Pat Roberts

Mr. ROBERTS

Mr. ROBERTS. Will the chairman yield?

Mr. ROBERTS. I ask unanimous consent the reading of the amendment be dispensed with.

Mr. ROBERTS. Mr. President, included in the half trillion dollars in new taxes in this health reform bill is a tax hike of $20 billion on medical devices, a $20 billion excise tax on lifesaving medical devices. The nonpartisan Congressional Budget Office and Joint Committee on Taxation have both confirmed that these excise taxes will not be borne by the medical device industry if in fact that is what the other side wanted to do. Instead, the tax will be passed on to patients in the form of higher prices and higher insurance premiums. My colleagues are going to speak in greater detail about this tax, but let me take a moment to talk about some of the people who will bear the burden, and what types of devices will be taxed. People with disabilities, diabetics, amputees, people with cancer and people with Alzheimer's are just some of the folks who will see their tax costs go up because of this tax. My amendment prevents this new tax from raising the already high cost for these groups by striking the tax on medical devices. This is a tax on innovative devices as well, a device such as the cyberknife. The cyberknife is a noninvasive alternative to surgery for the treatment of both cancerous and noncancerous tumors anywhere in the body. Yet under this bill, such cutting-edge devices will be taxed. Those who need the treatment offered by the cyberknife will see the cost of that treatment go up. When innovative and lifesaving technologies such as the cyberknife are taxed, when the costs of many tests increase because the devices used in the tests are taxed, when the new devices are not developed and when fewer manufacturers are able to survive in the anticompetitive environment this tax will create, consumers of health care will suffer for it. I urge my colleagues to support this amendment, and yield the remainder of my time to the distinguished Senator from Massachusetts, Mr. Brown.

Mr. ROBERTS. I ask consent to call up Roberts-Inhofe-Brown amendment No. 3579, and I ask unanimous consent Senator Crapo be added as cosponsor.

Mr. ROBERTS. I ask unanimous consent to temporarily set aside the pending motions and amendments so that I may offer an amendment, No. 3577, which is at the desk.

Mr. ROBERTS. Mr. President, I ask unanimous consent that the reading of the amendment be dispensed with.

Mr. ROBERTS. Mr. President, I ask unanimous consent now to temporarily set aside the pending motions so that I may offer a motion to commit, which is at the desk.

Mr. ROBERTS

Mr. ROBERTS. Madam President, I rise today to join my colleagues in support of this bipartisan agreement. Yes, there is a bipartisan agreement in regard to this bill. It can be done. It has been reached by the Senate Finance and Commerce Committees on the reauthorization of the Federal Aviation Administration and Airport and Airway Trust Fund; i.e., the Rockefeller substitute amendment No. 3452. I thank Chairman Rockefeller for his leadership. He is right; we need to move this bill. He referred to the 11 times it has been delayed. I have been working on this bill for 4 years. I know he has been working very hard, very diligently, and we do have a workable compromise. I think it represents the true meaning of that word. It shows what is possible when we roll up our sleeves and go to work together. So special thanks to Chairman Baucus and Ranking Member Grassley and to Senator Rockefeller and all of his staff and all of Senator Baucus's staff, everybody's people who have been working on this. In 2006, at my invitation, then-Secretary of Transportation Mary Peters joined me and Congressman Tiahrt from the fourth district of Kansas, local officials, all sorts of representatives from the aviation businesses in Wichita, for a roundtable discussion about the importance of aviation to Kansas and to the country. We then toured Cessna's manufacturing lines to see firsthand an example of the great work of Kansans who build 50 percent of the world's general aviation aircraft. Reauthorizing the FAA and the Airport Airway Trust Fund is not only a top national priority to, obviously me, Senator Brownback, and the Kansas delegation, but a top Kansas priority. We tried to pass this bill 2 years ago, and at that time 40,000 employees were in Wichita and the surrounding counties and they made their living building planes, manufacturing parts, and servicing aviation. Now, unfortunately, after delay and delay and delay due to the rough economic climate and conditions, that number has dropped to just over 25,000. That is a tremendous decrease with an awful lot of hurt for a lot of families in Kansas. Kansas is home to nearly 3,200 aviation and manufacturing businesses, including Cessna, Hawker-Beechcraft, Bombardier-Learjet, Boeing, Spirit, AeroSystems, Garmin, and Honeywell, to name a few. However, aviation isn't simply an economic engine in Kansas; it is part of our history, our way of life and, most importantly, part of our future. It is an example of our entrepreneurial spirit. Throughout this debate, I wish to point out that general aviation has been called to increase its contribution to the Airport and Airway Trust Fund to help pay for what everybody knows needs to happen: the modernization of our air traffic control system. All along the way, general aviation has stepped to the plate and agreed to help pay for the necessary increases to move our aviation infrastructure into next- generation technology. I cannot recall a time when any industry has come to me and said, We want to help and we are willing to support an increase--65 percent, by the way--in our taxes to do so, but that is exactly what the general aviation community did. Their only request has been that they be able to pay through the current efficient and effective tax structure, the fuel tax. So the agreement reached between the Finance and the Commerce Committees respects this request and allows the general aviation community to be part of the modernization solution without creating a new bureaucracy or any additional redtape. This raises an additional $113 million dedicated to updating the air traffic control technology that will increase safety and decrease congestion. At the same time, our commercial airlines and passengers are held harmless from tax increases. So, again, I am pleased this agreement recognizes the value of both commercial aviation and general aviation to our Nation's transportation system. I realize there have been strong feelings on both sides of this debate for a considerable number of years. My goals as we drafted the bill were very clear: First, ensure that our air traffic control system is upgraded and remains safe for all passengers and aircraft. Secondly, protect the general aviation community and Kansas jobs which would have been threatened by a new user fee. This legislation represents the best of a bipartisan compromise and a real effort to make our skies safer. I am very proud to be a part of this compromise, as are tens of thousands of workers employed in Kansas in aviation manufacturing. Our State has always been and remains the air capital of the world, and under this agreement it will continue. I thank my colleagues for helping us to reach a compromise that will maintain our world standing. I am very hopeful the Senate will continue to work in this spirit of bipartisanship on this bill. Yesterday Senator Brownback in his remarks, Senator Rockefeller in his remarks just a while ago, and Senator Hutchison made these same comments. We need to move quickly to a conference committee and eventually have this bill signed into law before the current program expires. I know when a train moves, everybody wants to put their car on the train. However, let's try to keep extraneous amendments--I don't mind Senators at all talking about their concerns, whether it be education, gay marriage, or earmarks; and I would expect we would hear a lot of speeches on earmarks--but we need to keep this bill the way it is and move this bill. Then there will be another train or I will have Kansas general aviation provide an aircraft for a more speedy amendment to go over to the House if that is the case. So let's try to keep our extraneous amendments if we can, despite our strong feelings, off this bill, and let's get something done. It has been languishing here for over 4 years and probably longer than that. I yield the floor.

Mr. ROBERTS

Mr. ROBERTS. Mr. President, I rise today to talk about prescription drug importation and patient safety. Senator Dorgan's amendment to allow for the importation of prescription drugs into the United States could have grave consequences for patient safety in America. In a recent letter to my good friend and home State colleague Senator Brownback, the Commissioner of the Food and Drug Administration, Dr. Margaret Hamburg, identified the four risks to patient safety that drug importation schemes pose: No. 1, the drug may not be safe or effective; No. 2, the drug may not be a consistently made, high quality product; No. 3, the drug may not be substitutable with an FDA-approved product; and No. 4, the drug may be contaminated or counterfeit. That is a lot of risk to expose already-vulnerable patients to. And think about this: Malta. Cyprus. Latvia. Estonia. Slovakia. Greece. Hungary. Romania. These are just a few of the countries that could be exporting prescription drugs to the United States if the Dorgan amendment passes. As a former chairman of the Senate Intelligence Committee, I have grave concerns about the ability of these countries to adequately protect their drug supplies. Our Food and Drug Administration, the FDA, is the gold standard for drug and product safety in the world, and even it has not been one hundred percent effective in preventing contaminated and counterfeit products from entering our supply chain. The recent scandals involving imported heparin, infant formula, and toothpaste have demonstrated the unfortunate limitations of the FDA's ability to conduct foreign inspections of food, drugs and cosmetics manufacturers abroad. If our own safety watchdog can't guarantee our protection, how can we expect that protection from Malta or Slovakia? There is a real risk that these countries will be vulnerable to importing drugs from countries that are known for high rates of counterfeiting. In the European Union last year, 34 million counterfeit drugs were seized at border crossings in just 2 months. The World Health Organization estimates that drug counterfeiting rates in Africa and parts of Asia and Latin America are 30 percent or more. And up to 50 percent of medicines purchased from Internet sites that conceal their address are found to be counterfeit. Do we really want an HIV or cancer patient in Ohio, or Arizona or Kansas to rely on imported medicines that may have zero effectiveness, or which may even be harmful? According to FDA Commissioner Hamburg, the Dorgan amendment does not adequately address these potential risks. In fact, the Commissioner says that the amendment ``would be logistically challenging to implement and resource intensive'' and that ``significant safety concerns . . . and safety issues'' remain. Senator Lautenberg has introduced a side-by-side amendment to Senator Dorgan's, requiring that, before any law allowing the importation of prescription drugs into the United States can become effective, the Secretary of Health and Human Services must certify that such a scheme will both pose no additional risk to the public's health and safety, AND result in a significant reduction in costs for consumers. I think that this amendment just makes sense. We must protect the prescription drug supply in America.

Mr. ROBERTS

Mr. ROBERTS. That phrase that the Senator just mentioned is, ``which is designed to kill legislation.'' My question has already been answered by the distinguished Senator, what does it mean, but there are no motions that have been considered or pending, including the pending motion to commit by the distinguished Senator--is the motion designed to kill this legislation? Because that is what you are going to hear on the other side, and that is not the case.

Mr. ROBERTS. Will the Senator yield for a question?

Mr. ROBERTS. I will tread with great care, I would say to my distinguished friend. I thank the Senator for this colloquy. But you asked what it means that ``the Senate should reject any procedural maneuver that''--that is in quotes--and what does that really mean? Well, it applies only to the Senate procedural motions. By itself it would have no effect on any substantive provision. That is the way it is commonly understood under Senate rules. It means, if adopted, the amendment would not remove any provision that has been identified as a tax increase on middle-class taxpayers, which is precisely what the Senator is trying to do. So basically it means nothing.

Mr. ROBERTS. Would the distinguished Senator yield for a question?

Mr. ROBERTS. Will the Senator yield for another question?

Mr. ROBERTS. I would like to get back to the side-by-side amendment allegedly being offered by the chairman of the Finance Committee, the Senator from Montana. I said straw man, and that is pretty harsh, but I intend it to be. We have seen how, if the language is examined, the amendment, at a minimum, is a red herring. You can fairly say the amendment, rather, has no other purpose than to facilitate a strong argument. On Tuesday, when Senator Crapo laid down his amendment, the majority didn't show us this side-by-side amendment until shortly before we thought--and they thought--we were going to vote. So that very limited notice makes you think it may be more likely to distract from or muddy the clear question the Senator from Idaho brought; that is, the motion to commit before the Senate. The motion was designed to be to be straightforward, and the Senator did that. A vote for the motion is a vote to send the Reid amendment and underlying bill back to the Finance Committee. Under the motion, the Finance Committee would report back a bill that eliminates the tax increases on middle-income taxpayers. One could not say it anymore simply. That is what the motion does. The other bill is a straw man. After the remarks by the distinguished leader, I would say this may be a seminal event. I think that is one of the key votes where the other side could start to realize this and start to finalize this without all the rhetoric and ideology and philosophical support for this bill, and they could start the road back, if you will, of doing it in a step-by-step, thoughtful way--doing it, meaning real health care reform. I commend the Senator. Again, this side-by-side is a straw man. The Senator is clear in what he wants to do. Under the Senator's motion, the Finance Committee would report back a bill that eliminates the tax increases for middle-income taxpayers. We can restart the debate in a bipartisan way, where we can agree on many common goals. I thank the Senator.

Mr. ROBERTS. I wish to thank our distinguished leader for pointing that out. It has been a seminal event. As I said before, I have the privilege of being chairman of the Rural Health Care Caucus. There are probably 30 of us in a bipartisan caucus to try to protect and improve the rural health care delivery system. I took that report by Mr. Foster, who is the actuary of CMS, and said, this is required reading. I made the point that if you mention CMS to a beleaguered hospital administrator or a member of the board or any medical provider--doctor, nursing home, home health care, hospice; even hospice is cut in regard to the cuts--they know if a CMS representative is knocking on the door, that is a lot like sending a cold shiver down their spine thinking it is Lizzie Borden. Of all of the agencies that now are shining the light of truth into darkness in regard to the nature of this bill in increased costs, and yes, rationing--no, it is not a scare tactic--CMS is that agency. It would be amazing if we could get CMS to report back on, if we knew what it was--the media reports are how we get the information on this new iteration of a bill where allegedly we are going to add in people from 55 years old into the Medicare system. You do that, and now all of a sudden even the national organizations, let alone the State provider associations who have been opposed to this, to say, Whoa, we can't do that. That is going to break the system. What I wish to point out and what I think is another piece of information that has sort of been overlooked, the CBO has estimated the cost to the Internal Revenue Service to implement taxes and penalties and enforce them--I am talking about the IRS now, not CMS, but the IRS that is going to implement and administer and enforce taxes and penalties on the bill--that cost is $10 billion estimated by CBO. That would double the budget size of the IRS. We have to train these people, and then you have to figure out what kind of questions they are going to ask of employers and employees in regard to the fines and the fees, you have to read the fine print. The American people understand this tremendous tax increase is going to be administered by the IRS and that is not going to be a happy circumstance. But those two things that the leader has brought out are absolutely primary in this debate. I think a side-by-side is a straw man. I think it is very clear about that. I am happy to comment on that further. I wish to give others an opportunity to speak.

Mr. ROBERTS. As Republicans, there is probably no principle that unifies us more than keeping taxes low on American workers and families, and I don't think our friends on the other side would dispute that notion. Indeed, the Democratic Party assumed control of the White House almost a year ago, as everybody knows, and seated large majorities here in the Congress. The one unmistakable distinction between the parties is this: Our party has respectfully opposed--I underline the word respectfully--opposed numerous efforts by the majority party to impose broad-based taxes increases on American workers and families. So one only need to look at the stimulus debate or the budget debate or the cap-and-trade legislation, and I could go on and on and on, more especially with the health care debate, and the bill before us. Don't you follow from that general principle?

Mr. ROBERTS. Would the Senator yield?

Mr. ROBERTS. Madam President, I will be very brief. I thank the Senator from Tennessee, not only for his statement but for his constant efforts. Facts are stubborn things. Yet he has pointed out basically what this report now confirms. During the last few months we have seen some commentary that says ``scare tactics,'' of all things. I happen to have the privilege of being the chairman of the Rural Health Care Caucus. I was in the House of Representatives when I had the privilege of serving there and I am a cochairman with Senator Tom Harkin of Iowa. There are about 30 of us who, from time to time, will correspond and meet and send messages back and forth to try to keep the rural health care delivery system viable. We have been worried for some time in regard to what is going to happen to Medicare, what is going to happen in regard to cost, what is going to happen in regard to rationing. Every hospital director, every hospital board in rural America has worried about these things--more especially about CMS, which has been described here in detail. That is the Centers for Medicare and Medicaid Services. I have to tell you, if you are a hospital administrator or if you are on the board of a local hospital in a rural area, and you hear the word CMS, it is probably not viewed in the best of considerations, that CMS is in charge of enforcing what H2S comes down with. So in terms of reimbursement, in terms of all things--competitive bidding--and I am talking about doctors, hospitals, nursing homes, home health care, hospice, all of this--when they hear the word CMS a cold chill goes down the back of their neck, more or less like expecting Lizzy Borden to come in the front door. So I am especially glad that the actuary, Mr. Richard Foster, the Chief Actuary from CMS, has shined the light of truth into darkness. He has taken the original bill we have been talking about for some time, as my colleague has pointed out, and said basically this bill is going to increase costs and is going to result in rationing. It does not take into consideration the latest iteration that we hear from the press and media about including people 55 to 65 into Medicare. It is going to be interesting, if we have enough time--although I know that the distinguished majority leader has asked for a CBO score--but I would sure like to know what Mr. Foster would think of that idea. I think it would be far worse. I encourage all of my colleagues who belong to the Rural Health Care Caucus to take a very hard look at this. This confirms what we have been saying for some time. These are not scare tactics, these are actual facts. Let me say, too, I know when this debate first started some of the national organizations that represent doctors and hospitals, perhaps nursing homes--certainly not any home health care--well, I take that back. There was a letter written by the home health care folks at one time, but certainly not hospices--indicating that they were lukewarm, warm to the bill, or would perhaps support it. I think the message was pretty clear--come to the breakfast or you won't come to lunch. That was pretty bare knuckles but they hoped that at least by insuring those who have insurance, that would make their situation better. Then, of course, came the latest iteration to this bill of putting in people 55 to 65, and the national association, in regard to our doctors and our hospitals, said: Whoa. Let me point out in Kansas and in many States throughout the country there never was the support. They knew exactly what would happen if we passed this bill and CMS would come knocking on their door. I might add it wouldn't be CMS that would actually do that, it would be the Internal Revenue Service under this bill, and that was one consideration where I made about a 15-minute speech and obviously not too many people paid attention. But all patients, all doctors, all nurses, all clinical lab folks, anybody connected with the home health care industry or hospice or nursing homes or whatever, should have known it is going to be the IRS that is going to enforce this as well as CMS, which has been doing most of the enforcing. In Kansas, the Kansas Medical Society said: No, no, we are not going to go along with this bill. I am talking about the bill we have been talking about for some time. The Kansas Hospital Association was adamant. They said no. Obviously that was because of advice they got from 128 hospitals in my State, saying: No, we cannot reconcile with this because of cost, because of the rationing. We are only being reimbursed at 70 percent or less, as we talk about it--and the doctors about 80 percent. Many doctors do not serve Medicare now in Kansas. Let me rephrase that. Some doctors don't serve Medicare in Kansas. If this bill passes, a lot of doctors simply will not serve Medicare. You can have the best plan or the best card in the world, it is not going to make any difference if you can't see a doctor. It is not worth a dime. Then I have to say the Kansas Nursing Home Association and Kansas Home Health Care folks and the Kansas Hospice folks all said: No, this is not where we want to go. This is self-defeating. This is not going to do what the sponsors of the bill and what everybody for health care reform hoped they would actually see happen. I don't know what the word is, I am--not overwhelmed, I am extremely glad; I am somewhat surprised but I am extremely glad that CMS again shined the light of truth into darkness. I commend Mr. Foster, the chief actuary. I recommend this as required reading for everybody who was going to vote for this bill and certainly with the latest iteration, where we are adding anywhere from 10 to 20 to 30 million people to Medicare, which will make the situation much worse in regard to Medicare being actuarially sound and costs going up, premiums going up, and also rationing, the dreaded rationing. It is not a scare tactic but actually a fact. I yield my time.

Mr. ROBERTS. Will the Senator yield for an observation?

Mr. ROBERTS. I thank the Senator for yielding.

Mr. ROBERTS

Mr. ROBERTS. So I may proceed for 15 minutes.

Mr. ROBERTS. I will try it again. I thought it was worked out. I ask unanimous consent for the second time that the order for the quorum call be rescinded so I may be--

Mr. ROBERTS. Is this a bipartisan objection, I would ask the Presiding Officer? The bill clerk continued with the call of the roll.

Mr. ROBERTS. I thank the President. I rise today to talk about health care in general and the latest proposal to come out in the form of the so-called compromise, if there is no objection. I wish to talk about the latest proposal to come out from what some of us have determined is the majority leader's behind-closed-doors effort for the compromise on the government-run health insurance plan. I will admit very readily I do not know all of the details of this plan, although I hope to in the very near future. I think most of my friends across the aisle are in the same boat and we are all getting our information from the Post, the Times, and the rest of the catch-up media. But this is the compromise, as I understand it: The majority leader will drop the government plan in exchange for two major policies: first, a national insurance plan run by nonprofit insurance companies and supervised by the Office of Personnel Management; and second, a massive expansion of Medicare to tens of millions of people age 55 and older. Putting aside the first policy which, frankly, I don't understand how it could possibly work, I cannot believe anyone is seriously considering expanding Medicare as a compromise to the government-run or so-called public option. It doesn't take a genius to see that a huge expansion of Medicare is, as one single-payer advocate in the House dubbed it, ``the mother of all public plans,'' further quoting: ``An unvarnished and complete victory'' for advocates of single-payer health care and socialized medicine. That is a very strong quote, but that is the way it was. In other words, this is not a compromise to the public option--it is worse. Maybe we need to remind ourselves why moving toward more government control of our health care system is such a bad idea. We need look no further than our current government-run insurance plans, Medicare and Medicaid, for examples. Government-run insurance plans currently control nearly half of the market. With the government's power, they have the ability to set payment levels for doctors and hospitals and home health care agencies and even hospices and all other health care providers, not based on the actual costs those providers incur when treating patients, but instead based on whatever arbitrary spending target the budget crunching bean counters determine the government can afford. To paraphrase one observer: These types of global government budgets transform patients from sources of revenue over which providers compete to attract and serve, into sources of cost for the government to avoid, shunt off, and treat as cheaply as possible. That is not right. This has clearly been the result in the Medicare Program, often heralded as the best of all of the government's health care programs. So to review: Medicare has been on an ever shrinking path toward bankruptcy for years. The latest reports from the Medicare trustees say the hospital insurance trust fund will go broke within the next 8 years. The program has $38 trillion in unfunded liabilities. How has the government responded? By severely underpaying Medicare providers and denying Medicare patients' claims. Medicare only pays doctors around 80 percent of their costs, and hospitals even lower. Privately insured Americans pay a hidden tax of nearly $90 billion a year to make up for these underpayments. But even that hasn't been enough to keep some providers in business and able to afford to accept Medicare patients. Medicaid is even worse. Medicare is also a huge denier of claims. I think many of my colleagues would be surprised to hear that Medicare denies claims more often than most private insurance companies. In fact, in 2008, Medicare had the highest percentage and the highest number of denied claims in the country. Think about that when you hear some Senators demonize private insurance companies for denying claims. Medicare is even worse. This bill already exacerbates these Medicare problems by cutting almost $\1/2\ trillion from this already woefully underfunded program. Now we are considering adding even more people. This is a sinking ship with no lifeboats, and we are adding more folks to the deck. By underpaying health care providers and denying claims, Medicare already rations health care. Expanding Medicare to tens of millions of new people as envisioned by this compromise we hear about will take government rationing to a whole new level. Because as the government takes over more of the health care system and becomes responsible for more of the increasing costs of that system, the only way it will be able to afford this commitment is to ration health care. As I have said countless times before, this bill gives the government all the tools it requires to ration care. From Comparative Effectiveness Research, to the independent Medicare advisory board, to the new powers granted to the Centers for Medicare and Medicaid Services, CMS and the U.S. Preventive Services Task Force, this bill puts the rationing infrastructure into place. The U.S. Preventive Services Task Force's recent change to its guidelines pertaining to mammograms was a perfect illustration of how your health care will be rationed under this bill. For those who don't know, the task force recently reversed its longstanding advice that women should start getting regular mammograms to detect breast cancer at age 40. Why is this important? Because under this bill, the recommendations of this task force will carry the weight of law for both government- run--i.e., Medicare--and private insurance. If the task force recommends a particular treatment or a particular set of patients, then Medicare and private insurers must cover it. If it doesn't, they don't. What do you think will happen to treatments and tests that don't get the task force's recommendation? They simply will not be covered. That is how the government will hold down health care costs, by rationing access to treatments and tests such as mammograms. Some government-controlled health care systems such as the one that exists in the United Kingdom are much more explicit about rationing. The rationing in this bill, quite frankly, is not as honest. Since Americans would never stand for the government explicitly rationing their health care, the authors of this bill had to come up with a pseudoscientific justification for rationing, and that justification is the main feature of this bill: Comparative Effectiveness Research, or CER. Very generally, it is very simple. CER is the comparison of two or more treatment options to see which one is better. Sounds great, right? Except when you realize that CER is not being conducted for the purpose of improving patient care but for the purpose of saving the government money instead. I read the CER section of the bill and I remember my amendment on CER and the distinguished chairman of the HELP Committee was very helpful, and said he would study it overnight. Because I had the word ``prohibit'' in the amendment we got into a great debate on what prohibit means. I thought it was pretty clear but, unfortunately, that was dropped from the bill, from the HELP Committee bill. We tried that again in Finance. It didn't work. We would like to try it again if we have time. This bill establishes a CER institute to conduct this research for the purpose of justifying government rationing of health care. CER will be the golden ring of rationing. So what we have here is a recipe for disaster: a bill that already significantly weakens the woefully underfunded Medicare Program and lays the foundation for a rationing infrastructure, plus a ``compromise'' that apparently will pour millions of more people into the program. In the no-holds barred search for a proposal that can attract 60 votes, I don't understand how any Senator can support this idea. This is just another Trojan horse, another incremental step toward the single-payer system. Again, as one House Member in the leadership observed: This gets not only the camel's nose under the tent, but his whole head and neck, too. It is another step toward socialized medicine and increased government rationing of health care. The American Hospital Association, American Medical Association, and the Federation of American Hospitals are finally taking notice of the advice they are receiving from their State and local hospitals and doctors. They, finally, have seen the light and have come out in opposition to this deal at least. I urge my friends across the aisle to resist this latest misguided attempt at deal making. The consequences are too dangerous. There is an awful lot of cactus in this health care world. I don't think we need to sit on each and every one of them. Before yielding back my time, I truly thank the distinguished Senator from Connecticut for his comity and allowing me to make these debate comments. I thank the acting Presiding Officer in his effort to be bipartisan. I think we will have a sad day in this body if one side or the other gets into a situation where we do not allow people to make remarks on not only the pending bills and specifically on the general issue of health care.