Floor Statements

Mr. Speaker, I am writing to honor the life of John ``Jack'' Edward Bresch, a long time health advocate who worked with us in Congress to improve our health care system--especially focusing on access to care for lower income children and families. Jack passed away on September 1, 2012 surrounded by family, under the care of hospice, after a brief and courageous battle with pancreatic cancer.

I first got to know Jack through his work as a lead lobbyist for the Catholic Health Association. He served as a key component of CHA's government affairs team from 1983 to 2000. A highlight of his time at CHA was to work closely with then First Lady Hillary Rodham Clinton and her White House team to develop and promote a plan for reforming the nation's health care system. He then went on to work for the American Dental Education Association until the time of his death.

In both of these positions, Jack was a tireless advocate for improving our health care system so that everyone has access to affordable, quality health care. With the dental schools, he was especially focused on improving access to dental care for low-income children. This is a serious problem in our country that was spotlighted by the wrongful death of twelve-year old Demonte Driver of Maryland.

Demonte was on Medicaid and died after complaining of a toothache when his mother could not find a dentist who would accept Medicaid to treat him. While they tried to find a dentist, his infection spread to his brain and he tragically died. Jack didn't want any more Demonte Drivers and he worked relentlessly for improvements in Medicaid to prevent this from happening again. He first helped make some incremental improvements to the law, but was most pleased when the Affordable Care Act became the law of the land--and was upheld by the Supreme Court.

Looking forward, affordable, quality health care will finally be a reality for all American families. And, thanks in no small part to Jack's efforts, pediatric dental care is an essential health benefit that must be covered by qualified health plans.

Jack and I shared a fundamental commitment to social justice, though I must admit that the roots of our commitment developed differently. Jack began his adult life as a Catholic priest and went on to serve as a Navy Chaplain during the Vietnam War. He left the priesthood many years ago, but he never wavered from his steadfast belief in social justice. He carried that forward in his career, his life, and his relationships.

Jack was a common figure to see barge into your office, join a meeting, or run into in the hall. He always had a big smile on his face. If I had to use one word to describe Jack, it would be gregarious. He seemed larger than life and was so full of positive energy.

Jack leaves behind a loving family that includes his wife, JoAnn; his children, Mary Elizabeth, James Richard, and Jeffrey John; and 10 grandchildren who all knew how much their grandfather loved them. He also leaves behind many colleagues and friends who are grateful to his commitment to our nation's health and who will miss him dearly.

Jack's final honor will be buried with full military honors at Arlington National Cemetery on January 24, 2013.

I want to thank the gentleman for yielding. One of the previous Speakers, Mr. O'Neill, mentioned that, and you forgot to mention this, but Tip O'Neill said that I probably had one of the best 5-minute speeches of any new Member of Congress, and if I could only learn to deliver it in less than 20 minutes, I'd have a great career here.

George is right: we ran against each other. And when you grow up in the Bay Area and you have people like Barbara Lee who leads in courage in being the lone vote against one of the unpopular wars, you learn what courage is and you learn with people who fight for children, for minorities, for all of the people in our area who need help. I'm just proud to have worked with them.

They've said that I'm the fifth oldest Member of Congress. That's absolutely wrong. I am the 430th youngest Member of Congress, and I just want to make sure that you get that straight in the Record.

Thank you, George. I'm honored, and I am particularly honored to be part of this great Bay Area delegation. In our 10 districts surrounding the Bay Area, we have, I think, the finest legislative group in the United States. Thank you very much.

Mr. Speaker, I rise today to pay tribute to the 40th anniversary of the creation of the Don Edwards San Francisco Bay National Wildlife Refuge, the first urban national Wildlife Refuge established in the United States. The Refuge is dedicated to preserving and enhancing wildlife habitat, protecting migratory birds, protecting threatened and endangered species, and providing opportunities for wildlife-oriented recreation and nature study for the surrounding communities of the south San Francisco Bay area.

As of 2004, the Refuge spans 30,000 acres of diverse habitats throughout South San Francisco Bay, including open bay, salt ponds, salt marshes, mudflats, upland areas and vernal pools. Located along the Pacific Flyway, the Refuge hosts over 280 species of birds each year. Millions of shorebirds and waterfowl stop to refuel at the Refuge during the spring and fall migration. In addition to its seasonal visitors, the Refuge provides critical habitat to resident species like the endangered California clapper rail and salt marsh harvest mouse. Today, hundreds of thousands of people visit the Refuge each year to enjoy its diverse wildlife and habitats.

The Don Edwards San Francisco Bay National Wildlife Refuge is part of a complex of six other wildlife refuges in the San Francisco Bay Area. Created by legislation signed by President Richard Nixon in 1972 as the San Francisco Bay National Wildlife Refuge, and administered since then by the U.S. Fish and Wildlife Service, it was renamed the Don Edwards San Francisco Bay National Wildlife Refuge in 1995 in recognition of Congressman Don Edwards' efforts to protect sensitive wetlands in the South San Francisco Bay.

I join in congratulating the Don Edwards San Francisco Bay National Wildlife Refuge on its 40th anniversary and I applaud the commitment of all who have contributed over these many years to preserving and protecting our precious San Francisco Bay.

Mr. Speaker, I rise today to congratulate J. Haley Durham Elementary School of Fremont, California, on its recent designation as a 2012 National Blue Ribbon School. The National Blue Ribbon Schools Program recognizes public and private elementary, middle, and high schools where students exemplify high performance levels or where significant improvements have been made in students' levels of academic achievement. Since Teresa Bonaccorsi became principal of Durham Elementary in 2010, it has made drastic improvements in test scores to become part of the prestigious group of schools who receive the award.

Just three years ago, Durham Elementary was part of the California Department of Education's Program Improvement list that tracks the progress of schools that have failed to meet the state's requirement of adequate yearly progress. Since taking the position as principal in early 2010 Mrs. Bonaccorsi has

led her school to improve its Academic Performance Index by 129 points, far exceeding the growth targets set by the state department.

Principal Bonaccorsi came to Durham Elementary School with experience as a classroom teacher, literacy coach, and district administrator. With a supportive staff and team of dedicated teachers, she has led an impressive improvement path for her students, a third of whom are from low-income families. James Morris, Fremont's superintendent of schools, praised Principal Teresa Bonaccorsi for leading the quick turnaround. ``When Teresa became principal, she got the staff on board, and they have done an incredible job,'' he said. ``You feel the pride in that school when you go there for what they've accomplished.''

It is essential to note that Principal Bonaccorsi would not have been able to reach this achievement without the support of the teachers, staff, parents, and the students themselves. It is evident that Principal Bonaccorsi has had a vast array of support, and everyone associated with the school should feel a sense of pride for working together to achieve success.

And I too could not be more proud of Durham Elementary's accomplishments. When the school was included on the Program Improvement list, parents had the option to move their children to another school, but they gave Mrs. Bonaccorsi a chance to turn the school around and I am happy they did. I have been a longtime advocate for equity and improvement in our public school system; I am honored to have such dedicated individuals in my district who exemplify those same goals. Principal Bonaccorsi is undeniably such an individual and I invite my colleagues to join me in congratulating her and her school on this prestigious award.

Mr. Speaker, I rise today to pay tribute to Lynn Bravewomon, a resident of Rayward, California. Lynn was recently honored for her outstanding efforts to eliminate homophobic behavior and bullying in Hayward schools. On September 29, 2012, Ms. Bravewomon received the annual Pryor Conrad Award from GLOBE (Gays and Lesbians Organized for Betterment and Equality of Alameda County) for her exemplary efforts.

The Pryor Conrad Award is presented to an individual or group for outstanding service to the LGBT community. As the 2012 award recipient, Ms. Bravewomon exceeded all the qualifications.

Lynn Bravewomon has been actively supporting students, teachers and the Hayward community for over 20 years, working tirelessly for a safe school environment for LGBT students. She has made significant contributions to achieve this goal.

Her contributions include creating Safe Learning Environments for LGBT students; authoring a resolution for No Name-Calling Week and the use of inclusive curricula; facilitating the committee developing the current Hayward Unified School District's Safe and Inclusive School Program; establishing No-Name Calling Week, Ally Week and Day of Silence as annual district-wide events affecting more than 15,000 students each year; facilitating the development of a 9th grade health curriculum that addresses standards related to healthy relationships, inclusive of sexual orientation and all gender expression; producing the film ``GSA Students Speak Out for School'' in collaboration with the Middle School Film Club; providing support for Gay Straight Alliances for middle and high schools and developing a manual for Ally Clubs for elementary schools and participating in the creation of the Hayward Unified School District's Equity Action Plan.

I have listed a few of Ms. Bravewomon's many outstanding contributions. She has truly made a difference in the lives of others through her tireless commitment and exemplary efforts. Her service is a model to follow. I join Lynn Bravewomon's friends, colleagues and admirers in appreciation for her advocacy on behalf of students, teachers and the Hayward community for a safe school environment for LGBT students.

Mr. Speaker, I rise today with my colleagues John Lewis (D-GA) and Gary Peters (D-MI), to introduce the Computers for Our Communities Act. This legislation will extend a provision in the tax code that encourages companies to donate computer equipment to schools and libraries.

I have a long history with this tax provision. In the early 1980s I met a young Steve Jobs who had the pioneering vision to put a computer into every classroom in America. However, when companies like Apple donated to schools, the deduction was limited to their cost of manufacturing the computer. Companies had no incentive to donate computers and software to our public schools. With bipartisan support in the House and Senate, we amended the tax code and created an enhanced tax deduction to encourage companies to donate computers to our schools.

Until 2012, Section 170 of the tax code enabled a corporation to take an enhanced deduction when they donated computer equipment to a public school, a library, or other educational institutions. We found a middle ground that allowed companies to deduct more than their cost of manufacturing a computer, but less than the fair market value when they provided this public service by donating computer equipment.

Nearly 30 years after this provision was first added to the tax code, a computer in classroom is no longer a revolutionary idea. Computer literacy is an even more important issue in a world with so much changing technology. Yet this tax deduction is once again on the chopping block. The section of the tax code that allows companies to take an enhanced tax deduction when computer equipment or software is donated to a school, library, or similar institutions, expired at the end of 2011. With this legislation, we can retroactively enact this tax provision and extend it through the end next year so there is no lapse in coverage.

Without this legislation, I worry we won't see donations of computer equipment to our public schools. Even adults who learn computer skills through community programs and public libraries will have to use aging technology. Our schools and our cities are already stretched by budget cuts and we need to do whatever we can to make sure that everyone has the ability to become computer literate.

The Computers for Our Communities Act will restore this tax provision through December 2013 and ensure that America's students

will continue to have access to the latest technological innovations. If we are serious about our commitment to having a computer in every classroom in America, we will pass this legislation.

Mr. Speaker, I rise to introduce the Medicare Secondary Payer and Late Enrollment Penalty Family Fairness Act. Today, the Social Security Act uses different definitions of familial relationships for purposes of Medicare secondary payer rules and late enrollment penalty protections. Beneficiaries over age 65 are subject to a more restrictive definition than younger beneficiaries who are eligible for Medicare due to disability. My legislation fixes that anomaly by creating a uniform definition so that Medicare beneficiaries of all ages are treated equally. I would like to thank my constituent Joseph Goleman for bringing this problem to my attention.

Medicare's secondary payer rules generally allow an individual to maintain employer-sponsored coverage after they've obtained Medicare eligibility and forgo joining Medicare Part B (and therefore having to pay the Part B monthly premium) as long as they maintain such coverage. In these instances, their employer-sponsored coverage remains their primary coverage, and Medicare Part A is their secondary coverage. Very importantly, the law also protects people in this situation who then transition to Medicare Part B when they lose that employer-sponsored coverage. The law shields these beneficiaries from the late enrollment penalty because they've maintained consistent coverage and therefore carry no adverse risk for Medicare. This is a key benefit as the late enrollment penalty is a substantial financial hit.

These rules exist because they are a win for beneficiaries with access to employer-sponsored coverage and a win for taxpayers. Beneficiaries gain because employer-sponsored coverage usually has lower cost sharing than Medicare and typically has lower deductibles as well. Plus, taxpayers win because Medicare isn't responsible for many new health costs for these individuals because they are being primarily covered by their employer's plan.

For people who become eligible for Medicare based on disability, the current law provides that these Medicare Secondary Payer and Late Enrollment Penalty rules apply to the beneficiary and his or her ``family member.'' For people who become eligible for Medicare by reason of turning 65, these protections only apply to the beneficiary or their ``spouse.''

The practical impact of these different definitions of familial relationships is that a person eligible for Medicare based on disability is protected from late enrollment penalties when covered by a same sex spouse on his or her employer plan. However, a person eligible for Medicare because they've turned 65 is not.

I learned of this problem after I received a constituent inquiry in my Fremont, California office. Joseph Coleman is a 34-year-old person with a disability and is enrolled in Medicare on that basis. After becoming enrolled in Medicare, he learned that he could obtain spousal coverage and thereby avoid having to pay the Part B premium. He was also rightly informed that he'd be eligible to rejoin Medicare Part B-- without paying a penalty--if that spousal coverage changed.

Imagine Joseph's surprise, anger, and fear when he went to exercise that right to rejoin Medicare Part B and he was told by a local Social Security office in our community, that that right didn't extend to him because he was in a same-sex marriage. Instead, he would be subject to a significant late enrollment penalty, which made Medicare Part B coverage entirely unaffordable for him.

Thankfully, Joseph reached out to me. My staff quickly discovered that he was, in fact, guaranteed the protection to rejoin Medicare without penalty. After several go 'rounds with the local Social Security office by my staff and Medicare's Region 9 staff, we were able to get Joseph the benefits to which he was due. However, it is clear to me that because there are two different standards in the law, mistakes are made and people are likely losing benefits to which they are entitled under current law. This certainly would have been the case with Joseph if I hadn't intervened.

Regardless of your position on same-sex marriage, revising the law to have a standard definition using ``family member'' for the Medicare secondary payer rules and the late enrollment penalty protection simply makes financial sense for Medicare. By converting to the term ``family member,'' we steer clear of stepping into any debate over the Defense of Marriage Act. While I oppose that law and would strongly support its repeal, that's not the fight we're waging today.

The simple goal of this bill is to right a wrong, which was brought to my attention by a constituent. If left unchanged, not only does the law treat Medicare beneficiaries in identical situations differently, it obviously results in confusion for those who enforce the law. I am sure more people than Joseph Coleman have been wrongly denied benefits based on misinterpretation of the convoluted law--potentially accented by personal prejudices.

I urge my colleagues to join with me in support of this small bill that affects few people, but simply clarifies the law. It will mean the difference between people obtaining quality, affordable coverage through Medicare Parts A&B, or being left behind.

Mr. Speaker, I rise today to pay tribute to Jose Joel Garcia, who is retiring from his position as Chief Executive Officer of Tiburcio Vasquez Health Center, Inc., a multi-site and multi-service community health center in Southern Alameda County, California. Mr. Garcia has provided exemplary leadership to Tiburcio Vasquez Health Center since August 1992 and has expanded the organization to include a myriad of clinical and social services through multiple facilities.

Prior to his appointment as CEO of Tiburcio Vasquez, Mr. Garcia held academic appointments at UC Berkeley's Graduate School of Public Health and the Graduate School of Business at the University of Colorado. Between 1982 and 1993, he helped develop and direct a multidisciplinary bi-national graduate student exchange program known as the University of California-Universidad de Guadalajara ``Intercambio Academico.''

Mr. Garcia received his undergraduate degree in Political Science from the University of California, Santa Barbara and a law degree from the Boalt School of Law at the University of California, Berkeley. He is an active member of state and federal bars and has published research on health policy, law and administration in the United States and abroad. His professional and social justice contributions have advanced health access through the creation of a local, statewide and national nonprofit health care infrastructure and a focus on strengthening community-based self-governance at health centers.

In recognition of his contributions, Mr. Garcia has received numerous awards. He currently serves on the Executive Committee and the Board of Directors of the Primary Care Association, which he co-founded. He is a Board Member of the Alameda Health Consortium and Community Health Center network. His past affiliations include directing Centro Legal de La Raza, co-founding the Berkeley Primary Access Clinic, and past Chairperson and Board Member of Eden Medical Center. He served for five years on the Board of Directors of the University of California, Berkeley Alumni Association.

I join Jose Joel Garcia's colleagues, friends and family in applauding his outstanding career in numerous arenas to benefit others. While he is stepping down from his CEO role at Tiburcio Vasquez Health Center, he will remain affiliated with the organization in some capacity. This is good news as Mr. Garcia has played a major role in shaping health care delivery in Alameda County. We will welcome his continuing leadership skills, talent, intellect, and experience.

Mr. Speaker, I rise in opposition to H.R. 8. I cannot support legislation that prioritizes millionaires over middle class families. By bringing this legislation to the floor, Republicans hold hostage the middle class tax cuts in order to help those who need it least. If enacted, this bill would give millionaires an average tax cut of $160,000 next year. Hedge fund managers and corporate CEOs who make up the wealthiest 2 percent of this country do not need a massive tax break. The Republican tax plan on the floor today not only favors millionaires, it takes away tax programs that help working families. Under this legislation, 25 million families and college students in this country will lose as much as $1,000 because of cuts to the Earned Income Tax Credits, the Child Tax Credit, and the American Opportunity Tax Credit. It is these lower and

middle income families that deserve our help. It is time to start creating a tax code that reflects our values by ensuring that every individual pays their fair share.

I stand with the House Democrats, the Senate and the President in supporting an extension of the middle class tax cuts. Working Americans are facing high unemployment and stagnant wages. They should have the certainty to know that they will not face a tax increase next year. Extending the middle class tax cuts means helping 114 million middle class families, including 13.2 million in California. If the House extends the middle class tax cuts--already passed by the Senate--these families will save an average of $2,200 on next year's taxes.

This country cannot afford to keep giving out tax breaks to the wealthy and large corporations. This Republican bill adds another $50 billion to our deficit in just one year. This is the wrong approach and is just plain irresponsible. We need to strengthen the middle class, put people back to work, and grow our economy. The first step is introducing fairness to our tax code and helping the middle class Americans who work hard and play by the rules. I urge my colleagues to join me in voting against the Republican giveaway to the most wealthy and to instead support the Democratic substitute which protects the middle class.

Mr. Chair, I rise in opposition to H.R. 6082, the so- called ``Congressional Replacement of President Obama's Energy- Restricting and Job-Limiting Offshore Drilling Plan.'' This bill opens up nearly every last piece of our public lands to drilling, giving even more to Big Oil. The bill would require oil and gas leasing off the East Coast, from Maine to South Carolina, off of Southern California and in the important fishery of Bristol Bay off Alaska. It opens up California's coastline to oil and gas companies as early as 2013. If this bill were to become law, areas that have previously been deemed off limits to oil development by state governments would be put up for lease.

This bill also fails to secure safety reforms for offshore drilling, nor does it ensure that oil companies are paying their fair share to drill on public lands. The California Coastline is an international treasure and is one of the primary drivers of our state's economy. We must protect our coastlines and the vital ecosystems they embody. We cannot place it at risk of an oil spill or give it away to reckless, profit-seeking oil companies. We cannot and will not drill our way to energy independence. Continuing to make our cars more efficient, investing in clean and renewable energy, ending subsidies and tax breaks for the fossil fuel industry, and putting a price on carbon emissions is how we can obtain a secure and sustainable energy future.

I urge my colleagues to oppose this senseless and harmful legislation by joining me in voting ``no.''

Mr. Chairman, I move to strike the requisite number of words.

I'd like to first thank my friend, Ms. Lee, for bringing up this important amendment. She knows so well that the less experience people in this body have had with the military, the fiercer they are. That goes to the Republicans wanting to exceed their own funding cap in the Budget Control Act by $8 billion. This is a moderate amendment to bring us back under the Budget Control Act.

This is the 12th year that we've been fighting and funding a war in Afghanistan and that area; and there's no peace, there's nothing, no stability. The war in Afghanistan has basically

contributed to our instability. Nothing has happened over there. Since 2001, we have spent $600 billion or $700 billion on this Afghani war alone, and the Defense Department appropriations bill wants another $600 billion.

Republicans like to talk about entitlements like Medicare driving the debt. Well, let me tell you, defense spending has become just as much of an entitlement, with a team of lobbyists and Members of this body who are more interested in protecting defense contractors than protecting our country's health, education, and economic growth.

This bill ignores administration proposals to delay or terminate military programs while providing funding instead for weapons that the Department of Defense doesn't want, doesn't need, and won't work. Apparently, funding wars and weapons instead of better health care, education, and repairing our infrastructure are more important to the Republican majority than all other issues.

I urge my colleagues to support this commonsense amendment and start reining in our out-of-control defense budget.

I yield back the balance of my time.

Mr. Chair, I rise today in opposition to H.R. 5856, the Department of Defense Appropriations Act for fiscal year 2013. Until we can rein in defense spending and treat it like all other federal programs facing damaging funding cuts, I cannot support yet another bloated defense budget. Republicans talk about how entitlements like Medicare are driving the debt. But it is clear that defense spending has become just as much of an entitlement, complete with a team of lobbyists and members of this body that are more interested in protecting defense contractors than protecting our country.

This bill marks the 12th fiscal year the United States has been fighting and funding the War in Afghanistan. During this time, we have pursued a variety of strategies and plans--none of which have delivered peace and stability to Afghanistan or the region. The War has, however, contributed to fiscal instability in our own country. Since 2001, we have spent $634 billion on the Afghanistan War alone. This appropriations bill is going to cost another $608.2 billion that we do not have. Yet the cycle continues.

This year's bill exceeds the Republicans' own funding caps set by the Budget Control Act by almost $8 billion. This bill ignores administration proposals to delay or terminate several military programs while providing funding for weapons programs the DoD said it doesn't want or need. Apparently, funding wars and weapons instead of better health care, education, and repairing our crumbling infrastructure are more important to the Republican Majority. It is unconscionable for us to be cutting these vital programs at the same time we're increasing the defense budget. That is why I joined with Representative Barbara Lee (D-CA) to offer an amendment to cut that $8 billion from the defense appropriations bill.

I urge my colleagues to support this commonsense amendment and join me in voting against this out of control defense spending bill.

Mr. Speaker, Don Berwick was Acting Administrator of the Centers for Medicare and Medicaid Services for President Obama. Unfortunately, the minority party in the U.S. Senate was able to prevent him from being confirmed into the post and so he was forced to leave at the end of 2011.

I've copied below a recent commencement address at Harvard Medical School by Dr. Berwick.

If Dr. Berwick doesn't embody the spirit we want for our medical professionals--as well as our public servants--I don't know who does.

I urge my colleagues to read this speech. Driving people like Dr. Berwick out of public service is not something of which anyone should be proud.

[From JAMA, June 27, 2012]

To Isaiah

(By Donald M. Berwick, MD, MPP)

THANK YOU FOR LETTING ME SHARE THIS GLORIOUS DAY with you

and your loved ones. Feel good. Feel proud. You've earned it.

In preparation for today, I asked your dean of students

what she thinks is on your mind. So, she asked you. The word

you used--many of you--was this one: Worried. You're worried

about the constant change around you, uncertain about the

future of medicine and dentistry. Worried about whether you

can make a decent living. You've boarded a boat, and you

don't know where it's going.

I can reassure you. You've made a good choice--a

spectacularly good choice. The career you've chosen is going

to give you many moments of poetry. My favorite is the moment

when the door closes--the click of the catch that leaves you

and the patient together in the privacy--the sanctity--of the

helping relationship. Doors will open too. You'll find ways

to contribute to progress that you cannot possibly anticipate

now, any more than I could have dreamed of standing here when

I was sitting where you are 40 years ago.

But look, I won't lie; I'm worried too. I went to

Washington to lead the Centers for Medicare & Medicaid

Services, full of hope for our nation's long-overdue journey

toward making health care a human right here, at last. In

lots of ways, I wasn't disappointed. I often saw good

government and the grandeur of democracy--both alive, even if

not at the moment entirely well.

But, like you, I also found much that I could not control--

a context torn apart by antagonisms--too many people in

leadership, from whom we ought to be able to expect

more, willing to bend the truth and rewrite facts for their

own convenience. I heard irresponsible, cruel, baseless

rhetoric about death panels silence mature, compassionate,

scientific inquiry into the care we all need and want in the

last stages of our lives. I heard meaningless, cynical

accusations about rationing repeated over and over again by

the same people who then unsheathed their knives to cut

Medicaid. I watched fear grow on both sides of the political

aisle--fear of authentic questions, fear of reasoned debate,

and fear of tomorrow morning's headlines--fear that stifled

the respectful, civil, shared inquiry upon which the health

of democracy depends.

And so, HSDM and HMS Class of 2012, I'm worried too. I too

wonder where this boat is going.

There is a way to get our bearings. When you're in a fog,

get a compass. I have one--and you do too. We got our compass

the day we decided to be healers. Our compass is a question,

and it will point us true north: How will it help the

patient?

This patient has a name. It is ``Isaiah.'' He once lived.

He was my patient. I dedicate this lecture to him.

You will soon learn a lovely lesson about doctoring; I

guarantee it. You will learn that in a professional life that

will fly by fast and hard, a hectic life in which thousands

of people will honor you by bringing to you their pain and

confusion, a few of them will stand out. For reasons you will

not control and may never understand, a few will hug your

heart, and they will become for you touch points--signposts--

like that big boulder on that favorite hike that, when you

spot it, tells you exactly where you are. If you allow it--

and you should allow it--these patients will enter your soul,

and you will, in a way entirely right and proper, love them.

These people will be your teachers.

Isaiah taught me. He was 15 when I met him. It was 1984,

and I was the officer of the day--the duty doctor in my

pediatric practice at the old Harvard Community Health Plan.

My nurse practitioner partner pointed to an exam room. ``You

better get in there,'' she said. ``That kid is in pain.''

He was in pain. Isaiah was a tough-looking, inner-city kid.

I would have crossed the street to avoid meeting him alone on

a Roxbury corner at night. I'm not proud of that fact, but I

admit it. But here on my examining table he was writhing,

sweating in pain. He was yelling obscenities at the air, and,

when I tried to examine him, he yelled them at me. ``Don't

you f-----g touch me! Do something!''

I didn't figure out what was going on that afternoon.

Nothing made sense. I diagnosed, illogically, a back sprain,

and I sent him home on analgesics. Then, that evening, the

report came: an urgent call from the lab. Isaiah didn't have

a back sprain; he had acute lymphoblastic leukemia. And we

didn't have his phone number.

The police helped track him down that night, to a lonely

three-decker, third floor, a solitary house in a weedy lot on

Sheldon Street in the heart of Roxbury. Isaiah lived there

with his mother, brothers, and his mother's foster children.

What followed was the best of care . . . the glory of

biomedical science came to Isaiah's service. Chemotherapy

started, and he went predictably into remission. But we knew

that ALL in a black teenager behaves badly. Unlike in younger

kids, cure was unlikely. He would go into remission for a

while, but the cancer would come back and it would kill him.

Three years later, he relapsed.

I drove to his apartment one evening in 1987 and sat with

Isaiah and his graceful, dignified mother around a table with

a plastic red-checkered tablecloth and explained the only

option we knew for possible cure--a bone marrow transplant,

not when he felt sick, but now, at the first sign of relapse,

when he was still feeling fine. He was feeling fine, and I

was there to propose treatment that might kill him.

They didn't hesitate. Isaiah wanted to live. He got his

transplant, from his brother. His course was stormy,

admission after admission followed, then chronic

complications of his transplant--diabetes and asthma. His

Children's Hospital medical record that year took up five

four-inch-thick volumes. But he got through. Isaiah was

cured.

We became very close, Isaiah and I, through this time and

for years after--long conversations about his life, his

hopes, his worries. He always asked me about my kids. And his

mother, close, as well. An angel--a tough angel raised by her

sharecropper grandfather on a North Carolina farm, who read

Isaiah the not act when she had to and who fiercely protected

him--and who, during the darkest times of his course,

continued to tend her ten foster children, as well as her

own.

I came to know Isaiah well, but it wouldn't be quite right

to call us friends--our worlds were too far apart--different

galaxies. But my respect and affection for Isaiah grew and

grew. His courage. His insight. His generosity.

But there is more to tell.

Isaiah smoked his first dope at age 5. He got his first gun

before 10, and, by 12, he had committed his first armed

robbery; he was on crack at 14. Even on chemotherapy, he was

in and out of police custody. For months after his transplant

he tricked me into extra prescriptions for narcotics, which

he hoarded and probably sold. Two of his five brothers were

in jail--one for murder; and, two years into Isaiah's

treatment, a third brother was shot dead--a gun blast through

the front door--in a drug dispute.

Isaiah didn't finish school, and he had no idea of what to

do for legitimate work. He got and lost job after job for not

showing up or being careless. His world was the street corner

and his horizon was only one day away. He saw no way out. He

hated it, but he saw no way out. He once told me that he

thought his leukemia was a blessing, because at least while

he was in the hospital, he couldn't be on the streets.

And Isaiah died. One night, 18 years after his leukemia was

cured, at 37 years of age, they found him on a street corner,

breathing but brain-dead from a prolonged convulsion from

uncontrolled diabetes and even more uncontrolled despair.

Isaiah tried to phone me just before that fatal convulsion.

He had my home number, and I still have the slip of paper on

which my daughter wrote, ``Isaiah called. Please call him

back.'' I never did. He would have said, ``Hi, Dr Berwick.

It's Isaiah. I'm really sick. I can't take it. I don't know

what to do. Please help me.'' Because that is what he often

said.

Isaiah spent the last two years of his life in a vegetative

state in a nursing home where I sometimes visited him. At his

funeral, his family asked me to speak, and I could think of

nothing to talk about except his courage.

Isaiah, my patient. Cured of leukemia. Killed by

hopelessness.

I bring Isaiah today as my witness to two duties; you have

both. It's where your compass points.

First, you will cure his leukemia. You will bring the

benefits of biomedical science to him, no less than to anyone

else. Isaiah's poverty, his race, his troubled life-line--not

one of these facts or any other fact should stand in the way

of his right to care--his human right to care. Let the

Supreme Court have its day. Let the erratics and vicissitudes

of politics play out their careless games. No matter. Health

care is a human right; it must be made so in our nation; and

it is your duty to make it so. Therefore, for your patients,

you will go to the mat, and you will not lose your way. You

are a physician, and you have a compass, and it points true

north to what the patient needs. You will put the patient

first.

But that is not enough. Isaiah's life and death testify to

a further duty, one more subtle--but no less important. Maybe

this second is not a duty that you meant to embrace; you may

not welcome it. It is to cure, not only the killer leukemia;

it is to cure the killer injustice.

Antoine de Saint-Exupery wrote, ``To become a man is to be

responsible; to be ashamed of miseries that you did not

cause.'' I say this: To profess to be a healer, that is, to

take the oath you take today, is to be responsible; to be

ashamed of miseries that you did not cause. That is a heavy

burden, and you did not ask for it. But look at the facts.

In our nation--in our great and wealthy nation--the wages

of poverty are enormous. The proportion of our people living

below the official poverty line has grown from its low point

of 11% in 1973 to more than 15% today; among children, it is

22%--16.4 million; among black Americans, it is 27%. In 2010,

more than 46 million Americans were living in poverty; 20

million, in extreme poverty--incomes below $11 000 per year

for a family of four. One million American children are

homeless. More people are poor in the United States today

than at any other time in our nation's history; 1.5 million

American households, with 2.8 million children, live here on

less than $2 per person per day. And 50 million more

Americans live between the poverty line and just 50% above

it--the near-poor, for whom, in the words of the Urban

Institute, ``The loss of a job, a cut in work hours, a

serious health problem, or a rise in housing costs can

quickly push them into greater debt, bankruptcy's brink, or

even homelessness.'' For the undocumented immigrants within

our borders, it's even worse.

For all of these people, our nation's commitment to the

social safety net--the portion of our policy and national

investment that reaches help to the disadvantaged--is life's

blood. And today that net is fraying--badly. In 2010, 20

states eliminated optional Medicaid benefits or decreased

coverage. State Social Services Block Grants and Food Stamps

are under the gun. Enrollment in the TANF program--Temporary

Assistance to Needy Families--has lagged far behind the need.

Let me be clear: the will to eradicate poverty in the United

States is wavering--it is in serious jeopardy.

In the great entrance hall of the building where I worked

at CMS--the Hubert Humphrey Building, headquarters of the

Department of Health and Human Services--are chiseled in

massive letters the words of the late Senator Humphrey at the

dedication of the building in his name. He said, ``The moral

test of government is how it treats people in the dawn of

life, the children, in the twilight of life, the aged, and in

the shadows of life, the sick, the needy, and the

handicapped.''

This is also, I believe, the moral test of professions.

Those among us in the shadows--they do not speak, not loudly.

They do not often vote. They do not contribute to political

campaigns or PACs. They employ no lobbyists. They write no

op-eds. We pass by their coin cups outstretched, as if

invisible, on the corner as we head for Starbucks; and

Congress may pass them by too, because they don't vote, and,

hey, campaigns cost money. And if those in power do not

choose of their own free will to speak for them, the silence

descends.

Isaiah was born into the shadows of life. Leukemia could

not overtake him, but the shadows could, and they did.

I am not blind to Isaiah's responsibilities; nor was he. He

was embarrassed by his failures; he fought against his

addictions, his disorganization, and his temptations. He

tried. I know that he tried. To say that the cards were

stacked against him is too glib; others might have been able

to play his hand better. I know that; and he knew that.

But to ignore Isaiah's condition not of his choosing, the

harvest of racism, the frailty of the safety net, the

vulnerability of the poor, is simply wrong. His survival

depended not just on proper chemotherapy, but, equally, on a

compassionate society.

I am not sure when the moral test was put on hold; when it

became negotiable; when our nation in its political discourse

decided that it was uncool to make its ethics explicit and

its moral commitments clear--to the people in the dawn, the

twilight, and the shadows. But those commitments have never

in my lifetime been both so vulnerable and so important.

You are not confused; the world is. You need not forget

your purpose, even if the world does. Leaders are not leaders

who permit pragmatics to quench purpose. Your pur pose is to

heal, and what needs to be healed is more than Isaiah's bone

marrow; it is our moral marrow--that of a nation founded on

our common humanity. My brother, a retired schoolteacher,

tells me that he always gets goose bumps when he reads this

phrase: ``We, the people . . . We--you, and me, and Isaiah--

inclusive.

It is time to recover and celebrate a moral vocabulary in

our nation--one that speaks without apology or hesitation of

the right to health care--the human right--and, without

apology or hesitation, of the absolute unacceptability of the

vestiges of racism, the violence of poverty, and blindness to

the needs of the least powerful among us.

Now you don your white coats, and you enter a career of

privilege. Society gives you rights and license it gives to

no one else, in return for which you promise to put the

interests of those for whom you care ahead of your own. That

promise and that obligation give you voice in public

discourse simply because of the oath you have sworn. Use that

voice. If you do not speak, who will?

If Isaiah needs a bone marrow transplant, then, by the oath

you swear, you will get it for him. But Isaiah needs more. He

needs the compassion of a nation, the generosity of a

commonwealth. He needs justice. He needs a nation to recall

that, no matter what the polls say, and no matter what

happens to be temporarily convenient at a time of political

combat and economic stress, that the moral test transcends

convenience. Isaiah, in his legions, needs those in power--

you--to say to others in power that a nation that fails to

attend to the needs of those less fortunate among us risks

its soul. That is your duty too.

This is my message from Isaiah's life and from his death.

Be worried, but do not for one moment be confused. You are

healers, every one, healers ashamed of miseries you did not

cause. And your voice--every one--can be loud, and forceful,

and confident, and your voice will be trusted. In his honor--

in Isaiah's honor--please, use it.

Donald M. Berwick, MD, MPP

Mr. Speaker, I don't think I look much like Bill Murray, or have his wit, but I sure feel like him in his role in ``Groundhog Day.''

There are pressing issues facing our country--mainly the need to get our economy back on track and start creating jobs. But, my Republican colleagues refuse to allow us to focus on that vital priority.

Instead, we are here for the 31st time in this Congress to consider repeal of the health reform law.

Nevermind that the House already passed repeal of the health care law early in 2011 and that bill is still sitting in the Senate awaiting their consideration.

Nevermind that 29 other bills have repealed particular provisions of the law.

No, we are going to once again take the time of this Congress to pass a bill that doesn't need to be passed because my Republican colleagues are mad at the Supreme Court for upholding the law.

We know that House Republicans don't intend for the Senate to take this bill seriously because they are rushing this bill to the floor today before the Congressional Budget Office has even had the opportunity to provide a score for health reform repeal. With that analysis, we would know the cost or savings associated with health reform repeal. But, Republicans don't feel any need for being informed before they vote because they know they hate health reform and they'll vote to repeal it no matter what.

Well, with a Congress that behaves like this, none of us should wonder why our approval ratings are at 12%.

What my Republican colleagues steadfastly refuse to acknowledge is that health reform is already helping people and repealing it will have serious negative consequences for millions of Americans.

Should Republicans succeed in their blind drive to repeal health reform:

6.6 million young adults would lose the guarantee of being allowed to obtain insurance coverage on their parents' health insurance plans.

17 million children with pre-existing conditions could again be denied health insurance coverage.

105 million Americans would again be subject to lifetime limits on health insurance--which could stop coverage when they need it most.

12.8 million Americans who are due over $1 billion in rebates from the health insurance industry this year would never see that financial relief.

The more than 5.3 million Medicare beneficiaries who have been helped with high drug costs would see that assistance disappear.

The 86 million people who have already received life-saving preventive benefits free-of-charge would lose access to that vital benefit.

The list goes on and on.

Repeal of ObamaCare is not what the American people want. When I go home, parents thank me for health reform because their children who are recent college graduates have health insurance, their parents on Medicare saved money on their prescription drugs, and they know they will soon not be locked-in to their current job for fear of losing health coverage. When they talk to me about what Congress should be doing, they emphasize, jobs, jobs, jobs.

I agree with my constituents. I urge my colleagues to vote ``no'' on this senseless political stunt of a bill and I implore my colleagues on the other side of the aisle to get on with the business that American's care about--jobs.

Madam Speaker, I rise today in reluctant support of the Transportation and Student Loan Agreement (H.R. 4348). We must prevent interest rates on student loans from doubling as they are set to do tomorrow. We must reauthorize our transportation programs and get people to work rebuilding our

infrastructure. This legislation, while far from ideal, accomplishes both of those worthy goals.

The bill does leave much to be desired. It invests far too little in the infrastructure investments we need, it restricts the ability of part-time students to afford college, underfunds transit, biking, and pedestrian projects, its ``Buy America'' provision is weak, and it includes a pay-for that could further weaken our pension system. However, given the situation we are in, passing it today is the responsible thing to do.

Continuing their trend of governing through hostage taking and brinksmanship, the Republican Majority has once again brought the nation to the edge of a vital program--in this case, Surface Transportation--expiring. More than three months ago, the Senate overwhelmingly passed a bipartisan, job-creating transportation bill with 74 votes. Instead of taking up that bill, as myself and many of my colleagues and the President urged, Republicans brought up a hyper- partisan bill that included numerous anti-environmental riders, gutted mass transit, and ended investments in pedestrian and bicycle infrastructure. Compared to that debacle, today's legislation is a vast improvement. It does not contain provisions mandating that the tar sands pipeline be built or that EPA rules on safe disposal of coal ash be undermined. Instead of slashing mass transit, it maintains funding. Most importantly, it will support more than 2 million American jobs, including 180,000 in California, rebuilding our nation and providing some certainty for California and other states to move forward with much needed infrastructure projects.

The student loan issue is another example, much like the payroll tax cut at the end of last year, of Republicans refusing to act in the interest of the American people until their hand is forced by overwhelmingly public opinion. On March 29th, House Republicans voted to allow student loan interest rates to double when they passed the Ryan Budget. They voted to increase rates on 7 million students, including 570,000 California students--the equivalent of a $1,000 education tax on these students and their families. After hearing an outcry from the public and feeling political pressure to act, the majority finally changed their tune. I wish that the interest rate fix we are voting on today was for longer than a year and I also wish we were not paying for it, in part, by punishing part-time students by taking away interest deferment for those students. But compared to allowing the interest rate hike staring millions of students in the face to go into effect, passing this legislation is the right thing to do.

Mr. Speaker, I rise today to honor the memory of my dear friend, Marion Sandler. A great American, philanthropist, and Democrat; Mrs. Sandler passed away at her home on Friday, June 1, 2012 at the age of 81. She is survived by her devoted husband of 51 years, Herb Sandler, their two children and two grandchildren. Marion's life exemplified the American dream; working hard, breaking down barriers and climbing the corporate ladder to success, earning the distinction as the first and longest serving woman chief executive officer in the United States. Mrs. Sandler and her husband would use their accomplishments to advance philanthropic causes and promote democracy. The Sandlers have made a commitment to the Giving Pledge, a charity where the participants pledge to give away the majority of their wealth to philanthropy.

Marion was born on October 17, 1930 in Biddleford, Maine, to immigrant parents whom ran a hardware store. She graduated from Wellesley College; and pursued her business interest at the Harvard- Radcliffe business administration program before earning an MBA from New York University. In 1955, Marion landed a job with Dominick & Dominick as their first female executive. She would stay on Wall Street for several more years before meeting her husband, Herb Sandler, and heading west, to San Francisco in 1961. I first met the Sandlers in 1963. When they offered to buy my Beacon Savings and Loan in Antioch, CA. Together, Marion and Herb purchased Golden West Savings and Loan. Starting with just two branches and twenty-six employees, the company eventually grew to 11,000 employees and 285 branches. I should have developed a partnership with them when I had the chance.

In the late 1980's the couple began seeking out philanthropic causes to support. Their search was methodical and they were adamant that whatever organization they supported was properly run and managed by people who would keep it that way. When they weren't satisfied with their options, they created their own non-profits. The Sandlers co- founded the American Asthma Foundation, the Center for American Progress, Center for Responsible Lending, ProPublica, and the Sandler Center for Basic Research in Parasitic Disease. They also generously contributed to organizations involved in medical research, the environmental protection, human rights, and civil liberties through the Sandler Foundation.

I invite my colleagues to join me in remembering Marion Sandler who has contributed so much to helping others through her philanthropy. Hers is a story of breaking down barriers and achieving success in a male dominated industry as well as living up to a high standard of excellence. Mrs. Sandler was a wonderful woman with enormous compassion for those in need. She will be missed.