Ron Wyden

Mr. WYDEN

Mr. WYDEN. Madam President, I would like an additional 5 minutes as coauthor of the amendment.

Mr. WYDEN. I appreciate the Senator's question. It seems to me that this is Government Waste 101. This is not complicated. Since its inception in 1980, it appears that this particular program, TV Marti, has had essentially no real Cuban viewership. We have been doing everything we can to find anything resembling a current study, a current report, any body of evidence which would indicate that there is an actual market, a group of Cubans who see this. As the Senator from North Dakota has indicated in his question, if you go into a coffee shop in Alaska or North Dakota or Oregon, this program doesn't pass the smell test. People are going to say: Look, we don't like Castro. And this isn't a debate about whether you like Castro. I have been studying this issue since my dad wrote a book about the Bay of Pigs, the untold story. So like many of my colleagues, I have been studying this issue for a long time. This is not a referendum on whether you are going to be tough on Castro or whether you like Castro. This is a referendum on whether we are going to allow millions of dollars of Government waste to go forward. We have been doing it for years. We should have pulled the plug some time ago. And yet, because this program sort of masquerades under the title of being tough on Castro, we just keep shoveling money at it. I thank the Senator from North Dakota, who has spent a great deal of time on it. I also want to come back to a point the Senator from North Dakota touched on that is very important. Personally, a lot of us would like to reexamine our policy with respect to Cuba. That is not what this amendment is about. This amendment is about one thing: whether we are going to sanction more waste. This program doesn't pass the smell test. You wouldn't possibly be able to explain it in a coffee shop. My hope is that we support real programs, such as Radio Marti, that are going to make a difference in terms of getting information to the Cuban people about areas where there is waste and not continue to fritter away scarce taxpayer resources. I thank my colleague for giving me the time.

Mr. WYDEN

Mr. WYDEN. Mr. President, very briefly, I thank Senator Lugar and Senator Biden, in particular, for working this arrangement out with Senator Dorgan and me. We think this is a waste of money. We are anxious to talk about it tomorrow after folks have had a chance, overnight, to look at it. I thank the Presiding Officer for the chance to make these brief remarks.

Mr. WYDEN

Mr. WYDEN. Mr. President, I ask unanimous consent I be permitted to speak for up to 30 minutes after the distinguished Senator from Massachusetts.

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

Mr. WYDEN

Mr. WYDEN. Mr. President, late last week, the Nation witnessed the end to a saga that was heartrending not only for the medical circumstances of the young woman at its center, but for the tragic controversy that surrounded it. The Congress has spoken once about Terri Schiavo, and in the near future the Senate's Committee on Health, Education, Labor, and Pensions is expected to hold hearings about one of the issues Ms. Schiavo's situation brought to the spotlight: the rights of the incapacitated and our society's responsibility toward that community. I hope the Congress will now begin a thoughtful examination of this and issues relating to end-of-life care. For that reason, I rise today to urge and encourage caution as the Senate moves forward. George Washington called the Senate the saucer to cool the legislation. I would say the Senate, in fact, must cool its own passions before proceeding. The alternative is unacceptable. The Senate must not revisit the dangerous zero-sum game of 2 weeks ago, creating a false debate between those who seek protection and those who desire choices and actually sacrificing one of those rights to secure the other. This body's responsibility is to find solutions that preserve both. Protecting the vulnerable and preserving end-of-life choices are not mutually exclusive. Advocates for the disabled are right when they say that losing physical or mental capacity must not deprive anyone of their rights even if they have not had or taken the opportunity to make their treatment and wishes known. There is legitimate cause for worry that the majority of our population might give short shrift to the real rights of a minority group. Journalist James Taranto summed it up well when he said: It was natural for an able-bodied person to think: I wouldn't want to live like [Terri Schiavo]. But someone who is disabled and abjectly dependent on others was more apt to be chilled by the talk of her ``poor quality of life'' and to think: I wouldn't want to be killed like that. Let us reject any legislative effort that springs from these false choices diminishing the rights of the incapacitated and all Americans. New Federal efforts may have the goal of protecting rights, but they may have the real effect of engineering outcomes with little regard to a patient's true interests. Instead of courting this risk, the Senate should seek to empower the disabled and all Americans. My sense is that momentum still exists in this body to act unwisely in a way that will produce more government and fewer choices for all Americans at the end of life, so let me be clear. I intend to oppose any congressional fiat that disempowers our citizens--disabled, abled, incapacitated, or otherwise. I will oppose any such dictate that restricts the choices for our citizens at the end of life and grows the role of government instead. In the last 2 weeks, Americans have overwhelmingly cautioned the Congress against government mandates for the end of life. Many voices are speaking. Some have been shouting. If the Senate can't yet distinguish the country's clearly stated desire, then this body ought to fall silent and listen harder before acting. In many ways, this is the central question of our time: whether the Federal Government will seek to expand its reach when the citizens wish for more individual empowerment. Presented with that question 2 weeks ago, the Senate got it wrong. The American people have made it clear that moving forward, there ought to be a course correction. True leaders will approach these choices dispassionately with a set of impartial principles. I will spend a few minutes discussing what I think those principles ought to be. First, the Senate should help empower Americans to make their own choices about the end of life, whatever those choices should be. Policy ought to be grounded on the principle that Americans setting their dining room tables, in their kitchens, discussing their wishes and their fears with their loved ones, and asking in the end that government should make sure their desires are carried out. The choices they have to discuss--discuss in their homes and in their workplaces-- ought to be expanded, not weakened, by Government and bureaucracy. Our policies should help their wishes to be honored by their families and their health care system--their lives sustained as they wish or unwanted treatment ended as they wish. Second, as the Senate looks at the end of life, the Senate needs to look at the entire picture. End-of-life care is more than respirators and feeding tubes and even more than living wills. The Senate has to get beyond today's hot-button questions. The Senate ought to look at the fundamentals: conquering pain, expanding hospice care, capping the great potential of comfort care, which is known as palliative care. Supporting new ways to treat a very ill patient physically, spiritually, and emotionally, long before the last days of life, is a good use of the Senate's time. Third, the Senate must address end-of-life issues with respect for constitutional boundaries that have been dangerously dismissed to date. For the last 2 weeks, issues of separation of powers and federalism have received virtually no attention. The Senate needs to reflect on the roots and the reason of federalism, which has given the States control over medical practice for more than 200 years. There is a line the Senate must not cross again. Beyond that line are the constitutional rights of States and, ultimately, the rights of our citizens. Those individual rights, or citizens rights, ought to be the Senate's first guideline in moving forward. I realize the temptation is to frame the debate entirely in terms of the heartbreaking situation of Ms. Schiavo. I believe it would be a mistake, however, to base Federal law on the basis of the tragic chaos that transpired in that woman's family. The Senate cannot jump in now and play medical czar to predetermine the outcome of every similar case. Our responsibility is to help individuals and their families to avoid the compounded tragedy that occurred in that family. Helping Americans make their wishes clear is paramount. There are a variety of ways this can be done. The 50 States and the District of Columbia have made provisions for the declaration of individual choices, often through the creation of an advanced directive or a living will. If the Congress acts, it certainly should not thwart State laws in this area. Our goals should be to increase awareness and access and to look for ways to aid the enforcement of those wishes of families and the health care system. Certainly, living wills should be encouraged, and thousands of Americans now are looking to fill these forms out. But in many instances, frequently that living will, a piece of paper, is not enough. Too often people will still be confused about an individual's real desires. Too often the language will not be clear or subject to misinterpretation. The bioethicist Carl Schneider of the University of Michigan said he is ``appalled'' at the number of people who are advising the public that a living will alone will be sufficient. He states: Living wills often do not work. So the national discussion about end-of-life choices should include information that will ensure that wishes be carried out, not just stated. As national leaders, those of us in the Senate can promote this discussion. Most folks looking into advanced directives today seem to think they can just avoid a controversy through a living will. Maryland Attorney General Joe Curran recently said that 27,000 people in his State alone downloaded the forms over a period of 7 days. That is compared with 600 downloads during just 1 week in January. But, as I have indicated today--and I know it will be surprising to many Americans--the reality is the laws vary with respect to living wills and advanced directives, and often they do not ensure enforcement of a patient's wishes. Therefore, Americans need to know about vital mechanisms in addition to the living will. For example, the health care proxy, which designates one person if a person becomes incapacitated, is another approach that may be a value to our citizens because it leaves no doubt as to who speaks for those who cannot speak for themselves. There are other options that can help ensure the effectiveness of an advanced directive. My home State uses a document called a ``POLST,'' which stands for ``Physician Orders for Life-Sustaining Treatment,'' a bright-pink document that physicians place in patients' charts to help nurses and hospice workers and other providers follow the wishes of the patients for end-of-life care. Studies show these physician orders, the product of a frank discussion between patients, families, and providers, result very often in the kind of end-of-life care that patients desire. There are various approaches being tested in other States as well, and the Senate should promote them. One of our most valuable guidelines in moving forward should be the 1990 Patient Self-Determination Act. Its spirit and letter ought to be honored for two reasons. First, the law was passed by the Congress to encourage and ease the use of States' advanced directives. It requires many Medicare and Medicaid providers to discuss advanced directives and how they will be carried out. Its requirements in that respect are as correct today as they were 15 years ago. The second requirement of the 1990 Patient Self-Determination Act is just as important. It prohibits discrimination against those who do not have an advanced directive. Now, it is estimated that as many as 75 percent of Americans do not have an advanced directive to guide their end-of-life choices. Under the Patient Self-Determination Act, mandating different and discriminatory treatment for Medicare and Medicaid patients without advanced directives is specifically ruled out. That is the kind of protection I believe all Americans deserve: protection that ensures the preservation of all their choices. Now, I am grateful that Senator Harkin and others are tackling vital issues, important issues that often go ignored, such as the concerns of those who are disabled. Americans should expect the Senate, however, to do even more. In this Congress, I will advocate vigorously for three pieces of legislation that take an appropriate Federal approach to key end-of- life issues. If the Senate has a commitment to consider the end of life seriously, I would expect those bills to come to a vote. They all involve issues I have been working on since the early 1970s when I was codirector of the Oregon Gray Panthers and taught gerontology at several Oregon universities. I have been working to improve care for older people and the dying throughout my service in the Congress and as a member of the Aging Committee in both the House and the Senate. For more than a decade, the people of my home State of Oregon have had a passionate and thoughtful debate on end-of-life issues. Through all of this, I have found that our health care system often neglects how people die and how important it is to make dying patients and their families more comfortable. Almost half of the dying experience moderate to severe pain in the last days of their lives. It does not have to be that way. The distinguished Presiding Officer is one of our authorities on medical technology, and he knows medical technology and know-how exist today to reduce the suffering that I am describing. What does not exist is a medical system that supports clinicians trying to address these issues or a system to support patients and families as they try to find help for pain. I intend to reintroduce the Conquering Pain Act, a bipartisan bill I have written that recognizes that too often at the end of life pain goes untreated for the dying patient. The Conquering Pain Act does not tell providers how to practice medicine. It certainly does not override the States' constitutional right to oversee medical practice. But it does serve to ensure that patients in every corner of our country, 24/ 7, 7 days a week, can get access to help as they try to deal with pain. This legislation creates six regional Family Support Networks to assist physicians and families of patients in pain, and it ensures that in every single community in this country Americans know where to turn to get information and help when loved ones are suffering. Americans deserve to know their health care providers and their families will have resources to ease suffering. I believe the ability to see a loved one's pain properly treated can help families across this country. It certainly will add dignity and preserve choices at the end of life. My second effort will focus on the vital work of hospice programs. More Americans are familiar with hospice today through Ms. Schiavo's case, but its true purpose may still be somewhat unclear. Hospice programs provide a range of services to control pain and other symptoms, maintain dignity, and provide comfort care, primarily to individuals in their own homes. But the hospice benefit under Medicare needs to be improved. Today, about 20 percent of patients who die in the United States receive hospice care, and of that low number few begin their care early enough to receive the full benefit of hospice. Medicare requires patients and doctors to stop all treatment that might bring a cure before they can begin hospice treatment. I do not believe--I do not think Senators will believe--that patients should be required to abandon all hope of recovery to get the good hospice care they need, but that is what the Medicare law states today. It makes no sense, and it ought to be changed. My Medicare Hospice Demonstration Act permits patients to seek hospice care as they seek a cure. It will not require patients and their families to abandon hope even as they move towards acceptance. For many, it will result in better care, more control, and more peaceful passage through the end of life. Finally, the Senate ought to promote training in what is called comfort care or palliative care in our medical schools. This is a practice that is important for the Senate to understand. Comfort care, palliative care, helps terminally ill patients live as actively as possible and helps their families cope. It neither hastens nor postpones death. It is offered in hospice programs, in the home, and in other settings. It prevents and relieves suffering by identifying, assessing, and treating pain and other problems. Those can include physical problems, emotional problems, and even spiritual concerns. Palliative care is appropriate even before hospice care. It is even compatible with aggressive efforts to prolong life, such as chemotherapy or radiation therapy. The Palliative Care Training Act will ensure that our country has more trained professionals to offer these critical comfort care services. The legislation addresses a need that the Senate has ignored too long. Without it, our citizens will not have enough dedicated professionals to meet this enormous need. As the distinguished Presiding Officer and I have discussed often, we are in the middle of a demographic revolution. We will have many more older people. It will not be uncommon for individuals to live beyond 100, and with Americans living so much longer than they did a century ago, it is important they have options that work for them. And demand for comfort, for palliative care, is certainly going to grow. With all the American health care system has to offer, there has to be better care for patients and their families at the end of life. I hope these three bills I have described will get careful and thoughtful examination in the days ahead and in the hearings that apparently will begin later this the week in the committee on which the distinguished Presiding Officer serves. As I have indicated, I believe the Senate has not been appropriately careful in recent weeks. When this body first considered legislation regarding Ms. Schiavo, I made my objections known. I was compelled to block the initial version of the legislation, a bill that was put forward without hearings, without discussion, and one that threatened to turn the Congress into a convention of case-by-case medical czars. In my view, that legislation intruded dangerously on States' rights to determine medical practice. I worked with colleagues so Congress could pass bipartisan legislation that in my view didn't set that dangerous precedent, particularly as it related to my own State's law that the people of Oregon have now approved twice. I didn't filibuster that final bill, which I had concerns about, but my concerns remain. I do not wish to see the steps of the Capitol as the new gathering place for Americans to bring their difficult family disputes at the end of life. I certainly do not want to see our Constitution trampled. Unfortunately, Congress has now opened the door to both those possibilities. The Senate has a renewed responsibility to do better. Each State's constitutional right to determine medical practice exists whether the Congress agrees or disagrees--to put it bluntly, whether Congress likes it or not. Congress cannot only respect the principle of States rights when it thinks the State is right. In the same way, the checks and balances the Founding Fathers set among the executive, legislative, and judicial branches, those powers are not up for negotiation because they produce an outcome that is unacceptable to some Americans. Before acting, the Senate ought to consider the very nature of federalism that has brought and held our States together for more than two centuries. Then the Congress should think carefully about whether it makes sense to tear down a basic pillar of our national contract. This body writes Federal laws. If the Senate does not like the effect of a Federal law, our prerogative is to change it. But it is not the Senate's prerogative to play constitutional chicken when matters happen outside of our jurisdiction. That is true no matter how strong our personal passions may be. I have fought for the rights of my State and its voters to decide the issue of physician-assisted suicide at home in Oregon. As I make this point, I want to point out that I voted twice against this law as an individual citizen. On two occasions, I cast my personal ballot against legalizing assisted suicide in my State. In addition, I voted against Federal funding of assisted suicide as a Member of this body. But the people of my State have spoken on an issue they have a right to decide at home in Oregon. As I have said in this body, I intend to defend their right to make that decision in every way I can. In the case of Ms. Schiavo, I believe that Floridians, through their representatives in the State legislature, deserve the same leeway to decide such medical matters for themselves. When Congress ignored the fact that Florida's legislature was still working on the case and ignored the right of the State courts to rule, it sought to weaken Florida's rights, Oregon's rights, and the rights of every State in our Nation. Any legislation this body passes now should not pose the same constitutional threat. The legislation I have outlined today will not, and I will oppose any legislation that does so again. It is an imperfect process even for States to rule on medical matters. End-of-life issues are about the heart and the head, about our personal morals as well as the law. Letting States decide is the rule of the Constitution I have sworn to uphold, and I intend to stand up for that principle. It is a critically important principle that the Senate stand for. And it is a principle that ought to dictate our actions before any legislation comes to a vote on the floor. In hearings this week--and in any part of the legislative process--there are responsibilities to fulfill before the Senate acts or there is a risk of gravely irresponsible legislation. The Senate should ask: Does any legislation on end of life meet key tests? Does it clarify and expand and ensure the choices that individuals and families can make? Does it aid in the honoring of those wishes once expressed, whether those wishes are to have life sustained or unwanted treatments withheld? Does it protect the rights of those in the disability community and those who are incapacitated, particularly when they have not had the opportunity to make their wishes known? Does it speak to more than the political debates of the moment and truly take in hand the basic issues at the end of life? Does it contribute to less pain, better care, and more peace for those at the end of life? Does it fully meet the responsibility of the Senate without usurping the constitutional role of the States and the judiciary? And finally, does it meet the obligations of the Senate to the American people without extending our reach into their personal lives? The Senate has an obligation to learn from the events of the last 2 weeks. Before acting, let us think. The Senate has been called the world's greatest deliberative body. Let us now be more deliberative as we dare to approach issues that are more intimate and more personal than any others we could discuss. The truth is, Americans' end-of-life choices should not be made by strangers in the Congress, pushed by the passion of one case or the political priorities that press on every side. Americans are going to continue to wrestle with end-of-life care for themselves and their loved ones for as long as breath is drawn on this soil. Americans will bring all they have to bear ethically, morally, and spiritually to make the best decisions for themselves and to honor the decisions of their loved ones. The Senate must equal their effort and do its duty with honor for those at the end of life. I yield the floor.

Mr. WYDEN

Mr. WYDEN. I object.

Mr. WYDEN. I object, Mr. President.

Mr. WYDEN

Mr. WYDEN. Mr. President, the Senate is now addressing probably the most gut-wrenching decision that an American family can ever face. Without even a single hearing, without any debate whatever, the Senate is tackling an extraordinarily sensitive concern that involves morals and ethics and religious principles, and this troubles me greatly. The practice of medicine and the regulation of it throughout our history has been properly left by the Constitution to the States. Now, regardless of how a Senator might feel about this tragic case in Florida--and feelings certainly run very high--a Senator ought to reflect on the implications of Federal intrusion before we cast this vote. I am particularly troubled at the prospect of setting a precedent that is going to have the Congress, in effect, playing ``medical czar'' in case after case because, colleagues, there will be thousands of cases just like this. I would ask the Senators, will the steps of the Capitol be the new gathering place for America to wrestle with these situations that all concerned consider tragic? I think that is a mistake. That is why I am going to vote against this legislation. Now, this legislation has particular repercussions for the people of my State. We have voted twice for assisted suicide. I will tell colleagues, I voted against both of those measures on assisted suicide. And I joined all of you, I think, here today in opposing Federal funding for assisted suicide. But I think these matters are not ones where we should trample on the prerogatives of the State quickly. And that is what we are doing today--without a single hearing, without a single opportunity for us to even hear from those most knowledgeable in the field. I know many colleagues want to speak on this, and I want to respect them. I would note that as a result of the cooperation shown, particularly by colleagues on the other side of the aisle, Senator Frist and others, there has been language added to this proposal so as to at least attempt to protect any State that has acted in this area. My guess is, when the Supreme Court tackles this, they are going to declare it unconstitutional. But as we go to the vote on this matter, I would urge colleagues to think about what it is going to mean when people from all over this country, all of our States, all of our communities, ask the Congress to step in on these kinds of cases. I think that is a very troubling precedent. It is my intention to vote no. I thank my colleagues, and particularly the majority leader for his courtesy. I yield the floor, as many others wish to speak on this matter.

Mr. WYDEN. I thank the Senator and withdraw my reservation.

Mr. WYDEN. Mr. President, reserving the right to object, and I do not intend to object, there is going to be 15 minutes on each side?

Mr. WYDEN

Mr. WYDEN. Mr. President, every time one turns around, the costs of the prescription drug program go up and up. The bipartisan Snowe-Wyden proposal is the only proposal that is being offered in the Senate to take steps to protect taxpayers and seniors. This does not undermine anything. Nothing is going to change other than the Snowe-Wyden legislation provides an additional tool in order to hold down the costs and protect taxpayers. Without this proposal, Medicare is going to be like a fellow standing in line at the Price Club buying toilet paper one roll at a time. Nobody in America shops that way. If one is buying a car or buying anything at a store, they try to get the best value. That is what this legislation is all about. In fact, the only areas where anything is required is when the private sector says an additional boost in bargaining power is necessary or in the case of what are called the fallback plans which are so important in the rural areas where there are no restraints at all in terms of what can be charged. Given the mounting concern about the cost of this program, where it has gone up almost every couple of months since it was signed, I would think that the other side, the opponents of the Snowe-Wyden legislation, would say: All right, we are going to oppose Snowe-Wyden, and here is our proposal. The fact is, the other side seems to say the status quo is just fine. The status quo with the costs going into the stratosphere is something that apparently they are not too upset about. Senator Snowe and I see it differently. We believe it is important to provide an additional tool, the kind of tool that is used in the private sector, and we think it will be meaningful. Ultimately, this vote is a vote about whose side the Senate is on. If my colleagues vote for this bipartisan legislation, they stand with taxpayers and seniors who would like this additional tool so that marketplace forces can be used to hold down costs. If my colleagues vote against this, in effect they are voting for the status quo because, I would just emphasize, there is no other proposal being offered by the opponents. They seem to say everything is fine. We do not. We think there is a bipartisan approach that makes sense. It is the approach that is used every single day in the private sector of this country. It uses marketplace forces to get the best possible deal, and ultimately what the Snowe-Wyden proposal is all about is whether common sense is going to prevail. I hope my colleagues will support it. Several additional colleagues-- Senators Leahy, Cantwell, and Kohl--would like to serve as cosponsors. I particularly want to thank Senator Conrad for his patience as this has been developed and gone through various iterations. I note my friend Senator Hatch, who has great expertise in this area as well, wants to speak. I wrap up by thanking Senator Snowe. We have been at this for 4 years. Both of us support this legislation. This is an important effort to try to get it right. When we started, nobody expected that the costs would escalate the way they have. This is likely to be the only vote the Senate gets to cast this year on prescription drug cost containment. I hope my colleagues will not pass up the opportunity to take a bipartisan step in the right direction, the direction of making this program work at a critical time when seniors are going to start signing up for the benefit that starts next year. I yield the floor.

Mr. WYDEN. I think that is very fair. After Senator Grassley is done, maybe we can work it out where I can have 4 minutes and Senator Stabenow can have 4 minutes.

Mr. WYDEN. Parliamentary inquiry: I need to speak with the Senator from Colorado and the Senator from North Dakota. I haven't had a chance to speak. Senator Snowe has done a superb job. In 3 or 4 minutes, I could sum up any additional comments. I know other colleagues want to speak and Senator Stabenow wants to speak. Could we work out something where we would have a few more minutes?

Mr. WYDEN. If it would be clear so colleagues understand that my colleague from Maine is the lead author of this amendment and I am her partner on our side. It will be the Snowe-Wyden amendment.

Mr. WYDEN. I just heard in the cloakroom the amendment that I am involved in is the Snowe-Wyden amendment dealing with bargaining power with respect to holding down the cost of prescription drugs.

Mr. WYDEN. Reserving the right to object.

Mr. WYDEN. For a question.

Mr. WYDEN. Will the Senator yield?

Mr. WYDEN. Mr. President, those who advocate drilling in the Arctic claim that the drilling is needed to reduce our Nation's dependence on foreign oil. But what is included in the Senate budget resolution doesn't increase U.S. energy security. To the contrary, it is a license to export Alaskan oil outside the United States. With the inflated revenue projections of $2.5 billion from drilling in the Arctic included in the budget, the Federal Government will be forced to sell the oil to the highest bidder to even come close to reaching that amount. Under the Senate budget, if the highest price is in South America, oil from that wildlife refuge would have to go to South America. If the highest price is in the Far East, Arctic oil would have to go to the Far East. If the highest price is in the Middle East, Arctic oil would have to go to the Middle East. With the weak dollar, it would be a virtual certainty that the highest price for Arctic oil would be outside our country. It would not reduce our dependence on foreign oil one drop to export Arctic oil overseas, but that is exactly what could happen under the Senate budget resolution. Now, last Congress, the House, in passing its Energy bill, recognized that drilling in the Arctic wildlife refuge won't help our Nation's energy security if the oil from that drilling is exported overseas. The House-passed Energy bill explicitly prohibited the export of oil from the Arctic wildlife refuge. But the Senate budget resolution fails to include an export prohibition. In fact, it invites exports by assuming revenues that can only be met by requiring the oil to be sold to the highest bidder, at a time when the dollar is weak. If the goal is energy security, then including the Arctic drilling in the budget resolution in this fashion is the wrong way to go about it. We can get more energy security, and we can get it sooner than from Arctic oil drilling under the Senate budget resolution. Last week, the President renewed his push for drilling in the Arctic by arguing it would produce nearly 10 million barrels per day. But the President acknowledged that that amount of oil would not be produced until 2025. We can get that much energy security and more, and we can get it now instead of waiting until 2025. We can get that added energy security by changing the current policies on exports of oil and petroleum and providing the right incentives for producers to develop the billions of barrels of recoverable oil that are in U.S. reserves but are not being developed today. Right now our country is exporting about 1 million barrels a day of petroleum products. That happens every single day. We could in effect get 1 million barrels a day more oil for our country, 10 percent more energy security, and we could get it right now by ending those exports. By comparison, the administration's Energy Information Administration says the amount of oil that the President says would be produced in the Arctic would only reduce our Nation's dependence by 3 percent, from 68 percent to 65 percent dependence on foreign oil. I seriously doubt the OPEC cartel will stop its anticompetitive practices because of a tiny increase in Arctic production 20 years from now that even the Energy Administration says would reduce our dependence on foreign oil by 3 percent. Our country can get more than three times that amount of increased energy security and we can get it now rather than 2025 by stopping exports of U.S.-produced petroleum products, and under the unrestricted export language of the Senate budget resolution we could end up with no additional energy security--no additional energy security, absolutely not. We can do much better than a 3-percent increase in energy security. We can do better than the 10-percent increase in security our country would get from eliminating exports. In fact, our country could produce an additional 40 billion barrels of oil, enough to replace all of our country's imports of oil for the next 10 years, and we could get that additional oil from existing reserves that could be produced in our country if the right incentives were provided. If we want to get serious about energy security, we can start today. We should eliminate the budget resolution's license to export Arctic oil out of our country. We should replace the budget's Arctic oil export license with policies that provide real energy security for our Nation. Mr. President, I suggest the absence of a quorum.

Mr. WYDEN. I thank my colleague.

Mr. WYDEN. That would be gracious. I will try to do that.

Mr. WYDEN. I ask unanimous consent to speak for--may I have up to 10 minutes? I don't think I will go that long.

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

Mr. WYDEN

Mr. WYDEN. Mr. President, I thank the distinguished Senator from North Dakota. I come to the floor this afternoon to talk about the way this budget deals with the fastest rising costs in America, and those are our medical bills. I am going to talk about two areas--Medicaid, and the question of prescription drug coverage under Medicare. I want to start by saying that regrettably in this budget, health care is done wrong. It is set up in a way that we are going to regret, and we are going to regret greatly. I want to take a few minutes to talk about why this budget gets it wrong on the health care issue. Health care is so important because of the demographic changes with which we are faced. First, with respect to the Medicaid program, the way I would describe this Medicaid budget is hurt the poor now, talk about reform later. I say this recognizing that I know that is not the intent of the distinguished Senator from New Hampshire. It is certainly not the intent of the Secretary of Health and Human Services, Mike Leavitt, who I know means well. But regrettably, that is what is going to happen under this Medicaid budget. The distinguished Senator from New Hampshire, when he talks about Medicaid, constantly says: We are not cutting Medicaid. The Senator from New Hampshire is correct in saying he is not cutting Medicaid. But he is certainly going to hold down the rate of growth in the program. So the Senator from New Hampshire cuts the ability of State and local governments at a crucial time when they are getting more people enrolled because of the hardships in the economy and when there has been a failure to deal with the long-term care issue. These factors are driving up the cost of Medicaid. The Senator from New Hampshire is right that this is about the rate of growth. But this budget is going to cut the ability of local governments and States and poor people to pay for these medical costs at the very time when States are going to need the dollars in order to deal with the increases in enrollment and the fact that long-term care under Medicaid has not been dealt with. In effect, what we are going to see is States and the poor get hit with a double whammy. States and the poor are going to have fewer dollars while at the same time States will not get relief from some of the bureaucratic water torture that is imposed on them. My home State of Oregon is perhaps the leader in desiring to have innovative approaches in Medicaid. Sometimes I jokingly say: I am a Senator from ``Waiver'', because my State consistently wants to waive out of the one-size-fits-all approach that is so often taken in health care. Oregon has seen this kind of bureaucratic water torture in a lot of different ways as we have tried to deal with a tough economy and making changes in the Oregon Health Plan. We saw that very often when something innovative was done elsewhere, you couldn't even expedite approval to do that in Oregon or in other states. We see the bias against home and community-based services in Medicaid. I very much want to see the more flexible approach, the more innovative approach that lets the States be used as a laboratory for innovation in the health care area. But make no mistake about it: Under this budget there are going to be fewer dollars for the kinds of reforms and innovations that are badly needed. In effect, the real mistake in this budget with respect to Medicaid is it essentially says: Let's put the cuts in funds first before we go ahead with reform. I and others have no dispute at all with the distinguished Senator from New Hampshire and colleagues on the other side of the aisle about the need for reform in Medicaid. There is no question about the fact that innovative approaches used in the private sector have not yet found their way into the Medicaid program. What the dispute is about is that we think it is going to be harder to get the reforms, harder to get the innovations if you cut off the dollars to the States and the localities right at the time they are having increases in enrollment, at the time that long-term care has not been dealt with, and certainly make it less likely that they will have the dollars they need to put in place the reforms. Senator Corzine and Senator Rockefeller, others, and I will be, through the course of this week, seeking to improve this budget resolution as it relates to the Medicaid program, because regrettably a lot of poor people and a lot of States are going to get hurt now. The discussion about reform will come later. Under this particular budget, it is going to be hard to get in place some of the reforms that I and Governors around the country, on a bipartisan basis, believe are necessary. The second area I would like to talk about as it relates to this budget is the question of Medicare and prescription drugs. Where we are headed now is the prospect that early in 2006, the Federal Government will be spending a ton of money on a prescription drug program and covering a very small number of people. That doesn't seem to me to be acceptable in this kind of belt-tightening climate and certainly is not acceptable with respect to the scarce use of Government resources. A group of Senators and I, on a bipartisan basis--Senators Snowe, McCain, Feingold, and others--have been seeking unsuccessfully to do what the Senator from New Hampshire has said he wanted, which is to find real savings. Here is what the Congressional Budget Office said. I see the Senator from New Hampshire here. I want to read to him the sentence specifically from the Congressional Budget Office letter of March 3, 2004. Paraphrasing, the Congressional Budget Office said: Giving the Secretary an additional tool would put greater pressure on manufacturers and could produce additional savings. In March 2004, the Congressional Budget Office found, with respect to single-source drugs, there was the opportunity to have leverage like the private sector has, and there would be some savings. You are going to hear during the course of the week that there are no savings. I hope my colleagues will look at the letter dated March 3, 2004, from CBO that attests to the fact that they believe there is a potential for additional savings. Of course, this was the kind of concern that motivated Tommy Thompson, in his last days as Secretary of Health and Human Services, to say he wished he had the power and clout that the legislation I have authored with Senators Snowe, McCain, and others, would provide. I believe that if we are going to adhere to the suggestion of the Senator from New Hampshire that we put a real focus on additional savings, we should not pass up the kind of opportunities that the private sector is using to generate savings, that Tommy Thompson said would be an invaluable tool for him, and the CBO said in March 2004 would provide the potential for additional savings. I say to the Senator from New Hampshire that, with all of that evidence--the private sector, the Secretary, Congressional Budget Office, and just plain common sense--nobody would shop for medicine the way Medicare is about to shop for medicine. I have compared it to the fellow standing in Price Club buying toilet paper one roll at a time, not using bargaining power. Nobody in the private sector uses their shopping opportunities in that way, but that is where we are headed with respect to the Federal Government. That is what I would like to change. Senator Snowe and I and others will be on the Senate floor during the course of the week. I am very hopeful that my colleagues will listen carefully. At a minimum, I believe that giving this opportunity, particularly as it relates to what are called the fallback plans and if the private drug plans ask for help is important. For the life of me, I cannot figure out how this will do any harm. The Secretary would have the discretion to make the decision as to whether to use this power overall, but it certainly cannot do any harm to start the kind of smart shopping approach that goes on in the private sector every day. That is the way timber companies do it, that is the way auto companies do it. Everybody says: Look, if you are buying something and you are going to buy more of it, you ask the people for a discount for the additional purchases you are making. That is what Senator Snowe, Senator McCain, myself, and others are going to seek to do. I also hope that as we discuss this in the course of the week, colleagues see that this will perhaps be the only vote in this Senate on the question of prescription drug cost containment through bargaining power. If the Senate Finance Committee, on which I serve, doesn't offer it as part of a piece of legislation coming through the Finance Committee, this could be the only opportunity for the Senate to go on record with respect to pharmaceutical cost containment. I say to my colleagues, when you go home and people ask you about the prices seniors are going to be paying for prescription drugs under Medicare-- look at the prices they are paying right now--I would not want to have to explain why I was against having the kind of bargaining power you see in the private sector every single day. So when I come to the floor this week with Senator Snowe and others, I hope colleagues will see-- and maybe there are other ideas out there--that this will be the only opportunity perhaps this year to hold down the costs of prescription drugs before the program is to be implemented next year. So when colleagues open the newspaper and see that the cost of the program has gone from $400 billion to $500 billion and to $700 billion--and I guess next we will hear about a trillion dollars--I hope they will remember that when they vote on the Snowe-Wyden legislation in the course of the week. This is legislation that Tommy Thompson said he wished he had, and CBO says it certainly has the potential to save for single-source drugs, and that goes on in the private sector all the time. The Secretary of Health and Human Services still will have substantial discretion under this legislation. So I hope colleagues will look at it. I also make the point, in closing, that this is not just removing what has been called the noninterference language. This goes beyond the so-called noninterference language and says that the Secretary would have to respond when private plans say they need that additional tool, and for what are called fallback plans, where it is deemed that there is inadequate competition. The question of health care is certainly going to be more important in the days and years ahead. It is going to be very important in the context of this budget because the proposal that deals with the Medicaid program is misguided. It cuts before it reforms. I believe that is going to hurt the poor and it is going to hurt the States. The Senator from New Hampshire will say--and will say correctly--that it is really not a cut; there is still going to be growth. But the bottom line is that it takes dollars out of the States and local governments to serve the poor when there is a time of increased enrollment and difficulties in paying for long-term care coverage. That is why it is wrong. In addition to the Medicaid part of the budget, the budget does not address cost containment in Medicare prescription drugs. I am very sad we were unable in the committee--on partisan vote, we lost by 2 votes--to get some private sector bargaining power into the Medicare prescription drug program at a time when the costs continue to escalate. Senator Snowe and I will be on the floor this week about this. I urge my colleagues to, as they consider this vote, recognize that this, perhaps, will be the only opportunity in this session of the Senate to vote to contain the cost of the prescription drug program before it starts in 2006. I hope the Senate will heed the words of Secretary Thompson, who said in his last days in office he wished he had this power. Under our bipartisan legislation there is an opportunity to respond when the private sector believes it needs additional leverage. It is just common sense. Unlike the concerns expressed earlier by the Senator from New Hampshire, who was concerned about additional spending, this is going to be about deficit reduction. This is going to be about saving money in one of the fastest growing parts of the Federal budget. It is about getting serious as we try to reign in the costs of health care that are escalating beyond those of any other in our society. Mr. President, I yield the floor.