S5994 CONGRESSIONAL RECORD — SENATE June 3, 2009 In his Senate confirmation hearing, mously upheld the decision of the dis- So many of us have been touched by DOE Secretary Steven Chu said: trict court that the tobacco companies the ravages of smoking and lost family Nuclear power . . . is going to be an impor- had engaged in racketeering. The court and friends. Yet we still see too many tant part of the energy mix. It is 20 percent found that for at least 50 years, the young people become addicted to ciga- of our electricity generated today, but it is companies have knowingly kept infor- rettes or pick up the newest smokeless 70 percent of the carbon-free portion of elec- mation from the American public tobacco product without knowing the tricity today. And it is baseload. So I think about the health and safety risks of real risks to their health. We cannot it is very important that we push ahead. their products and that they continue leave this to court settlements or to For that reason and every other rea- to do so today. These companies have the industry itself. We have been wait- son, for the economy and for the envi- worked together to deceive the Amer- ing for 50 years, and the evidence shows ronment and for our ability to provide ican public and cannot be trusted to we are still being deceived. Regulation our own energy in this country and regulate themselves. is long past due. This bipartisan bill, lower our reliance upon foreign coun- As generations of customers died with the support of over 1,000 public tries, I believe we need to move for- from illnesses related to smoking, the health, faith, education, and children’s ward rapidly. We intend to do so with tobacco companies have kept their organizations, is the best opportunity nuclear energy. profits up by marketing their products to help protect our children from the I yield the floor. to children through cartoon advertise- menace of tobacco. We have delayed f ments, candy flavorings, and sports long enough. sponsorships. Public health advocates, I again thank Chairman KENNEDY, CONCLUSION OF MORNING lawmakers, prosecutors, and family Senator DODD, and my colleagues on BUSINESS members who have lost loved ones to the HELP Committee for their hard The PRESIDING OFFICER. The Sen- the ravages of smoking have attempted work bringing this bill to the floor and ator from Rhode Island. to take on the tobacco companies, but getting us closer than any other point Mr. WHITEHOUSE. I ask unanimous they confronted a coordinated effort in the long history of this legislation consent that all time in morning busi- backed by billions of dollars to protect to finally seeing the effective regula- ness be yielded back. this deadly business. tion of tobacco products. In the next year, 400,000 Americans The PRESIDING OFFICER. Without I yield the floor and suggest the ab- will die from smoking-related illness objection, it is so ordered. sence of a quorum. Morning business is closed. and more than 450,000 children will be- come daily smokers. Every day, 3,500 The PRESIDING OFFICER. The f kids pick up a cigarette for the first clerk will call the roll. FAMILY SMOKING PREVENTION time. The legislative clerk proceeded to AND TOBACCO CONTROL ACT— Even those who do not smoke still call the roll. MOTION TO PROCEED pay a price—$96 billion each year in Mr. ROBERTS. Mr. President, I ask The PRESIDING OFFICER. Under public and private health expenditures unanimous consent that the order for the previous order, the Senate will re- to treat illness caused by smoking. The the quorum call be rescinded. sume consideration of the motion to companies will, of course, point to con- The PRESIDING OFFICER. Without proceed to H.R. 1256, which the clerk cessions and payouts over the years, objection, it is so ordered. but it is clearly not enough. As we will report. CRAIG THOMAS RURAL HOSPITAL AND PROVIDER The legislative clerk read as follows: work to reform our broken health care EQUITY ACT system, we cannot ignore this public A motion to proceed to the bill (H.R. 1256) Mr. ROBERTS. Mr. President, I rise health menace. to protect the public health by providing the today to again pay tribute to one of That is why it is vital that we finally Food and Drug Administration with certain the Senate’s finest: our colleague, the pass this legislation. The FDA is the authority to regulate tobacco products, to late Craig Thomas from Wyoming. Two agency most prepared to take on the amend title 5, United States Code, to make years ago this week, the Senate lost a certain modifications in the Thrift Savings regulatory, scientific, and public steady hand and a man who did much Plan, the Civil Service Retirement System, health challenges created by tobacco for his State of Wyoming. Craig was de- and the Federal Employees’ Retirement Sys- products. This carefully crafted com- pendable in the finest sense of the tem, and for other purposes. promise bill gives FDA the tools nec- word. He defined the word ‘‘depend- The PRESIDING OFFICER. The Sen- essary to take on the tobacco compa- able.’’ He was the epitome of a work- ator from Rhode Island. nies in three major areas: advertising horse, not a show horse. Mr. WHITEHOUSE. Mr. President, I and sales to young people, the composi- rise to speak in support of the Family tion of cigarettes, and representations On a personal note, for many Sen- Smoking Prevention and Tobacco Con- of health effects of tobacco products. ators, why, Craig was not only a col- trol Act, a bill that will finally give We have wasted too much time fight- league but a dear friend. I will cherish the Food and Drug Administration the ing the same battles over the same that always. Craig was also a fellow authority to regulate tobacco products. issues for years. This legislation finally marine. In this case, Semper Fidelis— This was the first bill for which I had enacts tough but constitutionally always faithful—is most appropriate. If the honor of voting in my new role as sound regulations on advertising tar- anyone faced trouble in their life, the a member of the Health, Education, geted toward young people. It puts a one person you would want by your Labor, and Pensions Committee—the warning label on every pack of ciga- side would be Craig Thomas. newest member—but it is the result of rettes that covers 50 percent of each This is why I am proud and honored years of tireless effort by members of side of the package. The companies again to join with my colleagues KENT this committee and by their staffs. I will finally have to disclose the con- CONRAD and TOM HARKIN, and with the especially commend its primary spon- tent of tobacco products, and FDA will new Senator from Wyoming, JOHN sor, our chairman, TED KENNEDY, who have the authority to regulate haz- BARRASSO, and the distinguished Sen- has long been committed to protecting ardous ingredients. Tobacco product ator from Utah, ORRIN HATCH, to intro- our Nation’s children from the dangers manufacturers will no longer be able to duce the Senate Rural Health Caucus of tobacco and nicotine addiction, and make unsubstantiated claims about bill in honor of Senator Thomas. The Senator DODD, who is so ably leading their products—FDA will have to bill we are introducing is the Craig that fight in his stead today. I thank verify any health claim based on its Thomas Rural Hospital and Provider them and our colleagues in the House impact on the population as a whole in Equity Act, with emphasis on the ‘‘eq- for the efforts that have brought us order to protect tobacco users and po- uity.’’ this bill before the Senate today. tential tobacco users. This will be paid The people of Wyoming and all of This legislation is long overdue and for by the tobacco product manufactur- Craig’s colleagues knew he fought for very much needed. Just last month, a ers and importers themselves, taking rural America and always put the three-judge panel of the U.S. Court of no resources away from the FDA’s needs of his State above all else. On the Appeals for the DC Circuit unani- other vital missions. health care front, why, Craig was truly

VerDate Nov 24 2008 01:57 Jun 04, 2009 Jkt 079060 PO 00000 Frm 00010 Fmt 0624 Sfmt 0634 E:\CR\FM\G03JN6.009 S03JNPT1 jbell on PROD1PC69 with SENATE June 3, 2009 CONGRESSIONAL RECORD — SENATE S5995 a champion for strengthening our rural BARRASSO’s staff: Erin Dempsey. I home health services. And it provides a health care delivery system and pro- know my staff has worked very closely 5-percent add-on payment for ground viding relief to our hospitals and other with Erin over the years, and I have a ambulance services in our rural areas. providers in our rural areas. great amount of respect for her hard One of the provisions in the bill—and He served for 10 years as the cochair work. We always have an expression: this is the one that Craig Thomas cer- of the Senate Rural Health Caucus. He We are only as good as our staff here— tainly championed—is a provision to actually took over the reins as cochair or at least some of us do actually allow marriage and family therapists after my fellow Kansan, Bob Dole, re- admit to that. Erin, thank you for and licensed professional counselors to tired from the Senate. And as I know being such a hero alongside Craig, and bill Medicare for their services and be personally, it is hard to follow in the now Senator BARRASSO. We are proud paid the rate of social workers. footsteps of Senator Dole—for that of you for everything you have done on Currently, the Medicare program matter, Senator Thomas. behalf of rural health care. only permits psychiatrists, psycholo- However, Craig did this with great This Congress, with health care re- gists, social workers, and clinical nurse ease and great pride. His steady leader- form at the front and center, Senators specialists to bill Medicare for mental ship put the caucus on the map, and he BARRASSO, CONRAD, HARKIN, HATCH, health services that are provided to our made great strides in showing all of and I will do our very best to lead in seniors. However, most rural coun- our colleagues the true needs of rural Craig’s absence and to ensure that ties—most rural counties—simply do health care. We will truly miss him rural health does not get left behind. I not have a psychiatrist or a psycholo- during the current health care debate. have made a personal commitment to gist. Marriage and family therapists, I and the members of the caucus miss make sure we get this bill done and ul- however, and licensed professional him and his leadership greatly. timately provide the much needed re- counselors are much more likely to One of the biggest accomplishments lief to our rural communities. practice in a rural setting and are for Craig in the Rural Health Caucus The Craig Thomas Rural Hospital often the only mental health profes- was passage of the Medicare Mod- and Provider Equity Act recognizes sionals available. ernization Act in 2003, which provided a that rural health care providers have Finally, this bill uses technology to big boost to our rural hospitals and very different needs than their urban improve home health services and providers. There was recognition and counterparts and that health care is quality of care by creating a pilot pro- support from our colleagues from all of not one size fits all. gram providing incentives for home our geographical areas, large and The Craig Thomas Rural Hospital health agencies to purchase and utilize small, for including these badly needed and Provider Equity Act—and the acro- home monitoring and also communica- rural health provisions. nym of that, by the way—everything tion technologies and facilitates tele- These provisions included in the has to be an acronym in Washington— health services across State lines. Medicare bill provided much needed re- is R-HoPE—so the R-HoPE Act of 2009 Today I am proud and honored to in- lief to rural health providers, enhanced makes changes to Medicare regulations troduce this bill on behalf of our beneficiary access to quality health for rural hospitals and providers. It former Senator and colleague, Craig care services, and improved provider recognizes the difficulty in achieving Thomas. We miss him greatly as a per- payments in our rural areas. So many the same economies of scale as large sonal friend, a confidante and col- times those payments simply do not urban facilities. This legislation equal- league. Our thoughts and prayers are even come close to the costs of the pro- izes Medicare’s disproportionate share with his wife Susan, his sons Peter, vider and the service they provide to of hospital payments to bring the rural Patrick, and Greg, and his daughter our rural citizens. hospitals in line with our urban hos- Lexie. However, you would never know that pitals. This bill also provides addi- Mr. President, it is time to pass this it was Craig Thomas behind the scenes tional assistance for small rural hos- bill. working to get these rural health pro- pitals that have a very low volume of Mr. President, I yield the floor. visions included in the Medicare bill. patients. Often these hospitals have The PRESIDING OFFICER. The Sen- Craig was more concerned with getting trouble making ends meet under the ator from New Hampshire. the work done rather than taking the Medicare payment system. NATIONAL DEBT credit. So instead of taking individual The Craig Thomas Rural Hospital Mr. GREGG. Mr. President, I rise credit for his hard work and his dedica- and Provider Equity Act, R-HoPE Act, today to return to a topic I have dis- tion on the Medicare bill, he applauded also provides a Capital Infrastructure cussed on the floor a number of times the entire Rural Health Caucus and Loan Program to make loans available but which I think needs to be discussed patted everybody else on the back. It is to help rural facilities improve crum- again because of the severity of its im- this kind of leadership that set Craig bling buildings and infrastructure. In plications for our Nation; that is, the Thomas apart from his colleagues. addition, rural providers can apply to massive amount of debt which we are However, Craig knew that while pas- receive planning grants to help assess running up in our country. sage of the Medicare bill was a giant capital and infrastructure needs. This massive expansion of our debt, step for rural health, we still had much The bill extends to January 1, 2011, at levels which we have never seen in work to do to ensure our rural system two incentive programs aimed at im- our history, as proposed by the Presi- can continue to survive. Sometimes proving the quality of care by attract- dent’s budget and the budget which when they ask me about health care re- ing health care providers to health pro- passed this Congress, threatens the form—‘‘they’’ meaning most of the peo- fessional shortage areas. The first is value of the dollar. It threatens to cre- ple interested in health care reform: the Medicare Incentive Payment Pro- ate instability through massive infla- the media, others, the health care pro- gram, which provides a 10-percent tion. And it clearly threatens the fu- viders—I simply say one of the things bonus payment to physicians who will ture of our children. we want to do is to make sure we pre- practice in shortage areas. The second I am not the only one who thinks serve what we have. This is why we is the Physician Fee Schedule Work this way. As you look around the were proud and honored to carry on his Geographic Adjustment—that is a world, there are a lot of folks taking a legacy by introducing the Craig Thom- mouthful—but it simply means it will look at where we as a nation are going as Rural Hospital and Provider Equity bring rural doctors’ Medicare fee and asking the question: Can we afford Act in the 110th Congress, and again in schedules for wages more in line with this debt as a country? this Congress. We can enhance Craig’s urban doctors. Interestingly, just a week and a half legacy certainly in this way. The bill also recognizes that other ago or so, Standard & Poor’s, the rat- I wish to especially recognize a mem- providers do play a great role in the ing agency, looked at the English situ- ber of Craig’s former staff who has al- rural health care delivery system. Our ation and put out a statement that the ways worked extremely hard to ad- bill increases the payment cap for rural triple A bond rating of England was in vance rural health care causes and who health clinics to keep them in line with jeopardy. They essentially took the ad- has remained a champion for Wyoming community health centers. It provides jective ‘‘stable’’ out from their des- as a member of Senator JOHN a 5-percent add-on payment for rural ignation of that bond rating and said

VerDate Nov 24 2008 00:26 Jun 04, 2009 Jkt 079060 PO 00000 Frm 00011 Fmt 0624 Sfmt 0634 E:\CR\FM\G03JN6.038 S03JNPT1 jbell on PROD1PC69 with SENATE S5996 CONGRESSIONAL RECORD — SENATE June 3, 2009 they had a negative bias on the triple Government—$800 billion a year which Then Mr. Yu, who is the former ad- A rating. They did not reduce it, but will have to be paid in just interest. viser to the Central Bank, made the they did put out a major warning sign. For every American, they will receive following statement just a couple of What does that mean? Well, if your $130,000 of debt—every American house- days ago. He said: bond rating as a nation drops, that hold will have $130,000 of debt on that The United States Government should not means the world community does not household to pay off the Federal re- be complacent and it should understand that have a lot of confidence in your ability sponsibility—and $65,000 in interest there are alternatives to China buying U.S. to repay your debt and it is going to payments annually for every American bonds and bills. Investments in Euros are an charge you a lot more to lend you household. That is more than many alternative, and there are lots of raw mate- money. The effect of a bond rating American households’ mortgages and rials we can buy too. China should not close those options. change for a nation such as the United more than their interest payments on Kingdom—which is one of the most sta- their mortgages, but that is what every Well, if the Chinese Government ble and industrialized countries in the American household is going to owe as starts to reduce its purchase of our world—is catastrophic. What brought a result of this dramatic expansion in bonds and our need to sell bonds is about this decision by Standard & debt. going up, what happens? That means Poor’s to put, at least on a watch list, What is driving this debt? Well, in the interest on the bonds is going to so to say, the bonds of the United King- the short term, obviously, it is the eco- have to go up because we are going to dom? It is the fact that England has so nomic downturn. But we are not going have to find somebody who wants to expanded its debt that its debt now to be in this economic downturn for- buy these bonds and we are going to represents approximately 52 percent of ever. Everybody is presuming we are have to make them attractive around its gross national product. starting to move out of it, and we will the world. As the interest on the bonds Well, where do we stand as a nation because we are a resilient nation. In goes up, taxpayers end up having to in our debt relative to our gross na- the outyears, what is driving this debt bear that burden and the next genera- tional product? This chart reflects the is spending—it is that simple—new, ad- tion ends up having to bear that bur- fact that historically, in the last 30 or ditional spending put on the books or den. 40 years, our debt has averaged be- planned to be put on the books under So what is the solution? How do we this budget. tween 30 percent and 40 percent of get around the fact that we are now on This blue line here, which flattens GDP, but in this economic downturn, an unsustainable course which will out where the debt stabilizes over the lead to a fiscal calamity for our Nation we are seeing a dramatic increase in next 5 years, is if we had current law. our debt as a nation. In the short run, and potentially put us in the position In other words, if the law that was in where we will have to devalue the dol- I have said many times, we can tol- place before the President’s budget was erate this for the purpose of trying to lar or have massive inflation? passed were to take effect and stay in Interestingly enough, the Economic float the economy, for the purpose of place, that is the blue line. That is the government being the lender of last Information Daily, another Chinese what the debt would do; it would sta- publication, hit the nail right on the resort, for the purpose of stabilizing bilize. But because the President has the financial systems. A short-term, head. Maybe because they are looking proposed so much new spending in ad- from the outside in and because of all huge spike in our debt is not desired, dition to the spending that is going to but it can be managed. We have done they have invested they can see these come as a result of the retirement of things, because they said the question this in the past. During World War II, the baby boom generation and the ex- for example, our debt went up dramati- that should be asked of Secretary pansion of entitlements, this debt just Geithner is, How do you propose imple- cally. But the key is, it has to come continues up in an astronomical way. menting fiscal discipline? How will you back down. It just can’t keep going up. This is a real concern for us. I recog- maintain the stability of the dollar Well, today, our debt is about 57 per- nize it is hard for a Congress to deal cent of our gross national product, our with anything but the next election— after the crisis—and I emphasize public debt. It is up around here on the and what we are talking about here is ‘‘after.’’ What they are saying is, after chart. As we see from this line, under really what we are doing to the next we get past this recession and the need the budget proposed by President generation—but we should be very con- to stabilize the financial structure of Obama, it continues to go up, almost in cerned—more than concerned, we our country and the need to float the a perpendicular manner, to the point should be really focused on this as our economy, how do we bend this curve where, by the end of the budget as pro- primary issue of domestic policy as we back to something reasonable and sus- posed by the President and as passed go forward as being a threat to our tainable? That is the question we by this Congress, the public debt will prosperity as a nation. should be asking around here as a Con- be approximately 82 percent of gross What are other governments saying? gress. We need to start asking it pretty national product. That is not a sustain- Well, China, which is our biggest cred- soon. able situation. Over the next 10 years, itor—we financed this debt by lending The President has said—he said it under the budget as proposed by the from China. They give us money to again yesterday—that one way you do President, we will be running deficits spend on our operations as a govern- this is by addressing the cost of health which represent $1 trillion a year, on ment. They have always looked on the care, and he is absolutely right. Health average—$1 trillion a year, on average. U.S. debt as something that was a good care is the primary driver—one of the As a percentage of our gross national investment, a safe investment, but the primary drivers—of this massive in- product, those deficits will be between Chinese are having second thoughts. In crease in expenditures at the Federal 4 percent and 5 percent. an extraordinarily embarrassing inci- level. But the President has put noth- As I have said before on this floor, dent, the Secretary of the Treasury, ing on the table so far that bends the you can’t get into the European Union speaking before an audience of sophis- curve on the question of the cost of if your deficit exceeds 3 percent of your ticated college students in Beijing, was health care—in fact, just the opposite. gross national product and your debt asked about the status of our debt that His budget proposed that health care exceeds 60 percent of your gross na- is held by the Chinese. He told them spending would go up $1.2 trillion over tional product. that Chinese assets are very safe, and the next 10 years and, more impor- These are all big numbers and nobody the audience laughed. The audience ac- tantly than that, it sets up a series of can catch up with those numbers, but tually laughed at the Secretary of the entitlements which will cost hundreds the basic implication is very simple. Treasury saying that Chinese assets of billions—as I said, $1.6 trillion in Under the present path we are on, the are very safe. That is an anecdotal in- new spending. He is suggesting that in- debt is going to double in 5 years, tri- cident, but it would never have hap- stead of keeping health care spending ple in 10 years, and the implications to pened 6 months ago, 2 years ago, be- at about 17 percent of gross national our children are that they are going to cause these types of increases in debt product, which is a huge amount of inherit a country where the payments as a percentage of our economy were money, by the way, more than any required on that debt are going to be nowhere in sight then—nowhere in other industrialized country spends by the single largest item of the Federal sight. almost 50 percent—the next closest

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We can’t afford more prosperous nation, not a nation willing to cosponsor that bill right now that. confronting massive inflation, leading and substitute it for the entire Ken- What we need in the area of health to the devalue of the dollar or massive nedy bill, so we get the full 2 percent care is to address the issue that the tax increases. we get in the Kennedy bill over 10 President said, which is to control the Mr. President, I yield the floor and years of reductions. costs of health care, not by expanding make the point of order that a quorum A simple warning label would be a the size of the costs of health care but is not present. tremendous improvement over this leg- by using the dollars in the health sys- The PRESIDING OFFICER. The islation—$787 million, a new mandate tem more effectively and by getting clerk will call the roll. to the men and women in our military better quality at lower costs, which The assistant legislative clerk pro- to pay for it, and it has been portrayed can be done, by the way. There are a ceeded to call the roll. as an effort to reduce the usage of to- lot of proposals for doing exactly that. Mr. BURR. Madam President, I ask bacco products with our youth. But one of them isn’t to create a sin- unanimous consent that the order for I covered for all our colleagues yes- gle-payer plan or a public plan which the quorum call be rescinded. terday the fact that when you go down essentially puts the government in The PRESIDING OFFICER (Mrs. and look at the CDC proposals to charge of health care and, as a result, GILLIBRAND). Without objection, it is so States on part of the $280 billion of drives up the cost of health care sig- ordered. MSA payments that the industry made nificantly and drives the spending up Mr. BURR. Madam President, I need- to States, that the States had spent a and the borrowing up that goes with it. ed to come to the floor and apologize pittance of what CDC projected on ces- So, yes, we have to address it, but we for a misstatement I made yesterday sation programs to get people to stop have to address it in a way that actu- on the current bill, the Kennedy to- smoking. But more alarming than the ally controls spending, controls the bacco bill. In yesterday’s debate, I stat- fact that States use the tobacco money rate of growth in spending and health ed that the CBO, the Congressional to fill their budget gaps and build side- care, and that doesn’t aggravate this Budget Office, report on the bill re- walks rather than to fund programs to additional debt. vealed that if enacted, smoking rates get people to stop smoking is the fact It is hard to understate the signifi- would decline 2 percent annually. In that in practically every case of 50 cance of the threat this debt rep- fact, I was wrong. States, the marijuana prevalence use resents. It is hard to understate it. I I prepared a chart yesterday that among youth was higher than the to- know I have spoken on this floor about showed, based upon what CBO said, bacco prevalence. it a number of times, but that is be- that we would reduce by 2016 the smok- Let me say that again. Marijuana cause it is so critical to our future as ing rate in the country to 17.8 percent, usage by our youth is projected by CDC a nation. We literally are bankrupting and also the CDC’s projection, which if to be higher in practically every State the futures of our children by putting we did nothing, we would reduce it to than what they have projected youth this much debt on their backs, by dou- 15.9 percent, clearly showing the CBO prevalence of tobacco use. It is actu- bling the national debt in 5 years and estimate under the current bill we are ally smoking. That does not nec- tripling it in 10 years. I am beginning considering would not bring the smok- essarily include smokeless. to feel a little bit like Cato the Elder, ing rate down as much as doing noth- For my colleagues, including myself, who used to speak in the Roman Sen- ing. I have spoken on the fact that we must ate and begin and end every speech The mistake I made yesterday was I keep tobacco out of the hands of our with ‘‘Carthago delenda est.’’ Finally, assumed the way I read it that the CBO children. It has an age limit. I would somebody listened to him, and they ac- estimate is it would reduce smoking 2 agree it has some problems on enforce- tually did destroy Carthage. percent per year. In fact, what the CBO ment. But marijuana is illegal. It is Well, I am saying let’s get the debt report actually said was it would re- supposed to be enforced in every com- under control. Let’s control the spend- duce by 2 percent over 10 years. So, in munity. It is supposed to be enforced in ing of this government. Let’s do some- fact, I have been way too generous to every State. Yet more kids use it than thing about this outyear spending be- the current bill that it would reduce they do tobacco products. fore we get to a position where the smoking to a point of 17.8 percent, In 1975, Congress commissioned the world loses confidence in our dollar, which was figured based on a 2-percent- University of Michigan to track youth loses confidence in our debt, before we per-year reduction. In fact, the gap be- smoking rates. At that time, youth get into the position where we have to tween doing nothing and passing this smoking was at an alltime high. How- inflate the economy or we have to bill clearly is much bigger than I had ever, those rates have started to come place taxes on our children that are so anticipated; that by doing nothing, we down and leveled off around 30 percent, high that they have no chance to have get much more value, if the objective all the way up to 1993. as prosperous and as competitive a life through passage of this legislation is to For some unknown reason at the as we have had. It is not fair, as I have reduce the smoking rate in the United time, youth smoking rates started to said before, for one generation to cre- States. increase around 1993, peaking at close ate this type of debt and pass it on to The bill that is being considered does to a new alltime high in 1997. the next generation to pay. It is not not change existing products. Let me In 1998, 12th graders who said they fair. It is not right. It is something we restate that. We grandfather in all the tried cigarettes in the last 30 days was have never done as a nation. Whenever tobacco products that are currently approximately 36 percent, according to we have run up debt significantly like being marketed. What CBO has con- the University of Michigan. this, we have always paid it down on an cluded is that then you have to perma- Congress did not have a good sense of equally quick basis. After World War nently figure that about the same rate why this was happening. Opponents of II, when our debt got to over 100 per- of Americans will continue to smoke the tobacco industry started blaming cent of GDP, we brought it down very because they do not have new options all this on the alleged manipulation of quickly. We need to bring it down to turn to. young people by tobacco manufactur- today. We need to have discipline Let me make this pledge to my col- ers through sophisticated marketing around here that leads to getting the leagues. If the CBO report that smok- and advertising campaigns. debt of this Nation back to a respon- ing will decrease by a scant 2 percent I heard a Member on the floor last sible level, which means something under the bill is because of new warn- night of the Senate basically blaming under 50 percent, hopefully closer to ing labels and graphic warning labels everything on these very creative mar- the historic norm of 40 percent; where that are mandated in the bill, then let keting techniques. Trust me, if they

VerDate Nov 24 2008 00:26 Jun 04, 2009 Jkt 079060 PO 00000 Frm 00013 Fmt 0624 Sfmt 0634 E:\CR\FM\G03JN6.012 S03JNPT1 jbell on PROD1PC69 with SENATE S5998 CONGRESSIONAL RECORD — SENATE June 3, 2009 were that effective, every company smoking. CBO recently stated that if it dering: Is this going to work? Is it would be figuring out how to adopt was enacted, youth smoking would re- going to hurt me? Because the FDA has those techniques. duce, over the 10-year period, 2 per- already said it is safe and effective; as The tobacco industry has a checkered cent—excuse me, 11 percent for youth, we bring on this new line of biological past, at best, when it comes to mar- 2 percent overall. But according to the products that are going to cure ter- keting and advertising. But what I am University of Michigan, youth smoking minal illnesses that are very expensive, suggesting is, it may not have been all rates have declined by 5 percent over we are not going to do it in a way that due to tobacco. There was another the last 5 years and 16 percent over the hurts our health because the FDA’s trend occurring in the 1993 to 1998 pe- last 10 years. gold standard is in place; that when we riod that virtually mirrored that of If this is an indication of how youth go to the store and we buy food, we are youth smoking, and it was the in- smoking rates will go over the next 10 going to be assured it is safe, some- creased use of illicit drugs by teen- years, we will actually slow the decline thing we haven’t been able to do for agers. Something much broader was by passing this bill. the last few years—spinach contamina- happening among youths in our society Let me say that again. My colleagues tion, salmonella in peanut butter. The during that time period. The Senate’s do not understand. We slow the decline list goes on and on. answer to smoking rate increases was of youth usage by actually passing this Why, with an agency that is strug- to pass a massive FDA tobacco regula- bill. It is the University of Michigan, it gling to meet their core mission, would tion bill, the exact bill we are debating is the Congressional Budget Office, all we ask them to take on a product that today. Congress said nothing else very reputable agencies. in legislation we say we know you can- would work to save our kids and bring I know I have a colleague on the floor not prove it is protecting public health down youth smoking rates. who wants to speak. I am going to or it meets safety and efficacy, but on Senator KENNEDY made the following yield the floor to him. But let me re- that we want you to turn your head, we remarks during the 1998 Senate floor mind my colleagues, we are talking want you to ignore the core mission for debate to emphasize the need to pro- about a massive expansion of regula- this new jurisdiction we are going to tect our children. I quote: tion for the FDA, not a massive expan- give you, but for everything else, we FDA Commissioner David Kessler has sion of regulation over tobacco. There want you to apply that gold standard, called smoking a ‘‘pediatric disease with its are a host of agencies currently that we want to ensure drug safety, device onset in adolescence.’’ In fact, studies show regulate tobacco. It is the most regu- safety, food safety but not with to- that over 90 percent of the current adult lated product in the United States of bacco. smokers began to smoke before they reached America. Now we want to centralize To my colleagues, it is very simple. the age of 18. It makes sense for Congress to do what we can to discourage young Ameri- that regulation into the FDA. Read the bill. You won’t vote for this cans from starting to smoke during these Let me read the FDA’s mission state- bill. You want to reduce youth con- critical years. . . . Youth smoking in Amer- ment: sumption of tobacco? It is real simple. ica has reached epidemic proportions. Ac- The FDA is responsible for protecting the We reduce it faster by doing nothing. cording to a report issued last month by the public health by assuring the safety, effi- Again, I think there will be a sub- Centers for Disease Control and Prevention, cacy, and security of human and veterinary stitute that all Members can vote for smoking rates among high school students drugs, biological products, medical devices, tonight. It accomplishes further reduc- soared by nearly a third between 1991 and our Nation’s food supply, cosmetics and tions of youth usage, because we don’t 1997. Among African-Americans, the rates products that emit radiation. constrict less harmful products in the have soared by 80 percent. More than 36 per- Just in the first phrase, ‘‘protecting future from coming to the market. We cent of high school students smoke, a 1991 the public health,’’ you are not pro- year high. . . . With youth smoking at crisis don’t lock an adult population in to levels and still increasing we cannot rely on tecting public health when you allow only being smokers because they are halfway measures. Congress must use the cigarettes to be sold. So the fact that addicted to nicotine. We give them op- strongest legislative tools available to re- we have constructed a bill that grand- tions, such as Sweden gave their citi- duce smoking as rapidly as possible. fathers every existing product but zens, where they have reduced adult to- Senator KENNEDY, on the Senate makes it practically impossible to bacco smoking at incredible rates be- floor, May 19, 1998. bring to market reduced-risk products cause of innovative new products that Of course, the Senate told the Amer- that allow Americans to give up the deliver nicotine in a way that reduces ican public that passage of the massive cigarettes and to move to something the risk of disease and reduces the rate FDA tobacco regulation bill back in else, the CBO was right, it will slow the of death. 1998 contained the ‘‘strongest legisla- reduction in smoking rates. We do If the objective here is to reduce dis- tive tools available’’ to address youth nothing for disease and death. We do ease, to reduce death, to reduce youth smoking issue. more for disease and death by not pass- usage, then I would encourage my col- Congress did not pass the FDA bill ing legislation than we do by passing leagues tonight, when Senator HAGAN we are debating today. What happened legislation. If the authors of this bill and I introduce the substitute, to lis- with youth smoking rates? They de- are, in fact, honest and the effort is to ten very carefully and support the sub- creased since 1998 to current alltime reduce youth access and youth usage, stitute. But at the end of the day, if lows. I am talking about record lows then the Members of the Senate should your objective is to reduce youth con- over a 34-year period. In 1998, we were do nothing. sumption of cigarettes, in the absence told by some in the Senate that youth Hopefully, tonight Senator HAGAN of passing that substitute, it is very smoking rates would not come down and I will offer a substitute that brings clear—the CBO and the University of absent a major bureaucratic expansion as much regulatory authority to an en- Michigan says: Pass nothing. over tobacco at FDA. Those Senators tity outside the Food and Drug Admin- Madam President, I yield the floor. were wrong, dead wrong. istration but one under the Secretary The PRESIDING OFFICER. The Sen- Today, we continue the same debate of Health and Human Services. Why? ator from Oregon. over basically the same bill, and we are Because I spent 15 years in Washington Mr. MERKLEY. Madam President, I debating this as if nothing else has trying to protect the integrity and the ask unanimous consent to refer to happened or changed. Obviously, some- gold standard of the FDA, so that when these tobacco orb products during my thing we are doing across this country every American goes to bed at night speech. is working, and it has nothing to do and they take that prescription they The PRESIDING OFFICER. Without with what Congress is talking about got from a pharmacist prescribed by a objection, it is so ordered. doing. It has to do with the passage of doctor, they don’t have any question as Mr. MERKLEY. Madam President, I the Master Settlement Agreement, ad- to whether, one, it is safe, or, two, it is want to start by thanking Senator vertising restrictions, awareness cam- going to work; that when they go to DODD for his tireless advocacy on this paigns, and education. the hospital and all of a sudden a doc- issue. The need to regulate tobacco None of these things are enhanced in tor shows them a procedure they are products has been evident for many H.R. 1256, the Kennedy bill. It is about going to have and a medical device is years, and for year after year it has design, not about keeping kids from involved, they are not sitting won- been impossible to accomplish this

VerDate Nov 24 2008 01:57 Jun 04, 2009 Jkt 079060 PO 00000 Frm 00014 Fmt 0624 Sfmt 0634 E:\CR\FM\G03JN6.013 S03JNPT1 jbell on PROD1PC69 with SENATE June 3, 2009 CONGRESSIONAL RECORD — SENATE S5999 goal. It is frankly unbelievable that like a cell phone in your pocket rather tacks, heart disease, cancer of the while we heavily regulate the produc- than a traditional can of smokeless to- esophagus, cancer of the stomach. tion and sale of aspirin, a product that bacco. They have done two other This is not a safe product. This is not is not addicting and not destructive, things to make this product appealing, safe tobacco. It is a product like ciga- tobacco, which is addictive and is de- and I have a sample right here. First, rettes that causes cancer and kills. structive, goes without regulation. they come in candy flavors. This one is Further, it is not a method of helping This bill will go a long way in help- euphemistically called ‘‘fresh.’’ It is a smokers to quit smoking. The purpose ing to keep these addictive tobacco mint candy. This one is of smokeless tobacco candy is not to products out of the hands of our chil- euphemistically called ‘‘mellow.’’ It is help people quit tobacco products, it is dren. This bill gives the FDA the legal a caramel-flavored candy. So they have designed to addict them to tobacco authority it needs to reduce youth thrown in the candy flavoring and a products. The idea that the tobacco smoking by preventing tobacco adver- really cool dispenser. And not only companies would be out marketing a tising targeting children. It provides does the dispenser look like a cell product designed to get people to quit the FDA with the authority to prevent phone—so teachers can’t tell what it using tobacco products is, quite frank- the sale of tobacco products to minors is—but it has a feature taken from the ly, obviously ridiculous. Unlike as well as the authority to prevent the world of the Pez candy dispenser. You Nicorette or the nicotine patch, which tobacco industry from misleading the pop it open, and out pops a single to- are designed to help people quit smok- public about the dangers of smoking. bacco tablet. You close it and shake it ing, tobaccoless candy does not help Additionally, this bill takes impor- around, open it up again, and out pops you quit and the doses do not get any tant steps in the regulation of smoke- another one. So we have three features lower over time. less tobacco. We are all familiar with here designed specifically to market to The U.S. Public Health Service Clin- the dangers posed by cigarettes—the children: the cell phone shape, the ical Practice Guideline notes: health effects have long been docu- candy flavoring, and the Pez-style dis- The use of smokeless tobacco products is mented—both on users and bystanders. penser. not a safe alternative to smoking, nor is We are also familiar with the steps Now, why is it tobacco companies there evidence suggesting it is effective in helping smokers quit. being taken in many cities and many need to market to children? It is be- States to rid our public areas of sec- cause when adult testers try out a to- It is no secret these products are dan- ondhand smoke. These actions, thank- bacco product, they rarely continue gerous. Six years ago to this very day, fully, have been quite successful, but using it. Therefore, they rarely become Surgeon General Richard Carmona they lead to a major dilemma for to- a customer of a tobacco company. A talked about what he called the ‘‘pub- bacco companies: if smoking becomes teenager who tries one of these prod- lic health myth’’ that smokeless to- socially unacceptable, how can the in- ucts—whose brain is still being wired bacco is a good alternative to smoking. dustry replace the hundreds of thou- and, therefore, is much more suscep- He emphatically said that was simply sands of tobacco addicts who die every tible to the influence of nicotine—is not true, and I think it is worth year? The industry’s response has been much more likely to become addicted quoting him at some length: to bet heavily on smokeless tobacco and become a lifelong customer or reli- I cannot conclude that the use of any to- products and to bet on addicting able customer. That is why the tobacco bacco product is a safer alternative to smok- ing. This message is especially important to youngsters to those products. companies are marketing tobacco communicate to young people, who may per- Chewing tobacco has been around for candy to our children. ceive smokeless tobacco as a safe form of to- a while, but it has its own limitations. There is no question that this to- bacco use. Smokeless tobacco is not a safe There aren’t many places—outside of bacco candy is dangerous. The Indiana alternative to cigarettes. Smokeless tobacco this very Chamber—in the United Poison Control has estimated that each does cause cancer. States where you can find a spittoon. tablet delivers 60 to 300 percent of the That statement is from a 2003 House So the tobacco companies are looking nicotine in a single cigarette. The hearing on tobacco harm reduction, for hip new smokeless tobacco products product is addictive. The product and I ask unanimous consent, Madam that don’t require spitting and that can causes cancer. And unless we pass this President, to have printed in the appeal to a new generation of children. bill and give the FDA the authority to RECORD the entire prepared testimony This picture was taken just a few regulate, soon you will see this tobacco delivered that day. blocks from this Capitol. It is of a new candy in a convenience store near you, There being no objection, the mate- product called ‘‘Snus’’ that R.J. Rey- and we will see more displays such as rial was ordered to be printed in the nolds is selling nationwide. It is a fla- the one shown here in Portland—to- RECORD, as follows: vored, pouched tobacco product adver- bacco candy advertised right next to TESTIMONY BEFORE THE SUBCOMMITTEE ON tised as not requiring spitting. And as ice cream. COMMERCE, TRADE, AND CONSUMER PROTEC- you can see here, it is advertised next Once the companies master the tech- TION, COMMITTEE ON ENERGY AND COM- to displays of candy and Peppermint nique of turning tobacco into kid- MERCE, UNITED STATES HOUSE OF REP- Patties. I should note that this con- friendly candy, there is no end to the RESENTATIVES tainer was not the original designed for variety of products that can be turned CAN TOBACCO CURE SMOKING? A REVIEW OF the Snus container. The original con- out. Already RJR has announced they TOBACCO HARM REDUCTION tainer was round. As reported by the are planning to launch two new forms Statement of Richard H. Carmona, M.D., of tobacco candy; sticks, which look M.P.H., F.A.C.S., Surgeon General, U.S. Portland Oregonian last December, it Public Health Service, Acting Assistant came in containers similar to chewing like toothpicks you suck on, and Secretary for Health, Department of tobacco, but teachers in schools no- strips, which are nearly identical to Health and Human Services ticed these containers in their stu- breath mint strips that dissolve on Mr. Chairman, distinguished members of dents’ pockets. your tongue. the Subcommittee, thank you for the oppor- So now R.J. Reynolds has redesigned Everywhere I go and talk about these tunity to participate in this important hear- them so that teachers can’t recognize products, people are outraged. Mean- ing. My name is Richard Carmona and I am that these are smokeless tobacco prod- while, the tobacco industry and its the Surgeon General of the United States of ucts in their students’ pockets. champions are trying to justify these America. Clearly, the marketing is aimed at products as safe alternatives to smok- Let me start with a few statements that were once accepted throughout society that young people. But it gets even worse. ing. That just isn’t so. And that rhet- have now been relegated to the status of Now R.J. Reynolds has come out with oric poses a real danger to consumers myth. another product that they are test who might think smokeless tobacco is Men do not suffer from depression. marketing in three cities across the harmless. In fact, this very rhetoric Domestic violence is a ‘family’ or ‘private’ country, one of which is in my home shows why we need to have the FDA matter. regulating this product. In fact, the The HIV-AIDS epidemic is of no concern to State of Oregon. Portland, OR, is a site most Americans. for the test market of tobacco candy. Surgeon General has determined the All of us here know that these three state- Tobacco candy, as you see here, also use of smokeless tobacco can lead to ments are very dangerous public health comes in what was designed to look oral cancer, gum disease, heart at- myths.

VerDate Nov 24 2008 00:26 Jun 04, 2009 Jkt 079060 PO 00000 Frm 00015 Fmt 0624 Sfmt 0634 E:\CR\FM\G03JN6.022 S03JNPT1 jbell on PROD1PC69 with SENATE S6000 CONGRESSIONAL RECORD — SENATE June 3, 2009 My remarks today will focus on a fourth When and if such a product is ever con- Every day, more than 2,000 kids in the U.S. public health myth which could have severe structed, we would then have to take a look will start to smoke, and more than 1,000 consequences in our nation, especially at the hard scientific data of that particular adults will die because of smoking. We have among our youth: smokeless tobacco is a product. to get youth to stop starting. But the answer good alternative to smoking. It is a myth. It Our nation’s experience with low-tar, low- is not smokeless tobacco. is not true. nicotine cigarettes is instructive to the issue We have evidence to suggest that instead As the nation’s Surgeon General, my top at hand. Low-tar, low-nicotine cigarettes of smokeless tobacco being a less dangerous responsibility is to ensure that Americans were introduced in the late 1960’s and widely alternative to smoking, just as smoking is a are getting the best science-based informa- endorsed as a potentially safer substitute for gateway to other drugs, smokeless tobacco is tion to make decisions about their health. the typical cigarette on the market at that a gateway to smoking. So I very much appreciate the opportunity time. Within a decade, the low-tar brands So we must redouble our efforts to get our to come before this Subcommittee today and dominated the cigarette market. Many youth to avoid tobacco in all forms. help refute this dangerous idea. smokers switched to them for their perceived We have some real work to do on the ‘‘cul- First, let me emphasize this: health benefits. ture’’ of smokeless tobacco, which is glamor- No matter what you may hear today or Unfortunately, the true health effects of ized by some sports stars. Chicago Cub read in press reports later, I cannot conclude these products did not become apparent for Sammy Sosa, who has made a public com- that the use of any tobacco product is a safer another 10 to 20 years. We now know that mitment to avoiding smokeless tobacco, is a alternative to smoking. This message is es- low-tar cigarettes not only did not provide a great example for kids. Past baseball great pecially important to communicate to young public health benefit, but they also may Joe Garagiola is now Chairman of the Na- people, who may perceive smokeless tobacco have contributed to an actual increase in tional Spit Tobacco Education program, and as a safe form of tobacco use. death and disease among smokers. regularly lectures young players against the Smokeless tobacco is not a safe alternative First, many smokers switched to these dangers of smokeless tobacco. to cigarettes. products instead of quitting, which contin- As Members of Congress, you can lead by Smokeless tobacco does cause cancer. ued their exposure to the hundreds of car- example too, not just in legislation, but in Our nation’s experience with low-tar ciga- cinogens and other dangerous chemicals in your own lives. I encourage you to avoid to- rettes yields valuable lessons for the debate cigarettes. Second, to satisfy their bodies’ bacco in all its forms. Do not fall for the over smokeless tobacco. craving for nicotine, many smokers unwit- myth—a very dangerous public health Tobacco use is the leading preventable tingly changed the way they smoked these myth—that smokeless tobacco is preferable cause of death in the United States. low-tar cigarettes: they began inhaling more to smoking. Do not let America’s youth fall Each year, 440,000 people die of diseases deeply, taking more frequent puffs, or smok- for it, either. caused by smoking or other form of tobacco ing more cigarettes per day. From the perspective of individual risk, use—that is about 20 percent of all deaths in In fact, we now believe that low-tar ciga- the cumulative effect on smokers of switch- our nation. rettes may be responsible for an increase in ing to smokeless tobacco is simply not The office I lead as Surgeon General has a different form of lung cancer, adenocar- known. But we clearly know that use of long played a key role in exposing the risks cinoma, which was once relatively rare. This smokeless tobacco has serious health con- of tobacco use. In 1986, the Surgeon General’s cancer is found farther down in the lungs of sequences. Overall, smokeless tobacco prod- Report The Health Consequences of Using smokers, indicating deeper inhalations, and ucts have been classified as a known human Smokeless Tobacco reached four major con- appears linked to a specific carcinogen par- carcinogen. And limited scientific data indi- clusions about the oral use of smokeless to- ticularly present in low-tar brands. cate that former smokers who switch to bacco: We must learn the lessons of the low-tar smokeless tobacco may not have as great a 1. Smokeless tobacco represents a signifi- cigarette experience. Not only did they fall decrease in lung cancer risks as quitters who cant health risk; to reduce an individual’s risk of disease, but do not use smokeless tobacco. 2. Smokeless tobacco can cause cancer and they also appear to have increased popu- From the perspective of population risk, a number of non-cancerous oral conditions; lation risk by delaying quitting and poten- there are even more unanswered questions. 3. Smokeless tobacco can lead to nicotine tially contributing to initiation among Even if there was some decreased risk for addiction and dependence; and young people. This has taught us that we smokers who switch to smokeless tobacco, 4. Smokeless tobacco is not a safer sub- must move cautiously in recommending any that benefit may be more than offset by in- stitute for cigarette smoking. supposedly safer alternative for people try- creased exposure of the overall population to Recognizing these serious health con- ing to quit smoking—because now, with this known carcinogen. sequences, Congress passed the Comprehen- more knowledge and the benefit of hindsight, The marketing of smokeless tobacco as a sive Smokeless Tobacco Health Education the science does not support early rec- potentially safer substitute for cigarettes Act in 1986. This law required the placement ommendations on low-tar cigarettes. could lead to: of Surgeon General’s warnings on all smoke- Mr. Chairman, in the interest of time I will More smokers switching to smokeless to- less tobacco products. shortly ask that the remainder of my state- bacco instead of quitting tobacco use com- Mr. Chairman and Members of the Sub- ment and the scientific information con- pletely; committee, I respectfully submit that tained in it be considered as read and made A rise in the number of lifetime smokeless smokeless tobacco remains a known threat part of the record. But before I do that, I tobacco users if more youth begin using to public health just as it was when Congress would like to ask for this Subcommittee and smokeless tobacco; acted in 1986. the Congress’ help in getting the message A rise in the number of cigarette smokers Conversely, time has only brought more out about the dangers of the myth of smoke- as a result of more youth starting to use disease, death and destroyed lives. less tobacco. smokeless tobacco and then switching to cig- The National Toxicology Program of the All of us in this room are very concerned arette use; and National Institutes of Health continues to about our nation’s youth. Kids growing up Some former smokers returning to using classify smokeless tobacco as a known today have a tough time of it. In addition to tobacco if they believe that smokeless to- human carcinogen—proven to cause cancer the normal struggles of puberty, many kids bacco is a less hazardous way to consume to- in people. are facing a host of other challenges. Many, bacco. As Surgeon General I cannot recommend especially minority kids, must struggle to Concerns about youth initiation are espe- use of a product that causes disease and find their way in unsafe neighborhoods. cially troubling. The scientific evidence is death as a ‘lesser evil’ to smoking. My com- So the temptation to engage in behavior clear that use of smokeless tobacco is a gate- mitment, and that of my office, to safeguard that is not healthy, and the opportunity to way to cigarette use. Young people may be the health of the American people demands do so, is very hard for our young people to especially attracted to smokeless tobacco if that I provide information on safe alter- resist. they perceive it to be safer than cigarettes. natives to smoking where they exist. According to a 2000 survey by the Sub- Studies show that more than one in five I cannot recommend the use of smokeless stance and Mental Health Services Adminis- teenage males have used smokeless tobacco, tobacco products because there is no sci- tration (SAMHSA) (The National Household with age 12 being the median age of first use. entific evidence that smokeless tobacco Survey on Drug Abuse), about 1 million kids Surveys also show that more than two in five products are both safe and effective aids to from age 12–17 smoke every day. Another 2 teenagers who use smokeless tobacco daily quitting smoking. million kids smoke occasionally. also smoke cigarettes at least weekly. Fi- Smokers who have taken the courageous And we know that smoking is often not a nally, independent research and tobacco step of trying to quit should not trade one ‘‘stand-alone’’ risk behavior; it travels with company documents show that youth are en- carcinogenic product for another, but in- others. The SAMHSA survey found that couraged to experiment with low-nicotine stead could use Food and Drug Administra- youth who were daily cigarette smokers or starter products and subsequently graduate tion-approved methods such as nicotine gum, heavy drinkers were more likely to use il- to higher-level nicotine brands or switch to nicotine patches, or counseling. licit drugs than either daily smokers or cigarettes as their tolerance for nicotine in- While it may be technically feasible to heavy drinkers from older age groups. More creases. someday create a reduced-harm tobacco than half of 12–17 year olds who were daily Finally, we simply do not have enough sci- product, the Institute of Medicine recently smokers had also used illicit drugs within entific evidence to conclude that any to- concluded that no such product exists today. the past month. bacco product, Including smokeless tobacco,

VerDate Nov 24 2008 00:26 Jun 04, 2009 Jkt 079060 PO 00000 Frm 00016 Fmt 0624 Sfmt 0634 E:\CR\FM\A03JN6.002 S03JNPT1 jbell on PROD1PC69 with SENATE June 3, 2009 CONGRESSIONAL RECORD — SENATE S6001 is a means of reducing the risks of cigarette NEDY’s wishes, and mine, of finally see- Through these cases, the American smoking. At this time, any public health rec- ing this bill signed into law. people learned that the lies and deceit ommendation that positions smokeless to- I would also like to thank Senator of the tobacco industry extended far bacco as a safer substitute for cigarettes or DODD for his dedication in carrying out beyond that of a Congressional hearing as a quitting aid would be premature and the aggressive schedule of the HELP dangerous. With the memory of our experi- room. The suits unearthed that the to- ence with low-tar cigarettes fresh in our Committee set forth by the chairman bacco industry had established and minds, we must move extremely cautiously so we can bring this legislation to the funded the councils and institutes before making any statement or endorse- floor. claiming tobacco was not a health haz- ment about the potential reduced risk of any As a cosponsor of this legislation, I ard; and had internal documents stat- tobacco product. firmly believe that we cannot afford to ing that No. 1, nicotine is addictive; Finally, my strong recommendation as wait another day for it to be enacted. No. 2, smoking is a habit of addiction; Surgeon General is a call for sound evidence This is not the first time that I have about tobacco products and their individual and No. 3, that in order to continue to risen to speak on the importance of prosper, cigarettes must be marketed and population based health effects. We need regulating the sale of tobacco products, more research. We need to know more about to younger and younger age groups— the risks to individuals of switching from but I am hopeful that with this legisla- below the legal smoking age of 18. smoking to smokeless; and we need to know tion we will take a giant leap toward The tobacco industry settled these more about the risks to the entire popu- eradicating the use of nicotine, by dis- lawsuits. The agreement, totaling lation of a promotion campaign that would couraging our youth from ever light- nearly $206 billion, was ordered to be position smokeless tobacco as a safer sub- ing-up, and chip away at skyrocketing distributed to the States in an effort to stitute for smoking. smoking-related healthcare costs. recoup Medicaid dollars spent on smok- Until we have this science base, we must Every year that passes, and this leg- convey a consistent and uncompromised ing-related health care costs. While islation is not enacted, another 4,700 $206 billion seems like a lot to you and message: there is no safe form of tobacco children in Rhode Island try a ciga- use. me, this amount of money only ac- Thank you. I would be happy to answer rette for the first time—that amounts counts for approximately 7 years of the any questions. to 1,400 children in my State alone be- Medicaid budgets of the 46 States. Mr. MERKLEY. Madam President, it coming regular, daily smokers each The fact that the industry did settle is a travesty that R.J. Reynolds can year. These new smokers become part should have been a clear sign that to- launch an addictive carcinogenic candy of the 8.6 million individuals nation- bacco production and marketing needs targeted at children with no review by wide suffering from smoking-caused ill- to be regulated. Unfortunately, around the Food and Drug Administration. nesses; they become part of the 400,000 the same time that the settlement oc- deaths every year attributed to to- Nicorette—designed to help you quit curred, the Supreme Court narrowly bacco use. We can and must do more to smoking—went to the FDA for ap- ruled—on a 5-to-4 margin—that the curb the use of this very serious and proval, but caramel tobacco candy or FDA did not have such authority to deadly poison. This is a public health mint tobacco candy—designed to hook regulate their products. The tobacco emergency that demands action. industry continued to aggressively kids on tobacco—is on the shelves in Over the years, the tobacco industry Portland, OR, right now with zero over- has been confronted with opportunities market tobacco products. Nearly 10 years later, this past De- sight. to do the right thing—to be honest cember, the Supreme Court upheld that This bill will finally bring some about the health effects of tobacco or tobacco firms could, in fact, be charged transparency and common sense to the even the intended targets of various at the State level with deceptive adver- regulation of tobacco. Finally, the marketing campaigns. In every in- tising practices of cigarettes. We have FDA will be able to address the single stance they passed up that opportunity on the one hand, no regulation; on the greatest public health menace in our and actively fought to continue allur- Nation. I am pleased that this bill does ing generation after generation to use other hand, the possibility of State en- include an amendment that Senator tobacco products. forcement. BROWN and I authored to require the I would like to use the time that I These two Supreme Court decisions Tobacco Advisory Committee to expe- have today to walk through some of further complicate the message re- dite the review of tobacco candy. I look those occasions in an attempt to dem- ceived by Americans regarding the use, forward to passing this bill and to onstrate how important the Family marketing and distribution of tobacco. keeping tobacco candy from store Smoking Prevention and Tobacco Con- In essence, the industry could be held shelves before the industry succeeds in trol Act is to the American people, not liable for certain advertising practices, hooking a whole new generation of our only to our health, but to our economic but direct, regulatory oversight of children. prosperity. those practices does not exist. Appro- Madam President, I yield the floor, In 1994, while I was in the House of priate guidelines do not exist. With and I suggest the absence of a quorum. Representatives, seven executives from this bill, we have the opportunity to The PRESIDING OFFICER. The the tobacco industry took an oath be- ensure that guidelines are established. clerk will call the roll. fore a House committee that they To add yet another layer to this de- The bill clerk proceeded to call the would tell the truth about tobacco. In bate, only 2 weeks ago, the U.S. Dis- roll. their statements and responses to ques- trict Court of Appeals for the District Mr. REED. Madam President, I ask tions from members on the committee, of Columbia ruled that the tobacco in- unanimous consent the order for the all seven individuals stated that they dustry falsely advertised ‘‘light’’ and quorum call be rescinded. believed nicotine was not addictive, ‘‘low-tar’’ cigarettes under the guise The PRESIDING OFFICER. Without and that new marketing practices were that they were less dangerous than objection, it is so ordered. not designed to reach younger and other products. This ruling comes after Mr. REED. Madam President, I rise younger age groups, below the legal 10 years from the date the suit was today in support of the Family Smok- smoking age of 18. originally filed—10 years too late to ing Prevention and Tobacco Control In order to support these claims, the prevent 10,000 Rhode Island children be- Act, but first, I would like to take a executives cited research councils and ginning to regularly use tobacco. Had moment to recognize the outstanding institutes. But these statements were we enacted the Family Smoking Pre- leadership of Chairman KENNEDY on contrary to what many public health vention and Tobacco Control Act, or a this important public health issue. officials were saying, and what I be- similar version of this legislation, This is not the first time he has ush- lieved. This further obscured the no- years ago, we could have prevented ered a bill on this topic from com- tion that smoking was a direct cause of some of those in my State and across mittee to the Senate floor. I am con- disease. the country from ever smoking. In- fident that my colleagues, in recogni- A total of 46 States—including my stead, the debate has dragged on for 10 tion of the tremendous, hazardous ef- own—States in which the majority of years. fects that tobacco has on children, ado- my colleagues represent—then pro- Unfortunately, this debate will con- lescents, adults, and seniors, will join ceeded to call their bluff, one lawsuit tinue to drag on. The tobacco industry me in fulfilling one of chairman KEN- at a time. has already publicly stated that it will

VerDate Nov 24 2008 01:57 Jun 04, 2009 Jkt 079060 PO 00000 Frm 00017 Fmt 0624 Sfmt 0634 E:\CR\FM\A03JN6.005 S03JNPT1 jbell on PROD1PC69 with SENATE S6002 CONGRESSIONAL RECORD — SENATE June 3, 2009 continue to argue the decision that was The PRESIDING OFFICER (Mrs. prevent Congress from acting to pro- recently rendered. Rather than taking HAGAN). The clerk will call the roll. tect the children and the citizens of the tortuous, time-consuming and very The legislative clerk proceeded to our country from this addictive prac- expensive path of taking the case call the roll. tice. Given these figures and the fact through litigation, I think we have to Mr. SANDERS. I ask unanimous con- that profit margins are estimated at 46 give the FDA the authority to regulate sent that the order for the quorum call cents per pack for Philip Morris, I can- tobacco products. be rescinded. not understand any argument against We have the opportunity before us to The PRESIDING OFFICER. Without legislation to regulate the marketing, put an end to the courtroom drama. objection, it is so ordered. advertising, and product standards of With the Family Smoking Prevention Mr. SANDERS. Madam President, I cigarettes and other tobacco products. and Tobacco Control Act, we can give am very pleased that we are finally Tobacco has been considered more the FDA the authority to regulate to- taking up this very important legisla- addictive than heroin. Let me repeat: bacco, restrict illegal advertising prac- tion. Regulating tobacco through the Tobacco has been considered more ad- tices targeting children, prevent the FDA is an essential part of addressing dictive than heroin. In fact, there are a unlawful sale of tobacco to our Na- public health issues related to tobacco number of anecdotal stories of former tion’s youth, and strengthen warning use, and I fully support this long over- heroin addicts who were able to kick labels. due legislation. The cost of smoking is their heroin habit but not their to- With this legislation, everyone wins. estimated at $96 billion a year in bacco habit. It was just too hard to The tobacco industry would have clear health care costs. The human toll is quit tobacco compared to heroin. Imag- guidance on advertising practices even more appalling: 440,000 smoking- ine that. which could help them avoid lengthy related deaths per year. Tobacco is re- Tobacco companies are adding nico- litigation; young people will not be tar- sponsible for one-third of all cancer tine and other chemicals to their prod- geted by aggressive tobacco media deaths in the United States each year, ucts to make these products even more campaigns; and the public health crisis and tobacco use is the most prevent- addictive. And they are not regulated. caused by tobacco use—which costs the able cause of death in the country. Nobody regulates them. They can add American people in health care dollars, There are many important provisions whatever they want whenever they in lost productivity, and in loss of in this bill, but this issue is primarily want. So we have multinational cor- loved ones—tremendous prices—would about our children. It is appalling that porate executives in three-piece suits hopefully begin to fade. in Vermont, one in every six high making huge amounts in compensation In preparation for our discussion, I school students smokes cigarettes, and packages based on selling a killing and looked back at some of the past state- nationally 20 percent—one in every five addictive product to the American peo- ments that I have made in support of high school students—smoke. Every ple and to our children. We should be regulating tobacco—and one sticks out day, about 3,600 children between 12 very clear when we take a look at in my mind: the tobacco industry has and 17 years of age smoke their first these CEOs and understand that they worked hard to earn the trust of the cigarette; 1,100 of them will become are nothing more than high-priced and American people. regular smokers, and 300 of those will high-paid drug pushers. This Congress We must try to win that trust back. ultimately die from this habit. That is has spoken out repeatedly against We must empower the FDA to regulate condemning over 100,000 kids every those horrendous people, the lowest of tobacco in order to rein in the use of year to a certain early death caused by the low, who are trying to get our kids tobacco by children, control the access tobacco. No wonder that 70 percent of into heroin and other drugs. We should that our children have to tobacco, and voters strongly support FDA having look at these CEOs in the same way warn the American public about its the authority to regulate tobacco. and say to them: How dare you try to dangers. Make no mistake, tobacco marketing The Senate is finally once again on sell addictive products to our kids, get and marketing to kids is big business. the path to having a meaningful debate them hooked into smoking cigarettes, The tobacco industry spends about $36 about our Nation’s health care system. and force them to end their lives pre- million every day marketing and ad- It is my hope that this debate will re- maturely and, in many cases, very vertising its addictive products in the sult in appropriate, high quality health painfully. United States. That is over $13 billion care coverage and access for every While one major part of this issue is a year. The multinational corporations American. Of course, we hope to do all stopping tobacco use before it starts, that market tobacco are not spending of this at the lowest possible cost. Congress will also need to take up the If we are serious about reforming our that kind of money if they don’t expect issue of cessation. About 70 percent of health care system, why wait? Smok- a big return. Some of these ads are not all smokers say they want to quit ing-related health care costs are sky- just trying to get older addicted smok- smoking, but tobacco is so addictive rocketing. Today the average cost of a ers to switch brands, they are mar- that even the most motivated may try pack of cigarettes in the country is keting to girls and young women to get to quit eight or nine times before they about $5 but the social cost is much them to start smoking and they are are able to do so. I look forward to more. marketing to teenage boys to get them working with my colleagues in the Every year, the public and private to start smoking. They are adding Senate to address what I see as an ad- health care expenditures caused by candy flavors to get young people to diction that leaves hard-working peo- smoking total approximately $100 bil- start smoking. ple struggling to make ends meet with lion, and $100 billion in lost produc- That our Nation’s most vulnerable limited choices in terms of cessation tivity. These are staggering totals. are subjected to these kinds of mar- programs. What we have to do as a na- I will repeat: we literally cannot af- keting campaigns of multimillion-dol- tion—and I know it is outside the scope ford to wait another day for this legis- lar profit companies is a disgrace and of this particular bill—is to make it as lation to be enacted. an outrage. Can one imagine a com- easy as possible for anyone in America We have the opportunity to begin pany trying to addict our young people who wants help in order to stop smok- charting a new course today. With this to a habit which will prematurely kill ing and kicking the habit to be able to bill, we will begin to chip away at them? I am not quite sure what kind of do so. We are not there right now. health care costs, steer our youth away morality exists on the part of people Sometimes it is complicated. Some- from smoking, and pave the way for a who do this. We are talking about an times it is expensive. Sometimes peo- healthier future for our Nation. industry where the largest company, ple do not know how to access ces- I look forward to working with my Philip Morris, brought in $18.5 billion sation programs. But I think that is a colleagues to enact this important in revenue in 2007 from their U.S. busi- goal we must strive for. piece of legislation and set forth on ness alone and over $64 billion in total Studies have shown smoking has be- this new path for a healthier and more revenues internationally. The tobacco come even more concentrated among prosperous America. industry spent nearly $28 million lob- populations with lower incomes and I yield the floor and suggest the ab- bying Congress in 2008, and from 1998 to with less education. Why do low-in- sence of a quorum. 2006, they spent over $248 million to come people smoke? Medical research

VerDate Nov 24 2008 00:26 Jun 04, 2009 Jkt 079060 PO 00000 Frm 00018 Fmt 0624 Sfmt 0634 E:\CR\FM\G03JN6.015 S03JNPT1 jbell on PROD1PC69 with SENATE June 3, 2009 CONGRESSIONAL RECORD — SENATE S6003 shows that being poor is, needless to Rhode Island and our senior Senator Even after the 1998 settlement agree- say, extremely stressful. And as any- from New Mexico. They argued that ment, one tobacco company noted, one who has ever been addicted to to- the FDA regulation of tobacco was ‘‘market renewal is almost entirely bacco knows, being anxious, being ‘‘long overdue.’’ They pointed out that from 18-year-old smokers.’’ They do stressful makes you reach for a ciga- every day we delayed, more kids would not say they are targeting minors. rette. start smoking and more citizens would That would be illegal. But somebody is We have a lot of work in front of us. face disease and death. That was al- going to have to explain to me how you I think this bill is a very good step for- most a decade ago. can focus your business model on 18- ward. The bottom line is, this Congress Since the FDA first tried to regulate year-olds without marketing to 17- has to, through the FDA, regulate to- tobacco, more than 20.6 million Amer- year-olds. bacco. Our goal has to be for these ican kids smoked their first cigarette, When I came to Congress after my companies to stop pushing their dan- and more than 2.6 million of those kids service as an AG, I strongly supported gerous and addictive product onto our will die because they did. Almost $1 FDA regulation of tobacco. I knew people, especially our kids. Our goal trillion has been spent on health care then the settlement did not provide the has to be to come up with programs to costs associated with smoking, and 4.6 kind of flexibility needed to effectively make it as easy as possible for people million Americans have lost their lives control tobacco industry actions. Since to get off their addiction. to cigarettes. the settlement was signed, the tobacco So we have a lot of work in front of We do not know how many young companies have shown us they will us. I think this bill is a very good step people would not be addicted today if evade it at every opportunity. On May forward. these companies had been prevented 22, the DC Circuit Court of Appeals af- Having said that, Madam President, I from advertising their products to our firmed the 2006 ruling that found to- yield the floor and suggest the absence children. We do not know how many bacco companies guilty of racketeering of a quorum. cases of lung cancer and heart disease and fraud. The original ruling con- The PRESIDING OFFICER. The could have been prevented if tobacco tained 1,300 pages describing tobacco clerk will call the roll. companies had not boosted nicotine company efforts to endanger the public The legislative clerk proceeded to levels and marketed light cigarettes as health and to cover up their activities. call the roll. if these cigarettes weren’t killers. We Many of these actions were taken after Mr. FEINGOLD. Madam President, I don’t know how many lives were lost the settlement agreement. ask unanimous consent that the order while Congress failed to act. But we do The court found the tobacco compa- for the quorum call be rescinded. know that number is too high—much nies ‘‘began to evade and at times even The PRESIDING OFFICER. Without too high. violate the settlement agreement’s objection, it is so ordered. I first became involved with this prohibitions almost immediately after (The remarks of Mr. FEINGOLD per- issue when I was New Mexico’s attor- signing the agreement.’’ After dis- taining to the introduction of S. 1173 ney general. In May of 1997, we joined banding a research program, according are located in today’s RECORD under a lawsuit that would eventually in- to the terms of the agreement, the ‘‘Statements on Introduced Bills and volve 46 States and 6 territories. In companies initiated a new research Joint Resolutions.’’) some ways, this lawsuit was like any program with the same office, the same Mr. FEINGOLD. Madam President, I other. My client, the State of New board, and even the same phone num- yield the floor, and I suggest the ab- Mexico, had lost thousands of lives and bers. sence of a quorum. billions of dollars because of the de- Given the obvious dangers of tobacco The PRESIDING OFFICER. The fendant. Our suit simply demanded res- products and the behavior of the to- clerk will call the roll. titution and damages. bacco company executives over the The assistant legislative clerk pro- But on a broader level, the tobacco years, why isn’t this product already ceeded to call the roll. cases were unprecedented. We were re- regulated by the FDA? This question Mr. UDALL of New Mexico. Madam sponding to a threat that impacts was answered implicitly by the Su- President, I ask unanimous consent every American. The suit began in Mis- preme Court in 2000, and the answer is that the order for the quorum call be sissippi and it spread to almost every instructive. The Court found that to- rescinded. State, regardless of politics or geog- bacco, unlike other FDA-regulated The PRESIDING OFFICER. Without raphy. We were addressing a national drugs, has no health benefits. In other objection, it is so ordered. problem because the Congress had words, tobacco is too unhealthy to be Mr. UDALL of New Mexico. Madam failed to act. regulated. President, I rise to support the Family In 1998, we negotiated a Master Set- Whatever you think of that ruling, it Smoking Prevention and Tobacco Con- tlement Agreement that was an impor- poses a serious question. Should an trol Act, and I wish to start by thank- tant step forward. But we knew there agency that regulates Tylenol be un- ing Senator KENNEDY and all those who was more to be done. Some have able to regulate a substance that kills have fought for this legislation over claimed the settlement makes FDA 440,000 Americans every year—more the years. regulation of the tobacco industry un- than—and think about this for a Watching this debate, I can’t help necessary. As somebody who helped ne- minute—more than alcohol, AIDs, car but think of the movie ‘‘Groundhog gotiate that agreement, let me tell you crashes, illegal drugs, murders, and Day.’’ In that movie, Bill Murray has that nothing could be further from the suicides combined? Tobacco kills more to live the same day over and over. truth. than all those combined. Is it possible Like him, I have been here before. We The settlement was not intended as a that one of the world’s most deadly ad- have all been here before. substitute for adequate Federal regula- dictive substances should be immune The FDA first attempted to regulate tion. In fact, the agreement originally from the rules that govern almost tobacco products in August 1996, al- called for FDA regulation as an inte- every other addictive substance that most 13 years ago. In 2000, a narrow gral part of efforts to protect the pub- can be legally sold in this country? majority on the Supreme Court ruled lic. The National Association of Attor- Some of those who have spoken on that the Congress had not given the neys General recently filed an amicus this bill have pointed out the FDA can- FDA authority to regulate tobacco. brief saying the settlement has not not solve the most significant problem But even as the Court struck down the stopped tobacco companies from mar- with tobacco—that when used as di- FDA rules, it noted that tobacco poses keting to kids. rected, it kills the user. But the FDA ‘‘one of the most troubling public In fact, tobacco company memos can stop tobacco companies from add- health problems facing our Nation demonstrate that their business de- ing ingredients that make their prod- today.’’ pends on recruiting what they call ‘‘re- ucts more addictive and more deadly. Immediately after that decision, this placement smokers.’’ Companies used It can stop them from lying to con- body considered legislation to provide to strategize about how to attract cus- sumers about the health impact of the needed authority. That legislation tomers as young as 13, and evidence their products, and it can stop them was introduced by the Senator from suggests this strategy has not changed. from marketing to our children. In

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The company in America, and the sponsors of this was 11 years ago; 11 years ago, the FDA thought she was one of their cus- bill have stated it numerous times: No. Modernization Act was passed. I was tomers, and they asked her to send me 1, to reduce youth usage; No. 2, to re- the lead sponsor of that bill, writing a form e-mail opposing this legislation. duce disease and death. That is the that bill in the House of Representa- She forwarded their e-mail, and at the public health component, and I agree tives. It took 21⁄2 years to construct it. beginning of the e-mail she wrote: totally with it. But I think what we Every Member believed that the gold They strongly urged me to copy the fol- have to look at is the experience of standard of the FDA was so important lowing message to you and to vote against what is happening today and what the that we never lost focus on the fact it. What they don’t know is I don’t smoke. assessments are of the bill that is being that we had to maintain the integrity But my 12 and 7-year-olds do because they considered that would grant FDA juris- of the mission statement of the FDA. have to go visit their dad, who smokes diction of this product. But no Member of Congress ever at- around them. Not only do they get a lot of Today, the Centers for Disease Con- tempted to extend jurisdiction over to- secondhand smoke, but my oldest one idol- bacco to the FDA because they were izes her dad and will probably end up smok- trol says smoking is being reduced an- nually by 2 to 4 percent. The Congres- concerned at the time that to do that ing because of him. So by all means, pass the would lessen that gold standard at the bill. sional Budget Office has looked at the Kennedy bill and assessed that over the FDA. Congress has waited too long to pro- How can you tell an agency that has tect this woman and her children. It is next 10 years the bill would reduce con- sumption by smokers at 2 percent. Let a regulatory responsibility to protect time to get this done. the safety and effectiveness of those me say that again. Currently, doing In ‘‘Groundhog Day,’’ Bill Murray products they regulate that we want nothing—not spending billions of dol- wakes up to a different day when he fi- you to do it on drugs and biologics and lars, not giving new authorities to the nally does the right thing. I am hoping medical devices, but we don’t want you FDA—we reduce smoking by 2 to 4 per- we will all wake up after this vote to a to do it on this new product of tobacco? cent per year. But if we put this bill new day—a day when our citizens have The risk and concerns and fears at the into effect—at $787 million annually— the health protections they should ex- time were that this might diminish the and we give the FDA authority and pect from their government. I would effectiveness of the FDA. ask you to join me in supporting this jeopardize the gold standard of the What has happened in 11 years? For commonsense legislation. agency which approves drugs and bio- 11 years, we have had a steady decrease I yield the floor. logics, medical devices and food safety, in smokers. Now we are going to adopt The PRESIDING OFFICER. The Sen- we are actually not going to reduce a bill that potentially locks us into ator from Wyoming. smoking usage as much as if we did just the products in 2007. Why have we Mr. ENZI. Madam President, I yield nothing. had a reduction? Because new reduced- 45 minutes postcloture time to Senator Why is that? This is very important risk products have come to the mar- BURR. because you will hear me talk over the ketplace. We ought to continue to The PRESIDING OFFICER. The Sen- next several days about reduced-risk bring new reduced-risk products to the ator from North Carolina. products. Reduced-risk products are marketplace. Unfortunately, this bill Mr. BURR. Madam President, let me products that deliver the nicotine does not do that. As a matter of fact, in say to my colleague, who had his con- needed for the addiction but reduce the section 910 of this bill, a so-called new stituent send him a letter and who risk of disease and death because it tobacco product would not be marketed served in an incredibly effective fash- may be moved from smoking products unless these three things were met: No. ion as State attorney general and who to smokeless products. The truth is, 1, it can show the marketing is appro- was involved in the MSA, the MSA was under the Kennedy bill, we basically priate for the protection of public very clear. States extorted—that is eliminate any product that wasn’t health; No. 2, the increased likelihood what I call it—money from the tobacco marketed in February of 2007—over 2 that existing users of tobacco products companies to pay for health care costs. years. We have put a marker in the bill will stop using such products; and No. That money that was part of the Mas- that says if there is a product in the 3, the likelihood that those not using ter Settlement Agreement was laid out marketplace that was not sold in Feb- such products will not start. on behalf of the tobacco industry to ad- ruary of 2007, it can’t be sold any more. Let’s take the first requirement and dress the health care costs in those But if it is a product that was sold be- put it into English. Before a company States but also to provide the re- fore February 2007, the FDA can’t could market a new tobacco product, it sources so those States could, in fact, change it one bit. It is grandfathered would have to show that its use is ap- do cessation programs for adults to in. propriate for the protection of public stop smoking. So what is the CBO’s assessment? health. Who in the world can show that What is our experience in the coun- What the Kennedy bill does is it grand- the use of a tobacco product is appro- try relative to the recommendations fathers every cigarette that was on the priate for public health? It is impos- given by the Centers for Disease Con- market 21⁄2 years ago and it doesn’t sible. In other words, this new tobacco trol to those States in terms of what allow the FDA to change it in any way. product—be it a cigarette, raw tobacco, they ought to spend on programs to get The only thing it does is to increase perhaps an alternative tobacco prod- individuals to stop smoking? Well, in the warning label. I stated on the floor uct—the companies would have to show the State of New Mexico, they have earlier today that if putting a warning that this new product is appropriate done very well. They have actually label on it reduces the usage of ciga- for the protection of public health. spent 44 percent of what the CDC sug- rettes, I am willing to do it today. I Somebody is going to have to explain gested they spend. will cosponsor it with anybody. The to me how a cigarette can be appro- But I think you would also find it truth is, what this bill does is it locks priate for the protection of public shocking to know that the prevalence in these products; therefore, it elimi- health. It cannot be done. Therein lies of marijuana usage in that State is 1 nates the choices adults have to try to why I grandfathered products before percent higher than the prevalence of get off of cigarettes and move to a re- 2007. smoking by youth. The prevalence of duced-risk product. Even if by some miracle the inventer youth marijuana usage is 1 percent My colleague pointed to the Supreme could show a product was appropriate higher than the prevalence of smoking Court ruling on the tobacco industry, for the protection of public health, this cigarettes by youth. In addition to and he was partially correct. He just would only meet a third of the quali- that, I might add that the prevalence didn’t tell the whole story. The whole fications for a new product to come to

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That sub- will have to show me how you can pro- communicate with consumers until stitute will bring full regulatory au- vide an example of a tobacco product you have an approved application, how thority to an entity to regulate this in- currently for sale that would satisfy would you ever get approval under sec- dustry. I am not up here saying we can- these standards: it discourages people tion 911? The devil is in the details. In not regulate it better than we do from smoking, and it deters young peo- fact, you cannot communicate, but you today. It is the most regulated product ple from starting. The bill’s manager, have to communicate to be able to pass in America. It is regulated by more the author of the bill, could not share the third threshold of allowing the agencies than any product that is sold with us exactly how you accomplish product to come to the marketplace. today. Can we do it more extensively? that. So it is disingenuous to suggest that Sure. Can we have better warning la- How does one go about assembling this bill is for the purposes of reducing bels? Absolutely. Can we be graphic in the data that is needed for new prod- death and disease when, in fact, those our description of what these products ucts when, in fact, you cannot actually things that are proven to reduce death cost? Certainly. But the question is, ask consumers about a product that and disease have strictly been forbid- Where is it more appropriate to do the has yet to have an application ap- den. And in the case of those that are regulation? proved. It is a catch-22. It sounds good. at market today, they would be pulled I suggest that creating a new entity Let me highlight another problem from the marketplace. under the Secretary of Health and with the bill as it relates to harm re- It would be fair to say that what we Human Services, where they have full duction. You heard me discuss harm- are doing is freezing the marketplace authority to regulate this product, to reduction products or products that are for cigarettes and chewing tobacco. In limit its advertising, to eliminate its less harmful. These are not found in 2007, I raised the issue with the HELP advertising, is a more appropriate H.R. 1256. Committee because this same bill was place than to give it to the FDA, where I am sure my colleagues are aware brought up. The answer I was told then their mission statement is to prove the that the legislation would ban several was that it may be difficult to bring a safety and efficacy of all products they products not sold in 2007. One of the reduced-risk product to market. Bring- regulate, but they can never do it on products is a product called snus. We ing a reduced-exposure product to mar- tobacco products; to put it under the have seen the can. It is a Swedish ket is much simpler. So I said: Let’s same guidance of the Secretary of smokeless tobacco, it is pasteurized, take a look at it. Maybe a cigarette Health and Human Services, who also and it doesn’t require one to spit. It is with less benzene or nitrosamines can oversees the FDA. a tool that in Sweden has been used to work, so I read the reduced-exposure What is so magical about putting get people off of cigarettes. Yes, it is portion of section 911. this at the FDA? I will tell you, be- still the use of tobacco products, but it The first part of the reduced-expo- cause they have attempted to do it for meets the threshold of diminishing the sure language reads that in the absence 10 years. It is because when you put it risk of death and disease. Some suggest of conducting a 20- to 25-year study on there, over time you will be able to because there is a wintergreen and tobacco products, if you can show a re- outlaw this product—or you think. there is a spice, that this is attractive duction in a harmful constituent in the I go back to this chart from the CDC, to kids. That is not the case. If that product, you can classify it as reduced the Centers for Disease Control, where were the case, we would see winter- exposure. That seems reasonable. in 48 out of 50 States the prevalence of green marijuana, because the usage or Then, in addition, those little pesky youth marijuana usage is higher than preference among youth is higher. The words pop up: ‘‘additional findings.’’ the prevalence of youth smoking. Don’t truth is, that has nothing to do with it. The reduced-exposure language states think just because you outlaw it you As I understand it, the product does that you must show how the product are going to reduce this country’s not require the burning of tobacco. It would actually be used by consumers. youth usage. As a matter of fact, you does not require the actual smoking of Once again, catch-22—you can’t talk to may find out you have increased youth tobacco. It generates no secondhand consumers until you have an approved access. smoke. It will not affect the children application. You can’t show how the The way to do it is to take the money near a user. According to the research product is going to be used by con- the manufacturers gave to the States done by a host of reputable scientists sumers unless you can talk to con- and use the money to provide the edu- and public health organizations, use of sumers. Therefore, there is no such cation, to provide the cessation pro- this product instead of cigarettes can thing as reduced exposure. grams, to provide the reduced-use prod- actually reduce death and disease asso- The bottom line? The bill that is ucts that will allow individuals to get ciated with smoking. Why would you being considered to give FDA jurisdic- off cigarettes and go to something that ban this product if the pretext of pass- tion brings no new harm reduction to really does reduce death and disease. ing this bill is to reduce the risk of tobacco users in America. It does to But if you pass the Kennedy bill, that death and disease? You would not. But smokers exactly what the bill states, it is not what we are doing. What we are we eliminate the ability for this prod- locks in place all the cigarettes that doing is we are locking in forever the uct to come to market in the future, were sold prior to February 1, 2007. Any 21 or 22 percent of the American people and that which is at market today we of the reduced-risk product that has who are going to smoke. In fact, the ban from the market. In other words, it been introduced in over 21⁄2 years auto- Centers for Disease Control said that if is clear that snus is far less dangerous matically goes off the market, and the we do nothing, by 2016 we will reduce, than cigarettes, and it would be appro- pathway through FDA for any new from 21 or 22 percent, the smoking rate priate for the protection of public technology that might not burn to- in America to 15.9 percent. We will ac- health because it eliminates second- bacco or that might use tobacco in a tually reduce it over 6 percentage hand smoke, it moves people away different way that enables somebody to points by doing nothing. from smoking cigarettes. It would quit smoking and reduces death and Yet we are getting ready, if we don’t meet much of the standard of the bill, disease—there is no pathway for it to support the substitute, to lock in a but the legislation still mandates that happen because there is no way to com- measure that assures us indefinitely the manufacturer of snus demonstrate municate with the public until you into the future that 21 or 22 percent of that snus will not encourage nonusers have an application, and a part of the the country will choose cigarettes as to start. application process means you have to their means of tobacco usage. It means Again, I am not sure how you com- communicate with the public to meet we will continue the rate of death and municate with the general public— the test that has been designed. disease. We may look back and say: which is strictly prohibited in the bill You know what this is typical of But we picked the strongest regulatory until you have an approved applica- what the American people think about agency that we could to be in charge of

VerDate Nov 24 2008 00:26 Jun 04, 2009 Jkt 079060 PO 00000 Frm 00021 Fmt 0624 Sfmt 0634 E:\CR\FM\G03JN6.035 S03JNPT1 jbell on PROD1PC69 with SENATE S6006 CONGRESSIONAL RECORD — SENATE June 3, 2009 the regulation of this product. Tell What they buy and what they eat is ac- first successful attempt to regulate to- that to a patient waiting for a life- tually not going to kill them. bacco. I should say, earlier efforts at saving drug and the reviewer who was Yet we have seen instances over the warning labels go back many years. reviewing the application was moved last 3 years where spinach is sneaked But this was the first successful at- over to the tobacco section, because through and peanut butter is sneaked tempt to regulate the use of tobacco this new responsibility they had made through. And as we become a more product. them take senior reviewers and get global economy, our concerns about What we did 20 years ago was suggest them over because they had to regulate where it is made and what they put on that the old days and the old ways of this product from day one. Tell the in- it mean that our review of food safety allowing people to smoke on airplanes dividual in America who is harmed be- has to be as stringent as everything had to change. Some of us are old cause of a medical device that should else. The FDA is struggling today. The enough to remember those days when have never been approved but got biggest mistake we could make is to you would make a reservation to fly on through the system because the gold give them another product and say, an airplane and you would tell them standard of safety and efficacy was not regulate this, and don’t regulate it whether you wanted to sit in the smok- adhered to at FDA because they were based upon the same standards you do ing on nonsmoking section—as if there asked to turn to tobacco and not prove everything else. But that is what we was any difference. For the most part, that public health was important on are doing. if you happen to be seated, at least, in this product and, therefore, new re- If you want to reduce youth access, the last seat of the nonsmoking sec- viewers looked at it and said: We don’t youth usage, if you want to reduce tion, you might as well be smack dab have to be 100 percent accurate on de- death and disease, vote for the sub- in the middle of the smoking section. So we decided to eliminate smoking vices. Or the biologic companies, when stitute tonight. Reject the base bill. If on airplanes. That was an amendment I they see a delay in the approval of an we do that, we will have successfully offered in the House of Representatives application, that actually invest bil- done our job. If, in fact, we fall prey to lions of dollars to bring a lifesaving over 20 years ago. It had the opposition jeopardizing the gold standard of the of the tobacco lobby and the opposition biologic to the marketplace that ends a FDA, mark my words, this body will be terminal or chronic illness, what if this of all the political leadership in the back at some point fixing a mistake House of Representatives—Democrats product doesn’t come because of what they made. and Republicans. They all opposed it we do? My only hope today is that there for a variety of different reasons. But These are questions we should be won’t be an American who loses their asking ourselves. The American people we called it anyway, and the amend- life by the actions we have taken. I am ment was successful. What it taught deserve us to fully vet this. But in 2 willing to concede that if the FDA gets days of markup on this bill, when ques- me was that Members of Congress are the jurisdiction, the authority to regu- members of the largest frequent flyer tions were asked, the answers were ig- late this industry, we will miss the op- nored. They were more interested in club in America. We spend more time portunity to take a lot of Americans on airplanes than most. If there is the speed with which we pass this than off of cigarettes and move them to something we want to change, it af- the accuracy of the policies that we other products, other products that are fects us personally. And this did. put in place. I have tried to keep the better for their health and not as like- So Democrats and Republicans came debate since yesterday on facts. I have ly to kill them. The statistics say that forward, and we started a trend which tried, when I made a claim, to produce that will happen. Ask yourself, know- I think has been very beneficial for this the numbers. The CDC is typically a ing that, is it worth risking that you country because once I passed that credible source. The Congressional might change the gold standard at the amendment, Senator FRANK LAUTEN- Budget Office is usually a credible FDA, that you might lower the bar for BERG of New Jersey took it up here in source. The University of Michigan, drug or device approval, that we might the Senate. He successfully passed it. many have come on the floor and used actually slip on food safety. I am not We worked together to eventually it as a credible source. This is not in- sure the risk is worth it. eliminate smoking on airplanes, and dustry hype. These are institutions This is about our kids. Vote for the the American people noticed. They that we come to the floor and use to substitute. This is about the status liked it. They reached an obvious and make our claims every day. What all of quo. This is about letting an outside rational conclusion: If secondhand them say is: Don’t pass this bill. But group have a win that has fought this smoke is dangerous in an airplane, they don’t say not to do something. for 10 years because they are in some then it is also dangerous in a train, in Tonight Members will have an oppor- battle with an industry. a bus, in an office, in a school, in a hos- tunity to vote for a substitute, a sub- Is it worth it for us to give them a pital, in a restaurant. Of course, the stitute that gives the same level of au- win versus the American people? I dominoes just kept falling. As they thority, that does away with adver- don’t think so. I encourage my col- fell, there were more and more restric- tising in total, that puts the same de- leagues to support the substitute to- tions on smoking in public-type places. scriptive labels on so that people can- night. Reject the base bill. So there were many things still to be not only read it in plain English but I yield the floor and suggest the ab- done, and we started thinking about see it in detail. It just doesn’t put it at sence of a quorum. the obvious need for change. We knew the FDA. Why? Because I spent 21⁄2 The ACTING PRESIDENT pro tem- we were up against one of the most years of my life trying to modernize pore. The clerk will call the roll. powerful lobbies on Capitol Hill with the Food and Drug Administration The bill clerk proceeded to call the the tobacco lobby. Not only were they through a piece of legislation we passed roll. very wealthy, with a lot of revenue in 1998. Why did it take so long? Be- Mr. DURBIN. Mr. President, I ask from the sale of their product, but they cause the FDA regulates 25 cents of unanimous consent that the order for also had ingratiated themselves to every dollar of our economy. When the the quorum call be rescinded. many Members of Congress of both par- American people go to bed at night, The ACTING PRESIDENT pro tem- ties. They did it in obvious ways: in they know if they take a drug that was pore. Without objection, it is so or- contributing to campaigns. They were prescribed by a doctor and filled by a dered. a major factor in some districts where pharmacist, it will not hurt them. Mr. DURBIN. Mr. President, pending they either manufactured their product More importantly, it is probably going before the Senate now is consideration or tobacco was grown. But they also to help them. It will make them better. of a bill that would dramatically befriended many Members of Congress, Or when they go to the hospital or the change the way we regulate tobacco providing charitable contributions to doctor’s office and they use a device, and tobacco products in America. This hometown charities for Members of the they know it has been reviewed and it is an issue which has meant a lot to me House and Senate. It went a long way is safe. They know that when they go during the course of my time in the to build up good will and to convince to the grocery store, there is an agency House and in the Senate. Members of Congress to oppose any called the Food and Drug Administra- Many years ago—over 20 years ago— other changes when it came to tobacco tion that is responsible for food safety. I offered an amendment which was the regulation.

VerDate Nov 24 2008 01:57 Jun 04, 2009 Jkt 079060 PO 00000 Frm 00022 Fmt 0624 Sfmt 0634 E:\CR\FM\G03JN6.040 S03JNPT1 jbell on PROD1PC69 with SENATE June 3, 2009 CONGRESSIONAL RECORD — SENATE S6007 Well, there were things we knew assistant majority leader over the last do, because you are offering the flavors needed to be done. You see, each day in 20 years, as a Member of the House and they will find in the ice cream. America, 3,000 to 4,000 children start Senate, are so important, the victories Look at the Sweet Dreams and Choc- smoking for the first time—3,000 to he has had such as stopping smoking olate Dreams cigarettes over here; 4,000 a day. During the course of that on airplanes and all of those other again, a variety of kid-friendly flavors. decisionmaking, about a third or a places. This legislation is extraor- This time, the cigarettes themselves, if fourth of them will decide to stick with dinarily important. you will notice down here, are pastel it. They will stick with it long enough I yield back to the assistant majority colors to make them even more appeal- that the nicotine chemical in the ciga- leader. ing to children. Not only are these rette creates a craving and satisfies an Mr. DURBIN. Mr. President, I thank cigarettes designed to appeal to kids, addiction which is tough to break. my colleague from Ohio for joining in. but the tobacco companies buy the ads Oh, I have seen people walk away He certainly recalls those infamous in magazines that teenagers read and from a lifetime of smoking in a few hearings in the House of Representa- try to draw them to their brands days. But I have also seen people strug- tives when the tobacco company execu- through advertising. gling for their entire lives trying to tives stood up and ceremoniously testi- Here is a familiar one: Camel. Look break that smoking habit—patches fied under oath that nicotine was not at this ad for Camel cigarettes that ran notwithstanding and hypnosis and all addictive. That, I think, was the begin- in Rolling Stone Magazine, Cosmopoli- those things. For a lot of people, it is ning of the end of the tobacco lobby in tan, and Vogue in 2004 and 2005. You a very hard thing to do. Washington, DC. Everyone knew that can see from this ad it is appealing. The tobacco companies know if they they were, at best, misleading and, at These packages are designed in ways to appeal to young people, and the adver- are going to have 400,000 of their cus- worst, just plain lying to the American tising as well. It took 39 State attor- tomers die each year, they have to re- people. When it came to their adver- neys general to get on the tobacco place them with children. If people tising, they denied for years that kids companies’ case before they finally wait until they are 18 years old or 21 were their targets. They said it hadn’t agreed to stop marketing these ciga- years old, they are likely to be smart been the case. enough not to start smoking, but if you rettes. Then one can take a look at some of So what is next? Well, until we pass are 12 or 13, it is an adventure. It is the tobacco companies’ internal docu- this legislation, it is inevitable that something that is forbidden, and it ments that came out during the course these tobacco companies will dream up shows that you are just like a grownup, of lawsuits, and let me tell my col- another way to market their product and kids try it. leagues some of the things they found. to the kids. The tobacco companies know that. The Lorillard Tobacco Company was This bill before us will make a dif- Although they deny it, they market to quoted as saying: ‘‘The base of our ference. For the first time we are going kids. They sell their products in a way business is the high school student.’’ to get serious about this. Tobacco that appeals to children, hoping that Philip Morris, in their internal docu- products are one of the few, and maybe teenagers and even younger will start ments, said: ‘‘Today’s teenager is to- the only, products in America that go taking up this tobacco habit because it morrow’s potential regular customer.’’ unregulated. You can’t sell food or is not only cool, it tastes good. The ad- U.S. Tobacco: ‘‘Cherry Skoal is for medicine in America without the Food vertising is appealing. Tobacco compa- somebody who likes the taste of candy, and Drug Administration, or even the nies spend over $13 billion a year pro- if you know what I’m saying.’’ I think U.S. Department of Agriculture, taking moting their products and many of I know what they are saying. a look at it. I will concede they don’t those marketing efforts are directed R.J. Reynolds, in an internal docu- inspect every package of food you will right at our kids. ment, said: find in the store, but they have an Mr. BROWN. Mr. President, would Many manufacturers have ‘‘studied’’ the overall responsibility to make sure the assistant majority leader yield for 14–20 market in hopes of uncovering the ‘‘se- that that product is safe for Americans a moment? cret’’ of the instant popularity some brands to consume. But tobacco is an excep- Mr. DURBIN. I would be happy to. enjoy to the almost exclusion of tion. Tobacco is not regulated. Tobacco Mr. BROWN. Mr. President, I wanted others. . . . creating a ‘‘fad’’ in this market can be a great bonanza. is not inspected. They somehow man- to reemphasize the words of the assist- age to wiggle their way somewhere be- ant majority leader for a moment be- So make no mistake about it. We tween food and drugs, saying, Oh, we cause I was walking through and heard know. We all know. Tobacco companies are not a food product, and we are defi- his comments about tobacco compa- have directed their ad campaigns and nitely not a drug product you would nies’ efforts to get children addicted. their recruitment at our children. I find in a pharmacy. But we know bet- As the assistant majority leader said, have said it before; it bears repeating. ter. Even though it is an odd way to de- more than 1,000 Americans a day— I have never met a parent who has said liver a chemical—a drug—tobacco de- 400,000 a year—die from tobacco-related to me, I got the greatest news last livers nicotine and a lot of other illnesses. I remember 15 years ago sit- night. My daughter came home and an- chemicals as well. So even though they ting in the House Energy and Com- nounced she had started smoking. were successful in Congress for decades merce Health Subcommittee listening I have never heard that. I don’t think exempting themselves from coverage to tobacco executives talk to us about I ever will. Most parents know that is and inspection by the Food and Drug a whole host of things that they a bad decision and one that can be Administration, this bill is going to weren’t exactly truthful about. But fatal. change that. from the point Senator DURBIN makes Cigarette companies claim they have Senator TED KENNEDY is recovering that 400,000 Americans die a year from finally stopped intentionally mar- from cancer, a brain tumor he has been tobacco-related illnesses, it is clear keting to kids and targeting youth in fighting for many months now, and we that what the tobacco companies know their research and in their promotions, all wish him the very best. He was the they have to do is they have to replen- but they continue to advertise ciga- one who pushed this bill. He is the one ish their customers. They have to find rettes in ways that reach these popu- who believed that the Food and Drug more than 1,000 new customers a day. lations. They continue to make prod- Administration should regulate to- They don’t go to our age group. They ucts that appeal to kids. bacco products. I am sorry he can’t be do not go to 50-year-olds and 60-year- For example, take a look at this one on the floor, because I would like to olds or 40-year-olds or even 30-year- on this chart. This is a product called give him a big shout-out for the years olds; they go to the people the age of Liquid Zoo. The packaging is powerful, he put into this effort. But we are here, the pages sitting in front of us. They and the cigarettes come in fun flavors: and we have a chance to pass this legis- go to teenagers. Those are the people Coconut cigarettes. How about that lation. whom they know they must addict to one? Vanilla cigarettes. Strawberry Here is what the bill does. It pro- replenish their customer base, if you cigarettes. Liquid Zoo offers these. It is hibits the colorful and alluring images will. That is why this legislation is so almost as if you are going into an ice in advertising that these tobacco com- important and why the efforts of the cream store, which most kids like to panies shamelessly use to appeal to

VerDate Nov 24 2008 00:26 Jun 04, 2009 Jkt 079060 PO 00000 Frm 00023 Fmt 0624 Sfmt 0634 E:\CR\FM\G03JN6.041 S03JNPT1 jbell on PROD1PC69 with SENATE S6008 CONGRESSIONAL RECORD — SENATE June 3, 2009 children. This bill also limits ads to rettes where they might be coughing. disclose their ingredients, and they only black-and-white text in news- They are trying to make it a smooth could sell them to kids and they could papers and magazines with significant transition from ordinary breathing to advertise to kids? You mean that actu- young readership, and in stores that breathing with tobacco smoke, so they ally happened? Well, it is happening are accessible to children. It makes it load up the cigarettes with these right now, and unless we pass this bill, harder for them to reach out to these chemicals. it will continue to happen. Unless we kids and to dazzle them with their art- If you go in and buy a box of maca- pass this bill, 1,000 of our children work and all of their images. It bans roni at the store and take a look at the today and every single day will start outdoor advertising near schools and side of the package, you will see the smoking and start an addiction which playgrounds so kids won’t be standing, contents. What is that macaroni made will lead to the deaths of at least one waiting to go into school, looking up at of? It will have 6 or 8 or 10 different out of three. That is the reality. We a billboard suggesting that after things and a nutrition labeling box. If can face our responsibility here, pass school, you better get a pack of ciga- you pick up one of these packs of ciga- this bill on a bipartisan basis and say rettes. It ends incentives to buy ciga- rettes and look for the ingredients, to America, it took a long time, but rettes by prohibiting free giveaways what is included in that cigarette, you this Congress of the United States of with the purchase of tobacco products, won’t find it. Why the exception? Be- America has finally put the public and it finally puts a stop to tobacco cause the tobacco lobby made sure health of the people we represent ahead sponsorship of sports and entertain- there was an exception. They don’t of the tobacco lobby. ment events. want you to know what is in that little Mr. President, I yield the floor and I wish to tell my colleagues that paper cylinder of tobacco. Now that is suggest the absence of a quorum. most of us know the warnings that going to change. This bill before us is The ACTING PRESIDENT pro tem- have been on cigarette packages for going to give the Food and Drug Ad- pore. The clerk will call the roll. more than 40 years have outlived their ministration the authority to require The legislative clerk proceeded to usefulness. Does anybody notice them disclosure of ingredients so that con- call the roll. anymore? They put them on the sides sumers know what they are getting Mr. BOND. Mr. President, I ask unan- of packages. They are really routine. into, and, of course, in the process, give imous consent that the order for the Folks don’t pay attention. us information we need to find out quorum call be rescinded. Well, we are going to change that. We what kind of dangerous, toxic chemi- The PRESIDING OFFICER (Mr. are going to have much more effective cals are being added to cigarettes. MERKLEY). Without objection, it is so warning labels on these products. This Those listening may say, Well, this ordered. bill requires large, clearly visible warn- Senator is getting carried away calling Mr. BOND. Mr. President, I ask unan- ing labels at least covering half of the them toxic chemicals. In fact, they are. imous consent that I may be permitted front and half of the back of the pack- They are toxic, and they are carcino- to proceed as in morning business for age of cigarettes. These labels will genic, they are dangerous, and they up to 12 minutes. have large text and graphics displaying make that smoking experience even The PRESIDING OFFICER. Without the dangers of smoking. Some people more hazardous for the people who are objection, it is so ordered. say, Why waste your time warning peo- involved in it. Don’t we owe that warn- NORTH KOREA ple? They know it already. Maybe they ing to consumers across America? Mr. BOND. Mr. President, East Asia do. Maybe they need to be reminded. Don’t we owe it to our kids? Shouldn’t is a very interesting and challenging But we have an obligation as a govern- we try to protect the American people area. There are tremendous opportuni- ment, as a people, to do everything we from the dangers that are associated ties. We have great friends there. The can to discourage this deadly addic- with the No. 1 preventable cause of potential for trade and better relations tion. death in America today, tobacco-re- continues to grow in many ways, and We are also going to require much lated illness? there are many good things that are larger warning labels in print ads for This bill has been a long time com- happening that we need to pursue in products. Some of these pictures I have ing. Some of us have been battling this that part of the world, but they are shown my colleagues, you almost need tobacco industry for two decades, and also coupled with some immense chal- a magnifying glass to find the Surgeon more. Now we have a chance to do lenges. There are some real problems General’s warning, which sadly has something. We had a press conference there. Unfortunately, we were re- gone ignored too often. We are going to earlier with Senator CHRIS DODD of minded of one of those key challenges improve that by requiring that warn- Connecticut, and he has kind of picked most recently; that is, North Korea. ing messages take up at least 20 per- up this standard and is carrying it for One of the world’s most secretive so- cent of any advertisement they have in Senator KENNEDY, who is the inspira- cieties, North Korea has increased its a magazine or on a billboard. tion for most of us when it comes to isolation from the rest of the world by Study after study shows that adver- this issue. Senator DODD just com- continuing to pursue its nuclear ambi- tising can influence young buyers. We pleted the Credit Card Reform Act a tions, along with its missile capability certainly want to influence them to couple of weeks ago, a measure we have potentially to deliver those weapons. make a healthy decision when it comes been trying to bring to the Senate floor As one of the countries still under to tobacco. This bill makes critical for 25 years. He successfully guided it Communist rule, Supreme Leader Kim changes to limit kids’ exposure to to- through. Here he is back 2 weeks later Jong-il heads a rigid, state-controlled bacco ads, and we know that is going with an issue that has been waiting in system where no dissent is tolerated. to prevent kids from trying cigarettes the wings for at least 10 or 20 years. I Its destroyed economy has suffered and getting addicted. salute Senator DODD for his extraor- from natural disasters, poor planning, One of the things we do in this bill as dinary leadership on these two historic and a failure to keep up with its bur- well is finally tell those who buy to- issues. geoning neighbors—China and South bacco products what they are buying. Senator LAUTENBERG, my colleague Korea. If you believe a cigarette is just to- when it came to banning smoking on North Korea, officially named the bacco leaves ground up and put into a airplanes, was at the press conference. ‘‘Democratic People’s Republic of paper cylinder, you have missed the Senator JACK REED of Rhode Island, Korea’’—and that in itself is an point. Those cigarettes are loaded with who has always been stalwart when it oxymoron—maintains one of the chemicals, not just the obvious natu- comes to this issue, was there. I said at world’s largest armies, but the stand- rally occurring nicotine but added nic- the press conference: I wonder if 20 ards of training, the discipline, and the otine to increase the addiction of years from now, a child or grandchild equipment are reported to be very smokers, as well as other chemicals of one of these Senators will come up poor. which they think will make the taste and say Granddad, explain to me. You The Korean war ended with the armi- of tobacco more appealing and will in mean you actually sold these ciga- stice of 1953. But when one visits the some ways help the new smoker get rettes with warning labels people demilitarized zone, as I did in March of through that first two or three ciga- couldn’t read and they didn’t have to 2006, the tension of the zone feels as if

VerDate Nov 24 2008 00:26 Jun 04, 2009 Jkt 079060 PO 00000 Frm 00024 Fmt 0624 Sfmt 0634 E:\CR\FM\G03JN6.042 S03JNPT1 jbell on PROD1PC69 with SENATE June 3, 2009 CONGRESSIONAL RECORD — SENATE S6009 the war has done anything but end. The gether with China and our critical al- budget reduced funding for more north has recently fueled the tension lies in Japan and South Korea to ground-based interceptors in Alaska by launching six short-range missiles, defuse this situation. and California. It scaled back funding renouncing the 1953 armistice, and South Korea’s President Lee Myung- for the airborne laser interceptor and threatening continued attacks on bak, unlike his predecessor, has em- canceled further research and develop- South Korea. braced the United States instead of ment for multiple kill vehicles—all of After 15 years of negotiations, bilat- North Korea. He has embraced working this at a time when North Korea is in- eral and multilateral talks, and a state constructively within the six-party creasing its sabre-rattling and Iran is of affairs worse than when we started, framework and with the United States, showing no signs of reducing its pro- it is time for tougher action, barring and we certainly ought not to be get- gram and continues to issue threats to all-out war. We hear people say: We ting into bilateral negotiations. The Israel and its neighbors in the Middle want to talk with them, we want to ne- six-party talks at the minimum are ab- East. gotiate with them, we need to pass a solutely essential. When I visited Israel in December, I resolution. The bottom line, as we say South Korea is one of our most im- went over to talk about intelligence. in the old country music song: We need portant security partners in the region. They only wanted to talk about one a little less talk and a lot more action. I was proud last year to support the thing. They needed missile defense— Talk has not gotten the job done. We United States-Korea Defense Coopera- short-range, medium-range, long- need action. tion Enhancement Act to strengthen range—because they are looking at A key to the successful resolution of this important alliance. We must take weapons coming in, missiles coming this difficult situation is our good the next step and approve the United into them: short range, potentially ul- friend China. China provides as much States-Korea Free Trade Agreement to timately long range. To protect our al- as 90 percent of the north’s energy, 40 further strengthen our economic and lies and Israel, we are working with percent of its food. Like Russia, it has strategic partnership. It is in our inter- them on the Arrow and certain other used its Security Council veto, regret- est, their interest, and the interest of programs that I am proud to support tably, against attempts to isolate peace and prosperity in the region. that give them that defense, but they Pyongyang. Without its support, its Japan is steadily increasing the role are in a position where they are subject poor neighbor would struggle to sur- it is playing in international security to attack, not only from long-range vive. And it appears that the North Ko- affairs. We must continue to support and medium-range missiles but very reans may be exhausting Beijing’s pa- these initiatives. Japan and the United short-range missiles, and we have to tience. Recent nuclear tests, last States work very closely together on provide them that kind of capability. month’s rocket launch, increasing the AEGIS missile defense system, and I hope my colleagues will reconsider threats, and the suspected restarting of robust support for ballistic missile de- the proposed cuts to ballistic missile the Yongbyon nuclear plant have re- fense is now more important than ever. defense. It is a threat that is here, it is ignited debate about how best to deal We have seen that these countries now, it is threatening our allies and, with this very troublesome neighbor. have the ability to shoot off missiles. yes, possibly, even the United States. As far as North Korea goes, in addi- Beijing was swift to slap down the re- We used to think we have mutually as- tion, I have recently agreed to cospon- cent nuclear test. I hope that was the sured destruction. We feared the only sor Senator BROWNBACK’s North Korea final straw for China. place that would be sending missiles at We need China to play a constructive us might be the former Soviet Union. Sanctions Act. The legislation would require the Secretary of State to relist leadership role and support the Secu- That ain’t so. North Korea has shown North Korea as a state sponsor of ter- rity Council resolution in toughening its ability, and others are working on rorism. This requirement could be existing sanctions and implementing it. them. When you look at the sanctions But we have made progress. Accord- waived by Presidential certification as provided for in the bill. But we were that have been applied to Iran, sanc- ing to the head of the Missile Defense able to hurt North Korea significantly tions should be applied to North Korea Agency, LTG Patrick O’Reilly, the when we imposed sanctions on the that are at least as tough if not tough- United States has fine-tuned its ability bank, the Bank of Asia, which was han- er than those on Iran. After all, it is to shoot down long-range missiles dling their transfer of funds. But in a North Korea that has actually tested launched by North Korea, based on a very unfortunate, misguided effort to and detonated a nuclear weapon and trio of tests mimicking such an attack. try to win the friendship of North fired missiles over Japan and through- At a recent conference at the National Korea, we took off those sanctions last out the region. And the North Koreans’ Defense University, he went on to say: year. That was a mistake. continued sabre-rattling could lead to We have made adjustments to give our- This is a challenging area. It is one proliferation in the region and alter selves even higher confidence, even though in which I hope others will pay great balances of power. Our friends there we intercepted three out of three times in that scenario. attention, and I look forward, when the may not be willing to see a nuclear budgets come before us, to talking General O’Reilly, in response to a North Korea unchecked and unbridled, about the need for ballistic missile de- question, said the U.S. ability to hit a posing threats to them. We do not need fense. We are seeing that threat. It is specific spot on a target missile had to put our allies and friends in a posi- being visited on a daily basis on our al- improved ‘‘dramatically’’ during the tion where they believe they must have lies in Israel. It is no time to back tests. ‘‘So, do I think it is likely that a nuclear counterweight. away from the tremendous technology you’re going to intercept if somebody After 15 years of happy-talk and dis- we have that could protect us, our al- launches out there?’’ He said, ‘‘Yes, I couraging attempts during the last lies, and our interests around the do. And the basis is those three tests months of the Bush administration to world. turn the six-party talks into two-party and what we know about the threat. I yield the floor and suggest the ab- talks, the time for tougher action is . . .’’ sence of a quorum. way overdue. My personal opinion was I can tell you that President Obama The PRESIDING OFFICER (Mr. the two-party negotiations last fall was fully engaged, working with our BURRIS). The clerk will call the roll. were a tragic mistake. Obviously, they National Security Council, to be able The assistant legislative clerk pro- did not stop what has happened since. to use the resources we have at our dis- ceeded to call the roll. North Korea poses security and hu- posal should a North Korean missile Mr. BURR. Mr. President, I ask unan- manitarian challenges to the world and launch have threatened the United imous consent that the order for the particularly to China’s core interests. States or other of our close allies or quorum call be rescinded. China’s ability to contain North Korea our interests. I congratulate him on The PRESIDING OFFICER. Without is critical in demonstrating it will pro- that. I applaud him for having that in objection, it is so ordered. vide leadership on the world stage, but place and being willing to use what was Mr. BURR. Mr. President, while the it is certainly not fair to ask China to necessary. But unfortunately—and I Senate is in consideration of a bill to handle it all. This is the world’s prob- don’t understand why, with the threats regulate tobacco, I think it is ex- lem, and I believe we can work to- we have—President Obama’s defense tremely important that Members of

VerDate Nov 24 2008 00:26 Jun 04, 2009 Jkt 079060 PO 00000 Frm 00025 Fmt 0624 Sfmt 0634 E:\CR\FM\G03JN6.046 S03JNPT1 jbell on PROD1PC69 with SENATE S6010 CONGRESSIONAL RECORD — SENATE June 3, 2009 the body understand that tobacco is ably before I was born. The risk is only pharmaceutical products that allow not an unregulated industry today. Let reduced by 10 percent. It meant it was people to actually either reduce or quit me preface this by saying that I am not 10 percent less likely to have a risk in- the habit of tobacco usage. proposing that we do not do something volved in it. But still, clearly, 90 per- When we look at the goal of a to- additionally in the Senate. I think we cent of users having the risk is pretty bacco bill—and the authors have said can regulate more effectively. But unacceptable. the goal is to reduce disease, death, what I have put up—I know it is hard Then we go to a category that never and youth usage—I ask the Presiding for the Presiding Officer to see—is the hit the market, except for experi- Officer, if you reduce from 100 percent current regulatory structure of the to- mentally through market testing. That the risk to 10 percent for U.S. smoke- bacco industry in America. It shows was tobacco-heated cigarettes, a prod- less or 2 percent for Swedish smoke- every Federal agency that currently uct that didn’t actually burn tobacco, less, does that embrace the spirit or in- has a regulatory jurisdiction over to- but it had a ceramic disk in the front tent of what the author of the bill is bacco: Department of Transportation, that glowed and got hot. As that hot trying to do? I say yes. But what I have Department of Treasury, Department air was pulled through the tobacco, the to share with my colleagues is this cat- of Commerce, Department of Justice, nicotine was extracted and delivered, egory that is at 2 percent, under the the Executive Office of the President, but the product never burned. It never current bill being considered, would be Department of Health and Human created secondhand smoke. In fact, it banned. Why? Because of an arbitrary Services, Department of Education, De- never had any smoke that actually was date that they have chosen to say if partment of Labor, General Services emitted afterward. Whatever was emit- the product wasn’t sold in the United Administration—the GSA—the Depart- ted was a vapor, and it dissipated. States before February of 2002, then ment of Veterans Affairs, Federal Then we have a new category called this product is not allowed to stay on Trade Commission, Department of Ag- electronic cigarettes, a fascinating the marketplace. riculture, the Environmental Protec- product, rather expensive. It actually runs off a battery. It extracts the nico- My point is, if the authors say the tion Agency, the U.S. Postal Service, objective of the legislation is to reduce and the Department of Defense. These tine and delivers it into the system in a totally different way than the to- the risk, as you reduce the risk, you re- are all Federal agencies that currently, duce the likelihood of disease, the se- today, regulate the product of tobacco. bacco-heated cigarette. But, clearly, we see that in two new iterations, we verity of death, isn’t this the category For any person to come to the floor of we would like more smokers to move the Senate and claim that there is not have gone from 100 percent risk to 90 percent risk to 45 percent risk and now, to? I think the answer is obviously yes. sufficient regulation of this industry We would like to move people away. right now is ludicrous. As a matter of with this new electronic cigarette, to a risk of less than 20 percent. One would We would like to reduce the health fact, this is the most regulated product cost. We would like to reduce death. If sold in the United States of America say, moving from here to here from the standpoint of risk is an advantageous we can do that by bringing this new currently. age of products to the marketplace, The proposal Senator KENNEDY has opportunity for people who use nonfil- this is beneficial to everybody. It introduced is a proposal that con- tered cigarettes. If we could get them makes a lot of sense. centrates all the regulation of tobacco over here, we have reduced the risk of in the Food and Drug Administration, death, and we have reduced the risk of That is not what the legislation does. an agency that was created for the sole disease. I have spent this day coming to the purpose, by its mission statement, of Let me move out to the next cat- floor trying to emphasize with my col- approving the safety and efficacy of egory, which is smokeless tobacco, U.S. leagues that what the legislation does drugs, biologics, medical devices, cos- smokeless tobacco. I need to draw the is grandfathers two categories, nonfil- metics, products that emit radiation, distinction because globally there are tered cigarettes and filtered cigarettes. and responsibility for food safety. new types of smokeless tobacco. But It says these are the only products that We are going to shift from all these U.S. smokeless tobacco all of a sudden will be allowed to stay on the market. Federal agencies and all the flowcharts reduces the risk to 10 percent. We have It means the 20 percent of Americans underneath them of different aspects of gone from 100 percent to 10 percent. We who currently have chosen to smoke, regulation currently for the tobacco in- have reduced by 90 percent the risk hopefully adults, are not locked into dustry, and we will concentrate this in presented by the use of tobacco prod- these categories from the standpoint of the Food and Drug Administration. It ucts. Now we move to the next cat- choice. Yet in Sweden, they created probably makes a lot of sense from the egory, which is probably hard to see. I this new product, and they have had a standpoint of consolidation, but what I would equate this to about 2 or 3 per- massive movement of people from want my colleagues to understand is cent risk. This is Swedish smokeless these two categories to this category. that this truly today is the most regu- snus, a pasteurized product. It is actu- This is not something I have made up. lated product sold in America, when we ally spitless. It can be swallowed be- The data is there to show. look at the expanse of the regulatory cause of the pasteurization. But, again, The authors of the bill would suggest framework that exists today. products that deliver the nicotine need we allow this product to be created, The authors of the bill have sug- to allow somebody to go from a nonfil- but there are three thresholds they gested we have to allow the FDA to tered product all the way over here to have to meet. The three thresholds have jurisdiction because there should a U.S. smokeless or to a Swedish they have set are absurd. Let me focus be two objectives. One is to reduce smokeless. We have now gone from 100 on the third threshold. They suggest death and disease, and the other is to percent risk to 2 or 3 percent risk. that the manufacturer would have to reduce youth usage of tobacco prod- Now a new category, not even on the prove this product wouldn’t be used by ucts. These are two goals I embrace market, a category already targeted as a nontobacco user. For you to accumu- wholeheartedly. a product that should not be: dissolv- late data to know whether a non- Let me share this chart. It starts able tobacco, a product that dissolves tobacco user would be interested in with a product I consider to be the in the mouth. That delivers what this using this product, you would have to base: 100 percent of these products pre- person needs over here from the stand- go out and present the product to them sents a health risk. What is the prod- point of being addicted to nicotine but and explain it before they could com- uct? Nonfiltered cigarettes. I know the puts the category of risk somewhere ment on whether they would be in- President of the Senate probably re- down in the 1 percent category. As in- clined to want to try it. But the bill members when all his friends smoked novation has taken place, we have al- forbids any communication about a nonfiltered cigarettes. The truth is, we lowed the opportunity for people to product that hasn’t been approved. So I probably still have some friends who do come off products that had 100 percent ask, how do we get a product approved it today. The continuum of risk goes risk down to products that reduce the if the threshold is to tell them what down in the next category, filtered risk by 99 percent. Then we have thera- the likelihood is of people who haven’t cigarettes. The industry introduced fil- peutics, such as gum and patches and used tobacco products using it, if you tered cigarettes at some point, prob- lozenges, that have minimal risk and can’t talk to people who haven’t used

VerDate Nov 24 2008 00:26 Jun 04, 2009 Jkt 079060 PO 00000 Frm 00026 Fmt 0624 Sfmt 0634 E:\CR\FM\G03JN6.047 S03JNPT1 jbell on PROD1PC69 with SENATE June 3, 2009 CONGRESSIONAL RECORD — SENATE S6011 tobacco products about using the prod- fore they vote on this bill is to read it. the HELP Committee considered and uct because the product hasn’t been ap- I don’t think that is too much to ask. they rejected it 12 to 8, 13 to 8—I can- proved? If they read the bill, they will never not remember exactly what it was. Let In Washington we call this a quite vote for it. If they read the bill, they me put Members on notice before they crafty way of making a claim but re- will understand that, one, this makes a come down here and make claims on it, versing in the bill the ability to use it. lot of sense. But, two, remember, when it is not the same bill. It is not the In essence, the bill that is under con- I went over the current regulatory same substitute. I am sure staff now is sideration creates these two categories structure, I didn’t mention the Food going to scramble to figure out what is indefinitely and says: It is OK if we and Drug Administration. I did men- in this new bill. have 20 percent of the American people tion the Department of Health and We listened to criticism. Where we who choose to use those products. Human Services. As we go down this thought we could better the bill, we did Hopefully, over time, more adults flowchart of things under the HHS, that. The fact is, there are still going won’t choose to use them. We are will- there is no FDA. We are choosing an to be Members who come and make ing to accept that 20 percent are using agency of the Federal Government that claims tonight, tomorrow—before this them, and they are going to die or have has never regulated tobacco. How can is all settled—that are not accurate. I severe disease. that possibly make sense? Maybe if you put them on notice now: I will come to If that is the case, then how can you claimed you were going to put it at the the floor and expose exactly what you come out and claim that this is a pub- Centers for Disease Control, they actu- say. lic health bill, that we are going to ally have some responsibility within This is not a debate where we are pass this bill because of the respon- the framework currently of regulating going to use the charts we had 10 years sibilities we have to public health? tobacco. But not the FDA. We may ago and say they are relevant today. Since 1998, smoking rates in America have taken the only piece of the Fed- This is not a debate where we are going have dropped from approximately 23.5 eral Government that doesn’t cur- to have information that was produced percent to 19.5 percent. The Centers for rently have any jurisdictional respon- in 1990 for an issue we are discussing Disease Control and Prevention, the sibilities to regulate tobacco, and we and debating in 2009. It is not right to agency that many come to the floor are giving them 100 percent of the re- do that to the American people. and quote with great frequency because quirement to regulate tobacco. In concluding—because I see my col- of their expertise, says if the Senate The truth is, we don’t need the FDA league is here wanting to speak—I does nothing, if we don’t pass a piece of to do it. We can do it by creating a new pointed out earlier that in 1998 the in- legislation, by 2016, the rate of smokers entity under the Secretary of HHS, the dustry made a massive payment to the in America will drop to 15.7 percent. same person who is over the FDA 50 States of this country. It was called But if we look at the Congressional today, and we would suggest doing that the Master Settlement Agreement, Budget Office that has had an oppor- by creating a new center. That new MSA. Mr. President, $280 billion that tunity to see the Kennedy bill, they es- center would be responsible to regulate the industry, over a fixed period of timate the Kennedy bill will reduce in total tobacco products throughout time, was paying out to States. It was smoking 2 percent over the next 10 the industry. for two purposes: No. 1, to subsidize years. Meaning in 2019, the rate will It is a Harm Reduction Center. Think health care costs—the Medicaid costs fall from 19.5 percent to 17.5 percent. about that: Harm Reduction Center. in States—that might have been from You get where I am going? By giving Let me go back to this chart: The con- the direct cause of tobacco usage; and, the FDA regulatory authority, we are tinuum of risk. If the objective is to re- No. 2, so States would have the re- going to increase by over 2.5 percent duce death and disease, then you have sources they needed to create cessation the number of smokers in the country to drive the risk down. To drive the programs so people would move from than if we did nothing. That doesn’t risk down, you have to bring less harm- this category, as shown on the chart, make much sense, does it? ful products to the marketplace. So to this category or quit tobacco use all Let me explain. When we lock in you have two choices. You have a bill together. these two categories and we eliminate that will do that through creating a I came to the floor yesterday—and I the ability for somebody who is a Harm Reduction Center that regulates will say for the purposes of the Pre- smoker to find one of these products to with all the authority the FDA has or siding Officer in the Senate, who is move to, we have now locked in the you can choose the Kennedy bill, which from Illinois—CDC made recommenda- category of smokers. When we explain basically isolates these two categories tions to every State to do this every it to somebody, it makes tremendous of 100 percent risk and 90 percent risk; year: How much of the money they got sense. The question is, Why would we and you put that into statute that the that year should be used for cessation do this? I expect Sweden to be up here FDA cannot touch products that are programs. arguing that this is the right strategy. over here, as shown on the chart, but, Well, in Illinois, Illinois devoted 6.1 Yet Sweden is the one that is the most more importantly, you structure it in a percent of what the CDC recommended progressive. Why? Because they are way that the FDA could never approve for cessation programs to cessation truly focused on the health of Swedes. any new products that are less harm- programs—6.1 percent. Mr. President, The fact that we claim that we are ful. 19.9 percent of the youth in Illinois doing this because of death and disease The Harm Reduction Center actually have a prevalence to smoking—way too isn’t true. We are doing this because 10 has two responsibilities. One, it is to high. In Illinois, though, 43.7 percent years ago somebody wanted to do regulate the entire tobacco industry have a prevalence to alcohol use. In Il- something punitive to an industry. As and, two, to facilitate smokers moving linois, 20.3 percent have a prevalence of a matter of fact, the date that is set in over to lower risk options because we marijuana use. I am not picking on the the Kennedy bill is February 2007, want to reduce the harm that poten- Presiding Officer of the Senate, and I meaning if the product wasn’t sold be- tially can be caused. am certainly not picking on Illinois. I fore 2007, it is banned from the market- I am going to speak later tonight, as will have used all 50 States before this place. Why did they use February 2007? I offer this substitute, which I hope is over with. Because they wouldn’t even change the every Member will take the oppor- As I said, one of the shocking things bill they passed out of committee in tunity to read on behalf of Senator to me, as I explored this chart, was 2007 to reflect 2009, which is the current HAGAN and myself. I am sure we will that I found that, I believe it was, 48 date. There was so little attention paid both speak tonight and throughout the out of the 50 States have higher youth to this piece of legislation that they day tomorrow as we get ready to have prevalence in marijuana use than of didn’t even go through to purge the a vote. It is my hope Members will smoking. date and change it. They printed the take the opportunity to review the sub- Well, some are going to claim the same page of the bill they had last stitute. reason you have to give FDA jurisdic- time. Let me put Members on notice right tion over this is because the age limi- I have said several times throughout, now, some will come to the floor and tation of 18 is not working, that youth the only thing I ask Members to do be- claim: Well, this is a substitute that are getting products. Well, you know

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The likelihood going to construct a regulatory regi- ized the Food and Drug Administra- is, we are going to wait longer for that men here that is going to take a prod- tion. It took 21⁄2 years to do. It was lifesaving drug. We are not going to re- uct that is legal to people over 18 and signed into law in 1998. duce health care costs because chronic it is going to allow a framework where We opened the entirety of the Food disease is not going to have new thera- people under 18 are not going to get it, and Drug Administration and re- pies because the applications will not when a higher percentage of them can vamped all the ways it worked to make be acted on. Heaven forbid we do this get a product that is illegal for every- sure we could reach new efficiencies in and all of a sudden somebody dies as a body in America. the approval of lifesaving drugs, bio- result of an FDA reviewer who looked I might also say to the Presiding Of- logics, which were new, devices. We at it and said: Well, you know, I know ficer, his State is not the lowest from spent a meticulous amount of time our core mission is to prove the safety the standpoint of the percentage they going through this with one goal in and efficacy of all the products we reg- chose of the CDC recommendation to mind: Do not lower the gold standard ulate—with the exception of tobacco devote to cessation programs. As a the American people have come to ex- because you cannot prove it is safe and matter of fact, one State had a com- pect through the FDA; do not lower the effective—so if I am going to turn my mitment of 3.7 percent. standard an applicant has to reach so head on tobacco, maybe I will turn my Now, $280 billion—paid for by the to- we can assure the safety and efficacy of head on this medical device because it bacco industry to cover health care the products we regulate. does not look too bad, and all of a sud- costs and cessation programs—I would Well, I thought that was important, den somebody dies from it. suggest to you, if the States had all and in 1998 it became law. And you This is a huge mistake for the Senate spent 100 percent of what the CDC told know what. When we had the entirety to do. I urge my colleagues: Read the them they needed to spend, we would of the FDA bill open to every Member bill. You will not vote for it. Read the not be here talking about the regula- of the House and the Senate, no Mem- substitute, it will supply the sufficient tion of the tobacco industry because ber of Congress offered an amendment amount of regulation to an industry cessation programs would have worked to give the FDA authority over tobacco that can be better regulated, should be and the rate of 19.6 percent today of because they knew, at the time, the in- better regulated—more importantly, a smokers would have reduced dras- tegrity of the FDA was more important substitute that goes much further from tically. than who controlled it from a regu- the standpoint of reducing youth usage I would remind you that the CDC latory standpoint. They did not want of tobacco, which gets at the heart of says, if we do nothing, by 2016, we re- to jeopardize the integrity of what the death and disease. duce the rate to 15.7 percent of the FDA core mission was. In fact, the substitute is the only bill American people. But when CBO looked But here now, 11 years later—I might that accomplishes what the authors of at the Kennedy bill, they said, in 10 also say, the Supreme Court ruled in a the current base bill suggest is the rea- years, in 2019, the Kennedy bill would court case that the FDA did not have son we are debating this issue. This reduce smoking to 17.5 percent. If we jurisdiction over tobacco. The reason chart I have in the Chamber proves it. do nothing, we get to 15.7 percent. If we they chose was, in 1998, the Congress It does it in the most visual of ways. If pass this bill, we get to 17.5 percent. If opened the FDA Act and did not give we do not allow these products to the objective is to have less smokers, FDA authority. Therefore, it was not come, you have now locked it into this. the answer is: Do nothing. the intent of Congress for FDA to have That is not what the authors suggest is But tonight, sometime around 6 authority. the objective. o’clock, Senator HAGAN and I will come So those who claim this is part of the I urge my colleagues, tonight, when to the floor not to suggest to our col- FDA—should have been, always would given the opportunity, listen intently, leagues that we do nothing but to sug- be—it is not the case. Because Mem- read the bills. Tomorrow, when you are gest to our colleagues we do the right bers of Congress had the opportunity given an opportunity to vote, vote for thing, that we find the appropriate and did not do it. Why? Because of the the substitute. Do not support the base place to put regulation, that we give it integrity of the Food and Drug Admin- bill. the same teeth the FDA has, that we istration. Why in the world would we Mr. President, I yield the floor. give them the ability not just to have have changed, in 11 years, to where we The PRESIDING OFFICER. The Sen- black-and-white print advertising— would risk the gold standard of drug ator from Alabama. such as the Kennedy bill does—I sug- approval, of biologic approval, of med- Mr. SESSIONS. Mr. President, I wish gest in my substitute we eliminate ical devices approval? Why would we to express my appreciation to Senator print advertising, we do away with it risk at a time where, every year for the BURR for his hard work on this issue. in total. past 3 years, we have had an issue on He is one of our most able Members. I We do not worry about whether food safety—we have had salmonella in think the fundamental premise of the Vogue magazine, which is typically peanut butter; we have had tainted study that showed his bill will reduce bought by an adult woman, might be spinach; we have had imported prod- smoking more than the bill on the looked at by a teenage girl. If we just ucts that have killed Americans; and floor, the Kennedy bill, is something eliminate print advertising, we do not the FDA is the agency responsible for that should give us pause. I know they have that problem. The Kennedy Bill the regulation of food safety—why have worked very hard on it. He has limits it to black and white. We ban it would we dump on an agency today worked very hard on it, and I hope my in total. that is struggling to meet their core colleagues will avail themselves of his If Members will take the opportunity mission of food safety a new product suggestion to read it—both bills—and to read both bills—to read the sub- such as tobacco? make a judgment on what they think stitute, to read the base bill—they will Why would we take an agency, such is best for the country. find out we are actually more expan- as the FDA, that regulates 25 cents of UNPRECEDENTED BUDGET DEFICITS sive from the standpoint of regulation. every $1 of the U.S. economy, and say: Mr. President, the unprecedented We actually accomplish the task of re- You know what. You have never regu- budget deficits we see today are cre- ducing disease and death. I believe, by lated tobacco before, but we would like ating fears of a surge in bond interest some of the things we do, we actually you to do it now. We would like you to yields and a fall in the U.S. credit rat- reduce the amount of youth usage, take senior reviewers who are approv- ing. I wish to talk about that. I have such as by eliminating print ads. ing lifesaving applications for drugs, talked about it previously. But I would But there is a big difference. I do not and we would like you to move them repeat my fundamental assertion that turn it over to the FDA. I do not do over to the tobacco area. nothing comes from nothing, nothing

VerDate Nov 24 2008 00:26 Jun 04, 2009 Jkt 079060 PO 00000 Frm 00028 Fmt 0624 Sfmt 0634 E:\CR\FM\G03JN6.049 S03JNPT1 jbell on PROD1PC69 with SENATE June 3, 2009 CONGRESSIONAL RECORD — SENATE S6013 ever could, as Julie Andrews said. So the idea he has proposed is not When you put too much of a product on Debts must be paid, and they will be farfetched. In fact, the Standard & the market, things happen, and people paid one way or the other. Either Poor’s—S&P—a few weeks ago lowered start demanding better returns. Two somebody is going to lose—either you its outlook on Great Britain’s debt. weeks ago, Barron’s reported as big are going to print money and inflate They put it on a negative outlook. news that the U.S. Department of the money or you are going to pay While the United Kingdom is keeping Treasury bond yields could top 4 per- back the debt with interest to whom- its AAA rating for now, the Wall Street cent this year. And it seems, since it ever will loan you the money to fund Journal notes that the negative out- already hit 3.7 percent yesterday, that the debt. We are moving into a decade look that S&P has found is a precursor we may get there sooner than Barron’s of the most unprecedented deficits in to a downgrade. They also note that even anticipated. the history of our country. Nothing has Japan’s debt, in fact, has already been So how does all this stack up with ever been seen like it before. It is irre- downgraded to AA2 from AAA. So the what the President estimated when he sponsible. We have not discussed it question is, are we next? submitted his budget earlier this year? enough. It is breathtaking to people Not only is our credit rating in dan- His budget estimated an average yield who examine it. ger, but it is costing more and more to on Treasury bonds at 2.8 percent for The estimated deficit for fiscal year borrow. This is very important. While the entire year. We already hit 3.7, and 2009, the one we are in, ending Sep- it may appear to be a separate prob- Barron’s said we are going to hit 4, so tember 30, is expected to be $1.84 tril- lem, I think it is related to us spending we are ahead of Barron’s schedule al- lion. That is a lot of money. That num- more and borrowing too much. The ready. So the 10-year Treasury bill is ber dwarfs even the $500 billion max- yield on the 10-year Treasury bond, increasing, and hopefully, it won’t imum, inflation-adjusted deficit—near- which rises with the increased govern- surge out of reason. Some are worried ly the same dollars to dollars—during ment debt and expectations of infla- about that. It does look like it may World War II. It was only $500 billion in tion, has surged 54 percent this year, well reach that 4 percent or more this World War II. So this year, the deficit from 2.4 percent to 3.7 percent as of year. That is bad news for American is projected to be 12.9 percent of the yesterday. It was 3.2 percent 2 weeks taxpayers. So we are like the credit cardholder. gross domestic product. In 1 year, the ago. Yesterday it was 3.7 percent. That When interest rates go up, it costs us deficit will be 12.9 percent of the gross is a significant surge. more. When the interest rates on domestic product of the United States So let me say it this way, and to re- Treasury bills go up, we have to pay of America. That is a level not seen peat: We will borrow this year a record more to get people to loan us money so since World War II. amount of money. Not only that, over we can spend it. I guess it is fair to say David Walker, the former Comp- the next 10 years, we will continue to troller General of the United States— we have only ourselves to blame. borrow at unprecedented rates. We are Even if you took the President’s as- that is what we call the Government borrowing because we are spending sumptions, interest on the debt is sup- Accountability Office—has been speak- more than we take in—a lot more than posed to be $170 billion this year. So ing out for a number of years on defi- we take in—and nothing comes from this Nation will pay on the debt we al- cits. He criticized President Bush for nothing. ready have accumulated $170 billion in deficits. He continues now to speak out How do we spend more than we take interest this year. That is a lot of since he has left government. He has in, in taxes? How do we do it? We bor- money. We spend $40 billion on the concluded that the United States of row the money. How do we borrow the Federal highway program. We spend America is in danger of losing our AAA money? We sell Treasury bills. We ask less than $100 billion on Federal aid to credit rating. He points out that the people to take their money out of their education in America. We are already cost of insuring U.S. Government debt bank account and buy U.S. Treasury spending, and will spend this year, $170 has risen so much that it recently cost bills. We have had an unusual situation billion on interest, on debt we have run more to buy protection on U.S. debt with interest rates being low, because up before. That equals $1,435 per house- than debt issued by McDonald’s Cor- people were so afraid if they bought hold. That is a lot of money, $1,435. By poration. That is his statement. In stock or private bonds, that companies 2019, according to the Congressional fact, a Wall Street Journal editorial in may go bankrupt, and they were inter- Budget Office, our own Budget Office’s March noted that the insurance rate ested in buying government bonds, evaluation of what the President’s for U.S. Government bonds rose 700 Treasury bonds, presumably the most budget is going to be, 10 years from percent to 100 basis points between secure bonds in the world. So we have now, the interest on the debt will not March of 2008 and March of 2009. That had a bargain and we have been taking be $170 billion; it will be $800 billion. means in this past month of March, it advantage of it. But all of a sudden That would be $3,433 per household, costs $10,000 to insure $1 million in now we are beginning to see a surge in more than twice the current debt inter- Treasury bonds. Who would think you these interest rates, because people are est payment that each household in would have to get insurance to guar- thinking: Well, if I don’t get a 3-per- America is to incur. Why? Because we antee the payment of U.S. Treasury cent return when I buy a Treasury bill, are spending too much. We are spend- bonds? As of May 28, that insurance and inflation next year is 5 percent, ing money we don’t have. We spent $800 cost had fallen to 45 basis points, but and my money is tied up for 10 years, I billion on a stimulus package. We are that is still more than three times am losing 2 percent a year. I am not spending $700 billion on the TARP Wall what it was in March of 2008, just a gaining money; I am losing money. The Street bailout. Our increase in spend- year ago. Not only that, as of May 28, world looks at it like that. The Chinese ing for the underlying Federal budget the cost of insuring our government’s and people in Saudi Arabia who have this year, the nondefense, the discre- debt is higher than that of France and excess wealth and bought Treasury tionary spending was a 9-percent in- Germany. bills are looking at this too and they crease. That is huge, many times the Mr. Walker goes on to note that the are demanding higher interest rates. rate of inflation, a 9-percent baseline United States has had a AAA credit That is why it is going up. That means increase. Most of my colleagues know rating since 1917. Furthermore, he each year we will pay a larger percent- that if you increase spending, or have states that given the current national age of the tax money we take in to pay an interest rate of 7 percent, your debt and deficit, the United States may interest on the debt than we would money will double in 10 years. So at 9 not deserve the AAA rating we have have if that had not been the case. percent, in less than 10 years, the today. That is a warning. I hope that is I am told that this rampant rise in amount of our spending would double; not so. I hope we don’t see a reduction Treasury rates is the talk of Wall entire government spending in 8 or 9 of our AAA rating, which has a real im- Street. How has it happened? Net debt years would be doubled. That is why we pact in how much we have to pay to sales; that is, the net sales of Treasury are running up debt. But the most borrow money, and we are borrowing a bills and the borrowing the government troubling thing is, it is going to con- lot. But I think this man deserves has done, increased from $332 billion tinue. hearing. This is a serious commentator last year to $1.555 billion this year. We have heard the President say, I on American deficits and debt. That is a lot. That is almost five times. am worried about this. We are going to

VerDate Nov 24 2008 00:26 Jun 04, 2009 Jkt 079060 PO 00000 Frm 00029 Fmt 0624 Sfmt 0634 E:\CR\FM\G03JN6.050 S03JNPT1 jbell on PROD1PC69 with SENATE S6014 CONGRESSIONAL RECORD — SENATE June 3, 2009 have to talk about this in the future. estimate of a deficit from $1.75 trillion Christina Romer, the Chairman of Have you heard that? Oh, yes. This is a to $1.84 trillion. I ask, do we remember President Obama’s Council of Eco- big problem. We are going to have to do that at that same time when the Presi- nomic Advisers, wrote about this in something about it in the future. Well, dent released his budget, he also re- 1992, in a paper titled ‘‘What Ended the the future is becoming now. The budget leased a plan that was going to show Great Depression?’’ in the 1930s. She that he submitted to us didn’t do any- that he was committed to frugality, concluded: thing about it in the future. Let me be and it would supposedly save $17 bil- Nearly all of the observed recovery of the frank with my colleagues. The budget lion? Remember that? Some people had U.S. economy prior to 1942 was due to mone- this year, the deficit this year the to laugh at it, really. It was pretty tary expansion [from gold inflows]. President projected would be $1.76 tril- amazing. There were these numbers She gives almost no credit to the in- lion. That has already been proven to out there, and he announced this fru- creased spending that occurred. be low. They are now estimating $1.84 gality package to save $17 billion. It Another report with Ms. Romer’s trillion in 1 year. And they project it wasn’t clearly understood, in my view, name on it, one that the President’s dropping down to maybe $500 billion in how insignificant that was, because at economic team put out this January— 3 or 4 years, assuming the economy is the same time they were announcing and she is the head of the team—was growing well. But over the 10 years, in saving $17 billion, the reaccounting of titled ‘‘The Job Impact of the Amer- the tenth year of his budget deficit, the the projected deficit for this very fiscal ican Recovery and Reinvestment annual deficit in the tenth year, is over year jumped $90 billion. So it dwarfed Plan.’’ It estimates that the $800 bil- $1 trillion. And over the 10 years, the the $17 billion in spending cuts that lion stimulus package will lower the average deficits from the President’s were announced at that time. So we unemployment rate and create 3.6 mil- own submitted budget would be almost had a $17 billion efficiency project, lion new jobs, and it includes a chart. $1 trillion a year, and the highest def- which remains to be seen whether it The chart, if you look at it today—and icit prior to this we have ever had was will be successful, and the total deficit it has been examined by others, such as $455 billion last year. So this is aver- expectation jumped $90 billion. Greg Mankiw, Chairman of the Council aging almost twice, really twice the The President’s budget proposes to of Economic Advisers—it shows that highest deficit we have ever had. take us to a debt level of 82 percent of their projected unemployment rate, The President has said, correctly, GDP by 2019. In 2019, the amount of without the stimulus package—that that these trends are unsustainable. He debt, in the country at that point rate would hit a certain level. Now recognizes that. He also said, according would amount to 82 percent of our en- that we have had the $800 billion stim- to Bloomberg at a townhall meeting in tire gross domestic product in Amer- ulus package, what does it show? That New Mexico on May 14, that current ica. That is a level not seen since 1946, we are trending, on unemployment, ex- deficit spending is unsustainable. He at the height of World War II. The dif- actly where they projected the unem- warned of skyrocketing interest rates ference between now and then, of ployment rate would be if there were for consumers if the United States con- course, is that that was during a war. no stimulus package at all. tinues to finance government by bor- It was widely known that those ex- Indeed, if you look at the numbers, rowing from other countries. So I agree penditures were temporary, and when very little of it has gotten out of there, with him on that, but it is time to the war was over, they would end; and, and you can see how little was stimula- start doing something. in fact, they did. tive, or job creating, or how much of it China remains the biggest foreign However, today, the President is pro- was spent on things it should not have holder of United States debt in Treas- jecting deficits averaging nearly $1 be spent on. Indeed, this Senate re- uries, and Prime Minister Wen Jiabao trillion as far as the eye can see, with jected and failed to adopt my amend- stated in March that China is worried no projections to show them drop, or be ment that would have said at least the about its investments. reduced. It has been popular to com- employers who hired people with this Not only that, but yields are cur- plain that, well, President Bush had money ought to run the E-Verify sys- rently rising despite an extremely un- deficits—and he did. I criticized him tem to make sure the people they hire usual move by the Federal Reserve to for that, and I think he could have are here legally in America and are en- directly purchase Treasury bonds. So done a better job. His highest deficit titled to work. That wasn’t even part the U.S. Federal Reserve—our banking was $455 billion. This year’s deficit will of it. gurus—have decided they will take be $1.8 trillion, and they will average Unemployment continues to go up. It money and purchase U.S. Treasury $900 billion over the next 10 years. Not was 8.9 percent in May, and a lot of bonds to keep the interest rates from 1 year in the next 10 years, according people think it may hit 10 percent. I going up so fast, because there are not to the President’s own budget, will his hope not, but I think it is likely to enough people out there to buy them deficit be as low as the highest deficit continue above 9 percent, which is all, I suggest. It holds the interest President Bush had, which was $455 bil- higher than what was projected, for rates down somewhat. lion. Even as a percentage of the total sure. The Fed has not done anything like gross domestic product, it is astound- I say all this to point out that some this since the 1960s. It is very unusual. ing. President Bush’s deficits averaged of the brilliant thinkers in our country Even then, it was a much smaller oper- 3.2 percent of GDP. President Obama’s believe we had to do all this; if we had ation. They announced a $300 billion budget, over the next 10 years, will av- not, the country would sink into the purchase plan in March and have made erage 7.3 percent of GDP each year— ocean. We could have this problem and $100 billion in purchases so far. If those twice what President Bush’s averaged. that problem. But the testimony we purchases are not carefully managed, I am worried that we are not getting had in the Budget Committee from the they could lead to inflation down the the kind of bang for our buck that we Congressional Budget Office, whose road; there is no doubt about it. Not hoped to get. We got an $800 billion numbers have held up pretty well so only that, but the Fed could get stuck stimulus package that was supposed to far, and they are basically hired by the with sizable losses if the yield on those go out there and build infrastructure Democratic majority here, but they are Treasury bills continues to rise. and create jobs now. It was money that nonpartisan and do a good job. They According to Barron’s, if rates rise 1 had to be spent in a hurry. The truth projected only a slight difference in un- percentage point, it could lead to a $140 is, though, that most of that money is employment, if you had a stimulus billion loss for the Fed in that deal of not going to be spent until after 2010. It package—only slightly better than if purchasing these bonds. That is $140 takes time to get that money out. The you didn’t have one at all. But, more billion. The Federal highway spending CBO estimated that $162 billion of the importantly, they concluded that over in America is $40 billion. This is a huge $311 billion now appropriated won’t be 10 years, the stimulus package, if we sum of money. spent until 2011, or later—not to men- passed it, would have a net negative ef- Let’s look at the deficit and debt tion that there is no evidence of the fect on the economy. It should help that are driving our interest rates government ever taxing and spending some in the 2 or 3 years from the mon- higher as part of his detailed budget re- its way out of a recession. That is not, eys being pumped out—it has to help leased in May. The President raised his historically speaking, proven to work. some out soon.

VerDate Nov 24 2008 00:26 Jun 04, 2009 Jkt 079060 PO 00000 Frm 00030 Fmt 0624 Sfmt 0634 E:\CR\FM\G03JN6.051 S03JNPT1 jbell on PROD1PC69 with SENATE June 3, 2009 CONGRESSIONAL RECORD — SENATE S6015 But the crowding out of private bor- reorganization policies of bankruptcy. and firmly established in the position rowing, the interest that will have to The U.S. Government could have put of those who sit on this side of the be paid on the debt over the 10-year pe- some money into GM in an effective aisle. At the moment, that sticking riod, will mean that the economy will way, I think, and had a positive ben- point seems to be irreconcilable. I want be less healthy at the end of 10 years efit. But just to pour the money in, as to talk about it in direct terms so that than if we hadn’t had the bailout pack- we have, in an unprincipled way, is not we understand what it is we are talk- age or stimulus package at all, which good. ing about and those who listen will un- confirms my view that nothing comes I will repeat one more time my con- derstand why those of us who are Re- from nothing. There is no free lunch. cern about the unlawful way, the un- publicans are determined to stand firm Debts have to be repaid. You cannot precedented way, in which this money on this point. create something out of thin air. If you is allocated. This is the point: Shall there be a spend something today and you have The money comes from the TARP, public plan, a government-run option resources today to spend today, and the Wall Street bailout. I opposed it be- in the choices that are available to you took them from tomorrow, they cause I thought the language was too people with respect to health care? are not going to be there tomorrow. broad, but even I didn’t know it was Along with Senator WYDEN of Or- Somebody is going to have a greater this broad. But we were told if we egon, I have cosponsored the Healthy burden to carry—our young people— passed the TARP bill, Secretary Americans Act, which is determined to than if we hadn’t taken their money Paulson and the Treasury Department create as many options as possible, to and spent it today. would buy toxic assets. He was specifi- create a wide range of choices for I have to say that I am not happy cally asked at a House committee Americans to make with respect to about this. I am worried about it. I do meeting whether he would buy stock in their health care. believe deficits matter. People who say banks. He said: No. His goal was to get We recognize we are going to have to deficits don’t matter—and some Repub- the money flowing again in the finan- change the tax laws in order to give licans used to say that—what planet cial markets, and we had to do some- people control over their own health are they from? Of course, deficits mat- thing about the financial markets. care dollars. Right now, health care is ter. You can cover them up, the Fed Senators were eventually convinced, the only part of the economy where the can help, and smart monetary policy and it was rammed through here in the individual receiving the goods or serv- and spending policies may make a dif- very shortest period of time—in a ices does not control the money that ference here and there, but in the long panic, really. A week had not gone by pays for the goods or services. So it is run, it drives you down, and we have to when he had decided to buy stock and obvious that you will not have market forces available in that circumstance. be serious about it. I hope as time goes not buy toxic assets, not to buy toxic If the individual who is receiving the by, we can work together in a bipar- mortgages. As time has gone by, that goods or services controls the money tisan way to try to establish some con- same money is used to buy stock in that pays for the goods or services, he trol over our spending. what was once a private corporation. Just Monday, GM went into bank- I think this is unbelievable. There or she will make a different choice ruptcy. We already have $20 billion in are no hearings on where the money is than if someone else is controlling the Federal Government money going into going. There is no public ability to un- money. But in health care, somebody else makes the choice, and that is why General Motors prior to bankruptcy, derstand what kind of justification the core function of the Healthy Amer- and the White House plans to add an- these banks, GM, or Chrysler had to icans Act, which Senator WYDEN and I other $30 billion. That is a substantial put forward to receive billions of dol- are cosponsoring, says individuals additional investment. This is what the lars from the taxpayers. It was all done should be in control of their own numbers show. First, the White House basically in secret, as far as I can un- money and we should have as many said we are going to be out of GM and derstand. They are telling the company choices as possible so that individuals get our money back in 5 years. That is they have to do this and that and firing can go out in the market. their goal, right? You heard that we the CEO and all of those kinds of There will be competing forces. Com- are going to get the money back. But things that have been occurring. I petition brings prices down. Competi- the Wall Street Journal has calculated don’t think the American people are tion creates new opportunities. Com- this, and they have said for the Federal happy with that. The American people petition fills niche markets. We believe Government to get their money back are very concerned—I believe they are all of that will happen if we have this out of GM, they would have to sell rightly concerned—because we are degree of choice. their stock, and GM’s market cap, the doing some things that have never been When we have had this conversation total value of their stock, would have done in the history of our Republic. It with officials of the administration, to reach a value of $80 billion. So to get is not healthy. they don’t disagree. As a matter of our money back in 5 years, the market I hope that somehow we can get our fact, many officials of the administra- cap or value of GM stock would have to footing again, get our balance, and re- tion have said to me: We really like total $80 billion. Let me remind you turn to the tried-and-true principles what you are doing with Senator that at its peak, in 2000, the highest that made this country great. WYDEN, and we applaud you, Senator GM ever got as a market cap was $56 I yield the floor. BENNETT, for reaching out in a bipar- billion. Their current market cap is The PRESIDING OFFICER. The Sen- tisan way to try to solve this problem. less than $1 billion—$441 million dol- ator from Utah. But we just have one additional factor lars. It goes beyond rationality to be- HEALTH CARE we would like to add to your bill. We lieve that in 5 years—or maybe ever— Mr. BENNETT. Mr. President, we would like to say that as a backup, as we are going to get our money back have just heard from the President of a final option, we want a government- out of GM. I am worried about that. the United States with respect to an ef- run plan to be there as one of the avail- That is one more example of the kind fort to get a bipartisan health care able choices, just in case none of the of spending we are doing, and the plan. I have been to the White House others work. That is, as I say, the money is being spent in a way that is summit on health care. I have heard sticking point here. not controlled. How does the Secretary the President speak directly to this I have said to members of the admin- of the Treasury decide how much issue. I applaud him in his effort to istration: If we end up with a govern- money to give? And to what corpora- make sure we deal with this problem ment-run plan as one of the options in tion? What about suppliers of GM? intelligently, and I accept at face value my bill, I will vote against my own What about automobile dealers, who his desire that it be done in a bipar- bill. are losing their shirts and going into tisan manner. The government-run option will bankruptcy? Nobody bailed them out. But as we have this discussion about change the playing field, will ulti- Somewhere along the way, it has doing this in a bipartisan manner, it mately drive out all of the other been decided that we need to do this. It all ultimately comes down to one choices because the government is in a should have been done according to the sticking point that seems to be firmly position to subsidize it. The govern- established constitutionally-approved established in the President’s position ment is in a position to make it more

VerDate Nov 24 2008 00:26 Jun 04, 2009 Jkt 079060 PO 00000 Frm 00031 Fmt 0624 Sfmt 0634 E:\CR\FM\G03JN6.052 S03JNPT1 jbell on PROD1PC69 with SENATE S6016 CONGRESSIONAL RECORD — SENATE June 3, 2009 attractive than anything else and only patients who were outside of the want to be in one of these single-payer, thereby gain the blessing of the voters health plan. He looked at it and said: government plans of the kind President because the voters will say: The gov- Yes, you need surgery. Obama wants as an option destroying ernment took care of those greedy I said: All right. When? the other options and choices there companies that would otherwise make He said: Will Wednesday be soon would be if we pass the Healthy Ameri- me pay this, that, or the other. Here, enough? cans Act. the government choice is cheaper; isn’t This was on a Monday. The rate for treating kidney failure— it wonderful that the government is I said: All right. dialysis or transplants—is five times looking out for me? Ultimately, we We went into a private hospital. It higher in the United States for pa- would end up with a government plan, was separated from the national health tients between the ages of 45 and 84 and single payer for the whole country. service. He performed the surgery. I nine times higher for patients 85 years I know there are many of my friends paid him cash, got the thing taken care and older. Again, there is a personal in- on the other side of the aisle who want of, and finished my time in Great Brit- terest here because members of my that, and they are very open about it ain with that particular problem family have kidney disease. I want and very direct about it. They say a solved. them in the United States with the number of things. They say the govern- I would like to think that was only kind of system we have where they do ment plan is cheaper, the government the case back when I was younger, but not have to wait and they do not have plan provides health care for every- I find it is still the case, not only in to worry about government regula- body, the government plan is fairer, Great Britain but in other countries tions. I want them here where it is five and that is what we ought to have. that have this kind of problem. times better than it is in Europe with I wish to spend a little time talking Let me share a few statistics with respect to kidney disease. about the experience of those countries you of what happens with respect to Right now, nearly 1.8 million Britons that have adopted that attitude. If I this single-payer system. are waiting for hospital or outpatient may be personal and give my own ex- One of the things we are told by treatments at any given time—1.8 mil- ample before I get into the statistics, I those who support single payers is that lion waiting in the circumstance that I will tell you about a situation when I the outcomes in these other countries described in my own situation. In 2002 was living in Great Britain and had a are really not any different than they to 2004, dialysis patients waited an av- medical problem. I won’t bore you, Mr. are in America, that we are paying far erage of 16 days for permanent blood President, with the details of the prob- more in America and the outcomes are vessel access in the United States, or 20 lem, simply that I went to a doctor in basically the same. The statistic they days in Europe, and 62 days in Canada. Scotland to see if anything should be usually use in order to prove that We often hear about the benefits of done. The doctor first signed me up be- America is not any better is life ex- being in Canada. I have constituents cause under the British system a doc- pectancy and infant mortality. They who come from Canada, who have tor—this shows how long ago it was, say as a country, our life expectancy is moved to Utah. Every time this comes but the system has not changed—got a not that much better than anybody up, they come to me and say: Senator, shilling a week for every patient he else’s and our infant mortality rate is whatever you do, do not give us the Ca- signed up on his list. So immediately as high or higher than other countries. nadian system. Whatever you do, make he wanted to sign me up so he would Shame on us, we are not getting good sure that America doesn’t go in the di- get that shilling for having me there, health care that we are paying for. rection the Canadians have gone. which would be a decimal of a pound Life expectancy is tied in very many Let me give you some examples to today rather than that old designation. cases to either ethnic or geographic lo- demonstrate why that is good advice. Once he had me signed up, as I say, cations. The life expectancy, for exam- This is one that broke out in the de- he examined me. He said: Yes, you do ple, in Utah, where the behavior is a bate in the Canadian Parliament. A need treatment. And he gave me a little different than it is in some other woman by the name of Emily Morely, piece of paper that would allow me to places, is substantially higher and has in March of 2006, was informed by her go to the Edinburgh Royal Infirmary, little or nothing to do with the health doctor that her cancer had spread and where I was to see a surgeon. So I went care. It has to do with the culture in she needed to see an oncologist, and to the Edinburgh Royal Infirmary and Utah that causes people to behave in a then she was told: You will not be able sat there for most of the day before a healthier lifestyle. to get an appointment for months. doctor could finally see me. Let’s go beyond this broad-brush ap- Well, if my cancer is spreading, I don’t The doctor saw me and checked me proach and look at some specifics. want to wait months for an appoint- out and said: Yes, indeed, you should The largest international study to ment. Her family raised a ruckus, they be scheduled for surgery. date has found that the 5-year survival called the local newspaper, a petition I said: Fine. I have a schedule. Can rate for all types of cancer among both was signed by her neighbors demanding you give me some idea when the sur- men and women is higher in the United she get care, and then, in response to gery will be so I can arrange my affairs States than in Europe. Isn’t that a sta- that, the government got her to a spe- to be available? tistic showing that we are getting a He said: My guess would be 9 months. cialist. Once again, in the government, I said: I am going to be returning to better result in America than in Eu- you respond to the voters. If you are the United States in less than 9 rope? A cancer survival rate is not getting bad publicity in the press, or months, so I guess we can just forget something that is due to the geography the voters don’t like what you are this. of where you are born. If you are born doing: Oh, let’s take her to a specialist. I communicated that to my father, in the inner city, that has something So she got to a specialist and he told who was in the United States, and he to do with infant mortality rates, or if her she had only 3 months to live. said: I don’t think so. Can you get a you live in a healthy environment, Well, she at least had time to put her surgeon who would operate on you that has something to do with life ex- affairs in order. Had she not had the right away? pectancy. Cancer survival rate has to intervention of her family and her So I inquired and I was told: Yes, you do with health care, and the health neighbors, it is quite likely she would can get a private surgeon, but the pri- care in the United States is better than have died before even seeing an vate surgeon cannot take the health it is in Europe and has produced a oncologist for the first time. care system dollars or pounds. He is higher survival rate for both men and But let’s go to another example that outside of it. If he stays in private women. may be even closer to home to the leg- practice, he cannot participate in the In Britain, there are one-fourth as islators. A member of Parliament in national health system at all. many CT scanners per capita as there Canada, Belinda Stronach, strongly I said: OK, that is fine. are in the United States and one-third supports the Canadian health care sys- My father said: I will pay it. Where as many MRIs. If we think the CT tem, and she would object to this kind can you go? scanner and the MRI produce a better of argument that the Canadian health I went to the private surgeon and, result in terms of health care, we want care system isn’t very good. But where yes, he had a practice where he took to be in the United States. We do not did she go when she was diagnosed with

VerDate Nov 24 2008 00:26 Jun 04, 2009 Jkt 079060 PO 00000 Frm 00032 Fmt 0624 Sfmt 0634 E:\CR\FM\G03JN6.053 S03JNPT1 jbell on PROD1PC69 with SENATE June 3, 2009 CONGRESSIONAL RECORD — SENATE S6017 cancer in 2007? She went to California stand this in time for any artificial The assistant legislative clerk pro- and paid for the treatment out of pock- deadline set for some political agenda. ceeded to call the roll. et. Even a member of Parliament who I understand the sense of urgency that Mr. DODD. Mr. President, I ask unan- supports the Canadian system recog- the Obama administration feels on this imous consent the order for the nized that the government plan didn’t issue, and I share the idea that now is quorum call be rescinded. work for her. And with her own health the time to address it. This is the Con- The PRESIDING OFFICER. Without at risk, she came to America and took gress in which we should pass it. But I objection, it is so ordered. advantage of what we offer here. don’t think setting a deadline to say it The 30 hours postcloture under rule There is the case of the mother in must be done in July, when we are XXII has expired. The question is on Calgary, Alberta who was expecting talking about 18 percent of GDP, is agreeing to the motion to proceed to quadruplets. I am the father of twins, that persuasive. H.R. 1256. and they came as a great surprise. We can examine these alternatives a The motion was agreed to. little more carefully than the present Quadruplets is something I am not sure f we could handle, and certainly they deadline will allow us to do. We can would require very good facilities to say: All right, why is quality the best FAMILY SMOKING PREVENTION deal with a pregnancy that produces cost control, and does our bill create AND TOBACCO CONTROL ACT quadruplets. She is in Albert, Canada, the kinds of incentives and rewards fo- The PRESIDING OFFICER. The Sen- and she is flown to Great Falls, MT, to cused on quality that will produce that ator from Connecticut is recognized. deliver the quadruplets. Great Falls, result, instead of saying: Whatever else Mr. DODD. Mr. President, I ask unan- MT, is not thought of as one of the you do, you have to have a government imous consent the only amendments in great centers of health care excellence option in there. You have to have a order today after the amendment is of- in the United States. Yet the facilities government plan that can compete fered by myself, Senator DODD, the in this small town in Montana were with all the rest of this, and thus set us HELP Committee substitute amend- better than any facility available any- up for the kind of situation where we ment, be the Lieberman amendment re: where in Alberta. would move as a nation to imitate TSP, and the substitute amendment of These are the examples of a govern- Great Britain or Canada or the others Senators BURR AND HAGAN. ment-run plan and because people who that have produced the kinds of exam- The PRESIDING OFFICER. Is there are getting the service don’t control ples I have talked about here. objection? the money the government plan can So I am more than willing and I am Without objection, it is so ordered. anxious to work with President Obama end up focusing on overall cost control ORDER FOR RECESS and his administration, to work with to the detriment of the people who are my friends across the aisle. I have Mr. DODD. Mr. President, I now ask trying to access it. I don’t think ulti- unanimous consent the Senate stand in worked with Senator WYDEN for these mately the American voters, having past 3-plus years to try to fashion an recess from 6 p.m. to 6:30 p.m. My in- gotten used to the access that they intelligent solution. But I repeat what tention would be to address for a few currently have—being used to the idea I said at the beginning: The sticking minutes some comments and then that they do not have to wait—would point in this entire debate is the de- would defer to others who may want to ultimately tolerate a government plan. mand on the part of the Obama admin- speak until we recess at 6 p.m. My consult to President Obama and istration that the final product have The PRESIDING OFFICER. Without to my colleagues here in the Senate is within it a government plan as one of objection, it is so ordered. to slow down a little. We are talking the options. And if that happens, I vote The clerk will report the bill. about restructuring 18 percent of the against my own bill. If that happens, I The assistant legislative clerk read entire economy. We spend 18 percent of do everything I can to say no. Because as follows: our GDP on health care. I agree abso- I am convinced if that happens, we end A bill (H.R. 1256) to protect the public lutely that it is long past time that we up with a situation where there is only health by providing the Food and Drug Ad- addressed this issue; that we ration- one option that survives. ministration with certain authority to regu- alize the challenge; and that we do One of my colleagues has described late tobacco products, to amend title 5, United States Code, to make certain modi- things that make it far more effective. this, I think, quite well. He says: Hav- As I have spent the last 3 or so years fications in the Thrift Savings Plan, the ing a government plan as one of the op- Civil Service Retirement System, and the working with Senator WYDEN to try to tions is a little like taking an elephant understand the problem and fashion Federal Employees’ Retirement System, and into a room full of mice and then say- for other purposes. the Healthy Americans Act in a way ing: All right, this is a roomful of ani- Mr. DODD. Mr. President, I rise to that will solve the problem, I have dis- mals, let’s let them compete. And as covered a great truth that I didn’t real- offer an amendment in the nature of a the elephant walks around the room, substitute to H.R. 1256. ize before, and that is this: The great- pretty soon there aren’t any mice left. est cost control factor in health care is As I understand it from the leader- A government plan is the elephant in ship, while there will be some com- quality. The best health care is the the room. cheapest health care. And it has been ments I will make this evening, briefly, Those of us who want to solve this about the substitute, and others may achieved in those places that have fo- problem intelligently say: Let’s learn cused on quality first and the patient have some comments to make before from the examples of those people who the evening concludes, there will be no first, and it has not involved any gov- have adopted a single-payer system. votes this evening. The leadership has ernment intervention. Let us realize that the American exper- notified us of that, so colleagues ought Dartmouth has done a study and told iment in health care produces better to be aware there will be no votes at all us the three cities in the United States outcomes in all of the areas I have out- this evening. where you get the best health care. lined. And as politicians, let’s realize If I could, I wish to take a few min- They are Seattle, WA; Rochester, MN; that the American voter will never utes to describe the substitute amend- and Salt Lake City, UT. I take some stand for the kind of rationing by delay ment, and I will yield the floor to oth- pride in that fact. And then the Dart- that seems to have crept into every ers who want to talk before the 6 p.m. mouth study goes on to say that if other system. Let’s take our time to do hour arrives and others who may come every American got his or her health it right. There is a bipartisan con- back around 6:30 to make some addi- care in Salt Lake City, UT, it would sensus to get it done. We can work to- not only be the best in the United gether and make that accomplishment, tional comments. States, it would be one-third cheaper if we are not quite so insistent that the AMENDMENT NO. 1247 than the national average. government plan ultimately is the only The PRESIDING OFFICER. The Those are the kinds of examples we way to go. clerk will report the amendment. should be focusing on and learning Mr. President, I yield the floor, and I The assistant legislative clerk read from, and then doing our best to write suggest the absence of a quorum. as follows. legislation that would support that. The PRESIDING OFFICER. The The Senator from Connecticut [Mr. DODD] Slow down. We are not going to under- clerk will call the roll. proposes an amendment numbered 1247.

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