizing or, some might say inelegantly, bribing insurance companies with billions and billions of taxpayer dollars to provide this benefit that they would not ordinarily provide because it is not cost-effective; it is not profitable. There are many other reasons this Medicare bill is not in the best interests of either Medicare recipients or our general population. It is a sad day when we essentially devise this scheme to try to transfer money from the Medicare system and the taxpayers' pocket to those who are already doing very well, indeed. Probably the saddest thing to me is not what might happen to the average Medicare recipient, which I deeply regret, but to the poorest of our Medicare recipients, the people who don't retire from an office job or some other undertaking that gives them the resources to move to some warm place and play golf every day, but the vast numbers of people who are sick, who are frail, who are chronically ill, who are poor, and who end up in nursing homes. Six million of them will be worse off under this bill. That is really hard for me to accept. I do not understand how a great, rich nation like ours can come to this point, where we impose new and extra burdens on the poorest of the poor and the sickest of the sick. I guess we think if somebody is in a nursing home and not out at a golf course that we will not see them; we will not care; we will not know. Maybe that is true if it is not your relative, your neighbor, your colleague, or your friend. But 6 million low-income, chronically ill or nursing home bound Medicare beneficiaries will be worse off under this bill because of formularies or increased co-pays. I find this not only hard to justify but cynical, cynical because some folks are making a bet that those poor people are not going to raise a fuss or a ruckus: Out of sight, out of mind. They will not show up to vote or certainly not give anybody any campaign contributions. So basically they do not exist. So we can turn our back on them. I do not understand what has happened to our country. I do not understand what we believe about our obligations to one another or our values when we would do that to our fellow citizens. I also do not know what universe some people are inhabiting because none of us knows what is going to happen tomorrow. Not a single one of us can predict when we might need help, when we might have that accident, when we might get that terrible diagnosis. We do not know. I thought the golden rule was the overriding philosophy that should guide us, but unfortunately in this bill that stands for an insurance company that is going to get billions of dollars for the unproven concept of health savings accounts. That is not what I learned in Sunday school but what somebody else figured out how to make some money off of. It is a sad story, but I have a lot of confidence in the intelligence of Americans and particularly for the generation that lived through the Great Depression and World War II. I am about to yield the floor to one of them. He is someone I admire and think so highly of, who had a lot of blessings in his life and never forgot where he came from. He never turned his back on people who were less fortunate than he was because he knew the basic lesson that I think some people forget--there but for the grace of God go I. If that were our hallmark, we would not be passing this bill, which puts so many of our seniors at risk, but even more than that puts at risk what we mean when we talk about America and American values. I yield to the Senator from New Jersey.

Mrs. CLINTON

Mrs. CLINTON. Mr. President, ever since the events of September 11, 2001 awakened this Nation to the very real dangers of the world we live in, we have been struggling to defend ourselves against terrorism. Our aviation system remains a primary target for terrorists, and we must be every vigilant in the fight to keep that system safe. The economic viability, not to mention safety and security, of our country is at stake in that fight. Nowhere is this more obvious than in New York. Not only did we bear the brunt of the worst terrorist attack in our Nation's history, but we also depend on our airports to fuel our state economy. John F. Kennedy Airport in Queens is the Nation's premier international gateway and contributes approximately $30 billion to the regional economy while employing 35,000 people. LaGuardia Airport, also in Queens, handles over 20 million passengers a year despite having only two 7000-foot runways on 680 acres. Our airports in Albany, Syracuse, Rochester, and Buffalo have seen strong growth in recent years with the arrival of low-cost carriers. Unfortunately, our economic and physical security remains at risk because we still have not developed a way to effectively scan each piece of passenger luggage for explosives. We have recognized that in the current world environment, we must scan each bag, but technology has not kept up with our needs. The current technology used in most airports in this country is known to have a false-positive rate of approximately 20 percent. This means that machines incorrectly identify 20 percent of all bags going through them as containing explosives, thus slowing down the process considerably as well as costing time and money. Even more dangerous is the false-negative rate of these machines. This number, the percentage of bags going undetected through these machines with bombs inside of them during test runs, should be close to zero. The actual false-negative rate is not publicized for obvious reasons, but it is known to be well above zero. I am proposing a bill today that seeks to create a major incentive for firms to invent a bomb-scanning technology that actually works. It will award $20 million to any firm that can successfully produce a machine that has a false-positive rate less than 10 percent, a false negative rate less than 2 percent, and is feasible for deployment en masse at our Nation's airports. Although we are currently spending money on researching this technology, that funding is clearly not getting us there fast enough. This new award will help to spur the private sector to develop new technology that will make a major difference in the safety of our aviation system.

Mrs. CLINTON

Mrs. CLINTON. Mr. President, ever since the events of September 11, 2001 awakened this Nation to the very real dangers of the world we live in, we have been struggling to defend ourselves against terrorism. Our aviation system remains a primary target for terrorists, and we must be every vigilant in the fight to keep that system safe. The economic viability, not to mention safety and security, of our country is at stake in that fight. Nowhere is this more obvious than in New York. Not only did we bear the brunt of the worst terrorist attack in our Nation's history, but we also depend on our airports to fuel our state economy. John F. Kennedy Airport in Queens is the Nation's premier international gateway and contributes approximately $30 billion to the regional economy while employing 35,000 people. LaGuardia Airport, also in Queens, handles over 20 million passengers a year despite having only two 7000-foot runways on 680 acres. Our airports in Albany, Syracuse, Rochester, and Buffalo have seen strong growth in recent years with the arrival of low-cost carriers. Unfortunately, our economic and physical security remains at risk because we still have not developed a way to effectively scan each piece of passenger luggage for explosives. We have recognized that in the current world environment, we must scan each bag, but technology has not kept up with our needs. The current technology used in most airports in this country is known to have a false-positive rate of approximately 20 percent. This means that machines incorrectly identify 20 percent of all bags going through them as containing explosives, thus slowing down the process considerably as well as costing time and money. Even more dangerous is the false-negative rate of these machines. This number, the percentage of bags going undetected through these machines with bombs inside of them during test runs, should be close to zero. The actual false-negative rate is not publicized for obvious reasons, but it is known to be well above zero. I am proposing a bill today that seeks to create a major incentive for firms to invent a bomb-scanning technology that actually works. It will award $20 million to any firm that can successfully produce a machine that has a false-positive rate less than 10 percent, a false negative rate less than 2 percent, and is feasible for deployment en masse at our Nation's airports. Although we are currently spending money on researching this technology, that funding is clearly not getting us there fast enough. This new award will help to spur the private sector to develop new technology that will make a major difference in the safety of our aviation system.

Mrs. CLINTON

Mrs. CLINTON. Mr. President, this is a day of considerable activity around the Senate because we have two significant pieces of legislation that are drawing the attention of Members who come to this floor to express their opinions. It is hard to know where to start. There are significant problems and issues with both the Energy bill and the proposed Medicare bill. But because they have only recently been provided--with the Energy bill only in the last 24 to 48 hours finally being made available; with the Medicare bill still not being available in its full form--it is difficult to know what to say because, although we have the outlines of legislation, we don't have the full details, and we certainly don't have adequate time to digest and analyze these important matters. So, I am sure that, like others, I am somewhat bewildered by the rush to deal with these two bills, to force action before the Thanksgiving holiday on such grave matters before our country. I want to say just a few words about the Energy bill, and then I want to say a few words about the Medicare bill, because I think it is important that the country understand what is at stake with both of these significant changes. With respect to the Energy bill, I am strongly opposed to it. I think it is bad for my State of New York and I think it is bad for our entire Nation. Yet I am very disappointed to find myself in this position where I feel compelled to oppose something called an Energy bill. There are provisions in this bill that are good, ones that I have worked on and have supported and am very pleased that they made their way into the final product. Of course, after the August blackout, I wanted to do everything I could in my power to ensure that New Yorkers never had to go through anything like that again. I thought certainly in the face of a massive blackout that this body and our friends on the other side of Capitol Hill would rally together to take appropriate steps to increase the reliability of our electricity transmission and distribution system. What could be more obvious? The lights went out, and they went out because of failures and problems within that system. Unfortunately, the Energy conference report did not get that job done, which to me is job one. I know the bill's proponents point to the fact that it includes mandatory enforceable reliability standards. I agree. Reliability rules are important. There should be mandatory rules with penalties, but those rules are not terribly meaningful if the entities that operate and manage the transmission system are unable to plan for and respond to crises. For that, you need a transmission system to be operated on a regional basis so responses can be coordinated on a regional basis and connected up to a national grid. At the very least, you need regional transmission organization. What have we found out today? There has been a report issued about what happened to cause the blackout. Although details are not yet fully available, we know there were a number of causes for what happened to us on August 14. The fact is, no one appears in charge of the sprawling, heavily loaded, and troubled part of the transmission grid running around Lake Erie. A portion of the Midwestern grid centered in Ohio has long worried industry regulators. The Energy bill that passed the House yesterday and which is now before us would create operating rules to lessen the risk of blackouts, but it does not overcome that region's fragmented line of authority where control is shared by 23 different power and transmission companies. The bill before us prevents the Federal Energy Regulatory Commission from setting up regional transmission organizations--so- called RTOs--that can effectively coordinate transmission on a regional basis. If you are supporting this bill because you think it will prevent future blackouts, you had better take another look at the bill. I start with this point because it is absolutely critical to my constituents and because there has been a lot of talk about how we had to move this bill because of the blackout. But how ironic it is that we move a bill which does very little to solve the problems that have now been analyzed and pinpointed as being at the root of what happened to us in August. That is just one of many problems with the bill. I join many of my colleagues in expressing dismay about the MTBE provision in the legislation. First, the bill provides a retroactive liability waiver for MTBE producers. This provision turns the so-called polluter-pay principle on its head. It basically says to communities from New York to California: Guess what; we may have contaminated your groundwater, we may have contaminated your wells, and we are not going to help you clean it up. I heard some of my friends on the other side say: Wait a minute; it doesn't remove liability from people who negligently used MTBE. The fact is, there is no good use for MTBE. It is a contaminant. It pollutes water. Whether somebody poured it in fast or poured it in slow, the result is the same. We don't know the full cost of these cleanups. I have read estimates that it could be on the order of $29 billion nationwide. In New York, we are coming to grips with that kind of extraordinary cost, especially in light of the budget problems that we face. Paul Granger, superintendent of the Plainview, NY, Water District, has provided estimates to my office about contamination on Long Island, one part of our State. But it is a beautiful part that has an underground water aquifer from which we draw water for Long Island. Mr. Granger estimates that testing the 130 supply wells known to be contaminated by MTBE will cost between $990 million to $1.4 billion. If you divide the 3.3 million Long Island population into that cost range, the MTBE drinking water cleanup costs will range from $118 to $315 per person. The cost impact for a typical family of four trying to make ends meet would be from $472 to $1,206 per family. With respect to the Plainview Water District, Mr. Granger informs me that in the event that MTBE wellhead treatment is required at all of its facilities, the average monthly cost for water will jump by 49 percent. As far as I can tell, this is another one of these unfunded mandates we like to pass around here. You have problems with water contamination directly caused by a contaminant that was manufactured by large conglomerates. They have deep pockets, and they could at least participate or contribute to helping to clean up water systems on Long Island, across New York, and across our country. Well, you are out of luck. Is that fair? I don't think it is fair. I don't think it is fair to the people of Plainview, NY. But it is fair if you consider it along those terms for the MTBE producers. Apparently, that is all that matters to the people who put this bill together. Maybe they don't have this problem in their States, although I have looked at the numbers. It looks as if all but 8 or 10 States are affected by MTBE. The costs associated with cleanup--where is money going to come from? Is this body going to pass on the billions and billions of dollars that are going to be needed to clean up our water systems across our country? I can't imagine under our current budget situation that is a likely possibility. Therefore, what are we going to have happen? Once again, the taxes on local people will rise--again, another unfunded mandate just like special education, just like No Child Left Behind, and so much else that we passed in this body and then let somebody else pay for it. New York City, which obviously has a very significant water issue, had been taking action to try to get some help in paying the bills and had sued the MTBE producers. Under this bill, their lawsuits are going to be thrown out of court. I find it hard to understand why local governments aren't going to be permitted to protect themselves and to get the resources from the people who profited from producing and selling MTBE. I thought that is the way the system worked. Somebody said it is the trial lawyers. I don't think so. Mr. Granger in Plainview, NY, and the city of New York are trying to protect their water supply. Yes, they may have to go to court to do that. Why should they be prohibited in this bill from doing so? As bad as the MTBE liability waiver is, the bill doesn't stop there when it comes to the MTBE producers. Unbelievably, the bill provides $2 billion in grants to MTBE producers. What about grants for the water systems of our country? What about lending a helping hand to Plainview, NY, and all the other places in my State that are looking at tens of millions of dollars to clean up their water supply? I can't understand how anybody can go home from this body and go back to wherever they represent and look into the eyes of their fellow citizens and say: Not only did we tell your mayor and your city council and your county leaders they couldn't sue, we are going to give $2 billion to the folks who polluted your water but not a penny for you. I wasn't on that side of this argument. Nevertheless, that is what is in this bill. There are many other problems in this bill. The numerous rollbacks of environmental and health protections deeply concern me. I hope we will be able to revisit those and try to figure out ways to avoid turning the clock back on making our air cleaner, on helping people avoid the ill effects of pollution and contaminants in their emissions. But there is so much else in this bill that, unfortunately, I believe will set us back. It is a shame because there are many ways this could have turned out differently, that we could have had the good provisions without so many of the egregious ones being put into this legislation. I will now turn to the other issue we are confronting in the Senate. I don't see how we can deal with a Medicare bill of this significance at this time when, so far as my office knows, we still do not have the final bill as I came to the floor. We will have a lot of explaining to do to our constituents. Every Member hoped we could get a bill to provide a prescription drug benefit for our seniors. They need it and they deserve it. I wish I could support this bill. Analyzing what we are able to find out and what the likely impacts will be leads me to conclude that not only will this bill not deliver on the promise of a drug benefit for our seniors but it will mean the slow, but steady unraveling of the Medicare system. Let's look at some of the people who will be directly affected by this 1,100-page bill. I cannot avoid mentioning this is a long bill. I am not sure anyone has read it yet--maybe some staff person in the basement has read it all--but it is 1,100 pages. I remember another long bill 10 years ago, a bill to change the whole health care system, not just tinkering with Medicare and trying to provide a benefit. A lot of our seniors are asking: What does this mean? Who can tell me what is in it? How will it affect me? On an individual level, that is an impossible question to answer. We do not know who is a winner or loser. My office is being inundated with calls from constituents, asking: I am a senior in New York City living on a small pension; what does this do for me? Or a widow in Buffalo, with high drug benefits: What does this do for me? We do not know yet. Here is what we do know. At first glance, there are a number of groups who definitely lose under this legislation. The numbers in the groups add up to about 25 percent of all Medicare recipients, 10 million or so. This bill causes retirees to lose benefits they currently have. At least 2.2 million retirees will lose under this deal and over half of them have incomes below $30,000. In New York, over 200,000 Medicare beneficiaries are likely to lose their retirement benefits. As a result, my phones are ringing off the hook over this. People are saying: I have good benefits; I do not want this if it will take away the good benefits. I have to say, honestly, based on my reading, the assessment on the numbers who will lose, I may even be a little conservative. Nevertheless, there will be a loss. We could have done more to avoid having 2.2 million lose, but the conferees chose instead to spend $12 billion on a slush fund for private insurers and $6.8 billion on tax breaks that will undermine insurance coverage even beyond Medicare. It is fair to say this bill threatens benefits that people already receive from their employers. There is no argument it is going to take that reality and turn it into something other than what it is. It is a bitter pill to swallow. This bill also threatens to reduce drug coverage for the 6 million people who are eligible for both Medicare and Medicaid. I have spoken about the so-called dual eligibles before because they are the people about whom I am most concerned. They are the lowest-income, sickest Medicare beneficiaries. Many rely on Medicaid right now for drugs because Medicare does not cover drugs. This bill bars Medicaid from providing drugs not covered by the new Medicare plan. That is a departure from the practice for all other Medicare benefit gaps. This will affect nursing home residents, people with disabilities, and the truly indigent nationwide. We estimate it will affect 440,000 in New York alone. If we look at the New Yorkers who are eligible for both Medicaid and Medicare, right now they can get access to any drug they need and they can access most any pharmacy. This bill will increase their copays, limit their choice of drugs, and restrict the pharmacy network. HIV/AIDS patients are particularly affected since this bill only requires coverage of two drugs in any class. HIV/AIDS patients need multidrug cocktails that may require more than two such drugs and often require very specific medicines that are prescribed for their condition. Some drugs they might take or have taken for a period of time could eventually encounter resistance within their bodies. For those patients, this provision on dual eligibles does a grave injustice. The millions who currently receive coverage through State prescription drug assistance programs, such as the one we have in New York called EPIC, are also at risk. In New York, over 400,000 seniors, nearly a quarter of our Medicare beneficiaries, rely on EPIC, which does not have a formulary and often offers better coverage than what a senior will be able to get under this bill. The compromise in the bill puts seniors in EPIC at risk of a new formulary, higher copays than they have now, and places limitations on the pharmacies they can use. It will force the New York Legislature to change the law and the design of EPIC, assuming they even want to continue it. I have also asked that seniors who will either have to disenroll from the current EPIC plan or will have to enroll in two plans to continue to qualify for drug coverage be given a grace period so they are not penalized if, in the confusion and disruption of this transition, they do not understand what they have to do to continue to get whatever State program is available because they have to sign up for a new Medicare benefit program to continue with EPIC. I recently heard from the people who are finalizing the bill that the new formularies, limitations on pharmacies, and higher copays will not only affect seniors in State prescription programs but also veterans who depend on the VA and members of the military in TRICARE, many of whom currently pay very low and in some cases zero copays. Again, the millions who have coverage throughout these programs will be worse off than they are now. What about the issue of premium support? For those 6 million seniors affected by the premium support experimental demonstration, overall Medicare premiums will increase yet again; this time, as the price of privatization. MedPAC has studied this issue and found that private plans cherry- pick. That means they pick the healthiest seniors to be in their plans. That is how they make a profit. If you are insuring the healthiest people, you do not have to pay as much money as if you insure people who are not so healthy. Therefore, they try to attract the healthiest beneficiaries. That way, they get a big payment for those healthy beneficiaries and they, frankly, do not have to pay much out when it comes to beneficiaries needs. The GAO has said the population is so much healthier that the Medicare+Choice plans are now overpaid by 19 percent when one considers the health condition of their beneficiaries. If fee-for-service has to compete and it is the only plan willing to continue to serve the sickest and costliest patients, anyone who wishes to keep their regular fee-for-service Medicare will see their cost rise, probably up 5 percent each year. But who knows how high that percentage will go in the future? Ultimately, the 6 million seniors across the country who are going to be put in the demonstration experiment will pay more just to maintain their Medicare benefit. This is not just an academic exercise for me because New York is likely to be one of the States with residents chosen for this experiment. Our seniors will be used as guinea pigs, so to speak, in the rush to try to in some way prove that Medicare, which has the most cost-effective delivery system, which has provided a guaranteed benefit that is the same across the country now for nearly 40 years, is somehow inadequate and unable to really deliver the goods. So we are going to see what happens when over 500,000 New York seniors who reside in areas that could be chosen for premium support are thrown into that mix, and told that you are just going to have to pay those higher prices, and just shovel that money out the door to the HMOs and other health insurers that are going to be standing there with their hands out. But the bill does not just create a radical scheme for Medicare; it really does take aim at our whole system of insurance by the inclusion of these so-called HSAs. They used to be called MSAs, medical savings accounts; so now I guess they are health savings accounts. The new name does not change the fundamental problems with these proposals. By promoting these accounts, these provisions will allow wealthy and healthy seniors to get tax benefits. But it would also mean increased premiums of as much as 60 percent for those who wish to keep their current private insurance. To arm the enemies of Medicare, there is a so-called cost containment provision which designates an arbitrary cap on Medicare. We are bound to hit that cap as the baby boomers age. Once we hit it, that guarantees that current Medicare benefits will be on the chopping block year after year. So I have to send out a big warning to everybody on Medicare, but also to those like me who are not that far away from Medicare, that we are looking at the dismantling of this program, and we are moving back toward a survival of the richest and the fittest. Now, considering all those harmed by the bill, you would think we would be getting a generous drug benefit out of all of this. Well, in fact, we do not. Many seniors will be paying more out of pocket for drugs under the skimpy benefit in this proposal than they are now without any so-called drug benefit at all. Every single senior in this country will pay more out of pocket than they do now for doctor services in 2005. That means that before the drug benefit even starts, seniors will be hit with increased cost- sharing. Seniors can expect a 10- increase in their Part B deductible right away, and yearly increases after that for the first time in history. Those increases are pegged to grow at a rate faster than seniors' Social Security checks. In addition, the drug premium may be $35 a month, on average, but it increases so quickly that seniors will be left paying more and more for little additional benefit. As we know, this bill creates a new insurance structure where seniors will continue to pay premiums for part of the year even though they are receiving zero benefit at the same time. Now, I don't know. I don't think we have ever passed an insurance plan in this country where you are told you have to pay all year but there are going to be a few months in the year that you don't get sick, don't get hurt, don't have an accident because you will be out of luck. There is not an insurance commissioner in this country who would gladly allow such an insurance policy to be marketed in their State. Yet here we are. Seniors will pay premiums, even in the so-called gap months, when they have no benefits. Then the $35 premium goes up to $40, and then nearly doubles, reaching $60 by 2013. I think that is a burden for seniors if the benefit they return is not guaranteed all year, every year, and if it, in and of itself, may not even meet the cost they put into the system. I have heard from some analysts that the break-even point for seniors in this bill is $835. Now, 40 percent of seniors spend less than that on drugs each year. According to the analysis I was given, this bill will actually represent a net loss to 40 percent of our seniors if they join. That is a lot of seniors. We are talking about 16 million or so. They will end up paying more in costs in premiums than they receive in returns. So when all is said and done, this is a bill that decreases some people's benefits, eliminates other people's benefits, and costs more to many. I think history has demonstrated the political repercussions of such experiments that go right to the heart of what people value the most; namely, their health. But now, even though there are many losers in this bill, I want to be fair. There are also some winners. They are many industries and some individuals. But there are winners. A recent study found this bill will give drug companies a $139 billion windfall. Because there is no cost containment in the bill, the drug companies are assured of their profits. Furthermore, the health plans--already overpaid 19 percent compared to what Medicare is paying for seniors in traditional Medicare--will receive another 7 percent on top of that in addition to the $12 billion slush fund in this bill. Now, there may be some help in this bill for some of the 12 million or so Medicare beneficiaries without any kind of drug coverage--not through Medicaid, not through Medicare+Choice, not through the VA, not through TRICARE. They simply do not have it. Maybe some among those 12 million might be winners but only if they make it through a thicket of confusion and hit a moving target. Because, let's face it, this is a very complicated bill. It is going to be very complicated to implement. I remember hearing a lot of complaints about that bill of 1,300 pages, the Health Security Act back in 1994, and that dealt with the entire health care system, not just with seniors. Now, all signs show this bill is not seeking to add prescription drugs; it is seeking to change the whole health care system. I have to give them credit, they got it to 200 pages less, so that is some accomplishment. I think we ought to look at what is going to be facing seniors as they try to make decisions about their health care. What I have done is to take the tales of two seniors, to look at what the differences would be, and what a typical senior would face when trying to determine what they could have under this bill. The first tale concerns a retired small business owner in New York City, an urban senior. Now, this senior has many choices in the first year, 2006. He looks at his choices. He has PPOs and HMOs and private drug plans and Medicare. He has choices. So he takes a look at his choices and decides to stay in traditional Medicare. He picks the private, stand-alone drug plan with the lowest premium of $35 a month. He gets into that plan. Then he discovers, too late, that his drug that he has been taking for a few years is not on the private insurer's formulary. So even though he has had bad side effects from the drug that is listed, he has to go through a lengthy appeals process. Although he eventually wins his battle with the private insurer, he has had to pay out of pocket for the drug in the interim. So suppose what he is suffering from is, let's say, diabetes--a very common disease among our seniors. In the process of trying to get on the right drug, trying to pay for the drug he has been on, he is locked into this plan and he cannot change until the next year. Now, let's go to year 2, 2007. So let's say the private drug insurer plan the senior was in has dropped out of Medicare, which happens all the time because its low premium, the $35 a month premium, could not sustain enough profit. But our elderly gentleman does not mind because he wanted to switch anyway. He did not want to stay in that drug plan because they did not treat him well. So he chooses another private drug insurer and he pays a higher premium. This time he decides to go with a more expensive premium, thinking he is going to get more of what he needs. He pays $50 for drug coverage on top of his now $79 Part B premium. But he makes absolutely sure his drug for diabetes is on the plan's preferred drug list and he can continue to see his doctor. During the year, however, the private insurer changes its formulary-- there is no rule that says it cannot--so that his drug gets assigned a higher coinsurance amount. Although the plans can change what they cover during the year--it can be the old bait and switch: Sign up with us. Your drug is on the formulary; and 6 months later, no, it is not-- the senior cannot get out of the plan until the year is up. So year 3, our senior does the math. This is a man who has really been working on this. He has spent a lot of his waking hours trying to figure out this maze of so-called benefits. To stay in traditional Medicare, he will pay the monthly premium of $83 in 2008, plus at least $50 for prescription drugs, in addition to relatively high copayments. The private insurer he was with has dropped out. If he joins an HMO, he can pay $75 for base Medicare coverage, plus $42 for prescription drug coverage. Now he is up to $192 a year extra to stay in regular Medicare, and he has to worry about whether or not the private drug plans are going to change on him again as they have in the past. You could make this even worse because suppose that the HMO plan no longer recognizes his doctor, and if he joined he would be stuck again for another year. It just goes on and on. I am not looking forward to explaining this to my 84-year-old mother. We are going to have to set up a whole gigantic bureaucracy of individual case counselors to try to explain to seniors what this all adds up to. And this maze, this totally confused picture, is what is available in an urban area where at least there are choices for seniors. Let's look at what happens to a woman who lives in upstate New York. Let's pick an 85-year-old widow who has had a stroke. She hasn't had drug coverage before. She has lived on a Social Security payment and a small pension from her late husband. She took regular trips across the border to Canada, though, because we are lucky in upstate New York. We can just go right across that border, or we used to be able to go right across that border. She could afford those drugs because they were a lot cheaper, and they were absolutely the same drugs. She takes five different drugs on a daily basis. In the first year, 2006, no private HMOs or PPOs plan to come to her town. She is up in the north country, up near the Adirondack Park. For anybody who has been up there, it is really beautiful. It is isolated, and it is really rural. She loves living there, and she wouldn't live anywhere else. Well, she has never had any of these private plans in her community before, and she doesn't know what is going to be available to her. So two of the new private drug-only plans are offered. One has monthly premiums of $60; the other has monthly premiums of $50. The lower premium plan has a complicated set of copayments that tends to be higher, when you add it all up--assuming somebody helps you figure out how to add it all up--than the higher premium plan. But she goes ahead and chooses the $50 plan, and she sees some relief. But she calculates that with annual drug costs below the catastrophic benefit, she is still not getting a very good deal because for her, she is still paying about 70 to 80 percent of what she had before. Now year 2--and this happens all the time in rural areas, as we know--the private plan drops out of Medicare. That is a common experience for rural residents. So Medicare must provide a fallback plan. This plan seems quite good to our widow. She pays $5 less than what she paid in the private plan the previous year, and her prescription drug benefits are covered. But year 3 the local papers announce that the payment rates for HMOs, which are 30 percent above the local cost of traditional Medicare, have finally attracted an HMO to the area. Remember, we are pumping all this premium subsidy out there. We have billions and billions of dollars to entice folks to come to the North Country and other areas. Well, this creates a dilemma for our senior because she now has to determine with whom she can go and who is going to take best care of her because if the HMO comes, maybe it will attract some competition. And let's say that another private drug-only insurer shows up. Medicare is providing bonuses to private plans who come to the area. So as a result, remember, even if it only lasts for just a year, even if it doesn't have your drug on the formulary, even if it no longer is affordable for you, once you have two competing private insurers, there is no fallback plan as an option. So the senior faces the so-called choice of monthly premium increases of $24 to stay in traditional Medicare or just $1 more per month to join the HMO. Given that this difference is $288 a year, it is not even a choice. That would wipe out her annual increase in Social Security benefits. She feels forced to go into the HMO. She loses her doctor, she loses the drug that she needs, and she has to go through an appeal. I can guarantee you, there is not going to be a lot of appeals courts in isolated areas like the North Country. So it is going to take a while even to go through this. Now this 87-year-old woman is having to fight for, litigate for, argue for the drug her doctor says she needs, or her former doctor, because she can't go to him anymore because there is no affordable regular Medicare fallback. So she is stuck with one of these two private plans. Here today; gone tomorrow. The lesson I draw from this is whether you live in a rural or an urban area, your choices are tilted toward enrolling in HMOs and PPOs. I think that is a shame. Medicare's strength, a reliable system of coverage and predictability, will have been replaced by a complex, insured-driven, cherry-picking system. There may be some seniors who will be helped under this bill. I hope I am healthy enough when I reach that age that I am not going to be disadvantaged by whatever we have in place, but I find it hard to explain how we could end up with a bill that is so much narrower, so much more uncertain than the bill that received a majority of votes in the Senate last year, the Graham-Miller-Kennedy bill. Among those who might gain under this bill, they are not only small in number, they don't even know who they are. I asked seniors this morning at a big meeting: Who among you knows for sure that you won't get hit by the fine print in the bill? How many of you really believe you are winners under this bill? Don't you wonder why nobody is really telling you everything you need to know to be an informed citizen, to make a decision in your own mind that you can then tell your elected officials what you think should be done? We are on a course to passing a bill where no senior watching or listening to this debate is going to be sure that he or she will be helped. We have pushed it past the next election so the full burden of trying to figure it out won't really fall on anybody until 2006. And if you look at this chart, it is kind of hard to draw any other conclusion. If you are a retiree, you would have no idea of knowing whether your former employer will keep you or drop you. If you are poor, you be poor enough to get coverage under Medicaid. And if you are, you may no longer get all the coverage you need for your needs. If you are sick, will you be sick enough to be covered under Medicaid, and under this bill will Medicaid really cover your particular health care needs? If you are in a nursing home, are you going to be really left to fend for yourself in a nursing home in a State prohibited from providing Medicaid wraparound funding. And your health needs will compete with those of children and other needy people? If you are in a State prescription drug program, you will pretty likely be a loser as well. If you are in the premium support guinea pig category, good luck, because I think you will see that you are going to have an amazing obstacle course to try to run. I must say many of the obstacles confronting our seniors are triggered by decisions we have had made for us in this conference that was quite small in number and exclusive in membership and came out with a product that is going to be very hard to defend. It will be particularly hard to defend if we look down the road and we see the threats to Medicare on the horizon. I have heard colleagues say--and I respect this--that this bill is not perfect, but it is all we could get. I understand that perspective. There is good and bad in every bill. I don't think since I have been here I have voted for a perfect bill or voted against a totally bad bill. I understand that perspective. I am grateful this bill does take steps to help our rural and small community hospitals to resolve some of our teaching hospital issues and to address the absolutely compelling physician payment issues. We should be addressing those important matters, but not in the context of a bill which will further undermine the program providing the capacity for hospitals and doctors to provide decent care at an affordable cost. This bill has too many flaws for us to go forward. The privatization scheme that is tied into this bill, in a box with a big bow saying prescription drugs, is one that will make structural changes to this program which has been the bedrock of protecting our seniors and guaranteeing them the health care they have needed. So I hope we can still salvage this bill. I hope we can still try to keep faith with our seniors. I think we should postpone dealing with it beyond the forced deadline of right before Thanksgiving, so that everybody has a chance to read and evaluate it. But if we are required to go forward, then I certainly cannot be a party to a bill that I think will undermine health care for our seniors, fail to provide the benefit that is advertised, and lead to the slow and steady unraveling of Medicare, which I consider to be one of the great achievements of our country in the 20th century. On behalf of the hundreds of thousands of seniors I represent, who are definitely losers under this bill, I have to respectfully request that we go back to the drawing board, that we try once again to do a job on a bill that will really help our seniors, and that we not take steps that will undermine the guarantee of health care under Medicare. I yield the floor.

Mrs. CLINTON

Mrs. CLINTON. Mr. President, I ask unanimous consent that the privilege of the floor be granted to the following fellows in my staff: Robyn Golden and William Rom.

Mrs. CLINTON

Mrs. CLINTON. Mr. President, as an original co-sponsor of S. 189, the 21st Century Nanotechnology Research and Development Act, I am delighted that the Senate is acting on this important legislation. I want to thank my Senate colleagues, particularly Senator Hollings and Senator Wyden. Senator Hollings' leadership on the Senate Commerce, Science and Transportation Committee was essential in winning the passage of this legislation, which has so much promise for New Yorkers and Americans generally. Senator Wyden has helped to shepherd this legislation through the Senate with his customary vision, determination and skill. In ten or twenty years, we may well view this legislation as one of the most important bills passed by the 108th Congress. The bill provides multi-year authorization for increased Federal research and development investment in nanotechnology. Experts believe that nanotechnology could have an impact on our economy and society as significant as the impact of the steam engine, electricity, the Internet, and the computer chip. Researchers and high-tech start-ups have already identified many potential benefits and applications of nanotechnology in health, energy and the environment, information and communications technology, advanced materials, manufacturing, and national security. It is possible that nanotechnology could lead to solar energy that is competitive with fossil fuels. Medical researchers are already working on using nanotechnology to develop tools for the diagnosis and therapy of cancer. In addition to funding research in nanoscale science and engineering, the legislation also supports exploration of the ethical and social dimensions of nanotechnology. I want to underline the importance of this component of the legislation. These provisions are intended to help ensure that we use this information to make intelligent decisions about the benefits and risks of this powerful new technology. We have a responsibility to ensure that appropriate safeguards are placed on the exploration of nanoscience and technology and that Congress exercises effective oversight of this process. I will work hard with my colleagues to ensure that Congress does its part. I am proud to say that New York is playing a leading role in the development of nanotechnology, and is already seeing concrete benefits from the National Nanotechnology Initiative. Three of the six university-based centers of nanotechnology funded by the National Science Foundation in 2001 are located at New York's world-class research centers at Cornell University, Columbia University and Rennselaer Polytechnic Institute. Long Island's Brookhaven National Laboratory is the future home of the Center for Functional Nanomaterials, supported by the Department of Energy. The State of New York and International SEMATECH and its member companies are planning to provide approximately $400 million in support to create a next- generation computer chip research and development facility at the University at Albany-SUNY. All of these investments are creating the foundations for future economic growth and the creation of high-tech, high-wage jobs, including in upstate New York. The 21st Century Nanotechnology Research and Development Act shows what this Nation is capable of when we come together and set aside partisan differences. The National Nanotechnology Initiative was launched by President Clinton in January 2000, and has continued to enjoy bipartisan support from President Bush and members of Congress. I urge my colleagues to continue to pay attention to nanotechnology after this legislation is passed. In many respects, this legislation is only the first step. As President Clinton noted when unveiling the National Nanotechnology Initiative, realizing the full promise of this technology may take twenty years of sustained investment. America's lead in this critical technology is by no means assured. Moreover, this legislation will not result in an extra dime being devoted to nanotechnology research, unless the legislation is followed by steadfast support for federal research and development in the budget and appropriations process. I hope that the Administration and the Congress look for ways to build on and strengthen the current initiative. I believe that there are many such opportunities. The National Institutes of Health have targeted a relatively modest amount of funding for the NNI, despite the broad range of nanotechnology applications for health and biology. In addition, I hope we can increase the Environmental Protection Agency's budget for nanotechnology because it has a role to play in a variety of settings, including pollution prevention. We should also explore ways to respond to calls for the development of clean sources of energy using nanotechnology. This legislation is a bold step in the direction of creating a brighter and more prosperous future for all Americans. In the years ahead, I look forward to continue working with my colleagues on both sides of the aisle to ensure the full development of this important initiative.

Mrs. CLINTON

Mrs. CLINTON. Mr. President, I thank the managers for working with Senator Enzi, Senator Schumer and myself on a compromise to ensure that our concerns are addressed. We understand that they have committed to pursue language in the conference report that expresses the committee's concerns about the Draft National CARES Plan recommendations of closure and reduction of services in long-term care, domiciliary care, and mental health services at VA facilities. The language urges that no closures or reduction in long-term care, domiciliary care, and mental health care services take place until the full analysis is completed. The language would also require the VA to submit updates on their progress in this analysis to the appropriate committees. Finally, the managers have agreed to send a letter to VA Secretary Principi outlining these concerns on our behalf.

Mrs. CLINTON

Mrs. CLINTON. Mr. President, first I want to thank Senator Grassley for the leadership that he has shown in addressing the needs of abused and neglected children. Together with Senator Landrieu and Senator Bunning, Senator Grassley has worked tirelessly and I know that this work comes from the heart. It is not an issue that gets in the headlines unless something goes wrong. It's an issue that one champions only because he or she cares. I also want to acknowledge the longstanding commitment of my friend Senator Rockefeller who is well known as the greatest ally of needy children in this esteemed body.

Mrs. CLINTON. I too am pleased to reach this milestone. When my husband and I worked to establish the program in 1997, we hoped that this program would become half the success that it has. My husband set a goal of doubling the number of children adopted out of foster care and last month we finally achieved that goal. In New York City, the number of children in foster care has plummeted by more than half since 1997 due in large part to the increased focus on helping available children for adoption. Nevertheless we still have a long way to go. Over 580,000 children remain in foster care, 126,000 of them are ready and waiting to be adopted into a loving home. That is why this legislation is so important. And not only does it continue the incentives for States to help children with special needs be adopted out of foster care, it adds a new incentive to focus on older children--those over 9--whose chances of being adopted grow slimmer by the year. These vulnerable children face the greatest danger of aging out of foster care, a transition that is associated with lower educational outcomes, higher rates of teen pregnancy, higher rates of poverty, lower rates of employment, and many other negative factors.

Mrs. CLINTON. Of course, as the number of children in foster care declines, as it has in New York City, it becomes increasingly difficult for states to qualify for adoption incentive awards. In order to receive such a bonus, states must exceed the highest number of adoptions they have achieved since the base year. Some have suggested that an alternative, and potentially more accurate, method for determining bonuses would be to look at the percentage of children in foster care who are adopted as opposed to the raw number.

Mrs. CLINTON. I very much appreciate all the time that has gone into this act. And I am pleased that we are going to work together to have the General Accounting Office look into what is the best way to structure the adoption incentives formula so that when we consider this legislation in the future we will have thoroughly explored other methods for calculating bonuses.

Mrs. CLINTON. Now, there have been some news reports lately that have argued that the Adoption Incentives Program has put children in dangerous situations by creating a strong financial incentive to place children for adoption out of foster care without regard to their safety or well-being.

Mrs. CLINTON

Mrs. CLINTON. Madam President, this is an issue that affects veterans across our country. My cosponsor, Senator Enzi, is concerned particularly about the impact on his veterans who live in rural areas and are not going to be able to travel the long distances that will be required if services are reduced, if facilities are closed. I know my colleagues from Iowa, Michigan, Washington, Oregon, Texas, in addition to Wyoming, have asked for similar relief. I hope my colleagues who are in States that, under this process, are in line to get enhancements and increases will vote for this because it doesn't affect your enhancements. It does not affect your increase, but it gives those of us who have mental health needs, who have rural health needs, who have domiciliary and long-term health needs the opportunity to get this process right and to fix the problems that would lead to the closure and reduction of services that are so needed in so many States for so many veterans. I hope this amendment will find favor with my colleagues and will give those of us who are particularly on shaky ground because of the recommendations of this commission a chance to have a more rational process that really takes into account the needs of our veterans. I ask for the yeas and nays.

Mrs. CLINTON. Madam President, I ask unanimous consent that reading of the amendment be dispensed with.

Mrs. CLINTON. Madam President, I thank the minority whip and the chairman and ranking member of the subcommittee for an opportunity to discuss this very important amendment. I call up amendment No. 2152.

Mrs. CLINTON

Mrs. CLINTON. Mr. President, I thank the Senator from Vermont for his exemplary leadership on these issues. During a very difficult time in the Senate's history, he has continued to deal with the challenges and criticism in his usual humorous, self-deprecating way. It is a real example for all Members. I, like many of my colleagues, have been following this debate not just for the last hours but for the last months. It is troubling for the two views being presented here to be so diametrically opposed about what the history is, what the facts are, what the law is, what the Constitution says and demands. My friends on the other side of the aisle have chosen this opportunity to try to garner public attention for their perspective, which is that somehow the Democrats, acting in what we believe is the highest sense of duty, our understanding of the Constitution and the law, have drawn a line. We have seen this hour after hour now in the Senate, in the big chart that says 168. That is how many of the President's nominees have already been confirmed. Those men and women are sitting on our Federal benches. They are making decisions that affect our lives. I voted for virtually all of them. They would not have been my choices. I would not have nominated some of these people in that 168 number, but they passed the test. They passed the test of judicious temperament. They passed the test of being people who understood the critical role of what it meant to be a judge in a free society like ours. So what is this really about? We got some hints from some of our colleagues on the other side of the aisle. This is about trying to gain political partisan advantage and also increase fundraising. I was amused to read a story about how some of their more extreme supporters sent back empty envelopes when solicited for funding for the Republican Senate campaign committee. Those contributors said: You are not tough enough. You need to make a big issue out of it. So, in obedience, the Republican leadership decided to do that. That is their choice. They can dominate the floor on whatever issue they choose. It is a shame they keep the attention on this issue to the exclusion of so many other important issues such as the economy, education, homeland security, what is happening in Iraq, and should happen. But that is their choice. That says a lot about their priorities as they respond to the music played by the most extreme of their privileged contributors. It is somewhat disquieting for those who have a memory longer than 24 hours, or longer even than 2\1/2\ years, to see the distortions that have been presented with great passion and conviction. But, nevertheless, beating on the table does not necessarily mean what you are saying is true. I am concerned, too, about the misleading way that the treatment of nominees during the Clinton administration has become a mantra on the other side of the aisle. I think 168 to 4 shows the Democrats in the Judiciary Committee and here on the Senate floor have shown great deference, 98 percent deference to the President's nominees and the will of the majority. That is certainly not something that nominees by President Clinton or the Democrats on the Judiciary Committee and in this body received when the shoe was on the other foot. I am a little bewildered by this because time and time again my friends on the other side overlook the history of how extremely qualified men and women from all walks of life, all races and ethnic backgrounds, were treated under the Clinton administration. The other side suggests that there were no mistreatments because there were so few, if any, filibusters. That is what they claim. Here are the pictures of the circuit court nominees blocked by Republicans. I know many of these people personally. I have the same feelings about them that I know some of my colleagues on the other side have about the nominees from their State. I know what they and their families have been put through for months, for years. And why was that? Because the way they were treated was done essentially in secret. I give the other side great credit. They did not come out in the open like we are. They did not come out and debate the merits and demerits of the nominees from the current administration. What happened is, these distinguished men and women never even got a hearing. They never got to appear before a committee in most cases. They never got a vote out of a committee. The Judiciary Committee, under Republican leadership, became a judge buster. You could not get out of the committee. You could not get to the Senate floor. So, of course, there could not be a filibuster because they never had the opportunity. I have a little chart that shows the difference in how nominees were treated, that clearly demonstrates we had 63 nominees, 23 circuit court nominees, 40 district court nominees. They are represented by apples on my chart. We grow a lot of apples in New York so I am partial to apples. These 63 well-qualified, distinguished lawyers and judges were stiffed. They were not even given, in many instances, the decency of a committee hearing. They were left hanging out there, twisting in the wind, by a Republican majority that decided: We do not want to have to stand up and say why we will not confirm these people because if we have to talk about it publicly, everyone will see through us and it will be demonstrated conclusively that this is not about the Constitution or the law. This is about blocking well-qualified nominees from a Democratic President from having lifetime tenure on the Federal bench. So, 63 qualified people were blocked. We have blocked 4 for a variety of reasons. We have been publicly willing to go on the record and say, for the world to hear, they are lemons. We cannot support these people. They do not have the temperament, the quality that should sit on the Federal bench. I find this sad. That is the word I would use. Neutral, nonpartisan experts agree that the Clinton administration judicial nominees were, by and large, moderate, accomplished, excellent choices. What are we given? We are given four people who, for a variety of reasons, are just waving red flags. I understand that. This is not about confirming judges. This is about exciting a base. This is about scoring political points. This is about raking the money in. I can imagine the phones are ringing over at the Republican Senate campaign headquarters. They are making so much money today because they have their hard-core base sending those dollars in. Keep standing up there, keep fighting. But I venture a guess that even a majority of those folks do not know the facts. They certainly are not going to get it from what is said on the other side of the aisle. It is sad, it is kind of heart breaking, actually. We had an opportunity during the 8 years of the Clinton administration to nominate 63 well-qualified people, none of whom were given the decency of fair treatment. It was done under the cloak of secrecy. It was done behind closed doors. It was done with anonymous holds. It was done with no committee hearing being scheduled. You can go through the individual accomplishments of these people, and it is stunning how well qualified they were. You can look at the names. I know many of these people. Republicans blocked 15 times more judicial nominees of President Clinton than have been blocked here. It has been a little difficult for many on this side of the aisle to explain to our constituents why we did not block more of them. A lot of the people who got through in that 168 were people many Members would prefer not to be on the bench, but we could not stand up in public and say why we would vote against this person, so we voted for them. When it comes to the four we blocked, we have more than ample reason. I regret the majority has chosen to politicize this important process. I regret that they have chosen to ignore history and to distort the facts. I regret they would decide to spend time on these matters instead of the many important issues that confront our Nation and our world. We have a lot of big challenges around the world. I am personally concerned about what is happening in Iraq, what is happening in Afghanistan. I wrote to the Secretary of Defense yesterday because of reports about potential threats from al-Qaida to hijack cargo aircraft and fly them into nuclear powerplants. We have a lot of very difficult issues facing us. But instead, my friends on the other side want to rewrite history, want to ignore the well-qualified people they blocked through every maneuver, faint, and incredible behind-the-scenes stealth they could come up with. I will now yield the remaining time on our half hour to my good friend and colleague, Senator Schumer, who has been a champion on this issue. Unanimous Consent Request--S. 1853

Mrs. CLINTON. No, Mr. President.