Bill Nelson

Mr. NELSON of Florida

Mr. NELSON of Florida. I think the point just made by the Senator from West Virginia and the Senator from South Carolina is most important. With this misinformation about the budget, isn't it curious that it comes at a time when we are discussing the Defense appropriations bill? There is not one penny in this bill, as pointed out by the Senator from West Virginia, for the war in Iraq. Just in Iraq, the war is costing $1 billion a week--$4 billion a month. That doesn't include all of the other necessary military expenditures, such as in Afghanistan and in Bosnia. Yet we are considering a Defense appropriations bill that does not have any money in here for the war in Iraq.

Mr. NELSON of Florida. Madam President, will the Senator yield?

Mr. NELSON of Florida. The Senator from South Carolina controls the time.

Mr. NELSON of Florida. Will the Senator yield?

Mr. NELSON of Florida. Will the Senator from West Virginia yield?

Mr. NELSON of Florida. Madam President, this Senator would like for the Senator from West Virginia to clarify, since the Senator from South Carolina has pointed out that we are talking about an annual deficit not close to $500 billion but now it might be approaching a $700 billion annual deficit, is that not all the more the responsibility of the Senate, which is part of the legislative branch? Under the Constitution, it is supposed to control the purse strings. Would that not make it all the more incumbent upon us to insist on what is going to be the supplemental bill to pay for the war so that we exercise our constitutional duty?

Mr. NELSON of Florida. Will the Senator yield for a question?

Mr. NELSON of Florida. I want to ask the Senator, when this Senator was assigned to the Budget Committee and the administration came forth with a budget, I questioned the figures because what was expressed was that we were not going to raid the Social Security trust fund to pay the normal expenditures of Government. Clearly, that is what the people in the country do not want. They do not want the Social Security trust fund raided to pay for expenses. Now, the Senator has come up with a new budget document that is saying the annual deficit could be as high as $500 billion but it could also be, by the words on the paper, $700 billion?

Mr. NELSON of Florida. I yield to the Senator from West Virginia.

Mr. NELSON of Florida. Unsubstantiated.

Mr. NELSON of Florida. Madam President, I was in Iraq last week, as the blood of a Florida soldier was still soaking into the parched sands of Baghdad. I still feel that we have sufficient security interests of the United States for us to be in Iraq, and, clearly, we better draw this to a successful conclusion to politically and economically stabilize that country. But I can tell you, when I read this kind of information that suggests that the American people and their Representatives in the Congress were being fed information that was not accurate--and it was intentional--then I get very concerned for this country's ability to conduct our war against terrorists, for we are only going to be successful in a war against terrorists from timely and accurate and truthful intelligence.

Mr. NELSON of Florida. I thank the Senator from West Virginia. I will have more to say about this as the debate continues on Defense appropriations. I will speak to this issue that I have raised here. It is of grave concern to me. I want, in the course of this debate, for us to be told in this debate a satisfactory explanation of why we are not planning for the supplemental on the Defense appropriations for the war in Iraq, why we are not planning for that and stating that in this Defense appropriations bill. I think that should be a part of the debate for all of the Senators to engage in. I yield the floor.

Mr. NELSON of Florida

Mr. NELSON of Florida. Mr. President, the Senate Foreign Relations Committee included in S. 925 an authorization for $2 million for the Dante B. Fascell North South Center. The Dante B. Fascell North South Center at the University of Miami is a public policy studies center that is dedicated to the analysis of complex global problems, with special emphasis on the Western Hemisphere. The center's research encompasses key areas such as trade and economic policy, migration, democratic governance, security, corruption, the environment, and information technology. Since its inception in 1984, the Center has become a valuable national and hemispheric resource, a focal point for cooperative study and an adept coordinator of international projects. It will remain so, and I hope it will continue to be a prominent focal point of Western Hemisphere studies. Congressman Fascell dedicated his career to improving relations with countries in the western hemisphere, lifting the people of these nations up. He understood how the culture of South America, Central America and the Caribbean is embedded in Florida culture, and embraced it. It is in this spirit that we honor his memory by providing resources to this Center.

Mr. NELSON of Florida

Mr. NELSON of Florida. Mr. President, while I recognize that medical malpractice insurance premiums have increased at an alarming rate in many States, I rise today in opposition of the Patients First Act of 2003, S. 11. This bill does not put patients first, and fails to address major parts of the problem. Any legislation aimed at reducing premiums for medical malpractice insurance must include reforms to the industry, and should be done by experts at the State level. Insurance regulation and tort law are traditional State issues. The Senate is moving forward on this bill even though it has not been vetted through the appropriate committees. To date, there have been no hearings in Judiciary or a markup of S. 11. In addition to foregoing the appropriate legislative process, I am also concerned that this proposal, as introduced, fails to do what it promises to do--ensure patients' access to doctors and decrease malpractice insurance rates for physicians. As a former insurance commissioner, I learned first hand that insurance is best regulated at the State level. That level or regulatory oversight over the industry ensures that residents of a particular State are all afforded the same protections and guarantees. A one-size-fits-all approach like S. 11 is not the best policy. In addition, one of the cornerstones of the McCarran-Ferguson Act in 1945 was that in exchange for exemption to Federal antitrust laws, the regulation of the business of insurance would be carried out at the State level. In the late 1980s and early 1990s insurers flocked to the medical malpractice insurance market because of increased cashflow and rising interest rates. These insurers pursued as much business as they could and as competition increased, prices dropped. This competition created an environment of underpricing the actual risks of the insurance. As the economy worsened and investment income dried up, insurance companies increased premiums to recover investment as well as insurance losses. The Senate should not ignore the business practices of the insurance industry in the so-called ``medical malpractice crisis.'' In a recent report by the Institute of Medicine it was estimated that 98,000 people die each year due to preventable medical errors. That is 268 each day. Why then instead of solely focusing on the tort system are we not also addressing this issue? After all these errors are the reasons most people seek compensation. The Senate's proposal fails to improve overall patient safety and the reporting of medical errors. Patients should have access to this information and be allowed to make informed decisions about their physicians. Proponents of this legislation argue that by limiting the risk of insurance companies through caps on damages, that by protecting their interests, we will then lower medical malpractice insurance premiums and ensure access to health care providers. I do not believe this is accurate. In the State of California, which already limits non-economic damages to $250,000, the average actual premium is $27,570, 8 percent higher than the average of all States that have no caps on non-economic damages. Clearly a cap did not keep these premiums from rising. In Florida, as in the Nation, we have had some sad malpractice cases. If patients had access to information about their doctors then perhaps Willie King may not have had the wrong foot amputated in 1995. Mr. King was admitted to University Community Hospital in Tampa, Florida, for the removal of his right foot. Imagine his surprise when he woke up to find that Dr. Rolando Sanchez had removed the left one instead. As it turns out 2 years earlier, Dr. Sanchez had settled a claim from a man who agreed to one type of hernia operation but instead had another, State records show. Still, Mr. King--who was already collecting disability--still had to have his other foot removed and was unable to remain independent as he had been prior to the operation. To cap damages, without regard to the extent of an injury is shortsighted and unfair. Caps just do not fix the problem. It is far more complicated than that. In California, which is often touted as the example of how effective caps are, medical malpractice premiums increased by 190 percent during the first 12 years following enactment of the $250,000 MICRA cap. It was not until California's Proposition 103 was enacted that malpractice premiums were lowered and stabilized. In Florida, where this issue is being hotly debated, insurers have made no guarantees to lower their premiums. Even after the Governor sought to get that assurance by further protecting them from lawsuits, the industry still refused to guarantee any sort of decrease in rates. In addition to caps not reducing malpractice insurance premiums, they are also unfair. Take the case of Janet Pandrea from Coconut Creek. In January 2002, at the age of 65, Mrs. Pandrea was diagnosed with cancer in her chest. Janet had been married for 46 years, she had been a healthy and active mother and grandmother. She was told to begin chemotherapy treatments, and died from complications after only 2 months. The doctors did not tell her family why she died so suddenly, so they requested an autopsy. The autopsy showed that she never had cancer. Janet should never have been subjected to the chemotherapy that killed her. The economic damages for a 65-year-old woman would cover only her medical bills. Her family would not be able to recover more than $250,000 for the loss of their wife, mother, and grandmother. Mr. President, I rise in opposition to this legislation, not because I do not think that there is a serious problem with the medical malpractice insurance in this country, but I do not support this bill because it will not reduce premiums or enhance a physician's ability to provide care.

Mr. NELSON of Florida

Mr. NELSON of Florida. Mr. President, yesterday the Senate voted on the nomination of David Campbell to serve as a U.S. District Judge for the District of Arizona. I was unable to vote because I was returning to Washington, DC from official travel to Iraq in connection with my duties as a member of the Senate Armed Services Committee. Had I been present, I would have supported Mr. Campbell's confirmation to the district bench. After reviewing his credentials, I believe Mr. Campbell is well prepared to serve in this important position and has the proper judicial temperament to fairly and justly apply the law.

Mr. NELSON of Florida

Mr. NELSON of Florida. Will the Senator yield?

Mr. NELSON of Florida. So I compliment the Senator and ask him why, if that was the promise that was made to American seniors, are we not considering this as the major bill on the floor, the MediSAVE amendment, instead of the package we have on the floor?

Mr. NELSON of Florida. I say to my colleague from Illinois, I think he has analyzed this about as well as anyone I have heard. We made promises to the senior citizens of this country that they would have a defined benefit that would cost a minimal amount with very little deductible, with no huge gap in the coverage, that would be a part of Medicare and that whatever it was to cost----

Mr. NELSON of Florida

Mr. NELSON of Florida. I ask unanimous consent that further reading of the amendment be dispensed with.

Mr. NELSON of Florida. Mr. President, I send another amendment to the desk.

Mr. NELSON of Florida. Mr. President, I came to talk today about this prescription drug bill. I certainly support this bill, and I am going to vote for it. I commend the chairman and the ranking member for how they have crafted this legislation. I commend the Finance Committee for how it has put it together. If I had my druthers, we would have passed those amendments that we would have had in the last few days that we didn't pass because, clearly, giving an option for seniors to go directly through Medicare for a prescription drug benefit is, in my opinion, keeping faith with the seniors. So many of us have already suggested that we wanted to modernize Medicare from a 1965 health insurance system funded by the Federal Government for senior citizens-- modernize that to the year 2003. If you were writing Medicare today instead of in 1965, 38 years ago, would you include a prescription drug benefit? Of course you would because the miracles of modern medicine, the miracles of prescription drugs so often today will take care of the ailments and the chronic problems; so that when the Medicare system was set up in 1965--38 years ago--the state of the art of medical care was centered around a hospital and doctors. But hospitals and doctors have new tools today. Some of those tools, by the way, that I will share with you sometimes come directly out of America's space program. They are the spinoffs of technology. Some of them have come out of the State of the Presiding Officer at the Marshall Space Flight Center. I am telling you, there is some miracle equipment that has come out of the space program. Part of the miracle of modern health care is prescription drugs. For that, I give great commendation to NIH, to our universities, and all the research institutions, and to the research departments of the pharmaceutical companies that are producing these new wonder drugs of today. But we ought to be modernizing Medicare with a prescription drug benefit that is a part of Medicare. The problem is, we cannot get the votes to do that. So what the Finance Committee has done is fashion a plan whereby you can offer in the private sector, through a preferred provider organization--a PPO is a managed care kind of concept--and they will provide it or the senior citizen can go and get two separate drug plans and directly there. But if they fail, there is a backup of the Federal Government doing its own prescription drug plan, according to the elements in the outline of what they have done in the legislation. I would prefer it if a senior citizen could, in fact, go to the private sector or have the choice of getting their prescription drugs directly from Medicare. That would be the senior citizen's choice. But we could not get the votes for that amendment. So we are proceeding on with the bill, and I am certainly going to support the bill because it is a major first step along the way to providing prescription drugs for senior citizens. We need to keep faith with those seniors. This is what a lot of us have talked about and said we wanted to do, and this is a first major step to do it. Since the Senator from Montana has come back in, I have been commending him on this package saying that I wish we had adopted a couple of the amendments that were offered over the last couple of days, but that I support the package. I commend him. This is a major first step on the road to keeping faith with our seniors. I appreciate what he has done. I would like to take a few moments to critique some parts of the bill.

Mr. NELSON of Florida. Mr. President, I wanted to come to the floor and offer some comments about the Medicare prescription drug bill. I wanted to give my accolades to the chairman and ranking member of the Finance Committee for how they have so expertly crafted a bill in a bipartisan fashion which is how this body ought to be operated, and so often we are operating exactly the opposite way. There are just too many partisan votes around here. They have shown, Senators Grassley and Baucus, that the spirit of bipartisanship in fact does live and that good work products can be accomplished. Antispam Legislation Before I make my remarks on the legislation, I want to recall to mind another bipartisan work product that was produced out of the Commerce Committee yesterday and will be coming to the floor. It is the antispam legislation. I have reserved for the floor to offer a major amendment to it. It is very possible that we will work out and the prime sponsors of the bill will accept my amendment, but it has to do with the question of spam, which is all of that unwanted e-mail everybody gets on their computer. I was just absolutely dumbfounded; One day I went in my Tampa office and I said: How about printing out for me the e-mail we received today, just one day. And they produced a full letter-sized sheet, single spaced, of e-mail that we did not want, that had come anyway. Of those e-mail messages, two of them were pornographic which, if that is happening in the office of a Senator, you can imagine what is happening all across the country. That is exactly what is happening. People are fed up. They want the Federal Government to do something about it. Fortunately, we have finally gotten the political will now that we are going to do something about it. I bring this up not only as an example of bipartisanship reflecting what Senator Baucus has done with this masterful crafting of a legislative package, but I wanted to alert the Senate to the fact that the antispam bill is going to come. I am going to have an amendment that will improve it. In the bill the only penalty is a misdemeanor. What I want to do is to strengthen that penalty and to give the prosecutors the tools so that the violation of sending unwanted and undisclosed in its address e-mail becomes an element that will trigger the Racketeer Influenced Corrupt Organization act, RICO. What that does is give prosecutors the tools to go after the criminal enterprise and then take their assets. Let me tell you what is in this morning's paper. Here is a good example of an e-mail scam that used a retailing giant's name in an attempt to capture credit card numbers and other personal data on a nationwide basis. They sent out millions of these e-mails. What they did is, they took a retailer, Best Buy, and they sent a message that said they wanted to offer something on Best Buy. Of course, it was all fraudulent. It was claiming to be Best Buy's fraud department. They said they were informing people their credit card number had supposedly been used in a suspicious purchase through Best Buy dot com. And then it instructed the card holders to go to a special Web link to help resolve the problem. Then when those Best Buy customers went to that Web link, they offered their credit card number and then ``Katie bar the door.'' Here is obviously a deceptive scheme, taking the advantage of a legitimate business, using a deceptive message in order to obtain credit card numbers which they then will use fraudulently to bilk people of millions of dollars. And because they send out hundreds of millions of these e-mail messages, it is time for us to get serious and not just come in with an antispam bill that is going to spank people on the hand with a misdemeanor but is going to go after the assets of the criminal enterprise under the RICO Act. I bring this to the attention of the Senate. That debate will be coming up hopefully fairly quickly. I must say, ever since I happened to talk about this down in Tampa that day I just checked my e-mail in the Tampa office, I have gotten so many calls and letters to say: Right on, Bill, right on. We can't even use our computer and our e-mail anymore, because we are so cluttered up with e-mail. It is time for the Federal Government to do something about it. We have a crime against mail fraud. The Presiding Officer, as a former U.S. Attorney, knows all about prosecuting mail fraud. If you did that kind of scheme I just showed you in today's Orlando Sentinel, and instead you used the mails and you sent out 100 letters like this same thing, posing as a department store, saying we have reason to think your credit card has been stolen, give us your card number so we can correct this--of course, it is a deceptive scheme; it gets your credit card number so they can charge--you would prosecute under the mail fraud statute. But that is sending out a hundred letters--my goodness gracious--through e-mail--snap, just like that, 175 million e- mail messages. Think how many people are going to bite and how many credit card numbers are going to be stolen--just in this particular case. That is why we have to give them strong penalties in the bill that is going to be considered by the Senate. That is why we have to be able to hook it as one of the elements that triggers the RICO Act--the Racketeer Influenced and Corrupt Organization Act--so that the prosecutors can go after the assets of the organized criminal thug ring. Prescription Drugs

Mr. NELSON of Florida. With the enormity of this subject, Mr. President, I could go all the way from 5 minutes to 55 minutes. So what is the pleasure of the Senator from Montana?

Mr. NELSON of Florida. I yield to the distinguished majority leader.

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