[Congressional Record (Bound Edition), Volume 155 (2009), Part 10]
[Senate]
[Pages 12658-12662]
[From the U.S. Government Publishing Office, www.gpo.gov]




                           HEALTH CARE REFORM

  Mr. SPECTER. Mr. President, I have sought recognition to address the 
subject of health care reform. I support President Obama's call for 
health care reform legislation this year. It has long been obvious that 
there is a need for health care reform in the United States. There are 
some 47 million people, perhaps more--the precise figure is not known--
who do not have health insurance or who are underinsured.
  I have prepared an extensive statement outlining some of the issues 
which I think ought to be addressed, and I have sought recognition this 
afternoon to summarize those comments briefly. I ask unanimous consent 
that, at the conclusion of my statement, the full text of my statement 
be included in the Record as if read in full.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.
  Mr. SPECTER. Mr. President, the question of health care coverage has 
long been debated in the Congress. There is a general consensus that we 
need to cover all Americans who, as I say, either have no insurance or 
are underinsured.
  In my capacity as ranking member or chairman of the Appropriations 
Subcommittee on Labor, Health, Human Services, and Education for more 
than a decade, I have taken the lead, along with Senator Tom Harkin--
then on a bipartisan basis, where we, as we have said frequently, have 
shifted the gavel seamlessly--to provide for a great deal of health 
care coverage. During that time, the issue of funding for the National 
Institutes of Health has received special attention, where that figure 
has been raised from some $12 billion to $30 billion; and with the 
recent stimulus package, an additional $10 billion has been added. In 
addition to extensive coverage and increased funding for the National 
Institutes of Health, which resulted in very substantial improvements 
in the health of Americans on items such as stroke and cancer and heart 
disease, that subcommittee has taken the lead on many other health care 
issues, which I will not take time now to enumerate.
  I have cosponsored the legislation proposed on a bipartisan basis by 
Senator Wyden, Democrat of Oregon, and Senator Bennett, Republican of 
Utah. I have had a series of discussions with Senator Baucus, chairman 
of the Finance Committee, and discussed the issue with Senator Enzi, 
ranking member on the Health, Education, Labor, and Pension Committee, 
and have directed my staff to work with the staffs of all the other 
Senators. I have noted the comment made by Senator Grassley when he 
came from a meeting at the White House of the interest in a bipartisan 
approach, and noted Senator Enzi's statement that it was his hope we 
would have a consensus for perhaps as many as 80 Senators, which I 
think is the objective. But one way or another, I do support what the 
President

[[Page 12659]]

has said about moving forward health care insurance at this time.
  It is my preference, my position, that we rely principally on the 
private sector. I think it is undesirable to put a massive bureaucracy 
between the doctor and the patient. I am open to some intervention on a 
public plan, as I delineate in my formal written statement. 
Pennsylvania has a plan where, when the insurance was unavailable on 
medical liability, the State stepped in with an insurance plan. And 
then, when the insurance was available, the plan was to have it phased 
out.
  I have noted with interest the suggestions made by Senator Schumer to 
have a public sector for a number of dimensions. One is to cover areas 
where there are no private plans. Certainly that is something that 
ought to be considered so that everyone has the availability of health 
care coverage. Senator Schumer's proposal further delineates the 
standing of a public plan to be on a level playing field with the 
private sector, and has specified a number of issues where that level 
playing field would be maintained, and they are specified in some 
detail in my written statement, although not exhaustively.
  Here again, it is a matter for discussion and deliberation. Health 
care reform is an opportunity for the United States Senate to verify 
and confirm its standing as the world's greatest deliberative body. All 
of these ideas are in their formative stages, and plans are being 
worked on. We have the Wyden-Bennett model. I joined that plan, not 
that I thought it was perfect--and in my floor statement adding my 
cosponsorship I specified the concerns I had--but I thought it was 
highly desirable. At that time there were some 14 Senators, equally 
divided between the two parties, which provided a critical mass, and I 
thought that was a good start to give impetus.
  Of course, with President Obama's emphasis, with his convening a 
forum on health care, where I was invited to attend and did 
participate, we are moving forward. I think it is very important to 
focus on items where we may have savings within the existing health 
care system. We have had very substantial Federal involvement in the 
TARP program proposed by President Bush last fall, which is very 
expensive. We have had very substantial Federal expenditures on 
President Obama's stimulus package, of which we all know the cost. And 
at a time when there is a substantial deficit and a very substantial 
national debt, we ought to look for ways for savings, and I think there 
are some very specific and concrete ways where savings can be obtained.
  I begin that analysis with the National Institutes of Health. What 
better way to cut down on health care costs than to prevent illness. 
What better way than to have scientific research provide the ways to 
prevent illness. I have introduced specific legislation recently--again 
delineated in some detail in my written statement--on a Cures 
Acceleration Network, an effort to bring the research from the National 
Institutes of Health, from the laboratory, to the bedside--as it is 
summarized, from bench to the bedside. The advances in medical 
research, statistics--and again they are delineated in my formal 
written statement--specify the tremendous improvements in health, where 
mortality has gone up and prolonged or saved lives in so many fields--
cancer, heart disease, stroke, et cetera. When you have a program for 
health care, then I think there are realistic ways to save money; where 
people who develop chronic ailments, which are very expensive, can be 
ameliorated or perhaps even prevented, but holding down health care 
costs.
  A separate item, which has received considerable attention, and which 
I spoke about at the President's health forum, is lifestyle, on 
exercise and on diet. Those are items which I have always been 
concerned about, being a squash player almost on a daily basis, and 
more recently taking up weight training as a result of an experience I 
have had with Hodgkin's and with some of the efforts to bring back 
balance. I feel that exercise is very important. My wife has always 
been very consistent on dietary considerations. There are some programs 
I recently heard a presentation on by the chief executive officer of 
Safeway on exercise and health, and there is a correlation along some 
lines in reducing health care premiums depending on people avoiding 
smoking, exercising, and care for their diet. I do believe there are 
very substantial savings that are involved. It would be my hope that 
the Congressional Budget Office could quantify some of these savings--
savings on NIH, savings on lifestyle, savings on advanced directives. 
And in presenting a health care reform plan to the American people, I 
believe it would be enormously beneficial to be able to point to these 
savings as offsets to whatever the cost may be.
  On the subject of advanced directives and living wills, there is a 
great deal to be saved. One study showed as much as 27 percent of 
Medicare costs in the last few days, few months, or the last year of a 
person's life. No one ought to say to anybody else what their directive 
should specify in terms of what kind of care they want under those 
circumstances, but I think it is fair to ask people to focus on it, to 
think about it, and to make a directive in that respect--revocable, 
they can change it but not leave it to the family in some extremist 
situation when they are in the hospital and the passion is all in one 
direction or another.
  On the subcommittee on Labor, Health, Human Services and Education, 
we took the lead on including information in the ``Medicare and You'' 
handbook to encourage people to have advanced directives and living 
wills, so that is an item where a savings could be attained.
  Another line for possible savings would be a toughening up of 
criminal penalties for people who cheat on Medicare and Medicaid. From 
my experience as district attorney of Philadelphia, I saw very concrete 
examples about the effectiveness of jail sentences on deterrence. If we 
are dealing with a domestic dispute or dealing with a barroom drunken 
knife brawl, tough sentences are not going to deter anybody. But if we 
talk about white collar crime, talk about people who are thoughtful in 
the way they may engage in Medicare fraud or Medicaid fraud, jail 
sentences would be effective. This is a subject I have taken up with 
the Attorney General and with the Assistant Attorney General in the 
Criminal Division. It will be the subject of a hearing this Wednesday 
afternoon, the day after tomorrow, when we will bring in experts in the 
field of Medicare and Medicaid and get into the issue as to what kind 
of savings might be available.
  That is a brief summary of the longer written statement I have. I 
will conclude by emphasizing my thought that all Americans need to be 
covered with adequate health care assurance, and this is a matter of 
the highest priority. It is President Obama's No. 1 priority, as I 
understand it, and I think properly so. I am prepared, as I said 
before, to put my shoulder to the wheel to try to get this job done. 
The experience in the Subcommittee on Appropriations for Health and 
Human Services provides some insights and some guidance, and it is 
something I think we ought to accomplish.
  I have already asked consent my full statement be printed in the 
Record. I would ask the stenographer to print it out exactly as if I 
read it. Sometimes it appears in smaller type, so I would like it in 
big type and, with the explanation I have given, people will understand 
why there is some repetition between these extemporaneous comments and 
the written text.
  Mr. President, there is no doubt America is in need of major health 
care reform. With a reported 47 million people without health insurance 
the status quo is not acceptable. Additionally, there are millions more 
Americans who are underinsured, with health insurance that is 
inadequate to cover their needs. Families are forced to make tough 
sacrifices in order to pay medical expenses or make the agonizing 
choice to go without health care coverage. There are far too many 
Americans whose financial and physical health is jeopardized by the 
rising costs of health care.

[[Page 12660]]

  In the coming weeks and months Congress will consider health care 
reform which seeks to address the health care crisis, by addressing 
access to quality care, wellness programs and payment improvements. We 
need to agree on a balanced, common sense solution that reins in costs, 
protects the personal doctor-patient relationship and shifts our focus 
to initiatives in preventive medicine and research.
  I believe that ensuring all Americans have access to quality, 
affordable health care coverage is essential for the health and future 
of our Nation. The creation of an insurance pooling system, such as the 
one established in Massachusetts in 2006, could serve as a model to 
provide health insurance to all individuals. The Massachusetts program 
created a connector which allowed individuals to group together to 
improve purchasing power to achieve affordable, quality coverage for 
the entire population and to equitably share risk. However, Congress 
must be mindful of the cost of providing this care and reforms should 
not affect those who want to maintain their current insurance through 
their employer.
  Health reform legislation should include health benefit standards 
that promote healthy lifestyles, wellness programs and provide 
preventive services and treatment needed by those with serious and 
chronic diseases. Health care coverage must be affordable with 
assistance to those who do not have the ability to pay for health care. 
While I am concerned about a requirement to obtain health insurance, I 
understand that without it, health providers are forced to write off 
expensive, uncompensated care that we all pay in the form of higher 
premiums.
  In reforming health care we must work to ensure equity in health care 
access, treatment, and resources to all people and communities 
regardless of geography, race or preexisting conditions. The effort to 
improve health care should improve care in underserved communities in 
both urban and rural areas.
  The effect of these reforms on employers and providers must be kept 
in mind. Affordable and predictable health costs to businesses and 
employers and effective cost controls that promote quality, lower 
administrative costs and long-term financial sustainability should be a 
part of these reforms. Payment reforms for physicians and other health 
providers should reflect the cost of providing health care so that 
there will be providers in the future.
  This legislation will present an opportunity to address a number of 
other health related issues, including fraud and abuse in the health 
care industry, advanced directives, medical research and Medicare 
reforms. These ideas are an outline for health care reform legislation, 
which I believe can benefit all Americans. I am eager to discuss these 
ideas and look forward to hearing from constituents, colleagues and 
interested parties on all aspects of health care reform.
  On March 5, 2009, at the request of President Obama, I participated 
in the White House Forum on Health Reform. During this forum, my 
colleagues from the Senate and House of Representatives and other 
health care interest representatives shared priorities and concerns for 
health care reform. This open process helped flush out ideas and 
develop a path for reform. Since that time, regional forums have been 
held throughout the country so more voices can be heard on this 
important issue and President Obama has worked closely with those 
representing all health care sectors to find common ground on reform. 
This effort was highlighted on May 12, 2009, by an agreement with 
executives of a number of groups, including the Service Employees 
International Union and PhRMA, to provide $2 trillion in health care 
savings.
  While the White House Health Forum was a bipartisan event, I am 
concerned that the passage of health reform legislation could be lost 
to partisanship. The effort to bring about health reform can and should 
be a bipartisan effort. As a cosponsor of the Healthy Americans Act, 
introduced by Senators Wyden and Bennett and cosponsored by seven 
Democrats and four Republicans, I have firsthand experience with 
finding common ground on health care.
  From the outset, the goal for passage of this legislation should be 
to have 80 Senators vote in support of it. Recently Senator Grassley, 
after a lunch with President Obama, noted that ``the White House 
prefers a bipartisan agreement.'' While some people have indicated they 
would prefer a bill passed by 51 percent, the White House's sentiments 
are encouraging. We have to try to get as broad a base as possible to 
get a bill passed.
  The most talked about issue to date is that of a public plan or 
Government-operated program competing against private plans in the 
insurance market. A starting point for discussion on this issue could 
be the proposal made by Senator Schumer on May 4, 2009, which seeks to 
maintain a level playing field between the private sector and any 
public plan. The proposal holds that any public program should comply 
with all the rules and standards by which the private insurers must 
abide. The principles include that the public plan should be self-
sustaining through premiums and co-pays. Further, the public plan 
should not be subsidized by Government funds and must maintain a 
reserve fund as private insurers do; not require health care providers 
to participate because they participate in Medicare and payments to 
providers must be higher than Medicare; be required to offer the same 
minimum benefits as private plans; and be managed by different 
officials than those regulating the insurance market.
  I recently spoke with Senator Enzi about this issue and he raised 
some concerns regarding fair competition between private and public 
plans. Specifically, he was concerned that there wouldn't be a level 
playing field as the Government doesn't have to make a profit, whereas 
private companies do. Further, if the public plan becomes insolvent 
will the Government intervene? I agree that competition lies at the 
heart of any successful market economy and these concerns and others 
need to be addressed as we discuss and consider a public plan option.
  There are many variations in which a public plan could be brought 
forward, including offering it as a fallback if no private insurers are 
willing to provide coverage in a region. In Pennsylvania, a State 
administered insurance program for doctors and hospitals was 
established to provide access to medical malpractice insurance. This 
program could be phased out if the insurance commissioner certifies, 
pursuant to annual review, that sufficient private insurance capacity 
exists. These principles could be extended to a public plan offered to 
individuals. Whereby a public plan could be put into place subject to 
annual certification by the Secretary of Health and Human Services that 
a public plan is necessary to provide stable and affordable health 
insurance; if it isn't needed then the Government plan shall be 
privatized or eliminated.
  This issue will be hotly debated as health reform moves forward. As 
we begin, let me be clear that I am opposed to placing a giant 
bureaucracy between a doctor and patient regarding health decisions. 
Americans should be able to get treatment when they need it, and I will 
work to protect this right as we move forward. As I have stated, I am 
open to discussing the best method in which to cover all Americans, 
including considering a public plan option and look forward to 
examining all of the options with my colleagues as the legislation 
progresses.
  Another issue that will be the focus of great debate will be the cost 
of the legislation. Until bill language is produced by the Finance and 
HELP Committees, it will be difficult to determine the cost of health 
reform. A recent estimate of this reform is $120 billion per year, 
which is, by all standards, a large sum. However, the cost of inaction 
may be far greater. The United States spent approximately $2.2 trillion 
on health care in 2007, or $7,421 per person. This comes to 16.2 
percent of gross domestic product, nearly twice the average of other 
developed nations. Every effort to find cost saving proposals that can 
also bring improvements to health reform should be included in this 
legislation.

[[Page 12661]]

  The National Institutes of Health--NIH--is the crown jewel of the 
Federal Government and is responsible for enormous strides in combating 
the major ailments of our society including heart disease, diabetes, 
cancer, Alzheimer's, and Parkinson's diseases. I believe continued 
funding for the NIH and medical research should be another tenet of the 
health care debate. The NIH provides funding for biomedical research at 
our Nation's universities, hospitals, and research institutions. I 
along with Senator Harkin led the effort to double funding for the NIH 
from 1998 through 2003. When I became chairman of the Labor, Health and 
Human Services and Education Appropriations Subcommittee in 1996, 
funding for the NIH was $12 billion; in fiscal year 2009 funding was 
increased to $30 billion.
  Regrettably, Federal funding for NIH has steadily declined from the 
$3.8 billion increase provided in 2003, when the 5-year doubling of NIH 
ended. To jumpstart the funding in NIH, I worked to include a provision 
in the American Recovery and Reinvestment Act to increase NIH funding 
by a total of $10 billion.
  NIH research has provided tremendous benefits to many individuals 
with diseases. The following are examples of the cost of and success in 
reducing cancer deaths and cardiovascular disease.
  Cancer: The NIH estimates overall costs of cancer in 2007 at $219.2 
billion: $89 billion for direct medical costs; $18.2 billion for lost 
productivity due to illness; and $112 billion for loss of productivity 
due to premature death.
  Breast Cancer: Breast cancer death rates have steadily decreased in 
women since 1990. The 5-year relative survival for localized breast 
cancer has increased from 80 percent in the 1950s to 98 percent today. 
If the cancer has spread regionally, the current 5-year survival is 84 
percent.
  Childhood cancer: For all childhood cancers combined, 5-year relative 
survival has improved markedly over the past 30 years, from less than 
50 percent before the 1970s to 80 percent today.
  Leukemia: Death rates have decreased by about 0.8 percent per year 
since 1995. For acute lymphocytic leukemia, the survival rate has 
increased from 42 percent in 1975-1977 to 65 percent in 1996-2003.
  Lymphoma: The 5-year survival rates for Hodgkin's lymphoma has 
increased dramatically from 40 percent in 1960-1963 to more than 86 
percent in 1996-2003. For non-Hodgkin's lymphoma, the survival rates 
have increased from 31 percent in 1960-1963 to 63.8 percent in 1996-
2003.
  Prostate Cancer: Over the past 25 years, the 5-year survival rate has 
increased from 69 percent to almost 99 percent.
  Cardiovascular disease: According to the American Heart Association, 
the estimated direct and indirect cost of cardiovascular disease in the 
United States in 2008 was $448.5 billion.
  Coronary artery disease: Between 1994 and 2004, the number of deaths 
from coronary artery disease declined by 18 percent.
  Stroke: Between 1995 and 2005, the number of stroke deaths declined 
13.5 percent.
  These are tremendous accomplishments and more must be done to build 
on our advancements. We ought to include the $10 billion in stimulus 
money in the NIH base funding level to see to it that the funding was 
not just a one-time shot. The $10 billion that was provided in the 
stimulus package for NIH was for a 2-year period; however, I feel that 
that $10 billion should be added to the $30 billion already 
appropriated in fiscal year 2009. I support a funding level of $40 
billion for fiscal year 2010 which would require raising the 
appropriation by another $5 billion.
  Scientists have approached me with stories of how NIH grant 
applications have skyrocketed since the NIH funding increase in the 
American Recovery and Reinvestment Act and that the boost has 
encouraged a new generation of scientists to dedicate themselves to 
medical research. The effort to increase NIH funding should also be 
matched by an effort to translate scientific discoveries in the 
laboratory to the patient's bedside. To meet this need, I introduced S. 
914, to establish the cures acceleration network--CAN. This $2 billion 
network would be a separate independent agency and would not take 
research dollars away from the NIH. The network would make research 
awards to promising discoveries. The grant projects would also have a 
flexible expedited review process to get funds into the hands of 
scientists as quickly as possible. Drugs or devices that were funded by 
the CAN--would benefit from a streamlined FDA review to speed up the 
approval process for patient use. Implementing this legislation as part 
of health reform would enhance the important research of NIH by 
bridging the chasm between a basic scientific discovery and new health 
care treatments.
  The issue of end of life treatment is such a sensitive subject and no 
one should decide for anyone else what decision that person should make 
for end-of-life medical care. Advanced directives give an individual an 
opportunity to make the very personal decision as to the nature of care 
a person wants at the end of their life. That is, to repeat, a highly 
personalized judgment for the individual.
  Advanced directives should be examined because of the great expense 
of end of life care. Statistics show that 27 percent of Medicare 
expenditures occur during a person's last year of life. Beyond the last 
year of life, a tremendous percentage of medical costs occur in the 
last month, weeks and days. It has been estimated that the use of 
advanced directives could save 6 percent of all Medicare spending or 
$24 billion in 2008.
  Individuals should have access to information about advanced 
directives. As part of a public education program, I included an 
amendment to the Medicare Prescription Drug and Modernization Act of 
2003, which directed the Secretary of Health and Human Services to 
include in its annual ``Medicare and You'' handbook, a section that 
specifies information on advanced directives, living wills, and durable 
powers of attorney. As the former ranking member and chairman of the 
Labor, Health and Human Services, and Education Appropriations 
Subcommittee, I worked to ensure that this information continues to be 
published in the ``Medicare and You'' handbook.
  There are many ways which have been discussed to improve the use of 
advanced directives. One approach could be to increase education for 
beneficiaries. It has also been suggested that filling out an advanced 
directive could be a requirement for joining Medicare. Another 
suggestion I received was to provide a discount on Medicare Part B 
premiums for those who fill out an advanced directive. While efforts to 
inform beneficiaries have improved, including a requirement that the 
issue be discussed at the beneficiaries' introductory Medicare exam, 
more must be done to increase usage of advanced directives. On this 
front, I am eager to explore and analyze the range of possibilities 
while ensuring that individuals and their families' sensitivities 
surrounding the end of life care receive paramount priority.
  Some of the most prevalent diseases of today can be prevented by 
small changes in people's behavior. For example, 30 minutes of moderate 
physical activity each day, the equivalent of a brisk walk, can reduce 
the risk of a heart attack by up to 50 percent. Increasing one's fruit 
and vegetable consumption can reduce the risk of colon cancer by up to 
50 percent. Obese and overweight individuals suffering metabolic 
syndrome and Type 2 diabetes showed health improvements after only 3 
weeks of diet and moderate exercise. Health care reform should include 
policies that encourage people to make responsible decisions about 
their health and create environments to do so. The health benefits are 
real, achievable, measurable, and cost effective.
  One way in which to encourage healthy behavior is through health 
education in schools, which is proven to reduce the prevalence of 
health risk behaviors among young people. For example, health education 
resulted in a 37 percent reduction in the onset of smoking among 7th 
graders. In addition, obese girls in the 6th and 8th grades lost weight 
through a health education program, and students who

[[Page 12662]]

attended a school-based life-skills training program were less likely 
than other students to smoke or use alcohol or marijuana.
  Funding community-based health programs could also be a tenet of 
health reform. In July 2008, the Trust for America's Health stated that 
an investment of $10 per person per year in proven community-based 
programs to increase physical activity, improve nutrition, and prevent 
smoking and other tobacco use could save the country more than $16 
billion annually within 5 years. This is a return of $5.60 for every $1 
invested. Opportunities to save money on the cost of health care 
through education and proactive community based prevention programs 
should be included in health reform legislation.
  Surveying recent caselaw reveals that individual criminals convicted 
of health care fraud can be sentenced to anywhere from 5 to 13 years in 
prison, substantial penalties and supervised release for a period of 
years. In any health care reform proposal, I believe we must address 
the significant potential for people of ill will and profit motives to 
defraud the Government at the expense of the taxpayers. Therefore, I 
will push hard for enhanced sentences with real jail time for white 
collar fraudsters. As the chairman of the Crime and Drug Judiciary 
Subcommittee, I will push for consideration of sentencing enhancements 
as at least one alternative and, where appropriate, lengthy jail 
sentences where the financial losses to the Government are great. It 
would be intolerable for criminals to defraud the Government of 
millions of dollars only to have to pay a fine that amounts to the cost 
of doing business.
  According to the National Insurance Crime Bureau and the National 
Health Care Anti-Fraud Association, the annual loss from health fraud 
is 10 percent of the $2.2 trillion spent annually on health care, or 
$220 billion. This amount of fraud must be identified and warrants real 
jail time, which should be taken up in this reform.
  Health care reform provides an opportunity to correct a longstanding 
problem in the Medicare payment system. In determining the payments to 
hospitals for services, Medicare takes into account the location of a 
hospital and how much those employees are paid. It is understandable 
that some areas of the country, where the cost of living is higher, 
should be reimbursed at higher levels. However, the current system has 
led to many imbalances that have left some areas of the country 
disadvantaged. In Pennsylvania, for example, the Scranton--Wilkes-Barre 
area and Allegheny Valley have received decreasing Medicare payments, 
which have forced a pay reduction to employees and a reduction in 
services to patients that rely on them.
  Last year, the Medicare Payment Advisory Commission--MedPAC--released 
a report calling for the system to be reformed. The commission stated 
that the current system created ``cliffs'' in payments, which resulted 
in arbitrary changes in payments in neighboring areas. These 
disparities can affect competition for employees and will harm services 
to Medicare beneficiaries. This legislation must include the reforms 
supported by MedPAC to correct this serious problem of inequity.
  The health care crisis in our country endangers the health of our 
people, our economic viability and our future stability. Now, more so 
than ever before, it is critical that we pass legislation to ensure all 
Americans have access to quality and affordable health care. This 
undertaking requires prompt and effective action. I remain open to 
ideas on how to accomplish this exceptional task and look forward to 
working with my colleagues to determine the best path to do so.
  In the absence of any Senator seeking recognition, I suggest the 
absence of a quorum.
  The ACTING PRESIDENT pro tempore. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. DORGAN. I ask unanimous consent that the order for the quorum be 
rescinded.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.
  Mr. DORGAN. Mr. President, I ask unanimous consent to speak in 
morning business for such time as I may consume.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.

                          ____________________