[Congressional Record Volume 145, Number 131 (Friday, October 1, 1999)]
[Senate]
[Pages S11757-S11761]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND
RELATED AGENCIES APPROPRIATIONS ACT, 2000
The PRESIDING OFFICER. Also, under the previous order, the Senate
will now resume consideration of S. 1650, which the clerk will report.
The legislative clerk read as follows:
A bill (S. 1650) making appropriations for the Departments
of Labor, Health and Human Services, and Education, and
Related Agencies for the fiscal year ending September 30,
2000, and for other purposes.
The PRESIDING OFFICER. Under the previous order, the Senator from
Maine is recognized to offer amendment No. 1824 on which there will be
30 minutes of debate equally divided.
The Senator from Maine.
Ms. COLLINS. I thank the Chair.
Amendment No. 1824
(Purpose: To express the sense of the Senate that diabetes and its
resulting complications have had a devastating impact on Americans of
all ages in both human and economic terms, and that increased support
for research, education, early detection, and treatment efforts is
necessary to take advantage of unprecedented opportunities for progress
toward better treatments, prevention, and ultimately a cure)
Mr. President, I do call up amendment No. 1824, which is at the desk,
and ask for its immediate consideration.
The PRESIDING OFFICER. The clerk will report.
[[Page S11758]]
The legislative clerk read as follows:
The Senator from Maine [Ms. Collins], for herself, Mr.
Breaux, and Mr. Grassley, proposes an amendment numbered
1824.
Ms. COLLINS. Mr. President, I ask unanimous consent that reading of
the amendment be dispensed with.
The PRESIDING OFFICER. Without objection, it is so ordered.
The amendment is as follows:
At the appropriate place in title II, insert the following:
SEC. ----. EXPRESSING THE SENSE OF THE SENATE TO RAISE THE
AWARENESS OF THE DEVASTATING IMPACT OF DIABETES
AND TO SUPPORT INCREASED FUNDS FOR DIABETES
RESEARCH.
(a) Findings.--Congress makes the following findings:
(1) Diabetes is a devastating, lifelong condition that
affects people of every age, race, income level, and
nationality.
(2) Sixteen million Americans suffer from diabetes, and
millions more are at risk of developing the disease.
(3) The number of Americans with diabetes has increased
nearly 700 percent in the last 40 years, leading the Centers
for Disease Control and Prevention to call it the ``epidemic
of our time''.
(4) In 1999, approximately 800,000 people will be diagnosed
with diabetes, and diabetes will contribute to almost 200,000
deaths, making diabetes the sixth leading cause of death due
to disease in the United States.
(5) Diabetes costs our nation an estimated $105,000,000,000
each year.
(6) More than 1 out of every 10 United States health care
dollars, and about 1 out of every 4 Medicare dollars, is
spent on the care of people with diabetes.
(7) More than $40,000,000,000 a year in tax dollars are
spent treating people with diabetes through Medicare,
Medicaid, veterans benefits, Federal employee health
benefits, and other Federal health programs.
(8) Diabetes frequently goes undiagnosed, and an estimated
5,400,000 Americans have the disease but do not know it.
(9) Diabetes is the leading cause of kidney failure,
blindness in adults, and amputations.
(10) Diabetes is a major risk factor for heart disease,
stroke, and birth defects, and shortens average life
expectancy by up to 15 years.
(11) An estimated 1,000,000 Americans have Type 1 diabetes,
formerly known as juvenile diabetes, and 15,200,000 Americans
have Type 2 diabetes, formerly known as adult-onset diabetes.
(12) Of Americans aged 65 years or older, 18.4 percent have
diabetes.
(13) Of Americans aged 20 years or older, 8.2 percent have
diabetes.
(14) Hispanic, African, Asian, and Native Americans suffer
from diabetes at rates much higher than the general
population, including children as young as 8 years-old, who
are now being diagnosed with Type 2 diabetes, formerly known
as adult-onset diabetes.
(15) In 1999, there is no method to prevent or cure
diabetes, and available treatments have only limited success
in controlling diabetes devastating consequences.
(16) Reducing the tremendous health and human burdens of
diabetes and its enormous economic toll depend on identifying
the factors responsible for the disease and developing new
methods for treatment and prevention.
(17) Improvements in technology and the general growth in
scientific knowledge have created unprecedented opportunities
for advances that might lead to better treatments,
prevention, and ultimately a cure.
(18) After extensive review and deliberations, the
congressionally established and National Institutes of
Health-selected Diabetes Research Working Group has found
that ``many scientific opportunities are not being pursued
due to insufficient funding, lack of appropriate mechanisms,
and a shortage of trained researchers''.
(19) The Diabetes Research Working Group has developed a
comprehensive plan for National Institutes of Health-funded
diabetes research, and has recommended a funding level of
$827,000,000 for diabetes research at the National Institutes
of Health in fiscal year 2000.
(20) The Senate as an institution, and Members of Congress
as individuals, are in unique positions to support the fight
against diabetes and to raise awareness about the need for
increased funding for research and for early diagnosis and
treatment.
(b) Sense of the Senate.--It is the sense of the Senate
that--
(1) the Federal Government has a responsibility to--
(A) endeavor to raise awareness about the importance of the
early detection, and proper treatment of, diabetes; and
(B) continue to consider ways to improve access to, and the
quality of, health care services for screening and treating
diabetes;
(2) the National Institutes of Health, within their
existing funding levels, should increase research funding, as
recommended by the congressionally established and National
Institutes of Health-selected Diabetes Research Working
Group, so that the causes of, and improved treatments and
cure for, diabetes may be discovered;
(3) all Americans should take an active role to fight
diabetes by using all the means available to them, including
watching for the symptoms of diabetes, which include frequent
urination, unusual thirst, extreme hunger, unusual weight
loss, extreme fatigue, and irritability; and
(4) national organizations, community organizations, and
health care providers should endeavor to promote awareness of
diabetes and its complications, and should encourage early
detection of diabetes through regular screenings, education,
and by providing information, support, and access to
services.
The PRESIDING OFFICER. The Senator from Maine is recognized.
Ms. COLLINS. Mr. President, I ask unanimous consent that the Senator
from Michigan, Mr. Abraham, be added as a cosponsor of this amendment.
The PRESIDING OFFICER. Without objection, it is so ordered.
Ms. COLLINS. I thank the Chair.
Mr. President, I am pleased to join my co-chair of the Senate
Diabetes Caucus, Senator Breaux, as well as the chairman of the Senate
Special Committee on Aging, Senator Grassley, and the distinguished
Senator from Michigan, Mr. Abraham, in introducing a sense-of-the-
Senate resolution to help address the devastating impact of diabetes
and its resulting complications on Americans of all ages.
This resolution calls for increased support for diabetes research,
education, early detection, and treatment. Diabetes research has been
underfunded in recent years. It is imperative that we increase our
commitment in order to take full advantage of the unprecedented and
exciting scientific opportunities that we have as the millennium
approaches for advances leading to better detection, treatment,
prevention, and ultimately a cure for this devastating disease.
Diabetes is a very serious condition that affects people of every
age, race, and nationality. Here in America, 16 million people suffer
from diabetes, and about 800,000 new cases are diagnosed each year.
Moreover, diabetes frequently goes undiagnosed. Of the 16 million
Americans with diabetes, it is estimated that 5.4 million do not
realize they have this very serious condition.
Diabetes is one of our Nation's most costly diseases, both in human
and economic terms. It is the sixth deadliest disease in the United
States and kills almost 200,000 Americans annually. It is the leading
cause of kidney failure, of blindness in adults, and amputations. It is
a significant risk factor for heart disease, stroke, and birth defects.
The disease shortens the average life expectancy by up to 15 years
Moreover, it is very costly in financial terms as well. Diabetes
costs the Nation in excess of $105 billion annually in health-related
expenditures. At present, more than 1 out of every 10 dollars that we
spend on health care is related to treating people with diabetes. About
1 out of 4 Medicare dollars are used to treat people with diabetes.
Indeed, more than 40 billion in tax dollars is spent each year treating
people with diabetes through Medicare, Medicaid, veterans' health, and
Federal employees' programs.
Unfortunately, there currently is no way to prevent or to cure
diabetes. Available treatments have had only limited success in
controlling the devastating consequences of this disease. This problem
is made all the more complex by the fact that diabetes is not a single
disease, but rather it occurs in several forms and the complications
affect virtually every system of the body.
Children with type I diabetes face a lifetime of multiple daily
finger pricks to check their blood sugar levels, daily insulin
injections, and the possibility of lifelong complications, including
kidney failure and blindness, which can be deadly, can be disabling.
Older Americans with diabetes also can be disabled by the multiple
complications of the disease.
Every year, the Juvenile Diabetes Foundation hosts a children's
congress in Washington, DC. They bring children from all over this
Nation to put a human face on the consequences of type I diabetes.
Recently, I had the opportunity to meet a courageous 8-year-old boy
from North Yarmouth, ME. Nathan Reynolds is an active young boy. He
loves school, biking, swimming, and baseball, and he particularly likes
collecting old coins. He is also suffering from type I diabetes. He was
diagnosed about 2 years ago, and it has completely changed his life and
the life of his family.
He has had to learn how to check his blood. In fact, his 4-year-old
brother reminds him to do it before each meal.
[[Page S11759]]
He has to give himself an insulin shot or get his teacher or the school
nurse or his parents to help him do so. Nathan can never take a day off
from his disease. It does not matter whether it is Christmas or his
birthday, he still has to prick his finger and check his blood sugar.
He still has to inject himself with insulin in order to keep relatively
healthy.
I will never forget the story a teacher told me of all the children
in her class making a wish for Christmas. Some of them wished for a new
toy, one wished for a pony, another wished to go to Disney World. But
one little boy who had juvenile diabetes made the wish that he could
just have Christmas without having to give himself ``yucky'' shots.
That story touched me deeply, and it hit home with the fact that this
is a lifelong condition for children who are diagnosed with type I
diabetes.
I will also never forget the anguish on a young mother's face who
told me her 5-year-old son had just been diagnosed with diabetes. ``How
do I tell him?'' she said. ``How do I tell him he is going to have to
have shots every day, that he is going to have to constantly prick his
finger to check his blood sugar levels? How do I tell him what this
means for him and for all of us who love him?''
There is also some good news. Exciting research is underway that
should lead to medical breakthroughs for Nathan, for other children,
and for adults who have type I and type II diabetes. Reducing the
tremendous health and human burdens of diabetes and its enormous
economic toll depends upon identifying the factors responsible for the
disease and developing new methods for treatment, prevention, and
ultimately a cure.
The next decade holds tremendous potential and promise for diabetes
research. Improvements in technology and the general growth in
scientific knowledge have created unprecedented opportunities for
advancements that might lead to better treatments, prevention, and a
cure.
Earlier this year, the congressionally mandated diabetes research
working group, an independent panel composed of 12 scientific experts
of diabetes and 4 representatives of the lay diabetes communities,
issued an important report. It is called ``Conquering Diabetes: A
Strategic Plan for the 21st Century.'' This important report details
the magnitude of the problem, and it lays out a comprehensive plan for
research conducted by the National Institutes of Health on diabetes.
In this report, the diabetes working group found, ``Many scientific
opportunities are not being pursued due to insufficient funding, lack
of appropriate mechanisms and a shortage of trained researchers.''
The report also concluded that the current level of funding, the
level of effort, and the scope of diabetes research falls far short of
what is needed to capitalize on these promising opportunities. The
funding level, the report found, is so far short of what is required to
make progress on this complex and difficult problem.
The report goes on to recommend a funding level of $827 million for
diabetes research at NIH in fiscal year 2000, and, indeed, many of our
colleagues signed a letter to the Appropriations Committee requesting
an appropriation of just that level to be included to advance the goals
of this legislation.
I am a strong supporter of increased research and of efforts to
double our investment in biomedical research over the next few years.
There is simply no investment that would yield greater returns for the
American taxpayers, and the commitment of the bill before us of an
additional $2 billion in funding for NIH, which represents nearly a 13-
percent increase, will bring us so much closer to that goal. This
strategy is particularly important as we move into the next century
when our public health and disability programs will be under increasing
strains due to the aging of our population.
I am also very pleased and commend the chairman of the subcommittee,
Senator Specter, and the ranking minority member, Senator Harkin, for
including very strong language in the report accompanying this bill
which recognizes that diabetes research has been underfunded in the
past and directs that funding for diabetes be increased at the National
Institute for Diabetes and Digestive and Kidney Disease and other NIH
institutes. Again, the chairman of the Appropriations Committee,
Senator Stevens, and the chairman and ranking member of the
subcommittee, Senator Specter and Senator Harkin, have all been
tremendous advocates for people with diabetes and are to be commended
for their strong leadership in this effort.
The amendment I am offering today does not earmark a particular
funding level for diabetes research. Rather, it is intended to heighten
awareness of the devastating impact of this disease, and it is intended
to affirm that diabetes research is a high priority. Most of all, the
amendment expresses the clear intent of the Senate that the National
Institutes of Health should substantially increase its investment in
the fight against diabetes along the lines recommended in this landmark
report, the $827 million recommendation.
We must ensure that sufficient resources are available to take full
advantage of the extraordinary and unprecedented scientific
opportunities identified by the diabetes working group. If we do so, we
can better understand and ultimately conquer this devastating disease.
I thank the Chair for his attention. I hope all of my colleagues will
join us in supporting this resolution to send a clear signal that we
are committed to conquering diabetes.
I reserve any remaining time I may have left.
Mr. GRASSLEY. Mr. President, I rise today in support of the sense-of-
the-Senate resolution regarding diabetes. I thank my colleagues from
Maine for sponsoring this resolution. Senator Collins and I were among
the original co-founders of the Senate Diabetes Caucus and have worked
together to raise awareness of the disease and the need for a cure.
Diabetes is a devastating illness that affects people of every age,
race, and nationality. More than sixteen million Americans suffer from
diabetes and 800,000 new cases are diagnosed each year. Diabetes is
also a leading chronic illness affecting children, a special population
with which it places an especially heavy burden.
Although many people with diabetes are able to survive with multiple
daily injections of insulin, it is not a cure for this dreaded disease.
Despite the availability of insulin, diabetes continues to cause
serious health complications, including kidney failure and blindness,
and it is the cause of nearly 200,000 deaths per year.
Diabetes costs our nation nearly $100 billion each year in direct and
indirect costs. In fact, more than forty billion tax dollars are spent
each year in treating people with diabetes through Medicare, Medicaid,
veterans and federal employees health benefits.
Past investments in diabetes research at the National Institutes for
Health (NIH) are beginning to show real promise for a cure and the
number of research opportunities in the field continue to expand. We
now stand at a pivotal juncture in the fight to cure diabetes and its
complications.
A report released in February by the congressionally mandated
Diabetes Research Working Group (DRWG) called upon NIH to substantially
expand its support for diabetes research and has identified specific
research recommendations as part of a new national plan to find a cure.
On April 26, 1999, a letter signed by myself, Senator Collins, and 37
of our colleagues was sent to Chairman Specter and Ranking Member
Harkin in requesting increased funding for diabetes research within NIH
in accordance with the DRWG report. And, it is clear from the work of
the Senate Appropriations Committee that diabetes has not been
neglected. Therefore, in an effort to bolster the work of the
committee, and I believe rightly so, this resolution is being
introduced today to send a clear signal to all Americans that diabetes
is a serious concern of the United States Senate.
We have not yet found a cure for diabetes. But, I am confident that
in time and with sufficient support, a cure will be found and we will
be able to declare victory over this debilitating disease.
Mr. SPECTER addressed the Chair.
The PRESIDING OFFICER. The Senator from Pennsylvania.
Mr. SPECTER. Mr. President, I congratulate the distinguished Senator
from Maine, Ms. Collins, for offering this amendment. I agree with her
that the amendment will appropriately
[[Page S11760]]
focus attention on the problems of diabetes, especially among the young
people in America.
I thank Senator Collins for noting the work of the subcommittee and
the full committee in moving ahead with funding on this important
ailment and, as she noted, with the very strong language that is
present in the bill encouraging the National Institutes of Health to
move forward.
I think it appropriate to note for the record that on June 22 of this
year we had a special hearing on diabetes. At that time, we had
testimony from officials at the National Institutes of Health, the
Director, Dr. Harold Varmus; Dr. Phillip Gorton, the Director of the
Institute of Diabetes and Digestive and Kidney Diseases; as well as a
number of others.
It is very important to put a human face on the issue, as Senator
Collins did with the specific reference in her speech to the
youngsters. At that time, we had coming forward the celebrity, Mary
Tyler Moore, a juvenile diabetic; Mr. Tony Bennett, the famous singer,
the grandfather of a child with diabetes; Mr. Alan Silvestri, a
composer and father of a child with diabetes; and also our
distinguished colleague, Senator Strom Thurmond, who has a daughter
with diabetes.
It is a curious factor, but a fact of life nonetheless, that when
people of celebrated stature come and testify, there is more public
understanding of the ailment and more willingness to face up to it in
the appropriations process.
In order to carry forward on what this sense-of-the-Senate resolution
requests--and I feel confident in predicting it will pass 90-something
to nothing; the only open question is how many Senators will be present
to vote for it; I think it will be a unanimous vote, but our ability to
carry that forward depends upon what we appropriate.
In the bill currently pending, we have an increase in NIH funding of
$2 billion. That is a tremendous sum of money. We have a bill which is
$4 billion higher than last year's bill, with the funding coming
largely for education, where we have an increase of $2.3 billion. In
assessing the priorities in education, we have put in more than $500
million more than the President's request. We have in excess of $35
billion for education.
When it comes to health care, Senator Harkin and I have taken the
lead in adding $2 billion, as we did last year. When we have assessed
those priorities, it has made it necessary to reduce funding on some
other proposals. I found myself in a very unique position in managing
this bill. I have voted against amendments I never voted against
before. I voted against an amendment to add $200 million on class size,
which I would like to have supported. The bill continues the funding at
$1.2 billion. If we added the $200 million on class size, in addition
to the $1.2 billion, there would not be room for funding for NIH, for
programs such as diabetes.
Then we had an amendment come up on afterschool programs, again, a
request for $200 million more. There is $200 million in the current
budget, and Senator Harkin and I took the lead of adding $200 million
to bring it to $400 million. I would like to have more for afterschool
programs, but I had to vote against that amendment, because if we add
$200 million more to afterschool programs, it has to come from some
place. And NIH is a big target out there. The amendment adding the $200
million for afterschool programs was offered by the Senator from
California, Mrs. Boxer.
Then Senator Dodd offered an amendment to add about $900 million more
to day care. I have always supported. But again, when you have a bill
of $91.7 billion, which is at the breaking point as to what this body
will pass--and I think there is a question as to whether we will have
51 votes for that because it is a lot of money, although staying within
the caps--again with great reluctance, I could not support Senator
Dodd's amendment on day care.
Then we had a very important social service block grant, again where
it is a matter of priorities. When it comes to health, I believe there
is no higher priority. I have said with some frequency that the
National Institutes of Health is the crown jewel of the Federal
Government--perhaps the only jewel of the Federal Government.
In my position as chairman of the subcommittee, which has the
baseline responsibility to fund the National Institutes of Health--and
Senator Harkin has the same consideration--we receive requests
constantly from people who have Parkinson's--we had a hearing this week
on Parkinson's disease. We had a hearing on prostate cancer, a special
concern on breast cancer, heart ailments, a very large number of
unknown diseases.
I said on the floor yesterday that Senator Harkin is very frequently
lobbied when he gets on the plane between Washington and Des Moines. I
find a lot of people with unique ailments on the Metroliner between
Washington and Philadelphia.
As Senator Collins has brought forward the issue this morning, I
think it is a very profound message. But to accomplish what Senator
Collins seeks, we have to appropriate the increase of $2 billion. Even
then, if there are 10 doors with research projects behind them, 7 of
those doors will not be opened, even with funding NIH at a level of
$17.6 billion.
So again, I thank my colleague from Maine--carrying on the great
tradition of Maine Senators.
I yield the floor, leaving her the remainder of the time before 9:30
to close.
Ms. COLLINS addressed the Chair.
The PRESIDING OFFICER. The Senator from Maine.
Ms. COLLINS. I again salute the Senator from Pennsylvania for his
tremendous commitment to medical research. Without his leadership, we
would not see the kinds of advancements that are being made. I thank
him for his support.
Mr. President, I ask unanimous consent the Senator from Ohio, Mr.
DeWine, and the Senator from Arkansas, Mr. Hutchinson, be added as
cosponsors to my sense-of-the-Senate amendment.
The PRESIDING OFFICER. Without objection, it is so ordered.
Ms. COLLINS. Mr. President, we are on the edge of an exciting
breakthrough in the treatment and ultimately the prevention and cure of
diabetes. That is why I am so excited by the possibility of a
significant increase in research in this area.
As the chairman of the Senate Diabetes Caucus, I have had the
opportunity to visit some of the leading-edge research labs that are
doing work on diabetes. I have visited Jackson Labs in Bar Harbor, MA,
where very exciting research is ongoing into the causes of both type I
and type II diabetes. I am very proud of the contributions made by
these distinguished scientists in my home State.
In addition, I have had the pleasure of visiting the JDF Foundation
Center at Harvard Medical School, where there is also tremendous
research underway. I am convinced, with the kind of increased
commitment called for by my resolution, and indicated in the
Appropriations Committee's report, that we can in fact break through
and reach a cure for this devastating disease.
Mr. President, I do not know whether there is any other request for
time. It is my understanding the vote is scheduled for 9:30. We have
reached that hour.
Mr. President, seeing no one seeking further time to speak, I ask for
the yeas and nays on the pending amendment.
The PRESIDING OFFICER. Is there a sufficient second? There appears to
be a sufficient second.
The yeas and nays were ordered.
The PRESIDING OFFICER. Is all time yielded back? Does the Senator
from Pennsylvania yield back the remaining time?
Mr. SPECTER. I do, Mr. President. The hour is 9:30. I think we are
set for the vote.
The PRESIDING OFFICER. All time having expired, the question is on
agreeing to the Collins amendment No. 1824. The yeas and nays have been
ordered. The clerk will call the roll.
The legislative clerk called the roll.
Mr. NICKLES. I announce that the Senator from Indiana (Mr. Lugar),
the Senator from Florida (Mr. Mack), the Senator from Arizona (Mr.
McCain), and the Senator from Wyoming (Mr. Thomas), are necessarily
absent
Mr. REID. I announce that the Senator from California (Mrs. Boxer)
and the Senator from Oregon (Mr. Wyden) are necessarily absent.
[[Page S11761]]
I also announce that the Senator from Michigan (Mr. Levin) is absent
because of a death in the family.
I further announce that, if present and voting, the Senator from
Michigan (Mr. Levin) would vote ``no.''
The result was announced--yeas 93, nays 0, as follows:
[Rollcall Vote No. 305 Leg.]
YEAS--93
Abraham
Akaka
Allard
Ashcroft
Baucus
Bayh
Bennett
Biden
Bingaman
Bond
Breaux
Brownback
Bryan
Bunning
Burns
Byrd
Campbell
Chafee
Cleland
Cochran
Collins
Conrad
Coverdell
Craig
Crapo
Daschle
DeWine
Dodd
Domenici
Dorgan
Durbin
Edwards
Enzi
Feingold
Feinstein
Fitzgerald
Frist
Gorton
Graham
Gramm
Grams
Grassley
Gregg
Hagel
Harkin
Hatch
Helms
Hollings
Hutchinson
Hutchison
Inhofe
Inouye
Jeffords
Johnson
Kennedy
Kerrey
Kerry
Kohl
Kyl
Landrieu
Lautenberg
Leahy
Lieberman
Lincoln
Lott
McConnell
Mikulski
Moynihan
Murkowski
Murray
Nickles
Reed
Reid
Robb
Roberts
Rockefeller
Roth
Santorum
Sarbanes
Schumer
Sessions
Shelby
Smith (NH)
Smith (OR)
Snowe
Specter
Stevens
Thompson
Thurmond
Torricelli
Voinovich
Warner
Wellstone
NOT VOTING--7
Boxer
Levin
Lugar
Mack
McCain
Thomas
Wyden
The amendment (No. 1824) was agreed to.
Mr. COVERDELL. I move to reconsider the vote.
Mr. HATCH. I move to lay that motion on the table.
The motion to lay on the table was agreed to.
Mr. DASCHLE. Mr. President, I ask to proceed as in morning business.
The PRESIDING OFFICER (Mr. Gorton). Without objection, it is so
ordered
____________________