John Ensign

Mr. ENSIGN

Mr. ENSIGN. Madam President, as our nation appears to draw closer to war, I rise with full consciousness of the burden that each of us has to help guide our nation during this time of peril. It is indeed a heavy burden to bear, but nothing compared to the burden of those who serve in our military. The vote to authorize the use of force in Iraq is one of the most difficult and important votes any of us will ever cast. We need to approach this issue as if we are sending our very own children to war because, in effect, we are voting to send our nation's children to war. Secretary of Defense Donald Rumsfeld recently told Congress that ``a decision to use military force is never easy. No one with any sense considers war a first choice.'' The risks of war are real but the risks of inaction may be even greater. As Ronald Reagan put it in his first inaugural address, ``I do not believe in a fate that will fall on us no matter what we do. I do believe in a fate that will fall on us if we do nothing.'' The threat posed by Saddam Hussein's regime is growing with each passing day. He has, at this moment, chemical and biological weapons he could use against us or share with terrorist networks that threaten us. He is pursuing nuclear weapons. He has used chemical weapons against his own people, and against foreign forces. He has invaded two of his neighbors and fired ballistic missiles at four of his neighbors. He supports terrorist networks, and has harbored senior al-Qaida terrorists in Baghdad since September 11. He has a long-standing hostility toward the United States, because we have denied him his ambition to occupy the territory of his neighbors and dominate the Persian Gulf region. He has openly praised the September 11th attacks, and his state-run press has called them ``God's punishment.'' He has warned that Americans should understand that ``every Iraqi [can] become a missile.'' Each of us needs to carefully weigh the risks posed by his regime the risk of acting and the risk of doing nothing in the face of this threat. And Mr. President, I submit that the risk of inaction far outweigh the risk of war in Iraq. Here is why: For most of our history, America has been able to rely on our geography to protect us. Two oceans, and friendly neighbors, provided a buffer against enemies who might want to attack us. After September 11th, we now know our invulnerability has passed away. We are not only vulnerable to terrorists who use airplanes as missiles we are vulnerable to terrorist networks and terrorist states that want to use weapons of mass destruction against us. As Secretary Rumsfeld has pointed out, when the threats came from conventional weapons, our country could afford to wait for an attack to happen, absorb the first blow, regroup, and then respond militarily. In the age of weapons of mass destruction, however, we can no longer afford to wait. In this new security environment, we must become more proactive in our efforts to prevent attacks that have the potential to be far worse than that of September 11. We must make sure when possible that those who have the desire to attack us are prevented from having the means with which to carry out those attacks. We have a right and an obligation to take anticipatory action in our own self-defense. This certainly would not be the first time that our nation engaged in preventative military action in defense of our homeland. During the Cuban Missile Crisis, President Kennedy ordered a military blockade of Cuba in 1962, an act of war under international law. This was done even though the Soviets were not engaged in an armed attack, nor were the missiles an imminent threat. Today, Saddam Hussein poses a similar threat. And we should give this President the authority he needs to deal with the Iraqi threat now, before it reaches our shores. Saddam Hussein poses a very real and imminent danger to the United States. According to the CIA, Iraq ``has broad capability to attack'' the U.S. ``with chemical or biological weapons and could build a nuclear bomb within a year if it obtains fissile material from abroad.'' Iraq ``probably'' has ``stockpiled more than 100 tons of mustard gas and other chemical weapons. Iraq has developed `large scale' capability to produce anthrax and other bioweapons in mobile facilities that are easy to hide and hard to destroy.'' The longer we wait, the stronger he becomes, and the harder he will be to defeat. Saddam Hussein's regime hosts terrorist networks and has directly ordered acts of terror on foreign soil. He has used weapons of mass murder before, and would not hesitate to use them again. Moreover, Saddam Hussein's ongoing defiance of U.N. Security Council resolutions has made clear that he has no intention of disarming or discontinuing his weapons of mass destruction programs. Remember, our goal is not to get weapons inspectors back into Iraq. Our goal is disarmament. And Saddam Hussein has shown that he is not willing to disarm. To the contrary, he has proven willing to pay an enormously high price to maintain his weapons of mass destruction aspirations. Under U.N. sanctions, he has given up about $180 billion in oil revenue to keep his weapons of mass destruction. As Richard Butler, a former U.N. chief weapons inspector has said, ``The fundamental problem with Iraq remains the nature of the regime, itself. Saddam Hussein is a homicidal dictator who is addicted to weapons of mass destruction.'' Congress recognized that fact in 1998 when it passed The Iraq Liberation Act stating that, ``It should be the policy of the United States to support efforts to remove the regime headed by Saddam Hussein from power in Iraq and to promote the emergence of a democratic government to replace that regime.'' We knew then what we know now-- that regime change and disarmament are inextricably linked. Just like there are career criminals there are career criminal regimes. Leniency only incites them to more violence. They are driven; they are compulsive. And unless they are constantly thwarted they will continue to prey on the weak and defenseless. We cannot stake the lives of tens of thousands of innocent American citizens on the hope that Saddam Hussein will never use his weapons of mass destruction against us. He has already proven that he cannot be trusted, and that he poses a great threat to the peace and stability of the world. This is a critical moment for the United States. If Saddam Hussein is appeased with more talk of weakened, compromised weapons inspections, which he has repeatedly defied, we risk leaving our country open for another catastrophic attack, one potentially far worse than the heinous acts of September 11th. As we debate how to deal with the Iraqi threat, we must never forget that in Saddam Hussein we are dealing not just with a homicidal dictator; we are confronting Evil that is akin to Stalin and Hitler. Just ask former Iraqi general, Najib Salhi. He defected from Iraq and was living in Amman, Jordan when one day he came home to find a package from Saddam Hussein's intelligence service. He opened it to find a video tape. When he put it into the VCR, he saw what he thought was a pornographic film--till he realized, to his horror, that he was watching the rape of one of his closest female relatives. The message was clear. They wanted to blackmail him into silence. That is the face of Evil. Or consider the fact that Saddam Hussein's regime has admitted to having weaponized aflotoxin--the only country in the world known to have done so. As former CIA Director Jim Woolsey has stated, ``The only use of aflatoxin is that it creates cancer, long-term cancer, especially in children.'' Aflatoxin has no military value. It has no battlefield use. It takes tens of years to kill its victim. It is a weapons whose only purpose is to kill innocent people for murder's sake. Richard Spertzel, the former chief biological weapons inspector for UNSCOM, declared that aflatoxin is ``a devilish weapon. From a moral standpoint, aflatoxin is the cruelest weapon--it means watching children die slowly of liver cancer.'' That is the face of Evil. Look at the attacks Saddam Hussein has ordered on his own people--on thousands of innocent men, women, and children--in Halabja, using a chemical weapons cocktail. Those attacks are causing cancer and genetic mutations that will be felt in this generation and the next. That is the face of Evil. Saddam Hussein is a man who has personally shot and killed members of his own cabinet; who has ordered his opponents to be burned alive in vats of acid; who forces those suspected of disloyalty to watch the gang rape of their mothers, daughters, wives, and sisters; who not only tortures dissidents, but tortures their children in front of them. He is the living incarnation of an Evil that cannot be appeased and cannot be deterred, and must be confronted and defeated. He has murdered hundreds of thousands of innocent people--and is pursuing weapons that will allow him to extend his deadly reach across oceans and continents--that will give him the capability to kill our people--our children, our families. The President has rightly called Saddam Hussein ``a student of Stalin.'' And I applaud him for his resolve in confronting the dangers posed by the Iraqi Regime. The President has awakened the world to the existence of evil in our midst--and challenged the world to confront that evil before it confronts us, at the cost of millions of lives. It is a natural reaction to flee in the face of evil. It is little wonder that much of the world has been reluctant to stand its ground and face down Saddam Hussein, which is why the President's leadership has been critical, and why it is so important for the United States Congress to show similar resolve, and demonstrate our unity with the President. In showing steadfastness and steely determination, the President made clear to the Iraqi regime, and the world, that we were not going to repeat the tired old pattern of meeting Iraq's threats with inaction. And that leadership has had an impact. One by one we have seen nations join the U.S. in recognition that Saddam must go. Some have said so publicly, others privately. Let there be no doubt: if we go to war, we will not be going it alone. Thanks to our President, the world understands that there is a price to be paid for defying the United States when our survival is at stake. And I believe that a strong show of support by Congress will strengthen the President's hand at the United Nations. While we greatly value the support of our allies in the war on terror, we must never give other nations the authority to stop us from defending our freedom or from acting in our own self-defense. We must do what we feel is right in protecting America, whether or not we have the approval of France, Russia, China or any of the other nations which currently sit on the U.N. Security Council. None of us takes the prospect of war lightly. War is difficult and dangerous, and lives will be lost. I understand the concerns many Americans have about war in Iraq, and I fully appreciate the sacrifice American families make when they lose a loved-one in the fight to keep America and the rest of the world free from tyranny and oppression. This country lives, freedom lives, because brave men and women were willing to die for it--willing to risk their lives, and give their lives, for a cause greater than themselves. As scripture teaches ``there is no greater love than this: that a man lay down his life for his friends.'' We are all concerned for the well being of our troops, and we thank them for their willingness to keep America safe from the evil that has been made so apparent in the last year. While I value diplomacy and rhetoric, there comes a time when force is inevitable--when our choice is not between war and peace, but between war today, when our enemy is weaker, or war tomorrow, when our enemy is stronger. That is the choice we face today. We have tried diplomacy. We have imposed sanctions. We have sent inspectors. All attempts to reason with the Iraqi Regime have failed. The only language Saddam Hussein understands is force. Indeed, in a way, we are already at war with Iraq. Since hostilities ended in 1991, Iraq has repeatedly violated the ceasefire conditions which were set out at the close of the Gulf War. Just ask our brave pilots who are being shot almost every day as they patrol the no-fly zones over Iraq. After President Bush's speech to the U.N., Saddam Hussein sent a letter to the U.N. promising to ``allow the return of United Nations weapons inspectors to Iraq without conditions.'' He went on to say that Iraq ``based its decision concerning the return of inspectors on its desire to complete the implementation of the relevant Security Council resolutions and to remove any doubts that Iraq still possesses weapons of mass destruction.'' Hours after that letter arrived at the U.N., Iraq was shooting at U.S. aircraft implementing those same relevant U.N. Security Council resolutions. Since 1992, the Iraqis have used anti-aircraft artillery, or Triple-A, against our aircraft in the northern and southern no-fly zones. In fact, over the last three years Iraqi Triple-A has fired at coalition aircraft over 1,000 times. This year to date they have fired on us over 400 times--and since that September 16 letter where Saddam pledged his support for U.N. resolutions they have fired on coalition aircraft more than 70 times. It appears that Iraq has actually stepped up its firing on U.S. and British planes since he agreed to cooperate with the U.N. Actions speak louder than words. And for 11 years Saddam Hussein's actions have shown that he is bent upon pursuing weapons of mass destruction at all costs. After all, three days after Saddam Hussein's September 16th letter pledging the unconditional return of weapons inspectors, Iraq's foreign minister stated U.N. resolutions were ``unjust and at odds with the U.N. charter and international law.'' He further declared, ``Iraq demands that its inalienable rights are met, including respect for its sovereignty, security and the lifting of the blockade imposed on it.'' Then Baghdad stated that the 1998 Memorandum of Understanding which exempted certain presidential palaces must stand. I am sure we will hear from time to time that Baghdad is once again stating that unconditional inspections could take place. The words change, but the actions stay the same. They keep right on firing at our pilots. Madam President, on September 11, 3,000 innocent citizens were killed. If their deaths are to have any meaning, our nation must not forget the lesson they gave their lives for us to learn. The era of our invulnerability is over. Evil exists--it is real, it is out there, and it seeks our destruction. If we ignore it, it will not go away. It will continue to stalk us, and kill more of our people. It must be confronted and it must be defeated. ``There is a time for all things,'' the Rev. Peter Muhlenberg told his congregation on the eve of the Revolutionary War, ``a time to preach and a time to pray. But those times have passed away. There is a time to fight, and that time has now come.'' We have listened and we have prayed. Now we must fight. For the best honor we can bestow on those who have died for our nation, and those who will die for our nation, is victory. Victory over terrorism. And if the President believes it is necessary to secure our freedom, victory over the regime of Saddam Hussein. Madam President, I yield back the remainder of my time.

Mr. ENSIGN

Mr. ENSIGN. Mr. President, one year ago, this Nation stood united. Together we mourned, prayed, and hoped. We hugged our loved ones a little bit longer and a little bit tighter. Our hearts wept for the thousands of families who unexpectedly and unbelievingly lost a husband or wife, a mother or father, a son or daughter at the hands of evil. It's hard to believe that an entire year has passed since that surreal day. While we have observed holidays, celebrated milestones, and continued with life, there are still daily reminders of the horrific events of one year ago. Flags still fly more frequently than before, security precautions still cause delay, and our hearts still weigh heavy when we think about the dreams that were cut short that tragic day. As we remember September 11, I encourage you to make today a day of introspection and compassion. Remember where you were last year when you heard the news. Remember the footage you watched in disbelief. Remember the pain you felt in your heart. Take those images with you throughout the day. Make it a point to leave work on time, have dinner with your family, talk to each other about what today means, and hug your loved ones a little bit longer and a little bit tighter. On your own or as a family, consider doing something for your community in honor of the victims of 9/11. It can be donating blood, making a financial contribution to a needy cause, or giving your time and energy to a worthwhile organization. I hope that we can all make today a positive and meaningful opportunity to unite our communities in helping others and honoring the victims of 9/11. Together we will send a strong message to the world that Americans remain united. Time will not steal our memory of the victims and attacks of September 11.

Mr. ENSIGN

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

Mr. ENSIGN. Madam President, I rise today to express my strong support for the Craig-Domenici hazardous fuels reduction amendment which is currently before the Senate. It is my hope that we can come to a consensus on this issue for the benefit of the forests, the animals that inhabit them and, more importantly, the people whose homes are near them. In my home State of Nevada, our all-time worst fire was in 1999. That season set an all-time record for the severity and breadth of fire damage. Nevada experienced over 1,100 fires which burned almost 2 million acres. To put that in perspective, in 1999 the total number of fires was 135 percent of the 5-year average and the total acres burned were almost eight times what we normally burn during 5-year periods. More acres were burned during a single 10-day period in August than had burned in any entire previous season on record. I am afraid 2002 could be another year like 1999. This year, Nevada is experiencing its fourth year of drought that has been classified from ``moderate'' to ``exceptional.'' Large fire activity began in mid- to late-May--about 3 to 4 weeks earlier than normal. And, quite honestly, we have been very lucky compared to other States such as Arizona, Colorado, Oregon, or California. We are grateful for that. But we know all too well that Nevada's fire season lasts longer than other States'. We still have the potential of a devastating fire season yet to come this year. With the current extreme drought condition combined with the buildup of dead and dying fuels, Nevada is placed in the ``extreme'' and ``advanced'' categories for potential fire behavior. I am particularly concerned about the Lake Tahoe Basin. When my family visited that area in August, I noticed the dry conditions of the area. There is no question that Lake Tahoe is a blazing inferno waiting to happen. The Lake Tahoe Basin is under the highest risk of wildfire potential. The entire region is classified as a class 3 risk for catastrophic fire. What is so distressing is that the land of this area is so environmentally sensitive. A catastrophic fire in the basin would result in an incredible amount of damage to communities. Homes and structures worth billions of dollars would be lost. Lake Tahoe, one of the Nation's crown jewels, could lose its defining quality of lake clarity. Millions of tourists come every year to recreate in the basin. Key recreation areas would be destroyed. A fire could cause tremendous damage to the sensitive watershed which feeds not only Lake Tahoe but supplies water to communities in Reno, Carson City, and the rest of northwest Nevada, eventually emptying into Pyramid Lake. The ecological consequences are distressing as well. Lake Tahoe is home to one of our Nation's proudest symbols--the bald eagle. Other endangered and threatened species are native to the basin. Their safety is threatened by fire. It is clear to me and anyone who actually goes out into the forests that something must be done to reduce the fuels buildup to prevent the outbreak of catastrophic fire. That is why I am an original cosponsor of the Craig-Domenici amendment. Currently, 74 million acres nationwide are classified as class 3 forests, which is the highest risk for catastrophic fires. The Craig- Domenici amendment will limit action to only 10 million of the 74 million class 3 acres. It is an emergency amendment. It only addresses 7 percent of the problem. I wish it would address more of the problem. Highest priority will be given to wildland-urban interface areas, which are areas near homes and communities, municipal watersheds, and forested areas affected by disease, insect infestation, and windthrow. The amendment seeks to cut through the bureaucratic mess that is currently in place that often needlessly delays implementation of these projects. It also seeks to expedite the judicial process. Too often, these essential fuels reduction projects are halted by frivolous lawsuits. Ultimately it is the forest and wildlife habitat that suffer. That is the case in my State where two projects in the wildland-urban interface were challenged by an outside party. The challenger was not even from Nevada. All the people in Nevada had agreed-- environmentalists in Nevada, the Forest Service in Nevada, the BLM in Nevada, and all the local people in Nevada--that this project was meritorious and was good for the environment. Yet somebody from the outside challenged in court and was able to block this important environmental project. Public land managers must be allowed to manage the land. Unfortunately, only one dissenter can stymie a completely collaborative effort to clean the forests. Without proper forest management, an accidental blaze can turn into a flaming inferno which can sterilize the land and destroy the habitat for many endangered species of plants and animals. The groups that are against our efforts claim they are environmentally friendly. What is environmentally friendly about obstructing sound management projects from going forward? Wildfires contribute heavily to air pollution, destroy wildlife habitat, and kill endangered species. While we were in Lake Tahoe this summer, the entire basin--which is truly one of the most beautiful areas in the world--was filled with smoke from the fires from far off in California and from Oregon. Anybody who is against air pollution ought to be for stopping and preventing these forest fires. Extremists in the environmental community claim they are concerned about the welfare of wildlife habitat and forest health. Yet they oppose commonsense projects that seek to lessen the devastating effects of catastrophic wildfires. This amendment seeks to ensure that fuel reduction projects continue in spite of these extremists. This legislation is absolutely necessary. It is necessary this year. It was actually necessary last year and many years before. Every year we talk about how we need to save the forests, but we do nothing to clean the forest to reduce the intensity of fires. We must be able to conduct these fuel reduction projects. Advocates on both sides of the aisle and both sides of the political spectrum agree on this. They are essential to continue the health of our forests. We have waited long enough. Our forests have waited long enough. I say to my colleagues, let us get this done. The fires we have seen this year are unprecedented. I, for one, am committed to do all I can to ensure that forests are protected, watersheds are protected, homes protected, and, most importantly, people are protected. I yield the floor. I suggest the absence of a quorum.

Mr. ENSIGN

Mr. ENSIGN. Mr. President, I rise today, along with my good friend, the Senator from New Jersey, to introduce a bill that will help solve the affordable housing crisis that is facing this Nation. There is a dramatic shortage of rental housing that is affordable to low and moderate income working families. FHA multifamily insurance programs are designed to stimulate the construction, rehabilitation and preservation of properties by insuring lenders against loss in financing first mortgages. The programs assist both the private and the public sectors towards the goal of providing affordable housing to those that otherwise may not be able to afford it. Last year, in a remarkable step, Congress granted a 25 percent increase in the FHA multifamily loan limits. The new loan limits are one great remedy to the affordable housing crisis facing our nation, but this alone does not do enough. Unfortunately, without additional legislation, the loan limits will again be outpaced by inflation and today's growing construction costs. The legislation that we are introducing solves this problem by indexing the multifamily loan limits to the annual construction costs index of the Bureau of the Census. This will allow loan limits to increase automatically, as costs increase. Without such a fix, the FHA multifamily loan program will again be limited in its ability to stimulate the development of affordable housing. This legislation will help halt the growing shortage of affordable rental housing faced by millions of Americans and give builders and lenders the confidence that they will be able to use the programs in their communities every year, even as construction and land costs rise over time. Additionally, this legislation raises the loan limits in high-cost areas. This will allow several major urban markets to take advantage of the new FHA multifamily insurance programs, and to provide much needed new affordable housing to low and moderate income families. I believe this legislation is an important step in our ongoing battle to ensure that each American has access to affordable housing. I would like to once again thank the Senator from New Jersey, Mr. Corzine, for his hard work on this bill, and for recognizing the significant effect this legislation will have for many low and moderate income families by dramatically increasing their access to affordable housing.

Mr. ENSIGN

Mr. ENSIGN. Mr. President, I rise today, along with my good friend, the Senator from New Jersey, to introduce a bill that will help solve the affordable housing crisis that is facing this Nation. There is a dramatic shortage of rental housing that is affordable to low and moderate income working families. FHA multifamily insurance programs are designed to stimulate the construction, rehabilitation and preservation of properties by insuring lenders against loss in financing first mortgages. The programs assist both the private and the public sectors towards the goal of providing affordable housing to those that otherwise may not be able to afford it. Last year, in a remarkable step, Congress granted a 25 percent increase in the FHA multifamily loan limits. The new loan limits are one great remedy to the affordable housing crisis facing our nation, but this alone does not do enough. Unfortunately, without additional legislation, the loan limits will again be outpaced by inflation and today's growing construction costs. The legislation that we are introducing solves this problem by indexing the multifamily loan limits to the annual construction costs index of the Bureau of the Census. This will allow loan limits to increase automatically, as costs increase. Without such a fix, the FHA multifamily loan program will again be limited in its ability to stimulate the development of affordable housing. This legislation will help halt the growing shortage of affordable rental housing faced by millions of Americans and give builders and lenders the confidence that they will be able to use the programs in their communities every year, even as construction and land costs rise over time. Additionally, this legislation raises the loan limits in high-cost areas. This will allow several major urban markets to take advantage of the new FHA multifamily insurance programs, and to provide much needed new affordable housing to low and moderate income families. I believe this legislation is an important step in our ongoing battle to ensure that each American has access to affordable housing. I would like to once again thank the Senator from New Jersey, Mr. Corzine, for his hard work on this bill, and for recognizing the significant effect this legislation will have for many low and moderate income families by dramatically increasing their access to affordable housing.

Mr. ENSIGN

Mr. ENSIGN. Madam President, I wish to talk about the Graham-Miller amendment for prescription drugs. First, I compliment the people who have been working on it. We think they are at least going in the right direction. They have adopted some of the parts of the bill that Senator Hagel and I had proposed, but I believe there are some fundamental flaws in the amendment as currently drafted. I was in a working group yesterday. I tried to point out some of these flaws, and I want to point those out on the floor because I think these are very important issues that we get fixed in any prescription drug bill that we eventually, hopefully, pass out of the Senate and someday get to the desk of the President. In the Graham-Smith amendment, for the people above 200 percent of poverty, they use the catastrophic bill; they use basically what Senator Hagel and I had talked about, where seniors pay out of pocket for the first x dollar figure and then above a certain dollar figure the Government would step in and take care of the costs. The problem is in the category of people below 200 percent of poverty, they basically give them full coverage with very little expected of the senior--only $2 for generic drugs on a copay and $5 for name brand drugs. Those seniors in that income category are not going to be held accountable. That is not enough money out of pocket to affect their behavior, in my opinion. The reason they have to be held accountable for the behavior is because we do not want people abusing the system and taking drugs. People say, well, these are prescription drugs. Why would anybody just get prescriptions? I happen to be a veterinarian by profession and have worked with people coming in with their pets. Talk to any pediatrician, any family practitioner in human medicine, it does not matter, they will tell you that people come to them, however they are feeling, if they are feeling ill, regardless of whether they need antibiotics, they expect them or they expect some kind of a prescription. With children in this country, we understand when their parents bring their kids to the doctor for an ear infection--almost all of those ear infections are caused by viruses. Viruses do not respond to antibiotics, yet almost every time when somebody walks out of the doctor's office for their kids' ear infection, that child is put on antibiotics. It is one of the reasons we have so many drug-resistant secondary bacterial infections in ear infections--because we treat with antibiotics. The virus is there, it kills normal-growing bacteria, and you get a secondary bacterial infection, which is a reason that a lot of kids need to have tubes put in their ears, along with all kinds of other problems. It is the same problem with a lot of seniors. If you are sick, you go to the doctor--you have a virus, whatever it is; you have a complaint, you expect to get better. A lot of times, physicians will prescribe medicine simply as a placebo effect. They know if I do not give this person something, they will go to another doctor. If the person is paying out of pocket, there is some incentive to ask the questions: Do I need these medications? Can I get a better price? Maybe I should buy the generic. The only difference between $2 and $5, generic versus brand name, is not necessarily that great incentive, but if they paid the first dollars out of their pocket, which is what our bill required, based on income--a sliding scale based on income--they would pay the first dollars out of pocket. For instance, somebody who made around $15,000 to $17,000 a year under our bill would pay, on average, $100 to $120 a month out of pocket. After that, other than a small copay, the Government would pick up the costs. That person with diabetes, taking five or six different drugs, would have gotten the help they need without losing all of their assets. Right now, they get no help, and our bill would have given them the help. Because we had some complaints about our bill--that if you make $1 more than $17,700 a year, you went from a maximum out-of-pocket expense of $1,500 to $3,500--we are trying to build more of a gradual scale into our bill so there will not be the dramatic dropoffs. We are also trying to put some of the money and give low-income seniors a little more help under our bill. We think we will be able to do this and still be within the $300 billion budget. What is important about being in the $300 billion budget? The fact is, unless we are within $300 billion, we are violating the budget we set up. That is the reason it needs a 60-vote point of order. If our bill were reported out, if it were done properly, if we would take our bill, report our bill out of committee, and take all of the bills that have been voted on, report them out of committee, our bill is the only one that could become law because it is the only one that only would have needed 51 votes. Our bill got 51 votes. The bill tomorrow that will be voted on, from what I understand, will only get 54 or 55 votes and therefore will not be able to waive the budget point of order. If the majority leader would take our bill to the Finance Committee, let that bill be reported out of the Finance Committee, we actually could have this process go forward. Our bill, within the budget, would not need the 60 votes. It does not seem as though any proposal will get the necessary 60 votes. So let's work together, go through the process, through the Finance Committee, and report out a bill like this. We are willing to work with people on the numbers. As long as we can fit within the $300 billion budget number, we will not have to get the 60 votes and we can get a bill reported out of the Senate. If we want to look at seniors this next year and say, we are really going to be helping you, I believe our proposal should get serious consideration from people. For those seniors who truly need the help, I don't believe we should look at them, especially with the November elections coming up, and say, sorry, politics got in the way again. The Republicans are blaming Democrats, Democrats are blaming Republicans, and the bottom line is seniors are not getting the help they need. I truly believe we need to give the seniors some prescription drug benefit. However, I also believe we need to do it in a fiscally responsible way for the young people in the United States. If we do not do that, we will regret it in the future. Let's work together on this and pass a real prescription drug benefit that we can afford. I yield the floor.

Mr. ENSIGN

Mr. ENSIGN. Mr. President, I thank the senior Senator from Kentucky for yielding time. There is a serious crisis going on in the State of Nevada. We have heard here today that insurance rates are not going up. Let me tell you that they are dramatically going up in Nevada, and it is because jury awards are out of control. About one-half of the doctors in southern Nevada have their homes up for sale because they cannot afford increased medical liability premiums. Whether these are OB/GYNs or neurosurgeons or orthopedic surgeons, many of the specialists are taking their practices and moving them to States that have enacted tort reform and/or medical liability reform measures that are similar to the McConnell amendment we are considering here today. In my State right now, obstetricians are telling pregnant mothers in late stages of pregnancy they will not deliver their babies. We are the fastest growing county--Clark County--in America. Yet these obstetricians are saying they are not taking any new patients. OBs are saying they will not take any new patients because they cannot afford to, and those are the ones who are staying in town. Unfortunately, many of them are leaving. Let me give you an example. There is a couple who are both OB/GYNs who practice together. In fact, they delivered my wife's and my three children. They have already been in several meetings to move their practice to either northern or southern California where their medical liability insurance rates would be about one-fifth of what they would pay in the State of Nevada. On July 3, our only level 1 trauma center closed for 10 days. This trauma center services four States. If someone has a serious accident and has severe trauma, this is where they would get the kind of care necessary for saving their life. The reason it is closed was, once again, was because doctors were afraid they would not be able to get the kind of insurance coverage they needed and they would lose everything they worked for their whole life if they were sued. The only reason it was reopened was because they were afforded insurance coverage that included a $50,000 cap on damages. They were told--If you practice here, and there happens to be some kind of a malpractice, we will cap the jury award at $50,000. Now, there are no such caps in the McConnell amendment we are discussing. However, I believe very strongly in caps on non-economic damages. I wish they were part of this amendment. As a matter of fact, yesterday Nevada's Governor proposed and laid out a compromise with Republican and Democrat legislators in which there would be a $350,000 cap on jury awards for non-economic damages. You would be able to recover, through economic damages, everything you would have ever earned and expenses you incurred for medical bills. But on non-economic damages there would be a $350,000 cap, except in cases where treatment was received at the trauma center--that would be kept it at a $50,000 cap. They did this because they know that it is the only way they can keep the trauma center open. In any case, there are several other provisions in the McConnell amendment that are very important. This idea of joint and several liability was mentioned. The Senator from Massachusetts talked about this; that it is important to keep joint liability so the patient would be able to get the whole award. Now let me tell you what this really means. If you are practicing in a trauma center, and if you are responsible for 1 percent of the medical malpractice that happened in a particular case, you can be held responsible for 100 percent of the jury award. Is that fair? That isn't fair. That is also one of the reasons rates continue to go up across the country. Neurosurgeons are leaving our State. This isn't about trial lawyers versus doctors. This is about availability of doctors. This is about whether we are going to have people such as Senator Bill Frist--a very talented heart surgeon--continue to go into the practice of medicine and who want to save lives. We have people who are not only leaving our State, but who are just retiring their practices early because of this crisis. One of the best surgeons in Las Vegas--a gastrointestinal surgeon-- was planning on retiring in 1 year. He actually retired this year because had he stayed in the practice an additional year, he would not have only had to pay $200,000 for insurance this year, but he would have faced what is called ``tail coverage''. Tail coverage is what a doctor pays when they quit practicing or change insurance companies in order to cover any claims which might arise from when they were covered under the previous company or while they were still practicing. He would have had to pay another $400,000 just for tail insurance. He makes about $200,000 a year. So, it would have cost him $600,000 to practice while he would have only earned $200,000 for the year. It was obviously ridiculous to stay in business, so he quit practicing. Las Vegas and southern Nevada lost one of their best surgeons because of early retirement, leaving even more patients without the services of a highly-trained, highly respected physician. That kind of situation is indicative of how badly broken the system is. Let me briefly mention just one of the abuses in our civil justice system and how that contributes to the overall problem we are having in runaway jury verdicts. If you are accused of medical malpractice you are brought into the courtroom, at which time the case is laid out. At some point during the case, ``expert'' witnesses are called to testify. I put ``expert'' in quotations because many physicians can be brought in as an expert. Unfortunately, there are physicians who are now working in concert with trial lawyers, and it is really their business to become expert witnesses even though they are not experts. Not to impugn their motives, but certainly this happens, and many times the abuse is blatantly outrageous. Yet the jury hears from the supposed ``experts,'' and in main part of that testimony, medical malpractice is found by the jury. This illustrates what is happening in States and cities all across the United States. It is a system that is prejudiced toward finding malpractice. While the McConnell amendment does not specifically address this issue, it does help bring some accountability and feasibility back to our civil justice system. I am a veterinarian, and I have worked in the health care profession for some time. Anybody who has worked in health care understands human error. Do you know why? It is because we are humans who practice. And anytime you have human beings practicing a profession, you are going to have errors--sometimes errors that can't be helped. There are some very sad cases, and we want to ensure those people continue to be able to have a remedy. But, outside of providing appropriate compensation, our system of secondary recovery it is out of control. The system needs to be brought back into balance. The bottom line is when you have human beings, there are errors. However, we must remember that often times those errors are not malpractice. The physician did not intend to hurt his or her patient. But more often than not, it can appear as malpractice to a jury. We need to make sure that we have a system in place that most justly adjudicates each and every case on its merits, and fairly places culpability where it should be placed. Under the current system, juries are out of control with awards that we are all paying for. Medicare costs and private insurance premiums are higher, and they keep going up every year. There are several factors that contribute to this rise in costs, but none more than the excessive, unfounded awards given out by juries on a seemingly regular basis.

Mr. ENSIGN. Let's enact this amendment to bring about some reasonable reforms to our medical liability system in the United States. There is a crisis happening right now in my home State of Nevada. Obstetricians are telling pregnant mothers in late stages of their pregnancy that they can't deliver their babies. On July 3, our only Level One trauma center closed for ten days, leaving victims of car accidents and gun shot wounds without appropriate care. Officials are saying it will probably have to close again. Neurosurgeons are canceling operations with patients who have spinal cord injuries that adversely affect every second of their daily lives. In fact, as I talk to you right now, the Nevada Legislature has been forced to meet in a special session with Governor Kenny Guinn to address this crisis. What is the common thread between these events? It lies in the fact that all of these health care providers are unable to afford the skyrocketing cost of their medical malpractice insurance. So, if this is a Nevada problem, then why would I bring this issue to the floor of the United States Senate? Because it is no longer just a Nevada problem; it is now a nationwide problem. President Bush recognized this fact last week when he called our medical liability system ``badly broken,'' and emphasized the immediate need for Federal medical liability reform. In order to illustrate this urgent need, let me give you some examples of what I am talking about: In Bisbee, AZ, the only maternity ward has closed. Expectant mothers must now drive more than a half hour to the nearest town to deliver; In Broward County, FL, 14 of the 16 practicing neurosurgeons are uninsured; In Mississippi, 324 doctors have stopped delivering babies in the last decade. Today, only 10 percent of family doctors will deliver babies; In Wheeling, WV, all of the neurosurgeons have stopped practicing. I could go on and on about a number of different States. We have to examine why this current crisis is happening. What it boils down to is two factors: affordability and availability. On affordability, let me give you a statistic from the American Medical Association. In 2000, medical liability insurance rates increased by at least 30 percent in 8 States, and by at least 25 percent in more than 12 States. I don't know too many physicians that can afford such rates. These rates are forcing more physicians, hospitals, and other health care providers to limit their practices or leave the profession altogether. On availability, thousands of doctors nationwide have been left with no liability insurance as major liability insurers are either leaving the market or raising rates to astronomical levels. Now, why are insurers raising rates and/or leaving the market? Because there is no stability in the marketplace for providing medical liability insurance. Why is there no stability in the marketplace? Because our healthcare system is being overrun by frivolous lawsuits and outrageous jury awards. Let me give you some statistics to illustrate these points. This information is according to the Physician Insurers Association of America's Data Sharing Project: Since 1998, the average claim payment value has risen from approximately $130,000 in 1988 to $330,000 in 2001. Likewise, since 1988, the median claim payment values have risen from approximately $50,000 in 1988 to $175,000 in 2001. In 1985, less than 1 percent of the claims that were paid were equal or greater than $1 million. Contrast that to 2001 when 7.9 percent of the claims paid were equal or greater than $1 million. This excessive litigation is leading to higher health care costs for every American and an unstable piece of mind for our health care providers. To fend off litigation, healthcare professionals are forced to practice defensive medicine by ordering unnecessary tests just so that they will not be sued for ``under-diagnosing'' their patients. A recent study by the Department of Health and Human Services found defensive medicine is costing the Federal Government an estimated $28 billion to $47 billion in unnecessary healthcare costs. And who else pays for those unnecessary costs? Every American with health insurance, in the form of higher premiums. Gone are the days when our civil justice system was used to help protect patients. Now we are left with a system that is used to primarily fatten the wallets of personal injury attorneys. More often than not, medical liability claims are more financially beneficial to the lawyers than they are to the injured and sick patients. According to the Physician Insurers Association of America's Data Sharing Project, only fifty cents of every dollar paid in medical liability awards go to the patients. Only 50 cents. Additionally, nearly 70 percent of all medical liability claims result in no payment to the plaintiff. So what does all this mean? It means that we need to bring some accountability back to the civil justice system by way of medical liability reform. Not only would this allow physicians to continue to concentrate fully on providing superior care to their patients, it would help tremendously in curbing the skyrocketing costs of healthcare for consumers. In addition, and probably even more staggering, is the success rate of most medical liability claims. Consider this information: In 2001, only 1.3 percent of all claims filed ended in a verdict for the plaintiff. In contrast, 61.1 percent were dropped or dismissed for various reasons. These numbers highlight the significant amount of frivolous lawsuits that are filed, costing healthcare professionals valuable patient time, and ultimately costing every insured American millions in increased health care costs. Medical liability reform is not something that is new to the Senate. During debate on the 1995 Product Liability Bill, the Senate considered and voted on medical liability reform proposals. In fact, one of those proposals is the exact amendment that we are considering here today. This amendment takes a sincere and aggressive approach toward helping reign in our out of control civil justice system. It does so in the following ways: sensible limits on punitive damages; elimination of joint liability on most damages, making sure that defendants are only liable for their fair share; modest limits on attorney's fees in medical malpractice cases to maximize patient recovery; collateral source reform to prevent plaintiffs and attorneys from ``double dipping'' for compensation; alternative dispute resolution to encourage states to develop mechanisms to help resolve disputes before they go to court; and periodic payments for large awards. Although I am strongly in favor of this proposal, I must mention that the one significant provision it is missing is a cap on non-economic damages. I believe this cap could only strengthen the proposal we are considering today. However, every other reform in this amendment has proven to be effective in bringing accountability back to the civil justice system. This amendment was passed in 1995 on a vote of 53-47. Therefore, with the number of Senators who supported this proposal before, coupled with the number of senators whose States are facing a medical liability crisis, I think we have an excellent chance to pass this amendment. Just to highlight that point, a recent study conducted by Wirthlin Worldwide found that 78 percent of Americans express concern that skyrocketing medical liability costs resulting from the current system could limit their access to care. Clearly, the American public sees the crisis we care facing and are calling for nationwide reform. Americans are afraid they will not have anyone to deliver their babies or perform life-saving procedures on their loved ones in emergencies, and they should not have to be. If there are senators here today that are still not convinced about the need and overall effectiveness of medical liability reform, let me briefly explain how to put your doubts to rest. Let's take a look at the wildly successful Medical Injury Compensation Reform Act (MICRA) of 1975 that California has in place. Now, I will concede that the amendment before us is not identical to MICRA, but it does incorporate all but one of the major provisions that MICRA contains. To further explore the impact of MICRA, just look at the difference between how medical liability premiums have risen in California versus the rest of the United States. According to the National Association of Insurance Commissioners, from 1976 through 1999, California's insurance premiums has risen 167 percent, while the other 49 States' premiums have risen 505 percent. Obviously, MICRA has brought about real reform in California's professional liability system, while still protecting the rights of injured patients. Studies have shown the following. The number of frivolous lawsuits going to trial has declined dramatically; injured patients receive a larger share of their awards; the number of disciplinary actions against incompetent health care providers has increased. The bottom line is that California's medical liability system works. Shouldn't these types of outcomes be shared by every state, and ultimately every patient, in America? Again, the amendment before us contains all but one of the major provisions that MICRA entails, so each senator has something to substantiate their vote. And let us remember one important point we are NOT limiting the amount of economic and non-economic damages that can be recovered by the patient. All we are doing is bringing some accountability and reasonability back to our civil justice system in the form of common-sense reforms which I know will lead to lower health care costs for every American. I know it is possible to pass these types of reform measures through the Houses of Congress, because while I was a member of the House of Representatives we passed some type of medical liability reform measure six times. Unfortunately, each time it was stalled in the Senate and real reform was never enacted. But the next time around I am hopeful that it will be different. And there is no better time than now for the Senate to make a strong statement on behalf of American patients. Let's make sure there are no more expectant mothers turned away at the door and refused pre-natal care. Let's make sure trauma patients receive immediate and appropriate medical services. And, let's make sure that we continue to provide patients everywhere the opportunity to receive affordable, accessible, and quality health care for years to come.

Mr. ENSIGN. Mr. President, let me finish my statement, and then I would be happy to yield. In the State of Nevada last year, the average OB/GYN made about $200,000. Now, taking into consideration that figure, their insurance rates went from about $35,000 a year to about $130,000 a year. We can't pass that cost on anymore. That means basically every OB/GYN in southern Nevada is going to have to either see double the number of patients they are seeing now or just quit practicing altogether. There is a huge incentive for these doctors to go to California where their rates will not only not go up, but they will actually go down from what they were the previous year. I keep mentioning California because California enacted the Medical Injury Compensation Recovery Act (MICRA). MICRA has all the reforms that are in Senator McConnell's amendment--plus they have the $250,000 cap on noneconomic damages. MICRA has been challenged in the courts four times. It has been upheld four times. It is not that people in the State of California do not receive injury awards. It isn't that the people in California are disadvantaged in some way so the patients don't get what they need. There was a situation in 1975 that California recognized as a crisis. Because of court challenges, the bill didn't actually take effect until 1985. But since that time, they have had a stable situation where insurance companies know approximately what is going to happen and know how much their costs are going to be. Consequently, their rates have stabilized. There are about 12 States right now, according to the American Medical Association, that are in crisis, Nevada being the worst of all. Because of this crisis, Nevada's Governor had to call a special legislative session. Now, we only meet every 2 years in our legislature. Therefore, he had to call a special session just to deal with this severe crisis that is going on right now.

Mr. ENSIGN

Mr. ENSIGN. If the Senator will yield.

Mr. ENSIGN. Madam President, I will address a couple of matters the Senator from Massachusetts talked about. First of all, the Senator said the plan in Massachusetts was more generous than this plan. It is a different plan in that it is a first-dollar coverage plan. I don't know if the numbers have been updated, but according to the report from the GAO, in Massachusetts, if you are 150 percent of poverty or below, you are covered up to a maximum out of pocket of $1,250. That is according to this report. The bottom line is the difference is Massachusetts covers the first dollars, but it caps the amount that Massachusetts will pay. Our plan caps the amount the seniors will pay. That is the difference. If they want to do first-dollar coverage in Massachusetts--and that is what we do in the State of Nevada--that is up to the State. What we want to do is say to the seniors, you will have the amount capped that you can actually pay out of your pocket so you don't end up going into poverty. Why didn't the State of Massachusetts make a more generous benefit? They only did it up to 150 percent of poverty. Why? Are people making more than $12,000 a year rich? Can they afford some of the outrageous drug costs? Of course they cannot. The reason they did that is because that is all the State of Massachusetts believed they could afford at the time. Do what you can with the money you have. The Federal Government is not unlimited in its resources. We have to be fiscally responsible to the next generation. Yesterday the amendment that the Senator from Massachusetts supported was outlandish. It would bankrupt this country and bankrupt Medicare. I believe it was irresponsible in the long run to the next generation. This bill we present today is responsible, but it provides the coverage seniors really need. When you combine it with the help the States are giving, those low-income seniors, those sad stories we have heard, those people are truly going to be helped. I yield the floor.

Mr. ENSIGN. Mr. President, I want to clear up a couple points the Senator from New York talked about. He said no benefit for somebody until they pay out-of-pocket expenses. He forgets the drug discount card which will save seniors somewhere from 20 up to 40 percent because of volume buying. So they immediately benefit, anybody who signs up for the plan. Our plan fits really well--I talked about this before--with those State plans that are already out there. The State of Nevada has a great plan using tobacco money. Other plans in States work very well with our plan. Those seniors who need help the most will get the help under this plan. Let's be honest about this plan. It is fiscally responsible to the next generation but also truly does get the help to the seniors who need it today.

Mr. ENSIGN. Mr. President, we are coming to the close of this debate. A couple of things need to be cleared up. There has been talk about the estate tax versus prescription drugs. Medicare is a program that is paid for out of the payroll tax. It has always been that way. Hopefully, it will always be that way. Payroll taxes pay for Medicare. Our amendment, we believe, is responsible. The difference between our bill is that the seniors pay their first dollar out of pocket for coverage. The other bills, the seniors pay a portion of the first dollar out of pocket. The reason for that is we thought it was important to keep the senior in the accountability loop. I mentioned that earlier in the debate, but it needs to be reemphasized. When seniors or any other patients in health care do not have to think about the financial aspects of their care, whether it is in purchasing drugs or in getting their health care, if they are only paying a small portion, they do not even think about that. But if they are paying the first dollars--and in our plan, if they have up to $17,700 in income, they will pay out of pocket $1,500--they are going to think about prescription drugs. This is about $120 a month. Seniors with whom I have talked literally would jump at knowing they would be limited to about $120 a month for prescription drugs. They just do not want to be bankrupt. They do not want to think they are going to lose their house. Many are concerned about long-term care, and that is their biggest fear--that they have to lose everything to get long-term care. It is the same with prescription drugs. They do not want to lose everything before they are so poor that they have to go on Medicaid to get prescription drugs from the Government. Our amendment is basically limiting out-of-pocket expenses. The other misconception of our amendment is that you do not get any help if you have, say, $9,000 in income. You absolutely do. That is what our prescription drug discount card is all about. Every senior on a voluntary basis--if they want to sign up--because of group buying, this cooperative-type buying, similar to what HMOs do today, can save about 40 percent. Most HMOs say you save 40 percent versus retail on their prescription drugs. Every senior who signs up for our plan would be able to save up to 40 percent on their prescription drugs, regardless of income. Regardless of where in any of these ranges they fit, they save up to 40 percent. When we combine that prescription drug discount card with limiting out-of-pocket expenses, along with what many States have done--if States want to be more generous, they can be. My State of Nevada is more generous. The State of Massachusetts, as we have learned today, is more generous. The State of West Virginia has a drug discount card that is working very well. Other States have put these programs into effect. Our plan fits with most of the plans that are already working across the country. So for those seniors who truly need the help, they will get it. I wish to close my time today with a couple real-life examples. Doris is a patient. She is 75 years old. We changed her name, obviously, for privacy reasons. She has an income of about $17,000 a year. This is a real-life case. She is being treated for diabetes, hypertension, and high cholesterol. She is on Lipitor, Gloucophage, insulin, Coumadin, and Monopril. These are common medications. These are $300 in monthly expenses, about $3,600 per year. To compare the various plans on a real-life case, under the Graham- Miller-Kennedy plan, the leading Democrat proposal, she would have out- of-pocket expenses of $2,200. Under the tripartisan plan, it is about $2,100. Under our plan, it is $1,700. Ours is more generous to the person who is really sick, who has a low to moderate income. Example No. 2: Betty is 68 years old with $15,500 per year in income. She has breast cancer, not uncommon for a lot of senior women. She takes morphine, Paxil, dexamethazone, Acifex, trimethobenzamide, and Nolvadex. These cost almost $670--almost $8,000 per year. Let's compare what happens under the various plans. Under the leading Democrat proposal, she would pay $3,180 out of pocket. Under the tripartisan plan, she would pay about $2,600, and under the Hagel- Ensign plan, she would pay $2,150. Once again, in a real-life example, the person who is sick who needs the most would do better under our plan, and that is why we are asking people to support this plan.

Mr. ENSIGN. Madam President, I wish to address some of the concerns of the Senator from Massachusetts. First, there are many States, at the income levels he is talking about--$9,000, $10,000, $11,000, and even in my State of Nevada up to the $22,500 a year level--that are already providing some help for senior citizens. The Republican Governor of my State was very visionary and put together something called the Senior Rx Program using part of the money from the tobacco settlement. For people with an income of $21,500 or less--they are non-Medicaid-eligible people--as long as they have been a resident of Nevada for at least 12 months, they can have a maximum benefit of $5,000 a year. They have no premium. They pay $10 for generic drugs and a $25 copay for preferred drugs. In the State of Nevada, that person Senator Kennedy was talking about who makes $9,000 a year is taken care of. In fact, that person does very well. That person does better than under the Democrat proposal-- much better. Also, if you go out and talk to seniors--I have been in a couple of very time-consuming and all-encompassing campaigns 2 out of the last 4 years--I talked to seniors all over our State, and if you say to them they are going to be limited to about $100, $120 a month of out-of- pocket expenses for those low-to moderate-income people, they are ecstatic; they will jump at that. They will say: Sign me up, as long as they are limited from losing everything or from being bankrupted based on prescription drugs or not being able to pay their rent. I say to the Senator from Massachusetts that maybe he ought to encourage the people in his State to take a look at what the people in the State of Nevada have done for their seniors, because the seniors in Nevada who truly need help, under this plan, are taken care of. Those who are higher income seniors--by the way, most seniors have their mortgages paid for. Most of them have their cars paid for, compared to young people. That is what a lot of this argument is about. Tell someone who is making $30,000 a year and has a couple of kids that in the future they are going to have to pay a lot higher taxes; they are already paying high taxes now, but in the future they are going to pay higher taxes because of what we are setting up today, especially if the plan the Senator from Massachusetts supports became law. If the plan the Senator from Massachusetts supports became law, taxes in the future are guaranteed to go up, otherwise our Medicare system will be bankrupt. Part of that is because of what I already talked about. When you take the patient out of any kind of accountability for what they are receiving, costs are going to skyrocket. We have seen that in our health care system today. A lot of the issues about which the Senator from Massachusetts was talking and the charts he was showing with drugs going out of sight is because people are not accountable for what they are getting. Insurance is taking care of it. Let us look at what we have before us today. Let us do something for those seniors, and I want to give a couple of examples. I want to show you real-life examples of senior citizens with real-life diseases who are paying real dollars out of their pockets for prescription drugs. The first example I want to use is a guy named James. He is about 68 years old with an income of about $16,000 a year. He is taking these following medications: Glucophage, Glyburide, Neurontin, Protonix, Lescol, and Zoloft, for a total cost of close to $500 a month, $5,700 a year. Under the three major competing proposals, that person with $16,000 in income, under the plan the Senator from Massachusetts supports, would pay $2,900 a year out of pocket. Under the tripartisan plan, $2,340, and under the Hagel-Ensign plan, $1,923 a year. That is what this person would pay. So this person who is really sick who needs the help the most is actually going to get the benefit they need, but yet will still have some accountability, and that is the balance in the plan that we have done. We feel this kind of an example is the reason that people should support our plan. I yield the floor.

Mr. ENSIGN. Madam President, I am the designee of the Senator from Nebraska. I yield myself 5 minutes.

Mr. ENSIGN. Madam President, I want to talk about a couple of philosophies that deal with this bill. We currently have a health care system that has evolved over time where we have low deductible policies and we have usually a small copay involved. That low deductible coverage over time has taken the patient out of the accountability loop. Somebody goes into the office. They have an annual deductible. They don't pay attention. They go in and they start getting their health care coverage. The doctor tells them whatever they should do. The doctor is trying to rush people through. They don't think the patient is paying for the care. So they don't take the time to explain why certain tests cost money. They know somebody else is paying for it. They don't think about the patient's cost because it isn't the patient. It is an insurance company that is paying the cost. By taking that patient out of the accountability loop, costs have skyrocketed in the United States. That is the fundamental flaw to the insurance system we have in our health care delivery system today. It would be akin to having homeowners insurance that paid for doing the landscaping around your house or painting the trim. We don't expect that. We expect those normal maintenance costs to be paid out of pocket. But if something like a fire happens to your house or some kind of other horrible thing happens--for example, I recently had a hose break in our washing machine. We ended up with probably about $30,000 worth of damage. Unfortunately, we had gone on vacation when the hose in the washing machine broke. We came home. There was all kinds of damage. We had to have floors replaced, walls; it was about $30,000 worth of damage. Our insurance kicked in. But I didn't expect my homeowners insurance to pay for repainting the trim on my house or landscaping or things like that. That is normal expenses in everyday life. That is why homeowners insurance has remained relatively inexpensive over the years. Health care insurance has not, because the patient doesn't think about the cost. Our plan says: Let's keep the patient accountable. Let's keep the senior citizen accountable. Senior citizens don't want to put a huge burden onto young people. Yes, they would like prescription drug coverage. The Senator from Massachusetts mentioned that seniors don't want to lose what they have saved for all the years. They want to make sure they have some security in their assets. We have said: Let's keep the patient in the accountability loop. Low- income seniors in our bill will pay the first $1,500 or about $120 a month out of pocket. They are going to pay that. Seniors can afford to pay that. They are willing to do that. After that, the Government is going to pay--other than a small copay--is going to pay so that the senior who has diabetes, a heart condition, cancer, that senior is going to be covered under our plan and is going to keep from losing all of their valuable assets. So because the first dollar coverage is paid by the senior instead of the Government, our plan is much more fiscally responsible to the next generation. That is why, when Senator Frist talked about it being a sustainable plan, our plan, in the future, will be sustainable because the patients--the senior citizens themselves--will shop for medicine; they will not just take whatever the doctor says. They will ask: what about generics? Is there a generic for that? They will do that because they are paying the first dollars out of their pockets. They will also ask: Do I need that medication? I am taking four medications. Do I need all four? Maybe the doctor would say: I forgot about the other medication you were taking. So this brings the patient back into being accountable for their own health care. That is critically important to our health care system and especially to this new prescription drug coverage that we want to add to Medicare. Madam President, I urge my colleagues to look at this very reasonable proposal. It is something that can be done, and can be done now, and it can be made permanent. I yield the floor.

Mr. ENSIGN

Mr. ENSIGN. Madam President, our plan is affordable to seniors as well as to taxpayers in future generations. Our plan keeps senior citizens involved in the choices they are making because they will pay the first dollar out of pocket. They have the prescription drug discount card so they will save 25 to 40 percent on the drugs they purchase; but they will pay the first dollar out of pocket so it keeps them involved in the choices they are making and helps the market work and keeps downward pressure on prices. It also works well with State plans. My State of Nevada used some of its tobacco money to cover senior citizens below $21,500 in income. Our plan fits in well with any of the State plans that have already been put into effect. The other advantage that this plan has is that it goes into effect at least a year earlier than any of the other plans. Lastly, our plan gives the help to those seniors who truly need it. Regarding the really sad stories we have heard on the floor of the Senate, this plan helps those seniors more than the Democrat plan, and it helps them even more than the tripartisan plan. If you are a moderate-income senior, with $17,000 of income or so and have $5,000 a year in drug costs, our plan helps those seniors more than any of the other two plans. I urge the other Senators in this Chamber to support the Hagel-Ensign plan.

Mr. ENSIGN

Mr. ENSIGN. Mr. President, I thank the co-author of this amendment, the Senator from Nebraska, for the great work he has done; and, by the way, that both of our staffs have done in coming up with an amendment that we think is fiscally responsible and that meets the needs of those seniors who need it the most. We have heard a lot of examples during the House debate, and during the Senate debate, about those seniors who are having to choose between paying rent and paying for prescription drugs, or paying their food bills and being able to pay their drug bills. We have heard about a lot of heartbreaking stories. Those are real stories that are out there. We have those stories in my home State of Nevada. We get letters from those people all the time. I got an e-mail a few weeks ago from a lady who sent this e-mail at 11:20 p.m. West Coast Time. She was up thinking--and probably looking through her medical bills--and just crying out for help, asking if I would be willing to take a moral stand to help seniors who need the help the most? Our amendment does exactly that. It helps those seniors who need help the most. But this morning, I was also thinking about our responsibility to our children and the next generation of young people coming up who are going to be working for a living and paying taxes. Will Medicare and Social Security be there for them? Will this country be there for them? Somebody has to pay for all of these programs that we are talking about. People have not wanted to means test Medicare and Social Security because they believed that they have earned this benefit, that they have paid in for this benefit. Realistically speaking, this new prescription drug benefit would not been earned by anybody that is going to get it, at least early on. Frankly, it is a straight giveaway to seniors. It is taking it out of the pocket of younger people who are paying into the system now and putting it into the pocket of older people who, while they were working and paying taxes, paid for a Medicare program that did not have a prescription drug benefit All of us feel a great responsibility to our parents and our grandparents, to take care of them in their golden years. But we must do this in a way that does not put such a burden on young people in our society that they cannot prosper. Why should their tax rates have to be so high just because we in the Senate wanted to get reelected, so we voted for things that just kept spending these young people's money? Ultimately, they will have no choice but to pay high taxes because politicians pay attention to the senior citizens because senior citizens vote. We need to pay strict attention to what we are doing here and whose money we are doing it with. Once we add a benefit to Medicare, we will not be cutting that benefit in the future. So whatever we do, we better do in a fiscally responsible fashion. Senator Hagel and the rest of the team that has put this amendment together believes that we have done exactly that: We have provided help to those seniors who need it, but we have done it in a fiscally responsible manner. I want to talk a little bit about the amendment and how it works. Senator Hagel has covered some of this, but I want to reemphasize a couple points and to use a chart for those who need to see it. I am kind of a visual learner and need a chart to understand things sometimes, to actually be able to see the numbers on a piece of paper so I can put them in my head. The way our bill works, first of all, is that we cap--this is catastrophic coverage--we cap the amount of out-of-pocket, expenses a senior citizen is going to have to pay. We do that based on income. The people who are have the lowest income get the most help. It goes up from there based on your income level. That seems to make sense if you think about it. Should a person like Ross Perot, who would qualify for this benefit, get the same help as somebody who makes $15, $16, $17,000 a year--a senior citizen? Should they get the same level of help? I think most people would say they should not get the same level of help. Our bill says that if you are lower income, you are going to get more help. It also says that the sicker you are, the more help you get because those seniors who are very sick or who have a chronic condition such as heart disease, diabetes--and we will talk about a few examples later--pay much more per year in prescription drug costs and our plan limits their out-of-pocket spending. Those are the people our bill actually helps more than the leading Democrat proposal or the so-called tripartisan proposal. For people who make $17,720 or less a year, up to 200 percent of poverty and below, we cap their out-of-pocket expenses at $1,500. This is a little over half of the seniors in this country. If you make between $17,721 and $35,440 per year, your out-of-pocket expenses are capped at $3,500, and it scales up from there. Once again, our program is completely voluntary. I have heard that in 1987 the Senate passed, and actually enacted into law in 1988, a catastrophic drug benefit plan. We hear people--and I am not sure if they were referring to our plan or not--saying seniors opposed the 1988 plan so much, that they repealed it the next year. They were not opposed to it because of the catastrophic coverage, they were opposed to it because one, they were forced to join; and, two, their Medicare premiums went up. Ours is a voluntary program, and it only has an annual enrollment fee of $25 per year. That is strictly to take care of administrative costs. We figure about $25 per year is what is necessary to handle these costs per enrollee. When you pay that fee and sign up for the program, you will get a drug discount card. You will be able to sign up for various plans in the area, and pharmaceutical benefit managers will have a list of pharmacies that are participating. They will have a formulary or a list of drugs that are offered. You will go through those, and you will say: I have this disease, or, I like that particular formulary; maybe I will get together with some of my fellow seniors or I will get together with my doctor and say, Which one of these plans do you recommend? Then you will sign up for that plan that best meets your needs. It is the competition between the plans and the volume buying that will allow the average senior to save somewhere between 25 and 40 percent on the drugs they buy with this drug discount card. Right upfront, they save 25 to 40 percent. Then, we cap their out-of- pocket expenses. So it is a two-pronged approach. We believe that because the senior pays initially out of pocket--about $100, $120 a month for the low-income seniors--that they will shop for their drugs and take advantage of the lower prices that are being offered as a result of competition between the participating entities. I want to give a couple of real-life examples of those cases we always hear about--those cases that tug at our heartstrings. James is a 68-year-old man who has an income of about $16,000 per year. He is being treated for diabetes. These are the various medications he is taking: Glucophage, Glyburide, Neurontin, Protonix, Lescol, and Zoloft. He has monthly prescription drug costs of $478.04, and a yearly cost of $5,736.48--so James is paying out of his own pocket over $5,700 right now. Medicare doesn't cover anything. To compare the various plans, first of all, under the Graham-Miller plan, James' out-of-pocket expenses would be $2,940.00. Under the tripartisan plan, he would pay $2,341.65. Under the Hagel-Ensign plan, he would pay $1,923.65. So for the low- to moderate-income person who has a serious disease, the Hagel-Ensign plan gives that person more help than any of the other bills. And example after example has been heard on this floor about has been this type of a case. If you don't like this one, we will give you the next one. Doris is a 75-year-old and has an income of around $17,000 a year. She suffers from diabetes, hypertension, and high cholesterol, which is not unusual for a senior. Her medications are Lipitor, Glucophage, Insulin, Coumadin, and Monopril, for a total cost of $304.03 a month, and $4,648.36 a year. Once again, here is how Doris would fare under the various plans Under the Graham-Miller plan, the leading Democrat plan, she would pay $2,220.00 a year out of pocket; under the tripartisan plan, she would pay $2,086.36 a year; and, under our plan, she would pay $1,714.84 a year. Once again, this person does better under the Hagel-Ensign plan more so than either of the other two plans which were voted on and failed to get the 60-vote point of order. To reemphasize, the plan we have all worked on together, including Senator Gramm of Texas, provides a Medicare prescription drug benefit in a much more fiscally responsible way and takes into account future generations. There is a third example I want to talk about. Betty, who is a 66- year-old, has an income of $15,500 per year. She is being treated for breast cancer. She is still receiving low-dose radiation therapy with Nolvadex. Her medication profile is as follows: Morphine, Paxil, Dexamethasone, Aciphex, Trimethobenzamide, and Nolvadex--monthly total of $668.33 and $8,019.96 per year. These are three real-life cases from Nevada. The names have been changed to protect their privacy. Betty's medications, under the three different proposals, once again: Under the Graham-Miller plan, the leading Democrat plan, she would pay $3,180.00 out-of-pocket expense; under the tripartisan plan, $2,570.00; and under the Hagel-Ensign plan, $2,152.00 out-of-pocket expense. The person who is the sickest, who is moderate to low income, is the person our plan benefits more than any of the other plans. That is why we think our plan is superior, because when we hear about people, when they go on the talk shows, when they talk in front of seniors groups, when we are hearing all these horror stories, these last three examples are the type of people about whom they are talking. So if my colleagues really want to help those seniors who need it the most, they should support our plan. The other thing is--and I will conclude with this--that we have had two other plans voted down today. The two plans that were voted down, because they did not get the 60- vote point of order, are pretty much dispensed with at this point. Senators should ask themselves if they want to get a bill done this year. If they do, this is your best chance of doing it. If we pass this plan in a bipartisan fashion, lay aside the politics--and we said we are going to put seniors ahead of politics, and ahead of being a Republican, or ahead of being a Democrat--we can pass a plan now. We should put seniors ahead of a political issue in this November's election. This Hagel-Ensign bill is the bill that offers that opportunity for people. So I encourage my colleagues to support our bill. It will be voted on tomorrow. We have a great chance and a great opportunity for the American people, and especially for those seniors and disabled people who are on Medicare, to really get the help that they need. Mr. President, I ask unanimous consent to add Senator Allard as a cosponsor of amendment No. 4315.

Mr. ENSIGN. I yield the floor.

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

Mr. ENSIGN

Mr. ENSIGN. It also requires that each beneficiary who buys a drug through the discount card program be made aware of generic drug alternatives at the time they purchase the drug. It is crucial to make prescription drugs affordable for seniors, which our program clearly does. However, it is also important to make sure Medicare's prescription drug program is affordable to the American taxpayer, which our plan also does. According to actuarial analysis, our proposal would cost approximately $150 billion over ten years. We are waiting for the final score from CBO, but that is where we believe our plan will come in. This is markedly less than any of the other plans out there, even the tripartisan plan. It is less than half of what the tripartisan plan would be. We must not only enact a responsible outpatient prescription drug program for our seniors, we must also do so without bankrupting the overall Medicare system. Another reason our program is the best fit for seniors is that it takes effect at the earliest date. Our program takes effect on January 1, 2004, a full year earlier than any of the other plans. Our program is also permanent, unlike some of the other proposals which sunset after a period of time. So, our plan is an immediate step that can be taken to help seniors until comprehensive Medicare reform can be enacted. I want to now compare our plan to the tripartisan plan and to the major Democrat plan that Senators Miller and Graham have proposed. These are real life examples. James is a 68-year-old, has an income of $16,000 per year, and is being treated for diabetes. He is taking these six different medications. His total monthly costs for these prescription drugs are around $478. His total annual costs are more than $5,700. Under the Graham-Miller approach, James would pay $2,940 out of his pocket. Under the tripartisan plan, he would pay $2,341.65 per year. Under the Hagel- Ensign plan, he would pay about $1,923.65 per year. As you can see, the Hagel-Ensign proposal would save James over $1,000 annually when compared to the Graham-Miller proposal, and over $400 annually when compared to the tripartisan proposal. Example No. 2: Doris is a 75-year-old, has an income of $17,000 per year, and is being treated for diabetes, hypertension, and high cholesterol. She takes Lipitor, Glucophage, Insulin, Coumadin, and Monopril every day. Her monthly cost is about $300, or about $3,650 per year. Under the Graham-Miller proposal, her out-of-pocket expenses would be $2,220.00; under the tripartisan plan, $2,086.36; and under our plan, about $1,714.84. The Hagel-Ensign proposal would save Doris over $500 annually when compared to the Graham-Miller proposal, and over $300 annually when compared to the tripartisan proposal. For those who are the sickest, who need the help the most, the Hagel-Ensign plan actually benefits them more than any other plan. In comparing our plan to others--just to point out what other people may point out as a supposed weakness of our plan--for those who pay $1,000 or $1,200 per year for drug costs, the other plans will help them more, and we readily admit that. But for a majority of the senior population who has high drug costs and needs help paying those costs, we think our plan works best.

Mr. ENSIGN. Betty is 66 years old, has an annual income of $15,500, and is being treated for breast cancer. She is still receiving low-dose radiation therapy and taking the following 6 medications: morphine sulfate, Paxil, Dexamethasone, Aciphex, Trimethobenzamide and Nolvadex. Her total monthly cost comes to around $670 and annually to about $8,000. Once again, to compare the plans with real life examples: under the Graham-Miller approach, she will pay $3,180.00 per year; under the tripartisan plan, she will pay $2,570.00 per year; under our plan, she will pay $2,152.00. So our plan is less, once again, than either of the other two major competing plans. Under our bill, those who need it the most will get the most help. For those moderate- and low-income seniors, our plan will benefit them the most, and--we cannot emphasize this enough--our plan is the most responsible to the taxpayer. We cannot afford to say to the young people in America, you are going to be paying for this huge prescription drug program that probably will not be there for you in the future, but you have to pay for it anyway. We have to think about the next generation, so we must enact a plan that is fiscally responsible. Our proposal says that we are going to give seniors--those who truly need it--the help that they need and ultimately deserve. But to the taxpayer, we are also saying we are going to be responsible to you. I yield the floor.

Mr. ENSIGN. Mr. President, I rise today to speak in support of the Medicare Prescription Drug Discount and Security Act of 2002, coauthored by myself and Senator Hagel with the help of Senator Gramm. This legislation provides an overdue and much needed prescription drug benefit to the Medicare Program. We are going to be voting on two different bills tomorrow; following that, we will be taking up our legislation. We bring this legislation to the attention of our colleagues. We need to offer a responsible solution to make medicine more affordable for those seniors who need it the most. This offers immediate help to our Nation's seniors in the form of a bill that is voluntary, reliable, and it gives seniors options. It complements, rather than replaces, the private prescription drug coverage that two-thirds of retirees have now. Many seniors like their current prescription drug plans and should not be forced to abandon them. The cost of prescription drugs is a major concern for many of my constituents, especially those who rely on only their Social Security benefits for their total income. Let's look at a typical senior. We will call her Mary. Mary has worked hard her entire life, makes $55,000 a year, and is about to retire in 2004--coincidentally, the same time our program goes into effect. Mary has never been much of a saver, so she will be relying almost solely on her monthly Social Security check to make ends meet. She can expect to get about $1,300 per month in benefits. Mary has diabetes and has to take six different prescription drugs every day to keep her healthy. The total cost of these drugs per month comes to about $475, about one-third of her income. Considering her other expenses, such as rent, food, and other monthly bills, Mary needs some help paying for her prescription drugs. The bottom line is Mary should never have to compromise her health by having to choose between buying prescription drugs or buying food for her table. Our legislation provides immediate, affordable, and permanent help so that seniors like Mary never have to make that choice. This legislation has two parts: First, all seniors would be protected from unlimited out-of-pocket drug expenses by instituting caps on their private expenditures. Once those caps are reached, the Federal Government would step in and cover the rest of the cost, minus a small copayment. Second, all non-Medicaid seniors could enroll in a discount drug card program that would give them access to privately negotiated discounts on prescription drugs. Let me now focus on the heart of our plan which protects seniors from unlimited out-of-pocket expenses, with the greatest protection going to those who need it most. Negotiated discounts on prescription drugs would be worked out through the private market, while Medicare would pay for drug costs after out-of-pocket expenditure caps have been met. This means, to our friend Mary, saving hundreds, possibly thousands, of dollars every year on prescription drug costs. In this chart, we see how our plan works as far as the various income categories are concerned. Mary fits in the category below 200 percent of poverty. For an individual who makes less than $17,720 a year, which is about 50 percent of the senior population today, we cap their out- of-pocket expenses at $1,500. After they have paid $1,500 out-of- pocket, the Government will then pay for the rest of their prescription drug expenses. Now remember, before they even start paying toward that cap, they have the prescription drug discount card. That saves them money, as well, on their prescriptions. Continuing with the catastrophic coverage, if an individual's income is between 200 percent and 400 percent of poverty, they are capped at $3,500. If their income is between 400 percent and 600 percent of poverty, they are capped at $5,500. For seniors above 600 percent of poverty, individuals would be covered after they pay what is equal to 20 percent of their annual income. The Hagel-Ensign plan has no monthly premium. It was said earlier that the tripartisan plan has the lowest monthly premium of any of the plans out there. Well, our plan has no monthly premium. What we do require is a $25 annual fee which is waived for those below 200 percent of poverty. Our $25 premium is used strictly for administrative costs. Additionally, participants would also pay a small copayment of no more than 10% per prescription after they reach their out-of-pocket limit. We believe the copayment system is important because it not only keeps costs low by forcing pharmaceutical benefit managers to compete for business, but more importantly to the consumer, in this case the senior buying prescription drugs, back into the accountability loop. The second part of our plan, the discount drug card program, works according to practical principles. According to a study conducted by the Lewin Group, one of the country's most respected health care actuaries, this approach would achieve significant discounts from full retail price between 30 percent and 39 percent. Here is how it works: First of all, the card is completely voluntary, for both seniors and drug manufacturers. Drug manufacturers, through pharmacy benefit managers, would compete for business on the basis of their discounts and services, ultimately offering seniors the lowest price for their prescriptions. Seniors could choose from among any number of competing drug card plans. If they became dissatisfied with their plan, they could enroll in a different plan the following year. The Federal Government would not be fixing or negotiating prices for prescription drugs. The program simply allows seniors, such as Mary, to receive the same kind of privately negotiated discounts on drugs that are available to those enrolled in private health insurance plans. Our plan also encourages the use of generic drugs whenever possible, in a couple of different ways. It requires the drug discount card issuer to include incentives in its program to use generic drugs whenever possible. Mr. President, could you remind me when there is about 3 minutes to go?

Mr. ENSIGN

Mr. ENSIGN. About 15 minutes.