Palliative Care Training Act

Mr. President, I rise to introduce two new bills to strengthen U.S. nonproliferation efforts. One of these is a new Conventional Arms Threat Reduction Act. The other is the fourth installment of the Nunn-Lugar legislation, the nonproliferation program that Sam Nunn and I sponsored in 1991.

In that year, Sam Nunn and I authored the Soviet Nuclear Threat Reduction or Nunn-Lugar Act, which established the Cooperative Threat Reduction Program. That program has provided U.S. funding and expertise to help the former Soviet Union safeguard and dismantle their enormous stockpiles of nuclear, chemical, and biological weapons, means of delivery and related materials. In 1997, Senator Nunn and I were joined by Senator Domenici in introducing the Defense Against Weapons of Mass Destruction Act, which expanded Nunn-Lugar authorities in the former Soviet Union and provided WMD expertise to first responders in American cities. In 2003, Congress adopted the Nunn-Lugar Expansion Act, which authorized the Nunn-Lugar program to operate outside the former Soviet Union to address proliferation threats. The bill that I am introducing today would strengthen the Nunn-Lugar program and other nonproliferation efforts and provide them with greater flexibility to address emerging threats.

To date, the Nunn-Lugar program has deactivated or destroyed: 6,462 nuclear warheads; 550 ICBMs; 469 ICBM silos; 13 ICBM mobile missile launchers; 135 bombers; 733 nuclear air-to-surface missiles; 408 submarine missile launchers; 530 submarine launched missiles; 27 nuclear submarines; and 194 nuclear test tunnels.

The Nunn-Lugar program also facilitated the removal of all nuclear weapons from Ukraine, Belarus, and Kazakhstan. After the fall of the Soviet Union, these three nations emerged as the third, fourth, and eighth largest nuclear powers in the world. Today, all three are nuclear-weapons-free as a result of cooperative efforts under the Nunn- Lugar program. In addition, Nunn-Lugar is the primary tool through which the United States is working with Russian authorities to identify, safeguard, and destroy Russia's massive chemical and biological warfare capacity.

These successes were never a foregone conclusion. Today, even after more than 12 years, creativity and constant vigilance are required to ensure that the Nunn-Lugar program is not encumbered by bureaucratic obstacles or undercut by political disagreements.

I have devoted much time and effort to overseeing and accelerating the Nunn-Lugar program. Uncounted individuals of great dedication serving on the ground in the former Soviet Union and in our Government have made this program work. Nevertheless, from the beginning, we have encountered resistance to the Nunn-Lugar concept in both the United States and Russia. In our own country, opposition often has been motivated by false perceptions that Nunn-Lugar money is foreign assistance or by beliefs that Defense Department funds should only be spent on troops, weapons, or other war-fighting capabilities. Until recently, we also faced a general disinterest in nonproliferation that made gaining support for Nunn-Lugar funding and activities an annual struggle.

The attacks of September 11 changed the political discourse on this subject. We have turned a corner--the public, the media, and political candidates are paying more attention now. In a remarkable moment in the first Presidential debate, both President Bush and Senator Kerry agree that the number one national security threat facing the United States was the prospect that weapons of mass destruction could fall into the hands of terrorists.

The 9/11 Commission weighed in with another important endorsement of the Nunn-Lugar program, saying that ``Preventing the proliferation of [weapons of mass destruction] warrants a maximum effort--by strengthening counterproliferation efforts, expanding the Proliferation Security Initiative, and supporting the Cooperative Threat Reduction Program.'' the report went on to say that ``Nunn-Lugar . . . is now in need of expansion, improvement, and resources.''

The first bill that I am introducing today is ``The Nunn-Lugar Cooperative Threat Reduction Act of 2004.'' It would underscore the bipartisan consensus on Nunn-Lugar by streamlining and accelerating Nunn-Lugar implementation. It would grant more flexibility to the President and the Secretary of Defense to undertake non-proliferation projects outside the former Soviet Union. It also would eliminate Congressionally imposed conditions on Nunn-Lugar assistance that in the past have force the suspension of time-sensitive nonproliferation projects. The purpose of the bill is to reduce bureaucratic red tape and friction within our Government that hinder effective responses to nonproliferation opportunities and emergencies.

For example, recently Albania appealed for help in destroying 16 tons of chemical agent left over from the cold war. In August, I visited this remote storage facility, the location of which still remains classified. Nunn-Lugar officials are working closely with Albanian leaders to destroy this dangerous stockpile. But the experience also is illustrative of the need to reduce bureaucratic delays. The package of documents to be reviewed by the President took some 11 weeks to be finalized and readied for President Bush. From beginning to end, the bureaucratic process to authorize dismantlement of chemical weapons in Albania took more than 3 months. Fortunately, the situation in Albania was not a crisis, but we may not be able to afford these timelines in future nonproliferation emergencies.

The second piece of legislation that I am introducing is the ``Conventional Arms Threat Reduction Act of 2004'' or ``CATRA.'' This legislation is modeled on the original Nunn-Lugar Act. Its purpose is to provide the Department of State with a focused response to the threat posed by vulnerable stockpiles of conventional weapons around the world, including tactical missiles and man portable air defense systems, or MANPADS. Such missiles and other weapons systems could be used by terrorists to attack commercial and military targets, and U.S. facilities here at home and abroad. Reports suggest that Al Qaeda has attempted to acquire these kinds of weapons. In addition, unsecured conventional weapons stockpiles are a major obstacle to peace, reconstruction, and economic development in regions suffering from instability.

My bill declares it to be the policy of the United States to seek out surplus and unguarded stocks of conventional armaments, including small arms, light weapons, MANPADS, and tactical missile systems for elimination. It authorizes the Department of State to carry out an accelerated global effort to destroy such weapons and to cooperate with allies and international organizations when possible. The Secretary of State is charged with devising a strategy for prioritizing, on a country-

by-country basis, the obligation of funds in a global program of conventional arms elimination. Lastly, the Secretary is required to unify program planning, coordination, and implementation of the strategy into one office at the State Department. The bill also authorizes a budget increase commensurate with the risk posed by these weapons.

The Department of State has been working to address the threats posed by conventional weapons. But in my judgment, the current funding allocation and organizational structure are not up to the task. Only about $6 million was devoted to destroying small arms and light weapons during fiscal years 2003 and 2004. We need more focus on this problem and additional funding to take advantage of opportunities to secure vulnerable stockpiles from proliferation, theft, or diversion.

In August, I visited Albania, Ukraine, and Georgia. Each of these countries has large stockpiles of MANPADS and tactical missile systems and each has requested U.S. assistance to destroy them. On August 27, I stood in a remote Albanian military storage facility as the base commander unloaded a fully functioning MANPAD from its crate and readied it for use. This storage site contained 70 MANPADS that could have been used to attack an American commercial aircraft. Fortunately, the MANPADS that I saw that day were destroyed on September 2, but there are many more like them throughout the world. Too often, conventional weapons are inadequately stored and protected. This present grave risk to American military bases, embassy compounds, and even targets within the United States. We must develop a response that is commensurate with the threat.

I am offering these two bills now, during the November session, so that the administration, Congress, and the public can begin an examination of their merits. I will reintroduce these bills when Congress reconvenes in January. I am hopeful for strong support that reflects the priority status of U.S. nonproliferation efforts.

Mr. President, as you know, we are trying to finalize the appropriations bills this week so that we can get that done and go home. But in these appropriations bills, there are a lot of surprises. One of them is a movement to water down the country-of-origin labeling, a law that was passed in the 2002 farm bill.

I will tell you that over the past weeks--in fact, before the election--I was in 45 communities and traveled 2,500 miles and found out that my State supports country-of-origin labeling and does not want to see it watered down. I heard from my folks. They strongly support it.

In Montana, we want ``U.S.A'' on it. They are proud of what they produce. They are proud of the finished product. Of course, I have supported country-of-origin labeling for many years, and I was glad to see it finally pass in 2002 when we passed the 2002 farm bill.

Now we are at the task of trying to write the administrative rules on a law that is already in place. We are having problems with that.

But as Congress completed the bill and the President signed it into law, we had some folks already trying to dismantle it. That is wrong. Some folks wanted to muddle it up. That was wrong for the simple reason that you can't implement a law unless you know what the rules are. We don't know what those rules are right now. In fact, I think it is kind of like if the Washington Redskins go over to play Baltimore in football and they don't make the rules until after the opening kickoff. I don't think that works very well.

But right now we have some folks who want to take another run at it. They are getting very aggressive and working overtime to get it done. Granted, the law has a couple of flaws in it. It is nothing that we can't fix. But keeping it muddled up all the time while we are trying to write the administrative rules becomes very difficult.

There is a move to defund the entire writing process at one time. That was defeated.

Now, instead of having a mandatory COOL law in effect today, which was the original intent to have a good program, of course, the rules continue because the implementation wasn't supposed to be until 2006. That was a compromise to continue the rulemaking process. Now I am told that there is another move again to soften the law and make it a voluntary law instead of a mandatory law. I don't support that. My producers don't support that. They are tired of waiting around.

We need to get the country-of-origin labeling done. It needs to be done right, and it needs to be mandatory.

I have a concern with the COOL law currently on the books. But today I am introducing legislation that begins to fix one part of that law.

Right now, very little beef will actually be labeled in the grocery stores. The law excludes over half of the beef sold in this country. But let me be clear. Under no set of circumstances do I support rolling back the country-of-origin labeling. If Congress votes to make COOL voluntary, it may as well repeal the law because voluntary COOL does not work.

On October 2002, the Secretary published guidelines for a voluntary labeling program so any retailer who chose to label could do it. But none did.

Some of my friends say if we mandate a program, then let us try voluntary again. It is now time to shift the balance of power in the world of agricultural marketing and mandate country-of-origin labeling.

You see, overwhelmingly, the folks who support COOL are small cow/ calf producers--my ranchers back home in Miles City, Judith Gap, Rudyard, Dillon, and across the State of Montana.

These are guys who have worked hard on their ranches each and every day. They raise and produce healthy cattle and they want ``U.S.A.'' on their products. I don't blame them. But they do not have a lot of say in this decision. Once the calves leave the ranch, producers lose control to other parts of the industry.

While what I am doing is offering a bill to fix it, let us expand the bill to processed meats. We have to do that. The bill I am introducing will remove the exemption in the law for processed foods. In practice, this means beef jerky, sausages, and marinated pork tenderloins which are all excluded from the labeling requirements as it stands. These are common consumer products and none of them would be just the same as they are for fish and shellfish which is already in effect. Looking at those rules, we are not asking for any more.

With that, let us understand that attempts to weaken the law cannot happen in this body nor should it happen on these appropriations bills.

Mr. President, our health care system is structured to cure but often neglects how we die and how to make dying patients and their families more comfortable. Today, I am introducing two bills which I believe will provide better care options for dying patients in our country. The Medicare Hospice Demonstration Act seeks to test ways in which to improve the Medicare hospice benefit, and the Palliative Care Training Act recognizes that we need a larger cadre of health care professionals who know how to help those with terminal illnesses have a better quality of life.

Although this Congress made improvements in the Medicare Hospice benefit last year, I believe we need to continue to test new modes of providing hospice care so that more seniors are not only aware of the benefit, but access it when needed. Medicare introduced the hospice program in 1983 as an optional benefit for achieving a ``good death''. This benefit is widely recognized as effective in improving quality of life for terminally ill patients. Hospice programs provide a range of services to control pain and provide comfort care, primarily to individuals in their own homes. In the past decade, the number of Medicare patients receiving hospice care has more than doubled. Today, about 20 percent of patients who die in the United States receive hospice care. However, average lengths of stay in hospice have been dropping. According to the GAO, twenty-eight percent of Medicare patients in the hospice program receive hospice care for one week or less. One reason for this shift in hospice use is patient unwillingness to forego curative care--or to abandon hope despite a terminal diagnosis. The Medicare hospice program pays for medical procedures necessary for pain control and other symptom management, but not those aimed at curing the patient. As a result, many seriously ill patients resist the program because it forces them to make a choice between the hope that there might be a cure and the acceptance that one's life is coming to an end.

The Medicare Hospice Demonstration Act would remove this obstacle by permitting patients to seek hospice care as they continue curative treatment. I believe more people would use the hospice benefit and use it in a timely manner so they could get the full benefit of the range of services hospice offers if they did not have to give up hope. I also believe that this concept along with counseling assistance provided by this demonstration project would help the medical community be better able to help patients accept hospice care.

The second bill I am introducing, ``The Palliative Care Training Act'', uses the model already in law for other specialities to create a Hospice and Palliative Care Academic Career Award. This award would foster the creation of faculty at our Nation's medical schools to teach palliative

care, once the specialty is recognized as a board certified specialty.

For some the term ``palliative care'' may be new. Palliative care improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification, assessment, and treatment of pain and other problems, physical, psychosocial and spiritual. It neither hastens nor postpones death. This type of care offers a support system to help patients live as actively as possible until death and to help the family cope during their loved one's illness and in their own bereavement. In addition, palliative care is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy.

No one likes to think about what it will be like at the end of our lives. We rarely have the discussions we need to have with our medical providers about how to help us have a ``good'' death. Much of the fault lies in the way we have structured our health care system. With all that the American health system has to offer, we need to make sure resources are put in place to assure patients and their families better care in their last days. I believe these two bills provide important components to do that.

Mr. President, our health care system is structured to cure but often neglects how we die and how to make dying patients and their families more comfortable. Today, I am introducing two bills which I believe will provide better care options for dying patients in our country. The Medicare Hospice Demonstration Act seeks to test ways in which to improve the Medicare hospice benefit, and the Palliative Care Training Act recognizes that we need a larger cadre of health care professionals who know how to help those with terminal illnesses have a better quality of life.

Although this Congress made improvements in the Medicare Hospice benefit last year, I believe we need to continue to test new modes of providing hospice care so that more seniors are not only aware of the benefit, but access it when needed. Medicare introduced the hospice program in 1983 as an optional benefit for achieving a ``good death''. This benefit is widely recognized as effective in improving quality of life for terminally ill patients. Hospice programs provide a range of services to control pain and provide comfort care, primarily to individuals in their own homes. In the past decade, the number of Medicare patients receiving hospice care has more than doubled. Today, about 20 percent of patients who die in the United States receive hospice care. However, average lengths of stay in hospice have been dropping. According to the GAO, twenty-eight percent of Medicare patients in the hospice program receive hospice care for one week or less. One reason for this shift in hospice use is patient unwillingness to forego curative care--or to abandon hope despite a terminal diagnosis. The Medicare hospice program pays for medical procedures necessary for pain control and other symptom management, but not those aimed at curing the patient. As a result, many seriously ill patients resist the program because it forces them to make a choice between the hope that there might be a cure and the acceptance that one's life is coming to an end.

The Medicare Hospice Demonstration Act would remove this obstacle by permitting patients to seek hospice care as they continue curative treatment. I believe more people would use the hospice benefit and use it in a timely manner so they could get the full benefit of the range of services hospice offers if they did not have to give up hope. I also believe that this concept along with counseling assistance provided by this demonstration project would help the medical community be better able to help patients accept hospice care.

The second bill I am introducing, ``The Palliative Care Training Act'', uses the model already in law for other specialities to create a Hospice and Palliative Care Academic Career Award. This award would foster the creation of faculty at our Nation's medical schools to teach palliative

care, once the specialty is recognized as a board certified specialty.

For some the term ``palliative care'' may be new. Palliative care improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification, assessment, and treatment of pain and other problems, physical, psychosocial and spiritual. It neither hastens nor postpones death. This type of care offers a support system to help patients live as actively as possible until death and to help the family cope during their loved one's illness and in their own bereavement. In addition, palliative care is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy.

No one likes to think about what it will be like at the end of our lives. We rarely have the discussions we need to have with our medical providers about how to help us have a ``good'' death. Much of the fault lies in the way we have structured our health care system. With all that the American health system has to offer, we need to make sure resources are put in place to assure patients and their families better care in their last days. I believe these two bills provide important components to do that.

Mr. President, I rise today to offer remarks on a bill that I am introducing that would make a stillborn child an insurable dependent for purposes of the Servicemembers' Group Life Insurance (SGLI) program.

Experiencing the death of a child results in both emotional trauma and financial hardship for parents and families. However, further stress is added when the family involved is in the military. I was recently contacted by a constituent family that experienced a stillbirth and subsequently learned that they were not eligible for the military's dependent death benefit because the child was stillborn.

The Servicemembers' Group Life Insurance (SGLI) program is currently available to all members of the uniformed services, their spouses, and dependents. Specifically, when a servicemember's family experiences the death of a child, the family is entitled to a $10,000 child death benefit under the SGLI program. However, if a servicemember's family experiences a stillbirth, the family is not eligible for a death benefit under the SGLI program because current insurance standards require that a death certificate be issued for a child to be covered. However, neither a birth certificate nor a death certificate is issued for a stillborn infant.

In a recent Federal court case, Warnock v. Office of Servicemembers' Group Life Insurance, the issue of whether a stillborn infant is an ``insurable dependent'' under SGLI was litigated. The court held as a matter of law that both statute and SGLI policy do not provide coverage for a stillborn infant. To further substantiate the necessity of modifying this insurance coverage, the Army Family Action Plan supported providing a death benefit for stillborn infants at their annual conference in 2003, thus demonstrating this is an important issue for all military families.

This legislation is imperative because it will alleviate some of the financial hardship that a servicemember's family must endure as a result of a stillbirth. My bill would amend Title 38 of the United States Code to make a stillborn child an insurable dependent for purposes of the Servicemembers' Group Life Insurance program.

By including stillborn infants within the scope of the SGLI program, we will be helping to ease the financial burden of military servicemember families at a time of great loss and emotional stress.

I hope that many of my colleagues will join me in supporting this essential legislation.