[Congressional Record Volume 155, Number 63 (Tuesday, April 28, 2009)]
[Senate]
[Pages S4782-S4795]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           EXECUTIVE SESSION
  NOMINATION OF KATHLEEN SEBELIUS TO BE SECRETARY OF HEALTH AND HUMAN 
                          SERVICES--Continued

  The PRESIDING OFFICER. The Senator from Maryland is recognized.
  Ms. MIKULSKI. Mr. President, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The Sr. Asst. Parliamentarian (Elizabeth MacDonough) proceeded to 
call the roll.
  Mrs. SHAHEEN. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mrs. SHAHEEN. Mr. President, I rise in support of our nominee for 
Secretary of Health and Human Services, Gov. Kathleen Sebelius. I have 
known her for over 20 years. I believe she is an excellent nominee, one 
who brings a wealth of knowledge and skill to the position at a time 
when we need it the most.
  As our country and the world begins to battle a very serious outbreak 
of the swine flu, we need Governor Sebelius's leadership now. Over 100 
deaths have been reported in Mexico, and here in America we have 
confirmed cases in 5 States. It is urgent we have a leader in place at 
Health and Human Services who can respond to this threat.
  Governor Sebelius is that person. She recognizes the need to work 
with experts and scientists on a global scale to make key public health 
decisions. Our citizens need and deserve to know that our Government is 
doing everything it possibly can to protect the public and to control 
this outbreak. We simply cannot afford to delay action in filling this 
important Cabinet post.
  Also, as we embark on national health care reform, we need a leader 
who appreciates the importance of health care security to everyday 
people. Kathleen Sebelius is a commonsense leader who understands the 
complexities of our health care system. Through her experience as 
Governor of Kansas, State insurance commissioner, and President of the 
National Association of Insurance Commissioners, she has a broad and 
deep understanding of health care and will be an outstanding leader as 
we work to fix our broken system.
  Governor Sebelius has worked tirelessly to improve the quality and 
affordability of health care for the people of Kansas, and she will do 
the same for all Americans.
  As a former Governor, I understand the pressures of balancing a 
budget and working across party lines to get things done, and I commend 
Governor Sebelius for her track record of success. Upon taking office, 
she faced a projected $1 billion deficit. So she implemented a top-to-
bottom audit of State government that produced significant savings and 
efficiencies. Under her leadership, Governor Sebelius expanded health 
care for children and worked to reduce the cost of prescription drugs. 
Working across the aisle, she was able to reorganize State health care 
programs to make health care more affordable by creating an independent 
State agency to control spending on health care and simplify the 
process of obtaining health care for her constituents.
  Undoubtedly, Governor Sebelius brings a wealth of knowledge and 
leadership experience that will be critical in her new role as the 
Secretary of Health and Human Services.
  I urge my colleagues to join me in supporting nominee Kathleen 
Sebelius for Secretary of Health and Human Services. She is the right 
choice at a time when we desperately need leadership at the Department 
of Health and Human Services.
  Mr. President, I yield the floor.
  Ms. SNOWE. Mr. President, I rise today to speak in support of the 
confirmation of Governor Kathleen Sebelius as Secretary of the 
Department of Health and Human Services.
  This nomination comes at a transformational moment and at a 
monumental time--as the American people look to the Federal Government 
to achieve systemic change to ensure that all have affordable access to 
health care. The Senate Finance Committee, of which I am a member--
along with the HELP Committee--is working mightily to craft reforms to 
address the current unacceptable reality of 70 million Americans 
lacking adequate coverage, and the increasingly unsustainable costs 
that undermine the health security of all Americans.
  At the same time, our Nation faces the most severe economic distress 
we have witnessed since the Great Depression, with more than 2.6 
million jobs lost last year. And it is the Department of Health and 
Human Services that stands at the forefront of helping to mitigate the 
consequences through our health and poverty programs. Therefore, there 
can be no doubt of the necessity for sound executive leadership at HHS.
  Indeed, given both its prominence and its status as one of the 
largest departments in the Federal Government--which also oversees 
programs upon which nearly 1 in 3 Americans rely for their health 
care--our next Secretary of Health and Human Services should be a 
talented public official possessing a depth and breadth of experience 
as both a skilled administrator and manager, and a professional 
committed to systemic health reform. In that light, as former Kansas 
State Insurance Commissioner and now as Governor--and with her 
experience in tackling health care issues in her State--I believe 
Governor Sebelius possesses the knowledge and skills to meet the 
pressing demands facing our next leader of HHS.
  In her work as Kansas State Insurance Commissioner she rightly 
recognized a takeover of her State's largest

[[Page S4783]]

health plan as a threat to affordable coverage and fought vigorously 
and successfully to maintain its independence. As Governor, she worked 
to reduce State government spending, and resisted tax increases until 
the Kansas State Supreme Court mandated a new school financing program. 
That is significant as, for health reform to succeed, we must ensure 
that every American is assured of affordable access to quality health 
coverage--but, of equal importance, we must reform health care to 
deliver better value and that requires a Secretary who will look first 
to cost savings and delivery reforms before we consider new revenue.
  Moreover, HHS will be well-served by a Secretary who is committed to 
building the bipartisan consensus necessary to pass the best possible 
health reform legislation that will have the greatest level of 
credibility with the American people. And on that note, it is telling 
that Governor Sebelius was the first Democrat elected Kansas State 
Insurance Commissioner in more than 100 years, that in her 
gubernatorial campaigns she has twice chosen a Republican running mate, 
and that Time Magazine ranked her in 2005 as one of the five best 
Governors.
  Given her history, I think the Governor understands the hazards of a 
politically polarized environment. Indeed, today, some propose that we 
craft the most significant health legislation in our history by 
undermining the very rules of the Senate which help ensure that this 
Chamber creates broad consensus--through the application of the budget 
reconciliation process. But to craft a complex reform of health care 
with this approach would be wholly inappropriate, as any bill it would 
produce would lack the broad support necessary to both enact and 
sustain such a momentous initiative. We should not be drawing lines in 
the sand up front in this debate. It is neither constructive nor 
conducive to the process, and Governor Sebelius should recognize that 
reconciliation threatens to simply increase polarization.


 =========================== NOTE =========================== 

  
  On Page S4783, April 28, 2009 the Record reads: It is neither 
constructive or conducive . . .
  
  The online Record has been corrected to read: It is neither 
constructive nor conducive . . .


 ========================= END NOTE ========================= 

  I also note that, while the Governor has enjoyed notable successes in 
Kansas, she has also experienced disappointments in her efforts to 
expand coverage, so she certainly comprehends the nature of the 
difficulties ahead. Certainly, there will be an intense struggle by 
myriad interests to protect the status quo. But the reality is clear. 
Unless we achieve an equitable, balanced approach, we cannot achieve 
sustainable health security for all.
  That should mean a level playing field with regard to the competitive 
environment. We must ensure there is proper regulation and oversight--
and at the same time, we must assure that real competition and 
innovation are facilitated among health plans--just as it exists 
between health care providers, and producers of drugs and medical 
devices. The creation of a public plan option certainly is no panacea 
to the problems of health coverage--it simply does not address the 
fundamental market reforms required. In her Finance Committee 
confirmation hearing, I questioned Governor Sebelius on this issue, and 
she noted that proper standards and regulation, similar to the approach 
I have taken with Senator Durbin in the Small Business Health Option 
Program Act, SHOP, to reform the small group market, is critical to 
making insurance markets work. I was pleased to see her willingness to 
examine this issue, as she noted, ``It may be at the end of the day 
that the standards are effective enough that the competition from a 
public plan is not a valuable asset.'' I look forward to working with 
Governor Sebelius to develop solutions to ensure that insurance markets 
do work effectively so we attain both the competitive pricing and 
choices in coverage which are so valued by Americans.
  I know that several of my colleagues will oppose Governor Sebelius' 
nomination over the issue of abortion rights in general and over 
campaign contributions from one doctor in particular. In that vein, 
Governor Sebelius has rightly noted that she should have consolidated 
reporting of all contributions from the doctor, his practice, and his 
family, both to her campaign and political action committees. 
Concurrently, it is important to note that all of these contributions 
were disclosed. And, in my view, there is no reason to believe this 
regrettable oversight was anything but unintentional.
  Moreover, it would be unrealistic to deny that sharp divisions exist 
in our Nation regarding reproductive rights, and I certainly respect 
there are deeply held views on both sides. At the same time, it should 
not be surprising that a nominee of our current President would hold 
the views she has espoused and, in my view, that must not unduly 
detract from a thorough and comprehensive analysis of her 
qualifications.
  Finally, the fact is that in this time of historic challenges--and 
especially given the concerning developments of this week, as we face 
the threat of an influenza epidemic--HHS should have a Secretary to 
lead the Department. While various units from CDC to the Department of 
Homeland Security have worked together to coordinate efforts and 
marshal resources to combat this outbreak, HHS leadership is vital to 
achieving optimal coordination of its agencies and effectively 
communicating to the public.
  Today, Governor Sebelius comes before us as an individual who is 
highly capable, eminently qualified, and managerially prepared to 
assume the helm of the Department of Health and Human Services. She is 
fully cognizant of the daunting challenges ahead, and she will be an 
asset to this administration. I look forward to working with her this 
year to achieve health security for all Americans, and I encourage my 
colleagues to join with me in supporting the Governor's confirmation.


 =========================== NOTE =========================== 

  
  On Page S4783, April 28, 2009 the Record reads: . . . capable, 
imminently qualified, and . . .
  
  The online Record has been corrected to read: . . . capable, 
eminently qualified, and . . .


 ========================= END NOTE ========================= 

  Mr. McCAIN. Mr. President, I regret that I must oppose the nomination 
of Gov. Kathleen Sebelius to be the next Secretary of Health and Human 
Services, HHS. I reached this decision after examining her 
qualifications and positions on matters important to the health and 
well-being of the American public. I did not treat this decision 
lightly, only reaching it after very careful deliberation.
  The next Secretary of HHS is expected to oversee an effort to 
overhaul our Nation's health care system in the coming year, and 
Americans need to know that their rights as patients will be respected 
and protected by Washington. While I appreciate Governor Sebelius's 
efforts to respond to some of my concerns about different health care 
proposals that the administration supports, her responses did not offer 
the assurances that I sought. Namely, I am concerned over her responses 
to questions posed to her by the Health, Education, Labor, and 
Pensions, HELP, Committee and Finance Committee members on the role of 
public health plans in health reform and over the role of comparative 
effectiveness and its potential role in dictating medical practice 
patterns.
  I believe that our Nation's health system is broken and in order to 
fix it, we must address health insurance as part of the overall reform 
effort. However, I believe that reforms should invigorate the free 
market system and promote competition among health insurance plans to 
cover every individual. I do not think that our Nation can afford, as 
Governor Sebelius and President Obama suggest, a government-run health 
plan included in a National Health Insurance Exchange. Such a plan 
would have many unfair advantages over private plans, including having 
the weight of the Federal Government to potentially administratively 
set prices. Additionally, and more importantly, a recent Lewin Group 
study estimated that about 120 million Americans could lose their 
employer-based coverage and be pushed into a government-run plan--
contradicting then Candidate Obama's promise that if Americans like the 
insurance they have today, nothing will change. My fears that a public 
plan would be unfairly advantaged and be the start to a single-payer 
system were unfortunately not alleviated by Governor Sebelius's 
responses.
  I strongly oppose a European style approach to health care where care 
is effectively rationed. Americans deserve the best health care system 
in the world--and with appropriate reforms we can continue to assure 
everyone access to quality health care. I also understand that today's 
medical research is increasingly focused on an individualized treatment 
approach for patients, and I believe that this treatment trend is 
threatened by efforts to embrace comparative effectiveness research. 
While I believe that comparative effectiveness research can provide

[[Page S4784]]

patients and doctors with the vital information necessary to make the 
right decisions in an individual's medical case, I am greatly concerned 
over how this research could be used by the Federal Government. One 
only need look at Great Britain where centralized authorities--rather 
than a patient's doctor--decide whether cancer patients can receive 
lifesaving care and which patients are denied access to beneficial 
treatment options to see why so many of us are alarmed. While Governor 
Sebelius said that the Medicare Modernization Act of 2003 prevented 
using comparative effectiveness research for coverage decisions, the 
National Institutes of Health appears to be moving in that direction by 
funding comparative effectiveness research that includes treatment cost 
comparisons. This trend is alarming and should be of concern to all 
individuals in vulnerable populations, such as minorities, women, or 
individuals with multiple conditions, who could be forced into a one-
size-fits-all treatment model.
  Overseeing health reform will be a herculean task and Americans need 
to be assured that they will not lose the private health coverage that 
they want to keep or that their treatment options will have to be 
approved by a government bureaucrat. Mr. President, while I respect the 
right of President Obama to nominate Governor Sebelius to be the next 
Secretary of HHS, she has failed to provide us with those assurances, 
and I regret that I cannot support her confirmation.
  Mr. ENZI. Mr. President, I rise today in opposition to the nomination 
of Governor Kathleen Sebelius as the Secretary of Health and Human 
Services. As U.S. Senators, one of our most important responsibilities 
is confirming qualified, and, hopefully, superior nominees to lead our 
executive agencies. I am one of several Senators with strong 
reservations regarding the nomination of Governor Sebelius, and it is 
important to take this time to explain my opposition to this 
appointment.
  In order to fulfill our responsibilities under the advice and consent 
clause properly, this institution has a process for vetting 
Presidential nominees. The nominee is required to complete a host of 
paperwork to the authorizing committee, in this case the Senate Finance 
Committee, accompanied by a sworn affidavit. I was very disappointed to 
learn that Governor Sebelius amended her paperwork to the Finance 
Committee as a result of unpaid taxes and understated campaign 
contributions.
  The HELP Committee held a hearing on Governor Sebelius' nomination 
due to the high number of health and early learning statutes and 
programs that fall under the committee's jurisdiction. During this 
hearing, I asked Governor Sebelius her thoughts on using reconciliation 
to advance comprehensive health care reform legislation. Her response 
was to keep all options on the table.
  I couldn't disagree more. But unfortunately it appears that is the 
direction health care reform will take this year. This week the Senate 
will vote on a conference agreement for the fiscal year 2010 budget 
resolution that includes reconciliation for health care reform. Using 
budget shortcuts--known inside the beltway as reconciliation--is the 
exact opposite of keeping all options on the table because it shuts out 
members of the minority party. It will also shut out many centrist 
Democrats, who want to see health care reform based on a competitive 
private market, which is fully paid for. That is not a formula for 
bipartisan success. An open, transparent process with a full debate is 
the best way to achieve a bipartisan product.
  At both the Member and staff level, Senators on both sides of the 
aisle continue to meet regularly to discuss health care reform, and 
specifically what shape it will take. I believe that if we continue to 
negotiate in good faith, this process can lead to a bipartisan health 
reform bill that will enjoy broad bipartisan support now and in the 
future.
  Ensuring access to affordable, quality and portable health care for 
every American is not a Republican or a Democrat issue--it is an 
American issue. Our health care system is broken, and fixing it is one 
area where I hope my 80 percent rule comes into play so commonsense 
reforms can be made. People who have worked with me over time know that 
the 80 percent rule is one of the main philosophies I follow to get 
things done. In applying this rule, I try to focus on the 80 percent of 
the issues the Senate generally agrees upon, while not fixating on the 
remaining 20 percent, which are divisive and can sometimes overwhelm 
the majority of issues that we agree on.
  The next Secretary of HHS will undoubtedly have a critical seat at 
the table in the health care reform debate. For these reasons it is 
important to have a Secretary in place who supports an open, 
transparent process without the distraction of tax issues, misreported 
campaign contributions, and questionable affiliations.
  I respect that the President is entitled to staff the executive 
branch with individuals of his choosing. We may not always agree on 
every issue. I am and will remain staunchly pro-life, and will continue 
to advocate for legislation to protect the rights of the unborn. 
However, if Governor Sebelius is confirmed, I will diligently work with 
her to overcome obstacles standing in the way of solutions to the 
health care problems facing America.
  Prior to her hearing, I met with Governor Sebelius and we discussed 
the unique challenges that face rural and frontier states. People 
living in rural areas in Kansas, similar to those in Wyoming, face 
difficulties in access to primary care physicians and preventive 
services. Rural and frontier areas struggle to attract and retain 
doctors and other health care providers. In the 10-steps health care 
reform bill I introduced last year, I emphasized the importance of 
access to affordable health care for people in rural and underserved 
areas. Governor Sebelius understands the challenges in this area--and I 
hope we can work together to find solutions for this common priority.
  In closing, while I intend to vote no on this nomination, it is my 
hope and expectation that we will put aside our differences to find 
meaningful solutions that will make a positive difference in people's 
lives.
  Mr. GRASSLEY. Mr. President, I am pleased to be here again to speak 
in support of the Fraud Enforcement Recovery Act. I urge my colleagues 
to join me in supporting this bill so we can pass this important 
legislation. I cosponsored this bill because I believe that we need to 
do something to show the American people that we are taking their tax 
dollars seriously and committed to rooting out fraud, waste, and abuse 
of Government programs.
  The fraud enforcement tools and resources provided in this bill will 
help Federal agents and Federal prosecutors devote more resources to 
investigations into financial and mortgage frauds. The criminal fraud 
law updates in this bill will also help send a message to individuals 
in the future that fraud against homeowners and investors won't be 
tolerated. While it is true the criminal law provisions can't apply 
retroactively to conduct that led us the current financial and housing 
crises, they will help prosecutors in the future and will help to deter 
future criminal conduct.
  Finally, and perhaps most importantly, this bill makes critical 
amendments to the Federal False Claims Act that will ensure those who 
rip off the Government can't hide behind judicial loopholes created in 
the law. These edits to the False Claims Act are important to ensure 
that the Justice Department and individual qui tam whistleblowers 
aren't blocked by some procedural hurdle put in place by judges. When I 
authored the 1986 amendments to the False Claims Act, I couldn't 
imagine the types of decisions we have seen from courts. These courts 
have read all sorts of new procedural and intent requirements into the 
false claims that were never imagined nor were they intended by 
Congress. These amendments will help restore the original intent of the 
False Claims Act and keep it working into the future so it can continue 
to add to the $22 billion already recovered under this powerful law.
  I urge my colleagues to join me in supporting this important 
legislation so we can show the taxpayers we are serious about fighting 
fraud against homeowners, investors, and the Federal Government.
  Ms. MIKULSKI. Mr. President, I rise today to support the nomination 
of Kathleen Sebelius to be the Secretary of Health and Human Services.
  I am pleased that the Senate today will finally confirm Governor 
Kathleen

[[Page S4785]]

Sebelius as the new Health and Human Services Secretary. Governor 
Sebelius brings much needed policy and management expertise to the job 
as our Nation Faces serious public health challenges. Our immediate 
concern is the effective coordination of our Nation's public health 
resources to combat the emerging swine flu pandemic. Sebelius and her 
team must immediately respond to contain this very serious threat.
  I look forward to working with her as she helps fulfill President 
Obama's promise to enact comprehensive health reform. Governor Sebelius 
will add urgency, substance, and know-how to pass complicated health 
legislation that will benefit American families and businesses.
  Govenor Sebelius will serve as the effective CEO of HHS and ensure 
its agencies are well run and consumer focused. She has the difficult 
task of not only restoring the public's confidence in our Nation's 
health agencies, but also building the trust of HHS' committed 
workforce. Special effort must be made to listen and learn from the 
scientists at FDA who lacked effective leadership during the previous 
administration. Governor Sebelius' immediate leadership also will help 
guide the implementation of the economic recovery act that included 
several important health initiatives--particularly the development and 
adoption of interoperable health information technology standards. I am 
confident she will meet the intent and deadlines enacted by Congress.
  Mr. DURBIN. Mr. President, I rise to speak on behalf of the 
nomination of Gov. Kathleen Sebelius as Secretary of Health and Human 
Services.
  Just a few moments ago at lunch, we were briefed by Secretary 
Napolitano and a spokesperson from the Centers for Disease Control 
about the swine flu epidemic. It is a serious issue, much more serious 
in Mexico and other places than the United States, but it is being 
taken very seriously and watched closely by those in charge of our 
public health in America. That is why it is so important for us to fill 
this particular spot in the President's Cabinet. It is the last spot to 
be filled. The nominee, the Governor of Kansas, Kathleen Sebelius, is 
an extraordinarily good choice for this post of Secretary of the 
Department of Health and Human Services.
  We consider so many health care issues. In fact, when the people of 
this country are asked about the priorities they identify, their 
highest priority is health care, as it should be. If we do not have our 
health, not much else matters.
  We have tried during this Congress with this new President to do that 
which is important to address the public health concerns of Americans. 
We passed a children's health bill to provide health care coverage, 
insurance coverage for an additional 4 million kids. We passed an 
economic recovery package that provides States with the resources they 
need to provide health care services to millions of low-income families 
and seniors on Medicaid. We passed a new law to help working families 
continue to pay for health insurance even after they lose their jobs. 
We also provided money in the Recovery and Reinvestment Act to fund 
investments in health information technology which can save the Nation 
billions of dollars and avoid costly and deadly medical errors. It has 
also provided assistance to community health centers, a resource in my 
home State of Illinois which is exceptional. It provides health care 
for those who have nowhere else to turn. It is some of the best care in 
America. In the Omnibus appropriations bill, we provided billions of 
dollars for medical research, infant and maternal health, and other 
health services for those least able to afford the care they need. We 
have a lot more to do, and that is why we need to fill this spot.
  The current economic crisis has made health care reform more 
important. More than 47 million Americans, including 9 million American 
kids, do not have health insurance. Those families woke up this morning 
with children in their houses without the peace of mind that if there 
is an accident, a diagnosis, or some illness, they would have health 
insurance to guarantee they have quality care, good doctors and 
hospitals to turn to. A third of Americans under the age of 65 have 
experienced a period without health insurance in the past 2 years. That 
is one out of three Americans under the age of 65. Families and small 
businesses work harder than ever to provide health insurance, and the 
costs just keep going up.
  As unemployment has reached 8.5 percent nationwide, this rate has 
troubled us. In some areas, it is much higher. It is 9.1 percent in 
Illinois. With each 1 percent rise in the Nation's unemployment rate, 
the number of uninsured Americans increases by 1.1 million people.
  One of the biggest worries I found among unemployed workers in 
Illinois is health insurance. I recently visited Richland Community 
College in Decatur. I sat down with a number of young men and women who 
lost their jobs, many of them with children. That was the first thing 
they brought up, whether their spouse was working and had health 
insurance, whether there was somewhere else they could turn. A growing 
number of businesses are backing away from health insurance because it 
is expensive.
  We cannot wait for the economy to improve before tackling this health 
care issue. Too many Americans have needs that cannot wait.
  There are no easy fixes to this, but I believe President Obama is 
right by stepping up and nominating Gov. Kathleen Sebelius to be 
Secretary of the Department of Health and Human Services.
  Last week, the Senate Finance Committee approved her nomination. 
Earlier this month, I had the opportunity to sit down with her and talk 
about the issues firsthand. Her commitment to this issue is not just 
lipservice. She has shown an ability to overcome partisan politics in 
her home State for her people and represent the best interests we need 
in America.
  During her two terms as Governor, Governor Sebelius and her 
administration have been notably bipartisan. She was elected to her 
first term with a former Republican businessman as her running mate. 
She ran a second time with the former State Republican chairman on her 
ticket. In a State where the opposition party holds strong majorities 
in both chambers, the Democratic Governor has been able to reach across 
the aisle to solve problems and help the people of Kansas.
  Before being elected Governor, she was Kansas insurance commissioner 
from 1994 to 2002. During this time, she refused campaign contributions 
from insurance companies. She protected the people of her State from 
increases in premiums by blocking the sale of Blue Cross Blue Shield to 
an out-of-State company. She helped draft a proposed national bill of 
rights for patients and served as the president of the National 
Association of Insurance Commissioners. This critical experience 
prepares her well in her new role on the President's Cabinet dealing 
with health care reform, Medicare, and Medicaid. While she has also 
dealt with these broader health coverage issues, she has not lost sight 
of the role that prevention and public health must play in any health 
reform effort.
  Through her Healthy Kansas initiative, Governor Sebelius encouraged 
Kansans to increase fiscal activity, choose a healthier diet, and avoid 
using tobacco products. As Governor, she made investments to help women 
avoid unintended pregnancies, increase health services for pregnant 
women, and provide support services for families. These are goals that 
I think most of us can certainly agree on.

  We discussed the issue of food safety, which is very important, with 
the Food and Drug Administration under her supervision, when she is 
confirmed in this process, and she understands there is a parade of 
concerns, whether it is salmonella in peppers and peanut butter, 
melamine-spiked pet food and milk products from China, E. coli in 
spinach, and the list goes on and on. We can do better. Secretary of 
Agriculture Vilsack and Kathleen Sebelius, once she is confirmed, can 
work together to bring us the very best in food safety in America and 
to protect families who count on their Government to do the job.
  I commend President Obama for his leadership on this issue, but with 
these two spots filled, with the Secretary of Health and Human Services 
and Agriculture, then we can step forward and get something done.

[[Page S4786]]

  There is also a big question about this issue of comparative 
effectiveness, which has been raised by some on the other side in 
relation to this nomination. Congress and President Obama are committed 
to expanding America's access to high quality health care, and that is 
why we have made comparative effectiveness research a high priority. 
Through the economic recovery package, we committed over $1 billion to 
funding research to compare the relative clinical risks and benefits of 
different treatments for the same illnesses.
  Some of my colleagues argue this research should only focus on 
clinical effectiveness, without taking into account the cost of a 
treatment or procedure. However, I think addressing cost is a major 
concern of everyone, not just in Government but of the American people. 
They believe health care costs are too high and they are interested in 
any steps we can take to reduce waste and use health care dollars more 
efficiently. That effort is an important part of health care reform. We 
can't continue to spend as much as we have on health care without 
breaking the bank, leaving deficits for our children and basically 
bankrupting the American Treasury.
  Part of the solution to our health care reform is reducing 
unnecessary cost and waste. Research may show that there are some 
treatments genuinely less effective than others in comparable 
populations. No one should be afraid of looking at the solid factual 
evidence to make these comparisons. Some of my colleagues oppose 
comparative effectiveness research and argue that Washington 
bureaucrats shouldn't interfere with a patient's right to choose 
treatment or substitute the Government's judgment for that of a 
physician. I don't argue with that premise, but let's get to the bottom 
line. When a decision is made about an illness affecting you or a 
member of your family, you want the most effective treatment. You want 
to be certain it is going to work. You want to have confidence that the 
person providing it is making the right choice.
  We have a right to ask whether there is a more economical choice, one 
that can reach the same result without the same cost; whether it is the 
use of generic drugs, for example, which have been proven to be 
effective and lower cost than many brandname drugs, or whether it is a 
procedure that is going to have a lot more chance of success. Why are 
we afraid to look at this information? Some on the other side are. They 
shouldn't be. This is common sense that we would ask these questions 
and come up with this information so we can make the right decision.
  I would add that Kathleen Sebelius has proven, as the executive in a 
major state in America, that she understands the responsibility of 
leadership and the accountability of those in leadership. Few 
challenges we face in America are as grave as our health care system 
and its need for reform, but it is an effort we must undertake. 
Unsustainable health care costs are the one primary threat to our 
economic security.
  The President said it: We are draining our Federal budget and placing 
at risk the financial well-being of America if we don't look at the 
real cost of health care. It is time for reform, and the first real 
step is to confirm Governor Kathleen Sebelius as our Nation's chief 
health official. Americans deserve someone they can trust to see this 
commitment through. She has shown this in her service in Kansas and her 
commitment to public life.
  I hope my colleagues in the Senate will join me in supporting her 
nomination today. There are some who have raised a myriad of different 
issues that concern them; some are even beyond the reach of Kathleen 
Sebelius in her role as Governor. She was given Federal Court cases and 
Federal laws to follow, and she did as she was bound to do by her oath 
of office. But we should give her a chance now at the Federal level to 
help lead this country into a new day of health care reform.
  Mr. President, I yield the floor, and I suggest the absence of a 
quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. KYL. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. KYL. Mr. President, Governor Sebelius is a talented public 
servant. Nonetheless, I will oppose her nomination for several reasons.
  Others have emphasized her relationship with Dr. George Tiller, so I 
will address another matter--my concerns about the use of comparative 
effectiveness research under the administration's proposed health care 
plan to ration health care.
  Comparative effective research is currently used to evaluate the 
strength and weaknesses of various medical interventions. If structured 
appropriately, it can be a great help to both physicians and patients, 
to help them make health care decisions. But without the appropriate 
safeguards, the Government can misuse it to deny or delay patient 
coverage and services based on factors such as age, relative health, or 
the number of people ahead in line for a particular treatment.
  Unfortunately, Governor Sebelius's answers to my questions made clear 
that the administration and Health and Human Services under her watch 
would be unwilling to support patient safeguards. She did not provide 
any assurance that Health and Human Services, Federal health care 
programs, or any new Government entity, such as the Federal 
Coordinating Council, will not use this tool to ration or deny care. 
This should be a matter of concern for every American.
  We must not enable a panel of Washington bureaucrats to decide who is 
eligible for a particular treatment or when they can get it. In 
countries that have government-rationed health care, patients sit on 
long waiting lists to have procedures such as an MRI or dental surgery 
or hip replacement, to name a few.
  I recently read an article in the Wall Street Journal by Nadeem 
Esmail, Director of Health System Performance Studies at the Fraser 
Institute in Calgary, in Alberta, Canada, entitled: ``Too Old For Hip 
Surgery.'' The article recounted stories of our neighbors in Canada who 
routinely wait months and even years for a specialist's care. Many 
cross the border to see U.S. doctors to get the immediate treatment 
they need. Lawsuits tied to Canada's health care rationing system often 
wind up decided by their courts. Is this what we want in America?
  Governor Sebelius's answers about comparative effectiveness research 
relied on two points, which were inaccurate and contradicted one 
another, raising more doubt rather than providing assurance. Let me 
briefly address those points.
  When Governor Sebelius stated during her hearing, ``The law prohibits 
Medicare from using comparative effectiveness research to deny 
coverage,'' she was referencing the 2003 drug bill which applies only 
to prescription drugs and not to any other aspect of medical treatment. 
So she is factually wrong to suggest that could be a future limitation 
on health care generally. Of course, the fact that we so limited it in 
the 2003 prescription drug bill makes the point that it does need to be 
limited.
  In this regard she also said: ``When authorizing comparative 
effectiveness research in both the Medicare Modernization Act and the 
American Recovery and Reinvestment Act, Congress did not impose any 
limits on it.'' That statement is true. It also is precisely the 
problem.

  The National Institutes of Health is already taking the steps 
necessary to make cost-based research a priority and to use it to 
ration health care. A recent National Institutes of Health project 
description states:

       Cost effectiveness research will provide accurate and 
     objective information to guide future policies that support 
     the allocation of health resources for the treatment of acute 
     and chronic conditions.

  Allocation of health resources is, of course, a euphemism for denying 
care based on cost. And Governor Sebelius will not agree to terminate 
this project.
  There is no question that health care reform is badly needed, and I 
want to work toward that goal. All Americans, especially those who are 
unemployed or who work for a business that doesn't provide health 
insurance or who have a preexisting condition deserve a better 
approach. But rationing based on cost is neither a practical nor 
satisfactory route to achieve it; it will delay access to treatment 
that may be urgently

[[Page S4787]]

necessary and discourage the kind of research that leads to promising 
new treatments.
  I believe every American has the right to choose the doctor, 
hospital, and health plan that best fits his or her needs. Flexibility 
is essential in medicine, and each patient should be cared for as an 
individual, with a treatment regimen crafted and tailored by his or her 
own physician, not by a Washington bureaucrat. So I oppose the 
nomination of Governor Sebelius to head the Health and Human Services 
Department, because I do not believe she is sufficiently committed to 
these same principles.
  The PRESIDING OFFICER. The Senator from Oregon.
  Mr. WYDEN. Mr. President, I rise to speak on behalf of the Sebelius 
nomination. And before he leaves the floor, I also want to say to my 
friend from Arizona that I think he knows I share many of his 
substantive concerns about what it is going to take to get bipartisan 
health reform legislation. For example, a key component of it will have 
to be malpractice reform. It will have to include the areas the Senator 
from Arizona has touched on--the question of comparative effectiveness. 
And I think in both of these areas there is a long way to go to get it 
right. It is my interest, particularly this afternoon, to assure the 
Senator from Arizona that there is going to be an effort to pull out 
all the stops to make this a bipartisan effort here in the Senate to 
fix America's health care, and I want to tell him I am looking forward 
to working with him on that.
  To pick up on this point, many Senators have come to the floor to 
discuss the needs of tackling health care issues in the kind of 
bipartisan fashion that Senator Kyl has talked about and I have 
mentioned. I strongly support the Senators who are making this a 
special focus of this discussion today when we consider Governor 
Sebelius's candidacy to head the Department of Health and Human 
Services.
  For a bit of background, Senator Bennett and I, in particular, have 
been working for several years in talking to most Members of the 
Senate. I personally have gone to see about 85 Senators in their 
office, to listen to them, to get their views about health care reform, 
all with an idea to make the issue of reconciliation on health care 
irrelevant. What we wish to do, Senator Bennett and I, working closely 
with the chairs and ranking minority members of our key committees, is 
to find a way to get a very substantial bipartisan vote here in the 
Senate for health care reform. I think we are well on our way to doing 
that. I believe there is literally a philosophical truce on health care 
within the grasp of the Senate.

  When one looks at this debate, both political parties have had valid 
points to make. My party, for example, is right on the idea that we 
cannot fix health care unless all Americans get good-quality, 
affordable coverage. The reality is, we cannot begin to organize the 
market for health care unless we get everybody covered. Without 
covering everybody, there is too much cost shifting, there is not 
enough focus on prevention and wellness, and we have a real question 
about what to do about clogging up hospital emergency rooms--which is 
an issue in Colorado and Oregon and across the land.
  So Democrats have been right on the point of saying to fix American 
health care all Americans have to have good-quality, affordable 
coverage. But our colleagues on the other side of the aisle--and 
Senator Bennett has championed this; Senator Grassley has championed 
this--have been right in saying there needs to be a significant role 
for the private sector in American health care as well. It is going to 
be important not to freeze innovation, to steer clear of price 
controls, to have a wide berth for the private sector to innovate and 
offer private sector choices as part of the solution to this challenge 
of fixing American health care. So we meld together these two points of 
view--Democrats who have been right on the idea that we have to cover 
everybody, Republicans who have had a valid point with respect to a 
role for the private sector--and, in my view, we are on our way to 68, 
70, 72 votes in the Senate for comprehensive health reform.
  So we very much need to tackle this in a bipartisan way. In my view, 
there are a few words that speak volumes about Governor Sebelius's 
outlook on the need for having bipartisanship in the health care arena. 
Those words were spoken by a former leader in the Senate, Bob Dole. I 
want to quote for the Senate a couple of the remarks made by Senator 
Dole when he came before us on the Senate Finance Committee.
  Senator Dole said:

       For more than 20 years, Kathleen Sebelius has served the 
     State of Kansas as a legislator, insurance commissioner and 
     Governor. All of her accomplishments required bipartisan 
     approaches. Her work has earned her the respect of Democrats 
     and Republicans. . . .

  Senator Dole goes on to note that one of our most respected former 
colleagues, Nancy Kassebaum Baker, has actually written Members of the 
Senate with respect to her support for Governor Sebelius.
  Then Senator Dole goes even further, and he says:

       Governor Sebelius and I are from different parties. We have 
     different views on different issues, some highly 
     controversial. But that is not the issue here today. 
     Candidate Obama is now President Obama and gets to make the 
     Cabinet selections. He has determined that she is well 
     qualified and that she understands the importance of the 
     enormous task before her when confirmed by the entire Senate. 
     I agree and that's why I am here to support her nomination. 
     We need a Secretary of Health and Human Services--

  Said Senator Dole--

     who has the skills, experience and courage to shape and guide 
     this historic legislation through Congress. It will not be 
     easy but I know Governor Sebelius will never stop trying.

  Those were the words of former Senator Dole, somebody to whom I look 
again and again for counsel on health care. I think it is fair to say a 
great many of our colleagues on the other side of the aisle look to him 
for counsel on health care.
  Those who know Governor Sebelius best, such as Senator Bob Dole, 
have, in my view, said it better than any of us could. They know her, 
they have worked with her, they have watched her try to forge 
coalitions. As insurance commissioner, she has been a leader nationally 
in the insurance field with the National Association of Insurance 
Commissioners. I think she is going to be a pragmatic coalition builder 
who is going to work with a very specific focus toward trying to bring 
the Senate together to tackle this critical issue.
  We know there are some particularly important challenges ahead of us. 
I have said one of the first priorities in health reform is to make 
sure those who have coverage today--in Colorado and Oregon and across 
the country--see that health reform works for them. Some writers have 
called that group the ``contentedly covered,'' the people who already 
have health care coverage in America today.
  I think there are four important priorities for the Congress to 
address in making sure those who have health care coverage today see 
that the system works for them. Those priorities are, first of all, 
making sure they can keep the coverage they have. We have written it 
into the Healthy Americans legislation. Chairman Baucus has it in his 
white paper. It has to be a matter of law. Sometimes people joke about 
it: We can put it in the Pledge of Allegiance. It is vitally important 
that people be able to keep the coverage they have.
  The second factor that is so important is to make sure people who 
have coverage have options to save some money on their health care in 
the future. They want to contain costs because they know right now they 
are not even getting an increase in take-home pay because health care 
gobbles up everything in sight. So let's make them wealthier in the 
process of health reform, and let's say that, if you want to have one 
of the additional choices, the private sector choices that are offered 
in health reform, and you can save some money by choosing one of those 
choices rather than keeping what you have, you get to keep the 
difference. That is something I think will be attractive to those who 
have coverage.
  The third area we ought to zero in on is making sure folks with 
coverage have the opportunity to be healthier. I think it is well 
understood that much of American health care is more sick care than 
health care. So let's get some incentives in place so everybody has a

[[Page S4788]]

new focus on wellness. I personally would like to see those who are on 
Medicare who lower their blood pressure and lower their cholesterol get 
reduced premiums. It is called Outpatient Care, Part B premiums. Let's 
give them a lower premium when they lower their blood pressure and 
lower their cholesterol.
  When there is a parent in Oregon or Colorado or across the country 
who enrolls a youngster in a wellness or prevention program--let's say 
for a weight problem--let's give the parent a reduction in their 
premium, again, to reward prevention. So we let people keep the 
coverage they have. They are going to be wealthier and they are going 
to be healthier.
  Finally, one last big challenge for those who have coverage. If 
individuals want to leave their job or their job leaves them, let's 
make sure their coverage is portable, that they can take it from place 
to place to place. I think we understand that this economy is real 
different than what we had in the 1940s, when somebody went to work 
somewhere and stayed put for 30 years until they received a gold watch 
and a big retirement dinner.
  The typical people in our States, Western States, now change their 
job 11 times by the time they are 40 years old, and they need portable 
health coverage. So let's make sure that coverage is something that 
fits the modern economy--again, consistent with an approach that let's 
them keep what they have and puts more money in their pocket and gives 
them the opportunity to be healthier.
  I think that is a vision for bipartisan health reform. It certainly 
has been largely shared by Chairman Baucus and Senator Grassley, and 
Senator Bennett and I have talked about it in our efforts as well. But 
it is going to take somebody with the kind of talent that Bob Dole just 
described, in the words I have offered today, once again, before the 
Senate Finance Committee.
  There is a reason that after 60 years of debate on health care reform 
in America that it has not actually gotten done. This is hard work, in 
terms of building a coalition. I put 6 years of my life into just the 
most recent effort and have visited with most of the Senate on it. I 
think there is a clear desire, given the importance to our economy.

  The fact is, we cannot fix the economy unless we fix American health 
care. Most of the experts are saying a lot of these budgets we are 
dealing with right now, the various bailouts--those bailouts are going 
to look like a rounding error compared to American health care if we 
don't get on top of these escalating costs. It has to be done, both in 
terms of fixing the economy, ensuring quality of life for our people, 
and because now the country is looking to the Congress to work in a 
bipartisan way. They have watched a lot of the past squabbles, they 
have watched a lot of the bickering over issues in the past, and here 
is an opportunity, as Senator Dole has described, of having a person 
who wants to work in a bipartisan way around a number of the ideas that 
I have mentioned this afternoon.
  I hope colleagues will support Governor Sebelius. I hope they will 
reflect on the words of Senator Dole because I think he said it best 
when he came before us on the Senate Finance Committee. I think there 
is an opportunity now for the Senate to show a country--and a country 
that is legitimately skeptical about Washington's ability to tackle big 
issues--the Senate now has an opportunity to show that on health care, 
Democrats and Republicans can come together. We are going to come 
together with individuals, leaders such as Governor Sebelius, who have 
shown the talent to work in a bipartisan fashion; and I, particularly, 
having listened to many of our Republican colleagues on the floor today 
talking about the Sebelius nomination, want to assure them that I agree 
with much of what they have said with respect to the need to avoid 
approaches that are partisan and jam one side or another.
  In fact, I have devoted much of the last 6 years to making those 
kinds of approaches irrelevant, to making reconciliation irrelevant.
  I think Governor Sebelius will work with us in a constructive way 
toward exactly that kind of result. Bob Dole has spoken about her 
ability to do just that before the Finance Committee, and I hope this 
nomination will now be approved expeditiously and Democrats and 
Republicans can work together tackling the premier domestic issue of 
our time: fixing American health care.
  I yield the floor.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER (Mr. Udall of Colorado). The clerk will call 
the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. DODD. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. DODD. Mr. President, may I inquire, what is the business before 
the Senate?
  The PRESIDING OFFICER. The business before the Senate is the 
nomination of the Governor of Kansas, Kathleen Sebelius, to be the 
Secretary of Health and Human Services.
  Mr. DODD. I would like to, if I may, spend a few minutes addressing 
that issue.
  I rise in strong support of Governor Sebelius.
  Let me thank the people of Kansas. This is a remarkable nominee. I 
know she has served the people of Kansas well during her tenure as 
Governor, insurance commissioner, State representative, and we are 
fortunate indeed that President Obama has asked the Governor of Kansas 
to come to our Nation's Capital to serve as the Secretary of Health and 
Human Services.
  We owe her a debt of gratitude as well for being willing to accept 
this responsibility at a time that, with the exception of some 15 years 
ago, only the second time in more than half a century, this institution 
and this city will grapple with one of the compelling issues of our 
day; that is, to deal with a national health care crisis in America. 
Governor Sebelius has demonstrated a willingness to take on a very 
large issue which is highly complicated and brings out passionate 
responses from people across the political spectrum. So we are 
grateful. I am grateful to her for taking on this challenge. I am 
appreciative of the President for asking her to do so. I would hope our 
colleagues would come together.
  There is always too much delay in a lot of nominations. I have been a 
Member of this body for many years. I think I can count on one or two 
hands the number of times, in more than two decades, that I have 
opposed nominees of either party. I have always been of the view that 
Presidents and elections mean things. If you are elected President of 
the United States, then a President ought to have an opportunity to 
carry out the mandates or the promises they have made as a candidate.
  So those of us who are in the opposition from time to time, other 
than disagreeing with or deciding to vote against someone because maybe 
there is some serious problem that underlies that nomination--but I 
have never felt the views of a nominee ought to necessarily decide my 
vote in favor of or against them; that Presidents ought to be able to 
have people they believe will help carry out their wishes and campaign 
promises; that if we in the opposition try to guarantee that people who 
share our views are going to be in the Cabinet, that seems to be 
contrary to the will of the American people who have made a different 
choice on election day. I know that is disappointing to people from 
time to time. I know that when I have supported various nominees of 
President Reagan, President Bush, No. 41, and George Bush, his son, No. 
43, voted in support of those nominees, there were those who were 
disappointed that I would cast a ballot for the nominee. But my answer 
always was that they were elected--obviously a very controversial 
election in the case of George W. Bush in 2000, but nonetheless 
ultimately he was the choice to be our President and as such deserved 
to be able to have the nominees in his Cabinet, the people he thought 
would best serve the country. There were occasions when I did vote 
against some nominees but never on the basis of what their views were. 
There may have been some other disqualifying factor, but there were 
very few over the years.
  So at this hour, it has been since March 2 that the President 
nominated Kathleen Sebelius to be the Secretary of Health and Human 
Services. We are now ending the month of April and

[[Page S4789]]

going into the month of May. We have been told as a nation over the 
last several days that we are now potentially facing a pandemic issue 
in the swine flu problem. Having a Secretary of Health and Human 
Services, which is the job that would necessarily coordinate and lead 
the efforts both at home and working with Secretary of State Clinton 
and others, coordinate the effort internationally on this matter--it is 
time to move along.
  While I know there are those who have very strongly held views about 
various matters that will come before the Department of Health and 
Human Services, elections have consequences. President Obama won the 
election. This is his choice to lead that agency and to deal with the 
myriad of other problems we must grapple with as a country. I think it 
is time for this body to discuss these matters over the appropriate 
period of time and then to move along and to not delay for as long a 
time as we have seen already a nomination of this importance.
  The HELP Committee, on which I serve--the Health Education, Labor, 
and Pensions Committee--and the Finance Committee held hearings on 
Governor Sebelius back at the end of the last month, and the majority 
leader attempted to get unanimous consent to move her nomination almost 
a week ago. Those efforts have been blocked by the minority party here. 
Now we find ourselves in the midst of what appears to be a global 
crisis, as I mentioned, and for no apparent reason that I can 
determine, other than maybe some politics, we still do not have the 
Secretary of Health and Human Services confirmed.
  I believe most Americans, regardless of political party, would like 
to see someone leading this agency and helping us grapple with these 
issues. I do not think they are going to be pleased, even if they 
disagree with the politics of the nominee, to have that spot vacant at 
a time when we need leadership, particularly someone as highly 
qualified as Governor Sebelius is.
  Again, I commend the Obama administration for its handling of the 
swine flu threat so far. It is clear that the various agencies in 
Government are working closely and collaboratively. As a result of the 
Health, Education, Labor, and Pensions Committee and many of my 
colleagues in the Senate, both Democrats and Republicans, we were able 
to pass and fund what was called the Pandemic and All-Hazards 
Preparedness Act and the predecessor bioterrorism legislation. The 
country as a whole has made great strides in surveillance, 
coordination, communications, and treatment capabilities.
  Let me specifically thank several of our colleagues, because I was 
deeply involved in those negotiations on that legislation many years 
ago--well, several years ago. They include Richard Burr of North 
Carolina, a Republican Member, our colleague, who is deeply involved in 
the issue; then-Majority Leader Frist of Tennessee was very involved; 
Senator Ted Kennedy of Massachusetts, and myself are the four, along 
with Judd Gregg of New Hampshire, involved from time to time in trying 
to craft that legislation dealing with the Pandemic and All-Hazards 
Preparedness Act and some of the bioterrorism legislation. My 
colleagues, on a bipartisan basis, put that together. Richard Burr was 
very deeply involved in that question, and we ought to thank him for 
his insistence so many years ago. So we have been involved in these 
issues on a bipartisan basis, and I would hope, again, this nomination 
can go forward on a similar basis.
  The U.S. response to this current global threat is evidence that 
those efforts taken some years ago are paying off. But the lead agency 
in all of this, and other possible health threats, is the Health and 
Human Services Department. That Department lacks a leader today, and 
that is the reason we are still here a week later debating whether this 
nominee of incredibly impeccable credentials is being held up for as 
long as she is.
  Having served on the so-called HELP Committee for many years, I 
cannot recall another time when the challenges facing the Secretary of 
Health and Human Services were so complex. I have already addressed 
some of those issues. Our economy is in the worst shape it has been in 
for decades. We have a health care system that is broken, impacting 
families, businesses, and our competitiveness as a nation.
  The Department of Health and Human Services and the agencies within 
its purview are in need of attention and leadership. It is critical 
that the Department once again base its decisions on the best available 
science, not the political ideology of the moment. President Obama has 
already made tremendous progress in this respect with the signing of an 
Executive order overturning the previous administration's harmful 
restrictions on embryonic stem cell research and the signing of a 
Presidential memorandum on scientific integrity. I commend him for it.
  He has moved quickly to appoint highly qualified candidates such as 
Governor Sebelius to key positions within the Department, such as the 
FDA Commissioner and the head of the Health Resources and Services 
Administration.
  Governor Sebelius brings a wealth of experience I have referenced 
already, working in a bipartisan fashion to improve the lives of 
families in her State. The outpouring of support, on a bipartisan 
basis, ought to be welcome and celebrated. Rarely do you see someone 
bring that much support across the political spectrum that Governor 
Sebelius has to this, the nomination to head this Department.
  The knowledge and expertise she gained as Governor, the insurance 
commissioner of her State, and the State representative will be 
instrumental in achieving comprehensive health care reform--reform that 
at long last will bring affordable quality health care, we hope, to all 
Americans.
  The case for reform of our health care system has never been stronger 
or more urgent, and I happen to be one who is optimistic about the 
prospects of achieving health care reform this year under the 
leadership of Max Baucus, the chairman of the Finance Committee; 
Senator Ted Kennedy, the chairman of the HELP Committee; and the 
respective leadership on the House side along with, obviously, 
President Obama; the participation of other people--our colleagues, 
such as Orrin Hatch, Mike Enzi of Wyoming, certainly Chuck Grassley, 
the Republican former chairman of the Finance Committee, now the 
Republican ranking member, and many others with whom we have had 
extensive meetings already trying to achieve what our majority leader 
has called for, and that is a strong, bipartisan effort here to put 
together a national health reform package. So a lot of good people are 
already buying in, trying to achieve that result. What we have been 
missing in all of this is the head of the Health and Human Services 
Department, to help pull that piece of the puzzle together for us as 
well.
  We are in such a different place than we were 15 years ago on this 
issue. Then we had a host of opposition lined up. Today, those who 
organized to torpedo those efforts 15 years ago, frankly, are at the 
table today anxious for us to share and put together a proposal that 
would enjoy that kind of support I mentioned a moment ago.
  The economics of our country are certainly in a much different place 
than they were in 1993 and 1994. Today, health care accounts for over 
16 percent of the gross domestic product of our country--health care 
costs. According to the Office of Management and Budget, by the year 
2018--not that far away--national health spending, if unabated, could 
account for a fifth, more than 20 percent of our gross domestic 
product. There are those who believe that within 10 years that figure 
of 16 percent could double to more than 30 percent of our gross 
domestic product. That is unacceptable.
  If you are not motivated by the morality and ethics of having 45 
million Americans without any health care, of which 9 million in that 
number are children, today we rank among the lowest scores or the worst 
scores of infant mortality among industrialized nations. There are 
100,000 people a year who die in this country from avoidable medical 
errors. Those are not the kinds of statistics we want to associate with 
our great country. So, in addition to the moral, the health care 
issues, the ethical questions, the economics of this issue demand 
attention.
  If you are not impressed by any other motivation on why we ought to 
achieve universal, quality, affordable health care, founded on the 
notion of prevention, then the economic justification

[[Page S4790]]

ought to persuade you. The health care system we have today puts 
personal finances at risk, threatens our global competitiveness. 
General Motors, to give you one example, estimates that health care 
costs add over $1,500 to the selling price of each automobile it 
produces, and it paid $5.2 billion in health benefits in 2004. That is 
more than it paid for steel. That will give you an idea why that 
company is facing as much pressure as it is, as well as other 
automobile manufacturers.
  Look at the foreclosure issue. There are 10,000 people today who will 
be at risk of losing their homes. That is true every day in our country 
in the midst of this major economic crisis. There are 20,000 people a 
day, on average, who are losing their jobs in the United States. So 
when you are losing your job, you may lose your home and retirement. 
Remember this: Almost half of all of those foreclosures that will occur 
today are partly caused by the financial crisis stemming from medical 
costs. I will repeat that. Almost half--50 percent of those 10,000 
foreclosures that will occur today are partly caused by the financial 
crisis stemming from health care costs.
  As chairman of the Banking Committee and a 26-year veteran on the 
HELP Committee, I share the President's belief that fixing the health 
care crisis is essential to fixing our economy.
  We can talk about all the other issues dealing with availability of 
credit and what is happening to banks and to the financial stability of 
the Nation, but we cannot have a conversation about all that and 
disregard the issue of health care. Twenty-eight million Americans who 
work for small businesses are without health care. Premiums on average 
are 18 percent higher than they were a few years ago. In Connecticut, 
premium costs have gone up 42 percent in 8 years. Imagine what that has 
done at a time when wages and salaries have not increased anything 
remotely close to that. Premiums and out-of-pocket costs for health 
care and individuals continue to skyrocket.
  Chairmen Kennedy and Baucus of the respective HELP and Finance 
Committees are working closely together on this process, trying to 
fashion a timeline and policy that will fit together. Both chairmen 
have stated a shared goal of marking up health care legislation in 
early June. I strongly believe that timetable is achievable. But we 
need to have a Secretary of Health and Human Services, if we are going 
to mark up a bill in June. We have had this nomination pending for more 
than a month, have spent a week debating it, and we are in the month of 
May. Most Americans want the petty politics put aside and the people in 
place we need to lead this effort. They care about health care. They 
understand what happens: When one loses their job, they lose their 
health care.
  Last year one in three Americans, between 2007 and 2008, had a gap 
where they had no health care for one reason or another. Lord forbid 
someone is in that gap and something happens to them or their spouse or 
a child and they end up having to pay out-of-pocket expenses for the 
care of that individual. That is a fear everyone has who faces that 
possibility or is in that situation today.
  I say this respectfully. It is time to get the people in place who 
can help us get this job done. Delaying this nomination because you 
don't agree with everything that Kathleen Sebelius says or supports is 
not justification for denying this administration and, more 
importantly, the American people a leader at the Department of HHS to 
move forward.
  I wish to say a quick word about the comparative effectiveness 
research which has been mentioned as a reason for holding up the 
nomination. This effort is about expanding Americans' access to health 
care, not restricting it. We also want to give patients and their 
doctors the tools they need to make the right decisions about care. 
That is what comparative effectiveness research is all about, 
empowering patients and medical providers. It is not about rationing 
care. Comparative effectiveness research is about helping patients and 
providers figure out together which therapies and treatments work best 
for them. It is not about restricting or limiting health care options 
but, rather, about helping them understand their health care better and 
more accurately chart a course of treatment. The President has made 
such research a high priority by having invested in it through the 
recovery act's $10 billion for the National Institutes of Health and 
$1.1 billion for comparative effectiveness research.
  I support the President and Governor Sebelius in this effort to 
inform patients and providers. This is the moment for health care 
reform. Failure is not an option for our Nation. I look forward to 
working with Governor Sebelius to make meaningful, lasting change to 
our Nation's health care system.
  While health care reform is a top priority, I also wish to address 
quickly another vitally important issue to the responsibility of the 
department; that is, early childhood education and development. This is 
an issue that has long been near and dear to my heart, since 1981, when 
I started the children's caucus in the Senate almost 30 years ago with 
Arlen Specter of Pennsylvania, who was a new Senator as well that year, 
along with people such as Patrick Moynihan, Bob Dole, and Bill Bradley. 
Each brought a deepening interest in what was happening to one out of 
four Americans who are children. As a result of our efforts over the 
years, we have made a difference.
  I am encouraged by the commitment of President Obama to early 
childhood education. I look forward to working on new proposals as well 
as strengthening current programs such as Head Start and the CCDBG for 
childcare to benefit children and families. An investment in our 
youngest Americans pays off in their readiness for school, their 
health, and job creation now and in the future and the need for fewer 
social services later in the child's life.
  Now is the time to put partisan politics aside, confirm Governor 
Sebelius so we can have the kind of leader most Americans are looking 
for and provide the guidance the Department of Health and Human 
Services will need if we are going to succeed in this effort.
  I urge confirmation of this remarkable individual who has offered her 
services to the country, who is making the kind of sacrifice to come 
forward and serve our Nation at a critical moment. That is to be 
celebrated. That is patriotism. I hope my colleagues will quickly 
confirm this nominee and allow us to begin the critical work of 
fashioning a national health care reform package.
  I yield the floor and suggest the absence of quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mrs. McCASKILL. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER (Mr. Kaufman). Without objection, it is so 
ordered.
  Mrs. McCASKILL. Mr. President, I rise this afternoon in support of an 
incredibly gifted public servant. I don't normally stand up and sing 
the praises of Kansas. I am not a huge fan of Kansas. I am a 
Missourian, and we have issues between Kansas and Missouri--usually 
between our basketball teams and our football teams.
  During the last decade, I have had an opportunity to get to know 
Kathleen Sebelius as a person, as a mother, as a wife, as a Governor, 
and as a friend. I want my colleagues to know that they are voting to 
confirm an extraordinary individual who will do an excellent job as 
Secretary of Health and Human Services in the United States.
  Kathleen Sebelius has shown courage and guts many times in her 
career. Frankly, running for Kansas's Governor as a Democrat shows guts 
and courage. We are talking about a State that is not warm and fuzzy 
about Democrats. We are talking about a State that is as red as 
Dorothy's ruby slippers. But she ran for Governor after she had served 
as commissioner of insurance in Kansas. So why was it that all these 
Republicans got excited about voting for Kathleen Sebelius? It was 
because she demonstrated, when she was commissioner of insurance in 
Kansas, that she was about fighting for them. It happened over an 
insurance company. Everyone needs to realize this is an experience she 
has had that relates directly to what we need right now as Secretary of 
Health and Human Services as we embark upon the most aggressive and 
ambitious health care

[[Page S4791]]

reform agenda this country has ever faced.
  When the largest health insurance company in Kansas wanted to sell--
this was a mutual company owned by the policyholders of Kansas and 
covered 70 percent of Kansans--all Kathleen Sebelius, the insurance 
commissioner, had to do under the law was sign off on it and say no 
harm would be done. But she took a look at it and said, wait a minute, 
I don't think the test should be that no harm is going to be done. I 
want to know what this sale is going to do to make things better for 
Kansans. She took on a titan--a big, huge insurance company. That is 
what we need right now, someone willing to take on the calcified silos 
of profit in our health care system and blow them up in order to 
deliver a better product. She said: I want to make sure this sale is 
going to reflect a better environment for health insurance for the 
people of Kansas.
  She fought them all the way to the Supreme Court of Kansas and 
eventually she won and was able to block the sale of this company. She 
said at the time that bigger is not always better, and unless they 
could show how this was going to be better for the people of Kansas, 
she would continue to fight them toe to toe. It was that kind of 
fighting spirit on behalf of regular people who don't have the tools to 
fight big insurance companies that uniquely qualifies her to be at the 
head of this important agency as we embark on the health care reform 
agenda.
  Not only did she have the guts to run for Governor--she won, which 
was remarkable. Here is an even more remarkable part. She went to 
Topeka, the capital, and began working with the Republicans. As 
President Obama has said over and over again, she said: I want to work 
with you. And she did. She wrestled with a senate and a house that was 
dominated by the Republican party in Kansas and, at the end of 4 years, 
what did the people of Kansas do? Did they say they were sick of the 
gridlock and didn't want this liberal Kansas woman anymore from the 
Democratic party as Governor? Oh, no, they did not; they reelected her 
by a wide margin.
  It is a remarkable thing, when you think about it, because this is a 
State that our former President won by 20, 30 points. Yet the people of 
Kansas realized they had a fighter. They looked past the party label to 
her courage, integrity, intelligence, and her willingness to go toe to 
toe with the big guys for them. I am proud she has been nominated. I 
know there have been some distortions about her record. I can assure my 
colleagues that she will make us all proud in this job. She will work 
with every one of us to try to find that common ground. She will leave 
no opinion behind as they consider the best way to move forward on this 
health care reform agenda.
  I am pleased to be able to stand for a few minutes and tell everyone 
in America to celebrate today, because we are about to confirm a 
fighter--someone who will fight for you and deliver the kind of health 
care in America that we deserve, at a price we can afford.
  I yield the floor and suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The bill clerk proceeded to call the roll.
  Ms. LANDRIEU. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Ms. LANDRIEU. Mr. President, I wish to speak for up to 10 minutes, 
maybe slightly longer, about the nomination of Gov. Kathleen Sebelius 
to be the Secretary of the Department of Health and Human Services. I 
wish to speak on behalf of the Governor because I think she is such an 
outstanding candidate for this particular job.
  As I look across the country, as many of my colleagues, and think who 
could fill this position, I have to say I was very pleased with the 
President's action to tap her for this important position because right 
now this Secretary is going to be charged with fulfilling the 
President's idea that all Americans should have health coverage. This 
is an idea that other Presidents have shared and about which many 
leaders in Congress, both Republicans and Democrats, have thought. It 
would be remarkable and wonderful for our country, the extraordinarily 
developed Nation that we are, to find a way--a cost-effective way, in 
my view; hopefully, a market-based approach--to solving one of the 
great challenges of our time, which is to provide health insurance, 
good coverage, for workers in the most productive Nation on Earth.
  It really is a failing, in my view, of our organized society and our 
Government that we have not in over 240 years been able to accomplish 
that. We have accomplished so many things that are a credit to our 
country, but this has eluded us.
  When President Obama ran in his campaign, and as I heard him speak 
even here and in the House Chamber for a joint session, he again 
expressed his passion for trying to find a solution. One of the first 
steps to finding a solution is finding a leader who has a good record 
of finding solutions on their own, a good record of working across 
party lines to get difficult jobs done. So in his action to achieve 
this goal, he has made a great first step to at least present to the 
Senate for our consideration a person who does not have a weak record 
but a strong record in this effort.
  I submit that as a Democratic Governor of Kansas, you have to be 
pretty good as a Democrat, first of all, to get elected in Kansas 
because, like Louisiana, it tends to be a more conservative State on 
some issues. Obviously, I think this Governor has demonstrated over and 
over, as insurance commissioner and as Governor of Kansas, the ability 
to get the job done. She was tapped before she was Governor by a 
Governor of Kansas to help actually implement and lead the children's 
health program. Her record is clear in the success of this program.
  She, as insurance commissioner, had a great deal of interaction with 
health insurers in that State and others that indicates to us she has 
the experience and the ability to do this. Working with the Federal 
Government during her time as Governor on all of these health care 
matters leads me to the conclusion that she is the right person to help 
us get this job done. The sooner we confirm her the better.
  I was very impressed to hear--I do not serve on this committee--that 
at her hearing, Senator Roberts, our colleague who is of the other 
party, spoke in her favor and voted for her. Even more impressive to me 
was that former Senator Bob Dole testified for her.
  This is not at all a typical partisan appointment. This is a person 
who has demonstrated through her leadership for many years in the State 
of Kansas the ability to tackle the toughest jobs and bring people from 
various viewpoints together. That is the kind of leadership I think 
America is looking for right now.
  I might add that in the most recent days, the outbreak of the swine 
flu in our country should compel the Members of this body to know this 
is not a job that should have a vacancy sign on the door right now. 
There could potentially be a pandemic. The Government is hoping for the 
best but preparing for the worst. While Secretary Napalitano has been 
charged with the task to coordinate Federal agencies, frankly I do not 
feel very comfortable having this job vacant. The faster we can get her 
in this position with her extraordinary credentials the better.
  I would like to make a few other points. As the chair of the Small 
Business Committee, I have to say again for the record--and I think 
Senator Snowe from Maine, my ranking member and long-serving member of 
this committee, would say the same thing if she were here--that no 
matter what we call a meeting on in the Small Business Committee--it 
could be on procurement, it could be a hearing on credit markets, it 
could be a hearing, which we have had, on the Small Business 
Administration itself, as I am standing here, every small business 
person, almost to the man or woman, will say: Senators, before I leave, 
or, Senators, I know this isn't the subject of this hearing, but could 
I please say I can't afford my health insurance; can I please say that 
it is very important for this country to find a way for small business 
entrepreneurs to get health insurance.
  Just for the record, for small businesses that employ the vast 
majority of people in this country, the percentage of coverage has 
dropped in the last

[[Page S4792]]

7 years from 68 percent of those businesses providing coverage down to 
59 percent. I know in my personal experience dozens of people who would 
say: You know, Mary, I would like to start a business. I think I have a 
good idea, and actually I have some money to start it, but I can't give 
up my health insurance because I have a preexisting condition or I have 
a son with leukemia or I have a daughter who has a compromised immune 
system.
  I cannot tell you how strongly I feel that our country is actually 
not only throwing cold water but almost freezing water on the 
entrepreneurial spirit because we can't seem to figure out how to 
provide health insurance--and not just for big companies but for medium 
companies and for emerging companies--and to have that coverage be 
portable and available when people want to leave a company and take a 
risk. They might risk their business, but they are not going to risk 
their life. That is a little too much risk to ask in order to start a 
business. You may risk your home, you may risk your fortune, but to ask 
people to risk their life is a little ridiculous. Yet that is where we 
are. So the faster we can get someone in this position who can help put 
their shoulder to the wheel and help our small businesses come up with 
a way, the better off we will be.
  Finally, I wish to mention two issues briefly. We concentrate a lot 
in this department on health care and that, of course, is the 
President's priority and it is our priority, but I don't want to fail 
to mention that I believe this Governor would be an extraordinary 
advocate for foster care children. There are 500,000 of these children, 
many of them with 4.0 grade point averages, amazingly. Many of them are 
the most extraordinary children. I have gotten to meet many of these 
young people as chairman of the Adoption Caucus and an advocate for 
foster care. This is despite the fact that some of them have spent 
several years of their youth living in an automobile.
  One of these children said to me one day that she got so hungry she 
would just eat paper. The only thing that made it edible was that she 
would pour salt on it, just to try to put something in her stomach. 
These 500,000 children and young people need someone such as Governor 
Sebelius because these are people in the custody of the Government. The 
U.S. Government, along with partners in our 50 States, have an 
obligation to these children for their health, for their education, and 
to try to help them launch successfully in life. Once we have 
terminated their parental rights--in many instances for good cause--we 
then have an obligation to be their parents and to reconnect them 
through adoption, if possible, or to long-term guardianship. We need 
somebody in this position who can do that.
  I know of Governor Sebelius's heart for foster care, for orphans, and 
for adoption. I think she will be a wonderful advocate to keep our 
adoption tax credit in place and to help Senator Grassley and I--we 
have been working on this with many other Members--find a way to reform 
the financing mechanism and the way we fund our foster care adoption 
system in this country, which right now funds the system and not the 
child. We want the money to support the decision of that good, solid 
judge who has a plan for the child. The problem is there is no money 
for the child because we are giving the money to the system instead of 
tying the money to the child. Senator Grassley and I have a vision to 
make that better.
  I hope we can confirm Governor Sebelius, knowing she has a proven 
record of governing her State, which is not easy for a Democrat, and 
remained very popular. That takes a great deal of effort in this day 
and age, given the partisan nature of our politics. We need to have a 
``position filled'' sign as opposed to a ``vacancy'' sign in this 
position, and we need somebody who understands the commonsense 
practical approach to governing that is going to deliver for this 
President and for us--for the American people--a health care system we 
can depend on, that we can afford, and that promotes risk-taking and 
entrepreneurship, which is the founding principle, in many ways, of 
this wonderful country.
  I thank the Presiding Officer for the opportunity to speak on behalf 
of the Governor, and I urge my colleagues to not wait any longer and to 
confirm this nominee and give her the support she needs. Do not apply 
any litmus test on any particular issue, but give her the chance I 
think she wants to have--I am confident she wants to have--to do a good 
job for us all.
  Mr. President, I yield the floor, and I suggest the absence of a 
quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The bill clerk proceeded to call the roll.
  Mr. CORNYN. I ask unanimous consent that the order for the quorum 
call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. CORNYN. I ask unanimous consent to speak up to 15 minutes on the 
pending nomination.
  The PRESIDING OFFICER. The Senator may proceed.
  Mr. CORNYN. Mr. President, Governor Sebelius, who has been nominated 
to be Secretary of Health and Human Services, testified before the 
Senate Finance Committee that she would not refuse to use certain 
comparative effectiveness research as a tool to deny or delay American 
citizens' access to health care. Said another way, a concern about 
comparative effectiveness research, $1.1 billion of which was funded in 
the stimulus program, can be used both for benign purposes, purposes 
that are completely understandable, as well as those most Americans 
would find repugnant; that is, for rationing of access to health care.
  Comparative effectiveness research is the comparison of various 
treatments or approaches to garner better data on what works best and/
or what costs the least. Comparative effectiveness research can be 
helpful and beneficial if it is used to inform health care decisions 
and individual health care decisionmaking and as a guide to evidence-
based medicine. Without appropriate safeguards--and these were the 
safeguards Governor Sebelius refused to embrace--the Government could 
actually use comparative effectiveness research to delay treatment and 
to deny care based on a one-size-fits-all approach to health care.
  The economic stimulus package included $1.1 billion for comparative 
effectiveness research. This research should only be used to better 
inform individualized decisionmaking; that is, a patient talking to 
their doctor and deciding what is in that patient's best interests. It 
should not be used for the Government to say: Patient, we will not pay 
your doctor for that procedure unless it meets our cookbook medicine 
model that is generated by comparative effectiveness research. Despite 
assurances that the stimulus money would not be used to evaluate the 
relative cost effectiveness of various medical treatments, the National 
Institutes of Health is already undertaking steps to use the stimulus 
money to conduct that kind of cost-based research.
  As I indicated, Governor Sebelius was asked before the Finance 
Committee how she plans to use comparative effectiveness research. As 
Secretary of HHS, she will be in the driver's seat in large part to 
determine how the policies of this administration and of this Congress 
will be implemented. My colleague Senator Kyl from Arizona expressed 
his concern before the Finance Committee vote in these words, with 
which I agree:

       Unfortunately, Governor Sebelius' answers made it clear 
     that the Administration is unwilling to support pro-patient 
     safeguards. She left me with no assurance that HHS, federal 
     health care programs, or any new entity--such as the Federal 
     Coordinating Council--will not use comparative effectiveness 
     research as a tool to deny care. And this should be of 
     concern to all of us.

  Instead of allowing the Federal Government to intrude further into 
personal decisionmaking and medical care, I believe that health care 
reform should enhance the individual relationships between doctors and 
their patients. I am concerned that using comparative effectiveness 
research to justify treatment denials based on cost will significantly 
limit patients' ability to choose health care services for individual 
needs. It will also reduce--and this is important--medical innovation 
and quality of care.
  When asked, Governor Sebelius did not have any convincing answers to 
what is one of the most important questions in the health care debate,

[[Page S4793]]

and that is, how do we contain rising health care costs, something that 
is going to render the Medicare Program insolvent in the next decade? 
As any employer will tell us, it makes it increasingly more difficult 
for employers to provide health care to their employees.
  According to the Congressional Budget Office, spending on health care 
will account for nearly 17 percent of the gross domestic product of the 
United States. In 2009, that will be as much as $2.6 trillion. America 
spends more than twice what other industrialized nations spend per 
capita on health care. Can we claim our health care product is twice as 
good as anywhere else in the world based on this increased spending? I 
doubt it, even though American health care is very good. But I don't 
think we could say we get our money's worth by spending twice as much 
as any other industrialized nation per capita on health care. Health 
care insurance premiums have risen much faster than workers' wages in 
recent years which means lower take-home pay for American workers. 
Health care reforms must ensure that this trend is reversed or we will 
have failed in one of the most important missions of health care 
reform.
  In the Finance Committee, I asked Governor Sebelius her specific 
ideas, other than delaying treatment and denying care, on how to 
contain costs. In my office I asked her, what about health care 
liability reform which, in my State of Texas, has made health care much 
more accessible by moderating the growth of medical malpractice 
insurance premiums, providing a more level playing field when it comes 
to doctors and hospitals being sued. She basically did not have much of 
an answer for whether that should be included. I happen to believe it 
is one of the cost drivers in health care cost and has to be addressed. 
I submit, with no little modesty, that the State of Texas has 
experience in this regard that the Federal Government could learn from. 
While I don't doubt some of the cost containment proposals in her 
answers could be worthy of pursuing, Governor Sebelius failed to prove 
that they will provide substantial savings in a $2.4 trillion health 
care system. The Congressional Budget Office is also skeptical that the 
proposals she mentioned will result in any substantial savings.
  Finally--and this should cause all of us to be concerned about 
whether there actually will be cost containment or cost savings in 
health care reform--I am puzzled by the fact that President Obama's 
budget actually asks for more money, $634 billion. That is not the 
total price; that is for a downpayment. In my State, as well as the 
State of the Presiding Officer, before people are accustomed to making 
a downpayment, they usually want to know what they are buying. But the 
budget proposal by the President called for $634 billion of additional 
spending as a downpayment in order to control costs in the long run, 
which is based on nothing more than hope, and that is hardly a 
strategy.
  We know we are already facing an unprecedented level of national 
debt. Unfortunately, Congress, under the new administration, has 
contributed greatly to the fact that we have seen more spending in the 
last 90 days than we have seen in Iraq, Afghanistan, and in Hurricane 
Katrina recovery. We know we have $36 trillion more in unfunded 
liabilities in the Medicare Program alone. So at a time when we need to 
figure out how we deal with unfunded obligations of the Federal 
Government, how do we more efficiently spend the 17 percent of gross 
domestic product that makes us spend twice as much as any other country 
in the world per capita, we are ignoring some of the huge unfunded 
liabilities of the Federal Government, and we are asked to take as a 
matter of faith that these proposals will result in savings without any 
concrete plan which can be analyzed and evaluated in the light of day.
  I firmly believe this country is spending enough money on health care 
today. What we need are innovative ideas about how to spend it more 
wisely. I have not heard any innovative ideas from Governor Sebelius or 
the current administration.
  What causes me even more concern is Governor Sebelius has made it 
clear that she supports a new government-run ``public plan'' for health 
care that is unequivocally a gateway to a single payer system. A new 
government-run public plan option will devastate private insurance 
markets by acting as a competitor, regulator, and funder. How in the 
world can the private market compete when the Federal Government comes 
in and sets prices which will cause employers to give up their 
employer-provided health insurance coverage to allow their employees to 
get coverage under the public plan? Indeed, the public plan, much like 
Medicare today, can be relied upon to use denial or delay or treatment 
rationing of health care in order to contain costs.
  The independent Lewin Group analysis found that a new public plan 
could mean that 118 million Americans will lose their current health 
care coverage, and 130 million Americans could end up on a government-
run health care plan. That is what I mean as a ``gateway'' to a single 
payer system through this so-called innocuous sounding public plan 
which will run competition out, will undercut it, and make it 
impossible to have the benefits of a competitive market, as we have 
seen on Medicare Part D, the prescription drug coverage plan, which 
actually, in an amazing feat, has a high public satisfaction and came 
in under proposed cost, mainly through a market-based mechanism that 
creates a market for insurance companies to provide prescription drug 
coverage. That is the kind of model we should be looking at to learn 
from in order to contain cost, not by Government delaying or denying 
access to health care under the guise of a ``public plan.''
  The Wall Street Journal recently wrote:

       Because federal officials will run not only the new plan 
     but also the ``market'' in which it ``competes'' with private 
     programs--like playing both umpire and one of the teams on 
     the field--they will crowd out private alternatives and 
     gradually assume a health-care monopoly.

  A public plan will also increase the cost of private health care. A 
report by the actuary Milliman estimated the ``hidden tax'' commercial 
payers pay to subsidize the costs of Medicare and Medicaid equals 
roughly $88.8 billion per year. This means that the average health care 
premium is $1,512, or 10.6 percent, more annually per family than it 
would be without the cost shift. A new so-called public plan option, 
which is a government-run program, would exacerbate the cost shift and 
drive up the cost of private health care at a time when we must seek to 
lower health care costs.
  Then there is the Washington Post that wrote on April 27:

       [President Obama's] nominee for secretary of health and 
     human services, Kathleen Sebelius, said that she wants a 
     public plan to ``challenge private insurers to compete on 
     cost and quality'' but ``recognizes the importance of a level 
     playing field between plans and ensuring that private 
     insurance plans are not disadvantaged.''

  The Washington Post said:

       We disagree. It is difficult to imagine a truly level 
     playing field that would simultaneously produce benefits from 
     a government-run system.

  I ask unanimous consent that this editorial from the Washington Post 
be printed in the Record at the close of my remarks.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  (See exhibit 1.)
  Mr. CORNYN. Throughout the campaign last year, the President promised 
Americans care such as Members of Congress receive. The irony is that 
Members of Congress do not have access to a public plan. As a matter of 
fact, we don't need one because there are private plans that provide 
the coverage we receive.
  I am concerned that Governor Sebelius is not up to the challenge of 
finding--and this is my final point--more than $90 billion of waste, 
fraud, and abuse in the Medicare-Medicaid Program each year.
  There are some who have said that what we need is Medicare for all. 
Well, right now Medicare, as I indicated, and Medicaid have roughly $90 
billion in fraud, abuse, and waste. I hope that is not what they mean--
that we need to carry over that kind of waste, fraud, and abuse into a 
Medicare or a single-payer system. According to an article in the 
Washington Post last year, more than $60 billion is lost each year to 
Medicare fraud alone. That is just Medicare--$60 billion of money that 
could go to provide services to Medicare recipients that is lost to 
people

[[Page S4794]]

who cheat and steal the Federal taxpayer. Medicaid services last year 
were estimated to be about $32.7 billion similarly lost to fraud, 
waste, and abuse. Medicare and Medicaid fraud drive up the cost of 
health care and, I believe, represent an unacceptable mismanagement of 
taxpayer dollars.
  When I asked Governor Sebelius about how she planned to fight fraud 
in our public programs, she only gave the vaguest of answers to my 
questions. Additionally, her record as Governor tells me that she is 
not yet ready to tackle that kind of fraud, waste, and abuse as 
Secretary of Health and Human Services.
  The Kansas State Legislature is planning to have hearings on whether 
Governor Sebelius was involved in a decision to provide more than 
$700,000 in ``extraordinary'' Medicaid funds to an organization linked 
to a number of her supporters. An article by the Kansas Health 
Institute said that:

       Regardless of the Medicaid question, which isn't likely to 
     be answered any time soon, many believe [the Medicaid 
     Director's] decision was based on the political connections 
     of those most closely involved.

  The article goes on to say:

       Some Kansas officials are debating whether State oversight 
     of [Kansas'] Medicaid program was strong enough. The debate 
     focuses on the inspector general's office, created in 2007 
     within the Kansas Health Policy Authority to ferret out 
     potential problems in Medicaid. The first inspector general 
     left in October and has told legislators the authority 
     hindered her work . . . The scrutiny came after a legislative 
     audit described $13 million in ``suspicious claims'' paid by 
     Medicaid in 2005 and 2006, before the authority took over the 
     bulk of the program. In one case, auditors said the program 
     paid a doctor $941 for a Cesarean section when the patient 
     was an 8-year-old boy.

  Republicans and, indeed, all of us, I believe, want a new HHS 
Secretary to be someone committed to work with them to reform the 
health care system in a bipartisan process that will reach the best 
result for the American public. Unfortunately, with a sense of 
foreboding, I read accounts that Democratic leadership wants to use the 
budget reconciliation process to jam a partisan health care reform bill 
through on an expedited basis without adequate debate or deliberation. 
I think that would be the worst of all possible outcomes. This is a 
serious enough issue that we need true bipartisan buy-in and 
contribution to workable health care reform.
  Unfortunately, Governor Sebelius backed a highly partisan process for 
health care reform that excludes representatives of 50 percent of the 
American people: the use of budget reconciliation that I mentioned. 
Governor Sebelius refused to say that she would not support the use of 
reconciliation to pass health care reform. In her response to committee 
questions, she wrote:

       There are many tools available and none of those tools, 
     including reconciliation, should be taken off the table.

  I am very concerned that using a partisan procedural trick to reform 
a system that comprises 17 percent of our gross domestic product is not 
in the best interests of the American people. The American people 
deserve open and full and honest debate about how to improve our health 
care system, not this kind of partisanship.
  Then, finally--and this is my final point--Governor Sebelius failed 
to disclose relevant information to the Finance Committee during the 
consideration of her nomination. Not only was there the matter of her 
tax returns--something that, unfortunately, has become a trend, it 
seems, in this administration's nominees--she also failed to disclose 
contributions from a controversial abortion provider until pressed by 
the media.
  The Associated Press wrote that:

       When the discrepancy became public Sebelius acknowledged 
     getting an additional $23,000 from Tiller and his abortion 
     clinic beyond the $12,450 she initially reported.

  While I appreciate her apology and her mention that it was only an 
inadvertent error, I am concerned that a Cabinet Secretary should be 
held to a much higher and more transparent standard.
  So I am sad to say I will not be able to support Governor Sebelius's 
nomination for Secretary of Health and Human Services.
  I yield the floor.

                               Exhibit 1

               [From the Washington Post, Apr. 27, 2009]

                         Reforming Health Care

       Of the many possible issues that could snarl health-care 
     reform, one of the biggest is whether the measure should 
     include a government-run health plan to compete with private 
     insurers. The public plan has become an unfortunate litmus 
     test for both sides. The opposition to a public plan option 
     is understandable; conservatives, health insurers, health-
     care providers and others see it as a slippery step down the 
     slope to a single-payer system because, they contend, the 
     government's built-in advantages will allow it to unfairly 
     squash competitors.
       For liberals, labor unions and others pushing to make 
     health care available to all Americans, however, the fixation 
     on a public plan is bizarre and counterproductive. Their 
     position elevates the public plan way out of proportion to 
     its importance in fixing health care. It is entirely possible 
     to imagine effective health-care reform--changes that would 
     expand coverage and help control costs--without a public 
     option.
       President Obama has said that he favors a public option but 
     has been sketchy on details. His nominee for secretary of 
     health and human services, Kathleen Sebelius, said that she 
     wants a public plan to ``challenge private insurers to 
     compete on cost and quality'' but ``recognizes the importance 
     of a level playing field between plans and ensuring that 
     private insurance plans are not disadvantaged.''
       The argument for a public plan is that, without the need to 
     extensively market itself or make a profit, it would do a 
     better job of providing good health care at a reasonable 
     cost, setting an important benchmark against which private 
     insurers would be forced to compete. Even in a system where 
     insurers are required to take all applicants, public plan 
     advocates argue, incentives will remain for private plans to 
     discourage the less healthy from signing up; a public plan is 
     a necessary backstop. Moreover, if the playing field is 
     level, public plan advocates argue, private insurers--and 
     those who extol the virtues of a competitive marketplace--
     should have nothing to fear.
       We disagree. It is difficult to imagine a truly level 
     playing field that would simultaneously produce benefits from 
     a government-run system. While prescription drugs are not a 
     perfect comparison, the experience of competing plans in the 
     Medicare prescription drug arena suggests that a government-
     run option is not essential to energize a competitive system 
     that has turned out to cost less than expected. Insurers and 
     private companies have been at least as innovative as the 
     federal government in recent years in finding ways to provide 
     quality care at lower costs. Medicare keeps costs under 
     control in part because of its 800-pound-gorilla capacity to 
     dictate prices--in effect, to force the private sector to 
     subsidize it. Such power, if exercised in a public health 
     option, eventually would produce a single-payer system; if 
     that's where the country wants to go, it should do so 
     explicitly, not by default. If the chief advantage of a 
     public option is to set a benchmark for private competitors, 
     that could be achieved in other ways, for example, by 
     providing for the entry of a public plan in case the private 
     marketplace did not perform as expected.
       Maybe we're wrong. Maybe it's possible to design a public 
     option that aids consumers without undermining competition. 
     If so, we certainly wouldn't oppose a program that included a 
     public component. But it would be a huge mistake for the left 
     to torpedo reform over this question.

  Mr. REID. Mr. President, the hole we have inherited is a deep one. We 
are all in it together, and together is the only way we will be able to 
climb out of it.
  One step that will put us back on the path to prosperity is reforming 
our broken health care system.
  We will soon begin debating the best way to give all Americans the 
access to quality, affordable health care that they deserve. We will 
begin to lay the groundwork for creating health care jobs that not will 
not only improve the health of our economy but of Americans everywhere.
  It will not be an easy task. It will take the cooperation of both 
Republicans and Democrats. It will take the collaboration of both the 
White House and the Congress. But right now, the President is playing 
shorthanded.
  Governor Sebelius will be a key player on his team. President Obama 
will benefit from having her experience and temperament in his Cabinet, 
and all Americans will benefit from her extraordinary leadership.
  Governor Sebelius has worked hard for the people of Kansas for more 
than 20 years--the first 8 in the State legislature, then as the 
State's insurance commissioner for another 8 years. It is safe to say 
she knows a thing or two about the complexities of insuring all 
Americans and the urgency with which we must do so.
  On her way to becoming insurance commissioner, Kathleen Sebelius 
refused to take campaign contributions from insurance companies. Once 
she got there, she made her mark by cracking down on HMOs and saving 
taxpayers money.

[[Page S4795]]

  For the last 6 years, she has served as the Democratic Governor of a 
bright red State. One doesn't succeed--let alone get reelected--in that 
environment without knowing how to put people ahead of partisanship. 
Governor Sebelius did just that--she expanded health care for children 
and made both health care and prescription drugs more affordable for 
everyone.
  Her integrity is beyond reproach, her expertise is essential, and her 
confirmation is long overdue.
  The only way for our economy to fully recover is by making the 
critical investment of reforming health care. The stakes are too high 
and the cost of inaction is too great.
  If we are going to start digging out of this hole, we must start by 
filling the hole over at HHS. And if we are going to fix our broken 
health care system, who is better equipped to lead that effort than 
Kathleen Sebelius?
  The PRESIDING OFFICER. The Senator from New Mexico.
  Mr. BINGAMAN. Mr. President, what is the business before the Senate?
  The PRESIDING OFFICER. The nomination of Kathleen Sebelius.
  Mr. BINGAMAN. Mr. President, I ask unanimous consent that any 
remaining debate time be yielded back and the Senate then proceed to 
vote on confirmation of the nomination of Kathleen Sebelius to be 
Secretary of Health and Human Services; that upon confirmation, the 
other provisions of the April 23 order remain in effect.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. BINGAMAN. Mr. President, I ask for the yeas and nays.
  The PRESIDING OFFICER. Is there a sufficient second? There appears to 
be a sufficient second.
  The question is, Will the Senate advise and consent to the nomination 
of Kathleen Sebelius, of Kansas, to be Secretary of Health and Human 
Services?
  The clerk will call the roll.
  The assistant legislative clerk called the roll.
  Mr. DURBIN. I announce that the Senator from Massachusetts (Mr. 
Kennedy) and the Senator from West Virginia (Mr. Rockefeller) are 
necessarily absent.
  I further announce that if present and voting, the Senator from West 
Virginia (Mr. Rockefeller) would vote ``yea.''
  Mr. KYL. The following Senator is necessarily absent: the Senator 
from Alabama (Mr. Sessions).
  The PRESIDING OFFICER (Mrs. Shaheen). Are there any other Senators in 
the Chamber desiring to vote?
  The yeas and nays resulted--yeas 65, nays 31, as follows:

                      [Rollcall Vote No. 172 Ex.]

                                YEAS--65

     Akaka
     Baucus
     Bayh
     Begich
     Bennet
     Bingaman
     Bond
     Boxer
     Brown
     Brownback
     Burris
     Byrd
     Cantwell
     Cardin
     Carper
     Casey
     Collins
     Conrad
     Dodd
     Dorgan
     Durbin
     Feingold
     Feinstein
     Gillibrand
     Gregg
     Hagan
     Harkin
     Inouye
     Johnson
     Kaufman
     Kerry
     Klobuchar
     Kohl
     Landrieu
     Lautenberg
     Leahy
     Levin
     Lieberman
     Lincoln
     Lugar
     McCaskill
     Menendez
     Merkley
     Mikulski
     Murray
     Nelson (NE)
     Nelson (FL)
     Pryor
     Reed
     Reid
     Roberts
     Sanders
     Schumer
     Shaheen
     Snowe
     Specter
     Stabenow
     Tester
     Udall (CO)
     Udall (NM)
     Voinovich
     Warner
     Webb
     Whitehouse
     Wyden

                                NAYS--31

     Alexander
     Barrasso
     Bennett
     Bunning
     Burr
     Chambliss
     Coburn
     Cochran
     Corker
     Cornyn
     Crapo
     DeMint
     Ensign
     Enzi
     Graham
     Grassley
     Hatch
     Hutchison
     Inhofe
     Isakson
     Johanns
     Kyl
     Martinez
     McCain
     McConnell
     Murkowski
     Risch
     Shelby
     Thune
     Vitter
     Wicker

                             NOT VOTING--3

     Kennedy
     Rockefeller
     Sessions
  The PRESIDING OFFICER. On this vote, the yeas are 65, the nays are 
31. Under the previous order requiring 60 votes, the nomination is 
confirmed. The motion to reconsider is laid upon the table, and the 
President shall be immediately notified of the Senate's action.

                          ____________________