John Ensign

Mr. ENSIGN

Mr. ENSIGN. Mr. President, today the Senate resumes consideration of the motion to proceed to S. 2061, the OB/GYN medical malpractice bill. Senators who wish to speak on the bill are encouraged to come to the floor during today's session. The Senate will recess from 12:30 until 2:15 for the weekly party lunches. At 5 p.m. the Senate will vote on the motion to invoke cloture on the motion to proceed to the bill. As a reminder, last night the majority leader filed cloture on the motion to proceed to S. 1805, the gun liability bill. The cloture vote on the motion to proceed to the gun liability bill will occur on Wednesday. I ask unanimous consent that the time until 12:30 p.m. be equally divided between the two managers or their designees; provided further that the time from 2:15 until 4:50 p.m. be equally divided in the same manner; with the final 10 minutes prior to the 5 p.m. cloture vote equally divided between the two leaders or their designees, with the majority leader in control of the final 5 minutes.

Mr. ENSIGN

Mr. ENSIGN. Mr. President, I ask unanimous consent that Dr. Rita Redberg, a legislative fellow for Senator Hatch, be granted floor privileges during consideration of S. 2061, the Healthy Mothers and Healthy Babies Access to Care Act.

Mr. ENSIGN

Mr. ENSIGN. Madam President, I want to sum up this debate telling one story and making a few other points. Some on the other side of the aisle claim ``they want to make health care a birthright for every single child born in this country.'' Yet they are driving the very doctors who bring America's babies into the world out of their medical practices. Let me remind you of Melinda Sellard's story. She is the unfortunate woman who went through a horrifying experience of delivering a baby on the side of the road in the middle of the night because her doctor had quit obstetrics altogether due to exorbitant insurance premiums. En route, she and her husband had to drive right past the Copper Queen Community Hospital, which closed its maternity ward 2 months earlier because of the medical liability crisis. Instead, the Sellards were forced out onto the highway to try to get to the only hospital within 6,000 square miles with obstetricians who could afford malpractice insurance. After enduring the excruciating pains of labor without anesthesia, Melinda was forced to give her newborn infant CPR, since the baby was not breathing immediately after delivery. She finally got her newborn breathing, wrapped him in a sweater she was wearing, and drove the rest of the way to the hospital where the emergency staff cut the umbilical cord in the parking lot. I urge my colleagues to think of Melinda and the other mothers in this country who have lost their doctors and to stand up to the trial lawyers and support cloture on this bill. The ``objects in your rear view mirror that are closer than you think'' should never be a woman and her newborn child on the side of the road. I yield the floor.

Mr. ENSIGN. Mr. President, we had a debate today--sort of a debate, because we are only debating whether to proceed to a debate on the issue of whether we are going to continue to allow obstetricians and gynecologists and nurse-midwives to be able to practice in this country because of the runaway cost of medical liability insurance. The Democrats are not even allowing us to proceed to the bill, just like last year, when we tried to pass a more comprehensive reform. If they don't like the bill, let's amend the bill. But to have no debate on the bill, it seems to me, they are completely turning their backs on the women and children of this country, and those babies yet to be born. I had a discussion this afternoon with the President of the American College of Obstetricians and Gynecologists. I was talking to her about the numbers of students going into the field of obstetrics and gynecology. At the Nevada School of Medicine, the lowest number ever of students have applied to go into obstetrics and gynecology. She pointed out a statistic in the State right next door, Utah. That number actually was zero. Zero have decided to go into obstetrics and gynecology. Let me repeat--in Utah, there are no new physicians this year who decided to go into obstetrics and gynecology. That is an alarming figure for the future. For those people who are saying it is a problem but it is not that bad--the problem is bad today and it is going to get much worse in the future. There have been statistics bantered about as to why this happened and why that happened. However, the bottom line is shown pretty well in this picture. This building is located in a very busy thoroughfare in Las Vegas. This is a picture taken last week . The sign says, ``OB/ GYN--For Lease.'' The represents what is going on in many places in Nevada and other parts of the country--OB/GYN practices are shutting down. There are obstetricians and gynecologists leaving my State. It is the fastest growing State in the country by far, yet we have OB/GYNs leaving. They are stopping their practices. Some of them are retiring early. Some of them are limiting their practices to only the practice of gynecology. For others to get coverage from the insurance companies, they have to limit the number of babies that they deliver each month. My wife and I have had three wonderful children. Three of the most remarkable experiences of my life were the births of our three children. I know a husband and wife team, Joe and Kirsten Rojas, both of them OB/GYNs. They are passionate about what they do. They love to deliver babies. We have been out to dinner with them and often they get interrupted, and they have to go off and deliver a baby. Some of the hardest working people are OB/GYNs. Yet now they cannot afford to keep practicing. They have to limit the number of deliveries. The Rojases are our friends. We talk with them, and they have actually talked about leaving Nevada to go to California to practice their passion of delivering babies. They love Las Vegas. As a matter of fact, Dr. Joe Rojas, his father, was my mom's gynecologist. Actually, he did surgery on my wife when she had a medical condition. I graduated high school with Dr. Joe Rojas. He was born and raised in southern Nevada, and his wife now is in practice in Nevada, and they may have to leave their beloved home because they cannot afford the high costs of medical liability insurance. I want to put up another chart that shows the comparison of the rates in States around the country compared with California. Some people are saying the insurance rates are rising or falling because of the stock market, or insurance companies are just raising the rates arbitrarily or because of some kind of actuarial tables. The bottom line is on this chart. This puts it into context. The one State where we have had medical liability reform for any length of time, and it has been since the mid 1980s after surviving multiple court challenges, is the State of California. They enacted what is called MICRA. It is a strong medical liability reform law that, frankly, you could not get passed in the State of California today because the trial lawyers are so powerful. Over the years the trial lawyers have made so much money off of lawsuits that they are, I would argue, the most powerful political lobby in the United States today. But in California they were able to enact a medical liability reform bill. Their rates are down here shown by the blue line. You see very little increase over the years all the way through 1999. The rest of the country is shown by this red dashed line. You can see the rates going up. This only goes through about 1999. If we took it out to the year 2004, to today, you would see another spike going up right now. Actually the biggest increases in medical liability insurance we have seen have been in the last few years. This crisis is growing and getting worse year by year. Let us just compare a few cities in two States that have enacted good medical liability reform versus cities in four States that have not. Los Angeles in California: They have their MICRA law which is an effective medical liability reform law. Denver, CO: Once again, they have had a law on the books for about 10 years. They have an excellent law there. Let us look here at OB/GYNs. There are some other specialties and the comparison is very fair, but us stay with OB/GYNs: Los Angeles, a little over $54,000 a year; Denver, their premiums are about $31,000 a year; New York City, $89,000; Los Angeles, $108,000. By the way, this number, because this is 2002 data, is very low. In Las Vegas, it is somewhere between $140,000 and $200,000 a year, depending on how many babies they are delivering and whether they are dealing with difficult pregnancies. Looking on: Chicago, $102,000; and Miami, $201,000 per year in medical liability premiums. Some people say these are rich doctors. Has anybody talked to an OB/ GYN and asked them how much money they make these days? In Maryland, they get paid $1,400 for a delivery--not just a delivery but all the precare, the delivery, and the aftercare--$1,400 for all of those visits, including the hospital time. In the State of Nevada, Medicaid pays $1,200. That is about what managed care pays in the State of Nevada as well. These are not rich doctors. By the way, we are not just talking about doctors; we are talking about nurse-midwives as well. When was the last time you talked to a rich nurse-midwife? They are in a crisis as well. A lot of them are having to leave their practices. In 2 States, legislators they have enacted excellent reforms, in too few states, nothing has been done. That is the simplest evidence we can give as to why it is so desperately needed to enact the bill we have on the floor today. It will protect people involved in the delivery of babies and those involved in the practice of gynecology. We have heard anecdotal stories about women delivering babies literally on the side of the road because they had to drive too far because their obstetrician left town. This is happening in my State, in Arizona, in Mississippi, in West Virginia--there are 19 States currently in crisis. Of the States that are left, all but five are showing signs of heading into crisis. The one thing we know, unless this problem is fixed, is that all of those States showing signs of crisis will head into the crisis as well. How bad does the situation have to get before this body and those who defend the trial lawyers finally say enough is enough? How bad does it have to get? How many women have to be denied the care they need? In the State of Nevada, sometimes politics drives this argument. Sometimes it drives many pieces of legislation around here. In the State of Nevada, our level I trauma center closed a few years ago. Just prior to its closing, the Democrat leaders in our State said there was no way they would pass medical liability reform--no way--it would never see the light of day. Our level I trauma center closed. What happened? Because of that closing, 3 weeks later a medical liability reform bill was passed in the State of Nevada. That medical liability reform bill is not a good one--it does have some good components, but it certainly does not go far enough. In the State of Nevada, we are trying to close the loopholes that were left open by that bill. The politics that can be generated out of debating the bill and going forward can be a positive thing for actually getting this bill passed. The level I trauma center that closed in my State is the same level I trauma center where Roy Horn--the famous entertainer from Siegfried and Roy who was attacked by the tiger this last year--was treated. Had that level I trauma center not been reopened, Roy Horn would probably not be with us today. The reason it is so apparent that this legislation would work is because we have the numbers here to show that in the States who have strong medical liability laws, much of the costs have been constrained. Case in point, the reason our level 1 trauma center was allowed to reopen was that our Governor stepped in and said: We will cover the level I trauma center under the State's liability protection. What does the State of Nevada have for liability protection? It has a $50,000 cap for total damages, which is much more severe than we have in this bill. We have only a $250,000 cap on noneconomic damages. You can get as much as you want out of economic damages, and you can get as much as a jury says. Whatever your medical costs, you can get all of those. But on pain and suffering, with some of the most outrageous runaway jury awards, we limit it to $250,000. Some say you are limiting the access to courts when you do that. In the State of California, once again, there have been tens of millions of dollars awarded in loss of income. For instance, a child was injured, and in one case $84 million was awarded by a jury. We are not limiting the access. We are trying to get rid of the frivolous lawsuits that are plaguing this Nation and leading to this crisis. There is a direct correlation. Senator Daschle stood on the floor earlier today and said this bill would not help doctors. I question that statement because the doctors are supporting this bill. Virtually every medical association in this country is supporting this bill today. If it is not providing relief to the doctors, why are they supporting this bill? The answer is obvious. The answer is, it will help. It will help our entire system, and it will help those women and children who are being denied access to care right now. Unfortunately, if we don't do something, this situation in the future is only going to get worse and worse and worse. The bill we have before us today, Senator Gregg and I introduced. I appreciate all of the great work he has done on this bill, which is a narrowed down version of what we tried to pass last year. What we tried to pass last year was a comprehensive bill. If we are not able to move to this bill today, we are going to try to do emergency room and trauma care and a good samaritan bill packaged together. If we can't get that done, we are going to do inner-city and rural health care areas-- underserved areas. We are trying to drive this issue home to the American people. They realize where their representatives stand. Some have said you are trying to get a rollcall vote. You are darned right we are. We are trying to let people know who stands with patients and who stands with women and children with this bill and who stands with the trial lawyers.

Mr. ENSIGN. I agree to the unanimous consent request with the caveat that if a Member of the majority comes over and seeks recognition, they will be recognized.

Mr. ENSIGN. Madam President, I suggest the absence of a quorum.

Mr. ENSIGN. Another friend of mine in southern Nevada, whom I was talking to about 6 months ago, is one of the best OB/GYNs we have in southern Nevada. He focused his practice on difficult pregnancies, on the high-risk pregnancies, pregnancies with complicating factors. Maybe there is diabetes involved. That is a very common problem. One of my goddaughters who babysits our children has gestational diabetes. It is not an uncommon problem among women. During that time, there can be complications develop because of diabetes. It can be a very serious problem, but if handled by highly trained physicians, usually you do not end up with any problems. Because my friend is in the high-risk category--by the way, he has never had a lawsuit against him--his insurance company this past year said he had to severely limit the number of babies he could deliver. This is his passion, and now he has to limit the number of high-risk deliveries. That means some other OB/GYN who is not as highly trained is going to have to deliver those babies. If you are getting ready to deliver and you have a high-risk pregnancy, you would want the best possible medical care you could get. You would want the most highly trained physician. If you were told that because of our medical liability crisis in this country--I am sorry, you cannot go see your doctor--the one you have come to trust, because they had to limit the number of babies they could deliver in this month, imagine how that whole family would feel--the father, the mother, the grandparents. It puts an unnecessary risk on that delivery we should not be facing. While no one wants to have medical malpractice cases, there are mistakes that occur in medicine. I am a veterinarian by profession. There are human mistakes. There is gross negligence. Those people should have the right to access a courtroom. They should have the ability of a remedy. I argue that our legislation actually gets them the remedy faster. It limits the attorney's fees so more of the money goes to the victim. It also gets the money to the victim faster. Right now it can take 6, 7, 8, 9, 10 years. A lot of times the patient may have already died. Our bill gets them the compensation they need much more quickly and in a fair manner. I have heard it described that this bill discriminates against women. That would be like saying the whole State of California and the whole State of Colorado discriminates against women. That is ridiculous. California and Colorado are the two best examples of medical liability reform having been enacted and have been enacted for enough time to see it work. The patients who are injured actually get the compensation they deserve and we do not have the proliferation of frivolous lawsuits we see in the rest of the country in the healthcare field. There are many areas of tort reform we need to address. This happens to be one of them. Anyone who has delivered or seen their child's birth knows the anxiety that builds up; it is a tense time. Every time one of our babies comes out of the birth canal, we are hoping and praying everything is going to be all right. The biggest fear of any parent is for something to go wrong. We want to know the best possible health care and the best possible health care provider is going to be there. That is not happening in too many cases. That is not happening because, I believe, the trial lawyers have been too powerful in the United States. We have to break that power base if we really want to care about the mothers who are expecting or about the level of gynecological care they have come to expect and deserve in this country. This legislation is critical to the future quality of life in the United States. It is critical that we put special interests aside and the interests of patients at the forefront. That is what we are debating today. Are we going to put expectant mothers, midwives, OB/ GYNs first? Or are we going to put the trial bar first? I yield the floor.

Mr. ENSIGN. The majority leader has the last 5 minutes.

Mr. ENSIGN. Madam President, what is the situation regarding time?

Mr. ENSIGN. Of the 10 minutes remaining, 5 minutes is for the minority and 5 is for the majority leader, is that correct?

Mr. ENSIGN

Mr. ENSIGN. Mr. President, I rise today to speak on the issue of medical liability reform and the bill pending before the Senate. This legislation is a narrowed-down version of what myself and Senator Gregg introduced last year, which in contrast was a broad-based medical liability reform bill. Today we pared it down to limit it just to OB/ GYNs, nurse midwives, and any other provider involved in the delivery of babies. The reason we have done this is fairly typified in my State and in many other States around the country by this picture. It is a real life picture taken only days ago: the building moniker reads ``OBGYN,'' and next to it, a sign now hangs that reads ``For Lease,'' and call a particular number. This sign indicates how OB/GYNs are leaving practice in my State and in other States across the country because they can no longer afford their medical liability premiums. This is a problem that some describe as not that big a deal. But if you talk to the women who cannot get obstetrical and gynecological services, it is a crisis to them. Southern Nevada is the fastest growing population center in the country. We have 6,000 new people moving in a month and are we not getting as many new OB/GYNs as we need. We need a lot of new doctors coming to our State. But instead of new doctors arriving to practice in Nevada, we have doctors limiting their practices and stopping either the practice of obstetrics or leaving our State altogether. The American Medical Association has identified 19 States that are in crisis, and all but 5 States are showing signs the crisis is building in their State. Some people have said: Well, this is about rich doctors versus rich lawyers. This is not about doctors versus lawyers. This is about access to care. This is about a woman who is thinking: ``I want to have the best possible care for my baby,'' and she cannot find a doctor. I have a good friend who lives in Las Vegas. He delivers high-risk pregnancies. These are the people you want to have as your best doctors. However, because of the huge increases in rates, his insurance company has limited him on the number of deliveries he can make during the year. That is not what we want to be doing. We want to have the best people delivering babies, especially for high-risk pregnancies which require the most skill. It is our legal system that is out of control. Unfortunately, we have trial lawyers out there who are taking advantage of our broken civil justice system. They are even advertising on TV. I am sure many people, when they watch TV, have seen these 1-800 numbers you can call to find somebody to sue. It is basically: Bring your Rolodex and we will figure out who you are going to sue. That goes for almost anything today, but it is especially prevalent in the field of medicine. Across America the crisis is happening not just with OB/GYNs. As a result, in this bill, we have decided to focus also on nurse-midwives, the overall practice of delivering babies, and providing gynecological care because it is the most acute problem we are seeing across the country. In my State, we did pass a medical liability reform bill in August of 2002, but the only reason that it was able to pass was because our trauma center closed. It was the only level I trauma center for a region of 10,000 square miles, and it closed because of the medical liability crisis. The only way that trauma center was able to open again was because the State decided to step in and put its liability cap on anybody who provided care through the level I trauma center. People have been arguing that $250,000 is not enough. Well, the State of Nevada's cap on damages is $50,000 for anyone who chooses to sue a healthcare professional that provided care at the trauma center. That alone allowed the level I trauma center to open. This is the same level I trauma center where Roy Horn, the famous person from the duo of Siegfried and Roy, was treated when he was attacked by a tiger. If it was not for the State of Nevada applying its $50,000 damage cap, that trauma center would not have been available for Roy. He certainly would be in much worse shape today if that had not been the case, and maybe he would not have made it at all if that kind of care was not available. This example indicates the politics of what can happen when a crisis gets so great that the trial lawyers cannot stand up and keep their stranglehold on our legislatures around the country. Today, we need to have the same thing happen in the Senate where people around the country call their Senators and say the crisis is too severe. We need to have special interests, especially trial lawyers' special interests, put aside, and we need to put the practice of medicine first. We need to put first access to quality care for women and those new babies coming into the world. We need to put their care above all else. Last year, the University of Nevada School of Medicine had the lowest number of students entering obstetrics and gynecology it has had since 1999. And, equally disturbing, each year since 2000, that number has continued to go down and down and down. This chart shows the very clear contrast of what has happened in my State and other States versus California. Why do I put California up versus the rest of the States in the country? The reason is because California enacted what is known as MICRA. MICRA is their medical liability reform law which they enacted in 1975. After withstanding eleven years of court challenges, it has now been in effect for about eighteen years and we know it is working. By the way, the people in lawsuits are getting plenty of compensation in California. But the difference in premium increases--California compared to the rest of the country--is stark. In California, from 1976 to today, there has been a 167-percent increase. For the rest of the country, however, it is over 500 percent. Moreover, these percentages do not reflect the last couple of years. If the last couple years were shown, this red line showing the 500 percent would almost be spiking because it is going up so rapidly. To put this in real dollar terms, so you can get a comparison between different States, here are some really good examples. This is 2002 premium survey data for selected specialties. We are comparing the cities of Los Angeles--once again, California has the MICRA law it enacted--and Denver, which is in another State that has enacted very similar legislation. The laws in California and Colorado are the ones Senator Gregg and I based our legislation on. These two States have strong medical liability reform in their States. These other States shown on the chart do not. Let's see the difference. Let's go down on the lower portion of the chart because we are talking about OB/GYNs. Let's talk about the difference in the States. For Los Angeles, $54,000 a year--still a lot of money, but $54,000. In Denver, it is around $31,000. In New York, it is $90,000. In Las Vegas, where I live, it was $108,000 in 2002, and you cannot get it for $108,000 anymore. Currently, it is closer to $140,000 or $170,000 in my State, and even higher. In Chicago, it is $102,000. In Miami, it is over $200,000 a year. Is there any doubt in anybody's mind these laws are working when you look at the comparisons? Like I said, this is data from 2002. If you had 2003 data, the numbers would be even more stark. Consequently, I think we need to call on our Senate colleagues to at least allow us to debate this bill. We are going to have what is called a cloture vote on the motion to proceed tomorrow. All that is is a parliamentary term here in the Senate as to whether we can proceed to the bill. The other side of the aisle is blocking us from even proceeding to the bill, blocking us from having a reasonable debate on whether we are going to allow women to have access to their OB/GYNs and to their nurse-midwife practitioners. I have talked to so many people in my State, including patients, doctors, nurses and other people throughout the healthcare system, healthcare industry, and they know it is a crisis. But I have also visited with people from around the country. My State is not the only one that is in this type of a crisis. We are seeing severe problems from Pennsylvania to Mississippi to West Virginia to Washington State to Oregon, and all across the country. State after State after State has a serious problem today. When debating whether to debate this bill--that is all we are doing today, debating whether to debate this bill--we need people to step up to do the right thing. We have a Presidential election coming up this year. I think the candidates need to explain where they are on this bill. Some of them are going to be out running for office and may not be able to vote on this, but they ought to at least take a position on this bill to let people know where they stand. Do they stand with the trial lawyers? Or do they stand with pregnant mothers and unborn babies who need to come into this world? I think it is clear where we should stand as a body. This body should, in no uncertain terms, stand with protecting the patients of America, with making sure when a woman needs care, whether it is obstetrics or gynecology, that the healthcare provider will be there. Too many of these providers are leaving practice today because of the high cost of liability premiums. I want to respond to a couple points the other side always brings up. They say the reason is not because of jury verdicts; rather, the reason for these premium differences is because of investments in the stock market the insurance companies made and then they went bad. The stock market went crazy last year. It went way back up. So if the insurance companies were investing in the stock market, they would be doing fine, and we would not see these types of increases. The insurance companies in California and Colorado were invested in the stock market, just as the insurance companies in New York and Nevada and Illinois and in Florida. Yet there is this difference. The only thing you can point to for the difference--and these are cities with similar population bases--is the reform laws that have been passed. They all invested in the same stock market. It was not the stock market that caused the premium increases. It was and is runaway jury awards. Our country, unfortunately, has become too litigious. It is not about personal responsibility anymore. Jury awards are just out of control. People say: Injured patients deserve their just compensation. Well, they get just compensation in Colorado and California. I don't think one could look at California and ask: Do they discriminate against women? That is one of the arguments you hear: Because women don't make as much money, that they are being discriminated against. Are we saying the whole State of California discriminates against women? It is a ludicrous argument. We have to have reasonable reform. That is what we have put forward today, reasonable reform, so that access to care is there. If access to care is not there, that is when discrimination against women will happen. The OB/GYNs, which is what this bill addresses, are the part of the medical profession that is in crisis the most. Of all of the various specialties, this is the one that is in the most severe crisis. Obviously, it affects women more than it affects men. So in effect, if we are not allowing women to have access to the OB/GYN care, not passing this bill will discriminate against women. People not voting for this will be discriminating against women. That is why we need to pass this legislation. If you are opposed to the final version of the bill, at least let us go to the bill, debate it, and amend it. But it seems the other side of the aisle, the Democrats in the Senate, don't want to have any part of this debate. The American people need to stand up to that. They need to stand up and make their voices heard, because this debate is too critical. We are having, and we will continue to have, babies not delivered with the kind of care they need. High-risk pregnancies need the absolute finest modern medicine can bring them. If those people are limiting their practices, and OB/GYNs are having to limit the number of deliveries they make, then those high-risk pregnancies will not have the kind of highly qualified medical care they need and deserve. I could go into a lot of other statistics. I could talk about various anecdotes of people I have met. I would rather just sum up with this: In a day and age where America has the finest health care system in the world, where we have the finest quality, the best doctors, the best research institutions, the best hospitals, and where people from all over the world who can afford it come to America because of the high quality of care, if we want to keep the highest quality of care, we must enact medical liability reform. This bill that is limited down to just affecting the practice of obstetrics and gynecology, we at least must start here. I want to go much further than this, but let's at least start here so American mothers who are having babies or American women who are seeking gynecological care can have access to that type of care. One last point has to do with the uninsured. I have heard in the Democratic debates talk about the 43 million uninsured. They want to do something about it. The main thing they could do to make healthcare insurance more affordable would be to enact reasonable medical liability reform. That is what we have before us today. So for those who are trying to make this a political issue, let's make it an issue that we actually do something about instead of just talking about it on the campaign trail. I yield the floor and suggest the absence of a quorum.

Mr. ENSIGN. I ask unanimous consent that the order for the quorum call be rescinded.

Mr. ENSIGN

Mr. ENSIGN. Mr. President, I want to make a couple comments about the bill in general and spending. We are debating whether to waive the budget point of order. There is a point of order in order simply because this transportation bill goes way over--tens of billions of dollars over--what we voted on as a body and agreed to last year. That is why a budget point of order stands against this bill. Transportation spending is one of the most legitimate uses of government dollars. Everybody benefits by it. I don't think there is any question. Anybody you talk to agrees it is a legitimate use of dollars. But there are people who want to go above the budget, who want to spend more than the trust fund brings in. The trust fund is that money that comes in because of user fee taxes paid into a fund that are supposed to build our roads and the like, the rest of the infrastructure. Instead of putting this tax on our children or on the next Congress because we are deficit spending and passing debt, when you pass debt on to the future, you are going to have to raise taxes in the future. We have seen Congress doesn't cut spending. So because you are passing taxes on to the future, the people who want a higher highway spending bill should have the courage to raise the taxes. I don't believe we should. But if those people want to spend more money, they should at least have the courage not to put it off to the next Congress to raise taxes. That is why this point of order should be sustained. To put this in the context of the economy and other spending, they are touting the jobs that will be created. Alan Greenspan testified that the biggest threat to our economy and to jobs is runaway Federal spending. The markets are watching us right now. Whether somebody is a supply side economist or a Keynesian economist, it doesn't matter what view they take, the one thing they will all agree on--whatever causes the deficit, they may disagree--is the deficit is a huge threat to the future growth of our economy and jobs in America. And they are all watching us right now. The markets are watching; the Federal Reserve is watching what we are going to do on this very bill right now. That is why it is so critical we exercise some fiscal discipline on such an important issue. It will help us all by voting for more transportation spending; it helps us all for reelection. That is why this bill is so popular. We politicians can get up here and tout how much money is coming to our States; it is going to help you for reelection. But we have to think about not just our parochial interests in our States but put that into the broader context of the overall economy and also in the context of what we are doing to future generations. If we keep deficit spending, we are putting taxes on to the future generations. We did the farm bill, the Medicare prescription drug bill, this transportation bill--we have passed so many things, plus all of the other discretionary accounts, on top of a war. And Americans understand that sometimes you have to deficit spend during recession and war. But we are out of the recession now. The war is still there, so we have that aspect of it. But to continue to add to the deficit with all of this other discretionary spending and going above the trust fund I think is wrong. That is why I call on colleagues, if they really want the $311 billion, or whatever the spending amount is they come up to, not to play games, not do this shadow game being done with a lot of the numbers. I appreciate what the chairman of the Finance Committee has tried to do. He was given a task and he has done the best he possibly could. I think too many games have been played. We ought to be honest. If we want to spin that number and if people want that number, they ought to vote for a gasoline tax increase to pay for it. That should be the only way we do this. Mr. President, I will conclude my remarks by saying I hope we act in a more fiscally responsible way than we are doing within this bill. I am applauding the President for putting his foot down and saying enough is enough. We have to get our fiscal house in order. I yield the floor.

Mr. ENSIGN

Mr. ENSIGN. Mr. President, I ask unanimous consent that the Committee on Agriculture be discharged from further consideration of S. 1537 and that the Senate proceed to its immediate consideration.

Mr. ENSIGN

Mr. ENSIGN. I ask unanimous consent that Senator Grassley be recognized for 2 minutes to make a point, and then I will follow.

Mr. ENSIGN

Mr. ENSIGN. I further ask unanimous consent that the treaty be considered as having been read the first time; that it be referred, with accompanying papers, to the Committee on Foreign Relations and ordered to be printed; and that the President's message be printed in the Record.

Mr. ENSIGN. Mr. President, as in executive session, I ask unanimous consent that the injunction of secrecy be removed from the following treaty transmitted to the Senate on November 24, 2003, by the President of the United States: Mutual Legal Assistance Treaty With Japan, Treaty Document 108-12.

Mr. ENSIGN

Mr. ENSIGN. I ask unanimous consent that the committee amendments be agreed to en bloc, the bill, as amended, be read the third time and passed, the motions to reconsider be laid upon the table en bloc, and that any statements related to the bill be printed in the Record.

Mr. ENSIGN. Mr. President, I ask unanimous consent that the Senate proceed to the immediate consideration of Calendar No. 407, S. 1522.

Mr. ENSIGN

Mr. ENSIGN. I ask unanimous consent that the substitute amendment at the desk be agreed to, the bill, as amended, be read the third time and passed, the motion to reconsider be laid upon the table, and any statements related to the bill be printed in the Record.

Mr. ENSIGN. Mr. President, I ask unanimous consent that the Banking Committee be discharged from further consideration of S. 811 and the Senate now proceed to its immediate consideration.

Mr. ENSIGN

Mr. ENSIGN. I ask unanimous consent that the Senate concur in the House amendment, the motion to reconsider be laid upon the table, and that any statements related to the bill be printed in the Record.

Mr. ENSIGN

Mr. ENSIGN. Mr. President, I further ask unanimous consent that the bill be read three times and passed, the motion to reconsider be laid upon the table, with no intervening action or debate; and that any statements relating to this measure be printed in the Record.

Mr. ENSIGN

Mr. ENSIGN. Mr. President, a lot has changed in the climate of the Middle East since I was there in 1995, but unfortunately not enough has changed. In 1995, the Oslo Accords were signed and suicide bombers detonated themselves on buses around Jerusalem. Eight years later, Israelis continue to face the daily threat of terrorism on their buses, in their grocery stores, in their restaurants, and in their cafes. For them, every single day is September 11. It's hard to imagine that kind of reality and the strength it takes to continue each day not knowing where the next attack will occur. I think about September 11 here in the United States, and the shock many Americans felt--not just at the terrible loss of life, but the fact that terrorists had targeted our people here in our own country-- where they live and work. I remember one commentator back then said-- today, every American learned what it is like to be an Israeli. We came together as a nation to comfort each other, but also to do whatever we could to prevent another attack on our soil and to eliminate the world of the evil terrorists who had targeted our innocent victims. In those moments and days that followed, leaders from around the world called to express their condolences. There were no calls to the United States to show restraint in responding to the terrorists. And it there were, they would have fallen on deaf ears. The world knew that President Bush and the United States would do whatever it took to keep our citizens safe. The security of our nation would always be our priority. But when September 11 happens on a daily basis in Israel, the calls they get are not to express sympathy, but to urge restraint in responding to the attack. Not only is Israel criticized for doing exactly what the United States has done--respond to attacks against its citizens by going after the terrorists where they hide--Israel is even criticized for taking steps to secure its homeland security and prevent further attacks. So where do we go from here? Well, the legislation I am introducing with my colleagues, the junior Senator from Florida, focuses on the fact that Israel has a right to make the security of their country a priority and that such security is a major and enduring national security interest of the United States. The bipartisan Israeli-Palestinian Peace Enhancement Act of 2003 contains strong, unequivocal expressions of the Senate's support for the President's June 24, 2002, speech and the vision of two states living side-by-side in peace and security. However, it expresses the Senate's expectation that the Palestinian Authority must meet certain conditions before a Palestinian state is recognized, including: a leadership not compromised by terrorism; a firm commitment to peace with Israel; the dismantling of terrorist infrastructures in the West Bank and Gaza; sustained security cooperation with Israel; and an end to anti-Israel incitement. It provides concrete, positive incentives for the Palestinians to achieve the reforms called for by President Bush and a negotiated peace with Israel by authorizing significant United States assistance, and a commitment to organize international assistance, to build the new state when it comes into being and has been recognized by the United States and Israel--conditions that can only occur in the absence of terrorism. Ambiguous promises of non-aggression are not enough. Lasting peace means the absence of terror. Without legitimate guarantees for the security of the state of Israel, there can be no lasting peace in the region. Words are cheap--and nowhere are they cheaper than in the Middle East. Until there is Palestinian leadership that is committed to eliminating the terrorist infrastructure, that is serious about making peace with Israel, and that envisions two states existing together, peace will not be known. Who can we trust to support Israel in this hour of crisis? Well, I believe we can trust President Bush. Particularly after September 11, the President understands thee can be no peace without security. He made that clear on June 24, 2002, when he gave an address in the Rose Garden that went above and beyond any other official United States position on the Middle East. He made clear that unless and until Israel has a trustworthy partner on the Palestinian side, there can be no lasting peace. And he emphasized that a Palestinian state could become a reality only after new leaders--not compromised by terror-- were elected and a practicing democracy, based on tolerance and liberty was built. That statement should be the road map to peace. That is why we have taken the principles the President laid out in his June 24 speech, and turned them into legislation. In closing, I would like to thank the original cosponsors of the Israeli-Palestinian Peace Enhancement Act of 2003, including Senator Bill Nelson, Senator Coleman, Senator Lindsey Graham, Senator Crapo, Senator Reid, Senator Bayh, Senator Edwards, Senator Allard, Senator Gordon Smith, Senator Allen, and Senator Boxer for joining me in working toward a lasting and true peace in the Middle East.

Mr. ENSIGN

Mr. ENSIGN. Mr. President, a lot has changed in the climate of the Middle East since I was there in 1995, but unfortunately not enough has changed. In 1995, the Oslo Accords were signed and suicide bombers detonated themselves on buses around Jerusalem. Eight years later, Israelis continue to face the daily threat of terrorism on their buses, in their grocery stores, in their restaurants, and in their cafes. For them, every single day is September 11. It's hard to imagine that kind of reality and the strength it takes to continue each day not knowing where the next attack will occur. I think about September 11 here in the United States, and the shock many Americans felt--not just at the terrible loss of life, but the fact that terrorists had targeted our people here in our own country-- where they live and work. I remember one commentator back then said-- today, every American learned what it is like to be an Israeli. We came together as a nation to comfort each other, but also to do whatever we could to prevent another attack on our soil and to eliminate the world of the evil terrorists who had targeted our innocent victims. In those moments and days that followed, leaders from around the world called to express their condolences. There were no calls to the United States to show restraint in responding to the terrorists. And it there were, they would have fallen on deaf ears. The world knew that President Bush and the United States would do whatever it took to keep our citizens safe. The security of our nation would always be our priority. But when September 11 happens on a daily basis in Israel, the calls they get are not to express sympathy, but to urge restraint in responding to the attack. Not only is Israel criticized for doing exactly what the United States has done--respond to attacks against its citizens by going after the terrorists where they hide--Israel is even criticized for taking steps to secure its homeland security and prevent further attacks. So where do we go from here? Well, the legislation I am introducing with my colleagues, the junior Senator from Florida, focuses on the fact that Israel has a right to make the security of their country a priority and that such security is a major and enduring national security interest of the United States. The bipartisan Israeli-Palestinian Peace Enhancement Act of 2003 contains strong, unequivocal expressions of the Senate's support for the President's June 24, 2002, speech and the vision of two states living side-by-side in peace and security. However, it expresses the Senate's expectation that the Palestinian Authority must meet certain conditions before a Palestinian state is recognized, including: a leadership not compromised by terrorism; a firm commitment to peace with Israel; the dismantling of terrorist infrastructures in the West Bank and Gaza; sustained security cooperation with Israel; and an end to anti-Israel incitement. It provides concrete, positive incentives for the Palestinians to achieve the reforms called for by President Bush and a negotiated peace with Israel by authorizing significant United States assistance, and a commitment to organize international assistance, to build the new state when it comes into being and has been recognized by the United States and Israel--conditions that can only occur in the absence of terrorism. Ambiguous promises of non-aggression are not enough. Lasting peace means the absence of terror. Without legitimate guarantees for the security of the state of Israel, there can be no lasting peace in the region. Words are cheap--and nowhere are they cheaper than in the Middle East. Until there is Palestinian leadership that is committed to eliminating the terrorist infrastructure, that is serious about making peace with Israel, and that envisions two states existing together, peace will not be known. Who can we trust to support Israel in this hour of crisis? Well, I believe we can trust President Bush. Particularly after September 11, the President understands thee can be no peace without security. He made that clear on June 24, 2002, when he gave an address in the Rose Garden that went above and beyond any other official United States position on the Middle East. He made clear that unless and until Israel has a trustworthy partner on the Palestinian side, there can be no lasting peace. And he emphasized that a Palestinian state could become a reality only after new leaders--not compromised by terror-- were elected and a practicing democracy, based on tolerance and liberty was built. That statement should be the road map to peace. That is why we have taken the principles the President laid out in his June 24 speech, and turned them into legislation. In closing, I would like to thank the original cosponsors of the Israeli-Palestinian Peace Enhancement Act of 2003, including Senator Bill Nelson, Senator Coleman, Senator Lindsey Graham, Senator Crapo, Senator Reid, Senator Bayh, Senator Edwards, Senator Allard, Senator Gordon Smith, Senator Allen, and Senator Boxer for joining me in working toward a lasting and true peace in the Middle East.