Sheldon Whitehouse

Mr. WHITEHOUSE

Mr. WHITEHOUSE. We have some catching up to do, and while we do that catching up, millions of Americans are out of work. My home State of Rhode Island has one of the highest unemployment rates in our country. Across my State and across our country, couples are sitting at the kitchen table at night after the kids are in bed, with the bills on the table in front of them, and they are trying to figure out how to make ends meet and it is not adding up. That is the reality many Americans face when we cling to the failed policy of the past, when we care more about keeping big oil happy than about finding new, inventive ways for the average American worker to find lasting, secure employment in the tradition of American entrepreneurship. Remarkably, there are those in Congress who would have us do nothing, who would remain wedded to tired, centuries-old technologies and left in the dust as other nations race for leadership in the new clean energy world. I submit this do-nothing caucus is selling America short. Don't they trust that when it comes to inventing new technologies and manufacturing valuable products, we are the best in the world? If Congress passes strong clean energy legislation that creates the necessary incentives for the research, development, manufacture, and sale of clean energy technologies, that spirit of innovation and entrepreneurialism will again lead the world, as it has so often over the centuries. We can have confidence in that. We have already seen some progress. It is clear, at least, that people outside the beltway get it. In the last 10 years, jobs in the technology sector have grown nearly 2\1/2\ times faster than overall. In 2006 alone, the American Solar Energy Society estimates that Federal, State, and local governments spent $8.6 billion on energy efficiency, creating 64,000 direct jobs and 83,000 indirect jobs. Their investment of an additional $3.2 billion in expanding new energy production created more than 7,000 direct jobs and nearly 9,000 indirect jobs. Every day in America, real people and real companies are moving into the clean energy economy. In Rhode Island, Newport Biodiesel is producing a cheaper form of home heating oil for Rhode Island families by recycling restaurant grease. Alteris Renewables is creating jobs in Rhode Island installing solar energy systems on residential homes. I recently visited a home in Charleston, RI, where a family has a new Alteris solar energy system on their roof and heard from them about the significant energy savings they will achieve. But this is only a fraction of the scale needed to revolutionize our economy. The American people, our researchers, entrepreneurs, and workers from the largest, most sophisticated research institutions and corporations to our smallest local businesses, can create clean energy jobs everywhere in the United States--in urban areas as well as rural, in the Rust Belt as well as the Wheat Belt, in our deserts and on our coasts. All they need is for us in Congress to set the economic parameters correctly, to level the playing field with foreign competition, to meet the market for investment in these products. America is waiting for Congress to act. As I close, let me address a couple of the points we often hear from the do-nothing caucus and their see-nothing supporters in the boardrooms of the big polluters. First, we simply cannot drill our way toward a secure energy future. It would take 10 years before we would see any tangible results from drilling, and the result would be negligible when it came. The United States has only 3 percent of known oil reserves. Yet we use 25 percent of the world's oil production. We cannot drill our way out of that math. The United States could supply 20 percent of our energy needs through wind power alone, not even factoring other forms of renewable energy. The choice is a clear one for the future: Do we continue to enrich ExxonMobil and continue our dependence on foreign oil from places such as Saudi Arabia and Venezuela or do we decide to lead the world and tap into America's most abundant resource, the innovation and entrepreneurship of the American people? We should also be skeptical of the champions of the status quo when they exaggerate the cost associated with transitioning to a clean energy economy. Our CBO has projected that clean energy jobs legislation would cost most American households on average less than a postage stamp per day, and it actually puts money back into the pockets of the poorest families, and that didn't even consider the savings to individuals and companies from energy efficiency practices and technologies. If prices go up a little but efficiency reduces demand and reduces use, families save. They always leave that part out of their see-nothing scenarios. We can easily increase our energy efficiency to cover 15 percent of our energy needs by 2020 and save American families and businesses nearly $170 billion in electricity costs. Of course, the do-nothing caucus overlooks the cost of doing nothing. Unchecked greenhouse gas pollution has already begun to melt our glaciers and warm our oceans, leading to stronger, more frequent storms and rising sea levels. America's insurers are worried about our coasts, home to over 53 percent of the U.S. population, where we generate over 83 percent of our gross domestic product. We put a lot at risk if we follow the lead of the do-nothing caucus. We have heard the ``Do Nothing Caucus'' argue that strong environmental legislation would hurt the economy and cost us jobs. It is the same old polluters' argument. It is as wrong now as it has always been before. In the 1990 debate on the acid rain program, manufacturers warned that the health benefits of the program were unclear and that their adoption could deal a ``crushing blow to U.S. business.'' But when the acid rain program was enacted, the program began delivering $70 billion annually in human health benefits, at a benefit-to-cost ratio of more than 40 to 1. Industry and environmentalists alike now agree the program was a success. Oops to that argument. In 1995, DuPont warned the costs of phasing out ozone-depleting chemicals would exceed $135 billion and that ``entire industries would fold.'' But when the phaseout became law, compliance costs turned out to be less than 1 percent of the doomsday projection. DuPont made millions selling substitutes for the phased-out chemicals, and we managed to shrink the hole in the ozone layer of our Earth's atmosphere. Oops again. We are at a crossroads. We can step toward the clean energy economy that beckons and show the world our capacity for leadership in the world economy, as we have done time and time again, or we can cling to the status quo, heads firmly wedged in the sand, and trade in our future for the well being of big oil and the Saudi Arabia royal family. The right choice is clear, and I am confident we will make it. I yield the floor. The PRESIDING OFFICER (Mr. Merkley.) The Senator from Texas is recognized. Tort Reform

Mr. WHITEHOUSE. Mr. President, I rise today to join my colleague from Oregon in discussing the challenges and opportunities America faces as we look to ensure our economic leadership and prosperity for the 21st century and beyond. America has always been a land of innovation and entrepreneurship. We led the way during the industrial revolution, which began at Slater Mill in Pawtucket in my home State of Rhode Island. We led the way in the information technology revolution that began in Silicon Valley. It is in American DNA to think boldly and through hard work to translate bold thinking into practical solutions, solutions that improve people's lives all over the world and bring prosperity to our shores. It is time for us to lead again. A clean energy economy beckons, and we must not, we cannot ignore the call. Congress must act to pass clean energy legislation that will promote, here at home, cleaner, cheaper renewable energy sources such as wind, solar, and biofuels. I stand here today in strong support of such legislation. Our transition to a clean energy economy is past due. This country has run on the same fuels at basically the same efficiency levels since the start of the industrial revolution over a century and a half ago. This was acceptable in 1900, perhaps even in 1950, but where does it leave us today, in 2009? First, it leaves us dependent on foreign oil. Approximately 40 percent of our energy needs are met through oil, and more than 70 percent of this oil, at a cost of $630 billion out of the American taxpayers' pocket every year, comes from foreign sources including Saudi Arabia, Venezuela, and other regimes that do not wish us well. It is the largest transfer of wealth in history, and we are on the losing end of it, and international big oil is only too happy to profit off America's decline. Second, while we enrich hostile foreign governments and international big oil, other countries have embraced the development, manufacture, and export of renewable clean energy technology, such as wind turbines and solar panels, so that now half of America's existing wind turbines are manufactured overseas. The United States invented the first solar cell, but we now rank fifth among countries that manufacture solar components. The United States is home to only one of the world's top 10 companies manufacturing solar energy components and to only one of the world's top 10 companies manufacturing wind turbines. Recently, two wind turbines went up in Portsmouth, RI. One was manufactured by Vestas, a Danish company, and the other by an Austrian company with a Canadian distributor that delivered the components to Rhode Island. These turbines are very welcome. It was like a barn raising when they went up. People came out to watch. As a result, Rhode Island and America got the benefit of cleaner, cheaper energy, but we missed out on the manufacturing jobs these projects should have created for American workers. Other countries that have embraced the demand for clean energy technology, such as China, Germany, Japan, and Brazil, are all investing more per capita in clean energy than the United States. I ask unanimous consent to have printed in the Record a Washington Post article dated July 16, 2009, ``Asian Nations Could Outpace U.S. in Developing Clean Energy.''

Mr. WHITEHOUSE. Mr. President, if the distinguished Senator from Oregon would care to complete his remarks, I would have no objection. I don't suspect anyone else would.

Mr. WHITEHOUSE. Mr. President, while we await the arrival of Senators who may be interested in offering their amendments, I ask unanimous consent to speak for up to 12 minutes in morning business.

Mr. WHITEHOUSE

Mr. WHITEHOUSE. Mr. President, I ask unanimous consent to speak as in morning business for up to 15 minutes.

Mr. WHITEHOUSE. I would let the distinguished floor manager and the distinguished Senator from Utah know that if someone does come to the floor and wishes to do their thing with an amendment, please feel free to give me the high sign and I will conclude my remarks and allow the business of the floor to proceed. I do not wish to keep anybody from offering an amendment, if they have one. But I did wish to take the time to talk for a minute about our health care system because I think people across the country are, right now, finding our dialogue in the Senate a bit confusing about health care, and they are starting to wonder what is going on. In particular, particularly for those who have insurance: What does this mean for me? Why is this important for me that the Senate be doing this work? I already have insurance. What do I stand to gain from all this? There are a great number of things Americans stand to gain from all this. But the issue I wish to focus on today is improvements in our delivery system. It is important for Americans who are listening to realize that the personal experiences so many of them have had are not unique. If you have had a loved one in the hospital and you have felt constrained to stay with that loved one through their illness in the hospital, if you have felt you could not leave them alone in that hospital for fear that something might go wrong, some drug might be misadministered, some call might go unanswered, if you feel that way, if you have had that experience, you are not alone. That is an extraordinarily common experience. If you have felt you missed an opportunity for the prevention of illness, nobody told you that you should have had this test, nobody told you this was a health consequence of something you were doing, that is an experience Americans have across this country. If you have had to ferry by hand your health records from place to place or if, similar to many Rhode Islanders, you have been rushed up for emergency specialty care in Boston and your paper records did not come with you and you have been in real peril in a Boston emergency room as they try to redo the tests they did not have access to because you did not have a comprehensive electronic health record, you are similar to many Americans. The consequences of that, of those problems, are renown throughout the health care system. The problems they cause are real ones. There are 100,000 Americans who die, who lose their lives every single year because of completely avoidable medical errors, most of them hospital- acquired infections. That is intolerable. That is a plane crash a day. Yet it is the status quo in the existing health care system. We have the worst health care outcomes of essentially any civilized developed country we compete with. The worst. Even though we pay twice as much per person for our health care than most of them, we have worse outcomes. That is the status quo of our health care system. The Economist magazine has reported that the health information technology infrastructure that supports our health care sector is the worst of any American industry, except one, the mining industry. That is not very reassuring, not in an industry where the possibilities for technology are so great, and where at the detection end and where at the treatment end, we are at the technological cutting edge of the world, but you get back to that back office and there you are with that paper record and no way to cross-reference for drug interactions. We are at a primitive stage with our health information infrastructure. That is the status quo of our health care system. Everybody, I suspect, has had the experience themselves or of a loved one who becomes sick unexpectedly who turns to their insurance company, the insurance company they have been writing those big checks to year after year, only to find out that when you turned to that insurance company in your hour of need, they turned on you, they turned against you. They tried to figure out a way to get you off coverage. They tried to talk you out of the coverage and the treatment your doctor has indicated. They fought with your doctor about whether they would pay it. For many people, the experience is not just of being the patient, the experience of being the spouse or the family member or the loved one of the patient who has to cope, who has to become the person who answers the deluges of mail, who makes the call after call after call, who waits through dial tones and through the voice mail and the voice messages to try to get to somebody to approve procedures the doctor has said you need. That is the status quo of our health care system-- millions of Americans told by their own insurance companies: Forget it. We are not going to pay for the treatment your doctor says you need. The major reason American families go into bankruptcy right now is because of health care expense. It is not just the uninsured. These are insured families who find their coverage limits have been reached, who find the insurance company has found a loophole, who find they have exceeded, in terms of all the peripheral costs of durable medical equipment and other things that might not be covered, but it is more than they can bear to get by and they are struggling to get by and they are dropped into bankruptcy; the most prominent reason American families go into bankruptcy. That is the status quo of our health care system. Those can all be better. We can revolutionize all those areas. We can revolutionize the quality of care and the safety of Americans when they are in the hospital. We can improve our health care outcomes so we are the pride of developing nations, and not the lagger. We can improve so we do not have the worst health information technology of any American sector. We can eliminate denials of care by insurers for preexisting conditions. We can provide adequate supports to Americans so bankruptcy is not a common symptom of illness in this country. The problem is, if we do not do anything about those existing problems, they are all going to accelerate. They are all getting worse. What do we have to look forward to? Well, we have to look forward to a $35 trillion Medicare liability, and we do not have $35 trillion to spend. That is a future liability. It is coming toward us. The people who are going to cause it are alive right now. They are not going anywhere. They are getting older every day. Time is not going to stop. And they are getting sicker every day because it is never going to happen that older people are healthier than younger people. There is a tsunami of health care costs bearing down on us. Just the Medicare slice of it is a $35 trillion liability for our country, and we do not have the $35 trillion. So it is either going to wreck us or we are going to have to take some very smart, very aggressive measures now to reduce those costs. If we do nothing, a family in Rhode Island in the year 2016--that is not too far from now; that is 7 years from now--a family in Rhode Island making $52,000, which is a pretty good income, a family making $52,000 will spend more than half their income on health care. By as soon as 2016, a Rhode Island family making $52,000 will spend more than half their income on health care. We use the word ``unsustainable'' around here. We are headed to where it is impossible for regular families to get health care. It is bad enough now, and it is getting worse. We have to act to stop it from getting worse. We have pretty close to lost our car industry. People used to say: What is good for GM is good for America. It was the emblematic American company. It is gone. It is in bankruptcy, and it is gone. It is now coming back out of bankruptcy, but it had to be swept through a bankruptcy. The catastrophic effect on our country of the loss of those jobs in the Midwest and then through the secondary providers across the country is a very real problem, and it is being felt in large part because those cars were so burdened with health care costs. If you go to Starbucks, there is more health care money in your coffee than there is coffee bean money. In those cars, there was more health care money than steel. The cost of health care per car was greater than the cost of steel per car. It is pretty hard to compete with Volvos and the Lexus and cars from places where they have a national health care system and the price of the health care is not buried in the cost of the car. It put our workers at a terrible disadvantage. That is only getting worse, and our manufacturing sector has enough problems without continuing to load health care costs on to it. If we can't get the message from the collapse of the auto industry, we are missing some very loud--indeed deafening--signals. Our last Comptroller General warned that this health care mess will sink our ship of state. He phrases it as a national security issue to get this right. He left the job to go and spread the word around the country warning us of what is coming. Not only is it bad now, it stands to get a lot worse. Here is the opportunity and the tragedy of this: It is that so much of this is waste. One recent voice on this subject is a former Cabinet member from the last administration. Paul O'Neill was the Secretary of the Treasury of the United States. He is no fool. He is a sensible and thoughtful man. He ran, for years, Alcoa, one of America's biggest corporations. He has extreme business experience. He also ran something called the Pittsburgh Regional Health Initiative which looked at improving the quality of care of hospitals in the Pittsburgh area. He was a leader in all of this. He knows his health care issues well. Here is what he wrote recently: There is $1 trillion of annual waste in the health care system that is associated with process failures. A trillion dollars a year--even by Washington standards that is a big number. That is a target that is worth shooting for. That is a target that we shoot for hard in the legislation we are putting forward. If we take a look at the President's own Council of Economic Advisers recent report, on July 9, a few weeks ago, they put out the report on the economic case for health care reform. They looked at the health care system from two measures: one, if you compare to it foreign countries and look at their gross domestic product share and extrapolate from that, what we could get our costs down to if we were sensible and thoughtful and didn't have such a wasteful health care system and, second, to look at the variation among the States, from State to State, from region to region, even as the recent article by Atul Gawande said, the differences within a State, between McAllen, TX and El Paso, TX. If you look at those, that gives you another means of calculating what you could get the costs down to. If you could get the waste out of the system, efficiency improvements in the U.S. health care system potentially could free up resources equal to 5 percent of U.S. GDP. From the Council of Economic Advisers, that is over $700 billion a year. Maybe it is a trillion, maybe it is $700 billion. Per year that is a big number. Looking at the internal discrepancies, they note: [It] should be possible to cut total health expenditures by about 30 percent without worsening outcomes [which] would again suggest that savings on the order of 5 percent of GDP could be feasible. Again looking at the calculation two separate ways, coming to the same number, $700 billion a year. The problem is, it will take some executive administration to get there. It is not easy. You don't just make your decision, flip up or down the light switch, it goes on, and you don't have to worry about it. This isn't like the sniper who lines up his shot, pulls the trigger, and the projectile goes. This is a problem where you are like the pilot landing in rough weather. You have to continue to steer through it. You have to continue to seek the savings. As the market adapts, you have to adapt with it. It takes executive leadership and administration to make this happen. That means the Congressional Budget Office can't score it. All they can say is that it promises a ``large reduction'' in American health care costs. But they can't score it. So the American public, with a lot of misinformation out there, has been beguiled into believing that what we are doing won't save money. We are determined to save money doing it. The Medicare system and the American health care system and the American economy will fail if we don't save money doing this. The target is as big as $700 billion to $1 trillion a year. Our health care system has been described memorably as a ``carnival of waste.'' It is time to bring the carnival to an end and give Americans the health care they deserve. There are a couple of pretty sensible ways to do this. The administration has focused on all of them. The first is, as I said earlier, health information infrastructure. Why should every American not have an electronic health record? Why, when you go to McDonald's, should the checkout person have a more robust health information infrastructure backing them up and connecting to inventory and connecting to sales than your doctor does? It makes no sense. We could save enormous sums if we had a national health information infrastructure--secure, confidential, reliable, interoperable. So if you went to get a lab test, it went into your record. If you went to the emergency room, it went into your record. If you stayed at the hospital, it went into your record. If you saw a specialist, it went into your record. All of your practitioners would know what was going on in your care. The more complex and chronic your conditions, the more valuable that would be. We don't have that now. It is the worst of any American industry except the mining industry. Quality improvement: In Michigan, there was a fascinating project, called the Keystone Project, where they went into the intensive care units in Michigan--not all of them but a great number of them--with process reforms in the intensive care units to reduce respiratory problems from not being elevated, to reduce line infections from catheters and from blood lines. The effect of that was, in 15 months, to save 1,500 lives and $150 million just in one State and not even all the intensive care units. It proves the proposition that quality improvement can save money and lives. Prevention is obviously the same. We will be on the floor shortly to debate Judge Sotomayor's nomination. She has lived with diabetes since she was a child. She has taken good care of herself so she had not created a lot of cost for the health system, but many people who don't manage their disease well, who don't get the prevention they need, end up with amputations, blindness, long and unnecessary hospital stays. There are areas where, by investing in prevention, we can save fortunes. Why don't we do this then? Why don't we have electronic health records on every doctor's desk for all Americans? Why don't we have every intensive care unit participating in a Keystone-type quality initiative? Why doesn't every community health center have a robust diabetes prevention program? It has to do with the bizarre economics of our health care system. Because the same thing is true for all three entities. If you are a doctor and you want to put electronic health record systems in for your patients, if you are a hospital and you want to improve the quality of care in your intensive care unit and put in a program that will do that, if you are a community health center that wants to invest in prevention to help the diabetic population stay healthy, you face the exact same predicament: The investment you have to make is 100 percent out of your pocket. The risk of the investment is 100 percent on your neck. The administrative burden is 100 percent on you. The hassle of it is 100 percent yours. All of the costs are on the desk of the doctor, on the desk of the hospital administrator, on the desk of the community health center. But the benefits from the electronic health record, the benefits and the savings from the quality improvement, the savings and the benefits from the prevention don't find their way back to that same desk. They go off to Medicare. They go off to the insurance industry. They connect to the patient in better care, but investment doesn't get the reward. The basic principle of American capitalism, which is the connection between risk and reward, has been broken in the American health care system. That is one of the things we get after in this bill. We could have electronic health records for every American, our hospitals and doctors highly motivated to pursue all the quality initiatives that will improve the quality of our care while it lowers the cost and avoids unnecessary hospitalizations and delays and infections, and so forth, and we could have the best prevention program in the country, but we have to make it work for people. That is part of what we are about in this health care reform. I will continue to explain why it is important that we reform our health care system and what the average American will gain from it. Today I focused on the elements of why delivery system reform can be improved. But every American will see that in their lives, their parents' lives, and in their children's lives. When we look back to where we are today from where we can be and where, with President Obama's leadership, we will be, we will look back and ask: My God, how could we have been living that medieval setup? Look how good it is now. That is our goal. That is our purpose. That is the promise of health care reform. I yield the floor and suggest the absence of a quorum.

Mr. WHITEHOUSE

Mr. WHITEHOUSE. Madam President, I ask unanimous consent that when the Senate completes its business today, it adjourn until 10 o'clock tomorrow morning, Tuesday, July 28; that following the prayer and the pledge, the Journal of the proceedings be approved to date, the morning hour be deemed to have expired, the time for the two leaders be reserved for their use later in the day, and there then be a period of morning business for 1 hour, with Senators permitted to speak therein for up to 10 minutes each, with the time equally divided and controlled between the two leaders or their designees, with the majority controlling the first half and the Republicans controlling the second half; that following morning business, the Senate resume consideration of Calendar No. 104, H.R. 3183, the Energy and Water Appropriations Act; finally, that the Senate recess from 12:30 until 2:15 p.m. to allow for the weekly caucus luncheons.

Mr. WHITEHOUSE

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

Mr. WHITEHOUSE. Madam President, I ask unanimous consent to speak as in morning business for up to 15 minutes.

Mr. WHITEHOUSE

Mr. WHITEHOUSE. Madam President, over the last several months I had the exceptional honor of serving as a temporary member of our HELP Committee--Health, Education, Labor, and Pensions--where I joined a truly remarkable group of Senators as we wrote and fought through and refined and ultimately passed our part of legislation that will begin to fundamentally transform our broken health care system. During that period, Senator Kennedy could not be with us, but we certainly felt his spirit and his presence and the tradition of service to this issue that he has embodied through that time. I think he would be proud of the Affordable Health Choices Act we brought out. I certainly am. This bill, in combination with the work now being done in the Finance Committee, will guarantee quality, affordable health coverage for all Americans. It will protect Americans against back-breaking medical costs. It will expand access to vital preventive services. It will fight fraud and abuse in public and private health insurance plans. It will help retirees with the high cost of coverage. It will improve the quality of care through fundamental delivery system reforms. It will build a 21st century health care workforce. It will provide a new voluntary insurance plan, a different choice for long-term care. Most importantly, it will bend--maybe even break--the cost curve. In short, we stand at the dawn of the most significant improvement of our health care system that our country has ever seen. My only regret is how remarkably, staggeringly, embarrassingly late we are to this task. We often talk about the health care reform efforts of 1993 and 1994 and how startling it is that it has taken us 15 years to return to such a paramount issue for our people. But as we all know, the debate over reforming health care goes back decades and decades. Let's take a quick trip back in time. From a 1992 New York Times article: ``Health Care Costs Dampen Hiring.'' This at a time when our national health care costs were $850 billion a year. Now they are $2.3 trillion a year; then, $850 billion a year. This could be the first recovery crippled by medical costs. Employee benefits--health insurance in particular--have become so explosive that manufacturers are increasingly coping with weak demand by cutting payrolls, not overtime . . . Health care costs, increasing at more than twice the rate of wages, have made benefits so expensive it would be surprising if companies were not responding. As they find other ways to avoid paying benefits--the growing use of contract workers, for example--they often say instead that they are merely giving employees some flexibility. That was 1992. We could have that same discussion today, only we would have to multiply the number by three. Here we are back in 1988 when the New York Times reported: ``Soaring Health Care Costs.'' At this time, instead of $2.3 trillion a year in health care costs, we were spending $500 billion. The article says: Health care amounts to 11.1 percent of gross national product in the United States,-- Now, of course, we are over 18 percent. --a bigger share than in any other advanced country. That didn't change. In 1987, Americans spent $500 billion on health care, 9.8 percent more than the year before. Those trends have continued. This year, spending on health care is expected to rise by 8.2 percent, more than double the inflation rate. And despite many efforts to slow health care spending, it is expected to grow by another 9.1 percent in 1989. . . .The average jump in premiums could hit 30 percent in 1989. But at the same time, we're getting less for it. Further back to 1979, 30 years ago when our annual expenditure was less than one-tenth of today. Today, $2.3 trillion; then, $200 billion. The article says: HEW Secretary Patricia Roberts Harris said the quality of American health care does not justify its price tag of more than $200 billion a year. Harris said health costs represent nearly 10 percent of the gross national product, the total value of goods and services produced in this country each year. The federal share of health costs will exceed $50 billion next year, including $30 billion for Medicare and $12 billion for Medicaid, and will claim 12 percent of the Federal budget. But for the passage of 30 years and for all of those numbers getting bigger, you could say the same today. Finally, last, but not least, from a 1955 New York Times article. This article predates me. I was born in October of that year. Here is what it says: As it does each year without fail, the government declared again this week that it is time to do something about the rising cost of medical care. Let me repeat that: As it does each year without fail, the government declared again this week that it is time to do something about the rising cost of medical care. Last year, the Nation's medical bill ran over $10 billion. It is now 25 times as much, and you could say the same thing. It was an increase of $3 billion since 1948. Of this sum, only about 25 percent was covered by some form of prepaid health insurance. In human terms, this meant that the American had to scrap his budget, dig into savings or go into debt, to pay some $7.5 billion for doctors, hospitals, dentists, nurses, and the myriad physical accessories of medical care. These words, from February of 1955, when one-fifth of the Members of this body were not yet born, could not be truer today. In human terms, the American had to scrap his budget, dig into savings or go into debt to pay for doctors, hospitals, dentists, nurses, and the myriad physical accessories of medical care. How little we have changed. Fifty-four years later, astoundingly, despite all of this time and all of this trouble and all of this tragedy, this is still a game to some people, a political game. Fifty-four years later, health reform still faces opponents who will do whatever they can to delay or derail the reform process, turning what is our most desperate domestic political crisis into political theater. Last Friday, one of our colleagues on the Republican side told a group of conservative activists: If we're able to stop Obama on this, it will be his Waterloo. It will break him. Think about that for a minute. One hundred thousand Americans die every year because of avoidable medical errors, and the response from the other side is ``let's find a way to break the President of the United States.'' More families now go into bankruptcy because of health care costs than for any other reason; families across this country who lose everything. And the response: ``Let's find a way to break the President of the United States.'' We watched Detroit crumbling under the weight of its health care costs, and General Motors, one of our fabled companies, fail. And what is the response? ``Let's not fix it. Let's find a way to break the President of the United States over this.'' We have a health care costs tsunami bearing down on us, one that truly could break the fiscal back of this country, but do they want to deal with it? No. They want to play politics to break the President of the United States. We have an insurance industry that turns on you when you have the nerve to get sick, denying you care and denying you coverage. They call it medical loss when they have to pay for you. Across this country people suffer. When they are sick, when they are down, when they are hurt, when they are at their weakest, their own insurers turn on them and try to interfere with their health care and try to deny them payment and coverage. What is the response from the other side? ``Let's try to find a way to break President Obama.'' This is not President Obama's Waterloo. This is not one man's battle. This is a war in which millions and millions of Americans are casualties every day: the child whose insurance policy carves out from her coverage the asthma care she desperately needs; the doctor whose office spends more time fighting the insurer over claims and authorizations than delivering health care; the small business owner whose employees are like family for her and who can no longer afford to cover their health care; the elderly retiree who falls into the Medicare prescription drug doughnut hole; the diabetic who cannot obtain a policy at all from anyone because he or she has a preexisting condition. This should not be a political battle of right versus left. It is truly a battle of right versus wrong. I have come to the floor countless times now to share Rhode Islanders' personal and family tragedies, their sorrows, and their frustrations with our present health care system. My constituents share their stories with me at community dinners across Rhode Island, in our senior centers, at coffees, and as I walk the main streets of towns across our State. Earlier this year, I launched a health care storyboard on my Web site where Rhode Islanders can share their experiences and ideas for health care reform. In just a few short months, literally hundreds of Rhode Islanders have written to me to share their ideas and experiences. Those stories are fraught with anguish, pain, frustration and, too often, tragedy. They break your heart. They break your heart to read. Rhode Island is a small State. If we have it happening hundreds and hundreds of times, in the Presiding Officer's State of New Hampshire and across this country, it has to be happening thousands of times, tens of thousands of times, hundreds of thousands of times every day. With all that suffering going on, with all the risks to our country of the perils of the costs coming at us from our health care system, if the other side can't care about the merits and substance of health care reform--if you cannot care about the merits and substance of health care reform, if, for you, it is just political theater, if all it is, is a way to ``break'' the President of the United States of America, in a time of domestic and international crisis, if your goal is to break the President rather than do something about health care, if that is how little you care about health care, then you can't care about the merits or substance of anything else because there is nothing domestically that is as important to our country as health care reform. If you cannot care about that and deal with us on the merits on that, then you can't care about anything. What is really frustrating about this is for these Rhode Islanders, tormented by our health care system, and for their millions of fellow Americans across the country, who have those same experiences, there is a better way. We are working toward it. We can find it, and we can make it happen. We have to do better, we can do better, and we will do better with this legislation than 47 million uninsured and millions more teetering on the brink, one paycheck away from losing their insurance, one illness away from losing their insurance. We can and we have to and we will do better under this legislation than 100,000 Americans dying every year because of avoidable medical errors and because, among other reasons, we have the worst health care infrastructure, information infrastructure, in health care than in any other American industry except the mining industry. We can make this better. We can do better and we have to do better and we will do better than health care outcomes for Americans that are at the bottom of all of our industrialized competitors--at the bottom; with all of our capabilities as Americans, our ingenuity and our entrepreneurship, we are at the bottom of developed nations in health care outcomes for our people, and we pay twice as much as they do to get there. America can do better than this. Beginning with the work of the HELP Committee, we are on our way. Let's not squander the opportunity and the responsibility this day presents. Let's not be distracted by calls for delay or appeals to the pettiest political instincts this Chamber could express. As I see it, we are about 55 years late already. We don't need further delay; we need to get this done. Year after year, Americans have had the same complaints about their health care system. We have it within our power, under the leadership of this President, to make it happen, and we will. I thank the Chair and yield the floor.

Mr. WHITEHOUSE

Mr. WHITEHOUSE. Madam President, I am informed that rollcall votes are possible throughout the day tomorrow as we work through any amendments to the Energy and Water appropriations bill.

Mr. WHITEHOUSE

Mr. WHITEHOUSE. Madam President, if there is no further business to come before the Senate, I ask unanimous consent that it adjourn under the previous order.

Mr. WHITEHOUSE

Mr. WHITEHOUSE. Mr. President, I wish to take a moment, in response to my good friends, Senator Graham and Senator Lieberman, and say a word on behalf of the U.S. Department of Justice and its prosecutors, who have been actively engaged in the war on terror for many years now and who have shown considerable success. The information they have is that the number of individuals who have been successfully prosecuted, convicted, and incarcerated as a result of military commissions numbers in the handful--perhaps even fewer than five. By contrast, just since January 1 of this year, more than 30 individuals have been charged with terrorism, successfully prosecuted, and sentenced to Federal prison--more than 30 convicted or sentenced just this year. There are 355 inmates in Federal prison now who have been successfully charged, prosecuted, convicted, and are now serving lengthy sentences as a result of their history or connection with international or domestic terrorism. I don't want to get into a discussion right now on whether military commissions are a good or bad idea, but what has proven tried-and-true in terms of actually putting terrorists behind bars, where they belong, has been the expertise and the experience and the capability of the U.S. Department of Justice. They have been successful. There are hundreds of terrorists behind bars. There are far more than have ever come through the military commissions during the course of this struggle. And I think we should bear that in mind as we speak about this issue and as we vote about this issue. There is a lot of high- quality prosecutorial work and a lot of patriotism in the Department of Justice, and there is a reason we should allow the professionals to sort out case by case which is the better venue for the trial, whether a military commission, however new and untested in this modern era, or the tried-and-true model of the U.S. Federal prosecutor. I yield the floor.

Mr. WHITEHOUSE

Mr. WHITEHOUSE. Mr. President, today, I proudly cast my vote to pass out of the Senate Health, Education, Labor, and Pensions Committee landmark legislation that will fundamentally change the direction of our dysfunctional health care system. The committee approval of the Affordable Health Choices Act is truly a tremendous victory for millions of Americans who struggle with a system that has continually failed to provide quality, affordable health care options for them, their families, their loved ones, and their businesses. It has been a special privilege to temporarily serve on the HELP Committee, in particular, with my distinguished senior Senator, Jack Reed. I do not think there is a formal rule against it, but it is a rarity in the Senate for two Members from the same State of the same party to serve on the same committee. My brief tenure on the HELP Committee gave me the chance to witness firsthand the resolve and caring leadership that is Jack Reed's hallmark and that was shown throughout this historic debate. I also applaud the unwavering commitment and leadership of President Obama, and the tireless efforts of my Senate colleagues, in the pursuit of meaningful, comprehensive reform. I feel really very privileged to have served with Chairman Dodd and Ranking Member Enzi. Chairman Dodd had this responsibility fall upon him when illness overtook probably his best friend in the Senate, Chairman Kennedy. And he gave me, at least, as a junior Senator, an education in Senate chairmanship. Ranking Member Enzi presented an unforgettable model of graciousness and civility. And all of the members of the committee worked hard and sincerely. I particularly thank our esteemed chairman, Senator Kennedy, for his longstanding leadership and dedication. He truly is the champion of health care reform. For decades, Chairman Kennedy has worked passionately on this important cause. And while he could not attend the markup, we felt his presence daily in the hearing room. And it is to his very great credit that we had this success today. I am pleased that the final legislation reflects the principles outlined by President Obama, who called for a new system to control skyrocketing health costs, expand coverage to the tens of millions left uninsured in our country, and ensure high quality, affordable health care for every American family. The bill also focuses on the priorities of Americans, from all corners of our country, whose powerful and often heart-wrenching stories underscore the urgent need for reform. Behind all the statistics and all the numbers and all the projections and all the demographics, as we all know in this Chamber, are a legion of personal and family tragedies and sorrows and frustrations that we have to address. The Affordable Health Choices Act invests heavily in the delivery system reforms that will drive down costs and bring our current outmoded, broken system into the 21st century. These changes are long past due and are essential if we are to protect our ship of state from the tidal wave of health care costs now bearing down on us. This legislation also upholds President Obama's promise: If you like the health care you have, you can keep it. But for the many Americans who want different choices or who do not have health insurance at all, we also offer a new public health insurance option that can and must compete in an open market with private insurance. As I have traveled throughout Rhode Island, at community dinners and senior centers, at coffees and on our main streets, I have heard stories of frustration and heartache at our broken health care system. Earlier this year, I launched a health care storyboard on my Web site where Rhode Islanders can share their experiences and ideas for health reform. In just a few short months, hundreds of Rhode Islanders have written to share their ideas and experiences. These are just a few of them. Paul and Marcela from Newport told me about the health complications that Paul and his son have endured from type 1 diabetes. The related medical conditions Paul has suffered from the diabetes have left him unable to work. To compensate for the family's loss of income, Marcela works tirelessly, taking on a full-time and part-time job to pay the bills. Like so many hard-working Americans, they fall just short of income eligibility cutoffs for State assistance programs, forcing them to bear the brunt of expensive medical cos, premiums, and prescription costs. On a stretched budget, balancing their medical expenses is a constant challenge, and Paul and Marcela keep hoping they will catch a break soon. I heard from Ben, a medical student in Providence, who, even at such an early stage in his medical career, has witnessed the devastating effect of being uninsured on the health and well-being of his patients. Ben shared the story of one of his patients who delayed treatment because he was unable to afford the medical bills. Only a few days later, this patient was rushed to the emergency room with a life- threatening infection. The treatment to save this man's life resulted in much higher costs for the patient and the hospital--costs that Ben knows may have easily been prevented if the patient was treated when the condition was in its early stages. Ben writes: It's these day-to-day decisions to postpone treatment that really hurt the uninsured. Mike from Riverside shared his experience of surviving cancer that was misdiagnosed and left untreated for several years. When he sought a second opinion, the final diagnosis was delayed for weeks as his paper medical records were shuttled from hospital to hospital. On top of this frustration, Mike received the devastating news that his leg had to be removed to prevent the cancer from spreading further. After his amputation surgery, Mike is thankful to be cancer free, but now his financial struggles have begun. With medical bills and health care premiums that exceed his monthly mortgage payments, Mike is wondering how he will make ends meet. I had coffee with Shirley, a Middletown resident who described her relief at turning 65. For the past 20 years, she and her husband did not have insurance. As self-employed business owners in their fifties, finding affordable insurance options was impossible, so they went without. They took their chances. Now 65 and eligible for Medicare, they finally have peace of mind. Shirley admits she and her husband were lucky to make it through those 20 years without serious health problems. During our meeting, she urged us to pass health care reform for the millions of hard-working Americans--hard-working, middle-class Americans--who are not as fortunate as she and her husband. For these Rhode Islanders--and for millions more Americans all over the country--there has to be a better way. We have to do better than 47 million uninsured and millions more teetering on the brink. We have to do better than 100,000 people dying each year from avoidable medical errors. We have to do better than health care outcomes for Americans who are at the bottom of all our industrialized competitors. America can do better than this. With this legislation, we believe the process has begun for America to do better than this. The work accomplished today by the HELP Committee is, of course, a first step in a long journey toward restructuring our health care system. The path to meaningful reform will not be easy. We have many rivers to cross, and our efforts to implement change will still face challenges. Certain stakeholders, invested in the status quo, will fight back against change; they will drag their feet; they will misinform; and they will mobilize--all with the singular purpose of defeating our progress toward comprehensive health care reform. I know the fight to secure final passage of our reform will be contentious, but I welcome a vigorous debate on the Senate floor because I also know our current system has reached a state of disrepair that is putting us at risk--as patients, as families, as competitive businesses, and as a nation. And failing to change the status quo is both unsustainable and irresponsible. I thank the Presiding Officer, and I yield the floor.

Mr. WHITEHOUSE

Mr. WHITEHOUSE. Madam President, I am here to talk about Judge Sotomayor. I am looking forward to her confirmation hearing, which begins next Monday. I continue to review her record, and I will not make my ultimate judgment until after the hearing. But I must say I am very impressed with Judge Sotomayor's qualifications, including her restrained and fact-based approach to deciding cases. I'm also impressed, as a former prosecutor myself, by her experience as a practicing attorney and as a line prosecutor. I think we are all impressed by her educational achievements. Like millions of Americans, I have been inspired by her personal story. Frankly, it gives me goosebumps to think of that little girl growing up in the projects in the Bronx and growing into the woman we see before us now at the top of the legal profession, with a career of exemplary conduct, exemplary academic achievement, exemplary judicial experience behind her. It is really a great story of American discipline and achievement. Unfortunately, critics of Judge Sotomayor's confirmation have unleashed an avalanche of innuendo meant to weaken the case for her confirmation. These criticisms began among the right-wing talking heads, but unfortunately, some of them are now voiced by my Republican colleagues here on the floor. Indeed, rather than waiting for the hearing to ask her about her record and her judicial philosophy, a number of my colleagues have come to the floor to attack her and her nomination. Today, I would like to briefly address two particular and--frankly, very surprising--attacks on Judge Sotomayor: first, the suggestion that her judicial philosophy is somehow outside of the mainstream; and, second, the suggestion that her life experience is somehow unhelpful to the judgment she would bring to the Supreme Court. First, Judge Sotomayor's judicial philosophy. My Republican colleagues like to suggest that judges appointed by Republican Presidents are neutral ``umpires'' and that judges appointed by Democratic Presidents are judicial ``activists.'' But Chief Justice Roberts himself, who, indeed, raised the ``umpire'' metaphor at his own confirmation hearing, reveals the falsity of that comparison. Jeffrey Toobin, a well-respected legal commentator, recently described a pronounced ideological predisposition in Chief Justice Roberts. In every major case since he became the Nation's seventeenth Chief Justice, Roberts has sided with the prosecution over the defendant, the state over the condemned, the executive branch over the legislative, and the corporate defendant over the individual plaintiff. Let me say that again: In every major case since he became the Nation's seventeenth Chief Justice, Roberts has sided with the prosecution over the defendant, the state over the condemned, the executive branch over the legislative, and the corporate defendant over the individual plaintiff. Maybe this is a pure coincidence, and maybe it is a further coincidence, to again quote Toobin, that this record ``has served the interests, and reflected the values, of the contemporary Republican Party.'' Maybe it is also a coincidence that in the Heller decision, the DC gun law case, the Roberts-led conservative block of the Court discovered a new constitutional right that had previously gone unnoticed through 220 years of the United States Supreme Court's history, and which just happens to appeal to the NRA and the Republican base. Perhaps that is all a coincidence. But I will confess to you, I doubt it. I think this record goes a long way towards disproving the metaphor of the Republican judge as neutral umpire. So let's put aside the notion that conservative men from the Federalist Society have no predispositions in legal matters but that anyone who differs from their views is the activist. That is just rhetoric, and what it's seeking to do is to normalize the right-wing activism that the Republican Party has calculatedly and over many years moved onto our Court. If you want to decide whether Judge Sotomayor has an appropriate judicial philosophy, look at her full record. Throughout her long career as a Federal judge, longer than any Supreme Court nominee since the 19th century, Judge Sotomayor, has on every major issue, shown that the facts and the law drive her determination of cases. On the Second Circuit, Judge Sotomayor agreed with her more conservative colleagues far more frequently than she disagreed with them. In 434 published panel decisions where the panel included at least one judge appointed by a Republican President, she agreed with the result favored by the Republican appointee in 413 cases--413 out of 434. That is 95 percent of the time, and it is no record of extremism. Indeed, it would seem to put her on the conservative side of the mainstream. And consider what she told Chairman Leahy: Ultimately and completely, as a judge, you follow the law. There is not one law for one race or another. There is not one law for one color or another. There is not one law for rich and a different one for poor. There is only one law. Furthermore, the idea that because the Supreme Court disagreed with Judge Sotomayor's Second Circuit panel decision in Ricci v. DeStefano, she is somehow outside the mainstream is patently absurd. First, four Justices of the Supreme Court agreed with the Second Circuit's interpretation of the law. Are Justices Stevens, Souter, Ginsburg, and Breyer outside of the mainstream? Hardly. Second, Judge Sotomayor and her panel were faithfully applying the settled precedent of the Second Circuit when they rendered their decision--just what a circuit court judge of the United States is supposed to do. The five Justices on the Supreme Court in the Ricci majority, in deciding the case, invented an entirely new test for resolving Title VII claims that, according to legal experts reported in the New York Times, ``will change the landscape of civil rights law.'' It is hardly fair to criticize Judge Sotomayor for not applying a test that did not even exist when she decided the case. Nor for failing to venture into landscape changes of civil rights law. In the Ricci decision and others, Judge Sotomayor's record demonstrates a long career of faithfully applying the law to the facts of the case before her--and the careful exercise of judicial discretion. That brings me to my second point. Wise exercise of judicial discretion is the longstanding tradition underlying the American system of law. It is harsh, narrow-minded, and ahistoric to contend that a rich life experience and natural empathy are at odds with that judicial tradition. Any lawyer knows the importance of judicial discretion, both in our common law system and to the interpretation of the Constitution. As Justice John Paul Stevens has explained: the work of federal judges from the days of John Marshall to the present . . . requires the exercise of judgment--a faculty that inevitably calls into play notions of justice, fairness, and concern about the future impact of a decision. . . . That faculty has served the Nation well for over two centuries. Indeed, discretion is at the heart of the judicial role. Our legal system bears the imprint of the experience and wisdom of generations of judges. As Justice Holmes famously explained, ``[t]he life of the law has not been logic: it has been experience.'' Indeed, as Holmes continued, [t]he law embodies the story of a nation's development through many centuries, and it cannot be dealt with as if it contained only the axioms and corollaries of a book of mathematics. This discretion, of course, does not mean that judges are without bounds. But there exists a broad and lively discretion that falls far short of ``judicial activism.'' Justice Benjamin Cardozo put it this way: The judge . . . is not to innovate at pleasure. He is not a knight-errant, roaming at will in pursuit of his own ideal of beauty or of goodness. He is to draw his inspiration from consecrated principles. . . .He is to exercise a discretion informed by tradition, methodized by analogy, disciplined by system, and subordinated to ``the primordial necessity of order in the social life.'' Wide enough in all conscience is the field of discretion that remains. Madam President, within this wide field of discretion, judges do not, cannot, and should not close their minds to their experience of the world, nor to what their experience teaches them about the effects of their decisions on the world. There has been plenty of empathy at the Supreme Court recently for the rich and powerful, resulting in decisions that frustrate congressional intent and deprive Americans of crucial statutory and constitutional protections. There has been plenty of empathy for right- wing ideology and plenty of empathy for big corporations. Should we not also admit to the Court a nominee who has common sense, who can appreciate how American laws affect different citizens, and who can also empathize with the poor and the weak, as well as the more fortunate? If reaching correct outcomes were as simple as plugging a few factors and elements into a computer, we would not need nine Supreme Court Justices. Quite simply, a broadened range of perspectives and experiences will make for better judgment by our Court. One final thing is worth noting about the judicial branch of government. It is designed to be a check and balance to the elected branches. The Founders were keenly aware of the corruption and passing passions to which those elected branches are vulnerable, and they established the judiciary as a place where all were equal before the law, and where power, money, and influence were intended to hold no sway. The courtroom can be the only sanctuary for the little guy when the forces of society are arrayed against him, when proper opinion and elected officialdom will lend him no ear. This is a correct, a fitting, and an intended function of our judiciary, and the empathy President Obama saw in Judge Sotomayor has a constitutionally proper place in that structure. If everyone on the Court always voted for the prosecution against the defendant, for the corporation against the plaintiff, and for the government against the condemned, a vital spark of American democracy would be extinguished. A courtroom is supposed to be a place where the status quo can be disrupted, where the comfortable can be afflicted, and the afflicted find some comfort when no one else will listen. A judge of the United States is not an orderly, neutered little functionary of the power structure. Judge Sotomayor's broad background and empathy prepare her better for that proper judicial role than would grooming in corporate boardrooms, scrubbing by the Federalist Society, and fealty to party ideology. I am looking forward to Judge Sotomayor's hearing as an opportunity for her to finally reply to her right-wing detractors, to demonstrate her intellect and qualifications, and to explain her judicial philosophy. My preliminary review of her record suggests that she understands the importance of judicial restraint and modesty, of adherence to precedent, of respect for the legislative branch, and of the timeless values enshrined in the Constitution. And she has articulated a desire to be scrupulously fair by keeping sight of--not denying--the lessons she has learned during her extraordinary life. Judge Sotomayor appears, more than anything else, to be a careful and conscientious judge. So let us not throw care and conscience to the wind by hurling unjustified, unhelpful, and tired labels at her; let us be proud to have a Justice of the Supreme Court with the type of broad life experience that will inform her good and proper judgment. Thank you, Mr. President, I yield the floor.

Mr. WHITEHOUSE. Madam President, I ask unanimous consent to speak as in morning business for up to 15 minutes.

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

Mr. WHITEHOUSE

Mr. WHITEHOUSE. Mr. President, I speak today about the importance of retaining funding for the Providence Emergency Operations Center in the fiscal year 2010 Department of Homeland Security Appropriations Act. The Providence Emergency Operations Center coordinates emergency response for 60 percent of the population of Rhode Island. I visited this state-of-the-art facility earlier this year and was very impressed by the caliber of its technology, its seamless integration of many different local law enforcement and emergency response agencies, and those who stand at the ready to protect the people of our state against disaster, terrorism, and other threats. This funding will help make necessary improvements to the facility, including expanding space and improving security and survivability, addressing shortfalls identified in a 2007 review by the Federal Emergency Management Agency. These funds are also expected to create approximately 20 new construction jobs, which are urgently needed in my State, where the unemployment rate has reached a staggering 12.1 percent. I urge my colleagues to oppose the Feingold amendment so that we do not deprive Rhode Islanders of the resources needed to meet federal requirements for effective emergency response efforts.

Mr. WHITEHOUSE

Mr. WHITEHOUSE. Thank you, Madam President.

Mr. WHITEHOUSE. Madam President, I ask unanimous consent that I be permitted to speak in morning business for up to 15 minutes.

Mr. WHITEHOUSE

Mr. WHITEHOUSE. Madam President, I have spoken many times on the floor of the Senate about the desperate need for reform of our broken health care system. Today the Congress stands at a moment of historic opportunity. The attention, hopes, and anxieties of the American people are focused on us like never before. We have seen over the course of the last 60 years constant lament over the system's flaws and failure--failure when true opportunities for reform arise. President Obama has now challenged this Congress to reform our Nation's health care system, to expand access to insurance, to improve below-average results, and to bring down its costs. It is about this last challenge--the challenge of our unimaginable and grotesque health care costs--that I speak today. In his recent speech to the AMA, the President called escalating health care costs ``a threat to our economy . . . an escalating burden on our families and businesses . . . a ticking time-bomb for the federal budget, and . . . unsustainable for the United States of America.'' I hope all of us share his sense of urgency. Our country's economic future may well depend on it. Over the past few weeks, I have been privileged to work with my HELP Committee colleagues to make long-awaited reforms and investments to control costs and wring savings from the system. In that process, much attention has been paid to the Congressional Budget Office's cost and savings estimates--estimates that, in many cases, have significant limitations. CBO, as we know, plays a vital role in our legislative branch by ensuring that we have objective, nonpartisan estimates of the likely costs and savings to the Federal budget of legislation. These estimates can help us make responsible and efficient use of the taxpayers' money, but we must recognize that in the particular context of health care reform, they are fundamentally limited by CBO's professional restrictions. CBO can only estimate health care costs and savings that have historic precedent. For example, since we have the experience of Medicaid and the Children's Health Insurance Program, CBO can estimate how much expanding coverage to all needy families will cost. These subsidies account for the vast majority of CBO's $600 billion estimate of the 10-year cost of the HELP Committee bill. On the cost savings side, however, CBO's capability is limited. We know our health care system is on an unsustainable course, and there is broad agreement on which of the broken pieces need fixing, but it is impossible to estimate cost savings with the degree of certainty CBO requires to provide what we call a score. CBO's Director has been refreshingly candid about this. In a recent letter to our budget chairman, Senator Conrad, he writes the following: Changes in government policy have the potential to yield large reductions in both national health expenditures and Federal health care spending without harming health. He continues: Moreover, many experts agree on some general directions in which the government's health policies should move, typically involving changes in the information and incentives that doctors and patients have when making decisions about health care. Yet many of the specific changes that might ultimately prove most important cannot be foreseen today and could be developed only over time through experimentation and learning. CBO's professional discipline requires it to score legislation through a rearview mirror, looking back, and basing its calculations on what it can chronicle has happened in the past. But when we propose to take the country in a new direction, when there is a turn in the road, when we seek to fulfill President Obama's promise of true change in America, the rearview mirror doesn't help much. We have not been where we need to go. In addition, getting there will require leadership, creativity, and perseverance. It will require executive administration with constant adjustments and improvements as we work toward our goal. Those factors are beyond the capability of CBO to predict. I speak not to criticize the hard-working public servants of the Congressional Budget Office. They do an exemplary job with the tools at their disposal. Americans owe them a particular debt of gratitude now for how incredibly hard they have worked over these past weeks, but their tools come with their own limitations. The point of this reform is to turn around a system that is spiraling out of control. We spent 18 percent of our gross domestic product on health care, the next highest spending Nation in the world--the next worst is Switzerland, at 11 percent. Even if our success in this reform is limited to shaving a few percentage points off our national expenditure on health care, that change will be worth hundreds of billions of dollars a year. Yes, there will need to be an initial investment in health care reform, but the potential savings are multiples larger. CBO's inability to score those savings does not mean that those savings are not both real and substantial. One measure of the potential savings is the recent report of the President's Council of Economic Advisers, June 2009. I ask unanimous consent that the executive summary of this document be printed in the Record.

Mr. WHITEHOUSE. This report compares the share of America's gross domestic product spent on health care to the share spent by our international industrialized competitors. It also looks to the wide variation in health care expense and quality, region to region, within the United States of America. From each of these measures, the report comes to the same conclusion: They estimate excess health care expenditures of about 5 percent of GDP, which translates to $700 billion per year. Former Treasury Secretary O'Neill has written recently that the target is $1 trillion per year. Whether $700 billion or $1 trillion, that is a savings target that is worth an enormous expenditure of executive and legislative effort to achieve, particularly when all the evidence suggests that achieving it will actually improve health care outcomes for the American people. Perfect examples of the savings that await us are in quality of care. I have spoken before about the Keystone Project up in Michigan which reformed care in a significant number of Michigan's intensive care units. It reduced infections, respiratory complications, and other medical errors. Between March 2004 and June 2005, just a little over a year, the project is documented to have saved 1,578 lives, 81,020 days patients otherwise would have spent in the hospital, and over 165 million health care dollars--just in a little over a year, just in intensive care units, just in one State, and not even all of the intensive care units in that State. In my home State, the Rhode Island Quality Institute has taken this model statewide with every hospital participating, and we are already seeing hospital-acquired infections and costs declining. Why aren't these quality reforms happening spontaneously all over the country? Because government and private insurers haven't set up the right rules for the game. When we began our intensive care unit reform in Rhode Island, the Hospital Association of Rhode Island estimated a $400,000 cost for a potential $8 million savings from the ICU reform program. That is a 20-to-1 return on investment. Super deal, right? Who wouldn't take that? Well, the hospitals pointed out that all the savings--the $8 million--went to the payers--to Medicare, to the insurance companies--and all the costs and all the trouble and all the risk came out of their own pockets. The savings actually cut hospital revenues. So with a lot of business experience around this Chamber, do we know a lot of businesses that would spend $400,000 in cash in order to lose $8 million in revenues? That is not a good economic proposition. We have made the rules such that it is not a good economic proposition for hospitals to invest that way. That is why the HELP Committee bill changes payment incentives and invests in grant programs so it begins to make economic sense for doctors and hospitals to invest in lifesaving and cost-saving quality improvements. If we can make it an economic win for providers to improve quality this way, think of the torrent of American ingenuity that will unleash. Now we are stuck. We are stuck in a bog of market failure, with the connection between risk and reward--the fundamental connection between risk and reward that is the basic engine of American capitalism--interrupted and disabled. But CBO can't score that innovation because we haven't been down this road before. There is nothing in the rearview mirror for CBO professionals to work with to determine what those savings will be. There is a similar problem in disease prevention. A study by the Trust for America's Health found that investing $10 per person per year in proven community-based programs to increase physical activity, improve nutrition, and prevent tobacco use could save the country more than $16 billion annually within 5 years. Out of the $16 billion in savings, Medicare could save more than $5 billion, Medicaid could save more than $1.9 billion, and private payers could save more than $9 billion, but those program providers don't get funded. That is why the HELP Committee bill establishes a prevention and public health investment fund to provide expanded and sustained nationwide investment in preventing illness. Well run, the savings could be enormous. But CBO can't score it because we haven't been down this road before, and there is nothing in the rearview mirror for CBO professionals to work with. A third area for significant efficiencies and savings is the contentious, inefficient billing and approval process. Right now, doctors and insurance companies are locked in an arms race. Private insurers delay claims and deny claims for reimbursement and throw up barriers to payment, and the providers, in turn, staff up and hire consultants and add people to fight back. This battle creates a colossal burden on the system, consuming perhaps 10 to 15 percent of all private insurance expenditure and then creating a reciprocal and probably actually greater cost shadow out in the provider community from having to fight back against that 10- to 15-percent expenditure. It all adds no overall health care value--none. It is pure administrative cost shifting. Even the insurance industry estimates that $30 billion per year could be saved through simplification of that process. That is why the HELP Committee bill has strong administrative simplification requirements. But again, CBO can't score it because this is another new road. Again, there is nothing in the rearview mirror for CBO to work with. Finally, multiple studies show that the private insurance market is plagued by inefficiency and waste. While administrative costs for Medicare run about 3 to 5 percent, overhead for private insurers is an astounding 20 to 27 percent--charges that consumers pay for higher premiums. A Commonwealth Fund report indicates that private insurer administrative costs increased 109 percent--they more than doubled-- private insurer administrative costs more than doubled from 2000 to 2006, just in 6 years. The McKinsey Global Institute and a leading health economist indicate that Americans spend roughly $128 billion annually on ``excess administrative overhead''--that is, $128 billion on excess administrative overhead--in the private health insurance market. That is why the HELP Committee bill establishes a strong nonprofit public health insurance option that would compete on even terms with private insurance companies, bringing down premiums, negotiating more efficient provider payments, and increasing consumer access--all through the power of free market competition. All this is done through the power of free market competition. But, again, CBO cannot score it because we have not been down that road before. There is, again, nothing in the rearview mirror for CBO professionals to work with. In the 1930s, Franklin Delano Roosevelt's proposal for an innovative program called the Tennessee Valley Authority faced this dour prediction from a Member of the House of Representatives: Mr. Speaker, I think I can accurately predict no one in this generation will see materialize the industrial empire dream of the Tennessee Valley. Another Member remarked: The development of power in that particular locality of the Nation . . . can be of no general good.'' Had FDR been cowed and discouraged by such pessimism, by the difficulty and uncertainty and novelty of his task, the TVA would never have brought electricity, jobs, and prosperity to millions of Americans. Likewise, today, it is precisely because our reforms are innovative and because they will take energy, commitment, and leadership to achieve that they are unscorable. That should be an inspiration to us, not a discouragement. Through this reform bill, we must challenge ourselves and the Obama administration to do that which economists and commentators cannot specifically score and analyze. With strong leadership and dedication, we can not only bend the cost curve, we can break it. Let's set a hard target, say, $500 billion in annual savings, and see how fast we can get there. Let's make this the Apollo project of our generation. The stakes are high enough to justify that effort. I thank the Chair and yield the floor.

Mr. WHITEHOUSE

Mr. WHITEHOUSE. Mr. President, we are now embarked in the Senate on one of the most important challenges that our country faces--we will begin to reform our tragically flawed and broken health care system to bring down its skyrocketing costs, to cover its tens of millions of Americans left uninsured, and to improve its way-below-average results so that high-quality health care comes within reach for every American family. The stakes are high. This week, in a speech before the American Medical Association, President Obama said: The cost of our health care is a threat to our economy. It is an escalating burden on our families and businesses. It is a ticking time bomb for the Federal budget. And it is unsustainable for the United States of America. The President said: Health care reform is the single most important thing we can do for America's long-term fiscal health. Savings in waste, confusion, unnecessary or defective care, and illness prevention could eventually well exceed $700 billion a year. It is not going to happen instantly, but it is a goal we can shoot for. I applaud President Obama's commitment and leadership, and I commend my Senate colleagues for their tireless efforts in the pursuit of meaningful, comprehensive reform. The new energy and focus we have seen in this debate isn't limited to us here in Washington. In recent months, doctors and hospitals, patients and insurance companies, labor unions and drug companies have all come together in support of the need for a restructure of our system. Amidst all this, it has been my great honor to join the Presiding Officer, the Senator from Oregon, on the HELP Committee, where he serves with such distinction and where much of the legislation to repair our broken health care system is being debated, written, and refined. In that capacity, I was recently invited to the White House to meet with President Obama, his health care team, and all of our colleagues on the HELP and Finance Committees. We discussed our priorities for reform, and we reported on the progress each committee has made in the past several weeks. In the coming weeks, we will hear a lot about the details of health care reform legislation, and those details are very important. But even more important are the hundreds of millions of American families in each of our States all over the country who have experienced real anguish--coverage lost or denied, hospital stays extended due to complications or errors, prescription drug bills rising and rising, with no end in sight, even losing everything because a loved one fell ill. A few months ago, I launched a page on my Web site for Rhode Islanders to share their personal experiences with our broken health care system, and hundreds of people have written in from all over the State. Anita is a social worker and mental health professional in Providence. She shared what she describes as the ``sad and rude awakening'' she experienced after opening her own practice last year. As a provider, like all providers, she takes great pride in the quality of care and attention she gives to her patients. Yet she often found herself burdened with an endless trail of paperwork and the time- consuming task of battling insurance companies and tracking down claims. Like so many of her colleagues, Anita is frustrated that she must spend so much time fighting administrative hurdles and navigating bureaucratic red tape. After years of training to become a health professional, Anita wishes she had more time to do just that--provide care to her patients. She writes: I would much rather spend the time seeing clients than negotiating automated telephone systems and waiting to speak to a person several hours per week. It is a total waste of human time and talent. I heard from Melissa, a self-employed writer from Newport, whose unpredictable income leaves her unable to afford health insurance. Without coverage, Melissa knows that she risks being one serious illness away from what she calls the ``brink of disaster.'' Through the stress and fear of not having insurance--through that brink of disaster that she lives on--Melissa waits and hopes that she doesn't get sick because that is the only option she has in this, our great country. Rhonda is a mother in Coventry. She told me about her struggle to get health care coverage for her family. As if raising her two sons wasn't enough work, this single mother works two jobs to make ends meet. Although her employer offered health coverage at an affordable price, Rhonda's limited income could not be stretched to cover the additional cost of coverage for her children. So her sons went without insurance for 3 years. Rhonda, like so many hard-working Americans, was caught between a rock and a hard place--making slightly more than the eligible income to qualify for health coverage through State assistance plans, but not making enough money to afford health care coverage on her own. She prayed every day her children would be spared from sickness or injury. I also received a story from Richard, in Providence, who told me about his father--a hard-working man who left work for 6 months to concentrate on fighting a battle against cancer. Sadly, just when Richard's father needed the support the most, his company dropped him from their health plan. Without coverage and unable to pay the costs out of pocket, his father was forced off his chemotherapy treatment. Richard's father was very lucky. The doctors cleared him of cancer. However, the medical bills were so high that Richard's parents lost their home. Remarkably, after all his family has been through, Richard feels fortunate that at least his father was covered for part of his treatment, but he urged us to fix ``this old and broken system.'' For these Rhode Islanders and for millions of more Americans silently suffering through their own personal catastrophes all over the country, we now have to be a voice. We must improve the quality of our health care, we must develop our Nation's health information infrastructure, and we must invest in preventing disease. We must protect existing coverage where it is good and improve it when it is not. As the President said, if you like your health plan, you get to keep it. We must dial down the paperwork wars, and dial up better information for American health care consumers. We must speak for the 46 million Americans, 9 million of whom are children, who right now as I stand here on the Senate floor have no health insurance at all. As Families USA reports, 47 million actually understates the problem because during the course of this year nearly 90 million Americans will, at one point or another, go without health insurance. We look around at dark and tumultuous economic times. Yet looking beyond the immediate economic perils we face, a $35 trillion unfunded liability for Medicare--not a penny set against it--is bearing down on us. As the President told the AMA earlier this week: . . . if we fail to act, Federal spending on Medicaid and Medicare will grow, over the coming decades, by an amount almost equal to the amount our government currently spends on our Nation's defense. In fact, it will eventually grow larger than what our government spends on anything else today. It's a scenario that will swamp our Federal and State budgets and impose a vicious choice of either unprecedented tax hikes, overwhelming deficits, or drastic cuts in our Federal and State budgets. We can only avoid that vicious choice by reforming the health care system. We are committed to making sure every American has health insurance coverage, but meaningful reform will take more than that. Think of it this way. If you had a boat out in the ocean and people overboard around it in danger of drowning, surely you would try to bring them all into the boat. But if the boat itself was sinking, if the boat itself was on fire, you would have to do more than just bring them on board. You have to repair the boat. You have to get it floating and moving forward. That is what we have to do with our health care system. It is not enough just to provide coverage for all Americans, we also have to right this ship. This means improving the quality of health care and investing in prevention, especially in those areas where improved quality of care and investment in prevention means lower cost so that, for instance, 100,000 Americans will no longer die each and every year because of entirely avoidable medical errors. This also means reforming how we pay for health care so what we pay for is what we want from health care. Government must act. At last, government must act. The problems of health care in America are rooted in market failures. We cannot wait for the market to cure a problem rooted in market failure. It is nonsense. We have to change the rules of the game. We also can't pay for one thing and expect another. We have to change the incentives. We do not expect Americans to go out and build our highway infrastructure for us. We do that through government. We can't sit around and wait for our health information infrastructure to build itself either. We cannot expect quality improvement and prevention of illness to flourish when we make it a money-losing proposition for the people who have to make it work. We have to change those incentives too. Opponents of reform are arguing that this process is going too quickly, that we need to slow down, wait, pause. They are loading down this bill with hundreds of amendments--170 amendments alone on the section that deals with preventive care. But haven't we waited long enough? Slow is what we have done for years, even decades. When I hear from Rhode Islanders with the stories I reported here, such as Richard and Rhonda and Melissa and Anita, I think not that we are going too fast, I think we are irresponsibly, even frighteningly late in getting after this problem and taking up this charge. If we wait much longer, we may be too late to avoid that tidal wave of costs that threatens to swamp our ship of state. To those who say slow down, I say keep up. Opponents of reform want people to believe that a system that costs too much, that lets insurance company bureaucrats make decisions about our health care; that is riddled with error, duplication, and waste; that leaves nearly 50 million Americans without any health insurance, is acceptable. Everyone says they want reform, but unless we get moving, all we will end up with is more of the same. As President Obama said this week: The status quo is unsustainable. Some opponents want to slow this down because they know if they slow it down they can kill it. We cannot let that happen. The stakes are way too high. The anguish out there, as you know in Oregon, as I see in Rhode Island, as all our colleagues see across the country, is real and it is everywhere. At last we can do something about it. Now is the time. This is the moment. Let us make this work. Let us, together, find a way to make this work. I yield the floor. I suggest the absence of a quorum.

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

Mr. WHITEHOUSE

Mr. WHITEHOUSE. Mr. President, I rise to urge my colleagues to support the Foreign Evidence Request Efficiency Act, which I have introduced on behalf of myself and the Chairman and Ranking Members of the Judiciary Committee, Senators Leahy and Sessions. It has been a pleasure to work with them on this truly bipartisan effort, and I am grateful for their support. Chairman Leahy, Ranking Member Sessions, and I have all served as prosecutors. I can say with no exaggeration that few responsibilities are more important to the rule of law, to the security of our communities, and to the rights and freedoms that we enjoy as Americans. I served as the U.S. Attorney for Rhode Island--Senator Sessions served in that capacity in Alabama--and I know we both will always remember the feeling of standing up in court to say: ``Your Honor, may it please the Court, I represent the United States of America.'' It was the honor of a lifetime. As my colleagues know, the United States routinely helps foreign law enforcement agencies as they pursue criminal conduct involving activity outside their borders, including inside the United States, and they do the same for us. This is exactly as it should be. As the world grows more interconnected and crime becomes increasingly global, it becomes all the more important for law enforcement agencies in the United States and around the world to work together to bring criminals to justice. Otherwise, it would be very hard to build cases against international organized crime organizations, drug cartels, purveyors of child pornography on the internet, and other criminal threats from outside our borders. One way that a law enforcement agency provides assistance to another is by gathering evidence from within its borders that a foreign law enforcement agency needs to prosecute a case. The United States routinely completes requests submitted to it by foreign law enforcement agencies just as it receives comparable assistance when it makes evidence requests in foreign countries. For example, let's assume that Spanish authorities are investigating a complicated financial fraud that is being conducted over the internet, apparently from a base in the United States. After conducting their investigation in Spain, the Spanish authorities submit a request to the United States for financial records, internet records, and various other kinds of evidence. U.S. Attorneys review the requests and then seek warrants for the evidence as appropriate. When the evidence is collected, the United States transmits it to Spanish authorities, leading to prosecution in Spanish courts. This process sounds quite simple, but unfortunately in practice it is extremely cumbersome. This is because under the existing rules, any foreign evidence request must be split up and sent to each district where the evidence exists. So take the Spanish example I just gave, and imagine that the financial records sought are in banks in six different federal judicial districts, that the internet records are in another five federal judicial districts, and that other documentary evidence is spread over another five districts. Under existing law, sixteen different U.S. Attorneys' Offices would have to work on the evidence request. This is incredibly inefficient and burdensome for U.S. Attorneys across the country. The Foreign Evidence Request Efficiency Act would end this problem by allowing such foreign evidence requests to be handled centrally, by a single or more limited number of U.S. Attorneys offices as appropriate. Why, as in my example, should sixteen U.S. Attorneys' Offices have to deal with an evidence request that one office can coordinate? Simply put, this reform would make life easier for our U.S. Attorneys. We owe them no less. Of course, respect for civil liberties demands that we not suddenly change the types of evidence that foreign governments may receive from the United States or reduce the role of courts as gatekeepers for searches. The Foreign Evidence Request Efficiency Act would leave those important protections in place, while simultaneously reducing the paperwork that the cumbersome existing process imposes on our U.S. Attorneys. Two points merit emphasis. First, by making it easier for U.S. Attorneys to collect evidence, the United States can respond more quickly to foreign requests for evidence. Setting a high standard of responsiveness will allow the United States to urge that foreign authorities respond to our requests for evidence with comparable speed. The United States will benefit if foreign governments cannot use our own delay to justify responding slowly to our requests. Second, the Foreign Evidence Request Efficiency Act would not change the United States' obligations to foreign nations. It would only make it easier for the United States to respond to these requests by allowing them to be centralized and by putting the process for handling them within a clear statutory system. I urge my colleagues to act promptly on this bipartisan legislation. I would like to thank the excellent attorneys in the Department of Justice who have worked with me on this legislation, and would like to request unanimous consent to insert their letter of support into the Congressional Record. I again thank Chairman Leahy and Ranking Member Sessions for their support. Mr. President, I ask unanimous consent that a letter of support be printed in the Record.