Rick Santorum

Mr. SANTORUM

Mr. SANTORUM. Mr. President, I ask unanimous consent that my letter addressed to Mr. Ron Davis of the National Marine Engineers' Beneficial Association be printed in the Record.

Mr. SANTORUM

Mr. SANTORUM. I will offer an amendment on Syria and speak on it and then I will be withdrawing the amendment.

Mr. SANTORUM. I thank the chairman for his assurance that the issue of Syria and the Syrian Accountability Act will be taken seriously by the committee. We hope, as a result of that, we can move forward with some productive legislation in the Senate to give our country a stronger hand in dealing with terrorism in the Middle East. Mr. President, I yield the floor.

Mr. SANTORUM. Mr. President, I want to echo the chairman's comments that this body in a very late session, under his leadership and that of Senator Biden, was able to pass this historic measure providing the President the fodder he needed to go to Europe and the G-8 and make a pitch that the United States is behind trying to take on this scourge that has enveloped a continent, the subcontinent of Africa, and he was able to do that. As a result, he has been able to get the European Union to make a substantial commitment to participating in this project. I don't know if it has been said yet, but not only did we believe it was necessary to provide the appropriate leverage for our comrades in Europe to participate, but it worked. It was successful. They have come to the table and we are grateful for that. I think Senator Bingaman's amendment, as the chairman suggested, is just further evidence of our commitment to funding. My belief is we should come forward with the necessary funds. I don't necessarily agree with Senator Bingaman that we need to put $3 billion in the appropriations process in the pipeline right now. The commitment was $2 billion plus $1 billion in matching funds. The President said he would put up $200 million in good faith. So that puts us at $2.2 billion which is what I believe is the number that is necessary to meet the commitment the authorization requires. I don't think it is necessary for us to appropriate $1 billion without having the match in place for that $1 billion. I think we can always come back, as we are maybe even this week, with supplementals throughout the course of the year to fulfill the commitment. Our commitment in the Congress was $2 billion plus $1 billion if other countries match it. So we need to put in $2 billion. We have $1.9 billion, as the Senator from New Mexico said. So we are not that far off. But the President did say he would put $200 million forward, whether or not it is matched, as a good faith effort. And so I think to comport with that, we should do our best, within the appropriations process, to come up with $2.2 billion. But I think anything beyond that, candidly, is unnecessary, under the authorization is unnecessary. And I hope we do what is required and candidly sit back and wait and see what kind of commitments we will get from the rest of the world before we start ponying up real dollars in the appropriations process when those dollars are contingent upon other countries coming through with their contributions. While I agree in principle with what the Senator from New Mexico said and will certainly support his amendment--I encourage Senators to support this amendment--I do so with the caveat that really full funding, under the understanding on this floor the night we passed it as well as the President's initiative, is, in my mind, $2.2 billion. And then we can go from there subsequently, depending upon the kind of support we get from other countries around the world. I yield the floor.

Mr. SANTORUM. Mr. President, I ask unanimous consent I be permitted to speak for 5 minutes following the last speaker in the unanimous consent request.

Mr. SANTORUM. Mr. President, I rise to talk about a piece of legislation that Senator Boxer and I introduced last year and reintroduced this year which has 63 cosponsors. I understand the Senator from California may be offering this amendment after these two votes and speaking on that amendment; and then my understanding is she intends to withdraw that amendment. But I think it is important that both of us have an opportunity to talk about the importance of this issue; and that is the Syrian Accountability Act. Many in this Chamber--obviously, 63--have very serious concerns about the role Syria is playing in the Middle East and in the world community. Syria is, unfortunately, being treated differently than other countries that have been listed as sponsors of terrorism. There are a couple handfuls of states that sponsor terrorism. Syria is one of them. Yet it is treated fundamentally differently than all of the other state sponsors of terrorism. Yet arguably--maybe with the exception of Iran--it may be one of the most egregious violators of international law, one of the worst in terms of sponsoring terrorism, and one of the most disruptive to peace in the Middle East and the Palestinian-Israeli peace process. In addition, even since we introduced this legislation last year, we have seen Syria's horrendous actions with respect to the support for Saddam Hussein and his regime during the recent operation in Iraq. So there are even additional reasons for Syria to be held accountable for their actions, which are against the security interests of the United States of America. We had Under Secretary Bolton just recently over at the Department of State talking about how Syria has a stockpile of nerve agent, sarin gas, and is trying to conduct research and development on nerve toxins like VX. So not only are they a sponsor of terrorism, disruptive to the Middle East process--and one thing I did not mention, which is as egregious as any, is their occupation and manipulation of the country of Lebanon. So they are, in a sense, occupying with a puppet government where they have terrorist camps which provide great disruption in the region. They are developers of weapons of mass destruction. They aided a country that we were at war with, at the time we were at war with them. They are an underminer of the peace process. The list can go on and on and on. There are very few countries that you can say as many negative things about as far as their impact on the world stage as the country of Syria. Yet this country treats Syria better than all of the other terrorist states that we have listed. I find that to be very troubling. Senator Boxer and I have introduced a piece of legislation which just wants the United States to treat Syria the way we treat all the other rogue nations in the world--no worse but certainly no better, given their record of disruption and instability in that region and their threat to the national security of this country. This legislation would require the President to prohibit the export to Syria of any items on the U.S. munitions list or any item on the commerce control list. In addition, under the Boxer-Santorum amendment, the President would be required to impose two or more of a menu of five other sanctions, including a ban on all exports to Syria, except food and medicine; a ban on U.S. businesses operating or investing in Syria; a reduction of diplomatic contacts with Syria; restrictions on travel by Syrian diplomats in the United States; and the blocking of all transactions in Syrian property. It does provide, as all these kinds of legislation provide, the President's ability to waive sanctions if he determines that waiving is in the national security interests of the United States. So I believe this is a vitally important measure for the U.S. Congress and our country, to go on record and say Syria--maybe one of the worst offenders and most destabilizing countries not just in the region but in the world--should be treated no better--not worse than but no better--than other state sponsors of terrorism. Senator Boxer and I talked to the chairman and ranking member about this legislation. We had a very good discussion yesterday about it. The chairman, who I see is in the Chamber, assured us this was of great interest to him, and he understands the concern of Senator Boxer and myself and the other cosponsors about this issue. If the chairman would like to make a comment, I think we have come to some sort of agreement as to how we might handle this situation. I yield to the chairman.

Mr. SANTORUM. Two minutes.

Mr. SANTORUM

Mr. SANTORUM. Mr. President, I rise in support of proceeding to the consideration of S. 11, the Patients First Act. The issue of medical liability reform has been studied extensively, and clearly Federal policymakers have an obligation to address the explosion in litigation across the country and jackpot-sized awards that are having a severe impact on doctors, hospitals and patients' access to care. This is a national crisis that requires a Federal solution. The crisis is not confined within State lines, as patients are losing access to physicians within their State and are having to cross State lines merely to get access to care. Similarly, physicians are being forced to leave their practices due to high insurance rates, and relocate to a State that has enacted some type of reasonable reform that has remained on its books through judicial review. In Pennsylvania and many other States, health care providers are facing enormous increases in their medical liability insurance premiums or are unable to obtain coverage at all due to a significant rise in scarce resources being drained from our health care system because of sporadic and sometimes frivolous health care litigation. As a result, real patients are being denied access to care and losing their family doctors because of exorbitant medical liability costs. In some States including Pennsylvania, some ob-gyns have been forced to stop delivering babies, trauma centers have closed, and physicians are grappling with how they can continue to provide other high-risk procedures. South Philadelphia now has no operating maternity wards. In Fayette County, a practice of three obstetricians that delivers half of the babies born in the area stopped delivering babies when faced with a premium increase from $150,000 in 2002 to $400,000 in 2003. And according to the Pennsylvania Medical Society, 72 percent of doctors in our State have deferred the purchase of new equipment or the hiring of new staff due to increased medical liability costs. To be sure, Mr. President, the health care profession is not free of error. And I fully support a person's right to seek just compensation when they are harmed by negligent or improper medical care. And I also fully support initiatives referenced over the past couple of days that would help to root our and prevent medical errors. But escalating jury awards and the high cost of defending against lawsuits--even frivolous ones--are driving up liability premium increases, with devastating results for patients. According to Jury Verdict Research, the median jury award increased 43 percent in just one year, 1999-2000. More than half of all jury awards today top $1 million, and the average jury award has increased to $3.5 million. And the vast majority of medical liability claims do not result in any payments to patients. And so how does this impact patients? Quite simply, medical professionals are fleeing from areas where medical liability premiums are escalating at a rapid pace. We have heard of many horror stories over the past couple of days and in Congressional testimony about patient access to care being adversely affected. The Wilkes-Barre Times Leader, on October 23, 2002, reported the experiences of one of my constituents in Northeastern Pennsylvania who suffers from two herniated disks, having to travel an entire day because high insurance premiums have decreased the number of neurosurgeons. The truth is--every American pays the price for this country's liability crisis, and Congress and the President have a responsibility to fix this very serious problem. Pennsylvania's own Representative Jim Greenwood has been a strong leader on this issue and has introduced the bipartisan HEALTH Act, legislation which would put in place new Federal minimum standards for liability reform, based on measures that have been proven to be effective in States like California with its proven MICRA reforms, to help prevent excessive awards that are driving up health care costs, encouraging frivolous lawsuits, and promoting time-consuming legal proceedings. The Patients First Act we are seeking to consider here in the Senate is largely based on the House-passed HEALTH Act, and includes many commonsense provisions which can serve as a bipartisan model for medical liability reform. It would establish a reasonable Federal fall- back cap on non-economic and punitive damages, but would allow States the flexibility to set levels higher and lower if they choose. It would allow for unlimited economic damages, and would ensure fair allocation of damages, in proportion to a party's degree of fault. It would also ensure that more of the awards from meritorious cases are paid to the patient instead of trial lawyers. Far from limiting the opportunities of patients to seek redress in the courts, S. 11 would ensure full and unlimited recovery of economic damages, of medical expenses, of rehabilitation costs, childcare expenses, all current and future wage earnings that are lost, including employer-based benefits, and any other economic losses. We have heard a lot from the other side of the aisle about how this legislation would somehow limit patient access to the courts by forcing a Federal mandate to limit non-economic damages to $250,000. This is completely false, and the other side of the aisle knows it. S. 11 would give States the flexibility to establish or maintain their own laws on damage awards, whether higher or lower than those provided for in this bill. And the experience of California shows that injured patients have not only maintained access to the courts, but in many cases have received multi-million dollar awards in economic damages, including minors and non-working spouses. The opponents of moving to consideration of this bill have also tried to move the spotlight away from the underlying issues of cost and access and suggest that the answer lies in insurance reform. This is a flawed argument that takes needed attention away from the real problems. Suggestions that liability rates are high because insurance companies are trying to recover past losses are, quite simply, factually wrong. As a matter of law, medical liability rates are determined by estimates of future losses from claims. State regulators are already required by law to reject liability insurance rates that are excessive. Changing insurance laws will do nothing to change the underlying reason for rising premiums--an increase in meritless litigation and skyrocketing jury awards. President Bush is committed to passing balanced bipartisan legislation that will put reasonable limits on liability lawsuits while allowing compensation for patients truly harmed by medical malpractice. Such reforms can save the Federal government and our health care system tens of billions of dollars in rooting out frivolous lawsuits and reducing defensive medicine. We can and should create a medical liability system that more equitably and rapidly compensates patients who have received substandard care, but which at the same time limits frivolous lawsuits and increases access to health care by reducing the excessive costs of the system. Mr. President, we have an obligation to at least move to consideration of this bill, to have the opportunity to offer amendments, and to show the American public that Congress is capable of working toward real solutions on this growing health care crisis.

Mr. SANTORUM

Mr. SANTORUM. Madam President, I move to reconsider the vote.

Mr. SANTORUM. Mr. President, I move to table the Harkin amendment and ask for the yeas and nays.

Mr. SANTORUM. Madam President, I ask for the yeas and nays.

Mr. SANTORUM. Mr. President, I think what the Senator from Iowa has done is a very worthy thing. The President has focused on this. Part of the President's plan is what the Senator from Iowa has before us. The problem with this is that this is a Medicaid proposal that is under the jurisdiction of the Finance Committee. The Finance Committee would like the opportunity, in the context of looking at the Medicaid Program, to work this through the structure. A, to have this amendment come to the floor, not having gone through the normal process, I think is inappropriate; B, this is a Medicare bill, not a Medicaid bill. I say to the Senator from Iowa, I know Senator Grassley has said to me he is willing to work with his colleague from Iowa on moving this forward. The legislation the Senator from Iowa has put forward has merit and will probably receive bipartisan support, but it does not belong on this bill. So I ask my colleagues--by the way, it is $1.75 billion. I understand there is an offset, but this is a Medicare bill and we should defeat this amendment. I ask unanimous consent that the Senator from Colorado be recognized to lay down an amendment.

Mr. SANTORUM

Mr. SANTORUM. Yes, we do share the same goal on this adult day care issue, and we do have some fundamental differences with one another's proposals and language on the matter.

Mr. SANTORUM. I am willing to work on this matter further, and do agree that since the Senate's and House of Representative's versions on the adult day care language will be different, we will have to find a solution to our differences on this important issue.

Mr. SANTORUM. Mr. President, I oppose the managers' amendment because of an amendment that is in the managers' amendment, the Corzine amendment which provides three States the opportunity to basically opt out of the Medicare Program for prescription drugs and have an entitlement flow of funding going to the States for the States to develop their own stand-alone drug benefit. As a result of that, States like mine and two others will not have the advantage of an integrated drug benefit which I fought very strongly for on this floor and which I believe will also lead potentially to this unlimited entitlement flow of funds to the States because of the way this language is drafted, the potential for lots of mischief in respect to double dipping, inter- government transfers, disproportionate share payments. We could be opening a virtual Pandora's box. Yes. For my States and two others. But I think, frankly, it is not good policy and does not do the kind of improvement of the overall Medicare program which my State should participate in as well as the other States represented here. There is no Federal oversight by the Secretary of Health and Human Services for this plan. There are a host of other problems with this amendment. It is my understanding that the managers gave a commitment that this amendment be included in the package. And so to honor the chairman's commitment, I will not object to this amendment nor call for a vote to strike the amendment. But I, unfortunately, will have to vote against this bill.

Mr. SANTORUM

Mr. SANTORUM. Mr. President, I call up amendment No. 1132 and ask for its immediate consideration.

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

Mr. SANTORUM. Mr. President, one of the key components that many Members on this side of the aisle would like to see accomplished is to draw as many people as possible into the competitive model set up in this bill. We believe it is the more efficient, higher quality delivery of health care services, the Medicare Advantage plan. Unfortunately, through negotiations, a lot of the incentives the President has to encourage people to get into those plans and thereby make them work have been taken out in the current version on the floor. That is to the great consternation, I know, of the White House and many Members on this side of the aisle. For quite some time I have been trying to think how they can create incentives--carrots, if you will, as opposed to sticks--to encourage people to get into these kinds of plans. Originally, I intended to offer a differential benefit--in other words, a benefit that would have what I call a standard benefit in the fee-for-service option and an enhanced benefit in the Medicare Advantage option. I was fairly convinced, in discussing with the people on my side of the aisle, we probably would not have a chance to succeed; that there were people who had made commitments that a differential benefit was not something for this time. I went about trying to figure out, could we create incentives to people to come into Medicare Advantage, which I believe is the future of Medicare and the best way to run the system without creating a differential benefit. The amendment before the Senate does that. The amendment before the Senate creates an option for beneficiaries who participate in Medicare Advantage. It is a pharmaceutical option. Instead of just having no pharmaceutical benefit, which you could if you do not get into the Medicare Advantage Program, we have the standard benefit which is required if you participate in the PPOs, HMOs, and POSs that will be created here. What I will do with this amendment is create another option for seniors who select Medicare Advantage. That option would be a zero premium catastrophic benefit. So you could choose between the standard benefit, the $35 premium, and the 50 percent copay, and the donut hole, and all the things described over and over again, or if you did not want to pay a premium but wanted some catastrophic coverage, wanted some benefit, no premium, no cost, you could join this. The CBO scored this as attracting twice as many people into the PPOs and HMOs as the underlying bill. It would make those plans much more desirable for beneficiaries. I believe that should be one of the goals of this legislation, to make the new and improved and stronger plan a more robust plan. Unfortunately, according to the Congressional Budget Office, when people move from the fee-for-service plan into the Medicare Advantage plan, the Congressional Budget Office assumes those plans will be more expensive. And because they will be more expensive, this amendment costs money. It doubles the participation but costs $20, to $25 billion, which is the back of the envelope. And God bless the CBO; that is the best they could do at this late hour. I firmly believe this is a reasonable compromise between those who would not want to have the differential benefit and those who would because it is unfair to the fee-for-service participants and those who believe we need to have an incentive for people to get into the Medicare Advantage Program. This strikes the compromise. This is where we could go. There are all sorts of things we have done to eliminate adverse selection and all the other problems inherent in offering two different benefits. We believe we actually address the vast majority of those problems in this amendment. Nevertheless, we have run into the roadblock that this bill has run into the entire time when it comes to the competitive model and CBO and their estimation of costs. For the record, the White House does not see it that way. The White House sees the competitive model as saving money. Under their scoring, this would probably actually save money and move people into a higher quality, more efficient system. Amendment No. 1132 Withdrawn As a result of the fact of the score which is $20 to $25 billion, and we do not have that, I am going to withdraw my amendment and hope this idea which I believe is in the center here is a compromise between two competing ideas of how to structure this bill. It will be considered in conference as a way of trying to bring the two sides together in something that does not disadvantage the fee-for- service plan but creates an opportunity for incentives to go to the Medicare Advantage plan. Mr. President, with that I ask unanimous consent to withdraw my amendment.

Mr. SANTORUM

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

Mr. SANTORUM

Mr. SANTORUM. I ask for the yeas and nays.

Mr. SANTORUM. Mr. President, to pick up on what Senator Baucus said, let me tell you what this does. There will be $6 billion spent on our side of the aisle to do the things about which we are concerned. What? Allow the competitive model to work, allow the new blueprint for Medicare to be successful, starting in 2009, because that is when the money is available, but what Jon Kyl and so many others on this side of the aisle have been concerned about is in this amendment. If my colleagues want to give competition a chance, this is the amendment they vote for. On that side of the aisle, what is $6 billion? For chronic care and disease management. Senator Kennedy has worked on this tirelessly. Five percent of Medicare recipients consume 50 percent of the Medicare benefits. What we need in the fee-for-service plan is programs for disease management and chronic illness management. As the Senator from Massachusetts said to me just a few minutes ago, nowhere else will we be able to find $6 billion to do this very important, cost-saving, quality improvement to the basic Medicare system. It is what both sides want. We have come together and we hope we will get strong support for this amendment. Several Senators addressed the Chair.

Mr. SANTORUM. Mr. President, I ask for the yeas and nays.

Mr. SANTORUM

Mr. SANTORUM. Sure.

Mr. SANTORUM. I see that you have a cost share of up to 70/30. I do not have that. I was just looking at the summary you provided, so I don't know whether there is no cost share for lower income or how the cost share works. All I know is it is up to 70/30. I do not know what that necessarily means. I see there is no deductible, so I was commenting on those two. If there is a cost share throughout, that is a positive thing. Maybe we would share the agreement there needs to be some sort of cost share, particularly for those who are not at poverty level. If you are at poverty level, then the cost share should be minimal because you don't want to use it as a great disincentive to the drugs prescribed to you. But if you have some income, you should have some responsibilities for putting forth some money for these drugs. That is ground we share. As the Senator from Illinois suggests, there is cost sharing under our plan. It is a little bit more than the Senator's. But the Senator's plan is more expensive, a lot more expensive than the plan we have here. The other problem I have is that it does not bring in any kind of private sector incentives, to try to reduce costs. One of the problems with the Medicare system today is it is a top-down, Government-run, one-size-fits-all plan, where the private sector, which administers this plan--Medicare administers it, but they do it through intermediaries which are really private sector entities. The private sector, in a sense, administers the Medicare plan. But they are an intermediary. In other words, they are just folks who interface with the beneficiary and collect money and pay bills and do what Medicare just doesn't have the capacity to do. The problem with that is they do not have any risk in doing their job. In other words, all they do is a ministerial job. They get paid to provide a service as opposed to what we do in this plan, which is vitally important. We say to those who want to provide Medicare benefits, whether it is through the stand-alone drug benefit we are providing or through the Medicare Advantage Program, which is a PPO and HMO product which has the Medicare drug benefit integrated into the entire benefit which is inpatient and outpatient procedures, we want you to assume some of the risk. Why is that important? What do I mean by risk? Insurance risk. The risk that if they do not manage the program well, they are going to lose money. When that is done to insurance companies, they tend to behave differently, when they have no risk, if the plan is not run well. The risk is if they really do a bad job, they could lose the contract, and that happens on occasion. But there is no financial risk to them if they are not managing this benefit correctly.

Mr. SANTORUM

Mr. SANTORUM. Mr. President, I ask unanimous consent that the Committee on Energy and Natural Resources be authorized to meet during the session of the Senate, on Wednesday, June 25 at 10:00 a.m. to consider pending calendar business. On Wednesday, June 25, at 10:00 a.m., the Committee will hold a Business Meeting in Room SD-366 to consider the following items on the Agenda: Agenda Item #3: S. 470--A bill to extend the authority for the construction of a memorial to Martin Luther King, Jr. Agenda Item #4: S. 490--A bill to direct the Secretary of Agriculture to convey certain land in the Lake Tahoe Basin Management Unit, Nevada, to the Secretary of the Interior, in trust for the Washoe Indian Tribe of Nevada and California. Agenda Item #6: S. 546--A bill to provide for the protection of paleontological resources on Federal lands, and for other purposes. Agenda Item #7: S. 643--A bill to authorize the Secretary of the Interior, in cooperation with the University of New Mexico, to construct and occupy a portion of the Hibben Center for Archaeological Research at the University of New Mexico. Agenda Item #8: S. 651--A bill to amend the National Trails System Act to clarify Federal authority relating to land acquisition from willing sellers for the majority of the trails in the System, and for other purposes. Agenda Item #9: S. 677--A bill to revise the boundary of the Black Canyon of the Gunnison National Park and Gunnison Gorge National Conservation Area in the State of Colorado, and for other purposes. Agenda Item #10: S. 924--A bill to authorize the exchange of lands between an Alaska Native Village Corporation and the Department of the Interior, and for other purposes. Agenda Item #13: S. 1076--A bill to authorize construction of an education center at or near the Vietnam Veterans Memorial. Agenda Item #14: H.R. 255--To authorize the Secretary of the Interior to grant an easement to facilitate access to the Lewis and Clark Interpretative Center in Nebraska City, Nebraska. Agenda Item #15: H.R. 1577--To designate the visitor center in Organ Pipe National Monument in Arizona as the ``Kris Eggle Visitor Center'', and for other purposes. In addition, the Committee may turn to any other measures that are ready for consideration.