H-1B Visa Fraud Prevention Act of 2007

Madam President, I rise today because I will be introducing my first bills as a Member of this esteemed body; legislation that I hope will provide a helpful step forward as we address one of the most significant challenges this Senate faces, reforming America's broken health care system.

I have heard from countless Rhode Islanders who have struggled to pay for their health care and who live in fear of losing coverage on which they and their families depend. I have met nurses frustrated and heartbroken that they must spend so much time coping with the paperwork and so little time caring for patients. I have talked with families whose lives and health were shaken by terrifying medical errors, lost paperwork, missed diagnoses that should have been totally avoided.

I believe our current health care system is too complex and costs so much, yet so often does not provide patients with the quality of care they should have. It does not have to be this way. I have seen firsthand that we can make the system work better for everyone, we can cut costs, save lives, and improve the quality of the health care we receive, a critical step toward ensuring that all Americans have health care they can afford.

In Rhode Island, we have been working and experimenting for years to find solutions to many of these challenges. I have been privileged to be part of much of that work, most directly when I founded the Rhode Island Quality Institute to focus on quality reforms in health care.

While we have a long way to go, so far we have been successful. It is that Rhode Island experience that I bring to you today. It is Rhode Island's good work that I hope will provide a good example.

Right now our health care system is a mess, such a mess that we should hesitate to call it a health care system. It yields unsatisfactory results at vast expense. What I wish to talk about today is not how you finance the health care system--that is an important issue--but it is a different issue. I don't even want to talk about how you get all Americans covered by our health care system. That is another important issue, but that is not the subject today.

The subject today is the issue of how the system itself runs, how it operates, put bluntly, how badly in America it runs. If we can reduce the cost of the underlying system by improving its performance, it will make solutions easier for financing our health care system and for finding a way to make sure every American gets health care coverage. Our health care system is a mess. The number of uninsured Americans is climbing and will soon reach 50 million. The annual cost of the system exceeds $2 trillion every year, and that number is expected soon to double. We spend more of our gross domestic product on health care than any other industrialized country in the world, 16 percent. That is double the European Union average.

There is today more health care in Ford cars than there is steel. There is more health care in Starbucks coffee than there are coffee beans. Worse still, for all this money we spend, we get a mediocre product. We have the best doctors, the best nurses, the best procedures and equipment, the best medical education in the world. Yet the system produces mediocre results. As many as 100,000 Americans are killed every year by unnecessary and avoidable medical errors. That is just the fatalities. Think how many people have to stay longer in the hospital and run up costs.

Life expectancy, obesity rates, and infant mortality rates are much worse than they should be in a country such as ours. We fail by most international measures. The system itself does not work. Hospitals are going broke. Doctors are furious, and paperwork chokes the system.

Quarrels between the providers and the payers drive up costs, while potential savings in billions of dollars are left lying on the table. More American families are bankrupted by health care costs than any other cause. It is a system in crisis.

I urge my colleagues to consider this point too. If we do not fix this system now, while we still can, if we don't get these savings now, then we are going to be forced to consider very tragic choices in the future: Cutting coverage for seniors now on Medicare, throwing children off S-CHIP or pushing more and more out-of-pocket costs onto families who need Medicaid in their struggle to get by.

Those will be tragic choices, awful choices, ones I hope we never have to deliberate. But if we end up having to make these choices because today we failed to do our duty, then shame on us.

I believe what is wrong with our system can be identified. The reasons for its failures can be identified. The causes of those failures can be corrected, and the failings can be cured.

In the days to come, I will speak at greater length on three critical areas of reform, one by one, and advance proposals for each one that will help provide a cure.

Today, I wish to highlight all three of the major failures, how they combine to worsen each other and keep our system broken, and how reforming those three areas can reinforce each other and repair our broken system.

Left unattended, these three conditions will continue to degrade our system. Properly reformed, they will begin to improve it. This is because what we are dealing with, in a nutshell, is market failure. Market forces are bottled up, logjammed, conflicted, and misdirected to push the health care system in a bad direction.

I trust market forces and I believe in market forces, but I see it as our job in Government to create the environment in which market forces operate in a healthy way to serve the public interest.

That is our job. It always has been. Where that healthy environment for market forces does not exist--which is the case right now in our health care system--Government must act. The market failure in health care has three core components: One, the American health care system does not optimize investment in quality of care, even where--indeed, particularly where--that quality investment in improving care would also lower costs; two, the system does not have the information technology infrastructure to support the improvements we need; three, the way we pay for health care sends perverse price signals that steer us away from the public interest.

These problems can each be fixed, but fixing each in isolation will not yield the change we need. Similar to three climbers roped together for an ascent, the three solutions need to track with each other, not necessarily in lockstep but staying close because each one reinforces the other.

Let me tell a story about each one of those problems to illustrate the three points. Let's look at the area where improved quality of care would lower costs. That intersection, where improved quality of care and lower costs converge, should be our Holy Grail. A good example comes out of the Keystone Project in Michigan, home to Senators Levin and Stabenow.

The Keystone Project went into a significant number of Michigan intensive care units to improve quality and reduce line infections, respiratory complications, and other conditions that are associated with intensive care units. In a 15-month span, between March 2004 and June 2005, the project saved 1,578 lives, 81,020 days patients would otherwise have been spent in the hospital, and it saved--in that 15 months--over $165 million.

The Rhode Island Quality Institute has taken this model statewide in Rhode Island, with every hospital participating. Infections in patients with catheters decreased 36 percent from the

first quarter of 2006 to the fourth quarter. Eleven out of twenty-three participating intensive care units had zero infections for 12 months. Savings from the initiative are on track to produce $4 million annually. That is pretty good money in Rhode Island.

What is true in intensive care units in Michigan and Rhode Island is also true far more broadly in health care. There are many areas where significant savings can be achieved by making care better. There could be initiatives similar to Keystone throughout the health care sector. They do not necessarily have to be reforms of existing procedures and practices because Keystone was. Quality improvements, quality reform, could well involve improvements in prevention and detection of illness, stopping it before it even gets to the hospital. There are vast and unexplored horizons out there, rich with opportunity, and the Keystone story is one example of how improved quality of care can lower costs and save lives. This takes us to the second story, this one about the reimbursement problem. Why isn't this quality reform happening spontaneously all over the country if these big savings are there? Think of Michigan, $165 million in 15 months in one State. That is big money.

Why isn't it being pursued? Why aren't we all doing this? Well, primarily because the economics of health care pays providers not to and punishes providers who try. When a group of hospitals in Utah began following the guidelines of the American Thoracic Society for treating community-acquired pneumonia, significant complications fell from 15.3 percent to 11.6 percent, inpatient mortality fell from 7.2 to 5.3 percent, and the resulting cost savings exceeded half a million dollars a year. But net operating income of participating facilities dropped by over $200,000 per year because treating the healthier patients was reimbursed at roughly $12,000 less per case.

In Rhode Island, when we got into this intensive care unit reform, the Hospital Association estimated a $400,000 cost for $8 million in savings, a 20-to-1 return on investment. But all the savings went to the insurers and the payers, and the costs came out of the hospitals' pockets. Do you know a lot of businesses that invest money in order to reduce their revenue? I don't. How many businesses would spend $400,000 in cash to lose $8 million in revenues every year? With reimbursement incentives such as the ones we have, it is no wonder that quality investments face an uphill struggle.

The final problem is our health care information technology, which is inexcusably underdeveloped and underdeployed. It has been described by the Economist magazine as the worst information technology system in any American industry except one, the mining industry. We are leaving massive savings in health care costs unclaimed as a result.

Some pretty respectable groups have looked at health information technology to see what an adequate system would save in health care costs, and here is what they report: Rand Corporation, $81 billion per year conservatively. David Brailer, the former National Coordinator for Health Information Technology, $100 billion per year. The Center for Information Technology Leadership, $77 billion per year. That is a lot of savings to leave sitting on the table, savings desperately needed by American businesses and American families.

Here is my third story, about a courageous and passionate doctor in Rhode Island trying to build an electronic health record for patients in our State. By the way of context, Rhode Island may be the lead State in the country at developing health information technology. We have Patrick Kennedy in the House, our Representative, who has been an absolute leader on this issue; Lifespan and other hospitals are leaders in electronic physician order entry; the Rhode Island Quality Institute is a leader in e-prescribing, electronic health records and health information exchange; Rhode Island Blue Cross is beginning to fund innovations; all the local Rhode Island health care folks are active in this. It is very impressive. I mean no criticism by telling this story, only to illustrate what an uphill struggle it is.

The lead on developing electronic health records in Rhode Island is being taken by a very frustrated doctor, Dr. Mark Jacobs, who put his practice on hold, went out and looked at what was available, found an e-clinical works platform, had it modified to suit what he thought would be more useful for his needs, and is now raising capital and trying to recruit his colleagues to get around that system and get it up. It is his passion, and he is dedicating himself to it with energy and conviction.

What Dr. Jacobs is doing is heroic, but if you went to any business school and if they asked you, what is the best way to seize that $81 billion a year in savings that RAND Corporation has said is out there, and you had said: Well, we are going to wait until a doctor gets so frustrated he is willing to give up his practice and go out and try to learn about health care technology and do it on his own, you would be laughed out of that business school classroom. They wouldn't just say you flunked the course, they would suggest you should maybe look at another livelihood. But that is exactly the system we have right now.

If a truckdriver were to go out with a pick and shovel building bits of the interstate highway for us, that would be pretty heroic and noble. But all the way back to Dwight Eisenhower, people in Government knew that would be a pretty nonsensical way to finance the Federal highway system.

We have work to do in these three areas: fixing our information technology to increase efficiency and generate savings; improving health care quality and prevention in ways that lower costs; and repairing the reimbursement system so it does not discourage those reforms but encourages and rewards them.

In the coming days, I will expand on each of these problems, and I will propose solutions in those three areas that will unleash market incentives in positive directions. As I conclude, my message is this: The health care system that underlies all our health care financing and coverage problems is itself broken. The underlying health care delivery system is itself broken. It is administrative and bureaucratic machinery, but it is still machinery. It needs to be repaired the way any broken machinery does. Fixing it, however, will reduce costs, improve care, and make a badly operating system run better and move us a critical step forward to making sure every American family has access to health care they can afford.

I sincerely hope to work with all of my colleagues on solving this. Please think of it this way: If your car is not running right, there is no Republican or Democratic way to tune it up. There is just getting it working. If your plumbing is jammed and water is flooding out, there is not a Republican or Democratic way to fix that. It is either flowing properly or it isn't. If your electric system is sparking and short circuited, again, there is no Democratic or Republican way to solve that problem. It is working right or it is not. Our health care system is not working right, and it needs to be fixed. Because the health care system is a dynamic system, you can't tell it what to do. You have to take the trouble to identify what is wrong, identify why it is wrong, and correct the cause.

Mr. President, I am pleased to join my colleagues, Senators Mikulski, Cardin and Warner, to introduce legislation that will reaffirm the Federal Government's continuing responsibility for the Washington Metropolitan Area Transit Authority, WMATA. Our legislation, in cooperation with State and local governments of the national capital region, will aid in the preservation and maintenance of our regional transportation system.

Our predecessors in Congress had a clear vision for rapid rail and bus service that would not only transport Federal employees, residents, and visitors around the national capital region but that would also alleviate traffic congestion, spur growth and development, improve the economic welfare and vitality of all parts of the region, and ensure that all area residents have sufficient mobility options.

The Washington Metro transit system has fulfilled that vision and more, providing critical support to the Federal Government and the region during emergencies, helping to protect the environment and improve air quality in our Nation's Capital, and attracting visitors from around the country and the world to ride the system--now a monument of its own.

With the Federal Government's commitment to reduce our Nation's dependence on foreign oil and to increase national security, Federal support of the Washington Metro system is more important now than ever before. Congress has a fundamental interest in the transit system, and we must join our longstanding regional partners to help meet the demand of Metro's growing ridership and aging infrastructure.

Since the Washington Metro transit system began operating its first 4.6 miles of the Red Line between Rhode Island Avenue and Farragut North in 1976, the Metrorail system has added over 100 miles and extended operations to a total of 86 stations throughout the District of Columbia, Maryland, and Virginia. Almost half of all Metrorail stations today serve Federal facilities, and 42 percent of Metro's peak period commuters are Federal employees.

Metrorail and Metrobus ridership continue to grow as more than a million riders on average per weekday choose Metro as their preferred mode of transit for traveling around the national capital region. Metrorail ridership has grown steadily at an average annual growth of 4 percent, according to the Progress Report on the National Capital Region's Six-Year Transportation Capital Funding Needs, 2007-2012, by the Metropolitan Washington Transportation Planning Board, TPB. The report predicts that transit ridership demand will exceed system capacity by the year 2010. New funding authorized in this legislation would provide the necessary resources to increase bus and rail capacity and meet forecasted ridership demands, before the system and region become totally mired in congestion.

The Washington Metro transit system has proven critical to the Federal Government, not only in moving its employees and serving Federal facilities but also in providing significant support during emergencies. Immediately following the September 11, 2001, terrorist attack on the Pentagon, Metro continued operations and helped safely evacuate hundreds of thousands of people from the downtown core of the District of Columbia. For a 30-day period after September 11, Metro opened Metrorail service half an hour early to support the Department of Defense as it heightened security actions and encountered major traffic congestion accessing the Pentagon.

Metro is a key component in emergency transportation and continuity of operations plans for the entire region, including the civilian and military Federal workforce. Without the use of the Metro system, gridlock would ensue on the region's roadways to a degree that would make all emergency transportation evacuation plans inoperable. With enactment of the legislation we propose today, Congress will assist the Washington Metro transit system to continue to provide its vital service and bolster security measures throughout the system.

Additional funding will also enable the transit system to continue to provide the invaluable service of helping to reduce traffic congestion throughout the region. With area roadways becoming increasingly congested, the Washington Metro transit system is critical to the region's infrastructure.

According to the 2005 Urban Mobility Report by the Texas Transportation Institute, TTI, the Washington metropolitan area has the third-worst traffic congestion in the United States. Washington area commuters sat in traffic for 145.5 million hours in 2003, costing drivers an estimated $2.46 billion and wasting more than 87 million gallons of fuel. The report shows that the Washington area would have the worst congestion in the Nation if not for its public transportation system. Moreover, the report concludes that Washington Metro transit improvements are necessary to help further relieve congested corridors and serve major activity centers.

Currently, Metrorail and Metrobus services result in 580,000 cars being removed from the region's highways each weekday and eliminate the need for 1,400 additional highway lane miles. A reliable and safe public transportation system is essential to encouraging more commuters to utilize alternative modes of transportation, especially as congestion on regional roadways is projected to increase, along with strong job and population growth in the National Capital region.

The Metropolitan Washington Council of Governments, MWCOG, estimates the area's population will grow 36 percent by 2030. Already struggling to meet its current ridership demands, the Washington Metro transit system desperately needs increased support from the Federal Government and State and local governments in the national capital region to keep up with the region's current and future economic progress.

Metro is an unparalleled asset to the region, not only reducing traffic congestion and air pollutants but also helping to reduce our Nation's dependence on foreign oil. Public transportation is an inherently energy efficient travel mode, with each transit user consuming an average of one-half the oil consumed by the typical automobile user, according to the American Public Transportation Association, APTA.

Current public transportation usage reduces U.S. gasoline consumption by 1.4 billion gallons each year. In concrete terms, that means 108 million fewer cars are filling up with gas per year, or almost 300,000 per day, 34 fewer supertankers are leaving the Middle East per year, and over 140,000 fewer tanker trucks are making deliveries to service stations.

Locally, the Washington Metro transit system saves the region from using 75 million gallons of gasoline each year. As gas prices continue to rise, many Washington area residents will continue to seize upon the opportunity to save money on fuel consumption by taking public transportation. Additional Federal funding will allow Metro to purchase 340 new railcars and 275 new buses, which are necessary to accommodate more riders and help further reduce oil consumption throughout the Washington region.

Public transportation not only helps reduce our dependence on foreign oil, but it also helps reduce toxic emissions and air pollution caused by the large number of cars sitting in bumper-to-bumper traffic on area roadways. The Washington Metro transit system eliminates more than 10,000 tons of pollutants from the air each year. Much of the Metrobus fleet is comprised of eco-friendly buses that run on ultra low

sulfur diesel fuel, compressed natural gas, diesel electric hybrid and advanced technology fuels. Investing in Metro is one of the most significant contributions the Federal Government can make to help protect the environment in the Washington metropolitan area.

Reliable Metrorail and Metrobus service is an attractive alternative to sitting in traffic, but if Metro does not receive additional funding, reliability will diminish along with the public's confidence in the transit system. Already, Metro is struggling to accommodate more riders and modernize its existing assets. Additional dedicated sources of funding are needed if Metro is to continue to serve the Federal workforce and thousands of other area residents and visitors.

For the past 30 years, the Washington Metro transit system has been a bedrock for the national capital region, providing reliable transportation, facilitating day-to-day operations of the Federal Government, spurring economic growth and sensible development, reducing sprawl and traffic congestion, and improving the quality of life for the region's citizens and visitors to the Nation's Capital.

The future of Metro and its continued success relies upon consistent support from the Federal Government and the regional localities it serves. Now is the time for the Federal Government to commit itself to providing more long-term Federal funding for the Washington Metro system. Together, along with our jurisdictional partners, we must continue to invest in the transit system that has brought so many rewards not only to the region but also to the Federal Government and the entire Nation. I urge my colleagues to support this bill as it moves through the Senate.

Mr. President, I am introducing this omnibus defense acquisition reform bill today to highlight the scope and urgent need for comprehensive reform in how the Pentagon procures its biggest and most expensive weapons systems.

Defense acquisition policy has been a major issue ever since President Eisenhower first warned the Nation, in 1961, about the military-industrial complex. As Operation Ill Wind in the 1980s and the Boeing tanker lease scandal just a few years ago have taught us, Eisenhower's comments apply with equal force today.

Despite the lessons of the past, the acquisition process continues to be dysfunctional. In the 110th Congress, major acquisition policy issues have arisen in some of the biggest defense programs, including the Navy transformational program, Littoral Combat Systems, LCS and the Air Force's second largest acquisition program, Combat Search and Rescue Vehicle Replacement Program, CSAR-X.

We can not do much to ensure that taxpayers' dollars are spent wisely in developing, testing and acquiring major defense systems. By increasing transparency and accountability and maximizing competition, comprehensive acquisition reform can provide the taxpayer with the best value; minimize waste, fraud and abuse; and, perhaps most importantly, help guarantee that the U.S. maintains the strongest, most capable fighting force in the world. That is what this legislative proposal is all about.

Our colleagues in the House Armed Services Committee have already taken considerable steps in this area, which I applaud. It is my intention to offer this acquisition package to the defense authorization bill this week. The defense bill which we will be considering this week in the Committee on Armed Services totals more than $650 billion. That's serious money.

As stewards of the taxpayers' dollars we must assure the public that we are buying the best programs for our servicemen and women at the best price for the taxpayer. I have already highlighted critical weapon systems with key acquisition problems. If we continue to buy weapon systems in an ineffective and inefficient manner so that costs continue to go up or the deployment of the system is delayed, it will only hurt the soldier, sailor, airman, or marine in the field.

The reason for this is quite simple. First, it does not take an economics degree to understand that the higher that costs of a weapon system unexpectedly goes up, the fewer of them we can buy. A prime example is the F-22 Raptor. The original requirement was for 781 jet fighters, now we can only afford 183. In addition, without fundamental reforms, such as I have proposed in this bill, we will continue to buy weapon systems in an ineffective manner, which usually results in long delays and unexpected cost growth, as requirements, acquisition policy and resources never get in synch.

One aspect of how the Pentagon buys the biggest weapons systems that my proposal addresses head-on is the ``requirements process''; that is, the process by which the Pentagon defines the weapon system it wants to procure. All too often, costly requirements, many of which are unrelated to what the unified commands say they need, are piled on to these programs irresponsibly, without regard to the bottom-line. Just as egregious is the tendency to drop requirements that the warfighter has said they need, which sometimes justified the system in the first instance.

There is an emerging consensus that one way of addressing these, and related, problems is by integrating processes, that is, aligning the acquisition, resources, and requirements spheres of the procurement process in a way that provides the necessary accountability and agility for the Pentagon to make sound judgments on its defense investments. Historically, each sphere has been stove-piped and allowed to operate independently in a way that has produced poor cost, scheduling and performance outcomes, to the detriment of both the taxpayer and the warfighter.

Elements of this legislative proposal that provide for ``integrated processes'' include 1. having the Service Chiefs help oversee acquisition management decisions; 2. standing-up a ``tri-chair committee''--so-called because it will be that headed by the primary players in the acquisition, resources and requirements communities-- that can help make enterprise-wide investment decisions more powerfully and with greater agility than any other procurement-related organization currently within the Pentagon 3. increasing the membership of the Pentagon's main requirements-setting body to include leadership from all three spheres; and 4. setting out guidelines that, when coupled with certain provisions currently under law, can help the Pentagon better manage unexpected cost growth.

Other elements of this proposal address particular structural problems in major weapons procurement that Congress has observed over the last few years. One such provision restricts the services from entering into multiyear contracts irresponsibly when buying weapons. Buying weapons under a multiyear contract restricts Congress's ability to exercise appropriate oversight. If Congress bought these items under a series of annual contracts, there would be a meaningful opportunity for it to annually review the programs' progress. For this reason, using multiyear contracts should be limited to only the best performing and most stable programs. The approach provided for under this legislative proposal would help to ensure that.

Other elements of this proposal would help reign in abuses in how the Government pays award fees and require defense contractors to maintain a robust internal ethics compliance program that can help maintain effective oversight of defense programs.

In developing this reform package, I have pulled the ``best of the best,'' that is, the best, most powerful ideas which enjoy the broadest consensus among some of the most respected experts, whose ideas have been ventilated in public hearings and reps over the last 3 years, including the Defense Acquisition Performance Assessment Report, a.k.a. the DAPA or the Kadish Report; the Center for Strategic International Studies' CSIS, Beyond Goldwater-Nichols Report; the section 804 report from the Undersecretary of Defense for Acquisition, Technology and Logistics; a number of reports and analyses from the Government Accountability Office and the Congressional Research Service; and others. Some of the elements of this package also institutionalize good ideas that the Pentagon has informally put in place recently.

Acquisition reform of a bureaucracy as large as the Pentagon does not happen overnight. That is why we need to act now. Our defense spending has doubled in the last decade, from $350 billion to $650 billion. Every American I talk to as I cross the country understands that we need to spend as much as necessary for national defense. However, how much is enough? Taxpayers also expect that we spend his or her hard- earned tax dollars in a sound and cost-effective manner. We have not been fulfilling that expectation. We need to. This proposed legislation sets us on that course.

Chairman Levin and I have discussed the need for greater oversight in the Senate Armed Services Committee and the common goal of producing concrete results on acquisition reform this year. I look forward to working with Chairman Levin to fully adopt this acquisition package this week and also working with his capable staff in taking comprehensive steps, similar to what our House colleagues have done, to assure that we buy weapon systems at the best price and field them as soon as practicable.

Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.

Madam President, I rise today to talk specifically about how we get our fiscal house in order as a nation and especially as a government. Just last week, the Congress passed--or at least the Senate passed and the House passed--a proposal for a budget which, unfortunately, fails the American people dramatically in the area of controlling spending and in the area of good tax policy. It creates a cascade. It is a Democratic budget that creates a cascade of new spending, hundreds of billions of dollars of new spending which will grow the size of the Government dramatically and which is, therefore, undisciplined in its approach.

It also proposes tax policy which will radically increase taxes on working Americans and have the effect of stifling what has been an extraordinary economic expansion, which in part has been a function of having a tax policy which understands that if you let people keep their money, they tend to be more productive with those dollars, they tend to go out and take risks, be entrepreneurs, create jobs, and as a result, the Federal Government gets more revenue because people creating these jobs pay taxes and we end up with more economic activity. We have had 72 months of growth, and we have created 7.4 million new jobs in this country, and that is a significant step in the right direction toward economic expansion.

But all that is at risk because we, as a government, tend to spend more than we take in, and we do not have in place a discipline necessary as a government to effectively manage our own house. This was reflected in the budget that was just passed, regrettably. Therefore, as we also look to the future, we are confronting a cost to the Government which is going to radically increase the expenditures of the Federal Government to a point where our children and our children's children will not be able to afford them.

In fact, just the cost of three programs alone--Medicare, Social Security, and Medicaid--by the year 2025, because of the retirement of the baby boom generation, will actually exceed the amount of money which the Federal Government has historically spent as a percentage of gross national product. So by about the year 2025, because of the retirement of the baby boom generation, three programs--Social Security, Medicare, and Medicaid--will absorb all the money that historically the Federal Government has spent, which means there will be no money left over for education, laying out roads, or environmental protection.

We will be in a position where our children, in order to bear the burden of those three programs, will have to pay a tax rate which will make it impossible for them to afford their own Government and will make their lifestyle significantly constrained. The pressure on them will be dramatic because the burden of taxes will exceed their ability to pay them and still maintain a quality lifestyle. Their ability to send their children to college, to buy a house, to have a good lifestyle, to have the luxuries which our generation has had will be constrained by the fact that the size of the Federal Government is growing out of control as a function of the retirement of the baby boom generation.

So these two events combined--the dramatic expansion in entitlement spending and the Democratic budget which was essentially grossly irresponsible in the area of spending on the discretionary side of the account and in the area of creating debt; it will add $2.5 trillion of new debt to the Federal Government over the 5 years of this budget-- these two events combined are going to put a lot of pressure on our economy and on the well-being of our Nation.

A group of us believe very strongly that we need to put in place mechanisms in this Government which more effectively discipline the spending of the Government. So I am introducing today, along with 27 colleagues--and that is a fair number of cosponsors--the Stop Over- Spending Act, SOS. This bill has eight basic elements. I am not going to go through them all, but I

wish to highlight the ones that are significant.

Basically, what this bill does is it puts in place disciplines which allow this Congress, if it desires to do so--all of these disciplines can be waived by 60-vote points of order, basically--if Congress desires to do so, it can limit the growth of the Federal Government to something that is affordable to the American people.

The most important discipline this bill puts in place is one over entitlement spending. Right now, we have nothing that controls entitlement spending. This bill says that if entitlement spending reaches a certain level of use of general funds of the Treasury--and most of these entitlement programs--Social Security, Medicare, and Medicaid--are not supposed to be overwhelming burdens on the general fund, the general fund being basic income taxes, not retirement taxes and health insurance taxes--if the burden of these programs exceeds a certain level, then there are mechanisms which allow us to take a second look at these programs to improve them, to make them cost- effective while delivering quality services.

In addition, this proposal puts in place caps, serious caps on discretionary spending so that we know that when you hit a certain level of spending and you are trying to exceed the amount of money the Federal Government should spend, there will be a 60-vote point of order before that can occur. That is only reasonable, that is only good budgeting, and it is something we need to have in place.

Unfortunately, the Democratic budget which was just passed essentially got rid of caps for the year 2009, 2010, and it puts them in place for 2008, but that is almost irrelevant because it raises them so high that there is no way anybody is going to hit those caps unless they are truly spendthrifts.

They basically add $200 billion of new spending over the next 5 years, and next year they dramatically increase spending, both through taking programs off the budget by declaring them emergencies, such as in the agricultural area, and putting them into the next year through advanced funding, which is a total gamesmanship, and then actually increasing the spending levels under the discretionary account. It is a grossly irresponsible cascade of new spending we see coming at us next year as a result of this Democratic budget. This Stop Over-Spending Act will try to discipline that in a more effective way, and it is time we did that.

In addition, it puts in place two very aggressive proposals to try to take a look at how we are managing the bigger programs of the Federal Government. One is a proposal which came from Senator Brownback which is a bipartisan commission on accountability and Federal review. It is basically a BRAC commission for all the Federal Government. So if we find programs that are overlapping--and believe me, there are an awful lot of overlapping programs in the Federal Government--if we find programs that are just not producing the results they are supposed to produce or which have served their time, which were supposed to be 3- year programs and they have been going on for 10, 15 years, we will have a mechanism where those programs can come back to the Congress and voted up or down, either they should be in place or not in place, the same way we approach managing the defense spending accounts through

Mr. President, today Senator Domenici and I are introducing the Public Mental Health Emergency Preparedness Act of 2007. I originally introduced this legislation during the 109 Congress to address mental health needs of those affected by disasters and public health emergencies, and I want to thank Senator Domenici for his support of this legislation and for his strong leadership on mental health issues. The Public Mental Health Emergency Preparedness Act of 2007 would take several important steps toward preparing our Nation to effectively address mental health issues in the wake of public health emergencies, including potential bioterrorist attacks. We are pleased to be introducing this important legislation in anticipation of reauthorization of the Substance Abuse and Mental Health Services Administration SAMHSA.

I want to acknowledge and thank our partners from the mental health community who have collaborated with us and have been working diligently on these issues for several years, including the American Psychological Association, the American Public Health Association, the National Association of Social Workers, and the American Academy of Child and Adolescent Psychiatry, and all the other groups who have lent their support.

The events of September 11, Hurricanes Katrina and Rita, and other recent natural and man-made catastrophes have sadly taught us that our current resources are not sufficient or coordinated enough to meet the mental health needs of those devastated by emergency events. We need a network of trained mental health professionals, first responders and leaders, and a process to mobilize and deploy mental health resources in a rapid and sustained manner at times of an emergency.

It is clear that the consequences of emergency events like hurricanes or terrorist attacks result in increased emotional and psychological suffering among survivors and responders, and we must do more to assist all who are affected. That is why I, along with Senator Domenici, am introducing the Public Mental Health Emergency Preparedness Act of 2007.

This bill would require the Secretary of Health and Human services to establish the National Center for Public Mental Health Emergency Preparedness the National Center to coordinate the development and delivery of mental health services in collaboration with existing Federal, State and local entities when our Nation is confronted with public health catastrophes.

This legislation would charge the National Center with five functions to benefit affected Americans at the community level, including vulnerable populations like children, older Americans, caregivers, persons with disabilities, and persons living in poverty.

First, the Public Mental Health Emergency Preparedness Act of 2007 would make sure we have evidence-based or emerging best practices curricula available to meet the diverse training needs of a wide range of emergency health professionals, including mental health professionals, public health and health care professionals, and emergency services personnel, working in coordination with county emergency managers, school personnel, spiritual care professionals, and State and local government officials responsible for emergency preparedness. By using these curricula to educate responders, the National Center would build a network of trained emergency health professionals at the State and local levels.

Second, this legislation would establish and maintain a clearinghouse of educational materials, guidelines, and research on public mental health emergency preparedness and service delivery that would be evaluated and updated to ensure the information is accurate and current. Technical assistance would be provided to help users access those resources most effective for their communities.

Third, this bill would create an annual national forum for emergency health professionals, researchers, and other experts as well as Federal, State and local government officials to identify and address gaps in science, practice, policy and education related to public mental health emergency preparedness and service delivery.

Fourth, this bill would require annual evaluations of both the National Center's efforts and those across the Federal Government in building our Nation's public mental health emergency preparedness and service delivery capacity. Based on these evaluations, recommendations would be made to improve such activities.

Finally, the Public Mental Health Emergency Preparedness Act of 2007 would ensure that licensed mental health professionals are included in the deployment of Disaster Medical Assistance Teams DMAT. Deployment of licensed mental health professionals will increase the efficacy of the medical team members by providing psychological assistance and crisis counseling to survivors and to the other DMAT team members. Further, this legislation would mandate that licensed mental health professionals are included in the leadership of the National Disaster Medical System, NDMS, to provide appropriate support for behavioral programs and personnel within the DMATs.

We must not wait until another disaster strikes before we take action to improve the way we respond to the psychological needs of affected Americans. I look forward to working with all of my colleagues to ensure passage of this bill that would take critical steps toward preparing our nation to successfully deal with the mental health consequences of public health emergencies.

I ask unanimous consent that the text and a letter of support be printed in the Record. Thank you.