[Congressional Record (Bound Edition), Volume 155 (2009), Part 16]
[Senate]
[Pages 21586-21596]
[From the U.S. Government Publishing Office, www.gpo.gov]




  TRANSPORTATION, HOUSING AND URBAN DEVELOPMENT, AND RELATED AGENCIES 
                  APPROPRIATIONS ACT, 2010--Continued


                           Amendment No. 2366

  Mr. DURBIN. Mr. President, I rise to speak in opposition to the 
Wicker amendment, No. 2366, pending before the Senate on the THUD bill, 
as it is known around here--the Transportation, Housing and Urban 
Development bill. This is a bill which obviously includes Amtrak. 
Senator Wicker, of Mississippi, has offered an amendment which relates 
directly to the funding for Amtrak and whether it will be cut off.
  The Senator from Mississippi says in his amendment he would cut off 
all Federal transportation funding for Amtrak in the next fiscal year 
unless Amtrak allows its passengers to transport guns in their checked 
baggage. This amendment would essentially impose upon Amtrak the 
standards for checking guns and ammunition that currently applies to 
airplanes. However, planes and trains have very different systems for 
handling checked baggage and different security concerns.
  Let's talk about the effect of the Wicker amendment. Amtrak has said 
it is not ready to allow guns and ammunition to be transported in 
checked baggage. Amtrak doesn't have the security infrastructure, the 
processes or the trained personnel in place to ensure that checked 
firearms would not be lost, damaged, stolen or misused. Senator Wicker 
is imposing a new burden on the Amtrak train system in America--clearly 
an unfunded mandate--so some passengers--I don't know how many--can 
check firearms in their baggage. If this amendment becomes law, Amtrak 
would have to let guns checked in baggage onboard, regardless of the 
fact that they aren't prepared for this, or they forfeit Federal 
transportation funding that the railroad desperately needs to provide 
services to millions of Americans.
  I understand the Senator from Mississippi is going to modify his 
amendment to provide for a March 2010 effective date, which, in effect, 
gives about 5 or 6 months for Amtrak to hire additional security 
personnel, to buy the equipment or create the equipment for this 
checked baggage and to establish procedures at all the Amtrak stations 
across America so some people can check a firearm on an Amtrak train. I 
don't know if 6 months is feasible for Amtrak to make such a 
significant policy change.
  Why is the Senator from Mississippi determined that we have to, in 6 
months, make sure that any American who legally owns a gun can take it 
with them on an Amtrak train in checked baggage? Shouldn't we take the 
time to take a look at this and consider the basic questions of safety 
and cost before we vote for this?
  Amtrak's current policy prohibits any type of firearm, explosive or 
weapon from being checked or carried on in baggage. This policy was put 
in place in the year 2004. Do you want to know why Amtrak put this 
policy in place in 2004? It was after the Madrid, Spain, train attack 
that killed 191 people and wounded 1,800 more. Amtrak's reasons for 
this policy were clear--safety and security. It was put in place in the 
aftermath of terrorist attacks that claimed lives.
  Let me quote from a statement issued by Amtrak on its current policy.

       Amtrak accepted firearms in baggage in checked baggage at 
     one time. Weapons had to be separately secured in baggage or 
     containers. However, after the terrorist attacks of September 
     11, 2001, Amtrak began to place restrictions on the carriage 
     of weapons on Amtrak trains. In 2004, the review and 
     evaluation of numerous security measures occurred again after 
     the attack on passenger trains in Madrid, Spain, on March 11, 
     2004. The purpose of this policy revision was to better 
     ensure the safety and security of Amtrak passengers and 
     employees. Amtrak decided to implement a total weapons 
     prohibition, including firearms. The only exception was for 
     sworn law enforcement personnel. Today, that policy is still 
     in effect.

  That exception is reasonable--for sworn law enforcement personnel. 
But the Senator from Mississippi wants to go beyond that. He wants to 
allow anyone who legally owns a gun in America--and I might tell you 
that the standards in many States are not that high for the ownership 
of firearms--to impose upon Amtrak an obligation to check baggage with 
an unloaded firearm in a container, as specified, and that Amtrak has 
to set up the process for that passenger, regardless of the cost to 
Amtrak, which incidentally neither the Senator from Mississippi nor 
anyone else on the Senate floor knows. We have no idea what this is 
going to cost.
  This amendment simply disregards the risk assessment that Amtrak 
conducted for the security of our rail network. It calls for 
eliminating all funding for Amtrak unless they adopt the policy on 
checking firearms in baggage the Senator from Mississippi is insisting 
on.
  The stakes for Amtrak are enormously high. In the current fiscal 
year, Congress has appropriated $1.49 billion for Amtrak's operations 
and capital improvements. This amendment would say Congress couldn't 
give $1 to Amtrak unless it changes the policy, as the Senator from 
Mississippi insists.

[[Page 21587]]

  Well, I can tell you what Amtrak means to my State of Illinois. With 
the increasing cost of gasoline, more and more people are relying on 
Amtrak. Thank goodness they are. Using Amtrak trains means fewer cars 
on the highway and less pollution. Families are saving money. It is a 
godsend for those who use them in college towns--sending their kids to 
school and letting the kids return using the trains.
  In Senator Wicker's home State of Mississippi, Amtrak had a ridership 
of 100,000 people last year. That number isn't as large as the 4.4 
million in my home State, but it is a fair number of people in 
Mississippi who found it convenient to ride on Amtrak trains. Last 
year, Amtrak employed 72 people in Mississippi and paid out over $4.5 
million in wages. The Senator from Mississippi says: If you don't 
accept my amendment to allow firearms in checked baggage, close it 
down.
  Nationwide last year, 28.7 million passengers rode on Amtrak--an 
average of more than 78,000 passengers per day. Amtrak employs nearly 
18,000 people nationwide with good jobs, but the Senator from 
Mississippi would rather see Amtrak's funding, riders, and employees 
cast aside unless he is satisfied that Amtrak's checked baggage policy 
allows people to take firearms onto trains.
  Besides concerns about terrorism, there are legitimate safety 
concerns with permitting weapons in checked bags on trains. Amtrak 
doesn't have the personnel, systems or security infrastructure needed 
to manage firearms aboard passenger trains. Amtrak cannot effectively 
safeguard against theft, loss, damage or misuse of transporting guns. 
Does the Senator from Mississippi expect Amtrak to assign someone to 
the baggage car to guard the suitcases that may contain the firearms? 
If he does, how is he going to pay for that?
  Passenger trains do not have nearly the baggage handling safeguards 
that airplanes do. Checked baggage on trains is carried in a separate 
train car. I wish to tell you, most of the rolling stock of Amtrak is 
decades old and certainly these baggage cars are as well. They were 
never designed with this level of security in mind. These train baggage 
cars are much easier to access during transit and in stations than the 
checked baggage compartments of airlines. That is fairly obvious.
  In addition, Amtrak trains stop much more frequently than airplanes, 
which creates more opportunities for access and theft and misuse of 
firearms in checked baggage. In fact, checked luggage is often unloaded 
and presented to passengers on the platform rather than a remote, 
secure baggage pickup area. In order to screen and capably manage 
checked firearms, Amtrak would need to significantly revise its baggage 
handling operations and the training of its personnel.
  What about special situations, such as when there is a homeland 
security alert due to specific threats against our rail network? There 
is not one word in the amendment of the Senator from Mississippi about 
how to deal with these homeland security threats when it comes to 
firearms and checked baggage. Should Amtrak be required to allow 
weapons on trains when there is a terrorism alert?
  I wish to know if the Senator from Mississippi ever considered that. 
I know it didn't come up in a hearing on this amendment because there 
has never been a hearing on this amendment.
  A serious effort at revising Amtrak's weapons policy would include an 
assessment of these safety and security issues. A serious legislative 
effort at revising Amtrak's weapons policy would also look at the cost 
this amendment imposes on Amtrak. There is a lot of criticism on the 
floor about spending and deficits. Here we have an unfunded mandate on 
Amtrak because at least one Senator--perhaps others join him--believes 
it is a good idea that people could show up at the Amtrak station and 
check their firearms. Are the people willing to pay more, every 
passenger pay more for tickets, so that person can have a guard on the 
checked baggage in the baggage car with the firearms in place? We 
regularly hear concerns about Federal spending, particularly from the 
other side of the aisle. But the Wicker amendment imposes significant 
security costs that would have to be absorbed by Amtrak. They may have 
to cut back in services or raise ticket prices to absorb the cost of 
this effort, because at virtually every Amtrak station in America they 
have to be prepared, with the Wicker amendment, to take on firearms as 
checked baggage.
  There have been no hearings on this amendment. The Senate has not 
given Amtrak or law enforcement or Homeland Security, or the baggage 
handling unions, or anyone affected by this amendment, the opportunity 
to even consider it and testify.
  Given time, given the opportunity to work with these stakeholders, we 
may be able to work out some kind of understanding that accommodates 
the concerns of the Senator from Mississippi, but the amendment we have 
before us is not a responsible approach to this challenge. To think 
that we would allow one person at one station to impose a burden and 
expense on Amtrak to be borne by every other passenger, to me, in this 
age of terrorism, is difficult to explain and impossible to accept.
  I urge my colleagues to think twice about this amendment. I know the 
political force behind gun amendments, but this goes too far. If it is 
a good idea, why doesn't it go through the ordinary process here? At 
least have a hearing and answer the basic questions I have raised and 
others have raised during the course of consideration of this 
amendment.
  I yield the floor.
  The PRESIDING OFFICER (Mr. Lautenberg). The Senator from Kansas is 
recognized.
  Mr. BROWNBACK. Mr. President, I rise to speak as in morning business. 
I ask unanimous consent to speak as in morning business for up to 10 
minutes.
  The PRESIDING OFFICER. Without objection, it is so ordered.


                       WTO Airbus Interim Ruling

  Mr. BROWNBACK. Mr. President, this issue is actually one that is 
related to the bill but it is not on point, so that is why I asked for 
that permission.
  Earlier this month, the World Trade Organization issued an interim 
ruling that the European Union's ``launch aid'' to Airbus is illegal. I 
say this is relating to the bill because a major transportation issue 
for us in the United States is the building of major aircraft, of 
aircraft to be able to transport individuals. What we have seen taking 
place over the last 15 years is Airbus subsidizing their way into the 
commercial aviation market and taking market share from Boeing and 
driving McDonnell-Douglas and other competitors out of the field 
altogether.
  Earlier this month, about 2 weeks ago, the World Trade Organization 
issued a major finding that the European Union was doing illegal launch 
aid as a subsidy and it was harming U.S. participants in this 
marketplace. This ruling is a big one for the Office of the U.S. Trade 
Representative, which has been pursuing this case for years. U.S. trade 
policy regarding the aerospace industry has been remarkably consistent 
for years and across several administrations.
  The United States has always contended that the launch aid which the 
EU provides to Airbus to develop new aircraft constitutes an illegal 
trade practice. Airbus's dishonest behavior has had a devastating 
effect on the commercial aviation industry in the United States. Launch 
aid gives Airbus access to billions in government funds which it could 
never afford to borrow on commercial terms. This free money directly 
harms the United States and our competitors in these fields. As the 
USTR pointed out in a 2006 submission to the World Trade Organization, 
launch aid helped force Lockheed and McDonnell-Douglas from the large 
commercial aircraft market. It forced them out of the field because of 
government subsidy by Europe.
  Launch aid has also contributed to a loss of 19 percent of Boeing's 
market share. Imagine two of your main competitors are forced out of 
the field, Lockheed and McDonnell-Douglas, and you lose 19 percent of 
market share, because of a European subsidization in

[[Page 21588]]

this field. This has harmed the United States substantially, in a big 
way, and this is a huge ruling for us.
  This WTO interim ruling is a big win for the United States and U.S. 
companies that have had to deal with dishonest behavior by Airbus over 
the years--or at least it should be a big win. For years the Department 
of Defense has said it cannot consider foreign subsidies when it holds 
a competition for defense procurements. In particular, DOD has said it 
would not consider launch aid last year when it evaluated the cost of 
the Airbus proposal to build a new aerial refueling tanker for the Air 
Force.
  So here we have a case, supported by administrations, Republican and 
Democrat, over several years against Airbus that comes out in our favor 
from the WTO, and the next big bid this may come into effect in is in 
the military bidding of this tanker, the $40 billion U.S. Department of 
Defense tanker bid. The Department of Defense is saying we cannot 
consider the issue of launch aid.
  I think that is wrong. I think it is wrongheaded. I think it is 
harmful and I think it is at cross purposes for our government, where 
one end of the government, the U.S. Trade Representative office, sues 
Airbus for subsidization and the other end, the Department of Defense, 
says we don't care, and if you give us a cheaper aircraft that way, 
that is fine. That is at cross purposes, and I think clearly what we 
should listen to is what the WTO has said, that this launch aid is 
illegal and it should not be allowed to use it to subsidize a military 
bid in this country by a foreign competitor.
  Last year the Air Force chose Airbus to build the tanker because the 
cost seemed very low. But now we know that the Airbus pricetag covered 
up development costs that were illegally subsidized by the EU, and we 
have that from a World Trade Organization interim ruling.
  The Department of Defense, I believe, has an obligation to listen to 
the Office of the U.S. Trade Representative when designing a new tanker 
competition. Defense procurement should be coordinated with our trade 
policy. If the WTO agrees with arguments made by the U.S. Trade 
Representative, why should the Department of Defense, our Department of 
Defense, be allowed to object? We cannot afford to have the Pentagon 
undermining our Trade Representative and our trade policy negotiating 
position at the World Trade Organization. We have seen how launch aid 
to Airbus distorts the commercial aircraft market, driving two major 
U.S. competitors out of the field and cutting back Boeing's share of 
the marketplace by nearly 20 percent. The WTO ruling should keep us 
from relearning that lesson in the military marketplace as well. 
Defense contracts should never stack the deck against American 
companies, particularly when the WTO foreign companies are engaged in 
illegal trade practices.
  Everyone agrees that the Air Force needs new tankers. In this current 
fleet of tankers, many of the planes are already over 50 years old, and 
when they are finally replaced some of them will be 80 years old and 
will still be out there flying. They need to be replaced. Tankers are a 
vital platform for the Air Force and for all of our Armed Forces. They 
enable the rest of our forces to deploy across the world. Taxpayers 
have a right to expect a new tanker competition will have a level 
playing field, particularly for U.S. entrants.
  We should not ask taxpayers to ignore the illegal trade practices of 
companies vying to build a new tanker and we should not ask taxpayers 
to outsource this crucial capability to a foreign company offering 
unrealistic, bought-down-by-the-Government-subsidy bargain basement 
prices, subsidization from the French Government, from the German 
Government, to get a U.S. military contract that puts our workers out 
of jobs.
  I call on the Secretary of Defense to ensure the new tanker 
competition accounts for the recent ruling from the World Trade 
Organization. DOD should factor the value of launch aid subsidies into 
the cost estimates for any tanker proposal Airbus might submit. This is 
the only fair way to account for the way Airbus manipulates the 
aircraft market and has done so successfully in the commercial aviation 
field to the great detriment of the United States.
  I call on the President to ensure Federal procurements are 
coordinated with U.S. trade policy. This kind of coordination should be 
a no-brainer. Our trade policy should not be undermined from within and 
our procurement policies should reflect our trade priorities.
  This is a key issue. It is a key issue up in front of the military. 
It is a key economic development issue for this country. It is a key 
contract, a $40 billion military contract. It should be won fairly and 
squarely by a U.S. company, not by a subsidized European group.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Tennessee is recognized.
  Mr. ALEXANDER. Mr. President, I ask to speak as in morning business.
  The PRESIDING OFFICER. Without objection, it is so ordered.


                            ENERGY CHALLENGE

  Mr. ALEXANDER. Mr. President, today I want to challenge two popular 
misconceptions in the Waxman-Markey climate change and energy bill that 
is now before the Senate after passing the House of Representatives.
  The first is the idea that deliberately raising energy prices will 
somehow be good for job growth and the economy.
  The second is that, whatever the problems created by Waxman-Markey, 
they can mostly be resolved by building more windmills.
  Waxman-Markey started out as a bill to reduce carbon emissions in 
order to deal with climate change. It has ended up as a $100-billion-a-
year energy tax nailed to a renewable energy mandate that will saddle 
consumers with expensive energy for years to come. Instead of a broad-
based, national clean energy policy, Waxman-Markey has given us a 
narrow, expensive national windmill policy.
  I believe cheap energy means good jobs.
  My perspective, of course, comes from Tennessee, where Alcoa has shut 
down its smelter where my Dad worked. They are waiting for a cheaper 
electricity contract from the Tennessee Valley Authority. Goodman, a 
company in Fayetteville that makes a large percentage of all the air 
conditioners in the United States, tells me that if their electricity 
prices go up too much then those jobs will go overseas. Eastman 
Chemical employs 7,000 Tennesseans and uses coal as a feedstock. The 
company says if Waxman-Markey goes through they too might be headed 
overseas. The Valero refinery in Memphis employs 600 people refining 
fuels, including jet fuel for Federal Express at its Memphis hub. 
Waxman-Markey would cost Valero $400 million or more per year. Today 
its profits are $40 million per year at that refinery.
  We have two big supercomputers at the Oak Ridge National Laboratory 
in part because of our abundance of low-cost electricity. Just one of 
these machines consumes 7 megawatts. Nationwide, computers use 5 
percent of our electricity and it is still growing.
  Our Governor has attracted two manufacturing plants to make 
polysilicon for solar cells--these are the ``green jobs'' everyone 
loves to talk about. Each of those plants uses 120 megawatts. If they 
are going to make affordable solar cells, they can't pay high 
electricity costs.
  A third of Tennessee's manufacturing jobs are in auto manufacturing. 
Auto parts suppliers watch their costs, including electricity costs, 
and if they go up too much they will be making auto parts in Mexico and 
Japan instead of Tennessee and Michigan.
  Last December 10 percent of Nashvillians, even with TVA's relatively 
low residential electric rates, said they couldn't afford to pay their 
electric bills.
  So let's step back for a moment and ask; What kind of America are we 
trying to create with this climate-change and energy bill? I suggest we 
want an America in which we have enough clean, cheap, and reliable 
energy to create good jobs and run a prosperous industrial and high-
tech society. In order to support the American economy that creates 
about 25 percent of

[[Page 21589]]

the world's wealth, we need to produce about 25 percent of the world's 
energy.
  We want an America in which we are not creating excessive carbon 
emissions and running the risk of encouraging global warming.
  We want an America with cleaner air--where smog in Los Angeles and in 
the Great Smoky Mountains is a thing of the past--and where our 
children are less likely to suffer asthma attacks brought on by 
breathing pollutants.
  We want an America in which we are not creating ``energy sprawl'' by 
occupying vast tracts of farmlands, deserts, and mountaintops with 
energy installations that ruin scenic landscapes. The great American 
outdoors is a revered part of the American character. We have spent a 
century preserving it. We do not want to destroy the environment in the 
name of saving the environment.
  We want an America in which we create hundreds of thousands of 
``green jobs'' but not at the expense of destroying millions of red, 
white, and blue jobs. It doesn't make any sense to employ people in the 
renewable energy sector if we are throwing them out of work in 
manufacturing and the high tech sector.
  That is what will happen if these new technologies raise the price of 
electricity and send manufacturing and other energy-intensive 
industries overseas searching for clean energy.
  We want new, clean, energy-efficient cars, but we want them built in 
Michigan and Ohio and Tennessee, not Japan and Mexico. We want an 
America where we are the unquestioned champion in cutting-edge 
scientific research and lead the world in creating the new technologies 
of the future. We want an America capable of producing enough of our 
own energy so we cannot be held hostage by some other energy-producing 
country. None of those goals are met by Waxman-Markey.
  This bill produces a huge new tax on the economy. In addition, it 
requires 15 percent of our electricity to come from a narrowly defined 
group of renewable sources defined as wind, solar, geothermal, and 
biomass. While promising and intriguing, we cannot expect renewable 
energy to do anything more in the foreseeable future than to supplement 
our current base load electricity production. It cannot replace it. 
What the Waxman-Markey bill proves, once again, is that one of 
government's biggest mistakes is taking a good idea, renewable energy, 
and expanding it until it does not work anymore.
  Republican Senators have a better idea: Produce more American energy 
and use less.
  First, we should build 100 new nuclear reactors over the next 20 
years, just as we did from 1970 to 1990. That would double our level of 
nuclear generation to 40 percent of our electricity. Add 10 percent for 
Sun and wind and other renewables, another 10 percent for 
hydroelectric, maybe 5 percent more for natural gas. By 2030, we begin 
to have a low-cost, low-carbon, clean energy policy that also puts us 
within sight of meeting the goals of the Kyoto Protocol on global 
warming.
  Step two is to electrify half of our cars and trucks. I think we can 
do it within 20 years. This should reduce our dependence on foreign oil 
by one-third, clean the air, and keep fuel prices low. According to 
estimates by the Brookings Institution scholars, we could do this with 
the unused nighttime electricity we have today without building one new 
powerplant.
  Step three is to explore offshore for natural gas, which is low 
carbon, and oil. We should use less but more of our own.
  The final step is to double funding for energy research and 
development and launch mini-Manhattan Projects like the one we had in 
World War II to meet seven energy challenges: improving batteries for 
plug-in vehicles, making solar power cost competitive, making carbon 
capture a reality, safely recycling used nuclear fuel, perfecting 
advanced biofuels, designing green buildings, and providing energy from 
nuclear fusion.
  Basically, our policy should be to conserve and use our nuclear gas 
and oil resources until we figure out how to make renewable and 
alternative energies more reliable and cost competitive.
  Instead of following this simple, fourfold, low-cost clean energy 
strategy, the Obama administration wants to spend tens of billions of 
dollars covering an area the size of West Virginia with 50-story wind 
turbines while it squirms uncomfortably at every mention of nuclear 
power.
  According to the San Francisco Chronicle last week:

       The Department of Energy is starting a new partnership with 
     the nation's six largest wind turbine manufacturers in an 
     effort to provide 20 percent of the nation's energy from wind 
     by 2030.

  In his inaugural address, the President spoke eloquently of powering 
the country with the wind, the Sun, and the Earth.
  In June, the Wall Street Journal asked Boone Pickens, Amory Lovins, 
Al Gore, and President Obama how to reduce dependence on foreign oil 
and contribute less to climate change. These 4 came up with 24 
suggestions, from placing veterans in green jobs to generating 20 to 30 
percent of electricity by wind, but made not one mention of nuclear 
power.
  Over the next 10 years, the wind industry will receive direct Federal 
taxpayer subsidies of about $28 billion, according to the congressional 
Joint Committee on Taxation. Most of this cost is due to the renewable 
production tax credit that is worth about 3 cents per kilowatt hour to 
wind developers and costs taxpayers $26 billion. Fully 75 percent of 
the renewable tax credit goes to wind. Solar, geothermal, biomass, and 
hydropower combined make up the remaining 25 percent. There will be $1 
billion for construction subsidies through clean renewable energy 
bonds. There will be an investment tax credit for residential and small 
industrial wind turbines. There will be accelerated depreciation of 
small wind turbines. Plus, there will be $11 billion provided by the 
stimulus for building the ``smart grid'' and new transmission lines. 
The North American Electric Reliability Corporation tells us the entire 
U.S. grid needs upgrading, but the transmission projects announced so 
far will all go to bringing wind and solar electricity from remote 
places to population centers.
  All this does not even mention the Waxman-Markey renewable energy 
mandate, which will have the practical effect of forcing utilities in 
many States to buy government-subsidized wind energy they do not 
necessarily need from far-away States with better wind resources.
  Let me give you an example. Between 2000 and 2004, the TVA 
constructed a 30-megawatt wind farm on Buffalo Mountain in Tennessee at 
a cost of $60 million. It is the only wind farm in the Southeast. You 
will read in the papers that having a 30-megawatt wind farm means 
generating 30 megawatts of electricity. That is only what they call its 
``nameplate capacity.'' That is not real output. In practice, Buffalo 
Mountain has only generated electricity 19 percent of the time since 
the wind does not blow very much in the Southeast. That means TVA is 
paying $60 million over 20 years to generate 6 megawatts of 
electricity. Multiply this out, and you will see it means spending $10 
billion to generate 1,000 megawatts, which makes Tennessee's wind mills 
more expensive than the costliest nuclear reactor.
  TVA considers the Buffalo Mountain wind farm to be a failed 
experiment. In fact, looking for wind power in the Southeast is a 
little like looking for hydropower in the desert. Nevertheless, Waxman-
Markey will now force TVA and every other utility in the country to get 
at least 12 percent of their electricity from a narrowly defined group 
of renewable sources. Hydroelectric dams, for example, probably the 
best source of renewable energy, do not count because--well, I am not 
sure exactly why. But environmental groups have been opposing them 
since the 1950s. Nuclear does not count as renewable, either, even 
though we have plenty of uranium and reprocessing the fuel could 
stretch it out for hundreds of years. Instead, the TVA is now 
requesting bids for 1,250 megawatts of renewable power that it does not 
really need and may not be able to use.

[[Page 21590]]

  Wind now produces 1.3 percent of America's total electricity and 4.5 
percent of our carbon-free clean electricity. Yet, according to the 
Energy Information Administration, wind turbines are being subsidized 
at 30 times the rate of all other renewables and 19 times the rate of 
nuclear power, which, by the way, provides 70 percent of our carbon-
free, clean electricity.
  So instead of a clean, broad-based energy policy or even a clean, 
renewable energy policy, what we have in practice is a national 
windmill policy. But wait a minute. They tell us all this is not really 
about producing clean, cheap energy; it is about creating green jobs. 
There are two problems with this argument. First, there must be at 
least as many welders, mechanics, construction workers, and engineers 
who would be employed in building 100 new nuclear plants during the 
next 20 years as in all the so-called renewable energies together. 
Second, while there may be hundreds of thousands of green jobs, there 
are tens of millions of red, white, and blue jobs in America that will 
be quickly lost because of rising energy prices.
  Let's look at California. The Golden State has been imposing 
renewable energy mandates for years. It has not built a base load coal 
or nuclear plant in 20 years. Meanwhile, it has built renewables, 
renewables, and renewables, with plenty of expensive natural gas to 
back them up. All of this contributed mightily to the California 
electricity shortage of the year 2000. Now the State has the highest 
electricity prices in the continental United States west of Washington, 
DC. Manufacturers are leaving in droves. Even Google and Yahoo are 
building their server farms elsewhere. With all of this job loss, the 
State had an 11.9-percent unemployment rate in July and, until 
recently, a $28 billion budget gap. Its bond rating is now the lowest 
of the 50 States.
  I cannot believe the high cost of electricity in California has not 
contributed to all of this. Has this tempered the State's enthusiasm 
for expensive renewable energy? Apparently not. California lawmakers 
are developing legislation to increase the current 20 percent renewable 
standard to 33 percent by 2020. State energy agencies have concluded it 
could cost $114 billion or more to meet the 33 percent mandate, more 
than double what the original 20 percent requirement cost. That comes 
to $3,000 per Californian.
  Yet, according to the Wall Street Journal's news page on July 3 of 
this year:

       The state auditor warned this week that the electricity 
     sector poses a ``high risk'' to the state economy. A staff 
     report from the state energy commission also warns that 
     California can find itself uncomfortably tight on power by 
     2011 if problems continue to pile up.
       Utilities complain that the ambitious renewable-energy 
     mandates, combined with tougher environmental regulations on 
     conventional plants, are compromising their ability to 
     deliver adequate power. ``Conflicting state policies are a 
     problem,'' said Stewart Hemphill, senior vice president of 
     procurement at Southern California Edison.

  Renewable energy is intriguing and it is useful. But today it is 4 
percent of our electricity. It has many challenges. What many people 
forget is that wind and solar energy is only available, on average, 
about one-third of the time. And electricity today cannot be stored in 
commercial quantities with current technologies; you either use it or 
you lose it.
  When you see 1,000 megawatts of wind and solar power reported in the 
newspaper, remember it is only about 300 megawatts because these 
sources only produce electricity about one-third of the time, compared 
to American nuclear plants producing electricity 90 percent of the 
time.
  Denmark, with the world's biggest percentage of wind power, claims to 
get 20 percent of its electricity from wind. Yet it still produces 47 
percent of its power with coal and imports more than 25 percent of its 
electricity from Sweden and Germany. Moreover, it is not clear that its 
carbon emissions have decreased at all over the last 10 years. Worse 
yet, because of wind variability, Denmark must export almost half of 
its wind power to Germany and then import nuclear and hydropower back 
from Germany, Sweden, and Norway.
  Then there is what conservation groups are calling energy sprawl and 
which we are only beginning to come to grips with. One nuclear plant 
generates 1,000 megawatts and occupies 1 square mile. One big solar 
thermal plant with giant mirrors generating the same 1,000 megawatts in 
the western desert will occupy 30 square miles. That is more than 5 
miles on a side. To generate the same 1,000 megawatts with wind, you 
would need 270 square miles of 50-story wind turbines. That is an area 
more than four times the size of Washington, DC, or that is an unbroken 
line of turbines along our ridgetops from Johnson City, TN, to 
Harrisburg, PA. If wind farms move offshore, you would need to line the 
entire 127-mile New Jersey coast with windmills 2 miles deep just to 
replace one nuclear reactor that sits on a square mile.
  We have not even talked about when these wind farms outlive their 
useful life cycle of 20 years or so. Who is responsible for their 
removal? We have already seen this problem in Hawaii and Altamonte Pass 
in California. The developers should be required to put up bonds to 
ensure these turbines are taken down in case the developers walk away.
  For those of us in the Southeast where the wind blows less than 20 
percent of the time, they say use biomass, which means burning wood 
products in sort of a controlled bonfire. That is a good idea as far as 
it goes. It might conserve resources and reduce forest fires, but we 
would need a forest 1\1/2\ times the size of the 550,000-acre Great 
Smoky Mountain National Park to feed a 1,000-megawatt biomass plant on 
a sustained basis. It would take hundreds of trucks each day to deliver 
the wood to the biomass plant. It is hard for me to see how this 
reduces carbon emissions.
  Already we are beginning to see the problems. Boone Pickens, who said 
wind turbines are too ugly to put on his own ranch, recently postponed 
what was to be America's largest wind farm because of the difficulty of 
building transmission lines from west Texas to population centers. The 
Sacramento Municipal Utility District pulled out of another huge 
project to bring wind energy from Sierra Nevada for the same reasons. 
The transmission lines were meeting too much opposition, particularly 
from environmentalists.
  We hope renewable energy can be reliable and low cost enough to 
supplement, but when we are talking about using wind energy as a 
substitute for base load energy, we haven't thought about what it is 
going to look like in practice.
  In conclusion, let's take a look at the true source of base load 
electricity, nuclear power. Nuclear power already produces 20 percent 
of our electricity and 70 percent of our carbon-free electricity. It is 
so profitable, there is enough to pay back construction loans and still 
have low rates. For example, TVA's Brown's Ferry will be repaid in 3 
years not 10 as had been expected. Nuclear power receives very little 
in the way of Federal subsidies. All 100 plants built between 1970 and 
1990 were built with private funds. The Price-Anderson insurance 
program for nuclear plants has never paid a penny of taxpayer money in 
insurance claims.
  There are other myths surrounding nuclear power besides subsidies. We 
need to dispel those. Nuclear opponents claim we don't know what to do 
with the fuel. That is not true. Scientists, including the 
administration's Nobel Prize winning Secretary of Energy, Dr. Chu, 
tells us we can store used fuel safely onsite for 40 to 60 years while 
we work out the best way to recycle the used fuel.
  We can't wait any longer to start building our future with clean, 
reliable, and affordable energy. The time has come for action. We can 
revive America's industrial and high-tech economy with the technology 
we already have at hand. The only requirement is that we open our minds 
to the possibilities and potential of nuclear power. As we do, our 
policy of cheap and clean energy based on nuclear power, electric cars, 
offshore exploration, and doubling the energy research and development 
will help family budgets and create jobs. It will also prove to be the 
fastest way to

[[Page 21591]]

increase American energy independence, to clean the air, and to reduce 
global warming.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Minnesota.
  Ms. KLOBUCHAR. I ask unanimous consent to speak as in morning 
business for up to 15 minutes.
  The PRESIDING OFFICER. Without objection, it is so ordered.


                              Health Care

  Ms. KLOBUCHAR. Mr. President, I will be speaking about health care, 
but I did want to note, I was listening to my colleague and friend from 
Tennessee. I have invited him before, but in Minnesota we think our 
wind turbines are so beautiful, we have opened a bed and breakfast near 
Pipestone. Come, stay overnight, and wake up in the morning and look at 
a wind turbine. I guess it is all in the eye of the beholder. We are 
excited about the power that wind has brought to our State.
  I wish to address the very important issue of health care. I first 
want to commend my colleague who is here with me today, Senator 
Cantwell, for her commitment to passing a proconsumer health care bill 
that is focused on reducing cost so that it makes health care more 
affordable to all people.
  I rise to speak about an issue that is an economic imperative--true 
reform in the way we pay for health care. If we don't act, costs will 
continue to skyrocket. The country spent $2.4 trillion on health care 
last year alone; that is, $1 out of every $6 spent in the economy was 
spent on health care. By 2018, national health care spending is 
expected to reach $4.4 trillion, over 20 percent of our entire economy. 
These costs are breaking the backs of our families and businesses. 
Premiums have doubled in just the last 10 years.
  We can see from this chart, in 1999, single coverage and family 
coverage. For single coverage in 1999, the premium was $2,196, the 
premium an individual would pay. Now it is up to $4,704. A family in 
1999 paid $5,791. Now they are paying $12,680, a doubling of the 
premiums for families. All of the statistics, all the studies show if 
we don't do anything, if we just put our heads in the sand, we will see 
a doubling of those premiums again.
  A recent study by the Council of Economic Advisers found that small 
businesses pay up to 18 percent more than large businesses to provide 
health care insurance for their employees, often forcing these 
businesses to lay off employees or cut back on coverage.
  I met with farmers today. I have met with cattle ranchers. I met with 
people who are farming and trying their best--self-employed. I have met 
with a small business up in northern Minnesota in Two Harbors called 
Branite Gear, a backpack company. They make fine backpacks for our 
troops. Do you know how much the owner of that company now pays for 
health care for his family of four: $24,000. He said he now employs 15 
people. If he would have known this back 15 years ago, when he started 
that company, he wouldn't have started it then. He is proud of that 
company, but his small business cannot afford to pay this kind of 
money.
  These costs are also breaking the backs of American taxpayers. At the 
current rate of spending, Medicare, such a crucial program for our 
seniors, a safety net, something they must have, is scheduled to be in 
the red by the year 2017. So those people who are 55 years old and want 
to have Medicare should care about cost reform. If you are 65 years old 
and you plan to live a great life until you are 95 or 100, you should 
care about a strong Medicare that isn't going in the red.
  A recent Congressional Budget Office estimate shows that the majority 
of the projected $344 billion increase in Federal revenues in 2010 are 
scheduled to go automatically to cover the rising cost of health care. 
To put it simply, my bottom line for health care reform is that we must 
get our money's worth from our health care dollars. Right now that is 
not happening.
  With 92 percent of our population covered, Minnesota is fortunate to 
have one of the highest coverage rates of health insurance in the 
country. Part of that is we have very good health care. We have a lot 
of nonprofit health care insurance agencies. We also have Minnesota 
Care which extends coverage to so many of our people who can't afford 
it. As any Minnesota family or business knows, the price of health 
insurance coverage has been going up faster than almost anything else, 
much faster than wages. People are worried about the stability of their 
coverage. That is where I have found unity between Democrats, 
Republicans, and independents. People want stability. They don't want 
to be thrown off because their kid gets sick. They want coverage, and 
they want their kid to have coverage. If they change jobs, they want to 
keep their coverage, and they also want more affordable health care.
  I have been pressing Senate colleagues and the administration to make 
sure we have reform that results in more affordable and more accessible 
health care coverage. The problem is, we are paying too much. We are 
not getting a good return all the time on what we pay. The solution 
must be to get the best value for our health care dollars; otherwise, 
costs will continue to wreak havoc on the budgets of government, 
businesses, and individual families.
  The root of the problem is that most health care is purchased on a 
fee-for-service basis so more tests and more surgeries mean more money. 
Oftentimes those surgeries and tests are completely unwarranted. We 
want quality, and we want outcome to be the measure of good health 
care. Quantity, not quality, is what pays right now.
  According to researchers at Dartmouth Medical School, nearly $700 
billion per year is wasted on unnecessary or ineffective health care. 
That is 30 percent of total health care spending.
  My favorite story is about an HMO in the southwestern part of the 
United States that said: Let's look at a better way to treat diabetes. 
Instead of having people trying to get in to see their doctors, we will 
have them seen by nurses and nurse practitioners, and we will have it 
overseen by two endocrinologists. They actually saw health care 
professionals more often and quality went up. Costs went down. And 
guess what. They got reimbursed less for that system because of the way 
our current system rewards quantity over quality.
  This chart says $50 billion. The reason it says $50 billion is that 
an independent study from Dartmouth looked at how Mayo Clinic, one of 
our premier health care institutions, treats chronically ill patients 
in their last 4 years of life. Quality is incredibly high. What they 
looked at was the Mayo protocol; if we use that in hospitals all over 
the country, how much would we save? You would think it would cost more 
because it is higher quality. You would actually save $50 billion in 
taxpayer money every 5 years just for this set group of patients, if 
the Mayo protocol was followed, because they have integrated care. They 
work as a team, and they are careful and do what the patient wants. 
They put the patient in the driver's seat.
  In Minnesota we have several examples of this coordinated, outcome-
oriented system, not just the Mayo Clinic but also St. Mary's in Duluth 
and Health Partners that has done some groundbreaking work with 
diabetes. As this chart shows, on spending per patient, just using the 
Mayo protocol for chronically ill patients, $50 billion would be saved 
every 5 years.
  To begin reining in costs we need to have all health care providers 
aiming for high-quality, cost-effective results. We must take 
significant steps to ensure that Medicare remains available for future 
generations. I want to be able to get Medicare and so do those people 
who are 65. To do that, we have to make the system efficient and cost-
effective with the highest quality. Let's reduce those hospital 
readmissions, have less infections in the hospitals. Let's put those 
kinds of Mayo quality standards in place like we see at the Cleveland 
Clinic and other places across the country.
  These policy changes are important steps to make sure Medicare is 
paying for the outcome of treatment, not the number of treatments.

[[Page 21592]]

  We have seen basic outlines from the Finance Committee bill, but we 
haven't seen it yet. I support the committee's efforts to develop a 
national program on payment bundling. In too many places, patients must 
struggle against a fragmented delivery system where providers duplicate 
services and sometimes work at cross-purposes. To better reward and 
encourage this collaboration, we need to have better coordination of 
care and less incentive to bill Medicare purely by volume. Increasing 
the bundling of services in Medicare's payment system has the potential 
to deliver savings and start encouraging quality integrated care.
  When it comes to improving care, changing who pays the doctor isn't 
as much the issue right now, when we are looking at improved care, as 
it is changing that payment system.
  The lesson of high-quality, efficient States such as Minnesota is 
that someone has to be responsible for the care of the patient from 
start to finish. Bundling will help encourage hospitals, doctors, and 
post-acute care providers to achieve savings for the Medicare Program 
through increased collaboration and improved coordination.
  One of the interesting things I don't think people always know about 
is, they say: If we save money, will that mean worse care? The answer 
actually is no. It is the opposite.
  Does higher spending equal better care? In fact, when we look across 
the country, higher spending does not equal better care. In fact, it is 
the opposite. Here we have a chart that shows the highest quality care 
in the country with the lowest utilization, where they are most cost 
efficient.
  Maybe you know your doctor well. You go to the specialist they refer 
you to so you are not running around with your x-ray to 15 different 
specialists not knowing who is better. Look at this: highest 
utilization has the lowest quality care.
  Research has shown moving toward a better integrated and coordinated 
delivery system would save Medicare alone up to $100 billion per year. 
Because Medicare is the single largest purchaser of health care, 
linking payment to quality outcomes is essential to improve health care 
outcomes for everyone.
  We must also stop paying for care that doesn't result in quality 
results. Reducing preventable hospital readmissions--and I am hopeful 
this will be in the Senate bill--is vital to curbing the wasteful 
health care spending plaguing our national budget. In one year, 
hospital readmissions cost Medicare $17.4 billion. A 2007 report by 
MedPAC found that Medicare paid an average of $7,200 per readmission 
that was likely preventable. Who wants to go back in the hospital? I 
don't think anyone wants to go back in the hospital. So not only are we 
getting lower quality care because certain quality parameters are not 
met, we are also spending more money for it.
  I am encouraged that the Finance Committee's outline includes a 
provision that calls for reduced payments to hospitals for preventable 
readmissions. We know there are some readmissions that are going to 
happen. It happens all the time--preventable readmissions. Paying for 
quality results also means reducing hospital-acquired infections. We 
should not have to pay for an infection that comes as a result of a 
hospital stay itself. No one wants to get an extra infection in a 
hospital, and there are vast differences among hospitals in those 
infection rates. So let's put those quality protocols in place.
  Third, we need to better reward integrated care systems. At places 
such as the Mayo Clinic, a patient's overall care is managed by a 
primary care physician in coordination with specialists, nurses, and 
other care providers as needed. It is one-stop shopping.
  It reminds me of a football team. We do not have 10 wide receivers 
running around, running into each other, just like we would not have 10 
specialists in health care. We have one quarterback who is a primary 
care physician, and then we have a team that works together. That is 
what we want to encourage in the health care system to save money.
  To better reward and encourage this collaboration, we need to 
encourage the creation of accountable care organizations. These are 
groups of providers that work together, as they do in Minnesota, to 
deliver quality, coordinated care to patients. We want to put 
incentives in that reward this kind of care.
  The President stood before his health care summit and asked: Why 
should Minnesota be punished when it rewards, when it creates this kind 
of good, high-efficient care? The sad thing is, right now it is because 
when we just base pay on volume and we do not pay any attention to what 
the results are or what the infection rates are or what the readmission 
rates are, we are not getting that kind of quality care people deserve.
  The last thing I want to focus on is something Senator Cantwell, who 
will be speaking after me, and I have been so focused on right now; 
that is, putting some kind of quality index in place. The proposal here 
is to move us toward a system that links quality to cost. Right now, we 
do not have that in place. I believe we need to do more in the finance 
bill than we even have in the House bill to get this value index in 
place. This is a bill I have introduced.
  Senator Cantwell is one of the lead sponsors, as well as Senator 
Gregg of New Hampshire.
  The indexing will help regulate overutilization because those who 
produce more volume will need to also improve care or the increased 
volume will negatively impact fees.
  This legislation will authorize the Health and Human Services 
Secretary to create a value index as part of the formula used to 
determine Medicare's fee schedule.
  By adding a value index, our bill uses cost measures that are 
structured to allow areas with justifiably higher costs--and we know 
there are different costs around the country--to compete on an equal 
playing field with lower cost areas. Rewarding value in this way would 
give physicians a financial incentive to maximize the quality of their 
services instead of the quantity.
  Linking rewards to outcomes creates the incentive for physicians and 
hospitals to work together to improve quality and efficiency. This 
proposal would also work in tandem with other proposals--like those 
being advocated by others and those I have mentioned today, the 
coordinated, integrated care, the bundling, and other ways--to improve 
the Medicare payment system.
  We know there are also other ways, and I will end with just 
mentioning these--that we can improve efficiency in health care 
spending: One, as a former prosecutor, I care a lot about this, to 
reduce Medicare fraud. Law enforcement authorities estimate that health 
care fraud costs taxpayers and costs those seniors on Medicare more 
than $60 billion every year. This is as much as 20 percent of total 
Medicare spending. There are ways, and we have some bills that have 
already been introduced, to greatly reduce this.
  Secondly, something the President raised in his speech before 
Congress is this idea of looking at malpractice reform. I can tell you, 
in Minnesota, in 2006, we had the lowest malpractice premiums in the 
Nation. Areas like ours, with more efficient care, tend to have lower 
malpractice premiums, and that is what our doctors want.
  One of the things we have is a certificate of merit system that has 
been implemented in a number of States and goes hand in hand with 
efficient care, requiring a medical expert to sign off on any 
complaint, and it has worked.
  We need to reform our health care system. I am so proud to be in the 
Chamber with my colleague, Senator Cantwell, a member of the Finance 
Committee, who has been, day to day, night by night, advocating for 
this kind of reform. We want our seniors to stay on Medicare and have 
the kind of safety net they deserve. We want people who are 55 years 
old to be able to get Medicare when they are the age to get Medicare. 
The way we do this is by actually increasing quality and decreasing 
costs.
  We do this in the State of Minnesota. We know we can do it in other 
places of the country. I plead with my colleagues on the Finance 
Committee that we have to look at the long-term costs

[[Page 21593]]

if we are going to bring reform. We have outlined some ways to do this 
today. We look forward to working with people from all over the 
country. But this has to be a major element of reform.
  I yield the floor.
  The PRESIDING OFFICER (Mrs. Shaheen). The Senator from Washington.
  Ms. CANTWELL. Madam President, I ask unanimous consent to speak as in 
morning business for up to 15 minutes.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Ms. CANTWELL. Thank you, Madam President.
  Madam President, I rise to talk about the health care reform bill and 
the most urgent need to make sure we have provider reform as part of 
the insurance reform package.
  I thank the Senator from Minnesota for her leadership on this issue. 
She has hit the ground running when it comes to the issue of health 
care reform, advocating for changes in policy and introducing 
legislation at the beginning of this year called the value index 
legislation. I am proud to be a sponsor of that legislation and proud 
we have worked together so diligently to try to communicate why this is 
so important for America.
  Clearly, Minnesota has had good results and is leading our country in 
the kinds of health care practices we need to adopt. Senator Klobuchar 
has been able to put that into legislation and to champion that 
legislation and to work on the floor organizing colleagues from like 
States to communicate this issue.
       I am happy to be joining her in the letter we are sending 
     to our Senate leadership and to the President of 1the United 
     States talking about why it is so important to get these 
     reforms adopted.
  So I thank her for being out here this evening to communicate this 
important public policy area, and, again, for having Minnesota be front 
and center in this debate.
  What we are trying to address is an urgent problem; that is, the 
Medicare system, basically--if we do nothing--is going to go broke. It 
is doubling in its cost to the Federal Government.
  We are talking about reform. We are talking about adding more people. 
So if we look at Medicare spending and where we are today and the 
amount we are going to see in the future, we know we are quickly 
growing that number--from 2009 to 2015--to be over $1.2 trillion. So 
the cost of this--of Medicare doubling over 10 years--is something we 
know as a country we cannot sustain.
  Without health care reform--without even the discussion of adding the 
uninsured--we know we cannot sustain the doubling of Medicare in the 
next 10 years. So we need to change the system.
  We know what the cause of this crisis is, too. There are many 
elements to health care and health care costs, but we know from the 
many hearings and testimony we have had from experts that the fee-for-
service system is driving up the cost of health care. Fee for service 
rewards providers for the quantity of services they provide without 
regard to whether those services benefit the patient.
  I ask my colleagues if they have ever experienced this situation I am 
about to describe because I know many Americans will tell you this is 
exactly what they have experienced. Have you ever asked yourself why 
your physician, while you are in the middle of a health care 
appointment, seems so hurried? Have you ever asked yourself why the 
doctor seems so hurried to go to the next appointment?
  Well, the reason is because that is the way we pay doctors. We pay 
doctors by the number of patients they see and the number of procedures 
they order. So the system we have today actually creates an incentive 
for doctors to spend as little time with each patient as possible.
  If we think about that, if we think about where our health care 
system is today, how is that good for delivering outcomes? How is that 
good for making sure the patient gets the best care?
  I want to make sure I am clear. This is not the fault of the doctors. 
They are just following the rules of the game as it is being played 
today. Indeed, many physician organizations are advocating the changes 
in organizational structure that the Senator from Minnesota and I are 
advocating. They understand it is a daunting task to reform health 
care. But in this case, they know the problem is simple enough to 
grasp. All we have to do is follow the money, and what we see in both 
private insurance and Medicare is that we are routinely paying for 
duplicative or inefficient care. Then the cost of Medicare and the cost 
eventually to taxpayers skyrockets.
  So if we look at the fee-for-service model, it is pretty clear. It is 
a feedback loop. In business, in technology we call this a positive 
feedback loop because it just feeds each other because we have more 
use, we order more tests, we have more duplication of services, and we 
have more spending, and the cycle just keeps going and it keeps 
perpetrating itself. The end result is, we just keep adding costs to 
our system.
  Nowhere is there an outcome that is judged here, nor is there a value 
to the patient. It is a fee for service that just generates more 
spending. We cannot emphasize that enough because the current system 
promotes an overutilization of what are scarce health care dollars and 
resources.
  As one national study shows, there is an estimated $700 billion a 
year in wasted health care dollars. That is health care spending that 
may not even be--certainly it is wasted dollars. Some people have said 
it can even do harm in the way the money is spent.
  So we are out here today advocating for a different model. We are out 
here saying it is good to talk about insurance reform, but if Medicare 
is one in every five health care dollars and Medicare is driving health 
care spending, it is also driving expensive health insurance. So if we 
have expensive fee-for-service Medicare that is helping to waste 
precious Medicare dollars, you bet it is also driving expensive health 
insurance.
  The good news is, we already know there is a viable alternative. The 
reason we know that is because we know there are States such as 
Washington and Minnesota and many others across the country that have 
put some of these new practices into place. We know they are working in 
the real world. In some parts of the country, we have reforms that have 
reversed these trends and they have cut costs and they have put the 
emphasis where it belongs.
  The bottom line is, they put the patient first. Imagine that: putting 
the patient first--not the number of procedures ordered, not the number 
of people seen, but putting the patient first by making sure we are 
focusing on their outcomes.
  These States and parts of the country have done this by organizing a 
delivery of care system so the doctors can take the time with their 
patients, and they can take the lead in coordinating their care. 
Patients in these delivery systems get better access to their 
physicians, they experience shorter waiting times, they benefit from 
coordinated care that is provided by their primary care physician and 
other health care individuals, and the health care outcomes are better.
  In fact, if we look at some of these States, and we look at some of 
the individual criteria, who in America would not like shorter waiting 
times to get to see the health care provider they need to see or better 
access to doctors or to have one doctor coordinate with their other 
health care providers their specific needs and treatments and to 
guarantee better outcomes?
  On this chart is data from the Robert Wood Johnson Foundation from 
2008 of what we get when we put a coordinated care delivery system in 
place and we integrate the care of the individual in the delivery 
system. So this kind of delivery system is good for individuals, but it 
is also good for the taxpayer because not only does the patient 
benefit, we cut down on the bureaucracy and that $700 billion of 
wasteful spending I talked about a few minutes ago.
  So I believe every part of the country ought to take heed of this 
phenomenal result and the fact that, as my colleague from Minnesota 
said, we could save the taxpayers over $100 billion a year if we made 
this change to coordinated care across the country.

[[Page 21594]]

  When Medicare is structured in a way that it encourages better 
quality and more efficient care, we will also see the price in private 
insurance go down as well because the cost of correlation of Medicare 
driving private insurance is there.
  So my colleagues who come from States that have more expensive 
Medicare might think that is somewhat of a benefit, but I guarantee it 
is also driving more expensive private insurance and your citizens are 
not getting the best care. This Robert Wood Johnson Foundation study 
proves that. If we were looking at other States, all these checkmarks 
on the cost and utilization would be high.
  So we know the health care debate puts us at a crossroads. It puts us 
at a crossroads about what we are going to do about our current health 
care system. We can either fix these problems or we can exacerbate it 
and make it worse. We all want to help the uninsured in America, but to 
add more people to this health care system, to cover more people under 
health care without changing the way we pay for Medicare is going to 
explode the Federal deficit. So we want to make sure we don't 
exacerbate this problem.
  As the Senator from Minnesota said, her home State has implemented 
these things. So has Washington State. We know that where health care 
costs are managed efficiently, we are producing great results. But we 
know the gap between these reimbursement rates in other areas of the 
country is still leaving us with inefficient delivery systems, and we 
know that for our States, we are delivering efficient care. If you 
continue to have inefficient systems in other parts of the country that 
pay more but are less efficient and don't deliver patients better care, 
you are going to continue to have health care practitioners migrate to 
those areas. That is why fixing the health care system but not 
addressing this issue is not a real solution for us because we cannot 
continue to see people from Washington and Minnesota and other places 
migrate to high-cost, high-paid doctor States, with no guaranteeing of 
better outcomes but certainly more pay for physicians.
  We know the fee-for-service model is bleeding our country, and we 
know we need to make changes to that. We need to have a quality care 
system. So that is why I joined Senator Klobuchar at the beginning of 
the year in introducing legislation for a value index and that is why 
we have been fighting in the Finance Committee to add these kinds of 
reforms to the system. I am very proud the Finance Committee is looking 
at insurance reform, to ban practices such as excluding individuals 
just because they have a preexisting condition, but provider reform in 
how Medicare is delivered is as crucial to delivering a good health 
care system in America. We are advocating that we have a health care 
system that puts the patient first, that puts them in the focus of how 
physicians get paid.
  We do this specifically by striking a blow against fee for service 
and replacing it with a model that allows physicians to spend more time 
with their patients, to better coordinate their care, to provide them 
with preventive care for the future, and to make sure they are getting 
the quality of care they deserve. As one of my constituents came into 
my office to talk about this said: I don't want to be medicated, I want 
to be cured. What she meant is don't just write me a prescription and 
tell me to go away; I want you to focus on my specific health care 
needs. That is what so many people think about our health care system. 
At a time when we do have advances in new technologies and preventive 
care and wellness, that can get our consumers focusing on their own 
health care needs.
  So our proposal changes the current payment incentive structure by 
using a new value index to measure the quality and efficiency of 
service. And only by replacing the fee-for-service system with this new 
value index will we start to control health care costs. According to 
testimony before the Senate Finance Committee, this is where we are 
going to get our biggest savings in health care cost reduction. The 
fee-for-service system, as one of the witnesses said, is the most 
broken part of Medicare. Under the value index system that we are 
proposing, the Federal Government would do much better and taxpayers 
would do much better in making sure we do not see that doubling of 
Medicare rates.
  That is why my colleagues and I are sending a letter--and I see my 
colleague from Washington on the floor, Senator Murray, who several 
years ago introduced the MediFair legislation; legislation that said we 
have to have fairness in the way Medicare dollars are spent around the 
country. We can't continue to incent areas of good practice while we 
are warning areas of inefficient care, and she has been a champion 
behind this issue for many years. So I appreciate her being on the 
floor because I know she cares passionately about this issue as well. I 
guess that is the point.
  Those of us who are from these regions are tired of providing 
efficient, coordinated care and not--I think the Presiding Officer is 
from one of those States. You can't believe the frustration we have of 
going to community after community, knowing we provide better outcomes, 
knowing we provide better care, knowing people have made it work on the 
lowest margins possible. Yet people are leaving our States because they 
can go make a better buck somewhere else off the inefficient health 
care system we are delivering. It would be one thing if they could make 
that quicker buck by going to some State and they were saying: You know 
what. We are more expensive, but we deliver more care. That is not what 
the Robert Wood Johnson Foundation says. It says they don't deliver 
better care. If you can imagine, if you have that fee-for-service 
model, where you are spending more and ordering more and out of time 
and so you order all that, how are you getting the best outcomes? You 
are throwing a lot of money at it, but you are not focusing on what is 
the real quality of care to deliver to that patient.
  I know my colleagues on the Finance Committee are trying to focus on 
health care reforms for the overall system. There are various proposals 
that I am sure we will see tomorrow as this draft legislation comes out 
talking about value-based reforms for hospitals and pilot programs for 
certain regions and accountable care organizations which can help, in 
the long run, drive down costs by having global health care budgets. 
But I would say to my colleagues we cannot just have tweaks to this 
system. We can't just have pilot programs. We can't just gently turn 
the wheel of the Titanic and think it is going to avoid the catastrophe 
we are going to see if we don't reform Medicare.
  So we will be working hard in the next couple weeks. As I said, we 
are sending a letter to the President and to the leadership here that 
it is time to fix this system; that we have the opportunity to have a 
21st century health care delivery system, with all the great 
information and all the great technology that is out there, but this 
system can't keep rewarding insurance companies by 435 percent annual 
profits just because our whole system is set up to order more. Because 
this isn't about paying for volume. The point is not to pay for volume; 
it is to pay for value. We want to make sure we are paying for that 
value and not just the fee-for-service volume system that currently 
doesn't put patients first in America.
  So we will be working hard to get these implemented so we can support 
this health care legislation.
  I thank the President and I yield the floor.
  The PRESIDING OFFICER. The Senator from New Jersey.


                    Amendment No. 2366, as Modified

  Mr. LAUTENBERG. Madam President, I seek recognition because in front 
of us we have a proposal I think could be very damaging to our country. 
An amendment has been proposed that I consider unnecessary and 
potentially dangerous which is being offered by the Senator from 
Mississippi, Mr. Wicker.
  What we are finding is that there is a challenge to whether Amtrak 
can continue to operate after the 1st of October. It has been modified, 
but initially it would propose a ban put on Amtrak's

[[Page 21595]]

operations unless guns can be carried in baggage on Amtrak trains. 
While that is an issue that could be discussed--think about it: Amtrak 
carries 28 million people in a year, and Amtrak produces far less toxic 
emissions and is much more energy efficient. We have been delinquent 
for so many years in investing in good railroading. In this advanced 
country, in this, the richest country in the world, no matter what our 
economic condition is, it is incomprehensible for that kind of a choice 
to be put forward: Either you carry guns in our trains--in your baggage 
on our trains or else we shut down the railroad.
  It is preposterous when you think of the services that are offered, 
not just directly on the Amtrak trains but on the Amtrak tracks where, 
in many States, it is also used by commuting services. It would cripple 
the functioning of our country. It is outrageous that, at this point in 
time, when we have worked so hard to generate funding for Amtrak to 
improve the service, to bring it up to the 21st century, and it is 
suggested that maybe we ought to shut it down because we have a 
disagreement about whether guns can be carried in baggage on railroad 
cars.
  This amendment now has moved the time period to discontinuing the 
service in March. Well, I don't know what the value of that is, very 
frankly. If that kind of a threat hangs over us, do we continue to 
invest billions of dollars? Do we try to get private investors to buy 
Amtrak bonds? I don't think so, not when we face a threat such as that.
  Last fall, this Chamber voted overwhelmingly, 74 to 24, to 
reauthorize Amtrak and modernize our Nation's passenger rail system 
and, oddly enough, the Senator from Mississippi voted for this 
legislation. Amtrak has made much progress because of that new law, but 
the amendment on the floor would undo all that.
  The Wicker amendment, as I said earlier, would completely shut down 
our Nation's passenger rail service. That is hardly a thing to do when 
our infrastructure is so severely degraded because of a far greater use 
than we ever expected. I wish to be clear. This amendment would hardly 
give Amtrak any time before it might be required to start allowing 
firearms to be carried on its trains. At this moment, Amtrak will tell 
you they don't have the means to carry these guns securely and safely.
  Senator Wicker noted in 2004 Amtrak made a decision to stop 
transporting guns in the name of security. Why did it happen in 2004? I 
remind those who can hear that it was September 11, 2001, and the 
terrorist attacks in Madrid which reminded us that railroad travel 
organizations are an attractive target for terrorist attacks.
  Amtrak determined it lacked the ability to securely transport checked 
firearms. It is a decision that was not casually made.
  I wish to be able to work with the Senator from Mississippi and 
Amtrak to see if we can develop a reasonable plan so that passengers 
can safely and reasonably transport guns in checked bags on Amtrak 
train. I don't agree with it, but I am happy to discuss it, in 
deference to Senator Wicker. When you think of what Amtrak means in our 
country, I remind you that on September 11, when the World Trade Center 
came crashing down, taking with it almost 3,000 lives, the only way you 
could get there on that day, and a couple days thereafter, was by 
train, by Amtrak. Aviation was shut down across the country and in much 
of the world. Highways were jammed beyond effective use. But Amtrak was 
there to help. And to say that our security doesn't raise the issue of 
whether we can transport guns on Amtrak--that doesn't make sense to me.
  If Senator Wicker's amendment is adopted, all Amtrak trains across 
the country, and those that use Amtrak's tracks, could come to a 
complete halt in a matter of months.
  It is outrageous to propose something this crippling over an issue 
that can be resolved. Yet, the Wicker amendment threatens to leave us 
with no passenger rail service in America. We cannot afford to sabotage 
our passenger train service to meet this crazy timetable--and I say 
crazy. When you think about it, for years, we fought to get Amtrak 
standing as it should be, the principal rail service in a country like 
ours. Amtrak was created in 1970, taken out of private hands and put 
into government hands as a quasi-government corporation. We are 
spending $1.5 billion a year to bring Amtrak up to current standards. 
The Recovery Act included $8 billion for high-speed rail, plus the 
President's budget called for a billion dollars annually for 5 years. 
By comparison, foreign governments--in 2005, France's national railway 
agency got $8.3 billion in government spending. I said it was $1\1/2\ 
billion in America, and France spent $8.3 billion. Why? Because it is 
efficient. It reduces toxic emissions and the dependency on foreign 
oil. Germany spent about $9 billion annually on passenger rail service. 
Spain has a plan to spend $150 billion on rail from 2005 to 2020, or an 
average of $10 billion a year. And we are trying to play catchup now.
  Since 1971, a total of $33 billion has been spent on Amtrak. That is 
almost 40 years, averaging less than a billion dollars a year, as we 
see what other countries have done. Ridership on Amtrak, in 1988, was 
21 million. In 2008, it was 28 million. People are turning to Amtrak 
because they know it is a very respectable way to travel, if it is 
available to you.
  So when we look at that and see that the growth of ridership is so 
substantial, that tells us we ought to figure out ways to do things 
differently. When we look at the whole picture, frankly, it brings a 
lot of concern when you think of the demand for Amtrak services. 
Amtrak, in the last year, had 28 million riders. For instance, New York 
City, the financial center of the world and the country, is dependent 
on the functioning of that financial system. We saw what happened when 
it almost broke down in these last months. In an average day in New 
York City, more people travel through New York's Penn Station than John 
F. Kennedy Airport, LaGuardia, and Liberty Airport put together on the 
same day. Penn Station--more people travel through there than all three 
of those airports in a day. And unless guns are permitted to be put 
aboard a train, we should shut down Amtrak? We should punish the 
American people because we cannot have guns travel on Amtrak trains? 
This cannot be justified by any stretch of the imagination.
  Also, we fail to look at something else. When we put people on 
Amtrak, we free up room in the skyways and on the highways. I cannot 
tell you how often I often fly between here and New Jersey, my home 
State, and I have had a pilot say welcome aboard such-and-such airline, 
and we will be departing soon for a 45-minute flight to Newark Liberty 
Airport. We get on the plane, the doors close, and they move us away 
from the gate, and the pilot gets on and says: We just learned that in 
the New York area we have a 2-hour delay, so we sat there looking at 
one another crossly. Everybody was angry and upset. If I had taken 
Amtrak--I came down yesterday in just over 2\1/2\ hours. What a 
difference. Very often, airplane trips less than 250 miles are the 
slowest means of travel because of the delays from airport to airport, 
and because of weather, et cetera. There are hardly any highways that I 
travel in the country, as my colleagues do--no matter what city you go 
to, if it is during particular hours, you cannot get there from here.
  I have been in the Senate now for 25 years. When I first came to 
Washington, the ride from where I live was about a 12-minute ride. Now, 
in the evening, I can wait a half an hour while red lights change to 
green and traffic doesn't move. Go by rail. We see what happens in a 
reasonable facsimile, when you look at the Metro, a very successful 
operation here in Washington, DC. People want the convenience, the 
reliability, and they don't worry about the weather. It makes us feel 
better about our time spent. We get home with the family, and we get to 
work on time, and we get to the doctor, and other places you have to go 
on a regular basis.
  I hope my colleagues in the Senate will look at this and say it could 
be an important issue for some people--certainly, for some particular 
interest. Typically, it is the NRA pushing this

[[Page 21596]]

interest, but discounting that, people have a right to vote. But I 
plead with my colleagues, please, don't punish the American people, or 
the American economy, and don't take the chance for that disruption, 
and don't diminish our ability for rapid movement if we have to in a 
moment of threat.
  I hope the vote will say if you want to have this discussion, let's 
have it, but don't put a sword hanging over the head of Amtrak.
  With that, I yield the floor and suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. REID. Mr. President, I ask unanimous consent the order for the 
quorum call be rescinded.
  The PRESIDING OFFICER (Mr. Udall of Colorado). Without objection, it 
is so ordered.
  Mr. REID. Mr. President, what is the status of the floor?
  The PRESIDING OFFICER. The Senate is considering H.R. 3288.
  Mr. REID. Mr. President, I ask unanimous consent that at 11 a.m. 
tomorrow, September 16, the Senate resume consideration of H.R. 3288 
and Senator Coburn be recognized for up to 30 minutes and that Senator 
Murray be recognized for up to 10 minutes; that upon the use or 
yielding back of that time as has been specified, the Senate proceed to 
vote in relation to the amendments in the order listed below, with no 
second-degree amendment in order to any of the listed amendments prior 
to a vote in relation thereto; that prior to each vote there be 2 
minutes of debate, equally divided and controlled in the usual form; 
that after the first vote in any sequence the succeeding votes be 
limited to 10 minutes each: Coburn amendment No. 2374; Coburn amendment 
No. 2377; Coburn amendment No. 2371; Coburn amendment No. 2370; Coburn 
amendment No. 2372; Wicker amendment No. 2366, as modified; and Vitter 
amendment No. 2376.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. REID. Mr. President, I am going to send to the desk--I think it 
is already there--cloture motions on the substitute amendment and on 
the bill. I am certainly hopeful that cloture will not be necessary. 
Senator Murray is a wonderful manager. She does great work. She is 
working to come up with an agreement that will provide for 
consideration of other amendments to the bill, but we have not been 
able to get consent. I hope we can.
  We have just entered into an agreement which will provide for votes 
in relation to seven pending amendments. There are at least two pending 
amendments that will not require rollcall votes. Maybe some of the 
others won't. Members should expect up to five rollcall votes tomorrow 
morning starting around 11:30.


                             Cloture Motion

  Mr. President, I have at the desk a cloture motion on the substitute 
amendment.
  The PRESIDING OFFICER. The cloture motion having been presented under 
rule XXII, the Chair directs the clerk to read the motion.
  The legislative clerk read as follows:

                             Cloture Motion

       We, the undersigned Senators, in accordance with the 
     provisions of rule XXII of the Standing Rules of the Senate, 
     hereby move to bring to a close debate on the committee-
     reported substitute amendment to H.R. 3288, the 
     Transportation, HUD and Related Agencies Appropriations Act 
     for Fiscal Year 2010.
         Harry Reid, Byron L. Dorgan, Mary L. Landrieu, Jon 
           Tester, Patty Murray, Jack Reed, Daniel K. Inouye, 
           Richard J. Durbin, Mark Udall, Bernard Sanders, Patrick 
           J. Leahy, Ben Nelson, Frank R. Lautenberg, Michael F. 
           Bennet, Tom Udall, Blanche L. Lincoln, Herb Kohl.


                             Cloture Motion

  Mr. REID. Mr. President, I have at the desk a cloture motion on the 
bill.
  The PRESIDING OFFICER. The cloture motion having been presented under 
rule XXII, the Chair directs the clerk to read the motion.
  The legislative clerk read as follows:

                             Cloture Motion

       We, the undersigned Senators, in accordance with the 
     provisions of rule XXII of the Standing Rules of the Senate, 
     hereby move to bring to a close debate on H.R. 3288, the 
     Transportation, HUD, and Related Agencies Appropriations Act 
     for Fiscal Year 2010.
         Patty Murray, Daniel K. Inouye, Al Franken, Jon Tester, 
           Benjamin L. Cardin, John D. Rockefeller, IV, Charles E. 
           Schumer, Mark Begich, Mary L. Landrieu, Mark Udall, 
           Byron L. Dorgan, Frank R. Lautenberg, Robert Menendez, 
           Patrick J. Leahy, Dianne Feinstein, Barbara A. 
           Mikulski, Harry Reid.

  Mr. REID. Mr. President, I ask unanimous consent the mandatory quorum 
as required under rule XXII be waived.
  The PRESIDING OFFICER. Without objection, it is so ordered.

                          ____________________