Ted Kennedy

Mr. KENNEDY

Mr. KENNEDY. Well, Mr. President, then I object.

Mr. KENNEDY. I object, Mr. President.

Mr. KENNEDY. I suggest the absence of a quorum.

Mr. KENNEDY

Mr. KENNEDY. Mr. President, gasoline prices in Massachusetts just passed the two-dollar mark, and are expected to go even higher in the months ahead. A year ago, the average price of regular gas in Massachusetts was $1.53 per gallon. That means that the average two-car middle class family is paying $56 more per month for gasoline than they were last year. That's the same as a $660 middle class pay cut for the year. In addition, the high price of gasoline is causing the prices of other consumer goods to go up as well, including groceries and other necessities. But while middle class families are hurting, the Bush Administration stands on the sidelines. They are doing nothing to encourage OPEC nations to increase production to bring down oil prices. They are doing nothing to prevent price gouging by the Administration's friends in the oil industry. The profits of the top five oil companies jumped 300 percent in just the past year. That's money taken right out of the pockets of middle class America, and the administration is doing nothing about it. The President has failed the American consumer with his weak gasoline policies and by pandering to the big oil companies. Today, I stand with my colleagues and demand that President Bush take immediate action to bring down prices at the pump that impose such a heavy burden on consumers. The President should confront OPEC and demand an increase in oil production. And the President should stop filling the Strategic Petroleum Reserve and release a million barrels of oil a day until prices stabilize. President Clinton released 30 million barrels in 2000 and this was effective in lowering the price of gasoline. The Reserve was created for times of crisis, and I believe strongly that it should be used sparingly and for true emergencies. Because the Reserve is almost full today, I believe we can draw down on it without jeopardizing our strategic interests. And the law allows it to be used when supply shortages cause economic hardships for the American people. Finally, the President should direct the Attorney General to intervene with the big oil companies to prevent price gouging. This is a crisis that is harming middle class families right now. We need action and we need it now. Every day that the White House continues to turn a blind eye to Big Oil, the worse it gets for the pocketbooks of average families. This legislation would call on the White House to reverse course and take immediate steps to provide some relief to American consumers.

Mr. KENNEDY

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

Mr. KENNEDY. Mr. President, I move to reconsider the vote, and I move to lay that motion on the table. The motion to lay on the table was agreed to.

Mr. KENNEDY. Mr. President, how much time remains?

Mr. KENNEDY. I will be glad to yield the 5 minutes to the Senator from Minnesota.

Mr. KENNEDY. Mr. President, I rise today in support of this amendment because it will give States the flexibility they need to reduce special education paperwork. We have heard from many teachers that they must take too much time out of their busy days to complete IDEA paperwork requirements. Teachers would rather spend that time in the classroom teaching their students. We have heard these concerns loud and clear, and we have responded with changes to make things easier for both parents and teachers. This bill reduces paperwork and meetings by: Streamlining educational planning and procedural requirements; simplifying the Federal application process; encouraging the use of technology; clarifying that no paperwork is required beyond what is in the Federal law; and requiring the Department of Education to develop model forms. These changes will go a long way to simplifying the work of special education teachers and giving them more time to do what they do best-- teach children. These changes will also make it possible for more parents to participate in their child's education. This amendment will give a limited number of States the opportunity to do even more to address paperwork by giving them flexibility to waive paperwork requirements. But today the Senate needs to make it absolutely clear that this flexibility does not include waiving Civil Rights protections for disabled students. Civil Rights are the very heart of the IDEA. The right to go to a public school, the right to learn alongside one's peers, the right to an appropriate education, and the right to due process, are fundamental to this law and we cannot allow waivers to trade these rights in exchange for less paperwork. In July 2002, President Bush's Commission on Excellence in Special Education gave Congress and the President its recommendations for improving results for disabled students. This commission offered many suggestions for reducing paperwork in special education and allowing these waivers was one of them. But the chair of the President's commission was absolutely clear that paperwork reduction should not threaten civil rights. Listen to what the chair, Governor Terry Branstad of Iowa, had to say when he testified before the House on the IDEA and the commission's report: `` . . . [A]s we are trying to reduce the paperwork, streamline it, and make it more efficient, we . . . want to . . . protect their civil rights.'' We must ensure that States live up to the full intent of the commission's recommendation--to balance paperwork reduction with civil rights protections. The chair of the President's commission is not alone in his concern for protecting civil rights while reducing paperwork. The National Council on Disability--the Federal agency responsible for advising President and Congress on issues affecting the disabled--says that, if not done carefully, waivers may have unintended consequences. According to the National Council on Disability: Waivers threaten educational quality because instruction and achievement are measured by documenting progress. Waivers threaten civil rights because compliance with the law must be documented. Let me first speak to the issue of paperwork and educational quality. Ask any teacher how he or she begins the day before the students arrive. They begin by reviewing a lesson plan that sets the goals for the day and describes how those goals will be reached. They develop tests for their students to see if they are meeting those goals. These lesson plans, goals, and tests are based on a thoughtful and comprehensive curriculum. This is all paperwork--paperwork that is necessary to ensure quality instruction for every student. Quality instruction for disabled students is no different. Special education paperwork ensures that schools think carefully about how best to educate a disabled student, then document their plan, and then document progress. Does any of that paperwork sound unnecessary? If States interpret these waivers as a license to set aside these important pieces of a disabled child's education, we have completely undermined the focus on academic and functional achievement in this bill. Just like the National Council on Disability, I also have expressed my great concern about protecting civil rights if States are given too much flexibility. In my opening statement, I addressed the issue of noncompliance with this law. All across this country, nearly 30 years after this law was first passed, many disabled children still are denied their right to a public education. Year after year, the majority of States fail to implement the IDEA and are found out of compliance with its most basic requirements. Reports from the Department of Education show just how rampant noncompliance with the IDEA is. From 2000 to 2003: 76 percent of States did not appropriately resolve complaints; 71 percent of States lacked effective systems to monitor and enforce the law; 71 percent of States did not educated disabled children with their peers; and 65 percent of States did not appropriately prepare students for post-school employment and independent living. These States already blatantly disregard the requirements of the IDEA. Imagine what would happen if these States are given waivers without the clear limitations set forth in this amendment, if they could feel free to waive any requirement in the name of paperwork reduction. The impact of unlimited paperwork waivers on disabled students in States like these could be devastating. Even with detailed requirements for education plans and other paperwork under current law, look at what is happening to disabled children all across the nation. The Richer family from Oregon writes that their school made the decision to shorten their son's school day by 3 hours--without asking the parents first. The same school district completed their son's education plan and assigned him to a classroom without including his parents in the decision. The Johnson family from new Jersey writes that it took 18 months to get an appropriate educational plan written for their child, and the school still will not provide the speech therapy and counseling services written on that plan. These are true stories, just like the hundreds of other true stories that parents have sent to me. This is why it must be made absolutely clear that these waivers are not a free pass out of accountability or a way to erode individualized education plans that are the cornerstone of the IDEA. Look at any other field--the legal field, the medical field, or business. In these fields, if it wasn't documented, it wasn't done. Insurers don't pay doctors when they don't document the care they provided. Clients don't pay lawyers if they do not document the hours spent on a case. And businesses don't provide their services without a contract. In every part of life, documentation is the way we guarantee that people did what they promised to do. It is not too much to ask that schools do the same so we can be sure they are complying with the law and giving every disabled child an appropriate education. I know that we demand a lot of our teachers. We ask them to not only educate our children to become productive citizens, but also to be counselors, mentors, and role models. And, yes, we ask them to do paperwork on top of that. Should the Senate do everything it can to make it easier for special education teachers to focus on the needs of students instead of focusing on paperwork? Absolutely--but not at the cost of educational accountability and civil rights for students with disabilities. Not if it undermines the foundations of the IDEA. Without the limitations set forth in this amendment, waivers may have the unintended consequence of allowing States to experiment with the civil rights of millions of disabled students for years to come. I do not object to giving States the chance to creatively address the issue of paperwork. This amendment offers States an exciting opportunity to make sure that teachers have more time to plan, take professional development courses, or provide extra help to students. Giving teachers more time means giving them a chance to do what they love most: focus on the needs of students. But the needs of disabled students cannot be met without first guaranteeing that they have the full protection of the law. This amendment provides that guarantee, while still encouraging paperwork reduction, and I urge my colleagues to support it. Mr. President, I thank the Senator from Pennsylvania for offering the amendment that will reduce the paperwork for teachers and also ensure the protection of the rights of disabled children. This amendment draws a clear line between unnecessary paperwork about the process and necessary documentation and ensuring every disabled child's right to a free and appropriate public education. The Senator from Pennsylvania has made it clear that States will not be allowed to waive the civil rights of disabled students or waive procedural safeguards guaranteed under law. This is a good amendment. It balances the needs of both the teachers and students. I thank him for his work on this amendment and also for his accommodation and willingness to work this out. It has been very helpful. I will wait for my colleague, the chairman, before urging the adoption of the amendment, but I expect it will be done momentarily. I suggest the absence of a quorum, with the time to be evenly divided.

Mr. KENNEDY. A very brief word on the technical amendment, the managers' amendment. We give assurance to all of our colleagues that it is a technical amendment. All the matters that are in that managers' amendment are directly related to provisions in the legislation. I give the assurance to our colleagues that is the nature and description of the managers' amendment, and we appreciate their willingness to accept it. We have several of our colleagues on their way over who wish to address the Senate on this issue. Then we will hopefully move along to final passage somewhere in the noon area.

Mr. KENNEDY. Mr. President, I yield myself 10 minutes. Today, the Senate moves a large step closer to guaranteeing that children with disabilities can obtain the education they need in order to reach their full potential. Today is a victory for disabled children, a victory for the parents of these children, and a victory for our country. Today we renew our commitment to the education of every child in the nation. We know that disabled does not mean unable. Children with disabilities have the same dreams as every other child in America--to grow up and lead a happy and productive life. We know that IDEA helps them fulfill that dream. IDEA says children cannot be cast aside or locked away just because they have a disability. Those days are gone in America--hopefully forever. Children with disabilities have rights like every other child in America, including the right to join other children in public schools so they can learn and prepare themselves for the future. This law is about disabled children and their rights. It is about their hope and dream of living independent and productive lives. It is about parents who love their children and fight for them every day against a world that's too often inflexible and unwilling to help them meet their children's needs. It is about teachers who see the potential in a disabled child, but don't have the support or training they need to keep it alive. That is what this law is about. It is our statement as a nation that these children matter and that we will do our part to help their parents and teachers and communities meet their education goals. That is why the government should make an iron-clad commitment to provide the resources for special education. That is why it is important to develop a solid education plan for each child, to chart the progress, and to hold schools accountable when they fall short. It sounds like No Child Left Behind, and it is--``No Child'' means ``No Disabled Child too.'' Later this month, we observe the 50th anniversary of the Supreme Court's historic decision in Brown v. the Board of Education, which struck down school segregation by race and said that all children have equal access to education under the Constitution. But it was not until the passage of the Education for the Handicapped Act in 1975 that the Brown decision had real meaning for children with disabilities. Only then did we finally end school segregation by disability, and open the doors of public schools to disabled children. Only then did the nation's four million disabled children begin to have the same opportunities as other children to develop their talents, share their gifts, and lead productive lives. We must never go back to the days when disabled children were excluded from public education, when few if any preschool children with disabilities received services, and when the disabled were passed off to institutions and substandard schools where they were out of sight and out of mind. We've made tremendous progress since those dark days. Today, six and a half million children with disabilities receive special education services. Almost all of them--96 percent--are learning alongside their non-disabled peers. The number of young children with early development problems who receive childhood services has tripled since 1975. The opportunities for further progress are boundless. We know far more about disability today than a quarter century ago. We understand the various disabilities of children, and how to help them all to learn and achieve. We are learning more each day about the enabling power of technology to help disabled children lead independent lives--it lets them communicate, explore the world on the Internet, move in ways we couldn't have imagined 5 years ago, much less in 1975 when the law was first enacted. This legislation builds on the enormous progress we have already made by recognizing that in several key areas, we must do better. We must do better in bringing the law's promise to all disabled students in all schools. That means fully enforcing the law in every school district in the country. A GAO analysis of compliance shows that from educational services to transition support, students are not getting what they are entitled to. Even when noncompliance is identified, the Federal response is intolerably slow. Some States violated the law for more than a decade before the Department of Education intervened. This failure has real world consequences for real children struggling to get an education. I have with me today almost 2,000 letters from parents across the Nation whose disabled children have been denied their educational rights under IDEA. This legislation will improve enforcement of IDEA at every level. It requires a State-Federal partnership to design a better monitoring system to hold States more accountable. We must also improve services for children nearing graduation, so they can leave school with the skills and continuing support they need to succeed. For persons with disabilities, the adult world offers little help to meet the challenges of daily life. It is vital for these steps to be taken in school, so that all children with disabilities can be reached before they enter the job market and the confusing maze of adult services. At best, only a little over half of students leaving special education have jobs or are continuing their education 5 years later. Often, they are transferred into the welfare system, with no recognition of their potential. Our bill places a major focus on early planning for that all- important transition, and better coordination with other Federal programs such as vocational rehabilitation and our Ticket to Work program, to link students to more options and maximize prospects for their independence. Welfare can't be the only option for students with disabilities when they graduate from school. Finally, we must do more to help special education teachers--to recruit them, to train them, and to support them in this challenging field. They are the men and women we depend on everyday to stand up and say to our children: You can do it. You can succeed. We also help special education teachers by reducing the unnecessary paperwork that distracts teachers from focusing on students. It creates better ways for parents, teachers, and school administrators to work together to meet children's needs without resorting to litigation, and provides more flexibility to parents to develop their child's education program by teleconferencing and video conferencing. The legislation authorizes new funds to improve the quality of alternative placements, and to provide better behavioral supports through whole school interventions. The legislation provides more flexibility for schools to discipline students, with safeguards so that discipline is not used as an excuse to halt educational services, and is not used to exclude or segregate disabled children because of the failure of the school to provide for the educational needs of the child. Our ultimate goal should be to support disabled children, not punish them for what they can't control. I thank the many persons who have brought us successfully to this day. First and foremost, I commend the thousands of parents who met with Members and staff, sent letters, made a phone call, and participated in other ways in making this legislation possible. They have been citizen leaders at their very best, and have opened our eyes to their cause and let us into their lives, and we are proud of all they have accomplished. Here in the Senate, I commend Chairman Gregg for his leadership on this legislation over the years, and for all he has done to bring this important reauthorization before the Senate. All of us are grateful to Annie White on his staff as well, for her dedication to making this bipartisan process work--and work, and work, and work. I commend the majority leader for scheduling the consideration of this legislation as soon as it was ready for action by the full Senate. Because of his willingness to act so quickly, we have a realistic opportunity to enact this important legislation into law this year. I also commend the distinguished minority leader for making consideration of this legislation possible and for his leadership on this and so many other issues of importance to the Nation and giving it the priority he has. I also commend Senator Sessions and John Little with his staff for their bipartisan effort in dealing with the discipline issue, which has needlessly plagued the debate on IDEA for so long. Senator Clinton deserves great credit for her work to ensure that new funds are provided to improve the quality of alternative student placements, to provide more effective behavioral supports for students, and to see that all schools are safe schools. Senator Harkin is always at the forefront of the movement for equal rights for all persons with disabilities, including children, and he has led the effort for full funding of IDEA. Mr. President, I yield myself 4 more minutes. Senator Dodd and Senator Jeffords worked effectively on this legislation to improve early childhood programs. They have been two pioneers in the development of the legislation since the very beginning, and they have been absolutely tireless in pursuing positive, constructive, responsive changes in these programs. They are both leaders on children's programs in the Senate. Senator Reed improved the training and recruitment of special education teachers. Senator Bingaman fought for strong enforcement of civil rights protections for every disabled student. Senator Mikulski strengthened support for students making the transition from schools to careers. Senator Murray improved the provisions on enforcement and the monitoring of the law and for caring for those children who are moving, who are in transition. I commend as well, the many members of our staffs, who have worked long and hard and well for the past 2 years. Our thanks go to Bethany Little, formerly with Senator Murray's staff; Jamie Fasteau, with Senator Murray's staff; Carmel Martin, formerly with Senator Bingaman's staff; Michael Yudin, with Senator Bingaman; Catherine Brown, with Senator Clinton; Justin King, with Senator Jeffords; Mary Giliberti and Eric Fatemi, with Senator Harkin; Rebecca Litt, with Senator Mikulski; Elyse Wasch, with Senator Reed; Maryellen McGuire, with Senator Dodd; Denzie McGoire and Bill Lucia, with Senator Gregg; Todd Haiken, with Senator Bingaman; and Dennis Borum, with Senator Reid. Our thanks also go out to the hundreds of disability and education advocates across the country who worked so hard on this legislation. I especially thank Jeremy Buzzell, Michael Dannenberg, Charlotte Burrows, Jim Manley, Jane Oates, Roberto Rodriguez, Kent Mitchell, Danica Petroshius and Michael Myers on my staff for their skillful work and dedication, and above all Connie Garner for all she has done for children with disabilities and their families and for never letting us forget what this debate and this law is really about. This bill represents our best bipartisan effort, and I look forward to its immediate and imminent passage and strong support from both sides of the aisle. As we move forward today to reconcile our differences with the House of Representatives, I hope we retain that same bipartisan spirit and quickly resolve our differences in this Congress and have this signed into law to benefit the children, the parents, and our country. Mr. President, I reserve the remainder of the time.

Mr. KENNEDY. Mr. President, how much time do I have?

Mr. KENNEDY. Mr. President, I yield myself 3 minutes. We have other speakers coming, but I want to read into the Record what difference this law has made, which really tells the story. This is a letter from Lyssa Bookman from Galloway, OH. This is a letter we received, actually, a few weeks ago. I pointed out earlier that we have over 3,000 letters on this legislation, very thoughtful letters, enormously compelling, extremely moving; in many instances, inspiring. I will just read from this letter: IDEA is necessary for all children. My personal experience started long before my daughter was of school age. She was diagnosed with Leukemia at nine months old. Due to her treatments she has long-term cognitive side effects. I have had to beg to get any services for her. I have never had to hire an attorney but have had to tell the building principal and superintendent of schools that they left me with no choice but to file suit against the district of the IDEA laws. As soon as I mentioned it I had what I was after. All my daughter needs is extra time to complete tests and assignments. If the law was not in place, I would not have a leg to stand on and my daughter would have been miserable in school. Homeschooling would have been my only option. She is now a fifth grade student in a gifted class with a 504 plan giving the slight modification of extra time. Without IDEA, she would not be able to handle the pressures placed on a gifted student. Learning disabilities and giftedness can go hand in hand and with IDEA the giftedness can shine and the disability overcome. IDEA gives the disabled child that chance to shine and takes one worry out of the parents' minds. Thank you for your efforts for the kids. They are the future. I have another letter from Cathie Davis of Tennessee. She writes: We moved to Monroe County, Tennessee where we will remain until Angel graduates high school. Angel was the first hearing impaired special needs student to enter their school system and they have gone above and beyond to see to it that Angel receives the best education possible. They provided her with an interpreter, Joyce Boyles who has been with her since the second grade. Mrs. Boyles put together a group they call singing hands as a way of teaching the other students how to communicate with Angel as opposed to only teaching Angel to communicate with them. These students (all hearing) along with Angel have been invited to perform at many events throughout the State of Tennessee, signing the words to songs such as ``I'm Proud to be an American'' by Lee Greenwood. Angel has made all ``A's'' and ``B's'' on the sliding grade scale and as of this year, without the aid of any Special Ed classes and on a regular grading scale, she has maintained a ``C'' average. Mr. President, this is the kind of mail we have received. There are others, obviously, who have not had as much success under the old bill. We tried to address those issues in the current legislation. Here is another parent who wrote. Her name is Denice Cronin, from Houston, TX. She wrote: IDEA gave me the rights to ask for testing outside of the school by an unbiased professional, paid for by the school. Based on these findings, the school adjusted their style of teaching and Bonnie again excelled. I still had to seek outside teachings to ensure her success. The Texas Reading Institute of Texas saved my daughter's sanity, as well as my son's. Today, she is a healthy 7th grade A-B student, still classified as learning disabled. She attends, completes and excels in the ``normal'' classroom. She even passes the TAKs instead of taking the ``alternative testing.'' Should she run into a setback, we have the rights and laws in place, due to IDEA, to protect and ensure she continues to receive a ``fair and complete education''. In the past, these children were stored away in back rooms, even if they were lucky enough to get into the school some years ago. We mentioned several who have been able to benefit from the bill. We are convinced that with the changes we have made in the legislation, many more families will be able to do so as well. Mr. President, I withhold the remainder of my time and suggest the absence of a quorum, and I ask unanimous consent that the time during the quorum call be equally divided.

Mr. KENNEDY. Mr. President, I understand the Senator from Pennsylvania is expected momentarily. Let me read a hopeful letter from Carolyn Wright, from Spokane, WA, which we received earlier this year: My son, Aaron, attends his neighborhood elementary school. He is in the same first-grade class as the boy who lives next door. Sometimes after school Aaron and the neighbor boy play together. They play Nintendo, sometimes ``boxing,'' or they play catch. None of that is unusual except that Aaron has Down Syndrome. If it weren't for the Individuals with Disabilities Education Act (IDEA) Aaron would not be in class with his neighbor. He would not get his chance to hold the flag during the Pledge of Allegiance. He would not have the opportunity to tell his friends that he has a cat or to learn that ``Joey'' has a dog. IDEA has helped Aaron be a part of his school community. Math is a difficult subject for Aaron so he has a different curriculum than other first graders and he is taught in the special education classroom along with other students who struggle with math. However, Aaron likes to read so he joins the first-grade reading group to improve his reading skills. Each area of Aaron's curriculum has been addressed so that he is in the least restrictive environment possible that will facilitate his learning. Whenever Aaron's Individualized Education Plan (IEP) needs revision, my husband and I are included in the discussion with the multi-disciplinary team. Placement options are discussed along with specific skill areas that need to be addressed, keeping in mind Aaron's position as a member of the community as well as his place in school. As part of the IEP team we determine what curriculum will best meet Aaron's needs. We are very grateful to have IDEA. Because of IDEA Aaron is a member of his neighborhood community and he is learning the skills he needs to be independent. He may never be able to live entirely independently but he will have a job and he will contribute to society. That is what this legislation is all about, Mr. President. We wish Aaron great luck. We believe there are many other ``Aarons'' in the country who will continue to benefit. We hope to do it in a better way. I suggest the absence of a quorum.

Mr. KENNEDY. I move to reconsider the vote and I move to lay that motion on the table. The motion to lay on the table was agreed to.

Mr. KENNEDY

Mr. KENNEDY. Mr. President, the Health Care Modernization, Cost Reduction, and Quality Improvement Act addresses three serious and related problems in our health care system that affect every American family: Health care costs are too high and are rising too rapidly. The quality of care received by too many patients is well below the standard that we are capable of achieving. In fact, the gap between the care we actually provide and the care we should be providing is so great that the prestigious Institute of Medicine has referred to it as a ``quality chasm.'' Our system lavishes funds on sickness care and neglects the health promotion and disease prevention activities that are the most effective ways of reducing health costs and assuring good health for as many of our people as possible. The legislation we are introducing is an effective way to modernize and improve the health care system, by using modern information technology, by paying for value and results and not simply for procedures performed or patients admitted to hospitals, and by focusing on improving quality and preventing disease. Controlling the soaring cost of health care is essential. In the year 2000, health insurance premiums grew 8 percent--two and a half times the cost of living. In 2001, premiums went up 11 percent--six times the Consumer Price Index. They went up 13 percent in 2002, and 14 percent in 2003--almost eight times the cost of living increase. By any standard, increases like that are unsustainable. We have to bring these costs under control--but there is a right way and a wrong way to do it. Arbitrary cutbacks for hard-pressed hospitals and physicians are the wrong remedy. With emergency rooms bursting at the seams, nursing shortages threatening the quality of care, and physicians forced to spend less time with more patients, we have an obligation to all our health providers as well. They're the backbone of our health care system, and we have an obligation to help them provide the quality care that every patient deserves. Fortunately, the right way to control costs is also the right way to achieve higher quality care. It's based on an emerging consensus of health experts and practitioners. It involves four fundamental principles--using information technology, paying for results, improving quality, and investing in prevention. The gap is vast and growing between information technology and the current practice of medicine. Health care in America is the best in the world, but it is also one of the least efficient industries in America. We spend a staggering $480 billion a year on administration alone--more than 30 cents of every dollar spent on care. Over a quarter of all personnel in the health care system today are performing administrative tasks, not providing care. The potential savings through modern technology are immense. Transactions in health care cost $12 to $25 apiece. Brokers and bankers used to have similar costs, but now, a transaction in these industries costs less than one cent. Information technology can also improve the quality of care, at the same time it reduces costs. Automated patient record-keeping can help bring real coordination to what is often a frighteningly fragmented health care system. Today, for one in five patients with significant health problems, various health professionals order duplicate tests and procedures. One in four patients arrive for a doctor's appointment and find that needed test results or records are not available. Information technology can end this waste of time and resources and also prevent the errors that reduce quality. Automated prescribing, for example, has reduced errors by 95 percent, and reduced hospital costs by an amazing 13 percent. It's time to end the disconnect between modern health care and modern information technology, and the savings will be immense. The gap between the best standard of care and the care that too many patients receive is staggering. A quarter of all breast cancer patients receive substandard care. A third of all patients diagnosed with high blood pressure receive substandard care. Half of asthma patients receive substandard care. Sixty percent of patients with pneumonia receive substandard care. Almost 80 percent of patients with a hip fracture receive substandard care. The Midwest Business Group on Health estimates that poor quality care costs employers $2,000 a worker every year. Improving quality can cut costs dramatically. But more important, it can reduce unnecessary suffering. For patients and their families, good quality care can truly mean the difference between life and death, and between disability and health. One of the highest barriers to improving the quality of care is the backward incentive system embedded in the way we pay for care. We need to start rewarding the quality care by paying for results, and not just for the number of procedures performed or the number of hospital admissions. Too often, the incentives today are geared to doing more-- not doing better. It makes no sense that doing better today can actually result in even greater financial hardship for health care institutions. If hospitals organize patient-tracking, home visits, and patient education to improve care for chronic diseases, they can reduce hospitalization dramatically. But the hospitals won't get paid much, if anything, for these improvements--and they will no longer receive the large reimbursements they would otherwise receive for inpatient care. Use of doctors specially trained to manage hospital intensive care units has been shown to reduce costs and improve outcomes. But fewer days in the ICU mean lower revenues for hospitals. That's wrong, and we need to correct it. Hospitals in Boston have already negotiated terms with insurers under which they are paid for results, rather than days of care. Some business associations, such as the Leapfrog Group, have begun to make quality standards a condition for participation in their insurance plans. the Department of Health and Human Services is testing the use of incentive payments to hospitals that meet specific quality standards. These steps are hopeful, but we need to make payment for results the rule, rather than the exception, in all aspects of our health care system. Another key step is to assure that the typical standard of care comes much closer to the best standard of care. We need to do far more to see that what we know how to do for patients is actually what is done. Opportunities are immense for improvements by targeting specific diseases that have high incidence, high costs, and high impact on individuals and families. Diabetes, for example, afflicts 17 million Americans. Patients with the disease account for one in ten dollars of overall health expenditures and one in four dollars of expenditures by Medicare. By using proven methods of prevention and treatment, we can save 10 million Americans from diabetes-related amputations, disability, or blindness during their lives--and save more than 50 billion dollars a year as well. Stroke is another example of the huge gap between what we could do and what we actually do. Stroke is the third leading cause of death and one of the major causes of disability. It strikes nearly 750,000 Americans each year. The economic cost is also staggering. The United States spends almost $50 billion a year in caring for persons who have suffered a stroke. Appropriate, timely intervention with clot- dissolving drugs has been shown to reduce disability and death by 55 percent but only three percent of patients receive the needed treatment. Chronic illnesses are major costs in the current system. Medicare beneficiaries with three or more chronic conditions account for almost 90 percent of Medicare spending. Well-organized care for patients with chronic conditions such as congestive heart failure, diabetes, asthma, and depression produce significant reductions in costs and significant improvements in outcomes. But only a fraction of patients with chronic conditions have the opportunity to benefit from such treatment. Finally, to cut costs and promote quality, we can do much more to stop illness before it starts. Health promotion and disease prevention must be central to our health system as hospital and physician care. Four hundred thousand Americans require medical treatment every year for diseases that are fully preventable by vaccination. Lack of exercise and poor diet cost almost $80 billion a year because of increased heart disease, cancer, and diabetes. The legislation being introduced today is a recipe for a peaceful revolution in the way health care in the United States is delivered. Building on a growing expert consensus, it provides a blueprint for a better health care system that will be lower in cost, higher in quality, and more closely oriented toward prevention. To assure that modern information technology will be fully utilized in health care, the legislation sets a goal of full implementation of a broad-based system of electronic medical records and automated bill- paying. It authorizes grants, loans and loan guarantees for health providers to install and implement clinical information systems that meet national technical standards for parameters such as security and interoperability. The bill also offers larger reimbursements for providers who implement these types of information systems. Over a period of time, it reduces payments for large health care facilities that fail to do so. The legislation also encourages the use of information technology to reduce the administrative costs, by requiring insurance companies to adopt the same types of computerized transaction-processing systems that are the norm in other industries. In these ways, the legislation begins the needed effort to enable the health care system to become a system that pays for value, rather than solely for procedures performed or illnesses treated. The Secretary of HHS is required to set quality standards for providers of services. Public and private payers will be required, through their reimbursement procedures, to reward the attainment of these quality standards, and are permitted to reduce reimbursements to providers who fail to meet the standards. When a provider of services believes it can provide higher quality care at lower cost, but feels that existing reimbursement procedures will not fairly recognize these innovations, payers are required to enter into good faith negotiations with providers to reach agreement on an alternative payment system. The legislation also has special provisions for payment for chronic care services in recognition of the special role of coordination of care, patient education, tracking, and follow-up in achieving quality care for individuals with chronic diseases. Finally, the legislation contains a number of important initiatives to improve the quality of care and strengthen health promotion and disease prevention. These include the establishment of a National Quality Council, and specific initiatives on diabetes, stroke, arthritis, nutrition, exercise, adult oral health, adult immunizations, and the provision of culturally and linguistically appropriate care for patients whose primary language is not English. America's health care system cannot continue to lurch from crisis to crisis. Our people deserve affordable care, and when illness strikes, they deserve the best care our system can provide. This legislation lays out a number of important steps to achieve this objective, and I look forward to working with my colleagues in Congress and the broader health community to achieve the important goals we share.

Mr. KENNEDY

Mr. KENNEDY. Mr. President, the Health Care Modernization, Cost Reduction, and Quality Improvement Act addresses three serious and related problems in our health care system that affect every American family: Health care costs are too high and are rising too rapidly. The quality of care received by too many patients is well below the standard that we are capable of achieving. In fact, the gap between the care we actually provide and the care we should be providing is so great that the prestigious Institute of Medicine has referred to it as a ``quality chasm.'' Our system lavishes funds on sickness care and neglects the health promotion and disease prevention activities that are the most effective ways of reducing health costs and assuring good health for as many of our people as possible. The legislation we are introducing is an effective way to modernize and improve the health care system, by using modern information technology, by paying for value and results and not simply for procedures performed or patients admitted to hospitals, and by focusing on improving quality and preventing disease. Controlling the soaring cost of health care is essential. In the year 2000, health insurance premiums grew 8 percent--two and a half times the cost of living. In 2001, premiums went up 11 percent--six times the Consumer Price Index. They went up 13 percent in 2002, and 14 percent in 2003--almost eight times the cost of living increase. By any standard, increases like that are unsustainable. We have to bring these costs under control--but there is a right way and a wrong way to do it. Arbitrary cutbacks for hard-pressed hospitals and physicians are the wrong remedy. With emergency rooms bursting at the seams, nursing shortages threatening the quality of care, and physicians forced to spend less time with more patients, we have an obligation to all our health providers as well. They're the backbone of our health care system, and we have an obligation to help them provide the quality care that every patient deserves. Fortunately, the right way to control costs is also the right way to achieve higher quality care. It's based on an emerging consensus of health experts and practitioners. It involves four fundamental principles--using information technology, paying for results, improving quality, and investing in prevention. The gap is vast and growing between information technology and the current practice of medicine. Health care in America is the best in the world, but it is also one of the least efficient industries in America. We spend a staggering $480 billion a year on administration alone--more than 30 cents of every dollar spent on care. Over a quarter of all personnel in the health care system today are performing administrative tasks, not providing care. The potential savings through modern technology are immense. Transactions in health care cost $12 to $25 apiece. Brokers and bankers used to have similar costs, but now, a transaction in these industries costs less than one cent. Information technology can also improve the quality of care, at the same time it reduces costs. Automated patient record-keeping can help bring real coordination to what is often a frighteningly fragmented health care system. Today, for one in five patients with significant health problems, various health professionals order duplicate tests and procedures. One in four patients arrive for a doctor's appointment and find that needed test results or records are not available. Information technology can end this waste of time and resources and also prevent the errors that reduce quality. Automated prescribing, for example, has reduced errors by 95 percent, and reduced hospital costs by an amazing 13 percent. It's time to end the disconnect between modern health care and modern information technology, and the savings will be immense. The gap between the best standard of care and the care that too many patients receive is staggering. A quarter of all breast cancer patients receive substandard care. A third of all patients diagnosed with high blood pressure receive substandard care. Half of asthma patients receive substandard care. Sixty percent of patients with pneumonia receive substandard care. Almost 80 percent of patients with a hip fracture receive substandard care. The Midwest Business Group on Health estimates that poor quality care costs employers $2,000 a worker every year. Improving quality can cut costs dramatically. But more important, it can reduce unnecessary suffering. For patients and their families, good quality care can truly mean the difference between life and death, and between disability and health. One of the highest barriers to improving the quality of care is the backward incentive system embedded in the way we pay for care. We need to start rewarding the quality care by paying for results, and not just for the number of procedures performed or the number of hospital admissions. Too often, the incentives today are geared to doing more-- not doing better. It makes no sense that doing better today can actually result in even greater financial hardship for health care institutions. If hospitals organize patient-tracking, home visits, and patient education to improve care for chronic diseases, they can reduce hospitalization dramatically. But the hospitals won't get paid much, if anything, for these improvements--and they will no longer receive the large reimbursements they would otherwise receive for inpatient care. Use of doctors specially trained to manage hospital intensive care units has been shown to reduce costs and improve outcomes. But fewer days in the ICU mean lower revenues for hospitals. That's wrong, and we need to correct it. Hospitals in Boston have already negotiated terms with insurers under which they are paid for results, rather than days of care. Some business associations, such as the Leapfrog Group, have begun to make quality standards a condition for participation in their insurance plans. the Department of Health and Human Services is testing the use of incentive payments to hospitals that meet specific quality standards. These steps are hopeful, but we need to make payment for results the rule, rather than the exception, in all aspects of our health care system. Another key step is to assure that the typical standard of care comes much closer to the best standard of care. We need to do far more to see that what we know how to do for patients is actually what is done. Opportunities are immense for improvements by targeting specific diseases that have high incidence, high costs, and high impact on individuals and families. Diabetes, for example, afflicts 17 million Americans. Patients with the disease account for one in ten dollars of overall health expenditures and one in four dollars of expenditures by Medicare. By using proven methods of prevention and treatment, we can save 10 million Americans from diabetes-related amputations, disability, or blindness during their lives--and save more than 50 billion dollars a year as well. Stroke is another example of the huge gap between what we could do and what we actually do. Stroke is the third leading cause of death and one of the major causes of disability. It strikes nearly 750,000 Americans each year. The economic cost is also staggering. The United States spends almost $50 billion a year in caring for persons who have suffered a stroke. Appropriate, timely intervention with clot- dissolving drugs has been shown to reduce disability and death by 55 percent but only three percent of patients receive the needed treatment. Chronic illnesses are major costs in the current system. Medicare beneficiaries with three or more chronic conditions account for almost 90 percent of Medicare spending. Well-organized care for patients with chronic conditions such as congestive heart failure, diabetes, asthma, and depression produce significant reductions in costs and significant improvements in outcomes. But only a fraction of patients with chronic conditions have the opportunity to benefit from such treatment. Finally, to cut costs and promote quality, we can do much more to stop illness before it starts. Health promotion and disease prevention must be central to our health system as hospital and physician care. Four hundred thousand Americans require medical treatment every year for diseases that are fully preventable by vaccination. Lack of exercise and poor diet cost almost $80 billion a year because of increased heart disease, cancer, and diabetes. The legislation being introduced today is a recipe for a peaceful revolution in the way health care in the United States is delivered. Building on a growing expert consensus, it provides a blueprint for a better health care system that will be lower in cost, higher in quality, and more closely oriented toward prevention. To assure that modern information technology will be fully utilized in health care, the legislation sets a goal of full implementation of a broad-based system of electronic medical records and automated bill- paying. It authorizes grants, loans and loan guarantees for health providers to install and implement clinical information systems that meet national technical standards for parameters such as security and interoperability. The bill also offers larger reimbursements for providers who implement these types of information systems. Over a period of time, it reduces payments for large health care facilities that fail to do so. The legislation also encourages the use of information technology to reduce the administrative costs, by requiring insurance companies to adopt the same types of computerized transaction-processing systems that are the norm in other industries. In these ways, the legislation begins the needed effort to enable the health care system to become a system that pays for value, rather than solely for procedures performed or illnesses treated. The Secretary of HHS is required to set quality standards for providers of services. Public and private payers will be required, through their reimbursement procedures, to reward the attainment of these quality standards, and are permitted to reduce reimbursements to providers who fail to meet the standards. When a provider of services believes it can provide higher quality care at lower cost, but feels that existing reimbursement procedures will not fairly recognize these innovations, payers are required to enter into good faith negotiations with providers to reach agreement on an alternative payment system. The legislation also has special provisions for payment for chronic care services in recognition of the special role of coordination of care, patient education, tracking, and follow-up in achieving quality care for individuals with chronic diseases. Finally, the legislation contains a number of important initiatives to improve the quality of care and strengthen health promotion and disease prevention. These include the establishment of a National Quality Council, and specific initiatives on diabetes, stroke, arthritis, nutrition, exercise, adult oral health, adult immunizations, and the provision of culturally and linguistically appropriate care for patients whose primary language is not English. America's health care system cannot continue to lurch from crisis to crisis. Our people deserve affordable care, and when illness strikes, they deserve the best care our system can provide. This legislation lays out a number of important steps to achieve this objective, and I look forward to working with my colleagues in Congress and the broader health community to achieve the important goals we share.

Mr. KENNEDY

Mr. KENNEDY. Mr. President, I yield 7 minutes to the Senator from Iowa.

Mr. KENNEDY. Mr. President, I understand we have 10 minutes.

Mr. KENNEDY. Mr. President, I yield myself 4 \1/2\ minutes. I join with my friend and colleague, Senator Harkin, in making sure that this body understands, and our friends all across the country, that this really isn't a partisan issue. I, quite frankly, commend the fact that we had an increase in IDEA funding, and I give tribute to the Senator from New Hampshire for that increase in funding. It is true that under President Clinton we had the expansion, moving toward smaller class size, afterschool programs. We had enhancement of teacher training and other kinds of factors in terms of the previous administration. But there is no question that there has been an increase in IDEA funding. We grant that. As Senator Harkin has pointed out, the issue is what are we going to do in the future. This discussion is really at a rather significant time in our American history because next Monday we celebrate the 50th anniversary of Brown v. Board of Education, one of the most important judgments in terms of knocking down walls of discrimination in our country, recognizing that we were going to knock down the walls of discrimination on the basis of race. Now for 29 years we knock down the walls of discrimination on special needs children, but we still have not fulfilled the requirement and the opportunity that presents. That is what the Harkin amendment is all about. Pass the Harkin amendment and we meet that responsibility, and we meet that obligation in 6 years. That is what we do. I am going to vote for the Gregg amendment that says he will increase the authorization. I am for it. If that is what passes, I will be there with Senator Harkin and with Senator Hagel battling to get the increased appropriations, but let's do it right. Why have we held these families up? I have four books here, a foot and a half tall, with individual life stories that represent families and special needs children who are trying to make it in the United States. The question is, are we going to meet our responsibility? We have from newspaper reports now that we are going to have a bonus of $100 billion this June, $100 billion more. The Harkin amendment says, let's take $2.2 billion of that and commit it to these families right here who are struggling and trying to make it every single day. Let me read from a typical letter, and it is replicated by the thousands. This is from Carla Leone of Arlington, MS: I have a 15-year-old son with Tourette Syndrome and associated disorders who is on an IEP, --an individual education program-- as well as a daughter in ``regular'' education. I had to quit my job in order to obtain special education services from the school district for my son--it was a full-time, complex job. First, the school didn't want to identify him as needing an IEP, then there was a several-year battle over what services he needed, and then once they agreed to services, there were a lot of problems with the school failing to provide the services (a common problem with implementation of IEPs). The basis for the problem is lack of funding, which pits regular education against special education, and gives the school major impetus from keeping the kids from being identified as needing special education . . . and most importantly fund this heretofore unfunded mandate. That could not be any more clear or compelling. We ought to not only think of the children but of their mothers and fathers. That is what this is about. Certainly, this is a question of priority. We in this country cannot afford to not meet what we committed. This body committed to this. The House of Representatives committed to it. A previous administration committed to help those families all over the country. We are only reaching half of that commitment now. The Harkin amendment will make sure we meet our responsibilities to all of them. What could be a better opportunity, a better priority? Money isn't everything, Mr. President, but it is an indication of a nation's priorities. That is what we have the opportunity to have in the Senate. That is why I believe the Harkin amendment should be approved. I withhold the remainder of our time.

Mr. KENNEDY. How much time do I have remaining?

Mr. KENNEDY. I yield the remaining time to the Senator from Iowa.

Mr. KENNEDY. Could we ask consent that be for both of the amendments?

Mr. KENNEDY. I move to lay that motion on the table. The motion to lay on the table was agreed to. Amendment No. 3146

Mr. KENNEDY. I move to lay that motion on the table. The motion to lay on the table was agreed to.