Veterans Health Care Authorization Act of 2009

Mr. President, I call up amendment No. 2785.

Mr. President, I ask unanimous consent that the reading of the amendment be dispensed with.

Inquiry, Mr. President. It is my understanding I am going to have 2 hours during this period of time under unanimous consent.

I reserve the remainder of my time and yield to the chairman and ranking member.

Mr. President, the reason we are having the debate now is because nobody would have the debate earlier. It is important for the American people. I don't have any opposition to veterans care. As a matter of fact, I support keeping our commitments. But as this thing wound out, on October 28 it came to the floor. Part of my amendment, when it actually came out of committee, was in the bill. It was taken out before it came to the floor, not by the members of the committee. It was taken out. But the very fact that we make an issue, because somebody wants to debate a bill and offer amendments on a bill, and then we are supposedly antiveteran because we think maybe we ought to pay for some things we do around here, so because we want to pay for it, we are cast aspersions that we don't want it to be debated. The worst thing that happens in this body is we pass bills that the American people have no idea about because we refuse to debate them.

I apologize to no one for having put a hold on this bill for a very good reason. The very good reason is this: Our veterans demonstrate courage greater than we ever demonstrate in this body. We ought to model that same courage. What is the courage I am talking about? The courage to make priorities, to make sure we keep those commitments. This bill, as it is written now, will cost $3.7 billion over the next 5 years. I think we ought to do that for these veterans. But I also think their sacrifice should not be in vain and stolen and paid for by their grandchildren. I believe we ought to pay for what we are going to do.

It is interesting that the Senator from Hawaii mentioned speaking at the World War II memorial. This bill, as written, excludes World War II veterans from the benefit. It excludes gulf war veterans from the benefit. What about them? Is the reason the other veterans, the Vietnam war veterans, the Korean war veterans were not included is because we thought we couldn't afford it? I think that is probably the reason. Which begs the question, if in fact we want to honor veterans, we ought to treat them the same, one, and we ought to have the courage to make hard choices about how we pay for it.

It is easy to charge this money to our grandkids. I have no doubt that is what we will end up doing. But the biggest threat facing our country today is not Islamic fascism and Islamic terrorism. The biggest threat facing the country today is the fact that every young child born today will encounter $400,000 worth of debt for benefits they will get nothing from. When we calculate the interest cost on that, by the time they are 25, they will have been carrying a debt load of $1,119,000.

As I look at my colleagues who want to do this but don't want to pay for it, I am bewildered to think that we can call and honor the courage and service of our veterans without taking some of the same courage to make some hard choices about funding of other things that are not nearly as important as our veterans. We can't do both. We can't continue down the road we are on. We can't continue to spend the money we are spending and borrowing, 43 cents of every dollar we spent this last year, borrowing it from our grandkids. It won't work. We will fail as a nation.

Look at President Obama's recent trip to China. What was the message that emerged? They are worried about us financially. They are worried about our deficit spending. Why are they worried? Because they own close to $1 trillion worth of our debt. They now impact our foreign policy decisions only by the fact that they own so much of our debt.

Can we continue to do this and have a free America? Can we continue to do this and our children have opportunity, at least to the level we have experienced? What are our veterans fighting for? Why did they put their bodies at risk, if it is not for a greater future for the country?

When we think about this past year--and it will be worse next year, it will be 44, 45 cents borrowed of every dollar we spend--do we not have an obligation to our grandchildren as well as our veterans? This isn't even a hard vote. Our entire contribution to the United Nations is wasted in the fraud of the peacekeeping we contribute to. We contribute 25 percent of the United Nations money, and we have reports and studies and leaked documents that show the vast majority of the money we put in the United Nations gets defrauded from the United Nations.

We are going to get to make a choice with this amendment. We will say we will treat all veterans the same, No. 1, and we are actually going to pay for it by saying it is a greater priority to take care of our veterans than to fund a corrupt, fraudulent peacekeeping force as run through the United Nations. That is what we are going to say.

If this amendment passes, it will send a wonderful signal to the United Nations to clean up their act. It will send a wonderful message to our children and grandchildren that we will finally start acting responsibly, and it will send a great message to veterans that we do care and we care enough to make sure the sacrifice they made will not be squandered by us not making hard choices.

We owe a lot to our veterans. The No. 1 thing we owe them is to make sure what they fought for and the future we have is secure in our children and grandchildren's generation. It is not secure today, based on the fiscal situation we find ourselves in.

I reserve the remainder of my time.

Madam President, may I inquire how much time I have remaining?

Thank you, Madam President.

I want to go back to the start of this again. The American people need to know what a hold is. What is a hold? A hold says that a bill is trying to go through the Senate without debate, without discussion, that by unanimous consent everybody agrees we ought to pass a bill the way it is. Unfortunately, 70 percent of the bills that go through the Senate pass that way. The American people get to hear no debate, get to have no knowledge about what is in the bill, whether there is controversy about what is in it. As a matter of fact, they do not know that the bill on the floor is actually different from the bill that passed out of committee. It has been modified, not with the vote of the committee but with the direction of the chairman only.

So the purpose of our holds is either you are against the bill--and I have no secret holds. Everybody here knows that. When I hold a bill, everybody knows the bills I hold, and I give a reason for why I hold them. I do not hold them sheepishly. The purpose for a hold is to develop debate, to have the very discussion we are having on the floor.

This bill was filed October 28. It was brought to the floor the week before

last without the ability to amend it, debate it, or discuss it. So the reason we are here today is so we can do just that.

I have stated numerous times--I have stated it to the chairman of the committee and the ranking member of the committee and others--I do not oppose--as a matter of fact, I am for providing for our veterans. What I am opposed to is us sinking our grandchildren in debt.

The Senator from Alaska makes the claim or insinuates that I was here when the tax cuts came through. I was not. I believe when you do tax cuts you match them with spending cuts.

There is $350 billion a year in waste, fraud, and abuse that goes through this government every year. Not one amendment out of over 600 that have been offered has been agreed to by this body to eliminate some of that waste--not one.

Everybody who has spoken against this amendment or for this bill, with the exception of Senator Burr, has a 100-percent voting record for spending money. Not once do they vote against any spending bills, not once since I have been in the Senate--5 years. Not one of those who are opposed to paying for this has said: I see something wrong with this spending bill. It is not a priority. We ought to cut it. Therefore, I am not going to vote for it.

I have had criticism because the first year I was here I actually voted for a war supplemental. But at that time, we had a deficit of $110 billion, not $1.4 trillion. At that time, we had an economy that was growing, not an economy on its back. At that time, we had not totally mortgaged our children's future.

It is time for all of us to change. It is time for all of us to make the same decisions everybody outside of Washington has to make every day, which means you have to make a choice. You get to make a choice on what is a priority and what is not. For, you see, our body, the supposed most deliberative body in the world, has a bias. The bias is this: Offend no one. Offend no one. How do you do that? How do you offend no one? You offend no one by taking the government credit card out of your pocket and putting it into the machine and saying: We do not have to make those hard choices. We are not going to offend anybody by cutting programs. We are not going to offend anybody with the $50 billion a year of waste at the Pentagon. The fact is, 2 years ago the Pentagon paid out performance bonuses of over $6 billion to companies that did not meet the performance requirements.

Sadly, not one American, not the Federal Government, got any of that money back. None of it came back because the other side of the story is, we fail to do oversight. We fail to do the hard work that does not give you a headline. That is very hard work to hold the executive branch and agencies accountable. So our veterans do sacrifice.

I am for the Caregivers Act. I am for us doing all these things. But I am only for them if, in fact, we will start making the same hard choices our veterans make, the same hard choices everybody else in this country makes when it comes to making a decision about the future.

You see, a lot of people in our country today are underwater on their mortgages. They are underwater on their mortgages. Guess who else is. We are as a nation. We are underwater. Let me show with this chart, for example, what the financial situation is with our country.

Medicare is broke. Part A will run out of money in 2017. We have 50 million baby boomers--I am one of them--who are going into Medicare in the next 8 to 10 years. So not only is the cost per Medicare patient going to go up, but we are going to add 50 million to it. It is broke.

Medicaid. It is broke. It comes out of your general tax revenue. But the States are broke over their share of Medicaid.

The census. It is broke. It is going to cost 2\1/2\ times what the last one did. It is total mismanagement by the Federal Government.

Fanny Mae and Freddie Mac--broke to the tune of $200 billion of your money, each one of them; $400 billion that your kids get to pay back, your grandkids. They do not get the opportunities because they are both broke. We have done such a wonderful job.

Social Security. It is the easiest to fix, but it is essentially broke because we have stolen $2.6 trillion from it. And then we are not being honest with the American public about what our true deficit is because when I said a minute ago that our deficit was $1.43 trillion, that is not true. That is Enron accounting. That is Washington accounting. The real deficit is well over $1.5 trillion because we stole more money from Social Security. Guess what. Next year, for the first time in the history of Social Security, more money will be paid out than will be paid in. For the first time, it runs in the red next year. We owe money, so technically it is not broke yet--until some of that $2-plus trillion goes back into it--but it is essentially broke.

How about the post office? They just announced their loss for this year. They are going to have a bigger loss next year. It is broke.

Cash for clunkers. That was broke when it started.

The highway trust fund. It is broke. We do not have enough money for what we are obligated to pay out. It is broke.

Now we are talking about government-run health care? A $2.5 trillion program? That is what the real number is on it when you get the Enron accounting out of the bill that Senator Reid introduced last night-- $2.5 trillion.

And now we are saying we do not have the courage to pay to take care of our veterans. I do not think the American people are going to tolerate this much longer, nor do I think they should tolerate it--that we will continue to steal the opportunity and future of our children.

I think the Senator from Alaska can be forgiven for not knowing all the abuse, fraud, and waste in the U.N. because in every country he mentioned, U.N. peacekeepers have been accused of rape and pillaging the very people they were supposed to have been protecting. In every country he mentioned, U.N. peacekeepers we paid for are raping the very citizens they are supposed to be protecting. Yet we do not have the courage to say: Time out. We are not sending you any more money until you clean up the mess. No, we are not going to do that. We are not about to do that. What we are going to do is we are going to say we will take the money for the veterans from our grandchildren and we will not make the hard choice. I think it would be a wonderful message to send to the United Nations that maybe they ought to start being transparent about where the money goes. Do you realize nobody can know where the money goes? You don't get to know. I, as a Senator, don't get to know. The President pro tempore doesn't get to know where the money goes. Yet your country puts $5 billion a year into that and you have no idea. The only way we find out is occasional leaks.

By the way, of all those U.N. peacekeepers who have raped and pillaged, not one of them has been convicted. Not one of the agencies, in terms of their eight programs that have been incompetent and wasted money, have been convicted. They are immune to conviction. The waste, fraud, and abuse of this country is only exceeded by one organization, and that is the United Nations. Yet we don't have the courage because the State Department is against this amendment, and they sent a letter outlining why they are against it. I am going to put into the Record why they are wrong. I ask unanimous consent that at the end of these remarks, my rebuttal statement in response be printed in the Record.

The State Department Bureau of Legislative Affairs opposes this amendment. It lists a number of programs as reasons to support the U.N. and oppose the Coburn amendment. Many of the programs and activities the State Department listed have experienced severe problems in execution or are taking credit for activities by national governments or private entities.

Let's take the recent elections in Afghanistan. The United Nations cannot account for tens of millions of dollars provided to the Afghan election commission, according to two U.N. audits--these are confidential; they weren't released; we just happened to be fortunate enough to have people who would give them to us--and interviews with

current and former senior diplomats. The Afghan election commission, with over $20 million in U.N. funding and hundreds of millions of dollars in U.S. funding, facilitated and helped mass election fraud and operated ghost polling places.

Should we keep sending them money for incompetence, waste, and fraud?

``Everybody kept sending money'' to the elections commission, said Peter Galbraith, the former deputy chief of the U.N. mission in Afghanistan.

Nobody put the brakes on. U.S. taxpayers spent hundreds of

millions of dollars on a fraudulent election.

This is a deputy to the senior U.N. official in Afghanistan. He was fired last month. He protested the fraud and he got fired by the U.N., that wonderfully competent organization.

As of April 2009, the U.N. had spent $72.4 million supporting the electoral commission, with $56.7 million of that money coming from the U.S. Agency for International Development. The Special Inspector General for Afghanistan Reconstruction states that the United States provided at least $263 million in funding for that election.

In one instance, the United Nations Development Programme paid $6.8 million for transportation costs in areas where no U.N. officials were present. We paid transportation costs, but no U.N. officials were present. Why did we pay it? Where did that money go? Where is the money?

Overall, the audits found that U.N. monitoring of U.S. taxpayer funds was ``seriously inadequate.''

In other words, it is there, they send it out, they don't have any idea, but you can bet well-connected people at the U.N. are making millions off U.S. dollars.

How about the monitoring of nuclear programs in North Korea and Iran? In 2002, the North Korean Government used United Nations Development Programme money--UNDP money or aid--to purchase--this is aid for them for development from the U.N.--they purchased conventional arms and ballistic missiles. With money we gave the U.N., the U.N. turns around, gives it to North Korea, and they buy missiles and arms. There is a real problem at the U.N. We will not face up to it.

It also transferred millions of dollars in cash to the Government of North Korea, with no oversight on how the money was spent--no oversight, just handed them millions of dollars in cash.

In September 2009, North Korea announced to the United Nations Security Council that it was almost complete in weaponizing nuclear materials from its nuclear reactor. Last week, North Korea announced the processing was complete.

We helped finance it through the United Nations. We helped finance it through the United Nations.

As of this morning, Iran had rejected the U.N. offer to send enriched uranium out of the country to prevent it from developing nuclear weapons.

We don't know how much U.N. money has gone in there yet, but I promise I will try to find out. But I can guarantee that millions of our dollars have been wasted that could pay for our veterans or we can borrow it from our children.

U.N. contribution: Funding 17 U.N. peacekeeping operations, including those in Haiti, Liberia, Lebanon, Darfur, and the Democratic Republic of Congo.

U.N. peacekeeping operations are plagued by rape and sexual exploitation of refugees. From 1994 forward, 68 separate instances of rape, prostitution, and pedophilia--68 separate times--and we pay half the U.N. peacekeeping costs. We don't manage the money; the U.N. manages the money.

What would happen if U.S. troops were doing that? Yet we have no control.

In 2006, reported BBC News: Peacekeepers in Haiti and Liberia were involved in exploitation of refugees. You can read that in the BBC News of November 30, 2006, if you want to look it up.

In 2007, leaked reports indicate the U.N. has caught 200 peacekeepers for sex offenses in the past 3 years, ranging from rape to assault on minors. Not one of them has been prosecuted, not one.

Just this month, Human Rights Watch reported that Congolese Armed Forces, supported by U.N. peacekeepers in the eastern Democratic Republic of Congo, have brutally killed hundreds of civilians and committed widespread rape in the past 3 months in a military operation backed by the United Nations. That is this month. Yet we continue to send billions of dollars every year to the United Nations.

I will be happy to yield for a procedural question.

I do not plan on consuming all of it at this time. I have about 10 or 15 minutes more to go, and I will be happy--is the Senator wanting time?

I have no objection to that.

Going back to the Congolese, most of the victims were women, children, and the elderly. Some were decapitated. Remember, these are U.N. peacekeeping forces--peacekeeping. Others were chopped to death by machete, beaten to death with clubs as they tried to flee.

They may not have been actual U.N. officers, but the U.N. was supplying all the logistics, all the transportation for this group of people. Where is the oversight?

U.N. contribution: Compiling forecasts of global agriculture production and identifying areas of likely famine and the risk of severe hunger, to facilitate food assistance. We make a contribution to the U.N. The Food and Agriculture Organization is currently hosting a U.N. conference, a food summit in Rome, where the opening speaker is Zimbabwe President Robert Mugabe who has literally destroyed his Nation, which used to be the bread basket of Africa and which is now dependent on food imports. We are helping to pay for President Mugabe-- who can't travel hardly anywhere else in the world because he is such a rogue dictator--we are sponsoring, through our dollars, meetings where he is the headline speaker.

The meeting was branded a failure within a couple of hours

of its start after the 192 participating countries

unanimously rebuffed the United Nations' appeal for

commitments of billions of dollars in yearly aid to develop

agriculture in poor nations.

It is not because they don't care about people having problems with food; it is they recognize the U.N. is ineffective at doing that and they are not going to commit more money, but we continue to commit more money.

The U.N. Environment Programme spends $1 billion a year--20 percent of it our money--on global warming and its effect on agriculture.

The U.N. has coordinated efforts by the global shipping industry and governments to prevent and respond to acts of piracy on the high seas.

It was totally ineffective. Do you know why we decreased the amount of piracy on the high seas? It is because of Task Force 51, which was formed by the U.S. Navy because the United Nations was totally ineffective in accomplishing that purpose.

I could go on and on. But the fact is, the United Nations is not only morally bankrupt in its leadership and efficiency, it is filled with fraud, waste, and, as noted, tremendous acts of violence through the peacekeeping armies it sends throughout the world. Yet we are going to have people say we shouldn't take some of that money away. We are not taking all the money away with this amendment anyway; we are just taking a small portion to pay for our bill.

We are going to have people actually vote to continue to do these things, instead of taking care of our veterans and not steal it from our children.

I heard Senator Tester speak about the wonderful things in this bill to help people who drive to VA clinics and VA hospitals. There is a better idea. If a veteran is deserving of care, give him a card. Let them go wherever they want.

Why should they have to drive 160 miles, when they can get the care right down the street from somebody they trust and they know. But instead we say: We are going to promise you health care, but you can only get it here. Real freedom for our veterans--real health care for our veterans is to honor their commitment by saying: Here is your card, you served our Nation, go get your health care wherever you want. If you want to get it next door or if you want to go to the M.D. Anderson or Mayo Clinic, you can. You can go wherever you want because we are going to honor your commitment.

I recognize our VA hospitals have done a magnificent job in improving their care, but I will tell you the test for the VA hospital system is this: Go ask any doctor coming out of training who experienced part of their time in a VA hospital and ask them to choose for their family: Do you want your family treated at a VA hospital or somewhere else where you trained? Nary a one will pick a VA hospital because the care isn't as good. It is better, and it is getting better all the time, but it is not as good. So we are saying to veterans: Here is where you have to go, when what we should say is: Thank you for your service. Here is what we owe you. Go get care wherever you want to get it or wherever you think you can get the best treatment.

On prosthetics, the VA is the best in the world. Nobody compares. On post-traumatic stress disorder, they are the best in the world. Nobody can compare. They are underfunded in those areas. This bill is right on that. But the real commitment is to give the choice. The veteran fought for freedom. Give them the choice, the freedom to choose what they want for them.

Why is it important we change how the Senate operates in terms of making hard decisions? The reason it is important is there are millions of these little girls out there. I have five of them, five grandkids just like her. She has a little sign around her neck. She says: ``I am already $38,375 in debt and I only own a dollhouse.'' Of course, when you divide up the $12 trillion which we passed this week in directly owned debt; it doesn't count the billions--I mean the trillions--we have borrowed from Social Security and the other trust funds, such as the waterway trust fund and all these other organizations we have stolen from, it doesn't include that. But that is for every man, woman, and child in this country. It is over $30,000 now, this year. I think when you look at her, you have to say, certainly, we ought to be making some changes. By the way, between now and 2019, that number goes to over $96,000 per man, woman, and child. But she is a child. This doesn't apply to veterans, but it applies to almost everything else we are doing.

This is what Thomas Jefferson said:

The democracy will cease to exist when you take away from

those who are willing to work to give to those who would not.

If you think about what is happening in our country right now and how things are being shifted, what we are doing is, we are on the cusp of a dramatic change in our country in terms of balance. This huge bill, which I will talk about later, is a major move in that direction. Senator Byrd and I were talking this morning about this. In this bill is a 5-percent tax on cosmetic surgery. Just the day before yesterday, the U.S. Preventive Task Force Services recommended--because it is not cost effective--that women under 50 not get mammograms unless they have risk factors. You tell that to the thousands of women under 50 who were diagnosed with breast cancer last year with a mammogram. Tell them it is not cost effective. But also in this bill is a 5-percent tax on breast reconstruction surgery after they have had a mastectomy. They are going to tax having their breasts rebuilt after their breasts have been taken off because it is an ``elective'' plastic surgery. It is an elective cosmetic surgery. We are going to have a tax on it because we have taxed elective cosmetic surgery.

We are in trouble as a nation because we have taken our eye off the ball. I see the majority whip is back. I told him I would be happy to yield. At this time, I will reserve the remainder of my time and yield the floor to the majority whip.

Exhibit 1

Rebuttal of State Department Talking Points on Coburn Amendment 2785

The State Department Bureau of Legislative Affairs opposes

the Coburn amendment to S. 1963, the Caregivers and Veterans

Omnibus Health Services Act of 2009 (S. 1963). In its formal

opposition, it lists a number of programs as reasons to

support the U.N. and oppose the Coburn amendment.

Many of the programs and activities that the State

Department listed have experienced severe problems in

execution or are taking credit for activities by national

governments or private entities. (Their document is after the

rebuttal).

Below is a list of those ``accomplishments'' and facts that

should be considered.

U.N. Contribution: Facilitating and holding elections in

Afghanistan and Iraq (U.N. Secretariat).

Response: The United Nations cannot account for tens of

millions of dollars provided to the troubled Afghan election

commission, according to two confidential U.N. audits and

interviews with current and former senior diplomats.

The Afghan election commission, with tens of millions in

U.N. funding and hundreds of millions in U.S. funding,

facilitated mass election fraud and operated ghost polling

places.

``Everybody kept sending money'' to the elections

commission, said Peter Galbraith, the former deputy chief of

the U.N. mission in Afghanistan. ``Nobody put the brakes on.

U.S. taxpayers spent hundreds of millions of dollars on a

fraudulent election.'' Galbraith, a deputy to the senior U.N.

official in Afghanistan, was fired last month after

protesting fraud in the elections.

As of April 2009, the U.N. spent $72.4 million supporting

the electoral commission with $56.7 million coming from the

U.S. Agency for International Development. The Special

Inspector General for Afghanistan Reconstruction states that

the United States provided at least $263 million in funding

for the election.

In one instance, the United Nations Development Program

paid $6.8 million for transportation costs in areas where no

U.N. officials were present. Overall the audits found that

U.N. monitoring of U.S. taxpayer funds was ``seriously

inadequate.''

U.N. Contribution: Monitoring nuclear programs in North

Korea and Iran.

Response: In 2002, the North Korean government used United

Nations Development Program, UNDP, aid to purchase

conventional arms, ballistic missiles. It also transferred

millions of dollars in cash to the government of North Korea

with no oversight of how the money was spent.

In September 2009, North Korea announced to the United

Nations Security Council that it was almost complete in

``weaponizing'' nuclear materials from its nuclear reactor.

Last week, North Korea announced the processing was complete.

As of this morning, Iran had rejected the U.N. offer to

send enriched uranium out of the country to prevent it from

developing nuclear weapons.

U.N. Contribution: Funding 17 U.N. Peacekeeping Operations,

including those in Haiti, Liberia, Lebanon, Darfur and the

Democratic Republic of Congo.

Response: U.N. Peacekeeping operations plagued by rape and

sexual exploitation of refugees--In 1994, a draft U.N. report

was leaked detailing how peacekeepers in Morocco, Pakistan,

Uruguay, Tunis, South Africa and Nepal were involved in 68

cases of rape, prostitution and pedophilia. The report also

stated that the investigation into these cases is being

undermined by bribery and witness intimidation by U.N.

personnel.

In 2006, it was reported that peacekeepers in Haiti and

Liberia were involved in sexual exploitation of refugees.

In 2007, leaked reports indicate the U.N. has caught 200

peacekeepers for sex offenses in the past three years ranging

from rape to assault on minors. In all of these cases, there

is no known evidence of an offending U.N. peacekeeper being

prosecuted.

Just this month, Human Rights Watch reported that Congolese

armed forces, supported by U.N. peacekeepers in the eastern

Democratic Republic of Congo have brutally killed hundreds of

civilians and committed widespread rape in the past three

months in a military operation backed by the United Nations.

Most of the victims were women, children, and the elderly.

Some were decapitated. Others were chopped to death by

machete, beaten to death with clubs, or shot as they tried to

flee.

The U.N. peacekeeping mission provides substantial

operational and logistics support to the soldiers, including

military firepower, transport, rations, and fuel.

The attacking Congolese soldiers made no distinction

between combatants and civilians, shooting many at close

range or chopping their victims to death with machetes. In

one of the hamlets, Katanda, Congolese army soldiers

decapitated four young men, cut off their arms, and then

threw their heads and limbs 20 meters away from their bodies.

The soldiers then raped 16 women and girls, including a 12-

year-old girl, later killing four of them.

The U.S. now pays 27 percent of all U.N. peacekeeping

operations. Reducing our contribution to these wasteful

efforts could help ensure that U.N. peacekeepers are not

funding widespread rape and exploitation of refugees.

U.N. Contribution: Compiling forecasts of global

agricultural production, identifying areas of likely famine

and risk of severe hunger, to facilitate emergency food

assistance (FAO).

Response: The FAO (Food and Agriculture Organization) is

currently hosting a U.N. food summit in Rome, where the

opening speaker is Zimbabwe President Robert Mugabe. Mugabe

is barred from travel to most Western countries because of

his atrocious human rights record, but receives an exception

for U.N. sponsored events. No G-8 leader attended the event

save the Prime Minister of Italy, the host nation.

``The meeting was branded a failure within a couple of

hours of its start after the 192 participating countries

unanimously rebuffed the United Nations' appeal for

commitments of billions of dollars in yearly aid to develop

agriculture in poor nations.''

The U.N. Environment Program spends over $1 billion

annually on global warming initiatives (and weighs in on its

effect on agriculture) but there is almost no auditing or

oversight being conducted. The U.N. Environment program has

one auditor and one assistant to oversee its operations.

According to the task force it would take 17 years for the

auditor to oversee just the high-risk areas already

identified in UNEP's work.

U.N. Contribution: Coordinating tsunami and earthquake

relief projects in Indonesia and Pakistan (U.N. Secretariat/

Mr. President, the majority whip is a formidable orator and he is appreciated in lots of ways. We work together on subcommittees on the Judiciary Committee. I have a fondness for him. Although one area he did not agree to work with me is to pay for it.

Never have I said I don't want us to do this for our veterans. Not once. The reason we are on the floor, the only reason we are on the floor having this debate is because of my hold; otherwise, we would never have gotten here to have the debate which I think is valuable for the people in this country.

But there has to come a time--every time I offer an amendment on this floor is never a good time--to start making our choices. That is what we hear all the time. Over 600 times in the last 4\1/2\ years, it is never a good time to start making hard choices. That is just what we heard.

The Senator from Illinois referenced Congo. Just this month the Congolese army, with the assistance of the United Nations, slaughtered a bunch of people. And we are supposed to continue?

I put two other things out there. Under Federal law, the Accountability and Transparency Act, the United Nations is required to tell the American people how our money is spent because the State Department is required to find it out and put it online. They have refused to do it. So we have no idea what it is.

Two years ago in the Foreign Ops bill, an amendment was agreed to by 100 Senators that there would be transparency. Our money going to the United Nations would be conditioned on the fact that the United Nations would be transparent on how it was spent. That was voted 100 to 0 in the Senate.

Guess what happened on the way to the bank coming out of the conference committee. It was eliminated. So now we send over $5 billion directly, $5.2 billion, plus billions more through USAID through the United Nations, and we do not have any idea how it is spent.

What we do know is that the United Nations is fiscally and morally bankrupt. It is loaded with fraud, loaded with duplication, and loaded with excess.

It would be a wonderful thing to send the United Nations a wonderful fire shot across the bow that they have to start being accountable for the dollars that the American taxpayer, that this little girl is sending them out of her future every year. It would be a wonderful thing for us to say that.

It is unfortunate, every time when we get down to the point where we have to make a hard choice, we always choose not to make the hard choice. That spells disaster for our country, and it also spells a total lack of leadership on our part to recognize what the real problems are that are confronting this country.

Our veterans deserve us to take care of them. I am for that. Our children deserve for us to do it in a way that protects their future-- the very thing for which our veterans serve.

Unfortunately, we will not do that with this amendment or any other time until the American people decide they have had enough of the careerism, the elitism, the lack of integrity, the lack of courage that is so often represented in the votes we cast in this body.

I reserve the remainder of my time, and I yield in my absence any time the Senator from North Carolina wishes to take from my time.

Mr. President, I listened very carefully to the chairman of the Veterans' Committee. He misses one major point: If, in fact, we don't send the money to the U.N., we will have money to pay for the veterans--if we don't send the money.

That is what this amendment does. It precludes that money from going from the State Department's budget to the U.N. I admit it is fungible, but that is money we will not send to something that is low priority, that is wasteful, that is nontransparent, and that the vast majority of Americans agree we get very little value from when we send that money to the U.N.

I also take issue with my friend's words that it is time. I think the chairman will agree that this bill was not noticed until October 28. That is when this bill was noticed. When the bill was noticed, the next day a unanimous consent request came through to say pass this without any debate, without any discussion, pass it through the Senate. I said, no, we ought to have a debate. At that time, we offered the Veterans' Committee a list of some 20 options of things that are lower priority than helping our veterans. They were rejected out of hand, which is the problem I have been describing on the floor earlier.

Every time it comes down to making a choice, the majority of this body chooses not to make a choice, not to choose a priority, not to do what we get paid to do, not to do what is in the best interests of the Nation. They choose to not choose. But by choosing not to choose priorities, we still choose, because what we choose is to take the money from our children. We choose to lower the standard of living of our children.

I want to tell you about veterans with whom I have spoken. I have had a lot of calls on this, because how dare somebody hold up a veterans bill before Veterans Day. The vast majority of the calls say we think you ought to support veterans, but we also think you ought to pay for it. Our country can't keep doing what we are going to do. So on the last appropriations bill through this body, I gave you an opportunity. We have heard three Senators today say there is no price we should not give to support our veterans. Direct quotes. ``No price is too great''? There is one price that is too great, because all three of those Senators who spoke those words refused to give up their earmarks to pay for veterans in the VA-MILCON bill. They all voted against paying for it in the MILCON bill by eliminating the unrequested items they had earmarked for them in the VA-MILCON bill. So, yes, there is a price that is too great--the price of helping yourself and your own constituency on a parochial basis and putting that ahead of the best interests for our veterans. So the words ``there is not a price too great'' ring hollow. We put our parochialism ahead of it.

I ask unanimous consent to add Senators Inhofe and Burr as cosponsors of my amendment.

Mr. President, as we talk about this debate, as my colleagues know me very well, the debate isn't about veterans; it is not about the veterans bill. It is about reestablishing some fiscal sanity in Washington of which we have none. This bill here--the health care bill that was released last night--over the next 10 years will spend $2.5 trillion. That is what it will spend. We don't know the accuracy of CBO. They certainly haven't done very well in the past on health care, as to whether it saves money. What we do know is that it doesn't cut the cost of health care, which is the problem. It transfers $2.5 trillion under the guise of the control of the Federal Government, which is not efficient.

I have not heard one colleague defend the United Nations. Nobody will get up in this body and defend the atrocities, the waste, and the fraud of the U.N. Nobody will say that. But those same people who actually agree with it but won't do anything about it will vote against this amendment. They will vote against the amendment. They won't defend what has very accurately been described as the behavior, the lack of fiscal sanity, the fraud and theft, the rape and pillage by the peacekeepers, the lack of oversight, and the total lack of transparency. They won't defend that with their words, but they will defend it with their vote. They are going to absolutely defend it with their vote. Once again, they are going to refuse to make the hard choice. Most of them listening to this agree, but it is the wink and nod that we play around this body. They know the U.N. is a big mess. They know it is a big problem. But they won't do anything to fix it. They will vote for complete transparency and vote to condition our funds on transparency, and when they get to conference, they will take it out. They will look good on the outside, but the inside of the cup will be absolutely filthy.

When is it we will see a turnaround in Washington that will match the courage of our veterans and meet the expectation of the citizens of this country? When is that going to happen? I will tell you when it is going to happen: It is going to happen when the Chinese start selling our bonds or quit buying them. That is when it will happen. Then we are not going to be able to make those decisions based on our choice. They are going to be dictated to us. They are going to be rammed down our throats.

The fact is that $3.7 billion is a lot of money. It is $3,700 million. That is hard to think about when you start talking about billions. Yet we are going to pass it. By the way, this bill that is so critical to get passed right now has no money in it for veterans for this process. Would the chairman agree with that? There is no money there now? It is not going to happen until a year from now, unless we put it in some supplemental program between now and next September 30. So what we are promising isn't going to come due, because we turned down an amendment on the VA-MILCON bill that would have allowed money to be available as soon as the VA-MILCON bill passed the conference committee and the President signs it.

How hollow does that sound? We claim one thing but our actions are totally different. And the VA says, by the way--at least intimated-- once they get this bill and the money, it will take at least 180 days to implement it. So add 18 months to right now to when our first veterans will see the benefit, especially the caregivers. And we could have, with the VA-MILCON amendment I offered--which was rejected--made that happen next month--at least the planning in the first 6 months of that--so that by March or April caregivers could actually start receiving this money.

I have tremendous worry for our Nation. If you open your eyes, you will too, because we cannot keep doing what we are doing.

Just some statistics. These are accurate, based on GAO, OMB, and Congressional Budget Office:

Ending September 30, not counting the supplemental, the Federal Government spent $33,880 for every household in this country. But we only collected an average of $18,000 per family. We borrowed, per family, $15,603 last year. Those numbers are going to be bigger next year. We are going to spend more, we are going to borrow more, and we are going to collect less. What is the implication of that? What is the implication of borrowing money we don't have and spending it on things that are not a priority, such as caring for veterans? The implication is that it will come to an abrupt halt in a very damaging and painful way--maybe not for us in this body but certainly for my children and my grandchildren, and certainly for those who follow us.

There is a bigger worry than the financial aspect of it. It is that we are losing, as we do this, the very integral part of what makes our Nation great. It is called ``sacrifice.'' That is why we honor our veterans. It is because they sacrifice, they put themselves on the line. Our heritage has been, from the founding of this country, to the very people who risk their lives and fortunes to initiate this country--the heritage has been of one generation sacrificing so the next generation can have greater opportunity and greater freedom and greater liberty.

As I said earlier, when we come back and get down to the actual voting on this amendment, most people will say: We can't do that. It is not time to make a hard choice.

I want to tell you, those veterans who have closed-head trauma made a hard choice. Those veterans who lost their lives and family made a hard choice. Those veterans who have severe disability and their families made a hard choice.

In a little while, we are going to dishonor that, because we are going to refuse to make a hard choice and rationalize in a way that it isn't going to do any good or make any difference, and we are not going to even attempt to get the out-of-control spending in Washington under control. We will reject the notion that you can, in fact, look at something and see what it is like, such as the corruption, such as the waste, such as the rape and pillaging of the U.N. peacekeeping troops, and we are going to say that is not important, and what is important is that we keep doing it the way we have always done it. We will continue to do it the way we have always done it.

The way we have always done it for the past 20 years does not honor what built this country. It doesn't honor making that sacrifice. It does not honor saying I will make a tough vote, even though the administration doesn't want me to make this vote. I will make a vote that is right for the country, right for the future, right for our kids and our grandkids. I will make that vote.

We will not see that today. We will not see the courage mustered up to choose between veterans and a sloppy, ill-run organization into which this country pours billions of dollars every year and continues unabated and uncontrolled and without oversight because we refuse to make a choice.

So my colleagues get a choice. Here is the choice: Ignore with a blind eye the absolute tragedies that are going on at the United Nations, the absolute waste, the incompetency, the favoritism, the theft that is going on and say you did something good for veterans.

The fact is, the reason our veterans have such severe injuries is because they protect our liberty, protect our freedom, and protect our future. We are not going to choose that today. We are going to choose the opposite. We are going to do the status quo. We are going to say this amendment does not make sense.

When will we muster the courage to make a real choice, to go out and defend that veterans are worth more than the waste at the United Nations? We will not make the choice because we know we can vote against this amendment and still tell the veterans we did it and we don't have to speak to our grandchildren and children. We will be gone. We will be out of here.

When their standard of living is 35 percent below the standard of living we experience today--by the way, that is what is forecast as the government takes over 40 percent of the GDP of this country and as we end up with interest costs in excess of $1 trillion a year just to fund the excesses of what we are doing today, which is less than 5 years away, and we will be spending $1 trillion a year on interest--we will have no recollection of this vote. We will have no recriminations against us. We will have just voted and said that is

another amendment to try to make us make a choice, but we refuse to make one.

By voting against this amendment, you are defending the audacity, corruptness, inefficiency, and fraudulent behavior of the United Nations. That is what you are doing. Nothing can be cut. Have you noticed that? Nothing is not important to the politicians of this city. Everybody has an interest group. Oh, we can't go against that. That is an absolute formula for disaster for our country.

I wish to enter into the Record some additional information on the United Nations. I only touched the surface on the amount of outlandish things that have gone on in the United Nations. I did not mention Oil for Food, billions of dollars, and of the people who took all that money, none of them got prosecuted. The U.N. Headquarters renovation is going to cost $2 billion. It should cost about $800 million. I did not talk about that or the lack of transparency in terms of the State Department, in terms of reporting how our money is spent at the United Nations.

I ask unanimous consent to have printed in the Record this information.

Mr. President, I will finish and give the chairman the last word. What the chairman and his committee are attempting to do is honorable. It is the right thing to do to help our veterans and to secure and help those who are helping our veterans. I agree. However, I don't agree that we ought to do that on the backs of our children. I think we ought to do it on our backs. We ought to carry that load. Our children and our grandchildren should not have to carry that load. We ought to be forced to make the sacrifices to pay for the sacrifices they have made for us. This bill does not do that.

This bill takes the easy route. It says you do not have to pay for it, it is not required. There is not anything we can get rid of, after I offered all these options to the committee in terms of what they could get rid of that would pay for it.

If we don't pay for it from what I offered, then get rid of our own earmarks, the things that make us look good. We chose to keep our earmarks and charge it to our grandkids. It is a wonderful choice and a wonderful thing for the American people to see.

On this vote, they are going to see three things. They are going to see all the people who voted to keep their earmarks vote against this amendment. The first thing they are going to say is: My earmarks are more important than paying for veterans, caregivers, and everything else expanded in this bill.

The second thing they are going to see is that we do not have the courage to take on fraud, waste and abuse and lack of transparency at the United Nations. They are going to see us fail to live up to the expectations they have for us.

Everybody in America knows we are in trouble financially. They know the Federal Government is too big. They know the Federal Government is inefficient. They know we can do better. They are just wondering when we are going to start. When will it start? When will be the first time we make a hard choice? I regret it is not going to be on this bill because it is symbolic. If there ever was a bill on which we should start to make the hard choices, it should be on a bill that honors and takes care of the people who have made hard choices for us, the people who have sacrificed their lives and their future and their families for us.

The third thing, regrettably, that they are going to see is that we are going to continue to play the game the way it has been played: Get the votes to defeat the amendment; we will take a little bit of heat; maybe somebody will notice. I will guarantee you, 20 years from now, our kids are going to notice, our grandkids are going to notice.

One final thought. If you are under 25 in this country, pay attention to me right now. If you are under 25--there are 103 million of you. Twenty years from now, you and your children will each be responsible for $1,919,000 worth of debt of this country for which you will have gotten no benefit--none. The cost to carry that will be about $70,000. That is not per family, that is per individual. The cost to carry that will be about $70,000 a year before you pay your first tax.

Ask yourself if you think we are doing a good job when we are going to take away your ability to get a college education, we are going to take away your ability to educate your children, when we are going to take away your ability to own a home, and we are going to take away your ability to have the capital formation to create jobs in this country. Watch and see. That number is going to grow every time we do something like this without paying for it, without offsets, without getting rid of something less important.

I yield back the time and yield the remainder of my time to the chairman of the committee.

Mr. President, I thank and congratulate the chairman of the VA Committee. This is important legislation in front of this body. It is my belief that this will move very quickly, as we can see from the short time agreement: one amendment--one amendment that I think is extremely important for all Members of the Senate to consider.

I rise in support of S. 1963, the Caregivers and Veterans Omnibus Health Services Act of 2009. This is actually the combination of two bills reported out of the Veterans' Affairs Committee this year, and it did enjoy bipartisan support.

The centerpiece of the legislation is the support it would provide to caregivers of severely injured veterans of current wars. The bill would provide counseling, support, living stipends, and health care for those caregivers.

As my colleagues know, family caregivers play an extremely important and, I might say, unique role in helping to meet the severely injured veterans' personal care needs. For some veterans, family members serve as their primary caregiver, some of whom have lost their jobs but, more importantly, have lost their health care as a result of that commitment to that family member.

As the chairman spoke about a servicemember he had remembered in this--Ted Wade is a North Carolinian--he made the same impression with me. I also think about caregivers Edgar and Beth Edmundson from North Carolina as well, the parents of Eric Edmundson, a severely injured veteran from Operation Iraqi Freedom. They have been caring for Eric since the day they took him out of the VA hospital--out of a VA hospital because the VA basically had come to the point where they said they could not improve Eric's life.

After Eric was injured on patrol along the Iraqi/Syrian border, he went into cardiac arrest while he was awaiting transport to Germany. It was in fact that cardiac arrest, that traumatic brain injury, that put Eric in a situation where he couldn't walk and he couldn't talk. As he lay in that long-term care provided by the Veterans' Administration, he got no better. He couldn't walk and he couldn't talk.

Eric's father stepped to the plate and immediately began researching all the options for Eric's treatment. Despite being told his son would not emerge from his vegetative state, Ed Edmundson pushed on. He sold his business, he cashed in his savings and retirement pay, all in an effort to provide Eric 24-hour care as a father.

Under his father's constant attention and relentless pursuit of new options, Eric received the treatment he needed. Without his dad's commitment, without the commitment of the rest of Eric's family--who basically dropped everything else important in life to focus on his needs--Eric would not be doing as well as he is today. I might say he walks and he talks and he continues to make progress every day because his most important caregivers, his parents, believed in him and they believed in what they could accomplish.

Let me tell you the rest of the story. Beth, Eric's mom, recently suffered a compound fracture of her ankle while caring for Eric's daughter Gracie. Because Beth and Ed have no health insurance, they are on the hook for $36,000 worth of medical bills. Had Eric chosen Beth, his mother, as his caregiver, and this legislation was in effect, we would have provided coverage for Beth to have health care coverage. I believe that is what this legislation is about--recognizing the individuals who make life-altering commitments to members of their family or servicemembers who, without that commitment, might not have the quality of life they have.

As I mentioned, assistance to caregivers is just one part of this bill. Other provisions would remove barriers to emergency care provided to veterans at non-VA facilities. It would expand health care services for women veterans, provide additional outreach to veterans in rural communities, provide additional improvements in mental health care services provided to veterans, enhance services to homeless veterans, improve the ability of VA to recruit and retain the needed health care professionals, authorize major medical facility construction projects, test a concept I introduced of providing veterans and their survivors with dental coverage, and much more.

This is a good bill. It is not perfect. It can be better. I urge my Senate colleagues to strongly consider supporting the amendment of Senator Coburn, and let me explain why.

When the committee passed this bill, we did not limit it to current veterans of current wars; we extended it to all veterans. Since it came out of committee in a bipartisan way, we have narrowed it down not to include all veterans. The amendment of Senator Coburn expands it to all veterans.

When the committee considered the caregiver bill, we considered it because we wanted to keep veterans out of nursing homes. That was the goal, to give them an alternative because the traditional role of the nursing long-term care facilities had not worked at improving the quality of care and the quality of life for these veterans. That was our goal.

Senator Coburn brings some definition to who is eligible for this based upon the fact that they would be headed toward a nursing home. We may tinker a little bit with the definition as to whether it is exclusive or totally as inclusive as we would like, but make no mistake, it is not different from the intent of the committee as to why the committee passed the caregivers act.

Let me mention one probably even more important piece of the amendment of Senator Coburn. It actually pays for what we are doing. We say the Secretary ``shall''--that means he has to implement everything in the caregiver bill. The amendment of Senator Coburn is going to say: You know what. We are going to take some money out of the funds that we pay to the U.N., and we are going to fund our veterans. I, for one, am tired of coming to the floor and spending money we don't have.

Why don't we take some of the money we have already appropriated and let's shift it? This is something novel for the Senate, but it is called prioritizing. Let's prioritize where the Federal investment should go. Let's make sure we pass the Caregivers and

Health Care Act. Let's make sure we pay for it with the Coburn amendment, and let's pull that money out of already-appropriated funds so we can not only look at our veterans, but we can look at our children and tell them this is a good bill.

I yield the floor.

Mr. President, I wish to be recognized under the 6 minutes I currently have available to me, and if the clerk will notify me at the end of that time, then I will go into Senator Coburn's allotted time.

Mr. President, I wish to reiterate, as the ranking member of the Veterans' Affairs Committee, this bill was reported out unanimously. I think it will receive unanimous support in its passage later this afternoon in the Senate.

Let me restate for Members, when the committee passed this bill out, we passed it out with all caregivers being included. It was after the committee reported it out that we narrowed it to OEF and OIF veterans and their caregivers. It was the intent of the committee to include all the people Senator Durbin, the majority whip, said we might consider later on but not now. The committee's intent was let's do it in the bill now.

It was also the committee's intent that these were individuals who were targeted for us to provide this caregiver benefit to so we can keep them out of nursing homes because of the Ted Wades, because of the Eric Edmundsons.

Senator Coburn's amendment is consistent with the bill that was passed out of committee unanimously. The bill says the Secretary ``shall;'' therefore, it means he has to. The Secretary will then have to prioritize spending within the Veterans Administration to fund these programs. The third piece of what Dr. Coburn's amendment does is rather than force the Secretary to prioritize within just VA programs, meaning there are going to be veterans who win and veterans who lose, why not say as a Congress: Why shouldn't we do what we are supposed to do? Why should we not prioritize the spending here?

What my good friend from Illinois suggested was why should we prioritize for the United Nations? Let me say the answer is quite simple: It is our money. The suggestion that the Congress doesn't have a fiduciary responsibility to fund programs we implement at a time we are borrowing 50 cents of every dollar we spend is ridiculous on its face.

To suggest that the Senate, the Congress can operate any differently than a family in America suggests that we ignore the input of everybody who asked us to represent them. We do represent the American people, 100 individuals who represent the entire country. How can we do it differently than any family who is out there struggling to meet their end-of-the-month obligations and when their revenue does not meet their expenses? What do they do? They either cut back their expenses or they find a place to raise more revenue.

Let me suggest this is as simple as, Is it time for us to prioritize where we are placing money? Members will have to decide: Is pulling money from the United Nations an appropriate place for us to pull money from to then spend on our country's veterans?

I believe we have an obligation, I believe we have a promise, even for programs that did not exist prior to this time, that when we see it is in the best benefit of the quality of life of our troops, that we provide that benefit for them. But I believe we also have an obligation to this generation and the next one and the next one to pay for it.

This is not a choice that is tough for Members. If you support the Coburn amendment, you support practically everything the committee supported when we passed the bill out by unanimous consent. If you support the Coburn amendment, you believe we have an obligation to pay for it. The only reason you would vote against the Coburn amendment is because you don't think it is appropriate for us to deprive the United Nations of this money to use as they see fit.

I suggest this is where the disconnect is with the majority of America. They would prefer the Senate to decide where that money went and to use it on these caregivers and these veterans programs.

I encourage my colleagues to support the Coburn amendment, support passage of this bill this afternoon when we take it up.

I wish to shift gears slightly because I think it is somewhat ironic that we are talking about expansion of services to our Nation's veterans at a time when some herald the introduction of a bill that, in all likelihood, will deprive other Americans of the ability to have affordable health care.

We have gone through several months of debate now about health care being accessible and affordable for all Americans. We have talked about reforms; let's change the system; let's reform the system; let's make it accessible and affordable; let's bend the cost curve down. In the last 24 hours, some have come and said we have accomplished that, it is amazing.

Let me remind my colleagues, we have all said health care is

unsustainable in its current level of investment, 17 percent of our gross domestic product. I find it somewhat odd that we would start the debate given that it is unsustainable in its current financial investment with how much more money does it cost to reform health care. The obvious answer to me is it should cost zero. If you are already spending too much, we should look at the reforms before we look at the coverage expansion.

I agree every American ought to be covered. As a matter of fact, Dr. Coburn and I have offered comprehensive bills to do that. But it is matched with real reform.

What was heralded in the last 24 hours is, in fact, a $2.5 trillion health care bill--$2.5 trillion--over a 10-year period of collecting the revenues and paying out the expenses. This is where gimmicks, smoke and mirrors--whatever you want to call it--are used in Washington. If you collect revenue for 10 years but you only pay benefits for 6 years, you don't get a true picture of what it is going to cost over 10 years. You get a true impact of the revenue stream which is over $800 billion.

From where will that $800 billion in new revenue appear? Taxes. They go up $493.6 billion--$493.6 billion. We will cut $464.6 billion out of Medicare. A $\1/2\ trillion we are going to take from a program with a designated population of beneficiaries of our Nation's seniors and those who are classified as disabled and we are going to take $\1/2\ trillion from Medicare and shift it over to meet the new burden of a health care plan yet to be constructed.

Why is this problematic? It is $1,063 per Medicare beneficiary every year. Over the 10-year cycle of this health care plan, we are going to steal from every senior in this country $10,363 worth of health care money. We are going to take it from their program, and we are going to put it over in this new program because it is paid for. Legitimately, when you raise taxes, when you raise fees, when you raise revenue, you are making tough choices. I think when you go in and tax health plans and that raises $149.1 billion; when you increase a penalty for a nonqualified health savings account and you get $1.3 billion--these are revenues. They are legitimate.

It is no smoke and mirrors. I don't think the American people believe for a minute this is deficit neutral. I don't believe for a minute they believe we are going to take $464 billion out of Medicare. If they do believe it, they know we are going to pay it back with future taxes on the American people.

That is fine, if that is the way we want to prioritize. But health care reform affects every American. This is a very personal issue for every American and every family. It touches them unlike anything else we do. The truth is, they know if you take it and you put it in one pocket and you take it out of the other pocket, the effect on them either has not changed or it is negative.

Let me suggest to my colleagues this bill is 2,074 pages. I will admit--I may be the only one--I have not read it since it was introduced at 6 o'clock last night. I am not sure there are many Members who have or could have. But let me suggest there will be a question about whether, for the first time, we use taxpayer money to perform abortions. Personally, I believe that is wrong. I will not support a piece of legislation that does that. This bill does that.

An employer mandate, at a time when American companies are trying to be competitive in a global marketplace? We raised $28 billion in employer mandates. I am not sure that is making U.S. companies more competitive in a global marketplace. I think the economy is the No. 1 challenge we have in America. I think 10.2 percent unemployment and going up--if it were a disease, we would be on the floor of the Senate calling it an epidemic and we would be doing whatever and spending whatever to help turn it around. But we are doing nothing. As a matter of fact, we are doing everything we can to try to drive up unemployment, to dry up the economy, and to make companies less competitive in a global market.

The President said one of the objectives of health care reform was we need to bend the cost curve down, we need to make sure there are cost savings in health care for every American. Let me tell you what the Congressional Budget Office says:

Under the legislation, federal outlays for health care will

increase during the 2010-2019 period, as would the federal

budgetary commitment to health care.

That is Washington language for: You know what. Our expenditures on health care are going to go up. What happens when Federal expenditures go up? Everybody's go up. That is a known fact by the American people. The coverage expansion would drive a new increase in government spending on health to the tune of $160 billion over 10 years. Make no mistake, this does not bend the curve down, it bends the curve up. We spend more money.

CBO scored the bill as reducing the deficit by $130 billion over 10 years, 2010-2019. What does it take into account, to come to that calculation? It assumes doctors are going to get cut 23 percent in their reimbursements in 2011. We have less than 1 million doctors to serve 300 million people. Does anybody believe for a minute we are going to allow a 23-percent cut to go in at a time when we are starved--trying to attract people to go into medicine as a profession? If it does go in, we are going to take $247 billion out of the pockets of doctors we rely on to perform the surgeries, to make the diagnosis for us and everybody else in this country.

The new creation of the CLASS Act, long-term care policy, shows in the CBO score a $72 billion savings. Let me explain it like this: Nobody qualifies today because it doesn't exist. People are going to pay premiums to be eligible for this long-term benefit. It takes about 20 years of paying in before somebody is going to be eligible to pull out. It is not similar to Medicare, when we created it, where, even if you never paid in, you started on day one. We are collecting revenues for 20 years before we ever pay out the first dime. It is not hard to understand why you would have a $72 billion surplus out of this.

Let me ask, what happens after that? What happens after you get past that 20-year number? The truth is, it starts to get into the trillions and trillions of dollars for which the Federal Government is obligated, based upon the premiums and the benefits people have assigned to it, that they pay out.

If you eliminated these two gimmicks, just on its face this bill would be $189 billion out of balance, in the red. It would not be paid for.

I suggest that is just two smoke-and-mirror tools. The start date was moved from 2013 to 2014. No longer is our focus on how do we get care delivered as quickly and as efficiently. We just pushed it off a year because we said the Congressional Budget Office says we are short on raising money, and we have raised all we can in fees and taxes. Maybe not all. I think they probably have some things targeted that are still yet to come out. The key thing is, even if you did implement it, there are 24 million Americans who are still without insurance. The objective to cover everybody was not met. There are $25 billion worth of unfunded mandates to our States. I don't know of a State that is in financial health today. There may be one or two.

My State of North Carolina was $4 billion out of balance. Last year, the Federal stimulus was $2 billion of closing the gap. That $2 billion, by the way, we didn't have. We borrowed to give to North Carolina and other States to create jobs. It was used to close budget gaps so they didn't have to make tough decisions. As a matter of fact, we found out this week, on one of the news channels, there is $98 billion that didn't have anything to do with stimulus.

We are the laughingstock of the world on the way we applied the stimulus package. But the sad part is not the fact that it has been uncovered, it is that it didn't do anything to put Americans to work. Now we are saying to the States we are going to put another $25 billion on you.

In Medicare, we are going to cut from the fee-for-service payments $192 billion. So we already have $247 billion over here that we are getting from doctors if we go through with the payment cuts. Now we are targeting another $192 billion out of Medicare reimbursements, right out of the pockets of doctors and hospitals. Is there a community hospital in America that will be able to survive, given the cuts that are getting ready to hit them? We cut Medicare Advantage $118 billion. Some

cheer that. I tell you who doesn't cheer it: the 20 percent of America's seniors who chose Medicare Advantage as their preferred choice to traditional Medicare because it required of them less out-of- pocket obligation, it didn't hit them for $750 deductible the day they walked into a hospital. What about those 20 percent of our Nation's seniors when they lose Medicare Advantage?

What about the $43 billion in DSH, disproportionate share payments, we pay the hospitals to make up for the uncompensated care they deliver? I guess the authors of the bill would say we are covering everybody so there is no uncompensated care. Wrong; 24 million are still without insurance. There is going to be uncompensated care, and we are taking away the money we are providing the hospitals to make up for the uncompensated care they delivered, meaning it is coming right out of their hide, that local hospital in the community we live in; $23 billion in unspecified cuts by the Medicare Advisory Board. Is America comfortable with us turning to another advisory board to cut $23 billion? We just had an advisory board say: If you are 40 to 50 and you are female, you don't need to worry about your breasts, don't need to go get a mammogram, don't need to do self-examinations--trust us.

One of the reasons the health care system in America is the best in the world is because we spend money to innovate. We hope companies find breakthroughs. We look at diagnostic abilities in an effort to try to detect early, so the options are greater and so the cost is less. But now, all of a sudden we are saying that is not important.

There are 162 million Americans who currently have employer-based health care. In this bill, regardless of what that employer does, they will not be eligible for subsidy. If they currently have coverage but they may be below income and for some reason their employer has to drop their health care or cut back on the plan because--maybe they are not competitive after this in the global marketplace--even though they would qualify from an income standpoint, they will not qualify because they were provided health care before. Our favorite, the IRS says it will take another $5 to $10 billion so they can actually go out and collect these fees and taxes.

The cost of the subsidies alone in the exchange is estimated by CBO to grow at 8 percent a year. I ask you, if the reason we have gotten into this discussion, had this debate, was we are trying to turn the cost curve down on health care, and we have quoted a 6-percent increase a year and a 5.5-percent increase a year and a 7-percent increase a year, why in the world would we be considering a plan that CBO tells us is going to have a cost increase for the subsidy of 8 percent a year? I would hope, if we had real reforms that worked, the cost of the subsidy would decline 8 percent a year.

I know there are others seeking time. I will not belabor this point. I ask Members: Support the Coburn amendment on the veterans bill. Support passage of the veterans bill. Read the health care bill. Be prepared to debate the health care bill for a very long time and be prepared to stand for the American people on what is right.

I yield the floor.

Mr. President, I ask unanimous consent that I be permitted to use my time on the bill and my time on the amendment as necessary.

Mr. President, as chairman of the Senate Committee on Veterans' Affairs, I had the honor of speaking at the World War II Memorial this past Veterans Day. As I stood there remembering my own comrades and their families, I thought of what the brave men and women in the service give up every day so we can enjoy the freedoms that come with American citizenship.

It is in that spirit that I urge this body to pass S. 1963, the Caregivers and Veterans Omnibus Health Services Act of 2009 without further delay.

The Nation's young veterans coming home from Iraq and Afghanistan have faced a new and terrifying kind of warfare, characterized by improvised explosive devices, sniper fire, and counterinsurgencies. Military medicine, fortunately, is saving more of these young servicemembers' lives than ever before.

In World War II, 30 percent of Americans injured in combat died. In Vietnam, 24 percent died. In the wars in Iraq and Afghanistan, about 10 percent of those injured have died.

As more of the catastrophically disabled are surviving to return home, more will require a lifetime of care. With our decision on S. 1963, we decide whether that care will be in their homes with the help of their family members or in institutions. If we want that care to be in the home, we need to help the families shoulder the burden of providing it.

During the prior administration, the President's Commission on Care for America's Returning Wounded Warriors--known as the Dole-Shalala Commission--found that 21 percent of Active Duty, 15 percent of Reserves, and 24 percent of retired or separated servicemembers who served in the Iraq or Afghanistan conflicts said friends or family members gave up a job to be with them or to act as their caregiver. By giving up a job, caregivers often give up health insurance, when they need it the most.

Studies also show family caregivers experience an increased likelihood of stress, depression, and mortality, compared to their noncaregiving peers.

Without a job, without health insurance, and in very stressful situations, family caregivers have worked to fulfill the Nation's obligation to care for its wounded warriors.

S. 1963 would give these caregivers health care, counseling, support, and a living stipend. The bill would provide caregivers with a stipend equal to what a home health agency would pay an employee to provide similar services. It would give the caregivers health care and make mental health services available to them. The bill also provides for respite care so caregivers can return to care for these veterans with renewed vigor and energy. It lets these young veterans return to their families and not to a nursing home.

While the caregiver program in this legislation will be limited at first to the veterans of the Iraq and Afghanistan wars, other provisions of the bill improve health care for all veterans.

There are provisions which make health care quality a priority, strengthen the credentialing and privileging requirements of VA health care providers, and require the VA to better oversee the quality of care provided in individual VA hospitals and clinics.

The bill will also improve care for homeless veterans, women veterans, veterans who live in rural areas, and veterans who suffer from mental illness.

About 131,000 veterans are homeless. S. 1963 would help these veterans obtain housing, pension benefits, and other supportive services. It would provide financial assistance to organizations that help homeless veterans.

Seventeen percent of servicemembers are now women. This legislation contains a number of provisions which are designed to improve the care and services provided to women veterans.

It would provide for the training of mental health professionals in the treatment of military sexual trauma and provide care for the newborn children of servicewomen. It would give women veterans a quality of care they have earned through their service to this country.

The bill also provides new assistance to veterans who live in rural areas. According to the VA, of the 8 million veterans enrolled in VA health care, about 3 million live in rural areas. This legislation would bring more services into rural communities through telemedicine and increased recruitment and retention incentives for health care providers. It also would increase the VA's ability to use volunteers at vet centers and create centers of excellence for rural health.

Finally, S. 1963 addresses the signature injuries of this war--PTSD and traumatic brain injury. According to a recent RAND report, one- third of veterans returning from Iraq and Afghanistan will develop post-traumatic stress disorder. Countless others will suffer from traumatic brain injury and face

significant problems in readjusting to life at home. Many studies have shown the importance of early intervention to the effective treatment of these invisible wounds.

This legislation contains provisions that allow Active-Duty military to seek mental health services at vet centers and increase access to care for veterans with traumatic brain injury.

Before concluding, I wish to share one of the many stories I have heard as I have worked to move this legislation through the Senate.

SGT Ted Wade sustained a severe brain injury after his humvee was hit by an improvised explosive device in Iraq. His right arm was completely severed above the elbow, and he also suffered a fractured leg, broken right foot, and visual impairment, among other injuries.

His wife Sarah Wade became his caregiver and a dedicated advocate for her husband, as well as for others who are providing caregiver services.

In testimony before the House Veterans' Affairs Committee earlier this year, Ms. Wade made the point that:

Young veterans with catastrophic injuries need support that

will be around as long as the injuries they sustained in

service to their country. Just like servicemembers need a

team in the military to accomplish the mission, they need a

team at home for the longer war.

I agree completely with that view. Veterans need all the support we can provide. We, as a country, can give them options that veterans of my generation never had. We can give them the option to really come home.

To those who are concerned about the cost of this legislation, I say we cannot now turn our back on the obligation to care for those who fought in the current wars. When we as a body vote to send American troops to war, we have promised to care for them when they return.

I firmly believe the cost of veterans benefits and services is a true cost of war and must be treated as such.

I ask that our colleagues accept no more delays and act on this important legislation.

Mr. President, I reserve the remainder of my time and yield the floor.

Mr. President, I yield 10 minutes to the Senator from Washington, Mrs. Murray.

Madam President, I yield 5 minutes to the Senator from Alaska, Mr. Begich.

Madam President, I yield 3 minutes to the Senator from Montana, Mr. Tester.

Mr. President, can you tell me how much time I have remaining?

Mr. President, let me make further comments about the pending bill on the floor and speak particularly about the cost of war.

To those who are concerned about the cost of this legislation, let me say I firmly believe we cannot renege on the obligation to care for those who honorably serve our country. When we as a nation vote to send American troops to war, we are promising to care for them when they return. The cost of veterans health care is a true cost of war and must be treated as such. The cost associated with the underlying bill does not need to be offset. The price has already been paid many times over by the service of the brave men and women who wore our Nation's uniform.

Regardless of what my colleagues may think about the United Nations and its role in international affairs, this is not the time or place to be debating those issues. At this moment, we are talking about meeting veterans' needs.

Iraq and Afghanistan Veterans of America agrees. IAVA writes that:

The amendment to S. 1963 brought to the floor is just the

latest in a long series of delaying tactics that plays

political games with veterans' health care and services.

This bill would provide family caregivers--who typically have full- time jobs--with health care, counseling, support, and a living stipend. This modest stipend would be equal to what a home health agency would pay an employee to provide similar services.

To assert that this legislation requires excessive spending is simply wrong. This spending is critical when taking into account the sacrifices these men and women have made for the Nation.

The sponsor of the amendment we are considering has expressed the view that S. 1963 unfairly discriminates against veterans because its caregiver assistance provisions focus on OEF and OIF veterans. While it is correct that the caregiver provisions target the veterans of the current conflicts, I do not believe that constitutes discrimination. The reasons for this targeting, at the least, are three: one, the needs and circumstances of the newest veterans in terms of the injuries are different--different--from those of veterans from earlier eras; two, the family situation of the younger veterans is different from that of older veterans; and three, by targeting this initiative on a specific group of veterans, the likelihood of a successful undertaking is enhanced.

I note that most major veterans groups support this bill and the caregiver provisions. I do not believe they would do so if they felt it was discriminatory.

As my colleagues know, I am a veteran of World War II. If we can provide help to the newest veterans in ways that were not available to the veterans of my generation, I support that 100 percent.

Veterans from Iraq and Afghanistan are returning home today to face new and different challenges. In World War II, a third of those injured on the battlefield did not make it home. Today, 90 percent of those injured make it home but often with catastrophic and life-threatening injuries. Some of these injuries leave invisible wounds. Unprecedented rates of post-traumatic stress disorder and other mental illnesses are affecting these young men and women. These veterans will be cared for somewhere, and by what we do today, we may decide whether that care occurs in a nursing home or in their own home. The soldiers of my generation had no such choice. I say, let's help the Nation's newest veterans to really come home, and let's help their families.

According to a report from the Center for Naval Analyses, 84 percent of caregivers for veterans were either working or in school prior to becoming a caregiver. An employed caregiver will lose, on average, more than $600,000 in wages, pension, and Social Security benefits over a ``career'' of caregiving. The younger the veteran's family, the more wages a caregiver will lose. We can no longer ask our newest generation to bear the cost of the Nation's obligation to care for its wounded warriors.

The premise of the amendment seems to be, if it is good for some, it is good for all. But the needs of veterans are not the same, and expanding a benefit to any veteran who might benefit could endanger the entire program. The underlying bill already includes a provision directing VA to report to Congress within 2 years after the law's enactment on the feasibility of expanding the provision of caregiver assistance to family members of veterans of prior service. Such an approach is not discriminatory; it is the responsible way to approach the issue.

I note that other health care improvements which would result from this bill help virtually every group of veterans, including women veterans, homeless veterans, and veterans who live in rural areas.

I urge this body to reject the amendment and pass S. 1963 today for the sake of all our Nation's veterans.

Questions have been raised about the scope of the caregiver provision. When the bill came out of the Veterans' Affairs Committee, it included a 2-year delay before the caregiver benefit could have been expanded. The bill as reported said the Secretary of VA could have expanded it to all veterans if it made sense. Under the bill now before us, the Congress will continue to have the opportunity to expand it beyond OEF and OIF veterans. Nothing has changed. Once VA has experience with the proposed new program, it can be expanded to all veterans.

Mr. President, I yield the floor and reserve the remainder of my time.

Mr. President, I wish to make further comments on some of the concerns our speakers have had.

The sponsor of the amendment has stated his primary goal is to increase veteran eligibility for caregiver assistance. It appears, however, that the amendment could well have the opposite effect and deny caregiver assistance to many OEF/OIF veterans by significantly narrowing the eligibility criteria for caregiver assistance.

The amendment would add a provision that would require that in addition to sustaining a serious injury and requiring personal care, a veteran would have to be so helpless as to require institutional care if personal care services were not available. This proposed modification is problematic because not all veterans in need of caregiver assistance would be appropriate for, or in need of, institutional care.

To illustrate, consider the example suggested by the Wounded Warrior Project, one of the principal advocates for the caregiver legislation: A veteran who is recovering from severe wounds, suffers from PTSD and depression, and needs help with feeding, dressing, and getting to the bathroom, under the provisions in S. 1963 this veteran would

be eligible for caregiver assistance. However, since the veteran in this example would not necessarily benefit from or require institutional or residential care, the veteran would not be eligible for caregiver assistance under the changes proposed by the amendment. Given the veteran's co-occurring PTSD and depression, however, the VA's failure to provide that assistance could have a severe impact on the veteran's mental health and well-being. PTSD, one of the signature wounds of the current war, is a condition which many long-term institutional care settings and nursing homes are not prepared to handle or treat. As a result, the inclusion of this new eligibility condition would exclude many veterans in critical need of caregiver assistance.

There is another problem raised by the amendment's proposed expansion of the caregiver assistance to all veterans. By expanding eligibility for caregiver assistance to all severely injured veterans, the amendment would convert a manageable initiative targeted on the veterans of the current conflicts into a huge undertaking that would surely encounter many problems.

The reasoning behind initially administering services to a smaller pool allows for greater efficiency and the opportunity to improve before expanding such services to a larger universe of veterans.

I note that the Disabled American Veterans argues against the pending amendment because of its potential impact. DAV writes, and I quote:

While the amendment proposed by Senator Coburn seeks to

extend caregiver services to veterans from all eras, its new

restrictive eligibility language could actually reduce the

number of severely wounded and disabled veterans returning

home from the wars in Iraq and Afghanistan eligible for such

services. For this and other reasons, DAV does not support

the Coburn amendment to S. 1963.

I ask unanimous consent that this letter be printed in the Record.

Mr. President, the proponent of this amendment has expressed the view that this veterans omnibus bill should be paid for and seeks to do so by directing a transfer from the State Department to VA of funds appropriated for ``Contributions to International Organizations'' and ``Contributions for International Peacekeeping Activities,'' both of which are categories of huge U.S. payments to the United Nations.

Regardless of any Senator's beliefs about the role of the United Nations or U.S. support for the U.N., this is neither the time nor place to be debating those issues. For that reason alone, I believe the amendment should be rejected.

I understand from CBO, however, this amendment does not even accomplish what I believe the amendment's author intends. According to CBO, the cost of the bill would still be estimated at the same level. According to CBO, having the State Department transfer funds to the VA is no different than having VA fund it through its own appropriations accounts.

It also appears that the amendment would change nothing with respect to U.S. payments to the U.N. Again, according to CBO, if the amendment's author wishes to have the State Department transfer funds to VA instead of contributing to the U.N., the amendment would have to be made to the State, Foreign Operations, and Related Programs Appropriations Act, and not to the pending measure which is an authorization bill.

This legislation has been delayed too long. To continue to obstruct this vital veterans bill while attempting to link it completely to unrelated U.N. spending is simply unacceptable.

This amendment should be rejected and S. 1963 should be passed by the Senate.

I yield the floor and reserve the remainder of my time.

Mr. President, I wish to make a point of clarification. This bill, the pending measure, is made up of two bills which is now S. 1963. It was S. 252, which was reported in July, and S. 801, which was reported in mid-October. Both bills were held at the time they went onto the calendar. No amendment was prepared to either bill. The first amendment was proposed on Monday of this week, 2 weeks after the bills were combined as S. 1963.

In closing, the debate about the United Nations is not one which belongs on a veterans bill. The underlying bill is a bipartisan approach to some of the most urgent issues facing all veterans--for women veterans, for homeless veterans, to help with quality issues, to help rural veterans.

This bill, by the way, also includes construction authorization for six major VA construction projects already funded by the VA spending bill.

I urge our colleagues to reject the amendment to S. 1963.

I yield back my time.

I suggest the absence of a quorum.

Mr. President, as has been mentioned several times, the majority leader unveiled the Democrats' health care reform bill yesterday around 5 o'clock. This bill was drafted behind closed doors. There was no Republican input. It didn't have any transparency until yesterday at 5 o'clock, despite the promises we have heard that government would be more transparent in this new administration. The 2,000-page bill released yesterday is expected to have a vote to proceed to it within the next 2 days. The bill is 354,654 words. To put it in perspective, the Bill of Rights is stated in 463 words; Lincoln's Gettysburg Address contained 266 words; the Ten Commandments has 297 words. This is over 350,000 words.

Why don't we have time to read this bill, digest it, allow our amendments to be put in the bill language, because, clearly, this bill will need amendments?

The health care of our citizens may be the most personal of all things to every person and every family. We are a democracy and the American people have a right to be heard on all issues but especially on this type of issue. We should be given the opportunity to read and hear what is in this bill, to hear it discussed, to hear from our constituents because it ought to be on the Internet. That is why we have the Internet access to bills that are introduced in the Senate. But by the time our constituents have a chance to read it, we will already have had a vote on whether to proceed to the bill.

Even after a cursory review, I know this bill includes changes that are disastrous to families, health care providers, and the economy. Higher taxes, mandates--especially for small businesses--penalties, cuts to Medicare, higher premiums, restricted choices, a government plan--the list goes on. The bill includes almost $1 trillion in taxes, including a new Medicare payroll tax; $8 billion in taxes on individuals who don't buy coverage; $149 billion in taxes on employers who don't offer the right percentage of coverage to employees; $102 billion in taxes on insurance plans, pharmaceutical companies, and medical device companies which study after study have shown will be passed on to the people who get these services and equipment.

To make matters worse, the bill includes almost $1 trillion in cuts to Medicare. It is guaranteed to reduce choices and coverage for seniors. In my State of Texas, 400,000 people love their Medicare Advantage, or at least they have it and are satisfied. They will lose Medicare Advantage under this bill. The Democrats are touting the cost of the bill as meeting the President's goal of being under $1 trillion because CBO scored it at $849 billion. But this is a budgetary sleight of hand, because what is actually being scored is the years 2010 to 2019. The actual spending in this bill won't take effect until 2014. They are taking the 10 years with 4 years where the bill is not spending anything. If you score it for the 10 years following when it actually comes into being, 2014 to 2023, the bill costs $2.5 trillion, not $849 billion.

Given more time to analyze this bill, who knows what else we would discover? If the Democrats think this is the reform Americans wanted, why rush the bill through the Senate? Why rush it through before we have the ability to review details?

The right approach is available. My colleagues and I have proposed commonsense and fiscally responsible ways to improve affordable access to health care. We need to do that. We have never said we don't need reform. What we have said is we need reform that will give more affordable access for coverage to Americans who do not have that access today.

We should reassess the goals of health care reform and implement policies that we know will reduce costs. For sure, reducing frivolous lawsuits. Study after study has shown the benefits of medical malpractice reform. In Texas, we have tort reform. We have seen a dramatic increase in physicians who are willing to practice medicine. It has lowered the cost of medical malpractice premiums, and doctors have been able to do their work with their patients with much more freedom, knowing they do not need to order unnecessary tests just to cover themselves in case they get sued. The majority insists on rejecting this suggestion that we have medical malpractice reform in the bill. Yet there is probably not anything that will save as much money as medical malpractice reform, that puts commonsense standards in place for frivolous lawsuits or lawsuits at all.

I will offer an amendment, or at least prepare one and hope to be able to offer it, that would cap damages, reduce malpractice premiums, and encourage doctors to practice in medically underserved areas. So many of our underserved areas, especially rural areas, have no doctors. There are counties in Texas that don't have a doctor within hundreds of miles and several counties. That is because the medical malpractice premiums are so high, they cannot afford to do it.

The small business premiums are going to go up, if this bill is passed. Small businesses already have a hard time offering coverage to their employees. Why would we make the problem worse, especially when we have the highest unemployment in decades? We should be allowing small businesses to pool together and buy plans. We have

championed that proposal for years in the Senate, but we have never been able to get over the hurdles to pass a small business health plan. If we could do that, we could spread the risk. The bigger risk pools would produce lower premiums and allow more small businesses to have access to and offer their employees affordable health care coverage. Allowing businesses to pool doesn't cost the government anything. Therefore, it would not require tax increases, as we see in the bill before us.

The Democrats are trying to address the problem of unaffordable insurance by offering credits to small businesses to offset the cost of premiums. But the credit only lasts for 2 years. That is hardly anything that is going to encourage businesses to take on the added cost when the credit lasts for 2 years. I will be preparing amendments that at least double that to 4 years, expand the eligibility and duration of these credits so we can help small business people. But even 4 years is not enough. We should offer credits all the way through.

Offering tax incentives. There are small businesses and individuals in this country who have no access to affordable coverage. Why not give every individual who purchases their own health insurance the same tax break a corporation gets for offering health care coverage to their employees? Employees who receive insurance through their place of employment do not pay taxes on the premiums they spend for insurance. Why should individuals who purchase their own health care coverage be treated differently? I have a bill, with Senator DeMint, that will help provide insurance for more Americans through tax credits and competition. Our approach would be a tax credit for every individual, $2,000 per year, and for families $5,000 per year for their purchase of health insurance. This would allow individuals to purchase their policies and own them so they would not have to be affected by what their employer offers or if they change jobs. This is the kind of reform that could make a difference.

How about creating a transparent marketplace online for consumers to go in and shop and hopefully have bigger risk pools, more competition, bringing the cost down? That is not the kind of marketplace that is in this bill. This exchange has so many mandates on the plans that, like the Massachusetts exchange, it would raise the cost of premiums and would not help in any way bring the cost down so that premiums are more affordable.

These are the ideas that would improve competition in the marketplace.

I can tell you, from the input I have received from my constituents since the bills have been out of committee, before the bill came to the floor or is on its way to the floor yesterday, because there were two committees that wrote bills that were put together and released yesterday, I have listened to what people say. I can tell you they don't want Medicare cuts. They don't want more taxes. Small businesses certainly don't want more mandates. They don't want government-run insurance. They know that a government plan is eventually going to crowd out the private insurance company plans throughout the country.

I am going to be preparing an amendment that will allow States to opt out without penalties, not just of the government insurance plan but of all the harmful measures. Why would we have a government opt-out by States, if they are going to still have to pay the higher taxes, if they are going to have to pay higher premiums to pay for the other States that have the plan? States should not be forced to participate in the government plan, nor subsidize and pay for such a plan through increased taxes.

I will prepare amendments that will exempt individuals and employers from the mandate to buy insurance, if this bill causes premiums to rise above their currently projected values.

The solution to health care issues is not to give more power to the government. The solution is to give more power to the American people. They deserve a system that assures that America will have the best health care in the world.

Which brings me to the new government task force that came out this week that is causing confusion at best and outrage at worst. That is the guidelines regarding screening for breast cancer. Breast cancer is the second leading cause of death in women in this country. Whether and when to screen for breast cancer has been debated for decades. In 1993, the Clinton administration proposed the government takeover of health care. In that proposal put forward by the Clinton administration, there would be no payment for mammograms for women under the age of 50. After the age of 50, there would be payment in the government plan for a mammogram every 2 years, exactly what has just been recommended by the Federal task force.

Since we have had the guidelines, which have been in place for many years, death rates from breast cancer have been declining. Since 1990, there are larger decreases seen in women younger than 50. The American Cancer Society states that these decreases are believed to be the result of early detection and increased awareness. The evidence has repeatedly shown that screening and early detection save lives.

Unbelievably, the United States Preventive Services Task Force has recommended against routine mammograms for women under 50, saying it is not worth subjecting some patients to unnecessary biopsies, radiation, and stress. The task force also recommended against teaching women to do regular self-exams. We have to ask the questions: Why this change? Why now? Nothing substantial in the clinical evidence, but the panel decided to review the data with health care spending in mind. Nearly everyone realizes that fewer screenings mean insurance plans, including a government-run plan, will save money.

This is how rationing begins. I hope America wakes up. This is how rationing begins.

In an article by the Wall Street Journal today, they recognized that. It reads:

Every Democratic version of ObamaCare makes this Task Force

an arbiter of the benefits that private insurers will be

required to cover as they are converted into government

contractors. What are now merely recommendations will become

de facto rules, and under national health care these kinds of

cost analyses will inevitably become more common as

government decides where finite tax dollars are allowed to

go.

That is a quote from the Wall Street Journal today.

The American Cancer Society came out after this incredible recommendation and said, with its new recommendations, the task force is essentially telling women that mammography at age 40 to 49 saves lives, just not enough of them. So if the screening is going to save your life or your mother's or your sister's or your wife's, would that screening be worth it?

Decisions about care must be between a doctor and a patient, not a doctor who has a loyalty to anyone but the patient, not a doctor who is working for the government and having to maintain government task force guidelines, such as the one we have just seen.

That is the crux of the debate on this health care bill that has been released in the last 15 hours. I am so worried we are now beginning to see the handwriting on the wall. The President said once there is no reason we should not be catching diseases such as breast cancer and colon cancer before they get worse. It turns out, there is a reason: cost.

The insurance companies have sort of said in the last day or so that they are not going to stop the coverage of mammograms for women starting at the age of 40. But when the government plan comes into effect, you know that every insurance company is going to say: If we are going to be competitive, we must adhere to the same standards as the government plan. It is going to happen.

We must have time to look at this bill. We must have time to look at what is happening to the choices, to the health care, to Medicare. The cuts in services, the taxes, the mandates are going to overhaul the health care of our country. We must have time to look at this bill before we have a motion to proceed. We must have time to study it. We must let our constituency study it because they will catch things they care about and they will inform us, and that is why we are here.

So I am very concerned that we are pushing too fast on something we should be taking slowly and carefully to assure we are not going to do something we are not sure is right, and

where we have the chance, to change what we see is wrong.

Thank you, Mr. President.

Mr. President, if the Senator will yield, I appreciate him giving us these statistics because it is 1 life out of 1,904 to be saved, but the choice is not going to be yours; it is going to be someone else who has never met you, who does not know your family history.

That was in the Clinton government reform, takeover of health care in 1993, and it was soundly rejected. It was soundly rejected. It was part of the reason it was soundly rejected--this mammogram rationing before the age of 50--because we had hearings on this, and every woman in the Senate at the time rejected--rejected--that plan, rejected keeping women under the age of 50 from having mammograms paid for by insurance plans.

So I thank the Senator from Arizona for connecting this and showing the statistics because this is not the American way of looking at our health care coverage. It is not the American way, and we must stop this government takeover of our health care.

Mr. President, I yield the floor.

Mr. President, it is no longer a secret that fraud represents one of the fastest growing and most costly forms of crime in America today. In no small part, our current economic crisis can be attributed to unchecked mortgage fraud. Mortgage fraud itself was spurred by rampant accounting fraud, which enabled crooked executives to fatten their larders on a bubble of fake equity. And on the back- end, securities fraud, in the form of market manipulation and insider trading, hastened the eventual market crash and maximized its impact on Main Street and average American investors. In response, this body passed the Fraud Enforcement Recovery Act, FERA, which directed critical resources and tools to anti-financial fraud efforts.

FERA was passed in response to an unprecedented financial crisis. Americans should expect Congress to do more than simply react to crises after their most destructive impacts have already been felt. We owe it to our constituents to be proactive and to seek out and solve problems on the horizon so that disaster can be averted.

In the midst of the debate concerning comprehensive health care reform, we must be proactive in combating health care fraud and abuse. Each year, criminals drain between $72 and $220 billion from private and public health care plans through fraud. We pay these costs as taxpayers and through higher health insurance premiums. As we take

steps to increase the number of Americans who are covered by health insurance, and to improve the health care system for everyone, we must also ensure that law enforcement has the tools that it needs to deter, detect, and punish health care fraud.

The Finance and HELP committees have worked long and hard to find ways to fight fraud and bend the cost curve down. They have done a great job. There's more work to be done, however, which is why today I, along with Senators Leahy, Specter, Kohl, Schumer, and Klobuchar, introduce the Health Care Fraud Enforcement Act of 2009.

This bill makes straightforward but critical improvements to the Federal sentencing guidelines, to health care fraud statutes, and to forfeiture, money laundering, and obstruction statutes. The bill would also make available more Federal resources to activities specifically designed to target health care fraud. Taken together, these measures send a strong and unmistakable signal to those who would engage in health care fraud that they will be caught, and they will be punished.

The bill makes important changes to the Federal sentencing guidelines to ensure that health care fraud offenses will be punished commensurate with the cost that these offenders inflict upon our health care system. Health care represents \1/6\ of our national economy, and so unchecked health care fraud has the potential to inflict devastating harm to our national prosperity.

Despite the enormous losses in many health care fraud cases, analysis from the United States Sentencing Commission suggests that health care fraud offenders often receive shorter sentences than other white collar offenders in cases with similar loss amounts. And according to statements from cooperating health care fraud defendants, many criminals are drawn to health care fraud because of this low risk-to- reward ratio. For this reason, the bill directs the Sentencing Commission to increase the offense score of health care fraud offenses by two to four levels, depending on the dollar amount involved in the crime.

The bill also clarifies that courts should refuse to entertain arguments by defendants that they can avoid stiff punishment because only a portion of their fraudulent claims were likely to be paid.

In addition, the bill updates the definition of ``health care fraud offense'' in the Federal criminal code to include violations of the anti-kickback statute, the Food, Drug and Cosmetic Act, and certain provisions of ERISA. These changes will allow the full panoply of law enforcement tools to be used against all health care fraud.

The bill also strengthens whistleblower actions based on medical care kickbacks, which tempt by health care providers to churn unnecessary medical care at great risk to patients and great cost to the taxpayer. By making all payments that stem from an illegal kickback subject to the False Claims Act, this bill leverages the private sector to help detect and recover money paid pursuant to these illegal practices.

The Department of Justice has had success both prosecuting illegal kickbacks and pursuing False Claims Act matters based on underlying violations of the Anti-Kickback Statute. Nevertheless, defendants in such FCA cases continue to mount legal challenges that sometimes defeat legitimate enforcement efforts.

For example, a court recently held that, even though a device company may have paid a kickback to a doctor to use a particular medical device, the bill to the government for the procedure to implant the device was not false or fraudulent because the claim was submitted by the innocent hospital, and not by the guilty doctor. In other words, a claim that results from a kickback and that is fraudulent when submitted by a wrongdoer is laundered into a ``clean'' claim when an innocent third party finally submits the claim to the government for payment. This has the effect of insulating both the payor and the recipient of the kickback from False Claims Act liability. This obstacle to a successful action particularly limits the ability of the Department of Justice to recover from pharmaceutical and device manufacturers, because in such instances the claims arising from the illegal kickbacks typically are not submitted by the doctors who received the kickbacks, but by pharmacies and hospitals that had no knowledge of the underlying unlawful conduct.

This bill remedies the problem by amending the anti-kickback statute to ensure that all claims resulting from illegal kickbacks are ``false or fraudulent,'' even when the claims are not submitted directly by the wrongdoers themselves. I want to emphasize that in such circumstances, neither anti-kickback nor False Claims Act liability will lie against the innocent third party that submitted the claim.

The bill also addresses confusion in the case law over the appropriate meaning of ``willful'' conduct in health care fraud. Both the anti-kickback statute and the health care fraud statute include the term ``willfully.'' In both contexts, the Ninth Circuit Court of Appeals has read the term to require proof that the defendant not only intended to engage in unlawful conduct, but also knew of the particular law in question and intended to violate that particular law.

This heightened mental state requirement may be appropriate for criminal violations of hyper-technical regulations, but it is inappropriate for these crimes, which punish simple fraud. The Finance Committee health care reform bill, America's Healthy Future Act, addresses this problem for the anti-kickback statute, but not for the general health care fraud offense. Accordingly, the Health Care Fraud Enforcement Act tracks the Finance bill and clarifies that ``willful conduct'' in this context does not require proof that the defendant had actual knowledge of the law in question or specific intent to violate that law. As a result, health care fraudsters will not receive special protection that they don't deserve.

Next, the bill provides the Department of Justice with critical subpoena authority for investigations conducted pursuant to the Civil Rights for Institutionalized Persons Act, also known as CRIPA.

Pursuant to that important statute, the Civil Rights Division of the Department of Justice investigates conditions in publicly operated institutions, such as nursing homes, mental health institutions, facilities for persons with disabilities, residential schools for children with disabilities, as well as jails and prisons, where there has been an allegation of pattern or practice of violating residents' Federal civil rights. Under CRIPA, only injunctive relief is available; the statute does not provide for the award of damages.

CRIPA investigations commonly concern allegations of inadequate medical and mental health care, unsafe living conditions, and the failure to protect residents from harm. The majority of CRIPA investigations are conducted with the voluntary cooperation of state and local jurisdictions. When unlawful conditions are identified, CRIPA investigations are typically resolved through a negotiated settlement agreement that addresses the reforms necessary to correct policies, procedures and practices to address the identified deficiencies.

Some jurisdictions, however, have refused to cooperate with the Division. CRIPA does not authorize the Department of Justice to issue subpoenas for documents, records, or even for access into the institution that is the target of the investigation. As a result, investigations have been hamstrung and the effectiveness of CRIPA to remedy systemic abuse of institutionalized persons has been unnecessarily limited.

For example, in a CRIPA investigation of a county nursing home in New Jersey, the local jurisdiction would not cooperate. The Division's investigation revealed inadequate medical and mental health care, unlawful restraint, and inadequate nutrition and hydration. In one particularly serious incident, which occurred weeks after a meeting with the county officials to request their cooperation with the investigation, a resident was fed so quickly by staff that she aspirated and died. Emergency room physicians extracted a volume of mashed potatoes from the resident's lungs that filled a Ziploc bag. Another nursing home resident slowly starved to death because staff improperly positioned that resident's feeding tube. The Division was compelled to file suit, resulting in a negotiated settlement more than 4 years after the investigation began. To be sure, these

abuses are a civil rights issue that demand attention even in the absence of fraud prevention. But substandard care also represents fraud and waste, because taxpayers have paid for the provision of satisfactory medical services at facilities that fall under CRIPA jurisdiction.

The absence of subpoena authority enables non-cooperating jurisdictions to obstruct and delay the Division in its mission to ensure that the Federal rights of persons in the custody of state and local officials are respected. The resultant litigation when jurisdictions exploit the absence of subpoena power is extraordinarily costly, yet the substantive outcome, appropriate injunctive relief, is the same.

The bill addresses the problem by authorizing the Department of Justice to issue subpoenas for access to any institution that is the subject of an investigation related to a violation of CRIPA, and for any documents, records, materials, files, reports, memoranda, policies, procedures, investigations, video or audio recordings, and quality assurance reports of such institution.

In a final substantive change, the bill corrects an apparent drafting error by providing that obstruction of criminal investigations involving administrative subpoenas under HIPAA, the Health Insurance Portability and Accountability Act of 1996, should be treated in the same manner as obstruction of criminal investigations involving grand jury subpoenas.

Finally, the Health Care Fraud Enforcement Act provides the resources needed for law enforcement to uncover and go after these frauds. Health care fraud cannot be fought effectively without more investigators and prosecutors. This bill authorizes the appropriation of $20,000,000 each year from 2011 through 2016 for investigations, prosecutions, and civil or other proceedings relating to fraud and abuse in connection with any health care benefit program. The bill authorizes the United States Attorneys' Offices to be appropriated an additional $10,000,000 each year for this purpose, the Criminal Division of the Department of Justice, $5,000,000 each year, and the Civil Division of the Department of Justice, $5,000,000 each year.

As we move toward meaningful health care reform, we must ensure that criminals who engage in health care fraud, and those who contemplate doing so, understand that they face swift prosecution and substantial punishment. Congress should move quickly to pass this legislation so that American taxpayers can be confident that their government has the tools and resources necessary to protect its investment in the health and welfare of our Nation.

I urge my colleagues to support the Health Care Fraud Enforcement Act of 2009.