Arlen Specter

Mr. SPECTER

Mr. SPECTER. Mr. President, on behalf of the distinguished majority leader, I have been asked to recite the closing words.

Mr. SPECTER

Mr. SPECTER. Mr. President, for the information of all Senators, the Senate will convene at 11 a.m. on Monday and immediately begin debate on the resolution to reinstate rule XVI. By previous order, there will be 6 hours of debate on the resolution with one amendment in order regarding scope in conference. As a reminder, a cloture motion on the motion to proceed to the House-passed juvenile justice bill was filed today. That vote will take place in a stacked series at 5:30 p.m., along with the rule XVI resolution and the amendment regarding scope in conference. Further, it is the intention of the majority leader to begin debate on the reconciliation legislation next week. Therefore, Senators should be prepared to vote throughout each day and into the evenings next week.

Mr. SPECTER

Mr. SPECTER. Mr. President, I ask unanimous consent that the resolution and preamble be agreed to, en bloc, the motion to reconsider be laid upon the table, and any statements relating to the resolution be printed in the Record.

Mr. SPECTER. Mr. President, I ask unanimous consent that the Senate proceed to the immediate consideration of S. Res. 161, submitted earlier today by the majority leader and the Democratic leader.

Mr. SPECTER

Mr. SPECTER. I understand S. 1427, which was introduced earlier today by Senator Thompson, is at the desk. I, therefore, ask for its first reading.

Mr. SPECTER. I now ask for a second reading, and I object to my own request.

Mr. SPECTER

Mr. SPECTER. Mr. President, I ask unanimous consent that the Senate proceed to the immediate consideration of Calendar No. 103, H.R. 1480, the water resources bill. I further ask unanimous consent that all after the enacting clause be stricken and the text of the Senate-passed bill, S. 507, be inserted in lieu thereof. I ask unanimous consent that the bill then be read a third time and passed and, further, that the Senate insist on its amendment, request a conference with the House, and the Chair be authorized to appoint conferees on the part of the Senate.

Mr. SPECTER

Mr. SPECTER. Mr. President, I ask unanimous consent that the Senate immediately proceed to executive session to consider the following nomination: Executive Calendar No. 165. I further ask unanimous consent that the nomination be confirmed, the motion to reconsider be laid upon the table, any statements relating to the nomination be printed in the Record, the President be immediately notified of the Senate's action, and the Senate then return to legislative session.

Mr. SPECTER

Mr. SPECTER. Mr. President, we are faced today with the unique challenges brought by the extraordinary biological, technological, and medical advances of this decade. We have seen miraculous breakthroughs in the fight against communicable diseases: the complete eradication of small pox, the near global eradication of polio, vaccines for ailments such as measles, rubella, and even the flu. Revolutionary new drugs and improved surgical techniques allow us all to lead longer, more productive lives. But past success is not a guarantee of future progress and science does not bear fruit overnight. Breaking the code for complex problems takes a steady and sustained commitment of people and money. As we enter the next century, we have a responsibility to perpetuate and improve upon our enormous capacity to prevent, detect, treat, and cure diseases of all types. The Congress continues to be gravely concerned with rising health care costs, as demonstrated by contentious debate as recently as last week during consideration of the Patients' Bill of Rights. According to the Health Care Financing Administration (HCFA), health care spending in this country had risen to $1.1 trillion in 1997, or an average of just under $4,000 per person. Private sources paid for a little over half of that, about $585 billion, with the remainder coming from public programs like Medicare and Medicaid. HCFA further predicts that public spending on health will nearly double over the next decade, reaching $2.1 trillion in 2007. I disagree with the premise that this is simply a dollars and cents problem. I believe science holds our best chance for both combating disease and controlling the ever-spiraling costs it imposes on society. For victims of cancer and heart disease, scientific research represents their only hope for new drugs and medical treatments that can add years to life. Research can produce miracle vaccines that save the lives of children stricken with deadly diseases like leukemia. And for growing numbers of elderly, research holds the key to stopping the ruinous effects of Alzheimer's disease, stroke and arthritis--all very expensive ailments to treat. To me, the equation is a simple one: less disease and illness mean less human suffering and lower health care costs. Over the next three decades, the number of Americans over age 65 will double. My state of Pennsylvania houses the second highest elderly population, currently totaling nearly 2 million citizens. Mr. President, unless science finds cures and effective treatments for disease and illness, our society will face even higher costs and our hospitals and nursing facilities will be strained to the breaking point. As Chairman of the Appropriations Subcommittee on Labor, Health and Human Services, and Education, I have said many times that I firmly believe that the National Institutes of Health (NIH) is the crown jewel of the Federal government, and substantial investment is crucial to allow the continuation of the breakthrough research into the next decade. In 1981, NIH funding was less than $3.6 billion. For the past three years, NIH funding has increased by 6.8 percent in fiscal year 1997, 7.1 percent in fiscal year 1998, and 15 percent in fiscal year 1999, for a total of $15.7 billion. I am continuing to fight to double the NIH budget, a sentiment which was unanimously supported in the United States Senate during the 105th Congress. Further, on January 19th of this year, I joined my colleagues, Senators Mack, Frist and Harkin in introducing S. Res. 19, a Sense of the Senate resolution to increase biomedical research funding by $2 billion for fiscal year 2000. Mr. President, I cite continued efforts to increase the Federal investment in biomedical research in order to highlight the public policy importance of scientific investment. I believe that the Federal government also has the responsibility to provide an economic environment that promotes Research and Development in biomedical research in the private sector as well. To make good business decisions, particularly relating to investment in R&D, biomedical and ``biotech'' firms need to have reliable and well defined tax laws. Today I am introducing legislation that would establish a 10 percent tax credit for investment in biomedical research, and would extend the R & D tax credit to 10 years. The purpose of the investment tax credit is to encourage biomedical research and to stimulate the economy, as well as to enhance our long- term competitiveness in the global biomedical arena. The investment tax credit would provide a 10 percent tax credit for purchases of capital equipment, instruments and supplies used in a laboratory setting by a biotechnology company. Without this tax credit, American companies will be competing with one hand tied behind their backs. The R & D tax credit has proven to be critical to the U.S. biomedical research industry. The credit has allowed for many successes in U.S. scientific research and innovation, such as rapid progress in finding cures for life threatening diseases such as AIDS, cancer, and multiple sclerosis. My Subcommittee has held hearings on the state of affairs in biomedical research, and I understand from many scientists that we are on the cusp of breakthroughs many of today's most complex diseases-- Alzheimer's, AIDS, heart disease, diabetes, and arthritis, to name a few. But, the scientists caution, it will only be through sustained investment, both public and private, that we will reap the rewards of biomedical research. If we cut investment in medical progress today, the consequence may be irrevocable and society may rue that decision for years to come. As we prepare for the 21st century, we must remain committed to providing an environment that fosters technological investment, scientific exploration, and global competitiveness. Future economic growth and the prosperity of all Americans depends on continued R&D in all sectors of our nation. Mr. President, we must act now to extend the R&D credit and send the right signal to our nation's researchers. Failure to act will not only jeopardize our research efforts, but it will also threaten the United States's world leadership in R&D and perpetuate the rising health care costs we so desperately have tried to contain. It should be noted that everything that is good and desirable is not necessarily worthy of a tax credit, but targeted tax credits are particularly appropriate where an activity engaged in by one company or individual provides such considerable benefits to society at large. We must constantly remind ourselves that medical innovation is the most viable, long-term solution for cost-effective quality care. Our task in Congress should be to assure that the path of innovation remains open, unobstructed and attractive to both public and private investors. For me, creating a better atmosphere for investment in medical research is more than a symbolic goal. It is a recognition that expanding our base of scientific knowledge inevitably leads to better health, lower health care costs, and an improved quality of life for all Americans. Mr. President, I urge my colleagues to support this important legislation, and urge its swift adoption. In my capacity as chairman of the Appropriations Subcommittee for Labor, Health, Human Services and Education, our subcommittee has the responsibility for funding the National Institutes of Health. The Senate passed a resolution targeting a doubling of National Institutes of Health funding over a 5-year period. That requires an enormous increase. Last year, with the cooperation of my distinguished ranking member, Senator Harkin, we increased NIH funding by $2 billion. The year before the Senate voted an increase of some $950 million, which was conferenced out at $907 million. This year the subcommittee faces a 302(b) allocation--if anyone is listening on C-Span II, that's how much money the subcommittee is allotted under the budget--that is some $12 billion under the President's request, about $12 billion under any logical sum of money to fund those three departments: The Department of Labor, the Department of Health and Human Services, and the Department of Education. We are struggling to try to find the funds to match last year's $2 billion increase. If we were to reach the goal set by the sense-of-the-Senate resolution we would have to come up with $2.3 billion. In talking to the people in the biotech industry, they are very much interested in having an investment tax credit. An investment tax credit of 10 percent would provide a real tax incentive to induce biotech companies to do research. We are on the brink of some phenomenal advances as a result of what happened with stem cell research late last year. Stem cell research has the potential to be a veritable fountain of youth, to tackle ailments like Alzheimer's or Parkinson's, or perhaps heart disease or cancer. There is a controversy on that question, as to whether embryos may appropriately be used for research. So far the Department of Health and Human Services and their legal counsel concluded that the current limitation on research would not apply to research on stem cells after they are extracted from embryos. Realistically, there ought to be no limitation at all, because in dealing with embryos we are not dealing with an entity which could produce life. These are discarded embryos from in vitro fertilization. This controversy is very similar to the controversy which existed with respect to fetal tissue, where arguments were made that using fetal tissue would lead to induced abortions where the fact of the matter was the fetal tissue was discarded fetal tissue, did not induce abortions. But the opportunities for phenomenal advances in medical research are virtually unlimited. In the absence of the ability of the Congress, given budget limitations, to meet the doubling goal within 5 years, an investment tax credit would be an enormous help in stimulating investments by the biotech companies. The research and development tax credit has been extended year by year, and a firm statement by Congress extending it for 10 years again would be an inducement for biotech. Mr. President, I ask unanimous consent that a copy of the bill be printed in the Record.

Mr. SPECTER

Mr. SPECTER. Mr. President, I ask unanimous consent that when the Senate completes its business today, it stand in adjournment until the hour of 11 a.m. on Monday, July 26. I further ask unanimous consent that on Monday, immediately following the prayer, the Journal of proceedings be approved to date, the morning hour be deemed expired, the time for the two leaders be reserved for their use later in the day, and the Senate then begin debate on the Senate resolution to reinstate rule XVI.

Mr. SPECTER

Mr. SPECTER. 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. SPECTER

Mr. SPECTER. I thank my distinguished colleague from Maryland for those kind remarks. In response, I am advised by officials of the State Department that early on were some problems in the United Nations agency. There is chaos, as one might expect, in Kosovo. The Kosovars are returning to their homes. Some have raised a point that the money was not being officially utilized. I have been advised by the State Department that the issue has now been corrected; so when I made inquiries of the State Department yesterday to liberate $2 million for the FBI, I was told that they had this collateral problem and have begun discussions on the matter with our appropriate colleagues to get the funds released.

Mr. SPECTER. If I may respond, that is consistent with what I was told. I did not want to use the expression ``hold'' because of the pejorative connotation in this Chamber. I made the same point by saying that there were obstacles to getting the funds released. But I think it is a matter of enormous importance. I am glad to hear the bipartisan group of women were meeting yesterday to exercise their leadership. This business about crimes against humanity and rape is just horrendous. We have to act, and act promptly.

Mr. SPECTER. I will.

Mr. SPECTER. Mr. President, the War Crimes Tribunal, which was created by United Nations resolution for prosecuting crimes against humanity arising in the former Yugoslavia, has brought very significant indictments out of the events in Bosnia. There have been indictments; there have been some convictions. The work of the War Crimes Tribunal has taken on even greater significance as a result of what has happened in the war with Kosovo, with the very noteworthy and important indictment against President Milosevic of Yugoslavia. The Tribunal is now in the process of gathering evidence in Kosovo. Justice Louise Arbour, who is head of the War Crimes Tribunal and has given notice of her intention to leave to become a justice in the Canadian judicial system, visited the Senate back on April 30, 1999. She met with a group of Senators, including myself, and pointed out the need for the acquisition of evidence. There had been a preliminary allocation of some $5 million. That was supplemented in the emergency appropriations bill with the direction for an additional $13 million, for a total of $18 million to go towards the Tribunal. The FBI dispatched a group of investigators to acquire evidence in Kosovo, but they have run out of money. Those funds, I believe, are available in the Department of State. I have discussed this matter with the FBI Director Louis Freeh. I compliment the FBI and Director Freeh for their very prompt action in going to Kosovo to gather evidence. From my own experience as district attorney of Philadelphia, I can personally attest to the fact that evidence has to be acquired when it is fresh. If you do not get it with immediacy, it disappears. A part of the evidence acquisition has been to question women who were subjected to rape. In conversations with officials of the State Department yesterday, I found that the $50 million which has been appropriated for the United Nations High Commissioner on Refugees has not been released. So there is an urgency in making those funds available for a variety of purposes, including a substantial part of the $50 million to give attention to the women who have been rape victims--in part to counsel them for their own mental health and in significant part to acquire their testimony in the prosecution of those violent perpetrators of the rapes. So I make these comments and urge that we move ahead with this funding which has been authorized by the Congress, $50 million to the U.N. High Commissioner on Refugees, and also urge that funding be provided in accordance with the direction of the Emergency Supplemental Appropriations Bill so the FBI can have the funding to proceed immediately to Kosovo to gather this very important evidence.

Mr. SPECTER

Mr. SPECTER. I thank the Chair. Mr. President, I had requested this time on behalf of myself and Senator Biden. We had originally requested 30 minutes, but because of the crowded schedule today, the time was set at 15 minutes. But I will be delighted to share the 15 minutes with Senator Biden if he arrives before the expiration of the time.

Mr. SPECTER

Mr. SPECTER. Mr. President, I have sought recognition in this special order to introduce legislation, on behalf of Senator Helms, the Chairman of the Foreign Relations Committee; Senator Biden, the ranking Democrat; Senator Dorgan and Senator Schumer, which would provide for electronic filing of Shippers' Export Declarations. This legislation takes up a recommendation of the Commission on Weapons of Mass Destruction and is directed to assist in our export control to stop those who would acquire the material for weapons of mass destruction from accumulating those weapons. At the present time, there are very sophisticated ways of ordering the component parts of weapons of mass destruction which are not known and cannot be readily ascertained because of the voluminous paper filings. This legislation would call for electronic filing and would enable our Government to be able to regulate in a desirable fashion, without undue burden on exporters, materials which can be used for nuclear, biological, or chemical weapons. This is a recommendation of the Commission on Weapons of Mass Destruction which filed its report yesterday with copies to the President and to the legislative leaders. This Commission was established by legislation under the Intelligence Authorization Act signed into law in October of 1996 when I chaired the Senate Intelligence Committee. This legislation was designed to deal with the enormous threat posed to the United States by weapons of mass destruction. When I chaired the Intelligence Committee in 1995 and 1996, I was aghast at the kinds of problems which I saw with respect to rogue nations having ballistic capabilities for the delivery of nuclear weapons. Since that time, it has been publicly commented that North Korea has nuclear capability; that they have trajectory and ballistic capability to reach parts of the United States; that they pose an enormous threat. It is well known that other rogue nations seek ballistic capability as well. We now find that a nuclear device can be carried across national borders in a suitcase. We have seen in the experience of the Tokyo subway catastrophe the potential for biological and chemical warfare. Those capabilities are so important that there needs to be preventive action to deal with them in advance of a catastrophe. Regrettably, our Government customarily reacts, instead of acting in anticipation. The Commission was formed because there are now some 96 separate agencies dealing with weapons of mass destruction, and the Commission filed in its report a recommendation urging Presidential action with the suggestion that the authority be concentrated in the hands of the Vice President. There have been jurisdictional disputes, turf battles, but the Vice President would have the clout to adjudicate disputes and to coordinate the efforts on this matter of such enormous national and international importance. The Commission recommended providing staffing, with a director to the National Security Council, a top level position, to preside over a council of representatives from the various Departments--State, Energy, Defense, Commerce, et cetera--with ranking officials who have been confirmed by the Senate. One of the key recommendations of the Commission on Weapons of Mass Destruction was to mandate electronic filing on export items which are in the category that they could provide component parts for weapons of mass destruction. My staff, Dobie McArthur, has already taken the lead in circulating this legislation among a number of Senators. We have had a favorable response from Senator Helms and Senator Biden, chairman and ranking member of the Foreign Relations Committee. There is an excellent opportunity that this provision could be included in a markup of Foreign Relations this month. As noted earlier, Senator Dorgan and Senator Schumer have also joined as cosponsors. What this legislation does is to provide for the electronic filing of what is known and currently required as a shipper's export declaration. In 1995, the Customs Service and the Census Bureau created the automated export system, but that system has been utilized by only about 10 percent of the filers. This legislation provides that the electronic filing requirement would come into operation 180 days after the Secretary of Commerce and the Secretary of Treasury certify that a secure Internet-based filing system is up and running. The requirements would be directed toward components which could be used in the manufacture of weapons of mass destruction. The problem is illustrated by action taken by Iraq in the acquisition of weapons of mass destruction. In a very sophisticated way, when Iraq was purchasing its component parts, instead of buying them all at one time and all from a single supplier, or quite a number of items from a single supplier a few times, the Iraqis would buy an item here, an item there, an item somewhere else, from a wide variety of suppliers, so it was impossible, without some tracking system, to find out exactly what Iraq was doing as they were acquiring these components for weapons of mass destruction. As we all know, there is dual use on many of these items; that is to say, they can be used for peaceful purposes or they can be used for putting together weapons of mass destruction. In this way, with a sophisticated system, a purchaser may acquire the ingredients to produce weapons of mass destruction. Electronic filing will put the matter all under one umbrella. Without undue burden on shippers, there can be a determination as to what is being purchased which has the potential for being turned into a nuclear weapon, a biological weapon, or a chemical weapon of mass destruction. Mr. President, how much time remains on my allotment of 15 minutes?

Mr. SPECTER. Mr. President, I will use that time on another subject of currency and importance.

Mr. SPECTER

Mr. SPECTER. Mr. President, I would like to make opening remarks on behalf of the distinguished majority leader to the following effect, that today the Senate will immediately proceed to a period of morning business until 10 a.m. Following morning business, the Senate will resume consideration of the Patients' Bill of Rights, with Senator Nickles or his designee to be recognized to offer an amendment. Under the previous agreement, there will be 100 minutes of debate on that amendment. Further amendments will be offered and debated in anticipation of completing the bill today. Senators can expect votes throughout the day. As a reminder, a cloture vote on the Social Security lockbox legislation will take place during tomorrow's session of the Senate. I thank my colleagues for their attention. Now, Mr. President, a parliamentary inquiry. May I proceed with the 15-minute order which has been allotted to me?

Mr. SPECTER

Mr. SPECTER. Mr. President, I have sought recognition today to introduce legislation that will help the United States achieve important non-proliferation and counter-proliferation goals by improving the process through which export data on shipments of proliferation concern is collected and analyzed. By requiring that export data related to shipments of proliferation concern be filed electronically, this legislation will make it possible for agencies with export control responsibilities to do their job more efficiently and effectively. To minimize the administrative burden on exporters, my legislation phases in the electronic filing requirement 180 days after the Secretary of Commerce and the Secretary of the Treasury certify that a secure, Internet-based filing system is up and running. There is already an electronic filing system available, but the existing system is being replaced with an Internet-based system that will be easier to access and use. When the new Internet-based system is in place, and that is expected to happen by early next year, my legislation will require that shipments of proliferation concern be reported electronically. The net result of enacting this legislation will be enhanced export control monitoring and enforcement, with minimal burden to shippers and exporters. Let me take a moment to provide some background information for my colleagues, to make it clear what my legislation does and why. Current law requires shippers, forwarders and exporters to file what is known as a Shipper's Export Declaration, or SED. The SED indicates what is being shipped, where it is going, who it is being shipped to. Most of these are now filed on paper, and it is a time consuming and difficult process to sort through all these paper SEDs to identify shipments of proliferation concern, to track them down and check them out. In 1995, the Customs Service and the Census Bureau created the Automated Export System, or AES, which makes it possible to submit SEDs electronically. With the SED information in electronic form, it is much easier to sort through the data and identify shipments of concern. About ten percent of SEDs are currently filed in electronic form through AES, and almost ninety percent of the forms are filed on paper. The data from the ninety percent of SEDs that are filed on paper is not as easy to review as it could be, and it is not possible to do the type of cross-checking and analysis that is necessary to zero in on the shipments that export officials need to monitor closely, and in some cases, prevent from being shipped. For example, before the 1991 Persian Gulf War, the Iraqis had a very sophisticated procurement strategy for acquiring weapons of mass destruction. They broke down their purchase requests and instead of asking for everything they wanted from one or two companies, asked for a few items from a large number of suppliers. If the Iraqis had grouped their requests, their orders would have raised eyebrows. Someone would have become suspicious, either the suppliers or export enforcement officers who reviewed the export data. As it was, the Iraqis ordered relatively small quantities of dual use commodities, items that can be used to create weapons of mass destruction but also have perfectly ordinary commercial uses, and combined them with shipments from other suppliers, sometimes from other countries, to make weapons of mass destruction. If all SEDs on items of proliferation concern had been filed electronically, as they will be when my legislation is enacted, it would have been much easier to detect what the Iraqis were up to and take preventive action. Not all of the shipments that are being reported on paper rather than electronically are of proliferation concern. Shippers in the United States export literally hundreds of thousands of items each month that do not raise proliferation concerns; agricultural products, toasters, automobiles, and all sorts of completely harmless goods. But there are other items that we have to watch more carefully; items that are on the Department of State's Munitions List or the Commerce Control List. My legislation will make it easier to track shipments of these items by requiring that SEDs be filed electronically for any item that is on the United States Munitions List or the Commerce Control List. With this information available in electronic format, agencies with export control responsibilities will be able to enforce our export control laws more effectively and prevent proliferation of WMD. By limiting mandatory electronic filing to items that raise genuine concerns about proliferation, my legislation will maximize the benefit to our national security without unduly burdening shippers and exporters. Mr. President, I ask unanimous consent that the bill be printed in the Record.

Mr. SPECTER

Mr. SPECTER. No, I will not, but I will yield in a minute. I will not now because I am right in the middle of my train of thought. I will be glad to yield in a moment and respond to whatever question the Senator from New York may have. I supported the Robb amendment, the last vote, because the Robb amendment had provided a standard for medical necessity, generally accepted medical principles, important operative procedures. At this stage of the record, without that definition of the requirement, as articulated in the Robb amendment, I thought that was improvement. Now we are fencing. To say that the air is filled with politics in this Chamber today would be a vast understatement. But in at least my effort to try to understand what is going on and to make an informed judgment, I am prepared to make a judgment for the Robb amendment or the Kennedy amendment or the Schumer amendment contrasted with the Nickles amendment or the Jeffords amendment. It requires a lot of analysis. But as I read these plans, I believe that Senator Jeffords, Senator Frist, and Senator Nickles are correct, that when you take a look at the language they are substituting, it places a higher standard on the HMO, the managed care operation, than does the provision in the Kennedy amendment which they are striking. Now I would be glad to yield to the Senator from New York on his time.

Mr. SPECTER. I thank the Chair. Mr. President, it is extraordinarily complex to work your way through the various provisions. Representations are being made on both sides of the aisle which are contradictory. The Senator from New York has just made a contention that the independent reviewer is not independent at all. My reading of the provisions in S. 326 at page 177 set forth the qualified entities as the reviewers and the designation of independent and external reviewer by the external appeals entity which specifies independence. I will not take the time now to read it. But that reference, I think, would establish the true independence of the reviewer. My principal purpose in seeking recognition was to deal with the comparison of the standards for ``medical necessity,'' which is the core of the argument at the present time. The pending amendment seeks to strike the language of the Kennedy amendment, which defines medical necessity as ``medical necessity or appropriate means with respect to a service or benefit which is consistent with generally accepted principles of professional medical practice.'' The language of the pending amendment, which would be substituted, provides for a standard of review as follows, at pages 179 and 180: In General.--An independent external reviewer shall-- (I) make an independent determination based on the valid, relevant, scientific and clinical evidence to determine the medical necessity, appropriateness, experimental or investigational nature of the proposed treatment; and (ii) take into consideration appropriate and available information, including any evidence-based decision making or clinical practice guidelines used by the group health plan or health insurance issuer; timely evidence or information submitted by the plan, issuer, patient or patient's physician; the patient's medical record; expert consensus; and medical literature . . . The accompanying report amplifies ``expert consensus'' as ``including both what is generally accepted medical practice and recognized best practice'' so that the language of the statute itself is more expansive in defining ``medical necessity.'' The commentary goes on to include generally accepted medical practice and adds to it: the recognized best practice. There is no doubt that in the articulation of these competing provisions, an effort is being made by one side of the aisle to top the other side of the aisle. It is a little hard, candidly, to follow the intricacies of these provisions because, as is our practice in the Senate, an amendment can be offered at any time, and to work through the sections and subsections is a very challenging undertaking.

Mr. SPECTER. Well, there is no suggestion that there would be that kind of a relationship. The language which the Senator from North Carolina cited takes care of one category of potential conflict of interest, that they will not have any material, professional, familial, or financial affiliation with the case under review, the participant or beneficiary involved, the treating health care professional, the institution where the treatment would take place, or the manufacturer of any drug, device, procedure, or other therapy proposed for the participant or beneficiary whose treatment is under review. If your question is, Would there be a triple firewall if you also specify the HMO? I would be inclined to have all the firewalls I could, as I do when I draft documents, as my distinguished colleague did when he practiced law.

Mr. SPECTER. Well, I believe that that is provided by the high level of independence specified in the preceding section (3)(A)(ii) which establishes the independence of the qualified entity which selects the independent reviewer.

Mr. SPECTER. I am glad to respond to a question at this time.