Craig Thomas

Mr. THOMAS

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 President, I ask unanimous consent that the order for the quorum call be rescinded.

Mr. THOMAS. Mr. President, I am pleased we now have gotten to the floor with this bill. Certainly, most everyone agrees that this may be one of the most important issues that we will undertake this year. Along with that, of course--which I guess is not unusual--it will be one of the most difficult. I think there is a strong feeling that this needs to be done. I believe that will drive us. We certainly have had a good deal of support from the administration, from the President, and from Secretary Thompson. So we have an opportunity to move forward. This is a very difficult issue. It is one that is hard to deal with, to make sure that everybody is treated properly. It is hard to deal with in terms of costs. It is also hard to deal with in terms of different parts of the country and how you have a delivery system that fits everywhere. It will be a challenge, but I believe we have no greater domestic challenge than reforming Medicare and providing seniors with access to prescription drugs. We will hear a great deal of the same sort of conversation during this week. We will also find that there are different ideas about how this is done. The committee approved a prescription drug bill last Thursday night after an all-day markup, which was interesting--by a substantial bipartisan majority, which is very good. So it is a promise that most of us have made to take a look at Medicare and to be able to strengthen it. It has been mentioned that it is more than 30 years old and hasn't been changed a great deal. The greatest change that has come about is in pharmaceuticals, which has become one of the most expensive aspects of health care and has not been covered under Medicare in the past. So I think we have two things we are seeking to do, and I hope we don't lose sight of them. One is to make the Medicare delivery system work better. Second is to include a reasonable access to pharmaceutical drugs. The program we have had has been difficult in a number of ways. We have had more and more providers that will not provide care under Medicare because the fees have not been equal to what they get in the private sector, and therefore access is not available. That is a difficult issue, particularly in rural areas where there are not a lot of providers. So we have to make sure we have a plan that puts this kind of program basically in competition with the private health care sector. The program has been inefficient and, no doubt, we need to change some things, particularly with respect to chronic illness. A relatively small percentage of the elderly use a very high percentage of the total expenditure. So it has to be oriented somewhat toward dealing with those things that we know are the most expensive, and this cannot be done without some special attention to those things. These are the people who need the most expensive drugs. We ought to have a plan in which seniors could choose what fits them best. We will be continuing to have the general plan that is in place now. If people find they want to stay with it, they will be able to do that. Nobody will be forced to change--at least in the near future. But there will be another plan, an alterative. We have felt that we could follow the plan that is used by Federal employees, generally, as an option. That would be one where there would be a plan laid forth, where we would have different sorts of insurance coverage, and providers will bid on doing that job. Maybe we would take the lowest bids--maybe the three lowest bids, or whatever. It would be a little different--sort of a PPO program, preferred provider program. Some say if you have a PPO, it won't cover everybody. In Wyoming, there are not formal PPOs, but we still have coverage for Federal employees, and there will be an arrangement made so where they are without a form of specific PPOs, they will still be available in the private sector. So I think that is, indeed, the way it ought to be. If we follow that plan, I think it would be one that we can really make available. One of the things we have been working on--and I happen to be chairman of the Rural Health Caucus--there has always been a considerable amount of difference in the health care programs between urban areas and rural areas. One of the things is, there has not been equity in payments. Payments in urban areas have been higher than in rural areas. They have thought the costs are not as high in rural areas. In fact, because of lower volume, they may be higher in rural areas than in urban areas. I had an experience recently where an MRI in one town costs almost 50 percent more than the larger city simply because they didn't have the volume. This bill, by the way, has that sort of remedy in it so that we will have urban areas and rural areas that will have equity in the way they are handled. We hope we can do that. Some have a concern about small counties. We have a situation now in Medicare where we deal with each county to determine the price of service. Here we will have 10 regions over the whole country, so it will be a broader base, which is the basis for insurance, to spread that over a broader number of people so that there is better equity for everyone. I think a lot of provisions in this bill will be much more advantageous for users than what we have had in the past. We will all be talking about this bill in more detail. I hope we can make some changes and we can remember the objectives. There are so many details involved with Medicare and with health care, as a matter of fact, that I think we have to focus on what it is we are seeking to do and to stay with that. I hope we can develop a vision of what we want this to be when we are through and try and stay within the parameters of that vision. The objectives will be to strengthen Medicare and provide accessible pharmaceuticals. There are, as we go about our work, lots of issues involved in health care, many of them beyond Medicare. We have to deal with those issues at another time. I hope we do not try to remedy all problems in health care and get it confused with this program, which is a specific program. For instance, we had some amendments having to do with refugees and legal immigrants. That is an issue, and it is a tough issue, but it is not part of Medicare and we ought to separate those issues so we keep it that way. I hope we maintain our focus so unrelated issues do not become wrapped up in this bill. We also need to be conscious of spending. We have a budget of $400 billion, an amazing amount of money. But when we compare it to health care costs, it is not huge. I did not think I would ever say $400 billion is not huge. Cost is something, and we have to do something that is efficient. Money is not endless, particularly when it relies largely on what you and I pay in every month. If we have total expenditures that continue out of control, we have to do something different as to how they are paid. We should keep that in mind. One of the keys--even though we should recognize the needs of low- income people certainly, and that is in the plan and we should do that, as opposed to higher income people--I think it is important everyone who is a beneficiary have some responsibility. When we have a program paying for all of the health care, we get overutilization, without exception. So there has to be some first dollar payment in this program, even though it can be very small, I believe. We need to take advantage of the opportunity with the volume of pharmaceuticals we will be using, for example, to hold down the costs somewhat. Health care has been going up almost 13 percent a year, which is much higher than almost every other activity. Part of it is because times change and we are doing things so people are healthier, and people are living longer partly because of that. Nevertheless, if you start adding up 13 percent a year on these costs, it would be an almost unmanageable program over time. I already mentioned this will serve all eligible seniors, whether they are rural or urban. I am hopeful as we go through this very complicated and difficult program. I am very pleased, particularly serving on the committee of jurisdiction, to have been involved in this debate and to see we are as far along as we are, and I am very confident we are going to come out with a package. That, of course, is our responsibility and what we ought to do. As we do that, I hope we have a vision of where we want to be when it is over and take a look at the issues we do in the interim and see if they are going to contribute to providing that program we envision for the future. It is one that ought to strengthen the program. It is one that ought to be available to people all over the country. It is one that ought to recognize the special needs, particularly of very low-income people. It is one that ought to give choice of different kinds of programs so you can choose something that fits you. I think we have to have a program that does not have runaway spending so that it destroys the whole program over time and that we also recognize related programs, whether it be VA or retirement. These had to be fit in so we could have a total package. I am looking forward to 2 weeks of considerable debate. I think with all these various issues, we will, frankly, have hundreds of amendments, most of which will be dealt with, and that is good. But as we look at all these different issues, I suggest to my friends in the Senate that we try to focus on what we want the result to be and measure these amendments against that. I am looking forward to the debate. I am sure most of us are. I think we can come up with a program that will be much better and provide services for the needy better than we have in the past. Mr. President, I yield the floor and suggest the absence of a quorum.

Mr. THOMAS

Mr. THOMAS. I understand, and you will probably have an opportunity to do that. Let me respond to what you are saying. You talk about how much better it is. I think if you had spent that many billions of dollars doing it on the other side, it perhaps would have been better as well. So I urge Senators to not accept this amendment and to let us continue to have a study of what might better be done rather than saying, flatly, we cannot even take a look at a possible modernization. I yield the floor.

Mr. THOMAS. Mr. President, this is a very short, simple amendment. What it deals with is Teton National Park. I think it is probably the only park in the country that has in it a commercial airport. Some years ago, the airport and the park agreed they could limit noise in the park. They had done so with commercial airlines, but they have not been able to do so with private jets. This would give them that authority. It has been approved by the Park Service, by the Interior Department, and we would like very much to have the authority for them to be able to deal with the noncommercial jets and the noise they create in Teton National Park.

Mr. THOMAS. I thank the President, and I thank the Senator from Mississippi. I will not take long. In fact, I just came from a markup in health care. I was very much interested in the discussion that was going on here. We are all involved, of course, in one way or another in air traffic control. I am a former private pilot and have experienced a great deal over the years. I don't fly anymore because I don't get enough opportunity to be safe. Nevertheless, I have listened. First of all, I am very much interested in doing all we can in government to modernize and make it as efficient as can be. That is what the administration seeks to do in various kinds of activities, taking a look at those to see if there is something that can be done governmentally. If they can do it just as well or better in the private sector, there ought to be some competition for that. I believe that. I believe that very strongly. I am always sort of surprised at the efforts made to keep the government from doing that. If they study it and come up with the right answer, I think that is a good idea, instead of saying we ought not to be doing any of those things. I am an advocate of trying to have competition to see how we can do the best thing. Currently, the FAA is reviewing the jobs done by the flight services staff to determine if these jobs could indeed be done better by the private sector. I think most everyone knows that President Bush and his Secretary have no intention of having private competition for the air traffic controllers. What we are talking about here is the flight service function, which is quite different. Currently provided for in general aviation, of course, is that pilots currently review it to see if flight service functions could be modernized by allowing the private sector to provide some of these services. So it seems to me that is reasonable. And to come in with an amendment that says you cannot take a look at doing something better is a surprise to me. The commercial airlines rely on the private sector for weather and all kinds of things. There is really no reason to think that is something that is done better by Government people than it is by private sector people. Who is flying the airplane, for example? That is where the real test comes. So it seems to me we ought not to adopt this kind of an amendment. Remember, this is a current A-76 study that is underway. It is a study, and we ought to give that an opportunity to happen. The FAA has categorized air traffic controllers as noninherently governmental. They have shielded the air traffic controllers from the A-76 study.

Mr. THOMAS. Sure. Yes.

Mr. THOMAS. Is there a question?

Mr. THOMAS. I am not aware of that. Are you aware of the outcome?

Mr. THOMAS. No.

Mr. THOMAS. May I answer the question, please? I do know why that is, and I would think you do, too. We decided it right here. I voted against it. I voted for having the private sector continue. That is why it was done, because it is a political thing, and you know it and I know it.

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

Mr. THOMAS. Mr. President, I have an amendment I send to the desk.

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

Mr. THOMAS

Mr. THOMAS. Absolutely.

Mr. THOMAS. Madam President, I wish to comment on what I hope is the progress of our Energy Policy Act of 2003 that is before us. It is a policy that is essential to our Nation's energy security, to our economic security. I think it will play a vital role in where we go with energy. This is comprehensive legislation that has to do with production, particularly in the West; let's say domestic production. It has to do with research, which is what this amendment is about. It has to do with understanding where we go in the future with alternative fuels. We take a total look at where we are. One important provision calls for an inventory of the Outer Continental Shelf and the resources there for the United States. This requires the Secretary of the Interior to survey all the Outer Continental Shelf resources currently under production and under moratoria, and to develop an inventory of those reserves in the areas that are not in production. An analysis will utilize the latest available remote sensing technologies, but the legislation specifically states that drilling will not be permitted in conducting this inventory. The measure directs the Secretary of the Interior to submit a report to Congress on the inventory 6 months after enactment of the bill. Offshore production, of course, has played an important part in our domestic picture. The western and central Gulf of Mexico have proven world class areas for natural gas and petroleum production, accounting for over 25 percent of domestic production. It is believed substantial natural gas resources exist in the eastern gulf, Atlantic Ocean, and off the coast of California. However, exploration of these areas has been prohibited by previous Presidential moratoria. Senator Graham's amendment now on the floor will strike that inventory from the Energy Policy Act of 2003. Opponents contend the passage will violate the Presidential moratoria and open the door for development of coastal areas. This is completely untrue. The sole purpose of the offshore inventory in S. 14 is to collect data on domestic offshore oil and gas resources to fully understand the potential of these regions instead of making future policy judgments on information that is outdated and incomplete. A number of people are very interested in this. I understand that. But I think we are being misled a little as to what it means. It is a comprehensive scientific inventory. I think the public has a right to know what the status of our national natural resources are for the future. We need to reexamine them because many of the assessments that were done some time ago are not up to par in terms of current technology. We need to do this. A number of organizations are opposed to the amendment--the National Association of Manufacturers, the U.S. Chamber of Commerce, the American Farm Bureau Federation--simply because they are so dependent on energy in the future. This is something that really affects lots of people. I have to say once again, it is an inventory of the resources that are available, not a license to produce. I yield the floor.

Mr. THOMAS. The Senator raises, of course, a basic question. As we talk about energy, what we are talking about is the future of our economy, in terms of jobs, in terms of doing the things we will want to do economically and environmentally. I have the same kind of feelings about my place in Wyoming. We have mountains and we have areas we are going to protect. But that does not mean we ought to avoid the idea of having a notion of where those resources are, and to be able to use some of them where they work together, preserving the environment. Certainly the U.S. Chamber, certainly the National Association of Manufacturers, are concerned about the future and the availability of energy so we can create jobs and continue to build the future economy.

Mr. THOMAS

Mr. THOMAS. Mr. President, I ask unanimous consent that the Permanent Subcommittee on Investigations of the Committee on Governmental Affairs be authorized to meet on Wednesday, June 11, 2003, at 9 a.m., for a hearing entitled ``Patient Safety: Instilling Hospitals with a Culture of Continuous Improvement.''

Mr. THOMAS. Mr. President, I ask unanimous consent that the Subcommittee on Competition, Foreign Commerce, and Infrastructure be authorized to meet on Wednesday, June 11, 2003, at 2:30 p.m.

Mr. THOMAS. Mr. President, I ask unanimous consent that the Committee on Indian Affairs be authorized to meet on Wednesday, June 11, 2003, at 10 a.m., in room 485 of the Russell Senate Office Building to conduct a hearing on the nomination of Charles W. Grim, D.D.S., to be the Director of the Indian Health Service at the Department of Health and Human Services; to be followed immediately by another hearing on S. 1146, to implement the recommendations of the Garrison Unit Joint Tribal Advisory Committee by providing authorization for the construction of a rural health care facility on the Fort Berthold Indian Reservation, ND.

Mr. THOMAS. Mr. President, I ask unanimous consent that the Committee on the Judiciary be authorized to meet to conduct a hearing on ``Judicial and Executive Nominations'' on Wednesday, June 11, 2003, at 9:30 a.m., in the Dirksen Senate Office Building Room 650. Panel I: Senators. Panel II: William H. Pryor, Jr., to be United States Circuit Judge for the Eleventh Circuit. Panel III: Diane M. Stuart to be Director, Violence Against Women Office, United States Department of Justice.

Mr. THOMAS. Mr. President, I ask unanimous consent that the Joint Economic Committee be authorized to conduct a hearing in room 628 of the Dirksen Senate Office Building, Wednesday, June 11, 2003, from 9:30 a.m. to 1 p.m.

Mr. THOMAS. Mr. President, I ask unanimous consent that the Committee on Health, Education, Labor, and Pensions be authorized to meet in executive session during the session of the Senate on Wednesday, June 11, 2003. The following agenda will be considered: S. 648, Pharmacy Education Aid Act of 2003. S __, Greater Access to Affordable Pharmaceuticals Act. Any nominees that have been cleared for action.

Mr. THOMAS

Mr. THOMAS. Mr. President, I will make a couple of comments that are a little different than the subject we have been talking about. It is something that I do not have the recommendation as to how we resolve it particularly, but I am persuaded we need to spend a little more time on it, which I intend to, and that is government activities we are involved in. Of course, the many government activities we are involved in are probably the largest combined organizational thing we do in this country. It would be interesting to know, and I intend to see if there is not a way for all of us to do so, to get a look at all the kinds of programs and different activities the Federal Government is involved in. It is massive, of course. We spend trillions of dollars on activities in the Federal Government. I do not suggest that is not legitimate. The Federal Government has a job to do and we need to do it. What I do believe is that because of the nature of it and because of the nature of this body, frankly, we do not really work very hard at ensuring that the delivery of these services is done as efficiently as it could be. We are a little different, of course, than the private sector in that there are some inherent barriers in the private sector. If one is not very efficient, they are not able to continue to compete with others and they are not able to go on. That is not true in the Government, of course. There is not that kind of limitation. So it seems to me we ought to give a little more thought to how we do things. It is quite natural that when there is a need somewhere, through the political process we bring up some resolution to the need, some way to work on the need, and it usually creates a new agency or creates a new department within an agency or a new function, and there is no real way to ensure that that blends in to what is already being done in an efficient way. There certainly must be lots of opportunities within this huge organization we have to be able to blend one thing in to another to do it more efficiently, to deliver it more efficiently. I think clearly there is reason to believe that activities that were begun 30 years ago may need to be reviewed to see if they still are needed, and if they are needed that they are done in a way that is most effective and efficient. I am really not critical of the people who are doing these things. I am critical, I guess, or at least inquisitive about the system, because the system is set up in such a way that it does not have a way to even consider change very often. As I say, in the private sector, people are forced to change from time to time in order to continue to be effective and to continue to modernize. I do not think it is reasonable to think that a program that started in the 1950s, and it is now 2003, that that program is being done as efficiently as it might be. I frankly sometimes think it would be a good idea if the various things we pass that go into some kind of services, some kind of activity, should expire and we should have to go through the process of reexamining what that operation is doing and if it is still needed--and it may or may not be--then see if it is being done in the most efficient way possible. There are operations in the Government, of course, that are designed to do that, such as OMB, the Office of Management and Budget, but it is very difficult. I am pleased that President Bush has a modernization program going, but there is all kinds of resistance. The resistance can be political: If it does not happen to suit one's particular community as a politician, why, they are opposed to that. I think it is fair to say clearly that the labor union leaders who are involved with Government unions are overreacting to the idea that some things ought to be made available to be done in the private sector, which I think is a very reasonable thing to do. We now have sort of an overstatement of things that are trying to be done in the National Park Service. Well, there should be a few things that are competitive with the private sector, but the whole Park Service is not going to be turned over to the private sector. No one has suggested that, but that is the kind of thing we get. I do think we ought to pay a little more attention to how we could make the delivery of services more efficient and how we could review the services that are being delivered to see if indeed they are in keeping with the times. That has to be done in a special way because it just does not happen automatically. Politics keeps it from happening. The complexity keeps it from happening. Sometimes labor unions are resistant to any change. I think it is our responsibility, and I intend to continue to look for opportunities, to examine, evaluate, and try to move forward in making the delivery of essential services more efficient whenever possible. I yield the floor.

Mr. THOMAS

Mr. THOMAS. We are in morning business, is that correct?

Mr. THOMAS

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