Byron Dorgan

Mr. DORGAN

Mr. DORGAN. Mr. President, for all the talk about taxes in this chamber, we often overlook one of the worst burdens of the current tax system. I'm talking about the monumental hassle that taxpayers face to file their tax returns each year. It is simply inexcusable that Congress has made it so expensive and complex for Americans to fulfill this basic civic duty. Taxpayers will probably spend somewhere around three billion hours and at least $75 billion next year in the effort to meet their federal income tax obligations. It's no wonder they barrage congressional offices with letters each spring imploring us to simplify the Tax Code. They are right. Each little provision in the tax code has a justification, but together they add up to a big headache for the American taxpayer. We can't blame the IRS for the misery endured this past year or in the years ahead. There's no way to truly simplify tax day unless Congress changes the underlying law. That's why I'm pleased to be joined by Senators Gregg and Durbin in introducing a tax reform proposal that we call the ``Fair and Simple Shortcut Tax'' (FASST) plan. Our plan would give most taxpayers the opportunity to pay their federal income taxes without having to prepare a tax return if they so choose. Some thirty countries already enable their citizens to pay their federal taxes in this way. We believe tax simplification along these lines can work in this country, too. Our approach would also be less costly than other major tax simplification plans that have been proposed in Congress in the past several years. Our bill is based on a principle that both sides of the aisle generally are eager to espouse--namely, choice. The bill would allow taxpayers to choose to pay their taxes without complexity, paperwork and hassle. Those who prefer to use the current system, with its complexity and expenses, could do so if they wanted. But if they want something simpler, they could choose that instead. Under FASST, most taxpayers could forget about filing a federal tax return on April 15th. Instead, their entire income tax liability would be withheld at work. There would be no more deciphering statements from mutual funds, no more frantic search for records and receipts, and no last minute dash to the Post Office in order to meet the midnight deadline. According to Treasury Department officials who have studied it, the FASST plan would give up to 70 million Americans the opportunity to elect the no-return option. Specifically, under the FASST plan, most taxpayers could choose the no-filing option by filling out a slightly modified W-4 form at work. Using tables prepared by the IRS, their employers would determine the employee's exact tax obligation at a single rate of 15 percent on wages--after several major adjustments--and withhold that amount. This amount would satisfy the taxpayer's entire federal income tax obligation for the year, absent some unforeseeable changes in circumstances or fraud. The FASST plan would be available for couples earning up to $100,000 in wages and no more than $5,000 in other income such as interest, dividends or capital gains. In the case of individual taxpayers, the wage and non-wage income limits would be $50,000 and $2,500, respectively. Popular deductions would continue under this plan: the standard deduction, personal exemptions, the child care credit and Earned Income Tax Credit, along with a deduction for home mortgage interest expenses and property taxes. Our bill would include critical savings incentives for average Americans by exempting up to $5,000 of all interest, dividends and capital gains income from taxation for couples, $2,500 for singles. Moreover, savings contributions made through employers would be excluded from the wage calculations in the beginning. Consider some of the advantages of this hassle-free plan: No taxpayers would lose. If a taxpayer prefers to file an ordinary return, he or she would still have that choice, and no one would be forced to lose a tax deduction that he or she wants to keep. Wages would be taxed at a single, low rate of 15 percent. A deduction for home mortgage interest expenses, the Earned Income Tax Credit, and other popular parts of our current tax code would be preserved. Other major tax reform plans would eliminate those deductions, which many people count on. The alternative minimum tax, AMT and the marriage penalty would be eliminated. Compliance costs for taxpayers and government alike would fall. If 70 million Americans chose the FASST option, hundreds of millions of dollars now spent on paper pushing could be used in more productive ways. Those taxpayers who continued to file under the old system would get relief too. The plan would reduce the marriage penalty by making the standard deduction for married couples double the amount available for single filers. Also, it would virtually eliminate the complicated AMT for most sole proprietors, farmers and other small businesses by exempting the first $1 million in self-employment income from the AMT calculations. This legislation also would provide a 50 percent credit for up to $1,000 in expenses that businesses might incur implementing the FASST plan. In addition, it would grant taxpayers who continue to use the current system a 50 percent tax credit for up to $200 in tax preparer expenses, provided they file their returns electronically. Finally, the bill would offer individuals a substantial incentive for savings and investment by exempting up to $500 of dividend and interest income, $1,000 for couples. Mr. President, millions of Americans in this country are tired of spending countless hours wading through complex forms and instruction books. Our bill is both simple and fair, and it gives most taxpayers the choice to avoid the annual nightmare that the federal tax system has become. In testimony before a Senate subcommittee earlier this year, IRS Commissioner Rossotti testified that it's ``unquestionable that this bill provides significant tax simplification.'' Imagine how much better life would be if April 15th were just another day. Under the FASST plan, for millions of Americans, that could be true. We urge our colleagues to support this important legislation, which we think will go a long way toward eliminating the burden of ``tax day'' for tens of millions of taxpayers in the future. I ask unanimous consent that the full text of this legislation be inserted in the Record immediately following my statement.

Mr. DORGAN

Mr. DORGAN. Mr. President, I am joining with my colleagues Senator Moynihan, Senator Daschle, and others today to introduce the Balanced Budget Refinement Act of 2000. This legislation seeks to address some of the unintended consequences the Balanced Budget Act, BBA, of 1997 is having on access to Medicare services vital to older Americans. The BBA has had a particularly serious impact on rural health care providers, and I am pleased that the legislation we are introducing today acknowledges the special needs of rural America. Like many of my colleagues, I supported the Balanced Budget Act when it was enacted by Congress in 1997 with strong bipartisan support. Prior to the passage of this law, Medicare was projected to be insolvent within two years (by 2001), so it was imperative that we took action to extend Medicare's financial health and to constrain its rate of growth to a more sustainable level. Thanks in part to this law, we have a flourishing economy in most parts of the country and the Medicare trust fund is projected to be solvent until 2025. But in some respects, the Balanced Budget Act was successful beyond our wildest expectations in reducing Medicare program costs. The Congressional Budget Office originally estimated that Medicare spending would be reduced by $112 billion over five years, but instead, the reduction in spending growth has been nearly double that amount. This unexpected result is having real consequences for Medicare beneficiaries and health care providers, and Congress simply must take action to address these problems before adjourning this year. Congress took a step in the right direction towards addressing the problems facing Medicare providers by enacting the Balanced Budget Refinement Act, BBRA, of 1999. Unfortunately, however, there is growing evidence that the negative changes resulting from the BBA have not been adequately addressed by the BBRA. Moreover, the impacts continue to disproportionately affect rural health care providers and the quality of care rural Medicare beneficiaries receive. Part of the problem facing rural providers is simply demographics: My home state of North Dakota is the second oldest in the nation, and our overall population is shrinking. In fact, in six of North Dakota's ``frontier'' counties, there were 20 or fewer births for the entire county for the entire year of 1997. Admissions to rural hospitals have dropped by a drastic 60 percent in the last two decades, and those patients who do remain tend to be older and sicker. This means that rural hospitals tend to be disproportionately dependent upon Medicare reimbursement, to the extent that Medicare accounts for 85 percent of their revenue. Obviously, given this reality, changes in Medicare reimbursement have a tremendous impact on the financial health of rural hospitals. Another part of the problem is that Medicare has historically reimbursed urban health care providers at a higher rate than their rural counterparts. Of course, some of this difference can be explained by regional differences in the cost of health care and variations in the health status of older Americans. But this isn't the whole explanation. Even after adjusting for these factors, a report by health care economists found that, for example, Medicare's per beneficiary spending was about $8,000 in Miami, but only $3,500 in Minneapolis. When average Medicare payments for the same procedure are compared, the disparities in payment in different areas of the country are dramatic. For example, Medicare pays $6,588 for the treatment of simple pneumonia in the District of Columbia, but only $3,383 in North Dakota. In my opinion, this difference is largely explained by a Medicare reimbursement system that is skewed in favor of urban areas. For the most part, the BBA further perpetuates this inequity, despite efforts by some of us to address this concern. There are a few areas of the Balanced Budget Act and BBRA that I think warrant further scrutiny and action, and these areas are addressed in the legislation being introduced today. The first is hospital payments, particularly for outpatient services. A recent analysis by a health policy research firm estimates that the BBA would reduce Medicare payments to North Dakota hospitals by $163.8 million between FY 1998 and FY2002. The BBRA passed last year restores only $16 million of those reductions. So even with BBRA refinements, North Dakota hospitals face a loss of $147.8 million in revenues. Outpatient services are a particularly critical component of care in many North Dakota hospitals: 40 percent of the hospitals in my state get more than half of their revenues from outpatient services. Senator Daschle and Moynihan's legislation will address the problems faced by rural hospitals by, among other things, providing a full inflation increase in Medicare payments to all hospitals in 2001 and 2002 and holding rural hospitals permanently harmless from the outpatient prospective payment system. This legislation also addresses the issue of home health reimbursement. Nearly 70 percent of the home health agencies in my home state are hospital-based, so the changes in home-health reimbursement are having a domino effect on North Dakota's hospitals. I am concerned that the Health Care Financing Administration's, HCFA, proposed rule for the new home health Prospective Payment System, PPS, does not take account of the smaller size of rural home health agencies and the higher fixed costs per visit. And, HCFA did not take sufficient account of the greater travel cost per visit in rural areas, and the higher incidence of chronic illness in rural communities. Today's legislation would address this concern by providing a 10 percent increase in rural home health payments for the next two years and repealing the 15 percent cut in home health reimbursement scheduled to take place on October 1, 2001. This legislation also proposes other changes I think are worth further mention, including a further delay in the arbitrary caps on the amount of physical, speech, and occupational therapy Medicare beneficiaries can receive, and a 10 percent increase in the base payment rate for hospice care, which hasn't been increased in over a decade. Finally, while all of the provisions of this bill will together help to ensure that Medicare beneficiaries can continue to rely on the quality care they need and expect, this legislation includes a number of changes that will also make Medicare an even better deal. In particular, this bill will expand Medicare's emphasis on preventive medicine by adding such benefits as coverage for glaucoma screening, counseling for smoking cessation, and nutrition therapy. The bill will also eliminate the current three-year time limit on Medicare's coverage of immunosuppressive drugs, the expensive medicines that transplant recipients need to keep their bodies from rejecting their new organs or tissue. In short, the Balanced Budget Refinement Act of 2000 addresses many of the needs and concerns of Medicare beneficiaries and health care providers. I hope this legislation will help lay the framework for the enactment of bipartisan legislation to address these issues before the 106th Congress goes home.

Mr. DORGAN

Mr. DORGAN. Mr. President, I want to talk today about the issue of prescription drugs. Some of my colleagues have already talked about this issue at some length. Let me add to that. In January of this year, on a cold, snowy day, a group of North Dakota senior citizens and I drove from North Dakota to Canada. It was not much of a drive, as a matter of fact, from Pembina, ND, to Emerson, Canada. We went to Canada to allow these senior citizens to purchase prescription drugs in Emerson, because the same drug that is marketed in Canada--in the same bottle, made by the same company--is sold in most cases for a fraction of the price for which it is sold in the United States. I want to illustrate that, if I may. I ask unanimous consent to use, on the floor of the Senate, two pill bottles. These bottles are for a medicine called Zocor.

Mr. DORGAN. The bottles are slightly different, one is bigger than the other, but Zocor is sold both in Canada and the United States. Zocor is one of a number of cholesterol-lowering drugs. In fact, Dan Reeves, coach of the Atlanta Falcons, has an advertisement saying he takes a similar drug to lower his cholesterol following some heart problems he had. In any event, Zocor is an FDA-approved drug produced by the same company, often in the same FDA-approved plant. Yet, this bottle of Zocor is sold in Winnipeg, Canada, for $1.82 per caplet. But if you are an American who is using Zocor to lower your cholesterol, you pay $3.82 per tablet. Again, if you buy it in Canada, it is $1.82 per tablet. But in the United States, the same tablet, by the same company, is not $1.82, but $3.82. The Senate just finished yesterday a debate about normal trade relations. This used to be called most-favored-nation status. Do you know what the situation is with respect to prescription drug prices? We have least-favored-customer status for the American consumer. Why do I say this? Because prescription drug prices here are higher than anywhere else in the world. Why should the American consumer pay prices that are 10 times, or 5 times, or triple or double the price paid by everyone else in the world for the same prescription drugs made in the same plants by the same companies? The answer is that U.S. consumers should not be least favored consumers as they are forced to be by the pharmaceutical drug industry. We can change that. How can we change it? We can change it by allowing our pharmacists and our distributors to be able to access the same FDA- approved prescription drug in Canada or in other countries--sold by the same company and produced in an FDA-inspected plant--at a lower price and pass the savings along to their customers. If we did that, the pharmaceutical industry would be required to reprice their prescription drugs in this country and reduce their prices. I want to talk about Sylvia Miller. Sylvia Miller is one of the senior citizens who went to Canada with me. She is from Fargo, ND. A columnist in Fargo wrote a piece about Sylvia Miller. Let me just acquaint you with Sylvia Miller by reading from this piece: Sylvia Miller isn't one to complain, but few people would blame her if she chose to complain just a little bit. . . . Sylvia knows that life isn't always easy, that people struggle with the lows and look forward to the highs. . . . She's had her share of dark days in her 70 years of life on this earth. The 1980s were a pretty rough decade for her. She beat breast cancer in 1981, then lung cancer eight years later. She's a tough lady. This article says she and her husband lived most of their lives in Durbin and then moved to Fargo in 1987, after ``we were flooded out by water coming cross country--the basement filled up nearly to the ceiling.'' Sylvia went with me to Emerson, Canada, 5 miles across the border, because she wanted to buy her prescription drugs at a better price. This article says Sylvia is a pleasant person. I know that because I know Sylvia. It also says she leads a disciplined life. She has to. She has diabetes. She also has asthma, and she has a heart that could be stronger. She tests her blood sugar level several times a day, eats wisely and at the right times, and the article goes on to say she gives herself shots four times a day, mixing three different insulins, uses two different inhalers for lungs which function below normal capacity, and she requires seven different prescription drugs every month. Last year, she received $4,700 from Social Security, and her prescription drug bill was more than $4,900. She says: Things don't quite add up, do they? On our trip to Canada, I stood with Sylvia and the others in this little one-room drugstore in Emerson, Canada. The exact same prescription drugs you can buy in this tiny drugstore are sold 5 miles south, in Pembina, ND, or 120 miles south in Fargo, ND. The difference is not in the pill--it is the same pill, same color, same shape, made in the same plant, marketed by the same company. The difference? Price. Americans are the least favored consumers. They pay the highest prices. So a group of senior citizens who pay too much for prescription drugs--such as Sylvia, who gets $4,700 on Social Security and has a $4,900 prescription drug bill--are trying to get a better price for the drugs they need to lead a good life by traveling to Canada. These senior citizens should not have to load up in a van on a cold winter morning and drive to Canada. The Customs Service will allow individuals to bring back from Canada a small amount of prescription drugs for their personal use. But there is a Federal law that says a pharmacist from Grand Forks, ND, or Montana or Vermont, can't go to Canada and access that same drug and come back and pass the savings along to their customers. Federal law says you can't do that. We aim to change that Federal law. The Senate has already passed our proposal. Senator Jeffords, Senator Gorton, Senator Wellstone and I, and a range of others have worked to pass this plan in the Senate. Our proposal says: Let's allow U.S. pharmacists and distributors to go to other countries and access the identical prescription drugs, approved by the FDA, at a lower price, bring them back, and pass the savings along to the American consumer. Of course, if we get this plan signed into law, what will happen is that the pharmaceutical industry will be required to reprice these drugs in this country. Now, guess what. The pharmaceutical industry is spending a fortune to try to defeat this proposal. It is in a conference committee. I am one of the conferees. The conference isn't even meeting. Why isn't it meeting? Because people have heartburn over this proposal, and they want to kill it. The pharmaceutical industry said the 11 former Food and Drug Administration Commissioners have come out in opposition to the proposal. Well, yesterday, I showed a letter that we received from David Kessler, the former Commissioner of the Food and Drug Administration under Presidents Bush and Clinton. I want to tell my colleagues what he says: The Senate bill which allows only the importation of FDA approved drugs, manufactured in approved FDA facilities, and for which the chain of custody has been maintained, addresses my fundamental concerns. He is not opposing what we are trying to do. This is a former FDA Commissioner. Dr. Kessler says further: I believe the importation of these products could be done without causing a greater health risk to the American consumers than currently exists. We need to give the FDA some additional resources to make sure we do not have counterfeit drugs imported. The pharmaceutical industry says this is an issue of safety. It is not. Here is an FDA Commissioner who says this can be done safely as long as you have safeguards. The pharmaceutical industry says this debate is about safety. They know better than that. It is about profits. Whose profits? Their profits. Donna Shalala, who is the Secretary of Health and Human Services, has also written us a letter. She has indicated she believes that the Senate approach is an approach that can work. Secretary Shalala has said: ``With respect to the three amendments now in conference''--one of which is the Jeffords-Dorgan amendment I am talking about that was passed by the Senate--``we believe the Jeffords amendment represents a promising approach'' that can be effective if Congress provides new and efficient resources--which we intend to do--to the FDA. So the head of the Department of Health and Human Services says this can be done safely as well, as long as we provide additional resources to the FDA. But, again, today, for those who are trying to kill this proposal, I would like to offer another challenge. Of course, no one has ever accepted the challenge, but I am interested in finding just one Member of Congress--one man or woman serving in the Senate or in the House out of 535 of us--to stand up on the floor of the Senate or House and say: I believe the American consumer should be treated as the least favored consumer by the pharmaceutical industry. I support that. I believe it, and I think we ought to leave it the way it is. I want one Member of Congress to stand up and say that. I want one Member of Congress to stand up and say: With respect to Zocor, a prescription drug to lower cholesterol, I believe that Americans ought to have to pay $3.82 per tablet for the same medicine for which the pharmaceutical industry will charge the Canadians only $1.82 per tablet. A similar discount is provided to the Italians, the Germans, and the English, and the Swedes, and the rest of the countries, because the big drug companies are charging Americans the highest prices in the world. I am not asking for the Moon here. I am only asking for one Member of Congress to stand up and support the pharmaceutical industry's pricing policies. And no one will. Because they want to kill this under the cover of darkness. They want to kill this by not having a conference, and by dropping it during some closed meeting in some crevice of this Capitol Building. This is not an issue without names and faces and consequences. Sylvia Miller went to Canada with me to purchase prescription drugs at a much lower price, as did other senior citizens. But it ought not have to be that way. There is no reason anybody ought to have to go anywhere else in order to access the same prescription drug for half the price they pay in the United States. That is unfair to the U.S. consumer. We can change it. And we can change it without compromising safety. We can change it, and should, and will. Let me mention a word about the prescription drug industry. I happen to think we benefit mightily from much of what they do. When they develop a new prescription drug, good for them. But much of the new work in prescription drug development is coming from public investment through the National Institutes of Health and elsewhere. We are making substantial taxpayer-funded investments in research. Much of that research is then taken by the pharmaceutical industry and used to produce new medicines, for which they charge higher prices to the American consumer than anyone else in the world. That is not fair. I want the pharmaceutical industry to be profitable, but profiting in ways that are unfair to the U.S. consumer should not be allowed. The pharmaceutical industry has said--and incidentally, they have sent people all around North Dakota to newspapers and TV stations with this message--that if what Senator Dorgan wants to do gets done, there will be less research done on new medicines. Interesting point. The pharmaceutical industry spends more money for research in Europe than it does in the United States, by just a bit. In other words, more research is done by that industry in Europe than in the United States. They say: If we charge less in the United States, somehow we will do less research. Yet they charge less in Europe and do more research there. And they charge more for prescription drugs in this country than in any country in Europe and do slightly less research. If their argument had any validity at all why is that the case? To those in the pharmaceutical industry, I understand that you have a responsibility to your stockholders. I understand that. You have the responsibility to earn a decent profit. I understand that. Yet the Wall Street Journal says that the pharmaceutical industry has profits that are ``the envy of the corporate world.'' We am not talking about price controls with the Senate proposal. We are simply saying if the global economy is good for the pharmaceutical industry--and every other industry in this world--then why is the global economy not able to work for Sylvia Miller? Why can't Sylvia Miller's pharmacist go to Winnipeg, Canada, and purchase Zocor, and bring it back and sell it at a price that is much less than is now charged in this country? The pharmaceutical industry will say: Gee, some of these countries have price controls. That is true. Some of these countries--many of them--say: All you can charge for prescription drugs is your cost plus a profit. Mr. President, I ask unanimous consent for 3 additional minutes.

Mr. DORGAN. Mr. President, one of the inconveniences of the global economy is that you have advantages and disadvantages, and you have to live with both. When you move products around in a global economy--and the pharmaceutical industry certainly does--you get the advantages of importing lower-priced compounds and chemicals with which to make prescription drugs. So the big drug companies benefit from the global economy. But one of the inconveniences of the global economy is that the conditions that exist in the country you are purchasing from comes with that product. Today, if I were to go up to my colleagues--and I will not--and turn over their necktie, I would find some of them are wearing a necktie made in China. So I say to them: If you are wearing a necktie made in China, governed by a Communist government, no doubt, when you purchased the necktie, you were contributing to the salary of the Communist leader of China. Do you feel comfortable with that necktie? But, of course, no one set out to give comfort to any government anywhere. They simply bought a necktie. That is why, when the pharmaceutical industry says, ``if you are able to access the lower priced drug in Canada, you are importing some sort of price controls,'' I say nonsense. All you are doing is taking advantage of the global economy, the buying and selling of goods back and forth across borders. Yes, it is inconvenient that some countries--in fact, many countries--do have price controls. But if pharmacists were able to access products in other countries at a lower price, why should they be prevented from moving them into this country? The Senate plan would allow this with complete safeguards, only for medicines that are approved by the FDA, only those medicines that are manufactured in an FDA-approved plant. Additional resources to the FDA would allow you to make certain you are not moving counterfeit products in and out of this country. With safeguards such as these in place, former FDA Commissioner David Kessler, Health and Human Services Secretary Donna Shalala, and others say it is perfectly appropriate and perfectly acceptable to give consumers, such as Sylvia Miller, the opportunity to have lower priced drugs in this country. I will finish by asking this: Is there any Member of the House or Senate who believes the U.S. consumer should be the least favored consumer in international trade on prescription drugs? Does anybody stand up in support of this? I fail to see one, in all my time discussing this over the last year and a half, who will stand up and say: Let me be the first to say I support the highest prices for American consumers on prescription drugs. No one will do that because they don't dare do it publicly. They understand how unfair this pricing scheme is. That is what Senator Jeffords and I, and Senators Gorton and Wellstone and many others, are intending to change. The Senate has passed our proposal by a wide margin. It is now in conference. Those who have the strings to pull want to dump it and kill it by not having a conference convened. I happen to be a conferee. I intend to be at a conference at some point and fight for this proposal. I yield the floor.

Mr. DORGAN

Mr. DORGAN. Mr. President, the legislation we will vote on after lunch contains a provision that will name a Federal courthouse in Grand Forks, ND. A Federal building in Grand Forks, ND, will be named the Judge Ronald N. Davies Federal Building. I want to describe to my colleagues something about Judge Ronald Davies. Some of my colleagues may have had the opportunity to visit the Norman Rockwell exhibit at the Corcoran Gallery of Art in downtown Washington, DC. Among the many examples of Americana in the Gallery is a famous painting of a little African American girl, hair in pigtails, head held high, being escorted into a school by U.S. marshals. It was the result of a ruling by an unassuming Federal judge, a son of North Dakota, that allowed this Nation to take one large step forward in expanding America's dream for all Americans. Forty-three years ago this month, on September 7, 1957, a Federal judge from North Dakota was asked to go to Arkansas to sit as a Federal judge and render a decision on a case involving civil rights. Surrounded by security guards because of threats on his life, Judge Ronald Davies carefully weighed the facts and the law and then issued an order that the New York Times later said was a landmark decision in civil rights, ordering the integration of the Little Rock public schools. Most people will not know the name of Ron Davies, but Judge Davies is one of North Dakota's proudest sons. He was made a Federal judge by the appointment of President Eisenhower in 1955. While on temporary assignment in Arkansas, he issued the decision that would become one of the landmark decisions on the issue of civil rights. He required the integration of the schools in Little Rock. Judge Davies was not a tall man. In fact, he was just over 5 feet-- about 5 foot 1, 5 foot 2--but he will certainly be remembered as a giant in the history of civil rights and integration. Despite threats on his life and National Guardsmen guarding the doors, this man sat in a courthouse and rendered the pivotal decision that will echo throughout this Nation's history. He replied, ``I was only doing my job,'' when asked about that decision. He was unassuming and unwilling to be in the national spotlight. In fact one news program called him an ``obscure judge.'' He agreed. He said, ``We judges are obscure and should be.'' Back then, he was also called ``the stranger in Little Rock.'' But he was no stranger to justice and no stranger to decency and no stranger to common sense. Men such as Judge Davies should be remembered. I think it is appropriate that we recognize this Federal judge with the fiery spirit, a man with an unerring sense of duty who went to Little Rock in a very difficult circumstance and did his job. When schoolchildren and citizens and visitors pass through the door of the Federal building in Grand Forks, ND, they will be reminded of the courage Judge Davies showed America as he sat and did his job in those difficult times in Little Rock. It was a turning point in our Nation's history. I can think of no better way to celebrate the life of Judge Davies, and also the important achievements his decision 43 years ago this month have rendered this country, than to put his name on the Federal building in Grand Forks, ND. So when this legislation becomes law later this year, that Federal building will be named the ``Ronald N. Davies Federal Building and United States Courthouse.''

Mr. DORGAN

Mr. DORGAN. Mr. President, I am joining with my colleagues Senator Moynihan, Senator Daschle, and others today to introduce the Balanced Budget Refinement Act of 2000. This legislation seeks to address some of the unintended consequences the Balanced Budget Act, BBA, of 1997 is having on access to Medicare services vital to older Americans. The BBA has had a particularly serious impact on rural health care providers, and I am pleased that the legislation we are introducing today acknowledges the special needs of rural America. Like many of my colleagues, I supported the Balanced Budget Act when it was enacted by Congress in 1997 with strong bipartisan support. Prior to the passage of this law, Medicare was projected to be insolvent within two years (by 2001), so it was imperative that we took action to extend Medicare's financial health and to constrain its rate of growth to a more sustainable level. Thanks in part to this law, we have a flourishing economy in most parts of the country and the Medicare trust fund is projected to be solvent until 2025. But in some respects, the Balanced Budget Act was successful beyond our wildest expectations in reducing Medicare program costs. The Congressional Budget Office originally estimated that Medicare spending would be reduced by $112 billion over five years, but instead, the reduction in spending growth has been nearly double that amount. This unexpected result is having real consequences for Medicare beneficiaries and health care providers, and Congress simply must take action to address these problems before adjourning this year. Congress took a step in the right direction towards addressing the problems facing Medicare providers by enacting the Balanced Budget Refinement Act, BBRA, of 1999. Unfortunately, however, there is growing evidence that the negative changes resulting from the BBA have not been adequately addressed by the BBRA. Moreover, the impacts continue to disproportionately affect rural health care providers and the quality of care rural Medicare beneficiaries receive. Part of the problem facing rural providers is simply demographics: My home state of North Dakota is the second oldest in the nation, and our overall population is shrinking. In fact, in six of North Dakota's ``frontier'' counties, there were 20 or fewer births for the entire county for the entire year of 1997. Admissions to rural hospitals have dropped by a drastic 60 percent in the last two decades, and those patients who do remain tend to be older and sicker. This means that rural hospitals tend to be disproportionately dependent upon Medicare reimbursement, to the extent that Medicare accounts for 85 percent of their revenue. Obviously, given this reality, changes in Medicare reimbursement have a tremendous impact on the financial health of rural hospitals. Another part of the problem is that Medicare has historically reimbursed urban health care providers at a higher rate than their rural counterparts. Of course, some of this difference can be explained by regional differences in the cost of health care and variations in the health status of older Americans. But this isn't the whole explanation. Even after adjusting for these factors, a report by health care economists found that, for example, Medicare's per beneficiary spending was about $8,000 in Miami, but only $3,500 in Minneapolis. When average Medicare payments for the same procedure are compared, the disparities in payment in different areas of the country are dramatic. For example, Medicare pays $6,588 for the treatment of simple pneumonia in the District of Columbia, but only $3,383 in North Dakota. In my opinion, this difference is largely explained by a Medicare reimbursement system that is skewed in favor of urban areas. For the most part, the BBA further perpetuates this inequity, despite efforts by some of us to address this concern. There are a few areas of the Balanced Budget Act and BBRA that I think warrant further scrutiny and action, and these areas are addressed in the legislation being introduced today. The first is hospital payments, particularly for outpatient services. A recent analysis by a health policy research firm estimates that the BBA would reduce Medicare payments to North Dakota hospitals by $163.8 million between FY 1998 and FY2002. The BBRA passed last year restores only $16 million of those reductions. So even with BBRA refinements, North Dakota hospitals face a loss of $147.8 million in revenues. Outpatient services are a particularly critical component of care in many North Dakota hospitals: 40 percent of the hospitals in my state get more than half of their revenues from outpatient services. Senator Daschle and Moynihan's legislation will address the problems faced by rural hospitals by, among other things, providing a full inflation increase in Medicare payments to all hospitals in 2001 and 2002 and holding rural hospitals permanently harmless from the outpatient prospective payment system. This legislation also addresses the issue of home health reimbursement. Nearly 70 percent of the home health agencies in my home state are hospital-based, so the changes in home-health reimbursement are having a domino effect on North Dakota's hospitals. I am concerned that the Health Care Financing Administration's, HCFA, proposed rule for the new home health Prospective Payment System, PPS, does not take account of the smaller size of rural home health agencies and the higher fixed costs per visit. And, HCFA did not take sufficient account of the greater travel cost per visit in rural areas, and the higher incidence of chronic illness in rural communities. Today's legislation would address this concern by providing a 10 percent increase in rural home health payments for the next two years and repealing the 15 percent cut in home health reimbursement scheduled to take place on October 1, 2001. This legislation also proposes other changes I think are worth further mention, including a further delay in the arbitrary caps on the amount of physical, speech, and occupational therapy Medicare beneficiaries can receive, and a 10 percent increase in the base payment rate for hospice care, which hasn't been increased in over a decade. Finally, while all of the provisions of this bill will together help to ensure that Medicare beneficiaries can continue to rely on the quality care they need and expect, this legislation includes a number of changes that will also make Medicare an even better deal. In particular, this bill will expand Medicare's emphasis on preventive medicine by adding such benefits as coverage for glaucoma screening, counseling for smoking cessation, and nutrition therapy. The bill will also eliminate the current three-year time limit on Medicare's coverage of immunosuppressive drugs, the expensive medicines that transplant recipients need to keep their bodies from rejecting their new organs or tissue. In short, the Balanced Budget Refinement Act of 2000 addresses many of the needs and concerns of Medicare beneficiaries and health care providers. I hope this legislation will help lay the framework for the enactment of bipartisan legislation to address these issues before the 106th Congress goes home.

Mr. DORGAN

Mr. DORGAN. Mr. President, I am pleased to join the subcommittee chairman, Senator Campbell, in bringing this hybrid bill to the Senate floor. The process by which we have arrived here today is one which I hope we will not replicate on other appropriations bills for the remainder of the year. I will not belabor the point about the process. It is unfortunate that the Senate was unable to enact its will on this legislation when it initially was reported out of the full Appropriations Committee on July 20. This is not a reflection on the chairman--he produced a bill in a short period of time acting on the instructions he was given. I cannot fault him for this. In fact, I congratulate him for many of the good decisions which were made on the substance of this legislation, but the fact remains that the Senate was not well-served by this process. The conference report before us today provides $15.6 billion in discretionary budget authority for high priority law enforcement, trade enforcement and good government programs. It is approximately $1.1 billion above the level of funding approved by the Appropriations Committee in July. It is also $1.9 billion above last year's enacted level. Yet is remains $900 million below the President's request. This is one of the main problems with the underlying bill. While funds were added for a number of administration priorities, the bill remains deficient in a few areas, primarily regarding IRS staffing and counter- terrorism programs. I have received assurances that additional funds will be provided for a number of these deficiencies in later appropriations bills. Former President Reagan used to say, ``Trust, but verify.'' I trust my colleagues and look forward to verifying that additional funds will be found. In many ways, however, this conference report is a good bill. Compared to the bill that was reported out of the Appropriations Committee, many of the problems with that bill have been resolved. Objectionable language regarding guns has been removed. Many agencies are fully funded at the requested level. The Customs Service's computer modernization program is well funded at $130 million. A good first step has been made to reduce the court house construction backlog. This bill represents a responsible and balanced piece of legislation. I want to note that it has been a pleasure working with Senator Campbell on this legislation. He and his staff have been professional and diligent in representing our interests and assisting us in formulating this legislation. I also want to take this opportunity to thank his staff, Pat Raymond, Tammy Perrin, and Lula Edwards for their hard work and cooperation in crafting this bill. I also wish to note the work of my staff, Chip Walgren, Steve Monteiro, and Nicole Kroetsch, on this legislation. As the chairman noted, this bill funds base operations for the Treasury Department, its agencies and other general government operations. It maintains current operating levels in most instances and annualizes the costs of FTE, full time equivalent, increases made in last year's bill. It is designed to limit, as best we can, undue impacts on personnel. We have tried to avoid funding cuts which would require reductions in FTE after we increased FTE levels in fiscal year 2000. Within the constraints imposed by our allocation, we have attempted to accommodate Members' requests where possible. However, our allocation also means that no Member received everything he or she requested. I would note that we received requests from over 75 individual Members to include funding for programs they consider of importance to their State or the Nation. I must note that there were a number of deficiencies in this bill when it was reported out of the committee. While I did not participate in the drafting of the conference report, I am pleased that many of those deficiencies have been addressed in this legislation. One of my major concerns is funding for the Customs Service Automated Commercial Environment, known as ACE. The original Senate bill had no funds for Customs' new and crucial computer improvement program. The existing system is the over-worked backbone of our trade flow system. It has been experiencing an ever increasing rate of failures and brownouts. Our trade volume has doubled over the last ten years. Based on the rate of growth in trade from 1996 to 1999, Customs anticipates an increase of over 50 percent in the number of entries by the year 2005. This is an antiquated system which is becoming increasingly expensive to operate. We need to fund ACE now. The House has provided $105 million for ACE and I am pleased that the conference report includes $130 million for this crucial program. Another issue that concerns me, as well as the administration, is funding for the Internal Revenue Service. While this conference report does better by the IRS than the original House or Senate bills, we are still more than $300 million below the President's budget request. I have spoken with the Commissioner of the IRS, Charles Rossotti, and I share his fears that funding at these levels may result in staff cuts. I ask unanimous consent that letters from Commissioner Rossotti dated September 8, 2000 and September 15, 2000 be printed in the Record.

Mr. DORGAN. Mr. President, there are a number of important national provisions contained within the conference report. One provision, however, is both of national importance as well as of importance to the people of North Dakota. I am especially proud that the bill names the Federal Building and United States Courthouse in Grand Forks, ND after Judge Ronald N. Davies. The late Judge Davies is one of North Dakota's proudest sons. While he grew up in Grand Forks, he is also claimed by Fargo. It was while serving as a judge in Fargo that President Eisenhower appointed him to the Federal bench in 1955. While not a household name, Judge Davies has gone down in history as the judge who ordered Arkansas Governor Orval Faubus to integrate the Little Rock public schools 43 years ago this month. It is only fitting that the Federal building in his hometown-- constructed the year he was born--bear his name. Some of my colleagues may have had the opportunity to visit the Norman Rockwell exhibit at the Corcoran Gallery of Art in downtown Washington. Among the many examples of Americana is the famous Rockwell painting of a little African-American girl, hair in pigtails, head held high, being escorted to school by U.S. Marshals. The painting puts a human face on an important turning point in our Nation's history. It was the result of the ruling by this modest and unassuming son of North Dakota that our Nation took one more step toward expanding the American dream to all Americans. I thank my colleagues for their support of this provision. I ask unanimous consent that articles from the Grand Forks Herald and Fargo Forum regarding Judge Davies be printed in the Record.

Mr. DORGAN. Mr. President, in the IRS Reform and Restructuring Act of 1998, we mandated specific goals for the IRS to meet in terms of taxpayer assistance and IRS performance. However, we continue to deny the IRS the resources it needs to meet these mandated goals. This is an administration concern, and it is my concern as well. We must do better by the IRS--if not on this bill--then in subsequent legislation. It is important that we maintain the concept and provision of ``service'' by the Internal Revenue Service. I am pleased we were able to fund the National Youth Anti-Drug Media Campaign at last year's level of $185 million. While this is still $10 million less than requested by the administration, it represents a continued commitment to getting the message to our young people that drugs can kill. To date we have appropriated over $500 million for the media campaign--with mixed results. We had two hearings this year on the campaign where many of these concerns were raised. While it remains a somewhat controversial program, I will continue to work with the chairman and others ensure that the campaign bears identifiable and quantifiable results. Finally, I am pleased that the conference report fully funds the administration's requests for the Bureau of Alcohol, Tobacco and Firearms to enforce existing gun laws. We fully fund the request to expand existing ballistics identification activities and to expand the Youth Crime Gun Interdiction Initiative, YCGII, program into 12 additional cities. Also, the objectionable gun preference provision-- inserted in the original Senate bill without debate--has been dropped. This was a wise action and I congratulate the chairman and others for taking this step. Again, while I strongly protest the process by which this conference report was drafted, in most respects--this is a responsible bill. It goes far to meeting our commitments to law enforcement and our Federal employees. I am committed to working with Senators Stevens and Byrd and the leadership to find additional funds for the IRS and counterterrorism on subsequent legislation. Mr. President, briefly, the statements made by the Senator from Colorado, Mr. Campbell, are accurate statements. He has done an outstanding job. I am very pleased to work with him. We worked closely together on this legislation. He knows I feel somewhat aggrieved by the process. This bill has not followed the normal course in coming from the full Appropriations Committee to the floor of the Senate. It was taken in an unusual circumstance. It was put into conference, and now a conference report comes to the floor. There are Senators who perhaps would have offered amendments on the floor who were precluded from doing so. That really should not be the case. This is not a good process. That is not Senator Campbell's fault. The Senator from Colorado is someone who did what was required of him with respect to the leadership decision. I hope we will not have this approach used in future bills. I will have more to say about the Agriculture appropriations bill which is supposed to be in conference now but on which there is no conference. I will speak more about that at a later moment. My sense is much of what is in this bill is on target. We are about $900 million below the budget request. We made progress in a whole range of areas. I was very concerned about the program called the ACE Program, the computer modernization program at the Customs Department, known as ACE--Automated Commercial Environment. The fact is the system for keeping track of what is coming in and going out of this country in trade, the system used by the Customs Service is simply melting down. We need to modernize that system. This program designed to do that was not funded in some of the earlier versions. The bill that is now on the floor does begin that funding with $130 million, a pretty robust amount of funding. For that I am most appreciative. This legislation is still short with respect to the Internal Revenue Service needs, with respect to some counterterrorism appropriations, with respect to an account called unanticipated needs. The chairman of the full committee has indicated to me that while this is the conference we are dealing with and we have to take action on this conference report, he anticipates being able to respond to those deficiencies in another circumstance. We will probably have an omnibus appropriations bill. The chairman of the full committee has indicated the deficiencies that exist will be responded to in some omnibus bill at the end. We will have to wait and see if that happens, but I expect perhaps this conference report was held for some period of time and certainly would be held at the White House. There is some discussion of a potential veto unless the holes are filled, especially with respect to enforcement capabilities at the Internal Revenue Service. I say that only because there are more and more sophisticated schemes being used by some of the largest corporate taxpayers about which the Secretary of the Treasury has talked a great deal. They do need enforcement capability to penetrate some of those schemes that are used to avoid paying a fair share of taxes. Pat Raymond, Tammy Perrin, and Lula Edwards on the majority side, and Chip Walgren, Steve Monteiro, and Nicole Koretsch spent a lot of time on this bill. As is the case with the legislative branch appropriations bill, this bill, the Treasury-general government appropriations bill, much credit must go to a lot of people who worked a lot of hours to make sure we funded these agencies properly. I wanted to make those points and say I do not like this process. It has produced a bill that is pretty good in almost all respects except for a handful of things that need some remedy. The chairman of the full committee has told me, and I think he has told the White House and others, that he intends to respond to those deficiencies in some other venue as we go along in the appropriations process, and I appreciate that. As we work to finish our remaining appropriations bills, it is my fervent hope that we can do this in the regular order. Bills passed by the full Appropriations Committee in the Senate should be brought to the Senate floor for debate and amendment, and then we send them to conference. When we have debate and amend a bill in the Senate, as we did with the Agriculture appropriations bill, which is critically important--it has my amendment that gets rid of sanctions on the shipments of agricultural products and stops using food and medicine as a weapon. The Senate voted for it by a wide margin. It has the amendment Senator Jeffords and I, Senator Gorton and others offered on reimportation of prescription drugs which would force the repricing of prescription drugs in this country. We adopted that. The House passed their bill the early part of July. We passed ours mid to late July. I am a conferee, and there has not been a conference. My expectation is there will never be a conference because they do not want to have a conference on something that controversial. Either one of those put to a separate vote in the Senate and the House will pass by 70 percent. I am worried this process will be used to hijack that bill. I serve notice that I intend to inquire of the majority leader later this afternoon when he comes to the floor or tomorrow at some great length saying, we lost the issue last year and were hijacked to stop using food and medicine as a weapon. They adjourned the conference and never reconvened. It looks as if they are fixing to not convene a conference this year. That is not the way we should expect the Senate to do its business. I am sorry to get off on that for a moment. Again, I appreciate the good work of Senator Campbell and look forward to not only proceeding with what is in this bill, which I think is good work, but also remedying a half dozen or so areas that I think come up short of what we need to do, and I think the chairman of the full committee has said we need to do that.

Mr. DORGAN

Mr. DORGAN. Mr. President, several months ago, the House of Representatives voted 237 to 197 to grant Permanent Normal Trade Relations to China. Before passing that legislation, however, the House added provisions that will require this and future Administrations to step up efforts to enforce China's compliance with its trade agreements and with internationally-recognized human rights norms. Today the Senate will vote on whether we too will approve granting PNTR to China. That vote is on the limited question of whether to make permanent the favorable trade treatment that the United States has afforded to China one year at a time for the past 20 years--just that, and only that. The only difference in this upcoming vote and past votes on normal trade relations for China is: Shall normal trade relations be permanent, as they are with virtually every one of our other trading partners? I have voted for normal trade relations in the past because China is a country of 1.3 billion people that is certain to play an important role in our future. The question is, will that role be a positive or negative one? I happen to think that involvement with China is preferable to non- involvement. And I think on balance that the movement of China towards more freedom for its citizens and a market-based economy is much more likely to occur through normal trade relations than through estrangement. While it is a close call, I have concluded that it is in our best interests to accord China Permanent Normal Trade Relations, because the legislation also establishes a commission to monitor human rights and labor issues in China and includes provisions that will ensure better enforcement of our trade agreements. I would like to explain my reasoning. I am mindful that there are some actions by China that give us pause. Threats directed at Taiwan, the transfer of missile technology to rogue states, and the abuse of human rights inside China are all reasons for concern. But I have seen almost no evidence that there has been any connection between Chinese behavior and Congress' annual review of China's trade status. On the other hand, there is evidence that the engagement with China by Western democracies has led to some improvement in a number of areas. It is my hope that those improvements will continue and be enhanced with Permanent Normal Trade Relations and China's accession to the WTO. I am under no illusion that granting PNTR to China and allowing it to join the WTO will lead China inexorably toward democratization, better human rights and economic liberalization. However, I find it notable that China's security services, and conservative members of the military and Communist Party feel threatened by those developments. They are leading the opposition to President Zhang Zhemin and Premier Zhu Rongji's efforts to restructure China's economy and join the WTO precisely because they fear it will weaken the Communist Party's absolute hold on power. The Dalai Lama and many of China's leading democracy and human rights advocates support Permanent Normal Trade Relations. They believe that the closer the economic relationship between the U.S. and China, the better the U.S. will be able to monitor human rights conditions in China and the more effectively the U.S. will be able to push for political reforms. However, other human rights advocates, including Harry Wu, believe granting China PNTR will weaken America's ability to influence China's human rights. That is why it is so important that the PNTR legislation establish a commission to monitor the human rights and labor situation in China and suggest ways we can intensify human-rights pressure on Beijing. Most of the farm groups and business groups from my state believe PNTR and the implementation of the U.S.-China Bilateral Trade Agreement will result in a significant rise in U.S. exports to China. I hope that is true. But I fear they will be disappointed. Most impartial studies have concluded that the gains are likely to be modest. Furthermore, I am concerned by comments which were made by China's lead trade negotiator that China has conceded only a ``theoretical'' opportunity for the U.S. to export grain or meat to China. This makes me wonder whether China has any real intention of opening its markets as contemplated in the bilateral agreement. That is why it is so important that the PNTR bill includes provisions that will require the administration to step up its efforts to ensure that China complies with its trade agreements. The systemic trade problems we are experiencing with China and many other countries, including Japan, Europe, and Canada, have little to do with this debate about Normal Trade Relations and a lot to do with our willingness to give concessional trade advantages to shrewd, tough, international competitors at the expense of American producers. Frankly, I am tired of it. The recent U.S.-China Bilateral Trade Agreement was hailed as a giant step forward. In fact, it comes up far short of what our producers ought to be expecting in such agreements. If we were given a vote on that agreement, I would likely vote no, and tell our negotiators to go back and try again. Our negotiators should have done better. It is outrageous that they signed an agreement that allows China, which already has a $70 billion merchandise trade surplus with the United States, to protect its producers with tariffs on American goods that are two to ten times higher than the tariffs we charge on Chinese goods. There is no excuse for that. But that circumstance is not unique to China. It exists in our trade relations with Japan, with the European Union, with Canada, and others. We now have a mushrooming merchandise trade deficit that is running at an annual $400 billion-plus level. It is unsustainable and dangerous for our country. We must begin to negotiate trade agreements with our trading partners that are tough, no nonsense agreements. We should develop rules of fair trade that give American workers and American businesses a fair opportunity to compete. Regrettably most of our trade policies reward those corporations that want to produce where it's cheap and sell back into our marketplace. That is a recipe for weakening our economy and it must stop. So, I voted for Normal Trade Relations with China previously, and I intend to vote to make it permanent, provided that we also require this and future Administrations to dramatically step up efforts to enforce China's compliance with its trade agreements and with internationally- recognized human rights norms. However, I want it to be clear that, if we accord Permanent Normal Trade Relations to China and we discover that they are not in fact complying with the terms of the bilateral agreement we negotiated with them or that they are retreating rather than progressing on the issue of human rights for Chinese citizens, then I believe we must reserve the right to revoke China's Normal Trade Relations status.

Mr. DORGAN

Mr. DORGAN. Reserving the right to object, I will not object, but I want to make a comment to the majority leader. This H-1B visa bill is important to all of us. It is important to those on the Democratic side of the aisle as well. We recognize that our economy is experiencing substantial and sustained growth, unparalleled growth, and to keep that on track we have to ensure our high-tech industry has the employees it needs. I was at a company in California some while ago and the president of the company said we have 2,000 open positions for engineers right now that we can't fill. There is not any way for us to fill them--2,000 jobs, engineers we need and we can't get. So we understand this issue. We want it to be resolved. I must say, the Democratic leader is not here today. On his behalf, I would mention to you that with regard to the discussions that you and he have had about the potential for five amendments on a side--he was fairly optimistic about being able to clear that. We think that can be resolved. We hope it can be resolved on next Tuesday. It is our understanding the Republican leader was amenable in those discussions to an agreement that would allow five amendments on each side related to H-1B or to technology-related job training, education, and access. It is also our understanding the Republican leader was amenable to our Democratic leader, or his designee, offering a Latino fairness amendment and a Liberian adjustment amendment. I want to make a comment on his behalf that support of relief for immigrants who have fled wars in Haiti, El Salvador, Honduras, and Guatemala, and to other longtime residents who have been in the United States since before 1986 is important to ensure fairness in the immigration system. If we do this, we will immediately increase the size of the legal workforce and also alleviate the shortage of low- skilled workers, and we will keep families together. We believe our offer is reasonable. We hope we can work out an agreement. I think the discussions we have had about the five amendments on each side is something that should give us some hope that we will be able to resolve this soon and certainly before this Congress adjourns. It is a very important issue. You want to address it. We want to address it. We believe we should find a way to connect here and reach agreement to do so.

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

Mr. DORGAN. Mr. President, if the majority leader will yield further under my reservation, as he knows, it is even difficult to agree to five amendments. We are willing to do that. The Democratic leader wants this bill done. I want it done. My colleagues want it done. We risk ending this session not doing something that we know should be done. We need to do this H-1B bill, and we need to increase the number of these visas. Let me also respond to the point the Senator from Mississippi made a moment ago. The Senator from Mississippi pointed out that if we bring additional people in to fill jobs here, which makes sense--I much prefer they come in and fill jobs in this country rather than have the company move their operations to India or some other country--it makes sense also not to move all of those jobs into the same part of the country. Because information technology now allows us to do this work anyplace in the country, what about targeting some areas of the country where we have had outmigration, where we have lost population? That is what the Senator from Mississippi said. I think it makes eminent good sense. I hope we can work on at least a piece of that. I will not object. Again I say it is our intention to get this legislation passed. We think the proposal offered in the last couple of days makes sense. We think we can probably clear that in the manner previously discussed between Senator Daschle and Senator Lott.

Mr. DORGAN. Mr. President, I ask unanimous consent to speak as in morning business.

Mr. DORGAN

Mr. DORGAN. Mr. President, I come to the floor of the Senate to discuss the fiscal policy questions that are ricocheting around this Chamber, and the House as well, about what the future will hold with respect to tax cuts, budget surpluses and/or deficits, investments in education, the possibility of reducing Federal indebtedness, and other spending. I want to talk about that because we now have a discussion in this town about the potential for big recurring budget surpluses every single year. It was not too many years ago in Washington, DC, that we had the leading economists in the country saying the 1990s would be a decade of anemic economic growth. We had very large budget deficits, the country was not doing well, and the economists said for the next decade this economy is going to grow very slowly. The economists did not know what they were talking about then. That is not unusual. I always thought there should be some sort of standard by which we measure economists and evaluate whether what they say has any validity in terms of what we experience. Of course, we have no such yardsticks, so these economists keep on talking and people keep on listening. That is why I am here today: What do we expect in the future, and what should we do in this country as a reasonable response to those expectations. I want to for a moment talk about the early 1990s and recall where we were. The unified budget deficit in 1992 was $290 billion and rising-- $290 billion just for that year and rising. Now we have a surplus in the year 2000. Economists said we would have continual, larger and larger deficits. That was wrong. We now have a surplus. Economic growth: Then it averaged 2.8 percent. We were apparently at the end of, or beginning to see the end of, a recession. Economic growth averaged 2.8 percent annually for the previous 12 years, and it looked as if we were finally ending a recession. Since 1993, economic growth has averaged 3.9 percent a year. Jobs: From 1988 to 1992, we had a difficult period, one of the worst in history in terms of the creation of new jobs. The economy did not produce many new jobs. From 1993 to date, over 22 million new jobs have been created in this country. Unemployment: It averaged 7.1 percent in the 12 years prior to 1993. Today it is at 4.1 percent on average, the lowest level in 30 years. Home ownership fell from 1981 to 1992. Now it is the highest in history. Median family income fell by about $1,800 from 1988 to 1992, adjusted for inflation. It has increased by over $5,000 since 1993. Real wages fell 4.3 percent in 12 years; real wages are up 6.5 percent since 1993. Welfare rolls increased 22 percent from 1981 to 1992; since then it has decreased by 53 percent. The Dow Jones was 3,000 in 1992. It is 11,000 now. The point is that this has been a very interesting time. Economists predicted this would not happen, but it did. Our economy is growing in a very robust fashion, and a lot of people are claiming credit for it. Probably everybody deserves a bit of the credit. The 1993 Economic Reform Act that was passed by Congress, which reduced the deficit and which made tough choices, was a signal moment in this country's fiscal policy history. It dramatically changed what happened in this country. We had the courage to do what was right. It was politically difficult to do. In fact, my party paid a price for it in the next election. Guess what. It put this country back on track, away from the growing deficits toward economic growth and toward opportunity. It is the year 2000, and we have had a remarkable 7 years. Now we are told by the same economists who predicted anemic growth for that decade that in the next decade we will have nothing but ever larger increasing budget surpluses. Should we believe them? Is that the basis on which we should develop our future fiscal policy for this country? I do not think so. Because we are inebriated by the sound of 10 years of surpluses, we have politicians walking all around the political landscape saying: What we should do now is pass bills that call for massive tax cuts; lock it in, they say; put it in law; let's provide $1 trillion or $1.5 trillion in tax cuts. It is very unwise, in my judgment, to do that. We do not know that we will have sustained economic growth. We do not know whether there will or will not be a recession 2, 3, or 5 years from now. We don't know what the future holds. We would be very wise to be cautious in how we handle this issue of future surpluses. We face some really critical choices. Those choices can provide both risk and opportunity: The risk of slipping back into big deficits, which no one in this country wants, and the opportunity to move forward and build on our recent economic successes. Those are the risks: Are we going to move backwards or forwards? I am not here on the floor of the Senate to say one side is all wrong and the other side is all right on this issue, but I will say this. Those who say the only agenda in fiscal policy is to begin cutting taxes right now, and cut taxes deeply, and cut taxes for those who have the most income in this country, risk slipping us right back into big deficits, putting us right back into the same old deficit ditch. That is the last place this country ought to want to be. How much budget surplus is there really? Even if all the things the economists say might happen, how much real budget surplus do we have? There have been some interesting pieces written in the last few weeks about this. There was a wonderful piece written by David Broder, a very respected columnist, in the Washington Post. There was an op-ed piece written by Paul Krugman, an economist, in the New York Times. There was a good piece in the U.S. News & World Report. They raised these questions, which we should raise here in Congress. How much surplus do we really have to use, if we are honest about where we are headed and what we are doing? Let's look at it. CBO says, $4.6 trillion in surplus over the next 10 years. I come from a town of 300 people and a high school class of 9. It is really hard for me to grasp what a trillion dollars might be. In fact, it is hard for me to grasp a billion or a million dollars--but trillions of dollars, $4.6 trillion. So people hear that word, and it is as if they have taken a big bottle of Jack Daniels and started slugging it down. All of a sudden they are talking about all kinds of wild, irresponsible plans they have because we have $4.6 trillion in surplus. But, of course, we do not have $4.6 trillion in surplus. What we have, in fact, if you take the Social Security trust funds away, is $2.2 trillion in surplus. But we really do not have $2.2 trillion in surplus. If you take the Medicare trust fund away--and everybody says they want to have a lockbox; and I assume you would want to lock a box with something in it--so you take that away, then you have $1.8 trillion available. And then you must adjust that figure for realistic spending, that is, how much money we are going to spend. The budget caps suggest that we will actually reduce Federal spending in domestic discretionary accounts in this country. However, we will have a population that is increasing and some inflation. And we are not going to say, with respect to law enforcement and education, and all the other essential functions of Government, that we are going to actually spend less next year than we are spending this year. That is not realistic. So adjusting for some realistic investment that makes this a good country to live in--building roads and teaching kids, providing for our common defense, all the things that make us a good country--then you have $1.2 trillion left. Then using some of the money for extending the solvency of Social Security and Medicare, which all of us know we must do because people are growing older and living better lives, you have $700 billion left. That is the surplus. This analysis, incidentally, comes from the Center on Budget and Policy Priorities. They say, the real budget surplus is not $4.6 trillion or $2.2 trillion. The real budget surplus is probably about $700 billion. So then how do you reconcile people coming to the floor of the Senate telling us they want to cut taxes by $1.3 trillion or more? The only way you reconcile that puts us right back in the same deficit ditch that we have been in before. Here is another analysis that comes from the Brookings Institution. This one says--using the exact same analysis but different elements of it--we do not have a $700 billion surplus, we have only about a $350 billion surplus--about $35 billion a year. That is the real surplus. They made some different calculations. I will not go through them all. But the point is this: Under either of these analyses--confirmed and also discussed in the Paul Krugman piece, the David Broder piece, and others--under either of these analyses, we do not have trillions of dollars in surplus. I wish we did, but we do not. It would be terribly unwise for this country to decide to lock into law very large tax cuts--the biggest benefits of those cuts going to the wealthiest citizens in this country--at a time when it will result in large deficits in the future. We would be very smart to be very cautious as we approach this. This is from Paul Krugman, who I believe is a really interesting thinker. He wrote an op-ed piece in the New York Times: The most likely prospect is that those big surpluses won't materialize. And when the chickens that didn't hatch come home to roost, we will rue the days when, misled by sloppy accounting and rosy scenarios, we gave away the national nest egg. His point is a very important one. I am going to talk about it in a moment. But what are our priorities if we are realistic about what we are going to do and what we think will happen? Our priorities ought to be to pay down the Federal debt first and foremost. If in bad economic times you increase the Federal debt, in good economic times you ought to reduce the Federal debt. That is the import of what Paul Krugman was saying, among other things. Here is another piece from U.S. News & World Report: Still, the same lack of understanding about the budget is evident today as we head into the crucial weeks of the campaign with big budget numbers and big political promises. If we get it wrong again, we could head back to those awful years--decades of apparently insuperable deficits, slow growth, and recurrent recessions. All of us could relate to the numbers better if we could knock off a few zeros from the trillions being discussed. Most American families with a lot of debt would know what to do with a windfall. They'd instinctively feel better if they used the money to redeem loans, freeing themselves from long-term obligations and insecurity, and I suggest the same principle should apply to the country, which is in exactly the same position. The point is this. With all the opportunities we have ahead of us if, in fact, we have budget surpluses, those will be lower than generally expected. And of all the opportunities ahead of us, the first choice and first claim, in my judgment, ought to be to reduce the Federal debt. We have a lot of proposals out there. There is one by Governor Bush where he talks about very substantial tax cuts. Frankly, I do not support them. It is not that I do not support providing some targeted tax cuts. Working families deserve some help in this area. But we cannot come around here with $1 trillion or $1.4 trillion in tax cuts, given what we expect the real surplus to be. It would put us right back in the same deficit ditch, right back in the same ditch. What we need to do in this political debate is to see if we can't, as Republicans and Democrats, understand that when we respond to this question of the fiscal policy of this country, and what the future might hold, that we be reasonably conservative and cautious, and protect ourselves from retreating back to the same policies we had previously. We are all responsible for those policies. There is not a set of fingerprints that lays the responsibility at one door with respect to what happened in this country. But we all ought to be responsible, as well, to say we are not going to let it happen again. In my judgment, we can do that now by saying to those who are campaigning for office-- both for this Chamber and the other body, and also for the Presidency-- let's have a real discussion about what the real surplus might be, and then evaluate what our priorities are with respect to that. Now, the tax cuts, I am not going to talk about them so much. The tax cuts that are being proposed around here are terrible. In almost every case they provide the biggest benefits to those who need them least. I know people will say: Well, that is all the same old class warfare. It is not class warfare. The bottom 60 percent of the population, earning incomes up to $40,000, get $227 a year; and the top 1 percent get $46,000 each. That is not tax class warfare, that is just a tax cut that should not happen. The question is, What should we do now? In my judgment, what we should do is establish a set of priorities, both in this Presidential campaign and in the campaigns for the Congress--the Senate and the House--and say, the priorities for using the actual budget surplus, which is much lower than the trillions of dollars being kicked around by some, is to, No. 1, pay down the Federal debt; No. 2, ensure the long-term solvency of Social Security and Medicare--we have a responsibility to do that--No. 3, address this country's urgent needs, and that means making some investments that we need in education, and other areas; and, no. 4, provide targeted tax relief for working families. All of these represent the priorities in the order that I see them. Others may see them differently. I think it is important, before we start down this road, to address this question of whether the trillions of dollars people are kicking around as expected future surpluses are going to be real. The answer is, with almost all thoughtful economists responding to it, to say, no, these are not real; the surplus is going to be much, much smaller than that. That ought to temper our desire and demand and appetite for these huge tax cuts being proposed that will result in very large future deficits. The single best thing we could do for this country and its children and our future is to begin paying down the Federal debt with the actual surpluses that will come in future years. It is the single most important way of strengthening this country's economy. I seldom ever quote Alan Greenspan because we have such disagreements on monetary policy, but I will break that rule today. He came to Congress, the Senate Select Committee on Aging, and said: . . . there are limited fiscal resources in this country and that until we have strong evidence that there is a major structural increase in the surplus, that trying to commit it to various different program[s] or even tax cuts, I think, is unwise. His point is, we ought to use the surplus to reduce indebtedness. We have a nearly $5.7 trillion Federal debt. If during bad times, during tough times, this country had to run up its debt in order to make ends meet, then during good times the greatest gift we could offer to America's children is to say we will reduce that indebtedness. It is not just a gift to children, it also happens to be the best way to assure long-term economic growth. I will make one additional point as we begin discussing fiscal policy and tax issues. My presentation here will not dim the appetite of those who come to the floor and say: I don't care about numbers. I don't care about philosophy. I was elected to Congress for one thing, and I am going to propose tax cuts until my last breath. I am going to propose tax cuts because those are the only two words I know. I don't care about how it all adds up or subtracts or how it all works out. Good for them. But they are the kind of people who steer this country into the deficit ditch, and I, for one, am not going to be a part of it. I would say to them this: To the extent that we have some ability-- and I think there is some ability, even though we are going to have smaller surpluses--to provide tax cuts, I would like tax cuts to go not just to the people who have benefited most from this economy. We have, after all, one-half of the world's billionaires in the United States; good for us--but when we talk about tax cuts, I would much sooner see scarce resources go to working families. They are the ones who need them most. It is interesting. Every time someone talks about a tax cut around here, they only talk about income taxes. Here are the taxes we collect in this country. This big red piece of the pie is payroll taxes. Those at the lowest end of the economic ladder pay a payroll tax that is the same tax as those at the highest end. Nobody wants to talk about these payroll taxes. These are the ones that have increased very substantially in recent years. So when we talk about tax cuts, maybe we could talk about trying to help those who are paying payroll taxes as well, rather than just those who are paying income taxes. Nearly 100 percent of the bottom fifth of our population are paying more in payroll taxes than income taxes. In fact, even the middle fifth, those making between $43,000 and $65,000 a year, 80 percent of them are paying more in payroll taxes than in income taxes. Yet every time you hear somebody saying let's cut taxes, all they want to talk about is income taxes because that means their tax cut proposal is going to benefit those with the most income. What about a tax cut proposal that says we are going to offset some of the burden of those folks who are going to work every day for the minimum wage and are paying a heavy payroll tax. How about giving them a little relief. So when the next time comes that we in Congress are talking about tax cuts, I am going to bring some of these charts out and ask: Does this not count, the pie chart that shows payroll taxes? Does it not count that the income earners at the lowest end of the scale are paying these things and it doesn't matter somehow? They don't deserve any help? That is just a tax that we won't talk about. That is not fair. It is not the way to do business. I think the warnings--perhaps the small craft warnings at this point, but major warnings later--by some good economists are saying: Watch out what you are doing here, talking about $4 trillion of tax cuts or $4 trillion of surplus or a $2.2 trillion surplus or a $1.5 trillion tax cut; watch what you are doing here and be careful, because this is not going to materialize, and if you do what you are talking about doing, it will pose significant dangers to the American economy. The best way to assure economic growth and opportunity in this country's future is to decide that if we have surpluses--and I hope we do--we will commit first and foremost those budget surpluses to reducing our country's indebtedness. Again, if in tough times you run up the debt, in good times this country ought to be able to pay it down. That is the greatest gift to America's children, and that is also the surest way to long-term economic health, growth, and opportunities. I yield the floor.

Mr. DORGAN

Mr. DORGAN. Mr. President, it has been more than a year since the Columbine tragedy, but still this Republican Congress refuses to act on sensible gun legislation. Since Columbine, thousands of Americans have been killed by gunfire. Until we act, Democrats in the Senate will read the names of some of those who have lost their lives to gun violence in the past year, and we will continue to do so every day that the Senate is in session. In the name of those who died, we will continue this fight. Following are the names of some of the people who were killed by gunfire one year ago today. September 15, 1999: Larry Gene Ashbrook, 47, Fort Worth, TX; Kristi Beckel, 14, Fort Worth, TX; Mackersher Beckford, 22, Miami, FL; Shawn C. Brown, 23, Fort Worth, TX; Sydney R. Browning, 36, Fort Worth, TX; Keith Brunson, 28, Miami, FL; Gary Burgin, 51, Cincinnati, OH; Ralph Burgin, 58, Cincinnati, OH; Jorge DelRio, 36, Miami, FL; Joseph D. Ennis, 14, Fort Worth, TX; Cassandra Griffin, 14, Fort Worth, TX; Leardis Lane, 59, Chicago, IL; Omar Martinez, 32, Miami, FL; Jerry Lee Miller, 63, Salt Lake City, UT; Ali Panjwani, 32, San Antonio, TX; Lamar Price, 34, Detroit, MI; Justin M. Ray, 17, Fort Worth, TX; Calvin D. Sangrey, 45, Seattle, WA; Lawrence Venson, 21, Washington, DC; Unidentified Male, 45, Sacramento, CA. Today is the one-year anniversary of a horrific shooting in Fort Worth, Texas. On this day one year ago, a gunman burst into the Southwestern Baptist Theological Seminary during a youth rally. Seven of the people whose names I just read were shot and killed and seven were wounded by a man they did not know. The gunman stormed into the church, cursed their religion, and shot multiple rounds of gunfire before he turned the gun on himself. We cannot sit back and allow such senseless gun violence to continue. The deaths of these people are a reminder to all of us that we need to enact sensible gun legislation now.

Mr. DORGAN

Mr. DORGAN. Mr. President, I ask unanimous consent to speak in morning business for as much time as I consume.

Mr. DORGAN

Mr. DORGAN. Mr. President, my colleague from Nevada, Senator Reid, and I were discussing some dialog that had taken place on the floor of the Senate earlier today, and we wanted to visit a bit about the issue of a prescription drug benefit for the Medicare program. We are in session in this 106th Congress perhaps only another 4 or 5 weeks at the outset, and much is left to be done prior to the adjournment of this Congress. One of the issues that most people think is very important to the American people is for this Congress to add a prescription drug benefit to the Medicare program. Almost everyone in this country now understands that the price of prescription drugs is moving up very quickly. Last year, the price of prescription drugs increased very rapidly. In fact, the cost of prescription drugs last year alone, because of increased utilization, price inflation and other things, increased 16 percent. The senior citizens in this country are 12 percent of our country's population but consume one-third of all the prescription drugs in America. Senior citizens are at a point in their lives where they have reached declining and diminished income years and they are least able, in many cases, to be able to afford to pay increasing prescription drug prices. There are a range of issues with prescription drugs. I talked about some of these in this Chamber before. There are wild price variations. The same drug in the same bottle made by the same company is being sold in Canada for a tenth of the price that it is sold to a consumer in the United States. The other day I held up two pill bottles of medicine on the floor of the Senate--exact same medicine, made by the same company, put in the same bottle, shipped to two different pharmacies, one in the U.S. and one in Canada. One was priced three times higher than the other. Guess which. The U.S. consumer was asked to pay three times more than the Canadian consumer for the same prescription drug. That is one issue. There is a second issue changing or altering the Medicare program to add a prescription drug benefit to the Medicare program. There is no question that if the Medicare program were being written today instead of the early 1960s it would include a benefit for prescription drugs. Many of the lifesaving prescription drugs that are now available were not available then. We clearly should add a prescription drug benefit to the Medicare program. We have proposed, the President has proposed, and the Vice President has proposed a plan that would provide an optional and an affordable prescription drug benefit available to senior citizens to try to help them cover the cost of their needed prescription drugs. Earlier today we had Members of the Senate talk about this being a big Government scheme. It is no more a scheme than the Medicare program. The Medicare program is not a scheme at all. It is something this Congress did over the objections of those who always object to anything that is new. We have a few in this Chamber. It has been done for two centuries. No matter what it is, they say: We object. The Medicare program was developed in the early 1960s at a time when one-half of the senior citizens in America had no health care coverage at all. We proposed a Medicare program. Now 99 percent of the senior citizens have health care coverage. Do you know of any insurance companies that are going around America saying: You know what we would like to do is provide unlimited health care insurance to people who have reached the retirement years? We think it is going to be a good business proposition to find those who are in their 60s, 70s, and 80s and provide health insurance because we think that is really going to be profitable. It is not the case. That is why 40 years ago half the senior citizens couldn't afford to buy health insurance. That is why there was a need for the Medicare program. We not only have a Medicare program, and one that works, but we now need to improve it by offering a prescription drug benefit. When we do, the same tired, hollow voices of the past emerge in this Chamber to say: You know what they are proposing is some sort of Government scheme. It is not a scheme. It is not a scheme at all. It is an attempt to strengthen a program that every senior citizen in this country knows is valuable to them and their neighbors. That is what this is. Most Members of the Senate understand that we ought to do this. Some who understand it ought to be done, don't want to do it through the Medicare program and are proposing we provide some stimulus for the private insurance companies to offer some sort of prescription drug benefit. But the private insurance companies come to our office and say: We won't be able to offer this benefit; we would be required to charge senior citizens $1,100 for $1,000 worth of benefit for prescription drugs. They say: We are not going to offer it; it doesn't add up; we won't do it. That is what the U.S. executives say. I am happy to bring out a chart, as I did the other day, to quote the head of the Health Insurance Association and others who say it won't work--I am talking about the plan proposed by the majority party--it doesn't work at all. But to have them come to the floor of the Senate calling our desire to add an optional prescription drug benefit to the Medicare program some sort of Government scheme doesn't wash. We are trying to do something that we think is thoughtful, we think is necessary, and we think most senior citizens will take advantage of on an optional basis because they understand the price of prescription drugs continues its relentless increase year after year after year. We have people who have never supported the Medicare program. They don't talk about it, but they have never supported it, never liked it. It is the same people who don't like to add a prescription drug benefit to the program. They say: Gee, we have financial problems with Medicare. Do you know what our problems are with Medicare and Social Security? Our problems are success. People are living longer. In the year 1900, people in this country were expected to live to be 48 years of age; a century later, people are expected to live to almost 78 years of age. In one century, we have increased the life expectancy nearly 30 years. That is success. Does that put some strains on the Medicare program and Social Security program because people are living longer? Yes. But of course that strain is born of success. This isn't something to be concerned about; it is something to be proud of. People are living longer and better lives, and part of that is because of the Medicare program. We ought to improve that program by adding the prescription drug benefit to that program now, in this Congress, in the remaining 4 weeks. I am happy to yield to my colleague from the State of Nevada.

Mr. DORGAN. I say to my colleague from Nevada, we do not have an answer, except I presume it is probably fairly simple: It is about profits. The companies that manufacture prescription drugs have a manufacturing plant, and they produce those drugs in the plant, and they put them in a bottle and put a piece of cotton on top, and they seal it up, and they ship it off. They will ship a bottle to Grand Forks, ND; they will ship a bottle to Reno, NV; and they will ship a bottle to Pittsburgh, PA. Then they will ship a bottle to Winnipeg, Canada, and into Brussels or Paris, and they price it. They say the U.S. consumers will pay the highest prices of anybody in the world for the same pill in the same bottle; we will charge the American consumer triple, in some cases 10 times, what we charge others. Why? Because they can. Why? Because they want to. The pharmaceutical industry has profits the Wall Street Journal says are the ``envy of the world.'' I want them to succeed. I appreciate the work in developing new drugs. But a lot of work in the development of new drugs is publicly funded by us, through the National Institutes of Health and other scientific research. I want them to be successful. I don't, however, want a pricing policy that says to the U.S. consumer, you pay the highest prices for drugs of anybody in the world. It is not fair. And too many of our consumers-- especially senior citizens--have reached that stage in life where, with a diminished income, they cannot afford it. One of the results of the unfairness of all of this and one of the results of not having a prescription drug benefit in the Medicare program is this: Three women who suffer from breast cancer are all seeing the same doctor and the doctor prescribes tamoxifen. Two of the women say: I can't possibly afford it; I have no money. The third, who can, says: I will purchase my dose of tamoxifen, and we will divide it into three, and we will each take a third of a dose. Or the woman, a senior citizen in Dickinson, the doctor testified before a hearing, suffered breast cancer, had a mastectomy. The doctor said: Here's the prescription drug you must take in order to reduce your chances of a recurrence of breast cancer. The woman said: Doctor, I can't possibly do that; I can't possibly afford that prescription drug. I will just take my chances with the recurrence of breast cancer. The point is that senior citizens across this country understand, because their doctor has told them the drugs they need to try to deal with their disease and try to improve their lives, all too often they cannot afford it. In hearing after hearing I have held, I have heard from senior citizens who say: My druggist is in my grocery store. The pharmacy is in the back of the store. When I go to the grocery store, I must go to the back of the store first because that is where I buy my prescription drug. Only then do I know how much I have left for food. In State after State, I heard that message. It is not unusual. That is why this is such an important issue, both with respect to international pricing and the unfairness of asking the American consumer to pay the highest prices in the world for these prescription drugs, but also in terms of whether we add a prescription drug benefit to the Medicare program. We have proposed that. What has happened is we have people dragging their feet here in the Congress. While they don't want to be against it, they understand we should do it; neither do they really want to do it in the Medicare program, because they have never believed that was a very good program and it was a program pretty much resisted by those would resist everything, as I said.

Mr. DORGAN. Mr. President, some weeks ago I was attending a meeting in North Dakota dealing with farm issues. An elderly woman came to the meeting. She sat quietly, said nothing. At the end of the meeting, after everyone else had pretty much left, we had shaken hands with a number of them, she came over to me. She was very quiet. She grabbed my arm and she said: I just want to talk to you for a moment about prescription drug prices. I am guessing she was in her mid to late seventies. She said she had serious health problems and she just couldn't afford to buy the prescription drugs her doctor said she needed. As she began talking about this, her eyes began brimming with tears and then tears began running down her cheeks and her chin began to quiver and this woman began to cry about this issue, saying: I just can't afford to buy the prescription drugs my doctor says I need. This repeats itself all over this country. If it is no longer a question of whether we ought to do this--and perhaps that is the case because we hear almost everyone saying we ought to do this--then the question remaining is: How do we do it? We say we have a program that works. The Medicare program works. It has worked for nearly four decades. We know nearly 99 percent of America's senior citizens are covered by that Medicare program. And we say let's provide an optional prescription drug benefit that senior citizens, with a small copayment, can access. Others say let's not do that. That is big government. Medicare is big government, they say. They say what we want to do is have the private insurance companies somehow write policies that would provide prescription drug coverage. Is that big insurance? If one is big government, are they saying we don't want big government, we want big insurance to do this? But if it is big insurance--and it is--let's hear what the insurance folks have to say about it. My colleague just mentioned it. Here is a chart. Mr. Charles Kahn, President of the Health Insurance Association of America, says: We continue to believe the concept of the so-called drug- only private insurance simply would not work in practice. It simply would not work in practice. I have had two CEOs of health insurance companies come to my office and say to me: Senator, those who are proposing a prescription drug benefit by private insurance company policy, I want to tell you as a President of a company, it will not work. We will not offer such a policy. And if we did, we would have to charge $1,100 for a policy that pays $1,000 worth of benefits. That is Charles Kahn, again, from the Health Insurance Association of America. Private drug-insurance policies are doomed from the start. The idea sounds good, but it cannot succeed in the real world. I don't know of an insurance company that would offer a drug-only policy like that or even consider it. That is from the insurance industry itself. Let me just for a moment ask this question. If the insurance industry would have been able to offer a policy for prescription drugs that was affordable and practical and usable, would they not already have done so? Ask yourself: If in 1960 it would have been profitable for health insurance companies to say, Our marketing strategy is to try to find the oldest Americans, those who are nearest the time when they will have a maximum call for needs in the health care industry, to find those people and see if we can insure them--if that were the case, would there have been a need for the Medicare program? No, there would not have. Of course, that is not the case. In the private sector, these companies are after profits. How do you find profits in health insurance? Find some young, strapping man or woman who is 20 years old, healthy as a horse, is not going to get sick for 40 years, and sell them a health insurance policy and not have them see a doctor in 40 years, and all the premium is profit. Good for them, good for the company, and good for the healthy person. But they do not make money by seeking out someone who is 70 years old and probably 5 or 10 years away from the serious illness that is going to have a claim on that health insurance policy, and that is why, in 1960, senior citizens could not afford to buy health insurance. Half of American senior citizens did not have it. The Federal Government said, we have to do something about it. Even when there were those who were pulling the rope uphill, trying to do the positive things, we had people here with their foot stuck in the ground saying: No, we will not go; no, it will not work; it is big government; no, it is a scheme. We have such people on every single issue in this Chamber. There is a story about the old codger, 85 years old, who was interviewed by a radio announcer. The radio announcer said to him: You must have seen a lot of changes in your life, old timer. The guy said: Yep, and I've been against every one. We know people like that. There are a lot of them in politics. I can tell you about people who are against everything new. Then, of course, we do it because it is important to do it; it makes life in this country better. About 10 years later, guess what. They said: Yes, I started that; I was for that. Of course, they were not. This is not about Republicans or Democrats at this moment. There is no Republican way or Democratic way to get sick; you just get sick. There is no Democratic or Republican way to put together a program like that. My point is there are some, Governor Bush and others, who have a proposition with respect to prescription drugs that will not work because those on whom they rely to offer a policy say they cannot offer it; it will not work; it cannot be done. If that is the case, and if they believe, as we do, that we ought to put a prescription drug plan in the Medicare program, then I say join us and help us and work with us over the next 4 weeks and get this done. The question is not whether, it is how, and the answer to the how is here. You cannot do it the way you say you want to do it. You cannot pretend to the American people you have a plan that will work when the industry you say will do it says it is unworkable. I did not come here to cast aspersions on anybody or any group. This is one of those issues of perhaps three or four at the end of this 106th Congress that we owe to the American people to do, and the only way we are going to get this done is if those who say they favor a prescription drug benefit in the Medicare program will stop coming to the floor and calling the Medicare program some giant Government scheme. Those who do that understand they are calling a program that has worked for 40 years, that has made life better for a lot of folks in this country, a scheme. Let's work together. Let's decide we will embrace those things we know will work and help people. That is why I am pleased the Senator from Nevada has joined me today. I will not go on at length, but the other issue--and at some point I want to visit with the Senator from Nevada about the other issue--is a Patients' Bill of Rights. We held a hearing in his State on that issue. Sometime I want to talk on the floor of the Senate about that hearing. That is another health issue we ought to do in this 4-week period. We owe it to the American people to do it. It is so important.

Mr. DORGAN. I will be happy to yield.

Mr. DORGAN. Mr. President, the Senator is right. I end by saying this is not about politics; it is about solutions to real problems. We understand this is a problem. Prescription drug prices are too high. They are going up too rapidly. Senior citizens cannot afford them. We have a serious problem in this country in this area. We understand we have a responsibility to do something about it. What? There are two choices. One does not work, and one we know will. This is not rocket science. We know what works. All we need to do is get enough votes in this Congress to decide we will do what works to put a prescription drug benefit in the Medicare program which is available to senior citizens across this country. Six or eight weeks from now, it can be done. We will have it in the Medicare program, and there will be a lot of senior citizens advantaged because of it. We will have more to say about this, but because others wanted to come to the floor today and talk about schemes and other things, I thought it was important--and the Senator from Nevada did as well--to provide the perspective about what this issue is. A lot of people speak with a lot of authority. Some are not always right but never in doubt. Some old codger said to me one day: There are a lot of smart people in Washington and some ain't so smart; it's hard to tell the difference. He is right about that. The currency in Congress is a good idea to address a real problem that needs addressing. We have a real problem that needs addressing now, and a good idea to address this problem of prescription drugs is to put in the Medicare program an optional program which is affordable, with a small copay that will give senior citizens who need it an opportunity to get the prescription drugs they need to improve their lives. Mr. President, I yield the floor.

Mr. DORGAN. I yield.

Mr. DORGAN

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