Congressional Record, Volume 155 Issue 110 (Tuesday, July 21, 2009)

[Congressional Record Volume 155, Number 110 (Tuesday, July 21, 2009)]
[Senate]
[Pages S7741-S7770]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

NATIONAL DEFENSE AUTHORIZATION ACT FOR FISCAL YEAR 2010--Continued

The ACTING PRESIDENT pro tempore. The Senator from Arizona.
Mr. KYL. Mr. President, I will make some brief remarks here, and at
the conclusion we will determine whether there is an agreement on the
other side so I can go ahead and lay down an amendment. But first I
want to discuss what that amendment will be. It is amendment No. 1628,
and in a moment I will seek to offer it and get it pending. It is an
amendment I introduced with Senator Lieberman, Senator Bayh, and
Senator McCain.
Like other Members of this body, we have watched recent events unfold
in Iran with great concern. This year began with talk of warming ties
and potentially reestablishing contact with Iran; that we would no
longer be afraid to talk to Iran and perhaps to even reach some kinds
of agreements. In recent months, however, the Iranian regime has
continued its support of terrorism, its illegal nuclear weapons program
in defiance of its NPT obligations, and its engagement in violent and
deadly repression of its own citizens.
While the administration has made clear its intention to continue to
pursue high-level talks with Iran, an overture which the regime has not
seen fit to even respond, the President has indicated that the window
for Iran to negotiate and demonstrate progress toward complying with
its international obligations is not open indefinitely.
I think President Obama was correct when he said:

Iran obtaining a nuclear weapon would not only be a threat
to Israel and a threat to the United States, but would be
profoundly destabilizing in the international community as a
whole and could set off a nuclear arms race in the Middle
East that would be extraordinarily dangerous for all
concerned, including for Iran.

In May, the President indicated that Iran would have until December
to show meaningful improvement. More recently, French President Nicolas
Sarkozy said on behalf of the G8 nations that they will give Iran until
September 2009 to agree to negotiations with respect to its nuclear
activities or face tougher sanctions.
If negotiations do not prove fruitful, the United States must be
ready to act quickly to increase pressure on Iran to end its support
for terrorist groups and its illegal nuclear program.
The Kyl-Lieberman amendment expresses the sense of the Senate that
the President should sanction the Iranian Central Bank if, by December,
Iran has not verifiably halted its uranium enrichment activities, as
well as come into full compliance with the Nuclear Nonproliferation
Treaty and the Additional Protocol.

By sanctioning the Central Bank of Iran--Bank Markazi--our
Nation would send the message that we will use all methods at
our disposal to stop the spread of nuclear weapons and oppose
sponsors of terror.

The case against the Iranian Central Bank is strong. It is knee-deep
in the regime's illicit activities. Last year, Deputy Secretary of the
Treasury Robert Kimmit revealed that between 2001

[[Page S7742]]

and 2006 the bank had moved $50 million from banks in London to
Hezbollah front organizations in Beirut. Hezbollah, of course, is a
terrorist organization.
It also processes transactions for Iranian banks that already face
U.S. sanctions. The Central Bank of Iran is instrumental in helping
Iranian banks--the very ones this body voted overwhelmingly to sanction
in 2007--to avoid sanctions. In March 2008, the Financial Crimes
Enforcement Network of the Department of the Treasury warned financial
institutions about the illicit behavior of the Central Bank of Iran.
Here is what the advisory said:

The Central Bank of Iran and Iranian commercial banks have
requested that their names be removed from global
transactions in order to make it more difficult for
intermediary financial institutions to determine the true
parties in the transaction. They have also continued to
provide financial services to Iranian entities designated by
the U.N. Security Council in its Resolutions 1737 and 1747.
The U.S. Department of Treasury is particularly concerned
that the Central Bank of Iran may be facilitating
transactions for sanctioned Iranian banks.

Under U.S. law, institutions that aid entities covered by financial
sanctions are liable to penalties. The Central Bank's activities
clearly warrant such action, and sanctioning the bank would increase
the effectiveness of existing measures. I urge my colleagues to support
our amendment at such time as we are able to get a vote on it.
The ACTING PRESIDENT pro tempore. The Senator from Connecticut.
Mr. LIEBERMAN. Mr. President, I thank the Chair and I thank my friend
from Arizona, Senator Kyl, for his very strong statement. I rise to
speak in support of this bipartisan amendment which I have cosponsored
along with Senator Kyl, Senator Bayh, and Senator McCain.
As you know, President Obama has made a historic offer to Iran's
leaders, inviting them to engage in direct diplomacy to resolve the
outstanding differences between our two countries. As the President has
repeatedly said, the door is open for the Iranians to come in out of
the cold, if they choose to do so. It is by suspending their illicit
nuclear activities and ending their support for terrorism that the
Iranians have a clear path to ending their international isolation and
taking their rightful place in the community of nations.
Unfortunately, as Senator Kyl said, it has now been more than 3\1/2\
months since the formal offer of engagement was made by President
Obama, and there has been no reply from the Iranians. Meanwhile, Iran's
illicit nuclear activities have continued to speed forward, in
violation of multiple U.N. Security Council resolutions. Thousands of
additional centrifuges are being installed, and more and more fissile
material is being stockpiled.
At the same time, Iran's support for terrorist proxies in Iraq, in
Lebanon, and in the Palestinian Authority areas has continued. And, of
course, over the past month we and the rest of the world have watched
with horror as the Iranian regime has engaged in a brutal crackdown
against its own people, who have sought no more than basic human
rights.
President Obama, together with our international allies, has been
very clear that we will not wait indefinitely for the Iranians to
respond to our offer of talks, nor will we enter into negotiations--if
that is the willingness of the Iranians--that go on without end. Two
weeks ago, at the annual G8 summit in Italy, the President joined with
other world leaders to make clear to the Iranians that they have until
the G20 summit in Pittsburgh, at the end of September, to return to the
negotiating table or face the consequences.
The amendment Senators Kyl, Bayh, McCain, and I have put forward
would place the full weight of the U.S. Senate behind the time frame
that the President and the G8 have articulated. Our amendment expresses
our strong hope that Iran seizes this historic opportunity for direct
dialogue.
We also make clear that if the Iranians have failed to engage with us
diplomatically by the time of that G20 summit 2 months from now, it is
our preference that multilateral sanctions be imposed through the
United Nations Security Council. However, the Iranian Government--the
regime that controls the people of Iran--must also understand that the
United States is itself prepared to put in place what Secretary of
State Clinton a while ago referred to as crippling sanctions in the
event that they in Tehran continue to flaunt the will of the
international community.
Specifically, our amendment asks the President to impose sanctions on
the Central Bank of Iran and other banks involved in proliferation and
terrorist activities, in the event that the Iranians haven't entered
into negotiations that are serious by the time of the Pittsburgh summit
or if they haven't suspended enrichment and reprocessing activities
within 60 days of that summit.

The Central Bank of Iran is the financial lifeline of that regime. It
is an entity that our own Treasury Department says has engaged in
deceptive financial practices and facilitated the efforts of other
Iranian banks that are involved in bankrolling proliferation and
terrorist activities to avoid international sanctions, and that have
themselves been sanctioned by the U.N. and our Treasury Department as a
result.
I will say this. The idea of imposing sanctions on the Iranian
Central Bank is not new. It has already been endorsed by a bipartisan
majority in this Chamber. Last year, the Senate Banking Committee,
under Chairman Dodd, adopted bipartisan legislation by a vote of 19 to
2 to urge the President to immediately impose sanctions against the
Central Bank. Also last year, the House of Representatives passed such
legislation that urged immediate sanctions.
More recently, the legislation that Senators Bayh, Kyl, and I
introduced this spring--the Iran Refined Petroleum Sanctions Act, S.
908--in addition to the other steps it takes--also expresses the sense
of the Senate that the President should impose sanctions against the
Central Bank of Iran.
I am very grateful to report that S. 908, the Iran Refined Petroleum
Sanctions Act, now has 67 Members of the Senate, a strong bipartisan
group of 67, or two-thirds, as cosponsors of that legislation. These
cosponsors range all across the ideological spectrum of Members of the
Senate, and clearly make the point to Iran and to the rest of the world
that whatever other differences we have, we stand together here as a
strong majority and beyond the Senate in our concern about the nuclear
proliferation and terror-sponsoring activities of the Iranian
Government.
You might say, if you are one of the 67 cosponsors of S. 908--which
does more than this amendment does but includes it--you have already
spoken in favor of this amendment.
This amendment, I want to point out and make clear, in no way ties
the President's hand in his diplomacy with Iran. That is not our
intent. The amendment is about empowering the President, giving him
additional leverage in his diplomacy, by endorsing the same timetable
that came out of the G8 summit a short while ago. The effect is this,
and I will repeat: The Iranians must appreciate that there will be
consequences if they fail to respond to the international community's
diplomatic initiatives; in other words, if they continue to speed their
nuclear program forward.
I think this amendment will send an unmistakable message to the
fanatical regime in Tehran, in support of the G8, in support of
President Obama: Either you can engage with the United States and the
world community and take steps to suspend your nuclear activities or
you can continue on your current course, in which case you will face
the crippling sanctions this sense-of-the-Senate resolution calls for.
I thank the Chair, and I yield the floor.
The ACTING PRESIDENT pro tempore. The Senator from Arizona.
Mr. McCAIN. Mr. President, before my colleague Senator Lieberman
leaves the floor, I wish to thank him for this amendment. We are
working right now to see if we can get the amendment pending and
possibly a voice vote, because it is clear it is a very important
amendment and one where I think we need to express very strongly the
sense of the Senate, given the situation as it exists in Iran.
I wish to thank Senator Lieberman, and right now it is my
understanding that your side is checking to see if it is an agreeable
amendment. Hopefully,

[[Page S7743]]

we will get that decision and move forward with it right away on a
voice vote, if that is agreeable to the Senator from Connecticut.
The ACTING PRESIDENT pro tempore. The Senator from Connecticut.
Mr. LIEBERMAN. I thank my friend from Arizona. I am encouraged by
that. And in talking to the other cosponsors, we would be happy to have
a voice vote. It would send a message.
The ACTING PRESIDENT pro tempore. The Senator from Arizona.
Mr. McCAIN. Mr. President, the amendment is straightforward and
expresses the sense of the Senate that there should be a date certain--
and soon--by which Iran is required to end its nuclear program or face
severe sanctions. The amendment expresses that if the Iranian regime
has not accepted the offer of the United States of direct diplomatic
talks by the time of the G20 summit in late September or if it has not
suspended all of its nuclear enrichment and reprocessing activities
within 60 days after the summit, and if the U.N. Security Council does
not adopt new and significant and meaningful sanctions on the regime,
the President should sanction the Central Bank of Iran.
The situation with respect to Iran is nearing the crisis point, if it
is not there already. We have all watched the brutal crackdown in the
streets of Tehran and elsewhere as the Iranian regime imposed the
results of a fraudulent election. We have been astonished by the
courage and resolve of those Iranian citizens who have protested for
their own inalienable rights in the face of repression. And we have
known that, while these dramatic events have played themselves out, the
Iranian regime has continued its enrichment of uranium, growing ever
closer to the day on which it has a nuclear weapons capability.
The Iranian regime has gotten away with too much for too long. Its
illicit nuclear activities, combined with its development of
unconventional weapons and ballistic missiles, support for Hezbollah
and other terrorist groups, and its repeated threats against Israel and
the United States, represent a real and growing threat to the security
of the United States and the Middle East. It is in the interest of the
United States, and the world's other great powers, to achieve an end to
the Iranian nuclear program.
The administration has held out an ``open hand,'' making clear that
it intends to open direct talks with Iran. Yet 3\1/2\ months since the
President's formal offer, the Iranian government has made no response,
nor has it suspended its enrichment activities, as required by U.N.
Security Council resolutions. Time is not on the side of those pushing
the Iranians to cease these dangerous actions. Administration officials
and others, including the French President, have stated that they will
not wait interminably while the Iranian nuclear program proceeds.
At the G-8 summit 2 weeks ago, the assembled leaders agreed that the
Iranians do not have forever, and that they should return to the
negotiating table by the time of the G-20 summit in September. This
amendment puts the Senate on record behind that timeframe, irrespective
of any Senator's individual view about the likelihood of agreement
soon.
Make no mistake: we must not wait interminably. According to the
IAEA's latest report, Iran has increased its stockpile of low enriched
uranium by some 60 percent in the previous 6 months, and has brought
the number of active centrifuges above 7,000. The IAEA also reported
that Iran denied inspectors access to the Arak heavy water reactor. As
the threats--including to the State of Israel--continue.
As the Secretary of State has recently articulated, should Iran
continue to defy the international community, it must face severe
sanctions. Should the regime not take up the historic offer extended to
it, this resolution advocates sanctions on the Iranian Central Bank,
the country's major connection to the international financial system.
The U.S. Treasury Department has stated that the central bank has
engaged in deceptive financial practices and facilitated the movement
of funds to those involved in proliferation and terrorist activities.
This must end, and in fact 67 Senators have cosponsored legislation--
the Iran Refined Petroleum Sanctions Act--that urges the President to
sanction the central bank.
By adopting this resolution, we will send an unmistakable message to
the government of Iran that its actions are unacceptable and will
result in real and severe consequences if continued. The administration
has offered to talk; the ball is in the Iranian court, and if that
regime continues down its destructive path, we have no choice but to
impose crippling sanctions for its continued defiance.
I urge my colleagues to support this amendment.
Let me point out again, this amendment is a sense-of-the-Senate
amendment, an important sense of the Senate but certainly one that
allows the administration the latitude it needs in its handling of its
relations with Iran.
I yield the floor.
Ms. STABENOW. Mr. President, I would first ask to speak as in morning
business.
The ACTING PRESIDENT pro tempore. Without objection, it is so
ordered.
Ms. STABENOW. Mr. President, I want to recognize that tremendously
hard work both the chair of the Armed Services Committee and ranking
member are doing. We are very proud of the chairman, coming from
Michigan, and of all of his excellent work in standing up for the
troops. This bill is another example of that.
I would like to congratulate him and the Senator from Arizona for
working together on this very important bill.

Health Care Reform

Ms. STABENOW. Mr. President, I want to speak for a moment on health
care. We are hearing a lot, as we hear from colleagues, many
colleagues--not every one but many colleagues on the other side of the
aisle--about the need to be against health care reform, to be a ``no.''
We all know that saying no to health care reform means we are going
to have the status quo. ``No'' equals the status quo. For too many
families, too many businesses all across this country, that is
absolutely not acceptable.
The status quo works, it is good--for special interests making
profits off the current system. But it is bad for American families,
American small businesses, American manufacturers that are trying to
pay the bills and trying to make sure health care is available for the
employees.
We need change. We are here because the system, with all of its good
parts--and there are many strengths in the American system--is also
broken in too many cases for people. We want to build on what works and
what is great and we want to fix what is broken.
Right now our current health care system is bankrupting too many
families. We know over 60 percent of bankruptcies are linked to medical
expenses, and 75 percent of families who file bankruptcy actually have
health insurance. Those with insurance, on average, are putting out
medical expenses of over $18,000 when they file--even though they have
an insurance policy.
There are many families--we are not only talking about those who do
not have health insurance, but those who do who find themselves in very
difficult situations.
I am constantly amazed when I hear the argument about: We can't do
any kind of reform because reform means putting a bureaucrat between
your doctor and yourself. You and your doctor can't make decisions
about what you need for your health care.
Do you know who stands between you and your doctor right now? An
insurance company, an insurance company bureaucrat. Your doctors can't
just give you whatever tests they wish. You are not able to get
whatever care you need for your family. The first call they make is to
the insurance company, and it decides.
Reform is about putting health care decisions back in the hands of
doctors and patients and being able to create a system that actually
works for people. That is what it is all about.
I set up online the Health Care People's Lobby for those I represent
in the State of Michigan so they could share their stories. We have a
lot of folks lining the halls who represent all kinds of interests, all
kinds of special interests, and they tell us what they think should be
happening or not happening. But in Michigan we have set up the Health
Care People's Lobby so people can share their stories about the real

[[Page S7744]]

world operating under the current system.
If the system worked today, there would be no reason for us to be
here. We would be working on something else. But the fact is, we are
spending twice as much on health care as any other country and have 47
million people at any one time who do not have health insurance. Those
two numbers don't add up.
On top of that, people who are currently covered are battling every
day to try to get what they thought they were paying for or to make
sure their family is covered or that test or procedure or medicine can
be covered.
One constituent of mine in Michigan, Sandra Marczewski from
Waterford, MI, wrote to me that she and her husband have been without
insurance for 7 months now. She writes:

You have no idea the fear I walk around with every day.

That is too many people in Michigan, over a million people in
Michigan, without insurance altogether, and millions more who are
fearful every day if they lose their job, their health care goes with
it, for themselves and their families. People every night are putting
the kids to bed and worrying about whether someone is going to get
sick, saying a prayer: Please, God, don't let the kids get sick. Don't
let me get sick. I have to be able to go to work so I can make sure we
still have our health care.
There are a lot of people, as I mentioned before, who make a lot of
money off of the status quo, off of the current system. It is no
surprise they don't want to change it. All the ads we see, all the
things going on, all the scare tactics that are going on--and there are
plenty of scare tactics going on right now--all of that is about trying
to scare people and raise red flags. It is easy just to be no, no, no.
We certainly hear that around here all the time, people who are just
saying no to any kind of progress or change or making things better for
people.
The reality is, the status quo for a lot of folks means more profit,
and that is underlying a lot of the motivation of what is going on
right now. Our job is to make sure the American people can afford
health care and have the care they need for their families. For too
many families, the status quo means insecurity, expenses, and fear that
come along with not knowing whether they are going to be able to afford
the health care they have from month to month and whether they will, in
fact, even have health care.
We are here because when it comes to health care, American families
and businesses are in a serious crisis, and they are asking us for
action. The status quo is not good enough anymore. It is not working.
It is going to bankrupt families, businesses, and the country. High
health care costs are causing cuts in benefits, increases in premiums,
adding to the ranks of the uninsured at alarming rates. Even those who
have insurance, as I indicated before, are feeling the pain of the
current system. Every day in America families are forced to choose a
different doctor because their health care plan was changed, because
their employer can no longer afford the old plan they had.
Skyrocketing health care costs make American businesses less
competitive in the global economy. It costs us jobs, and I can speak
directly to that coming from the great State of Michigan.
Every day in America, families see their health care plan benefits
eroding because they cannot keep up with high premiums, copays, and
deductibles. Every day in America, people decide to skip a doctor visit
and the medication and treatment they know they need because they
cannot afford the payment--in the greatest country in the world--
because the expense is too high. Year after year, as health care costs
increase, American families are losing the very parts of their health
care they value most: their choice of doctor, hospital, and insurance
plans; their choice of treatments; the security and stability that
comes from knowing they are covered if anything goes wrong. That is
what we are about fixing. That is what we will fix as we do health care
reform.
Recently, Families USA found that the average costs of family
coverage in the workplace rose 78 percent in 7 years--78 percent.
During those years, health insurance company profits ballooned 428
percent. At the same time, wages went up about 15 percent. So wages go
up 15 percent, health insurance profits go up 428 percent, and premiums
just keep rising for businesses and individuals.
The fact is, we cannot wait to get started on reform. The status quo
is not acceptable and ``no'' equals the status quo. So we are here
working with colleagues to get it done. Doing nothing is not
acceptable.
Recently, the nonpartisan Robert Wood Johnson Foundation released a
report that projects if Federal reform efforts are not enacted within
10 years, the cost of health care for businesses could double and the
number of uninsured could rise to over 65 million people with middle-
class families being hit the hardest. The report shows if health care
reform is not enacted, individuals and families would see health care
costs dramatically increased.
Total individual and family spending on premiums and out-of-pocket
costs could increase 68 percent in the next 10 years. I cannot imagine
68 percent out-of-pocket costs. That is if we do nothing, if we listen
to those just saying no. Even under the best-case scenario, health care
costs would likely increase, according to this report, at least 46
percent. And I can tell you absolutely wages are not going to go up 46
percent. Businesses could see their health care costs doubled within 10
years. The report found that employer spending on premiums would more
than double, and even in the best-case economic condition, employer
spending on health care will rise 72 percent. The result would likely
be far fewer Americans being able to be offered insurance or accepting
employer-sponsored insurance. Estimates suggest a drop of 56 percent of
Americans who are now covered by their employers, dropping from 56 to
49 percent in 10 years.
So there are many numbers. There are numbers that relate to the
public programs of Medicaid and children's health insurance and the
increased cost there as well and what will happen if we do nothing. The
amount of uncompensated care in the health care system will increase,
and the worst-case scenario: the total of uncompensated care could
double.
By the way, when we say ``uncompensated care,'' that does not mean
somebody is not paying for it. That is why our premiums, if you have
insurance, go up so much. It means someone can't afford to see a
doctor, can't take their children to the doctor, so they don't get the
tests on the front end that they need or they don't see a doctor. They
wait until they are really sick, and then they go to the emergency
room. They are served, as they should be, and it is the most expensive
venue in which to do ongoing care for people. But they are served, and
then guess what happens. Everyone who has insurance sees their rates go
up to pay for it.
That is what it means when we say that covering the uninsured will
lower costs as we go out. I mean it will take time to do this, but over
time what we are doing is working to change the way we pay for health
care now because we pay for it in the most expensive way, by ignoring
the problem, not focusing on health and wellness and primary care but
waiting until people are in the worst possible situation: they go to
the emergency room, they get care when they are sicker than they
otherwise would be if they could see a doctor. And then we pay for it.
That is what we want to change and will change under health care
reform.
So this is about many facets. We know we have a system in America
that works for many; they are blessed. We are blessed to have health
insurance. For the many who have insurance, it allows them to cover
their family needs. The system works well. But for many others it does
not. And the reality is, we all pay for a system that does not work
effectively for everyone. We all end up paying because the reality is,
you can say: Well, I am not going to buy a car, I do not need car
insurance; I am not going to buy a house, I do not need house
insurance, but sooner or later, you are going to get sick, and just
because you don't have health insurance does not mean there is not
going to be a cost for yourself and your family.
We are a great country. We can do better than what we are doing
today. We have to do better. We are working hard to have a bipartisan
effort that will move reform forward in this country, to make a real
difference to

[[Page S7745]]

change the system so it works for everyone and begins to lower the cost
over time of what is happening, the explosion in health care costs in
this country.
The option of saying no is not good enough. ``No'' equals the status
quo. We just cannot have that. The public gets it. It is time for us to
get it as well and move forward. I yield the floor.
The ACTING PRESIDENT pro tempore. The Senator from Arizona is
recognized.

Amendment No. 1628

Mr. McCAIN. Mr. President, I call up the Lieberman-Kyl amendment and
ask for its immediate consideration. It is at the desk.
The ACTING PRESIDENT pro tempore. The clerk will report.
The assistant bill clerk read as follows:

The Senator from Arizona [Mr. McCain], for Mr. Kyl, for
himself, Mr. Lieberman, Mr. Bayh, and Mr. McCain, proposes an
amendment numbered 1628.

The amendment is as follows:

(Purpose: To express the sense of the Senate on imposing sanctions with
respect to the Islamic Republic of Iran)

At the end of subtitle C of title XII, add the following:

SEC. 1232. SENSE OF THE SENATE ON IMPOSING SANCTIONS WITH
RESPECT TO THE ISLAMIC REPUBLIC OF IRAN.

(a) Findings.--The Senate makes the following findings:
(1) The illicit nuclear activities of the Government of the
Islamic Republic of Iran, combined with its development of
unconventional weapons and ballistic missiles and support for
international terrorism, represent a grave threat to the
security of the United States and United States allies in
Europe, the Middle East, and around the world.
(2) The United States and other responsible countries have
a vital interest in working together to prevent the
Government of the Islamic Republic of Iran from acquiring a
nuclear weapons capability.
(3) As President Barack Obama said, ``Iran obtaining a
nuclear weapon would not only be a threat to Israel and a
threat to the United States, but would be profoundly
destabilizing in the international community as a whole and
could set off a nuclear arms race in the Middle East that
would be extraordinarily dangerous for all concerned,
including for Iran.''.
(4) The International Atomic Energy Agency has repeatedly
called attention to the illicit nuclear activities of the
Islamic Republic of Iran, and, as a result, the United
Nations Security Council has adopted a range of sanctions
designed to encourage the Government of the Islamic Republic
of Iran to cease those activities and comply with its
obligations under the Treaty on Non-Proliferation of Nuclear
Weapons, done at Washington, London, and Moscow July 1, 1968,
and entered into force March 5, 1970 (commonly known as the
``Nuclear Non-Proliferation Treaty'').
(5) The Department of the Treasury has imposed sanctions on
several Iranian banks, including Bank Melli, Bank Saderat,
Bank Sepah, and Bank Mellat, for their involvement in
proliferation activities or support for terrorist groups.
(6) The Central Bank of Iran, the keystone of Iran's
financial system and its principal remaining lifeline to the
international banking system, has engaged in deceptive
financial practices and facilitated such practices among
banks involved in proliferation activities or support for
terrorist groups, including Bank Sepah and Bank Melli, in
order to evade sanctions imposed by the United States and the
United Nations.
(7) On April 8, 2009, the United States formally extended
an offer to engage in direct diplomacy with the Government of
the Islamic Republic of Iran through negotiations with the
five permanent members of the United States Security Council
and Germany (commonly referred to as the ``P5-plus-1
process''), in the hope of resolving all outstanding disputes
between the Islamic Republic of Iran and the United States.
(8) The Government of the Islamic Republic of Iran has yet
to make a formal reply to the April 8, 2009, offer of direct
diplomacy by the United States or to engage in direct
diplomacy with the United States through the P5-plus-1
process.
(9) On July 8, 2009, President Nicolas Sarkozy of France
warned that the Group of Eight major powers will give the
Islamic Republic of Iran until September 2009 to accept
negotiations with respect to its nuclear activities or face
tougher sanctions.
(b) Sense of the Senate.--It is the sense of the Senate
that--
(1) the Government of the Islamic Republic of Iran should--
(A) seize the historic offer put forward by President
Barack Obama to engage in direct diplomacy with the United
States;
(B) suspend all enrichment-related and reprocessing
activities, including research and development, and work on
all heavy-water related projects, including the construction
of a research reactor moderated by heavy water, as demanded
by multiple resolutions of the United Nations Security
Council; and
(C) come into full compliance with the Nuclear Non-
Proliferation Treaty, including the additional protocol to
the Treaty; and
(2) the President should impose sanctions on the Central
Bank of Iran and any other Iranian bank engaged in
proliferation activities or support for terrorist groups, as
well as any other sanctions the President determines
appropriate, if--
(A) the Government of the Islamic Republic of Iran--
(i) has not accepted the offer by the United States to
engage in direct diplomacy through the P5-plus-1 process
before the Summit of the Group of 20 (G-20) in Pittsburgh,
Pennsylvania, in September 2009; or
(ii) has not suspended all enrichment-related and
reprocessing activities and work on all heavy-water related
projects within 60 days of the conclusion of that Summit; and
(B) the United Nations Security Council has failed to adopt
significant and meaningful additional sanctions on the
Government of the Islamic Republic of Iran.

Mr. McCAIN. The amendment is in the name of Senators Kyl and
Lieberman. I am calling it up on their behalf.
The ACTING PRESIDENT pro tempore. Is there further debate? If not,
the question is on agreeing to the amendment.
The amendment (No. 1628) was agreed to.
The ACTING PRESIDENT pro tempore. The Senator from Tennessee.
Mr. ALEXANDER. I ask unanimous consent to speak as in morning
business.
The ACTING PRESIDENT pro tempore. Without objection, it is so
ordered.

Health Care Reform

Mr. ALEXANDER. Mr. President, I listened carefully to the Senator
from Michigan. Republicans and I believe most Democrats want health
care reform this year. The President said he wants health care reform
this year. Republicans want health care reform this year. We want to
make sure it is done right. Let me put it this way: If we were in an
operating room and a seriously ill patient came in and we knew we had
only one chance to save that patient's life and to make that patient
healthy, our goal would not be to see if we could do it in the next
week, it would be to see if we could get it right.
So far, the proposals we have seen coming out of the committees have
not gotten it right. One might say: Well, that is a Republican view of
Democratic proposals. Perhaps it is. But the proposals we have seen
coming out of the Senate HELP Committee and out of the House of
Representatives flunk the most important test, which is cost. The most
important test is whether Americans can afford their health care and,
after we get through fixing it, whether they can afford their
government. According to virtually everyone we have heard from, the
legislation we have seen simply does not meet that test.
In my opinion, what we should do instead is start with the framework
of the bill sponsored by Democratic Senator Wyden and Republican
Senator Bennett which has 14 cosponsors--8 Democrats, 6 Republicans.
This is a different sort of framework that offers virtually every
American coverage, does so without any Washington takeover or
government-run programs without raising the debt one penny, according
to the Congressional Budget Office. Remember, I said that is a
framework. I do not agree with every single part of that bill, although
I am a cosponsor, but it may be a much better place to start than what
we have seen so far.
That is not just my opinion. Lately, we have heard a lot about the
Mayo Clinic in Rochester, MN. President Obama has talked a lot about
the Mayo Clinic. The point is, at the Mayo Clinic and a few other
clinics around the country, there have been significantly better
outcomes. In other words, if you go there and come out, you are more
likely to be well, and at a lower cost. And the question is, Why?
The President has repeatedly pointed to the Mayo Clinic, Democratic
Senators point to the Mayo Clinic, and Republican Senators point to the
Mayo Clinic. Here is what the Mayo Clinic had to say on Friday about
the legislation that is being considered in the House of
Representatives:

Although there are some positives in the current House Tri-
committee bill, including insurance for all and payment
reform demonstration projects--the proposed legislation
misses the opportunity to help create higher quality, more
affordable health care for patients. In fact, it will do the
opposite.

That is the Mayo Clinic talking.

[[Page S7746]]

In general, the proposals under discussion are not patient
focused or results oriented. Lawmakers have failed to use a
fundamental lever--a change in Medicare payment policy--to
help drive necessary improvements in American health care.
Unless legislators create payment systems that pay for good
patient results at reasonable costs, the promise of
transformation in American health care will wither. The real
losers will be the citizens of the United States of America.

That is the Mayo Clinic talking about the bill we are beginning to
see in the House of Representatives.
I think the prudent thing to do is to try to make that bill better or
start over and certainly not try to pass a 1,000-page or 2,000-page
bill in 1 week or 10 days without knowing what is in it, as we did with
the stimulus bill earlier this year.
That is not just the opinion of the Mayo Clinic. Here is a letter to
House Members on July 16, a few days ago, from a number of clinics,
including the Mayo Clinic. These are the Intermountain Healthcare,
Gundersen Lutheran Health System, the Iowa Clinic, the Marshfield
Clinic, the Rural Wisconsin Health Cooperative, ThedaCare, and
Wisconsin Hospital Association.
I ask unanimous consent to have this letter printed in the Record
following my remarks.
The ACTING PRESIDENT pro tempore. Without objection, it is so
ordered.
(See exhibit 1.)
Mr. ALEXANDER. It goes on to say:

On behalf of some of the nation's leaders in health care
delivery--

These are the people whose hospitals we go to, whose clinics we go to
when we are sick or when we hope to stay well--

we write to you to comment on the House bill.

They say:

We applaud the Congress for working on this. However, we
have got significant concerns.

They go on to say there are three of them.
The first is about the Medicare-like public plan, as they call it, a
public plan with rates based on Medicare. They say it will have a
severe negative effect on their facilities, that they lose a lot of
money every year, hundreds of millions of dollars. Because what happens
is that Medicare, a government-run plan, pays its doctors and its
clinics and its hospitals about 80 percent of what private insurance
companies are paying. So roughly 177 million of us have private
insurance of one kind or another. If a doctor sees you, he gets paid
100 percent. But if you go to one of these clinics and hospitals, they
are paid according to the government rate, which is roughly 80 percent
of the private rate. These clinics say that is not sustainable for
them, and that if that continues, some of those providers, such as the
Mayo Clinic, will eventually be driven out of the market. What market?
The market for Medicare patients. Those are the 45 million senior
Americans who absolutely depend on Medicare for their service because
for most of them, that is their only option. If that is the case, what
that means is they will not be able to go to the Mayo Clinic or to the
MeritCare Health System or to the Iowa Clinic or to the doctor they
choose because that doctor will not be a part of the Medicare system
because of low reimbursement.
So that is the first objection these clinics make to the bill they
see coming because the bill they see coming proposes to create another
government-run plan with government-set rates.
The second objection they have is geographic payment disparities.
They say that we are a big country and there ought to be differences in
the pay among different geographies.
Third, and maybe this is the most important of all, that the
President has said and many of us in the Senate have said we need to
change the way we pay for medical care, and we ought to pay more for
value, for quality, for results, and less for volume--in plain English,
not how many patients a doctor can see but how many of his or her
patients stay well or get well.
We have talked about that for weeks here in our hearings. But what
these respected voices in medicine are saying is that the legislation
we see today--and understand, this is not even in a bill that has
presented to us in the Senate yet in a way upon which we can act--does
not meet the test for that. The legislation we have seen so far is
running into a lot of trouble.
David Broder, the respected columnist from the Washington Post, said
that the plans which have been passed in a partisan way are ``badly
flawed'' and ``overly expensive.'' I mean, the Democratic plans; we
have Republican plans that we would like to be considered. I mentioned
that the Wyden-Bennett plan, which is the only really bipartisan plan
here, has not been given one bit of consideration so far in the Senate.
And then Senator Burr and Senator Coburn have a plan, Senator Gregg has
a plan, and Senator Hatch has a plan. We all have different ideas. As I
said, we would like for them to be considered, today I'm talking about
the Democratic plans that are now being considered.
The Congressional Budget Office, of course, is the nonpartisan office
in this Congress that we count on as an umpire to tell us what we are
really doing. It is not supposed to have any political rhetoric. Last
Thursday, the head of the Congressional Budget Office, Douglas
Elmendorf was asked at a Senate Budget Committee hearing what he
thought about the bills which had begun to emerge.
He said:

The legislation significantly expands the Federal
responsibility for health care costs.

In other words, here we go, at a time when we are in a recession and
where the President's proposals for other programs will add more to the
debt in the next 10 years, three times as much as we spent in World War
II, and we are talking about legislation that would add another $2
trillion. We haven't dealt with cost which is where we ought to start.
Look at the 250 million who have health care and ask the question: Can
you afford it? Then after we get through fixing it, can you afford your
government? And what the head of the CBO is saying, as far as the
government goes, the answer is no.
Then the Lewin Group, a well-respected private agency, was asked what
would happen if we had a government-run program which many of us
believe will lead to another Washington takeover. We are getting
accustomed to this, Washington takeovers of banks, of insurance
companies, of student loans, of car companies, now maybe of health
care. The Lewin Group said 88 million people will lose their private
employer-sponsored insurance. How could that happen? It could happen
because a small employer or a big employer would see one of these plans
that is beginning to come out take place. To be specific, the Senate
HELP Committee plan says you either have to provide everybody who works
for you insurance or pay $750. There are a lot of employers who cannot
afford to provide everybody the kind of insurance that is envisioned.
So they will say: OK, we will pay the $750 fine to the government. What
happens? All those employees lose their health insurance. Where do they
go? Into the Government plan. That is their option. Some of them may
have a choice of other plans, but if they do have a choice and one of
the choices is a government-run plan, it may have the same future the
Mayo Clinic and others were saying Medicare was causing to them.
The government will set a low price for the doctors and a low price
for the clinics. So all these employees who now have insurance that
they like will lose that insurance because of the passage of this bill.
The government will set the provider rates and physician rates low, and
so they will be part of a government plan for which many doctors and
many hospitals and many clinics will not offer services. It is similar
to giving somebody a bus ticket to a bus station with no busses.
Then there are the Medicare cuts. According to the Washington Post
last week, Medicare cuts will pay for one-half the cost of health care
for the uninsured in one of the bills being proposed.
If we are to find savings in Medicare and take from the 45 million
elderly people who depend on Medicare, every bit of those savings ought
to be put back into Medicare and not spent on some new program. I don't
think legislation that is paid for half by Medicare cuts is going to go
very far in this Chamber.
Then there are the employer taxes. According to the National
Federation of Independent Businesses, the House version has an 8-
percent Federal payroll tax. I mentioned the Senate

[[Page S7747]]

version, a $750 annual fine per employee, if the employer doesn't offer
insurance. The NFIB, small businesses, estimates that will lose about
1.6 million jobs.
How could that be? Well, if a small employer or even a large one has
government-mandated costs added and they have less money, they will
hire less employees. That is one of the options they have.
Then there is the income surtax. There is a whole string of trouble
for these bills. USA Today on Monday said: It is the highest tax rate
in a quarter of a century that is proposed: A 45-percent top tax rate
with all taxes included.
Then rationing, there are provisions in this bill which would have
the government make decisions about which treatment you will have and
how long you will have to wait to see a doctor.
Finally--I say ``finally'' because this is the subject I want to
spend a moment on--there is the Medicaid State taxes. Sometimes this
gets confusing. Mr. President, 177 million Americans have private
insurance, but a lot of people have government insurance now. Veterans
do. Military people have TRICARE insurance. About 45 million older
people have Medicare. But then there is a program called Medicaid,
which is the largest government-run program. About 60 million people
are in it now. The Federal Government pays about 57 percent of it, and
the States pay 43 percent. Every Governor I know--and I was once one--
has struggled with the Medicaid Program. I once came up here in the
early 1980s and asked President Reagan to take it all, let the Federal
Government run it and give us Governors all of kindergarten through the
12th grade. I thought that would be a good swap.
I saw a couple of Democratic Governors earlier today, and we talked
about the story every Governor faces. If you have an extra dollar and
you want to put it in higher education so you can improve the quality
of the University of Colorado or Tennessee or keep tuition from going
up, what happens to it? That dollar is stolen because it has to go in
the increasing Medicaid cost. It is an inefficiently managed program.
The Federal Government keeps changing the rules. The Governors have to
get permission from Washington whenever they make minor changes. It is
demolishing State governments right and left.
If our real goal is to help people, then why under these new plans do
we say to low-income people--defined as, say, a family of four who
makes less than $32,000--your only option is going to be to go in the
Medicaid Program under this plan. It is estimated by the Congressional
Budget Office and others that 15 or 20 million Americans will be added
to the 60 million in the Medicaid Program. What will they find when
they get there? They will find that 40 percent of the doctors don't see
Medicaid patients. When we add another 15 or 20 million people to it,
it may be a larger number. Why don't they do see Medicaid patients? For
the same reason the Mayo Clinic warned about this government plan in
its letter. It is because Medicaid only pays its doctors and its
hospitals about 72 percent of what Medicare pays.
If you are confused by that, it works out pretty simply. Medicare
pays 80 percent of what the private insurers pay, and Medicaid pays
about 72 percent of what Medicare pays. If you are a doctor or a clinic
or a hospital, you get paid about 60 percent, if you are helping a
Medicaid patient, of what you would if you were helping one of us who
has his or her own private health care. You can see that will be a
pernicious trend. If we continue to dump low-income people into a
government-run Medicaid Program, that is what will happen.
There is another thing that happens with Medicaid. Many members of
the committees working on this bill said: We can't let that happen. We
can't be inhumane and just say we are out here to help people who are
uninsured, and we are going to dump 20 million of them into a
government-run program that doesn't have enough doctors and hospitals
and clinics. We will have to raise what we pay to doctors and clinics.
That sounds good, but that is very expensive, particularly for a
program such as Medicaid that, according to the Government
Accountability Office, $1 out of every $10 is fraudulent, is wasted.
That is $32 billion a year. That is the program we are going to expand?
That is the program we are going to say to low-income people:
Congratulations, go into this program where you are not likely to find
a doctor every time you want one, and there are a lot of hospitals and
clinics that will not take you because we will not pay them for that.
Because Senators and Congressmen hear that, they say: We will raise
the rates. Here is the proposal: The proposal is, we are going to
increase the number of people who are eligible for Medicaid by 133 to
150 percent of the Federal poverty level. That is a substantial
increase. Then, if we are going to do that and put many more people
into the program, we are going to have to order an increase in what we
pay the doctors and the clinics to serve them, maybe up to 83 or 85
percent of the Medicare level.
Let me talk about what that would do in one State. We called the
State Medicaid director in Tennessee. Our program is called TennCare.
We said: What would it cost Tennessee if we increase coverage of
Medicaid up to 150 percent of the Federal poverty level? The answer
came back, nearly $600 million a year. That is the State's share of the
cost which is a little more than a third. The Federal Government's
share is twice that. So the Federal Government is saying: That is all
right. We know Tennessee doesn't have the money to do that, so we will
pay it all for the first 5 years. Then, after 5 years, so the talk
goes--and we were told, when we were working on this bill, this is an
assumption--we will shift these costs back to Colorado, back to
Tennessee. Back comes what in today's dollars is about $600 million to
the State of Tennessee.

Remember what I said. This is a program doctors don't want to go to
because they don't get paid very well. So we will have to increase the
amount of money we pay doctors. So if States are required to pay
doctors and providers under the Medicaid system 110 percent of what
Medicare is paid, that still isn't what doctors and hospitals get, if
they see somebody with private health insurance. That is about the same
amount of money, about $600 million added just for the State cost,
which brings the total new state cost for paying physicians and
hospitals more and for all the new people in the Medicaid Program to
$1.2 billion. That is a huge amount of money.
We throw around dollars up here and figures that make any amount of
money seem unimaginable. What is $1 trillion, what is $10 trillion,
what is $40 billion. We former Governors can imagine it. I figured it
out. If in 5 years you shifted back to the State of Tennessee just its
share of those costs from the expansion of Medicaid and paying the
doctors and hospitals more, the bill for the State of Tennessee to pay
the increased Medicaid costs would be an amount of money that equals a
new 10-percent State income tax.
The truth is, for our State--and I believe for almost every State--it
is an amount of money that nobody has enough taxes to pay. You can run
politicians in and out and defeat them for raising taxes all day long,
and they still couldn't come up with ways to pay for it. In other
words, these bills are based on a premise and assumption that will
either bankrupt the States or, if the Federal Government says we will
pay for it all, it will add $5, $6, $700 billion more over 10 years to
the legislation we are considering.
We need to think that through. Is that the best way to help people
who are low income? I don't think so. I think there are much better
ways. The Wyden-Bennett framework is a better way. It rearranges the
tax deductions we have for people who have health insurance from their
employers and it says: Let's take the available money and give the
money to low-income people who then buy private health insurance. It
may be a very basic plan. But at least they would have health
insurance, and they wouldn't be stuffed in a government program 40
percent of the doctors wouldn't see and that many of the best clinics
and hospitals wouldn't allow them to come in.
We have been told already by the Congressional Budget Office that
proposal would not add a penny to the debt. Not only does it not create
a new government program, it actually makes the Medicaid Program,
except

[[Page S7748]]

for Americans with Disabilities, history. In other words, if you are
poor, you are not stuffed into a program that nobody else would want to
join anyway. You have a chance to buy your own insurance, and you are
not consigned to the worst run government program we have today.
So there are some real possibilities with health care, and there are
some plans on the table that will lead us in the right direction. We
have advice from distinguished Americans with a stake in this--which is
every single one of us--but the most distinguished are those who deal
with it every day. The Mayo Clinic is saying the proposed legislation
misses the opportunity to help create higher quality, more affordable
health care for patients. In fact, it will do the opposite.
Shouldn't we slow down and get it right? Shouldn't we get it right?
This is the only chance we have to do this. If we do it wrong, we will
not be able to undo it. This is 16, 18 percent of the American economy
we are talking about. People have tried to do it for 60 years, and they
failed.
The only way we will do it is if we do it together. The Democrats
have big majorities over on that side. They do in the House. But that
is not the way things usually happen around here. The President has
said--and I take him at his word--and many of the leaders have said--
and I take them at their word--that we would like to get 70, 80 votes
for the health care result. We would too.
But in order to do that, we are going to have to do it the way we
usually do when we have bipartisan events around here. We get some
Democrats and some Republicans and they sit down with the President and
they share ideas and they agree on some things. They don't just say:
OK, here it is, and we are going to vote down almost every significant
idea you have on the way through.
I respect the fact that Senator Baucus is trying to do that in the
Finance Committee, and perhaps he will succeed, working with Senator
Grassley and others. But this is going to take some time. It cannot be
done overnight. There are many sections to this bill. Each of them
might be 500 pages long. They have enormous consequences to
individuals. That is why we have all these clinics writing and saying:
If you do it the way it looks like you are going to do it, you may
drive us out of the business of helping Medicare patients.
Do we really want to do that? Do we really want to say to 45 million
Americans who depend on Medicare: We are going to pass a bill that will
accelerate the process whereby respected clinics and the doctor you
might choose will not see you anymore because they cannot afford to
because the government will not pay them under the system we have?
So I would suggest we start over, literally, conceptually; start over
and listen to these clinics and doctors and focus on the delivery
system and focus, first, on those 250 million Americans who already
have health insurance and ask the question: Can they afford it? And,
what could we do to make it possible for those Americans to afford it?
And can we do it in a way that permits us to be able to honestly say
when we are through that those same 250 million Americans can afford
their government when we are through without adding to the debt?
Then let's look at the 46 million people who are uninsured. Of
course, we need for them to be insured. But the fact is, 11 million of
the uninsured are already eligible for programs we already have; 10
million or so are noncitizens--half of them legally here, half of them
not; a large number of them are making $75,000 a year and could afford
it but just do not buy it; and another significant number are college
students.
So we are going to have to go step by step by step and see in what
low-cost way we can include a large number of these 46 million
Americans, who are not part of the system, in the system. But that is
the wrong place to start. That is the place to end.
So, Mr. President, all I am saying is, on the Republican side of the
aisle we can tell you what we are for. Some of us are for the Wyden-
Bennett bill with our Democratic colleagues. That is the only
bipartisan bill before us today. It has not even been seriously
considered by this body, but it is there, and it has significant
support in the House. We have two doctors over here: Dr. Barrasso, who
has been an orthopedic surgeon for 25 years, and Dr. Coburn from
Oklahoma, an OB/GYN doctor. They would like to be involved in the
process. So far their ideas are not really being adopted in the result
we might have. We have Senator Gregg from New Hampshire, one of the
most respected Senators, who has been a part of many bipartisan
efforts, and he has his own bill. He would like to be more a part of
it, but his ideas do not fit the way things are going. But the way
things are going are too expensive for the Congressional Budget Office
and take us in the wrong direction, according to the Mayo Clinic.
So maybe we ought to step back and say: Well, let's listen to these
other ideas. Let's go very carefully. Let's work with the President.
Let's see if we can get a result. Let's keep a four-letter word out
there that is a good word; and that is ``cost,'' and make sure we focus
first on the 250 million Americans who have health insurance and make
sure they can afford it; and, second, make sure when we finish fixing
health care that those same Americans can afford their government.
I thank the Presiding Officer, and I yield the floor.

Exhibit 1

July 16, 2009.
Hon. Ron Kind,
Longworth House Office Building,
Washington, DC.
Dear Congressman Kind: On behalf of some of the nation's
leaders in health care delivery, we write to you today to
comment on the House health care reform bill introduced
earlier this week. We would like to thank you for the
opportunity to comment on this legislation. We applaud the
Congress for its commitment to passing comprehensive health
care delivery system reform this year. However, we have
significant concerns about the current language of the bill
and we ask that these concerns, set forth below, be addressed
before the committee action is concluded.

Medicare-like Public Plan

First, we are concerned that a public plan option with
rates based on Medicare rates will have a severe negative
impact on our facilities. Today, many providers suffer great
financial losses associated with treating Medicare patients.
For example, several of the systems that have signed onto
this letter lost hundreds of millions of dollars under
Medicare last year. These rates are making it increasingly
difficult for us to continue to treat Medicare patients. The
implementation of a public plan with similar rates will
create a financial result that will be unsustainable for even
the nation's most efficient, high quality providers,
eventually driving them out of the market. In addition,
should a public plan with inadequate rates be enacted, we
will be forced to shift additional costs to private payers,
which will ultimately lead to increased costs for employers
who maintain insurance for their employees. We believe all
Americans must have guaranteed portable health insurance, but
it is critical that we not lose sight of the need to ensure
adequate and equitable reimbursement.

Geographic Payment Disparities

Second, our health care systems are among the most cost-
efficient in the country in caring for Medicare patients.
However, many of us operate in states with some of the lowest
Medicare reimbursement rates in the nation. Current physician
payments due to geographic disparities are actually greater
under Medicare than under commercial insurance. This may be
difficult to believe, given the government's rate-setting
power, but flows from the fundamentally flawed payment
methodology. To date, health care reform proposals simply
continue the current payment methodology, despite the fact
that formula changes have been identified to address this
problem. We support payment changes that work to reduce
geographic disparities, rather than perpetuating the flaws in
the current payment system. While we believe that the
Institute of Medicine study is a good first step, we
encourage Congress to take this further and enact payment
reforms that will address the existing disparities.

Value Index Proposal

Third, consistent with statements from President Obama, we
believe that focusing on, defining, measuring, and paying for
value is essential for controlling cost within the U.S.
health care system. The system must be reformed to compensate
for value instead of volume. We believe inserting a value
index into various aspects of the Medicare payment system
(e.g., physician fee schedule, hospital rates) is the means
to accomplish this end goal of compensating for quality
rather than quantity.
We appreciate the opportunity to comment on this
legislation. We urge you to address the above-stated
concerns, which will demonstrate that Congress is serious
about preserving the best parts of the existing health

[[Page S7749]]

care delivery system. If we can be of assistance to you
moving forward, please do not hesitate to contact us.
Sincerely,
Everett Clinic, Gundersen Lutheran Health System,
HealthPartners, Intermountain Healthcare, Iowa Clinic,
Marshfield Clinic, Mayo Clinic.
MeritCare Health System, Park Nicollet Health System,
Rural Wisconsin Health Cooperative, ThedaCare,
Wisconsin Hospital Association, Wisconsin Medical
Society.

The PRESIDING OFFICER (Mr. Udall of Colorado). The Senator from
Illinois.
Mr. BURRIS. Mr. President, throughout this Nation's history, our
freedom--and at times our very survival--has rested squarely on the
shoulders of the men and women of our Armed Forces.
As a member of the Armed Services Committee, I am proud to know many
of these brave warfighters we have. We rely upon their training and
discipline. We depend upon their service and their sacrifice. In
return, we owe them nothing but the very best.
That means keeping our commitment to every soldier, sailor, airman,
and marine at every stage in their career--from the day they report for
training to the day they retire and beyond.
We can start to honor this commitment in the most basic way by
ensuring that their facilities are safe and adequate. That is why I
plan to offer an amendment that would help eliminate vegetative
encroachment on training ranges. Excessive vegetation can actually
render training grounds unusable. If a training range is heavily
overgrown, it can lead to dangerous situations, including fires and
obstructive lines of sight.
In a recent study by the U.S. Army, 70 percent of the facilities
surveyed are experiencing limitations due to uncontrolled vegetation.
This is unacceptable. We must take action now.
My amendment calls upon the Secretary of Defense to perform a
comprehensive study of training ranges across every branch of the
military. We must develop a plan to reclaim any overgrown land for its
rightful use by our fighting men and women of America. This will help
us ensure that we can train them adequately and safely so they can
fully prepare for any mission they are assigned to perform.
But we cannot stop there. Our commitment begins on the day someone
volunteers for service in the Armed Forces. But it does not end, even
after their service has drawn to a close. That is why I believe it is
important to extend dislocation benefits to every servicemember,
including those whose service is coming to an end.
Over the course of a career in the American military, a service man
or woman and their family may be ordered to relocate a number of
times--moving here, moving there, this assignment, that assignment.
Each move can be quite costly. From basic travel expenses to the
purchase of household goods to utilities to rent, it takes a lot to
relocate an entire family.
Since 1955, Congress has helped members of the service defray these
costs by paying a ``dislocation allowance'' to each person we reassign
to a new duty station. This eases the financial burden on military
families and means that personnel decisions can be made without fear of
breaking the bank--at least for most servicemembers, that is.
Unfortunately, those who retire are not covered under the current
system, despite the fact that their final orders may require a
permanent change of station. So after years of supporting service men
and women when we ask them to relocate, we abandon them at the time of
their final move. We leave them to fend for themselves, even though the
expenses they incur will be as high as ever, and even though their
income has been reduced to half of what they had been paid during
Active Duty.
So we simply cannot stand for this. We cannot allow those who have
served us honorably to be left out in the cold at the end of their
careers. We must offer these benefits to all Members of our Armed
Forces, even those who have been asked to move for the last time.
That is why I am calling for a study to examine the feasibility of
extending the dislocation allowance to retiring servicemembers. We
should find a way to make this work. The cost of moving demands it. Our
servicemembers support it. And, most importantly, it is the right thing
to do for our troops.
Colleagues, Members of this great body, let's come together to stand
for those who sacrifice on our behalf and protect this great country of
ours that allows us to do what we do in America, with freedom and
opportunity. Let's provide our men and women in uniform with the
support they need at every stage of their careers--from the first day
of basic training to the day they are discharged.
Cutting down on vegetation encroachment will keep our trainees safe
and help prepare them for years of honorable service. When that service
ends, dislocation benefits will help them retire with some measure of
financial security.
So I urge my colleagues to join with me in supporting these
initiatives I put forth. We owe our troops nothing less.
Thank you, Mr. President. I yield the floor.
The PRESIDING OFFICER. The Senator from Rhode Island.
Mr. REED. Mr. President, I suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The assistant legislative clerk proceeded to call the roll.
The PRESIDING OFFICER. The Senator from South Carolina.
Mr. DeMINT. Mr. President, I ask unanimous consent that the order for
the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. DeMINT. Mr. President, I ask unanimous consent to speak for up to
10 minutes as in morning business.
The PRESIDING OFFICER. Without objection, it is so ordered.

Health Care Reform

Mr. DeMINT. Mr. President, I wish to speak for a few minutes about
health care and the need for health care reform in the country today. I
think most Americans would agree we need to do everything we can to
make affordable health insurance available to every American and,
hopefully, that is what this health reform debate will be about.
Unfortunately, we are seeing a pattern develop here that has been
going on all year--since the President took office--that has many
Americans alarmed at the rapid pace we are spending and borrowing,
imposing new taxes, and taking over various aspects of the American
economy. I know a lot of Americans are alarmed and some are outraged.
More than any other comment, I am hearing Americans say: Why don't you
slow down and read the bills before you continue the expansion of
government.
Now we are talking about health care, and we see that same pattern of
crisis and rush and it ``has to be done today, hair's on fire'' type of
mentality here in Washington so that we almost have to call this a
``son of stimulus'' health care bill. Because certainly the last time
the President tried to ram a massive bill through Congress before we
had a chance to read it, we ended up with this colossal stimulus
failure that has actually resulted in the loss of jobs in America and a
burden of debt on our children that is almost unimaginable. It makes no
sense for us to follow that same pattern with health care--nearly 20
percent of our economy--to have a government takeover with a bill we
haven't even completely seen yet, that is supposed to be passed in the
next 2 weeks, even though the bill wouldn't take effect until 2013.
What is the rush? The whole purpose of the Senate is to be the place
where the legislation comes to cool down, where we deliberate, we look
at the details. The President himself has admitted he is not aware of
the details of the bill he is out selling every day.
We do have serious problems in health care that we need to fix. The
unfortunate thing is I have no confidence that the President actually
wants to make health insurance affordable and available to all
Americans because when he was in the Senate, Republicans proposed a
number of alternatives that would have done that. Yet in every case--
every opportunity he had to make health insurance more available and
affordable to Americans--he voted no. Let's review some of them,
because I think we have to recognize that the point of this health care
debate is not to make sure every American is insured, but to make sure
the government is running our health care system. The most personal and

[[Page S7750]]

private part of our lives they are talking about turning over to
bureaucrats at the Federal level. This makes no sense.
What we could do is be fair to those who don't get their health
insurance at work. If people get their health insurance at work, as we
do here in Congress, your employer can deduct the cost of it and the
employee is exempt from paying taxes on those benefits. That is
equivalent to about a $5,000 a year benefit to families who get their
health care or health insurance at work. Why can't we offer that same
fairness to Americans who don't get their health insurance at work? It
is something I actually proposed here in the Senate while President
Obama was a Senator, that we would give fair tax treatment; at least
let them deduct it from their taxes. He voted no, as did I believe
every Democrat, and they killed the bill in the House. This was basic
fairness to make health insurance a little more affordable to people
who didn't get it at work. The President voted no.
We hear a lot of talk about how we need a government plan to make the
private plans more competitive. Why not make all the insurance
companies compete with insurance companies all over the country instead
of what we do now? A lot of Americans don't know that the reason we
don't have a competitive private health insurance market is that the
Federal Government makes it impossible. You have to buy your health
insurance in the State where you live, so a few insurance companies
basically have monopolies in every State of the country. What if
someone such as myself who lived in South Carolina could look all
across the country, find a policy I wanted at a better price, and buy
it? Why can't we do that? Well, I proposed we do that. We introduced it
on the Senate floor. It would have created a competitive health
insurance market and allowed people to buy all over the country. Barack
Obama voted no, as did all of the Democrats, to kill the bill. Now they
are talking about: Well, we need a government option to create some
competition, to have a real competitive market. He voted against it.
What about allowing Americans who put money in a health savings
account, or their employer puts it in there for them--their own money--
why not let them use that money to pay for a health insurance premium
if they don't get it at work? It sounded like a good idea to me, to
make it a little bit easier, a little more affordable to have your own
health insurance, so I proposed that bill here in the Senate. Barack
Obama voted no, as did all of the Democrats, and they killed the bill.
What about the idea of allowing a lot of small employers--I was a
small businessman for years. It was hard to buy health insurance as a
small employer, but I did. It cost me a lot of money, a lot more than
the big employers. But what about allowing a lot of small employers to
come together and form associations and buy health insurance so they
could offer it to their employees less expensively? Well, it is a good
idea that was offered right here on the floor of the Senate by
Republicans. Barack Obama voted no, as did most of the Democrats, and
they killed the bill.
There is a long list here I could go through, but every single bill,
every single health reform idea that has been proposed here, the
President, when he was in the Senate, voted against. Everything that
would have made health insurance available and affordable to the
average American who doesn't get their insurance at work was voted no
by this President.
Now he is saying, We need the government to take it over because it
is not working. The reason it is not working is we won't let it work.
The part of health insurance, the health care system that works the
best today is when you have your own health insurance and you pick your
own doctor and you and your doctor decide what kind of health care you
are going to get. It is not a perfect system, and insurance companies
have a lot of work to do to make things work better because I have to
argue with them a lot myself. But the part of the health care system
that doesn't work is the part that the government runs, Medicaid and
Medicare, the SCHIP and TRICARE. Some of the people who get those
benefits such as our seniors say Medicare works fine, but,
unfortunately, doctors don't want to see them coming because Medicare
and Medicaid don't cover the cost of even seeing a patient. So many
physicians are closing their practices to our seniors because they have
government health insurance. Government health care does not pay enough
for the physician and the hospital to see the patient, so they shift
the cost over to the private market.
The worst part of all of these government plans is they are trillions
of dollars in debt--debt that our children are going to have to pay
back. These programs are broke. Yet they want to expand these programs.
They want to take the part of health care that is not working and
essentially force it on every American. They want every American to
have a Medicaid plan where doctors don't want to see us coming because
we are not paying enough of their costs.
As I look at this whole health care reform debate--and I am glad to
see the President out taking shots at me for saying we have to stop him
on this, because we have been on a rampage since he took office,
passing one government program after another, expanding spending and
debt at levels we have never imagined in this country. It is time to
slow down and take stock of where we are. Other countries that have to
lend us money to keep us going are beginning to wonder, Can we pay our
debts? We have doubled our money supply by the Federal Reserve, and
that means big inflation, higher interest rates. Yet we are moving
ahead with this health care plan that is going to expand our debt as a
nation, raise taxes on small businesses that create the jobs. It looks
as if we are going to penalize Americans who don't decide to buy health
insurance, and we are moving again toward a government program that we
know won't work. There is not one Federal program that has worked as
advertised, that has worked to the budget we said it would be to. This
week we have had announcements of what we have already passed as far as
stimulus over the last year is going to mean trillions of dollars--
trillions of dollars--we are going to have to borrow and that our
children are going to have to pay back.

I appeal to my colleagues: We don't need to rush through a bill in
the next 2 weeks before we go on our August break that affects one-
fifth--20 percent--of our total economy, that gets the government to
effectively take over the most personal and private service that we ask
for as Americans. We don't need to pass a bill such as that, that we
won't even have time to read. What the President and I think a lot of
the proponents of this bill are afraid of is if we are able to go home
on the August break and we take this bill and we put it on the Internet
where people can read it, and radio talk shows and bloggers all around
the country are able to tell the American people what this bill is and
what it will do, and get past this utopian rhetoric that we are hearing
from the President and look at the nuts and bolts, because everything
he is saying this bill is going to do the Congressional Budget Office
and other experts are saying, No, it isn't going to work that way. It
isn't going to save us money, it is going to raise our taxes, it is
going to cost jobs in America, and it isn't going to fix health care.
We need to go back to the basics, including some of what I have
mentioned already, that would reform health care and make private
health insurance work better, make it more affordable, and get it into
the hands of more Americans. Why should we give up on freedom and move
to a government plan when we haven't even given freedom a chance to
work in health care?
I know the government can't run health care and I don't want them
running my plan. One of the best ideas I have heard in this debate is
whatever we pass, Congressmen and Senators ought to have to take that
health plan. I am going to have an amendment to that effect if they try
to get this on the floor before August.
But I appeal to my colleagues: Let's listen to the American people.
Let's stop this rampage toward bigger and bigger government. Let's take
our time and look at this bill and, for once, do something right. Our
health depends on it.
Thank you, Mr. President. I yield the floor.
The PRESIDING OFFICER. The Senator from Florida is recognized.

[[Page S7751]]

Amendment No. 1515

Mr. NELSON of Florida. Mr. President, I ask unanimous consent that
the pending amendment be laid aside in order that I might call up
amendment No. 1515.
The PRESIDING OFFICER. Is there objection?
Without objection, it is so ordered.
The clerk will report.
The assistant legislative clerk read as follows:

The Senator from Florida [Mr. Nelson] proposes an amendment
numbered 1515.

Mr. NELSON of Florida. 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:

(Purpose: To repeal the requirement for reduction of survivor annuities
under the Survivor Benefit Plan by veterans' dependency and indemnity
compensation)

At the end of subtitle D of title VI, add the following:

SEC. ___. REPEAL OF REQUIREMENT OF REDUCTION OF SBP SURVIVOR
ANNUITIES BY DEPENDENCY AND INDEMNITY
COMPENSATION.

(a) Repeal.--
(1) In general.--Subchapter II of chapter 73 of title 10,
United States Code, is amended as follows:
(A) In section 1450, by striking subsection (c).
(B) In section 1451(c)--
(i) by striking paragraph (2); and
(ii) by redesignating paragraphs (3) and (4) as paragraphs
(2) and (3), respectively.
(2) Conforming amendments.--Such subchapter is further
amended as follows:
(A) In section 1450--
(i) by striking subsection (e);
(ii) by striking subsection (k); and
(iii) by striking subsection (m).
(B) In section 1451(g)(1), by striking subparagraph (C).
(C) In section 1452--
(i) in subsection (f)(2), by striking ``does not apply--''
and all that follows and inserting ``does not apply in the
case of a deduction made through administrative error.''; and
(ii) by striking subsection (g).
(D) In section 1455(c), by striking ``, 1450(k)(2),''.
(b) Prohibition on Retroactive Benefits.--No benefits may
be paid to any person for any period before the effective
date provided under subsection (f) by reason of the
amendments made by subsection (a).
(c) Prohibition on Recoupment of Certain Amounts Previously
Refunded to SBP Recipients.--A surviving spouse who is or has
been in receipt of an annuity under the Survivor Benefit Plan
under subchapter II of chapter 73 of title 10, United States
Code, that is in effect before the effective date provided
under subsection (f) and that is adjusted by reason of the
amendments made by subsection (a) and who has received a
refund of retired pay under section 1450(e) of title 10,
United States Code, shall not be required to repay such
refund to the United States.
(d) Repeal of Authority for Optional Annuity for Dependent
Children.--Section 1448(d) of such title is amended--
(1) in paragraph (1), by striking ``Except as provided in
paragraph (2)(B), the Secretary concerned'' and inserting
``The Secretary concerned''; and
(2) in paragraph (2)--
(A) by striking ``Dependent children.--'' and all that
follows through ``In the case of a member described in
paragraph (1),'' and inserting ``Dependent children annuity
when no eligible surviving spouse.--In the case of a member
described in paragraph (1),''; and
(B) by striking subparagraph (B).
(e) Restoration of Eligibility for Previously Eligible
Spouses.--The Secretary of the military department concerned
shall restore annuity eligibility to any eligible surviving
spouse who, in consultation with the Secretary, previously
elected to transfer payment of such annuity to a surviving
child or children under the provisions of section
1448(d)(2)(B) of title 10, United States Code, as in effect
on the day before the effective date provided under
subsection (f). Such eligibility shall be restored whether or
not payment to such child or children subsequently was
terminated due to loss of dependent status or death. For the
purposes of this subsection, an eligible spouse includes a
spouse who was previously eligible for payment of such
annuity and is not remarried, or remarried after having
attained age 55, or whose second or subsequent marriage has
been terminated by death, divorce or annulment.
(f) Effective Date.--The sections and the amendments made
by this section shall take effect on the later of--
(1) the first day of the first month that begins after the
date of the enactment of this Act; or
(2) the first day of the fiscal year that begins in the
calendar year in which this Act is enacted.

Mr. NELSON of Florida. Mr. President, this is the widows and orphans
amendment. This is the dastardly subject we have been dealing with for
years, where there is an offset from an insurance payout, that
servicemembers pay insurance premiums and/or retirees pay premiums,
which is offset by Veterans Department disability compensation, which
otherwise the veteran's surviving spouse and children would be able to,
under existing law, be eligible for both, but there is an offset.
This particular amendment is going to eliminate that offset. Every
year, we come to the floor on the Defense authorization bill and we
offer the amendment and we have an overwhelming vote in the Senate.
Every year, it goes to conference and, for years and years, in the
conference committee with the House, they would say you cannot pass an
amendment that would even reduce the offset for widows and orphans.
Only in the last couple years have we had some modest reduction of the
offset. Then, on an earlier piece of legislation this year, we had a
little bit more reduction of the offset. What this amendment will do is
completely eliminate the offset.
I wish to point out at the outset, I have a letter from the Military
Coalition, and I ask unanimous consent it be printed in the Record.
There being no objection, the material was ordered to be printed in
the Record, as follows:

The Military Coalition,

Alexandria, VA, July 15, 2009.
Hon. Bill Nelson,
U.S. Senate,
Washington, DC.
Dear Senator Nelson: The Military Coalition (TMC), a
consortium of nationally prominent military and veterans
organizations, representing more 5.5 million members plus
their families and survivors would like to thank you for your
sponsoring of Amendment No. 1515 of FY2010 NDAA (S. 1390).
This Amendment, like your bill, S. 535, would repeal the law
requiring a dollar-for-dollar deduction of VA benefits for
service connected deaths from the survivors' SBP annuities.
The elimination of this survivor benefit inequity is a top
legislative goal for TMC in 2009.
We strongly believe that if military service caused a
member's death, the Dependency and Indemnity Compensation
(DIC) the VA pays the survivor should be added to the SBP
benefits the disabled retiree paid for, not substituted for
them. In the case of members who died on active duty, a
surviving spouse with children can avoid the dollar-for-
dollar offset only by assigning SBP to the children. That
forces the spouse to give up any SBP claim after the children
attain their majority--leaving the spouse with only a $1,154
monthly annuity from the VA. Those who give their lives for
their country deserve fairer compensation for their surviving
spouses. Your amendment would also end this inequity.
The Military Coalition again thanks you for sponsoring this
Amendment to restore equity to this very important survivor
program and encourages your colleagues vote for its passage.
Sincerely,
The Military Coalition:

Air Force Association, Air Force Sergeants Association, Air
Force Women Officers Associated, American Logistics
Association, AMVETS, Army Aviation Assn. of America, Assn. of
Military Surgeons of the United States, Assn. of the US Army,
Association of the United States Navy, Commissioned Officers
Assn. of the US Public Health Service, Inc. CWO & WO Assn. US
Coast Guard, Enlisted Association of the National Guard of
the US, Fleet Reserve Assn., Gold Star Wives of America,
Inc., Iraq & Afghanistan Veterans of America, Jewish War
Veterans of the USA, Marine Corps League, Marine Corps
Reserve Association, Military Officers Assn. of America,
Military Order of the Purple Heart, National Association for
Uniformed Services, National Guard Assn. of the US, National
Military Family Assn., National Order of Battlefield
Commissions, Naval Enlisted Reserve Assn., Non Commissioned
Officers Assn. of the United States of America, Reserve
Enlisted Assn. of the US, Reserve Officers Assn., Society of
Medical Consultants to the Armed Forces, The Military
Chaplains Assn. of the USA, The Retired Enlisted Assn., USCG
Chief Petty Officers Assn., US Army Warrant Officers Assn.,
Veterans of Foreign Wars of the US.

Mr. NELSON of Florida. This letter supports this legislation. It is
from the Military Coalition. The Military Coalition is a group of 34
organizations, and their signatures are on the letter--alphabetically,
from the Air Force Association all the way to the last one on the list
of 34, the Veterans of Foreign Wars of the United States. All those
organizations that you would expect are in between; there are 34 of
them endorsing this amendment.
I wish to tell you about this particular amendment. I filed this
bill--and this is nonpartisan--years ago with Senator Sessions and
eight other original cosponsors. It will repeal the law that takes
almost $1,200 per month from families who have lost a loved one because
of military service. This survivors benefit plan, otherwise known

[[Page S7752]]

by its initials as SBP, is an annuity paid by the Defense Department.
Survivors receive the benefit when either a military retiree pays a
premium as income insurance for their survivors or when a servicemember
dies on Active Duty.
The other law is dependency and indemnity compensation, referred to
by its initials DIC. It is a survivor benefit paid by the Veterans'
Administration. Survivors receive this benefit when the military
service caused the servicemember's death.
What this amendment will do is fix this longstanding problem in the
military survivor benefits system. The problem is, it requires a
dollar-for-dollar reduction of the survivor benefits from the SBP, paid
by the Department of Defense, offsetting against the dependents and
indemnity compensation, DIC, paid by the Veterans' Administration.
You know the great quote, following one of America's bloodiest wars,
by President Lincoln in his second inaugural address--and the war was
still raging at that point. He said that one of the greatest
obligations in war is to ``finish the work we are in; to bind up the
Nation's wounds; to care for him who shall have borne the battle''--in
other words, the veterans--``and for his widow and his orphan.''
Following Lincoln's advice to honor truly our servicemembers, they
need to know their widows and orphans, their survivors, will be taken
care of. We certainly agree that the U.S. Government must take care of
our veterans, their widows, and their orphans. In keeping with that
principle, we need to repeal this offset that denies the widows and
orphans the annuity their deceased loved ones have earned on Active
Duty or have purchased for them. A retired military member can purchase
this SBP, and it is an insurance policy so their survivors will have
income.
Over in the Veterans' Administration, we have a law that says, if you
are disabled a certain percentage, we are going to take care of you.
One should not offset the other--particularly, when somebody has paid
premiums on an insurance policy.
Well, that dollar-for-dollar offset is what has me so agitated for a
decade now. I have already explained that, for the survivors benefit
plan, there are two ways to qualify: The military retiree goes out and
voluntarily pays into an insurance program with their retirement
income. Later, the statute was added that the survivors benefit plan is
available to an Active-Duty servicemember if they are killed as a
result of military service. For retirees, the SBP is an insurance
program that protects the income of survivors; and for Active-Duty
military members, SBP is compensation for the servicemembers'
beneficiaries.
On the other hand, the dependents indemnity compensation is a benefit
payment to the survivors of a servicemember who dies from a service-
connected condition. For almost a decade, I have fought to repeal the
law that requires the dollar-for-dollar offset of these two very
different benefits. Back in 2005, the Senate took the step in the right
direction and passed, by a vote of 92 to 6, my amendment to repeal that
offset. When it got down to the conference committee, you know what
happened. In the 2008 Defense authorization bill, we cracked the door
to eliminating the offset. In the conference committee negotiations
with the House, we made some progress when we got a special payment of
$50 per month, which would now increase to $310 per month by 2017
because of money savings found in the tobacco legislation passed
earlier this year.
Our efforts have been important steps in the right direction, but
they are not enough. We must meet our obligation to the widows and
orphans with the same sense of honor as was the service their loved
ones had performed. We need to completely offset this SBP and DIC. We
must continue to work to do right by all those who have given this
Nation their all and especially for the loved ones they may leave to
our care.
In that letter that I have had entered into the Record, it says:

The elimination of this survivor benefit inequity is the
top legislative goal for [the Military Coalition] in 2009.

I will not take the time to read the names of the 34 organizations
that signed the letter, but they are all fairly well known to every one
of us.
On February 24 of this year, during a joint session of the Congress,
the President said:

To keep our sacred trust with those who serve, we will
raise their pay, and give our veterans the expanded health
care and benefits they have earned.

I say amen to that. I ask that President Obama help us end this
injustice to widows and orphans of our Nation's heroes.
Mr. President, may I inquire if there is someone else who wants to
speak now, because if there would not be, I would like to speak as in
morning business.
Mr. McCAIN. I object. Let's dispose of the amendment.
The PRESIDING OFFICER. The Senator from Arizona objects.
Mr. McCAIN. I object to the Senator from Florida going into morning
business until we dispose of the amendment. Then he can do it right
away.
Mr. NELSON of Florida. I merely inquired if another Senator wants to
speak. Certainly, I would withhold asking for a unanimous consent.
Mr. SCHUMER. Mr. President, I intend to speak on the Thune amendment
and was scheduled to speak in the next few minutes. If it is OK with
the floor leaders, if my colleague will speak for a brief amount of
time, I am happy to go after him. It is up to the floor managers.
Mr. McCAIN. Mr. President, I say to the Senator from Florida, we will
find out if there are others who want to speak on his amendment. If
not, we are in favor of disposing of his amendment. Part of the
agreement we made, in order for us to proceed, was that if anyone came
to the floor to speak on the pending amendment, that Senator would have
priority. If it is agreeable to the Senator from Florida, the Senator
from New York would go ahead and then we could go back to him speaking
in morning business.
Mr. NELSON of Florida. Of course. It is my understanding the Senator
from South Carolina had just spoken as in morning business. That is why
I was inquiring. I am very grateful to the ranking member of the
committee for us to go ahead and dispose of this amendment.
Mr. McCAIN. Why don't we wait until after the Senator from New York
finishes, to make sure there is no one else who wants to speak on the
amendment of the Senator from Florida.
Mr. SCHUMER. Mr. President, if my colleague needs 5 minutes, I am
happy to yield to him, if I would come after that. I ask unanimous
consent that be the case.
The PRESIDING OFFICER. Is there objection?
Without objection, it is so ordered.
The Senator from Florida is recognized.
Mr. NELSON of Florida. Mr. President, I ask unanimous consent to
speak as in morning business.
The PRESIDING OFFICER (Mr. Kaufman). Without objection, it is so
ordered.
Mr. NELSON of Florida. I thank the Chair.
(The remarks of Mr. NELSON of Florida pertaining to the introduction
of S. 1484, S. 1485, S. 1486, and S. 1487 are located in today's Record
under ``Statements on Introduced Bills and Joint Resolutions.'')
Mr. REED. Mr. President, if the Senator from Florida is prepared, I
have conferred with the ranking member, the Senator from Arizona, and
we are prepared to voice vote the amendment.
The PRESIDING OFFICER. Is there further debate on the amendment?
If not, the question is on agreeing to the amendment.
The amendment (No. 1515) was agreed to.
Mr. NELSON of Florida. Mr. President, I move to reconsider the vote,
and I move to lay that motion on the table.
The motion to lay on the table was agreed to.
The PRESIDING OFFICER. The Senator from New York.

Amendment No. 1618

Mr. SCHUMER. Mr. President, I know we are not now on the Thune
amendment. I know we have gone aside to other amendments and that we
will be debating Thune tomorrow morning, but there are so many of my
colleagues who want to speak, and I have a lot to say. So I will speak
for 5 minutes tomorrow morning, but I will give the bulk of my speech
this afternoon.

[[Page S7753]]

Mr. President, I rise in staunch opposition to the Thune amendment. I
believe it is a dangerous amendment that would go far beyond
authorizing gun possession for self-defense and not only create a
serious threat to public safety but also severely undercut American
federalism.
Amendment No. 1618, authored by Senator Thune, would force States and
localities from across the Nation to permit individuals from other
States to carry hidden and loaded handguns in public, even where the
elected representatives of those States have chosen to bar these
persons from possessing firearms. The legislation would require every
State with concealed carry legislation to honor concealed carry
licenses issued by any other State so long as they abide by the State's
location restrictions for concealed carry.
This amendment is a bridge too far and could endanger the safety of
millions of Americans. Each State has carefully crafted its concealed
carry laws in the way that makes the most sense to protect its
citizens. It is obvious what is good for the safety of people in New
York City or Philadelphia or Chicago or Miami or Los Angeles is not the
same thing that is needed in rural Idaho or rural Tennessee. Yet this
amendment, in one fell swoop, says the protections some States feel
they need to protect law enforcement, to protect its citizenry, would
be wiped away.
The amendment will incite the dangerous race to the bottom in our
Nation's gun laws. Let's examine the lineup of people who could carry
concealed weapons in 48 States under this amendment. And I don't
disparage each State for doing what it wants within its own borders,
but why impose that on States outside their borders?
Arizona law allows a concealed carry permit to be issued to an
applicant who is a known alcoholic. So alcoholics would be in the
lineup. They could carry a concealed weapon in States outside of
Arizona simply because Arizona allowed them to do so.
Texas, which is one of the top 10 sources of guns recovered in crimes
in New York City, a city in which I reside, is obliged to issue a
permit to a person who has been convicted repeatedly of illegally
carrying a handgun. Therefore, we can place arms traffickers in this
lineup.
Mississippi law leaves access to concealed carry permits for members
of hate groups.
Alaska and Vermont allow adult residents of their States to carry a
concealed weapon without a license or background check as long as they
are allowed to possess a gun, even if they have committed violent
misdemeanors, have committed misdemeanor sex offenses against minors or
are dangerously mentally ill and have been voluntarily committed to a
mental institution.
Again, each State has its own views. The State of Vermont is a
beautiful State. It is different from New York State in many ways, and
the laws that fit for Vermont don't necessarily fit for New York.
A 17-year-old Crip or Blood from New York--a member of a gang;
dangerous, maybe violent--could head to Vermont, obtain a Vermont
driver's license, buy a gun, and return to New York or he could buy a
whole bunch of guns and return to New York. When law enforcement stops
him, a loaded gun tucked in his pants or a whole bunch of guns in his
backpack, all he would have to do is claim he is a Vermonter visiting
New York, show his Vermont ID, and the New York Police Department would
be unable to stop him. This runs shivers down the spines of New York
police officers, of New York sheriffs, of New York law enforcement. And
it doesn't just apply to New York. This could apply to any large State.
Imagine law enforcement stopping one of these characters with a
backpack full of guns--a known member of a major gang--and having to
let them go. Imagine how empowered gun smugglers and traffickers would
feel. Their business would boom. These are people who make money by
selling guns illegally to people who are convicted felons. They could
go to the State with the weakest laws, get a concealed carry permit--if
that State allowed it, and in all likelihood it might--and then start
bringing concealed guns into neighboring States and States across the
country. Their business would boom, but our safety would be impaired.
Imagine routine traffic stops turned into potential shootouts.
Police officers in New York have the safety and the peace of mind in
knowing that the only people who might legally have a gun are those who
have been approved by the police department. That is how we do it in a
city such as New York. We have had our problems with crime. Thank God
it is much lower now, due to the great work of the New York City
police. But now they would be totally unprepared, walking on tiptoe.
And if the criminal simply said: I am from this State--wow. I shudder
at the thought.
Beyond the very real threat this poses to law enforcement and the
safety of our police officers and the safety of our citizens, it would
create a logistical nightmare. A police officer making a stop of a car
would have to have in front of him or her the laws of all 45 States
that now allow or whose residents would now be allowed or even whose
people had gotten carry permits who would now be allowed to carry
concealed weapons in New York.
What about States rights? I have not been on the side--it is
obvious--of the gun lobby for as many years as I have been here in the
House and Senate. I have always believed, though, there is a right to
bear arms and that it is unfair to say the second amendment should be
seen through a pinhole and the first, third, fourth, fifth, sixth,
seventh, and eighth amendments should be seen broadly. I don't think
that is fair.
But every amendment has limitations. Through the years when I have
been involved in this issue, the NRA and other gun groups have argued,
frankly, that the States ought to make their own decisions. All of a
sudden we see a 180-degree hairpin turn. Now they are saying that the
States cannot make their own decisions. Why is it that every other
issue should be resolved by the States except this one? The amendment
flies in the very face of States rights arguments and takes away
citizens' rights to govern themselves.
I say to my colleagues who have laws and citizenry who probably want
the laws not drawn as tightly as my State, if you open up this door,
one day you will regret it. Because if you say that the Federal
Government should decide what law governs, you are taking away States'
right to govern themselves.
In the 1990s, after the passage of the Brady Act, the National Rifle
Association funded multiple legal challenges to it, citing the 10th
amendment, that the right to bear arms therefore resided in the States.
Indeed, Mary Sue Falkner, who was then a spokesman for the NRA, said at
the time:

This is not a case about firearms per se, but about whether
the Federal Government can force States and local governments
against their will to carry out Federal mandates.

Similarly, in reference to Brady, the NRA's chief lobbyist said that
the Federal Government was getting too much involved in State affairs.
The gun lobby's rallying cry has always been, ``Let each State
decide.'' But with this amendment, again, a 180-degree flip.
Clearly, large urban areas merit a different standard than rural
areas. To gut the ability of local police and sheriffs to determine who
should be able to carry a concealed weapon makes no sense. It is wrong
to take away any State's rights to make decisions about what can make a
resident safer. A one-size-fits-all approach to community safety leads
us down a very precarious road.
Make no mistake, this is a serious amendment. It is, even though not
the intention of the author, a dangerous amendment. There will be
needless suffering, injuries, and deaths if this amendment is agreed
to.
I talked to my colleague Senator Thune. We are friends. We saw each
other in the gym this morning. He said to me: What about truckdrivers
who have the gun in the cab of their truck and ride across State lines?
I am sympathetic to that. I supported laws that allow police officers
in New York to carry their gun when they cross over into New Jersey to
shop or whatever. But you do not need this law to deal with that
problem, because it creates so many other issues. There are ways we can
deal with the problem that the Senator from South Dakota brought up

[[Page S7754]]

to me in the gym this morning, without decimating State laws that
protect individual safety.
Make no mistake about it, this amendment would affect every State in
the country, but I do not see the Governors on board. It would affect
every city in the country. I don't see the mayors on board. It would
affect every county in the country, but I don't see the sheriffs on
board. It would affect every town in the country, but I don't see
police chiefs on board.
Before we rush to judgment, shouldn't we ask our Governors, our
mayors, our sheriffs, our police chiefs if this will make our
communities safer or less safe? If this will put the men and women, the
brave men and women who defend us and protect us on police forces, in
jeopardy? Why don't we seek their guidance?
I urge my colleagues to give thoughtful and careful consideration to
the consequences of the Thune amendment. I believe if they do, they
will vote against it tomorrow at noon.
I yield the floor.
I suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The bill clerk proceeded to call the roll.
Mr. DURBIN. Mr. President, I ask unanimous consent the order for the
quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. DURBIN. I ask unanimous consent to speak as in morning business.
The PRESIDING OFFICER. Without objection, it is so ordered.

Health Care Reform

Mr. DURBIN. Mr. President, as we meet here today we are discussing
the Defense authorization bill. We debate it each year. It is basically
an authorization for the expenditure of funds in defense of America. It
is a significant bill with a lot of different parts. I commend the
Senators who have brought this to the floor, Senator Carl Levin, the
chairman of the Armed Services Committee, and his Republican
counterpart, Senator John McCain.
I know this bill is important and I know we will be returning to
substantive amendments on this bill very shortly. But while we have
this break in the action, I want to address another issue which is
being debated in almost every corridor on Capitol Hill, and that is the
issue of health care reform. It is an interesting issue and an amazing
challenge to this Congress, to try to grapple with the health care
system in the most prosperous Nation on Earth.
Despite our prosperity, we know there is something fundamentally
flawed with our health care system. We spend more than twice as much
per person in America on health care as any other country, and the
results do not show that money is being well spent. Many other
countries, spending a fraction of what the United States spends, end up
with very different and much better results in terms of survival from
certain diseases and illness, and mortality rates. There is something
to be learned here about how we can be more effective in providing
health care for our citizens and not break the bank.
Most Americans know what I am talking about when I talk about cost,
because they are facing cost issues every day. They know health
insurance premiums in America in the last several years have gone up
three times faster than the incomes and wages of Americans. We have
learned it is not unusual for one-fourth of Americans to spend 1 out of
every $10 in income for health insurance. Some, a smaller group but a
significant group, spend up to $1 out of every $4 in income on health
insurance. The number keeps going through the roof with no end in
sight. It worries us, not just as individuals and members of families,
but businesses that are trying to do the right thing for their
employees and be competitive.
It worries units of government because, whether it is your State
government providing assistance for Medicaid or whether it is the
Federal Government concerned about Medicare and Medicaid, the costs of
health care are growing so quickly that they could easily put us into a
perpetual debt situation, something we do not want to see, something we
cannot leave to our children.
Now we are debating in the House and in the Senate, in a variety of
different committees, how to change this health care system. Needless
to say, it is a contentious debate. There are a lot of different points
of view. There are some people and companies in America that want no
change in our health care system. Most people do. Some don't. Many of
those who are resisting change, who are unwilling to support the
President's efforts to move us in this direction, are the very same
companies and people who are profiting from the current system.
Make no mistake, when you spend billions of dollars on a system, much
more than any other country, you are going to end up in a situation
where many people are profiting handsomely from the current system.
When you talk about reform--reducing the cost, reducing the payments,
being more cost effective--these people see money going out the window,
and they are going to fight it.
That is what the battle is all about. We have been through it before,
and now we have returned to it. But in addition to cost, there is also
the issue of the availability of health insurance. This morning's
Chicago Tribune, on the front page, told the story of a man who sadly
is one of the victims of this situation. He lives in a suburb of
Chicago, and he works as a doorman at one of the buildings. He had a
bad back. He finally was told--he tried a lot of conservative
treatment; it just did not work--you are going to have to have back
surgery.
So he did what he was supposed to do. He went to his insurance
company and said: The doctor is recommending a surgery, and I want to
know if it will be covered by my health insurance. Well, the health
insurance company sent back to him written confirmation that the costs
of the surgery would be covered by his health insurance. So he went
through with the surgery and ended up incurring $148,000 in medical
bills.
I think you know how this story ends. They turned in the bills to the
insurance company, and they denied them. They said: We did not really
approve this surgery. You should have taken a more conservative
approach to it.
Well, he thought he had done everything he was supposed to. What
followed was a battle with this insurance company, day after day, month
after month, while people were saying: Send us the $148,000. This man
of limited means was fighting to finally get this health insurance
company to pay what they promised to pay. It took him months.
When it was all over, Mr. Napientek, Michael Napientek, ended up with
coverage. Had he failed to get the coverage for that surgery, it would
have wiped out his entire life's savings. That is the reality of health
care. That is the situation too many people find themselves in, so
vulnerable in a situation where one medical bill denied by an insurance
company bureaucrat can literally wipe out their life's savings.
We can do better. We have to do better. That is what this debate is
all about. First, we have to reduce the cost of health care for
families and businesses and governments across America. There are ways
to do that. We can lower costs to make sure every American has access
to insurance. We can make it clear that no one can be turned down for
insurance coverage because of a preexisting condition. We can make
certain there is no discrimination in the premiums that are charged
individual Americans because one is a male and another female; one is a
certain age and another not. We can make certain there is more fairness
in the way people are treated by these health insurance companies.
This idea of denying coverage for preexisting conditions, imagine how
frustrating that must be to realize that if you turned in a claim this
year on your health insurance because you had a bad back, and you went
to the doctor next year, when it came time for surgery they would not
cover it.
This happened to a friend of mine, a fellow I grew up with in East
St. Louis, IL, in the trucking business. He not only owned the
business, he drove the trucks. When he reached 60 years of age, his
back was killing him. Well, at that point his company had lost its
health insurance. Why? Because the wife of one of the employees had a
sick baby. Her sick baby incurred a lot of medical bills, and the cost
of health insurance went through the roof. They

[[Page S7755]]

had to cancel the company's health insurance, give the employees some
money, and say: Fend for yourself.
He was in the same boat. He went out to get private health insurance,
complained about a bad back. The following year when the doctor said he
needed back surgery, he turned in a claim to his health insurance
company, and they said: No, it is a preexisting condition. We will not
cover your back surgery.
Do you know what he had to do? He ended up filing a worker's
compensation claim claiming that his back injuries had to do with
bouncing around in a truck for 30 or 40 years, not an unreasonable
conclusion. Do you know who he sued? He sued himself. He sued as an
employee of the company. He sued himself as owner of the company.
Is that crazy to reach that point? And he won, incidentally. They
said it is subject to worker's compensation. We will pay for the
surgery.
He had done everything right, providing health insurance for his
employees until he could not afford it, trying to get private insurance
for himself at the age of 60, then turning in a claim and being turned
down. He could have been wiped out by that surgery, just as the man on
the front page of the Chicago Tribune.
We are all in this vulnerable situation because the health insurance
companies have so much power over our lives. I listen to those on the
other side of the aisle who come--not all of them but many--every
single day and say we do not need to change this system. Who are they
talking to? Who are they listening to? They are not listening to people
like these who find out every day that they do not have coverage, that
the cost of insurance is too high, that their doctor is in a debate
with a clerk at an insurance company over whether they are going to get
the necessary and proper treatment for a medical condition. That is the
reality.
There are many ways to address this, and we should. We have to
address it by making sure everyone has access to health insurance
regardless of preexisting conditions, health status for a medical
condition. We have to get rid of the so-called lifetime caps.
Imagine that a diagnosis tomorrow that you or someone you love in
your family has a chronic condition that is going to call for medical
treatment for a long period of time, and then you realize there will
come a moment when that health insurance company would say: We are out
of here. You just broke the bank. You hit the cap on your policy.
We have to put an end to that. We also have to limit the out-of-
pocket expenses individuals have to pay. There comes a point where
people cannot afford this expense. We have to require equal treatment
for men and women--Black, White, and brown, young and old, whether they
live in a rural area or in a city.
We have to make sure if a health insurance policy in America is
offered, it is a good policy that covers the basic needs. There are
policies that do not. They sell health insurance you can afford, and
guess what. It is worthless. That is not good for America and it is not
good for our families.
There are ways to lower costs. We ought to be pushing for prevention.
We ought to be trying to find ways to keep people well, incentives for
the right conduct and healthy outcomes. Right now there is not much of
a reward or an incentive for wellness. We also have to give support to
small businesses. When we look at the insured in America, most of them
are small business employees and their children. The poorest people in
America are covered by Medicaid, the government health insurance, as
they should be.
Folks are fortunate, like myself, under the Federal Employees Health
Benefits Program, and most others who have health insurance policies,
to have coverage. But the folks in the middle who get up and go to work
every day for the small businesses of America--and their kids--are the
ones who do not have coverage. We can do better.
One of the proposals before us in Congress is to make sure small
businesses can start getting into pools where they can use that pooling
power to reach out and have health insurance coverage that is
affordable. That is within our reach.
Senator Reed is on the Senate floor today. He and I were fortunate
enough to be at lunch today when our colleague from Connecticut, Chris
Dodd, got up and spoke about what had happened in the HELP Committee,
the Health, Education, Labor and Pensions Committee, in preparing a
bill on health care reform. There were 800 amendments filed. They met
for 61 days. Some 400 amendments were considered and voted on. Over 100
of those were from the Republican side of the aisle. They were trying
their best to create a bipartisan compromise to get through the bill.
But Senator Dodd came up and talked about this, not in terms of a
specific bill and its provisions; he talked about the historic
opportunity we have. He said for many of us, for most of us now serving
in the Senate, this may be the only time in our political careers when
we can change the health care system for the better; when we can make
sure that people in America have a better chance to be able to afford
the cost of health care.

He certainly inspired us when he pulled out this magazine and showed
us a picture of our colleague, Senator Teddy Kennedy, on the cover of
Newsweek, and the quote from Ted Kennedy that says: ``We're almost
there.''
There is a long essay in here about Ted Kennedy's terrific public
career and how much of it has been spent on this issue of health care;
what it meant to him personally when his son was diagnosed with bone
cancer and had to have his leg amputated; what he went through in a
plane crash; when he has seen others and what they have gone through.
Teddy Kennedy reminds us that these opportunities do not come around
very often. There is lots we can debate and argue about, but at the end
of the day the American people want to see the debate end. They want to
see us acting together responsibly for health care that is centered on
patients; to make sure they have a health insurance policy they like,
that they can keep; to make certain they have a good strong
confidential relationship with their doctors for themselves and their
families; to make sure, as well, they are not excluded from coverage
for preexisting conditions; to make sure that health insurance is going
to be affordable; and to make sure it covers all Americans.
We can do it. We are a great and prosperous nation. We have a
President who is committed to it. And working with him on a bipartisan
basis we can get this done. We can work with the health care
professionals--the doctors, the nurses, those leading hospitals--who
can show us the way to reduce the cost of care without reducing its
quality.
This is our chance. For those who are saying no, that they want the
status quo, they do not want to change it, only a small percentage of
Americans agree with them. Most Americans agree what I have talked
about today needs to be done. We have to overcome those voices of
negativity and doubt who continue to come to the Senate floor, those
who create fear of change.
Let me tell you, this is a great, strong country that tackles big
problems. We have never been assigned a bigger assignment than this
one, health care for America. It touches all 300 million of us. We have
to make sure it is done fairly, done effectively, and done quickly. If
we let this drag out for months beyond this year, it is going to be
harder and harder for us to reach our goal.
I encourage my colleagues on both sides of the aisle to work toward
that goal, make certain that President Obama's leadership is rewarded
with health care reform that does make a difference.
I yield the floor.
The PRESIDING OFFICER. The Senator from Missouri.

Amendment No. 1501

Mr. BOND. Mr. President, I rise today to discuss an amendment that I
am cosponsoring with my friend and fellow cochair of the Senate
National Guard Caucus, Senator Leahy. We will be introducing a
bipartisan amendment to strengthen one of our Nation's most important
military and civilian resources, the National Guard.
The National Guard, as I think everybody in this body knows, has a
long and proud history of contributing to America's military operations
abroad while providing vital support and security to civil authorities
at home.
Since September 11, 2001, our citizen soldiers and airmen have taken
on

[[Page S7756]]

greater responsibilities and risk, from fighting in Iraq and
Afghanistan to providing critical disaster assistance in the United
States.
Now we see the tremendous value of the National Guard forces every
time we look as they confront terrorists, provide critical support in
unique areas such as Afghanistan where the agribusiness development
teams are working to help provide agricultural know-how and better
income to the farmers of Afghanistan, to areas where they provide
water, food, and health supplies to victims of natural disasters.
Furthermore, the Guard is a tremendous value for the capability it
provides our Nation. It provides 40 percent of the total military force
for around 4.5 percent of the budget. In other words, the Guard
provides tremendous bang for the buck.
There is no doubt today we are asking more from the men and women of
the National Guard than ever before, often at great cost to their
families and their own lives.
I think this means we have a heavy responsibility to support our
citizen soldiers and airmen in their unique dual mission of developing
military support abroad and providing homeland defense stateside.
While serving abroad, National Guard troops serve under Air Force and
Army Commands in what is known as title 10 status, which refers to the
section in the U.S. Code dealing with the military. But when the Guard
operates at home, they serve under the command and control of the
Nation's Governors in title 32 status.
I had the honor of serving as commander in chief of the Missouri
National Guard for 8 years. I can tell you that Missouri has a wide
range of natural and sometimes human disasters ranging from tornadoes
and floods to blizzards and ice storms. I called out the Guard for
every single one of those and several more I probably cannot even
remember: threatened prison insurrections, other civil disobedience, to
tracking down escapees from prison. Right after Katrina--I think it was
about a year after Katrina--I visited Jefferson Barracks, MO, where one
of our National Guard engineer units is stationed.
They told me proudly that when Katrina hit, they immediately sent one
of their National Guard battalions to Katrina. They had all the
equipment, the high-wheeled vehicles, the communications equipment.
They did such a wonderful job, the adjutant general of Louisiana called
and said: You have two more battalions; send us another one. They said:
That is where the problem comes in. We only have equipment for one out
of three battalions. The Guard was one-third resourced. We could have
sent them down there in tennis shoes and a taxicab, but they needed the
equipment that an engineer battalion has to deal with the problems of
the aftermath of the floods and the hurricane. I think there is a lot
more we can do to make this unique arrangement work more smoothly. The
Guard will continue to play a critical role in response to another
natural disaster or, heaven forbid, terrorist attack. To the men and
women of the National Guard, we say: Thank you for that support.
But more needs to be done. The amendment we are introducing today to
strengthen the Guard consists of two planks which are designed, first,
to increase the Guard's voice inside the Pentagon and, second, to
clarify how the Federal military support to civil authorities will
occur here at home.
We would give the Chief of the National Guard more muscle in the
Pentagon, providing a seat for him on the Joint Chiefs of Staff. With
40 percent of the force, one would think that big a portion of our
total military capability would deserve to sit with the outstanding
leaders of the Army, the Air Force, the Marines, and others who are
there. One would think this large a segment of our force would be
represented. When we have big decisions on the future of our resource
allocation for the military--title X and, in this case, also title
XXXII--they ought to be at the table.
Last year--I thank my colleagues--we successfully authorized the
promotion of the Chief of the National Guard to the rank of four-star
general in last year's empowerment legislation. Additionally, this
year's empowerment amendment will make certain that the Chief of the
National Guard Bureau has a Vice Chief in the grade of lieutenant
general. When you are dealing with that many problems, there is a major
operation that needs to be handled by a deputy to the four-star Chief
of the National Guard. It is critical to the day-to-day operations of
the National Guard Bureau and to ensure the Guard is adequately
represented inside the Pentagon.
This amendment will also fill the gaps between civilian and military
emergency response capabilities. We would give the National Guard
Bureau, in consultation with the States' adjutant generals, budgetary
power to identify, validate, and procure equipment essential to their
unique domestic missions so they will be better prepared to respond to
emergencies here at home. The next time they call for a second engineer
battalion, I hope we have the equipment to send one to whatever State
or maybe our own State where they are needed.
The amendment also supports the designation of National Guard general
officers as commanders of Army North and Air Force North commands. This
will ensure unity of effort and of command between the National Guard
in the 54 States and territories and the very important U.S. North
command which protects the United States in the continental United
States.
Finally, our amendment gives State Governors tactical control of
Federal troops responding to emergencies inside their State or
territory. Time and time again, we have seen Reserve units stationed
within close proximity to a natural or manmade disaster forced to stand
by and watch when they could have been assisting injured victims in
preventing loss of property. This amendment ensures that all available
military forces be utilized as early as possible in an emergency
situation. This way, our State leaders can act more quickly and
decisively to mitigate disasters at home. Our citizen soldiers stand
ready to defend the Nation, secure our homeland from natural disasters
and terrorist attacks, and are now fighting overseas in the war on
terror. Neither the homeland response nor the Federal military support
missions of the Guard are likely to diminish in importance at any time
in the foreseeable future. In fact, the need for the National Guard is
greater now than ever before. Now more than ever, as budgets are
constrained and entitlements continue to grow at alarming rates, we
should not be looking to reduce the Guard but, rather, fully to man and
equip it.
We have a responsibility to give the Guard the equipment, resources,
and bureaucratic muscle they need to meet their critical dual mission.
In order to do so, it is imperative we strengthen the decisionmaking
capability of Guard leaders within the Department of Defense and make
sure they are at the table.
As one former leader of the Guard said: If you want us in on the big
plays, at least let us in the huddle when you are planning to call
those plays. That is what this amendment does.
I thank my colleagues for their past support of the Guard. I join
with Senator Leahy in asking for continued support of the National
Guard by voting for this amendment.
I yield the floor.

Amendment No. 1597

The PRESIDING OFFICER. The Senator from Kansas.
Mr. BROWNBACK. Mr. President, I ask unanimous consent to set aside
the pending Thune amendment and call up my amendment No. 1597.
The PRESIDING OFFICER. Without objection, it is so ordered.
The clerk will report.
The assistant bill clerk read as follows:

The Senator from Kansas [Mr. Brownback], for himself, Mr.
Bayh, Mr. Kyl, and Mr. Inhofe, proposes an amendment numbered
1597.

Mr. BROWNBACK. I ask unanimous consent that reading of the amendment
be dispensed with.
The PRESIDING OFFICER. Without objection, it is so ordered.

(Purpose: To express the sense of the Senate that the Secretary of
State should redesignate North Korea as a state sponsor of terrorism)

At the end of subtitle C of title XII, add the following:

[[Page S7757]]

SEC. 1232. SENSE OF THE SENATE ON REDESIGNATION OF NORTH
KOREA AS A STATE SPONSOR OF TERRORISM.

(a) Findings.--The Senate makes the following findings:
(1) On October 11, 2008, the Department of State removed
North Korea from its list of state sponsors of terrorism, on
which it had been placed in 1988.
(2) North Korea was removed from that list despite its
refusal to account fully for its abduction of foreign
citizens, proliferation of nuclear and other dangerous
technologies and weapon systems to terrorist groups and other
state sponsors of terrorism, or its commission of other past
acts of terrorism.
(3) On March 17, 2009, American journalists Euna Lee and
Laura Ling were seized near the Chinese-North Korean border
by agents of the North Korean government and were
subsequently sentenced to 12 years of hard labor in a prison
camp in North Korea.
(4) On April 5, 2009, the Government of North Korea tested
a long-range ballistic missile in violation of United Nations
Security Council Resolutions 1695 and 1718.
(5) On April 15, 2009, the Government of North Korea
announced it was expelling international inspectors from, and
recommissioning, its Yongbyon nuclear facility and ending its
participation in disarmament talks.
(6) Those actions were in violation of the June 26, 2008,
announcement by the President of the United States that the
removal of North Korea from the list of state sponsors of
terrorism was dependent on the Government of North Korea
agreeing to a system to verify its declarations with respect
to its nuclear programs.
(7) On May 25, 2009, the Government of North Korea
conducted a second illegal nuclear test, in addition to
conducting tests of its ballistic missile systems launched in
the direction of the western United States.
(8) North Korea has failed to acknowledge or account for
its role in building and supplying the secret nuclear
facility at Al Kibar, Syria, has failed to account for all
remaining citizens of Japan abducted by North Korea, and,
according to recent reports, continues to engage in close
cooperation with the terrorist Iranian Revolutionary Guard
Corps on ballistic missile technology.
(9) There have been recent credible reports that North
Korea has provided support to the terrorist group Hezbollah,
including by providing ballistic missile components and
personnel to train members of Hezbollah with respect to the
development of extensive underground military facilities in
southern Lebanon, including tunnels and bunkers.
(10) The 2005 and 2006 Country Reports on Terrorism of the
Department of State state, with respect to Cuba, Iran, North
Korea, and Syria, ``Most worrisome is that some of these
countries also have the capability to manufacture WMD and
other destabilizing technologies that can get into the hands
of terrorists. The United States will continue to insist that
these countries end the support they give to terrorist
groups.''.
(11) President Barack Obama stated that actions of the
Government of North Korea ``are a matter of grave concern to
all nations. North Korea's attempts to develop nuclear
weapons, as well as its ballistic missile program, constitute
a threat to international peace and security. By acting in
blatant defiance of the United Nations Security Council,
North Korea is directly and recklessly challenging the
international community. North Korea's behavior increases
tensions and undermines stability in Northeast Asia. Such
provocations will only serve to deepen North Korea's
isolation. It will not find international acceptance unless
it abandons its pursuit of weapons of mass destruction and
their means of delivery.''.
(b) Sense of the Senate.--It is the sense of the Senate
that the Secretary of State should designate North Korea as a
country that has repeatedly provided support for acts of
international terrorism for purposes of--
(1) section 6(j) of the Export Administration Act of 1979
(50 U.S.C. App. 2405(j)) (as continued in effect pursuant to
the International Emergency Economic Powers Act (50 U.S.C.
1701 et seq.));
(2) section 40 of the Arms Export Control Act (22 U.S.C.
2780); and
(3) section 620A of the Foreign Assistance Act of 1961 (22
U.S.C. 2371).

Mr. BROWNBACK. Mr. President, this is a bipartisan amendment put
forward by Senator Bayh and myself. I ask unanimous consent that
Senators Kyl and Inhofe be added as cosponsors.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. BROWNBACK. This is a bipartisan resolution and sense of the
Senate that the administration should relist North Korea as a state
sponsor of terrorism. As my colleagues know, the Bush administration,
through a great deal of hoopla, listed North Korea as a state sponsor
of terrorism. They took them off the list in spite of such terrible and
erratic behavior as nuclear weapons, missile technology, and now taking
U.S. citizens hostage and holding them. Nonetheless, the Bush
administration, as part of the six-party talks, did an agreement, a
deal to delist them as a state sponsor of terrorism. All that got us
was more nuclear weapons, more missiles being sent off, more
provocative action by the North Koreans, and a dismal situation.
What we are asking with the amendment is that it is a sense of the
Senate that North Korea should be relisted as a state sponsor of
terrorism.
In that regard, I wish to enter a few items in the Record to be
printed at the end of my presentation that are currently in the news.
This is yesterday's front page of the Washington Post where it talks
about ``[North] Korea's Hard-Labor Camps: On the Diplomatic Back
Burner.''
I ask unanimous consent that this full article be printed in the
Record.
The PRESIDING OFFICER. Without objection, it is so ordered.
(See exhibit 1.)
Mr. BROWNBACK. That is an old story. Unfortunately, we know very well
about the gulags that exist in North Korea and the 200,000 people we
believe are in those. Here is today's Washington Post. This was new
information I found shocking: North Korea building mysterious military
ties with the military junta in Burma now taking place and the
possibility of them giving military equipment and supplies, I suppose
possibly even nuclear arms and missile technology, to the military
government in Burma.
I ask unanimous consent that this be printed in the Record at the end
of my statement.
The PRESIDING OFFICER. Without objection, it is so ordered.
(See exhibit 2.)
Mr. BROWNBACK. If that is not enough to relist them as a state
sponsor of terrorism, I don't know what is. But there is a full record
we can go forward with on relisting North Korea as a state sponsor of
terrorism. At the outset, I think we ought to look at this and say this
is an extremely tough situation for the United States. It is one on
which we need to take aggressive action to confront them on what they
are doing to militarize some of the worst places and worst actors
around the world and what North Korea is doing to threaten interests of
the United States.
All this is taking place while Kim Jong Il is ill. To what degree, we
don't know for sure. A succession is being discussed. Of what nature,
we are not sure. But clearly North Korea is doing the most provocative
things they have probably done in the history of that provocative
nation. It is taking place right now. We should notice it and recognize
these are terrorist actions. We should clearly call for them to be
relisted.
I have, many times, spoken before regarding the long and outrageous
list of crimes of the Kim regime. I will not go through those again at
great length. But I will say the crimes committed by the North Korean
regime include not only those external and diplomatic of nature--
violating agreements, treaties, conventions, and proliferating
dangerous technologies to the world's worst actors--but the regime has
also committed massive and unspeakable crimes against the North Korean
people themselves who for decades have been beaten, tortured, raped,
trafficked, starved, used as medical experiments, subjected to
collective familial punishment, and executed in the most brutal and
painful ways. If you want further details on that, read yesterday's
Washington Post article.
Hundreds of thousands languish in the gulag and concentration camps
spread out over the entire country. All the while, the world watches
and wrings its collective hands. As we pledged never again, we watch as
yet again another criminal regime commits a genocide. Never again
becomes yet again.
I have introduced legislation to address these issues. I hope the
Foreign Relations Committee can find time to take it up.
The amendment before us today deals with another aspect of the North
Korean criminal state, its longstanding and robust sponsorship of
international terrorism. The amendment would place the Senate on record
as standing for the proposition that North Korea's hostile and
provocative actions will not be ignored. Indeed, they will have
meaningful consequences under the law. This amendment, of which Senator
Bayh is the lead cosponsor, expresses the sense of the Senate that the
Secretary of State should redesignate North Korea as a state sponsor of
terrorism based on its nuclear and missile

[[Page S7758]]

proliferation, abductions, and material support for terrorist groups.
On October 11, 2008, the State Department removed North Korea from
the list of state sponsors of terrorism on which it had been placed
since 1988. At the time, this is what President Bush said to the North
Korean regime upon announcing that North Korea would be removed. He
said:

We will trust you only to the extent that you fulfill your
promises. If North Korea makes the wrong choices, the United
States will act accordingly.

They have made the wrong choices. We should act accordingly.
At the same time, then Candidate Obama said:

Sanctions are a critical part of our leverage to pressure
North Korea to act. They should only be lifted based on North
Korean performance. If the North Koreans do not meet their
obligations, we should move quickly to reimpose sanctions
that have been waived and consider new restrictions going
forward.

They have not lived up to their obligations. They have continued
provocative actions. They should be relisted.
Let's examine how well the North Korean regime has lived up to its
commitment since being removed from the list. Since removal last
October, the North Korean regime has done the following: launched a
multistage ballistic missile over Japan in violation of U.N. Security
Council sanctions; kidnapped and imprisoned two American journalists
and sentenced them to 12 years of hard labor in a North Korean prison
camp; pulled out of the six-party talks vowing never to return; kicked
out international nuclear inspectors and American monitors; restarted
its nuclear facilities; renounced the 50-year armistice with South
Korea; detonated a second illegal nuclear weapon; launched additional
short-range missiles; is preparing to launch long-range missiles
capable of reaching the United States; and today news accounts are
reporting about North Korean proliferation to the Burmese junta,
including perhaps nuclear proliferation.
Add to this a long history of other ongoing illicit operations that
finance the North Korean regime's budget, including the following:
extensive drug smuggling; massive and complex operations to counterfeit
U.S. currency, many of which are believed to be in wide circulation;
money laundering; terrorist threats by the regime against the United
States, Japanese, and South Korean civilians. That is what this regime
and group has done and is doing. That is some of what they have done
since they were delisted from the terrorist list.
What have we done in response? The U.N. Security Council has passed
another sanctions resolution similar to the same resolution North Korea
has brazenly violated to get us to this point. In 2006, the State
Department, in its terrorism report, said this about keeping North
Korea on the list: North Korea ``continued to maintain their ties to
terrorist groups.''
They said:

Most worrisome is that some of these countries [including
North Korea] also have the capability to manufacture [weapons
of mass destruction] and other destabilizing technologies
that can get into the hands of terrorists.

If that was the justification for the terror list in 2006, certainly
North Korea's actions today fit that standard--perhaps even more so
than back then, and I believe it is more so.
We cannot have it both ways. If we removed North Korea from the
terrorism list last year as a reward for its dubious cooperation on
nuclear weapons, we would only be reversing that step by adding it back
after the regime betrayed its commitments and followed up with hostile
and provocative actions.
I would also like to address this issue: It often has been raised
with me--and the Secretary of State herself has raised this indirectly
with me--that the multiple statutes that control the list of state
sponsors of terrorism do not provide the legal ability for the
Secretary of State to redesignate. I think this argument is flawed, and
I would like to summarize that by reading the relevant portions of each
of these acts, because here is the key point on it, that they are
saying: Well, we have to find factual basis that is different from the
first round for us to do that. We are going through a legal review of
doing this. But here the state sponsor of terrorism list is controlled
under two different acts: the Arms Export Control Act and the Foreign
Assistance Act.
As to countries covered by the prohibition, it says this. This is
quoting from the Arms Export Control Act:

The prohibitions contained in this section apply with
respect to a country if the Secretary of State determines
that the government of that country has repeatedly provided
support for acts of international terrorism.

That is what it says in the Arms Export Control Act. The list I have
just read goes through what has taken place, and they are clearly and
repeatedly providing support for acts of international terrorism. It
does not say anything about they cannot be relisted or we have to go
through some elaborate finding process, that it cannot be based on
actions they have done. These are the actions they have done in the
last 6 months that are of public record. And it says the Secretary of
State makes this determination and has fairly wide discretion to be
able to do it.
Under section 628 of the Foreign Assistance Act, it says: The United
States shall not provide any assistance to any country if the Secretary
of State determines that the government of that country has repeatedly
provided support for acts of international terrorism.
Again, the statute is very broad in its statement. It does not say
anything about they cannot relist them. It says they can do this on the
discretion of the Secretary of State.
I do not know why we need to wait any longer, with the actions this
government has taken and even with these most recent ones reported
today of working with Burma or of the publicly done ones we know about
of nuclear weapons detonation or the ones of missile technology being
launched. Why do we need to wait longer?
I recognize this is a sense of the Senate, so it is just a sense of
this body. But this body has had a strong impact in prior actions when
we took a sense-of-the-Senate resolution to list the Revolutionary
Guard in Iran, that we believed they should be listed as a state
sponsor of terrorism. The administration acted not long after that to
list them as a state sponsor of terrorism.
I believe if this body took strong action here now and said we
believe North Korea should be relisted as a state sponsor of terrorism,
it would send a very strong and proper signal to the administration--
not that we are doing your job, but we believe this is the case and
this is something that is meritorious toward North Korea and its
actions.
That is why I urge my colleagues to support the bipartisan Bayh-
Brownback amendment and vote for this amendment to the Defense
authorization bill.

Mr. President, with that, I yield the floor.

Exhibit 1

[From the Washington Post, July 20, 2009]

N. Korea's Hard-Labor Camps: On the Diplomatic Back Burner

(By Blaine Harden)

Seoul.--Images and accounts of the North Korean gulag
become sharper, more harrowing and more accessible with each
passing year.
A distillation of testimony from survivors and former
guards, newly published by the Korean Bar Association,
details the daily lives of 200,000 political prisoners
estimated to be in the camps: Eating a diet of mostly corn
and salt, they lose their teeth, their gums turn black, their
bones weaken and, as they age, they hunch over at the waist.
Most work 12- to 15-hour days until they die of malnutrition-
related illnesses, usually around the age of 50. Allowed just
one set of clothes, they live and die in rags, without soap,
socks, underclothes or sanitary napkins.
The camps have never been visited by outsiders, so these
accounts cannot be independently verified. But high-
resolution satellite photographs, now accessible to anyone
with an Internet connection, reveal vast labor camps in the
mountains of North Korea. The photographs corroborate
survivors' stories, showing entrances to mines where former
prisoners said they worked as slaves, in-camp detention
centers where former guards said uncooperative prisoners were
tortured to death and parade grounds where former prisoners
said they were forced to watch executions. Guard towers and
electrified fences surround the camps, photographs show.
``We have this system of slavery right under our nose,''
said An Myeong Chul, a camp guard who defected to South
Korea. ``Human rights groups can't stop it. South Korea can't
stop it. The United States will have to take up this issue at
the negotiating table.''

[[Page S7759]]

But the camps have not been discussed in meetings between
U.S. diplomats and North Korean officials. By exploding
nuclear bombs, launching missiles and cultivating a
reputation for hair-trigger belligerence, the government of
Kim Jong Il has created a permanent security flash point on
the Korean Peninsula--and effectively shoved the issue of
human rights off the negotiating table.
``Talking to them about the camps is something that has not
been possible,'' said David Straub, a senior official in the
State Department's office of Korean affairs during the Bush
and Clinton years. There have been no such meetings since
President Obama took office.
``They go nuts when you talk about it,'' said Straub, who
is now associate director of Korean studies at Stanford
University.
Nor have the camps become much of an issue for the American
public, even though annotated images of them can be quickly
called up on Google Earth and even though they have existed
for half a century, 12 times as long as the Nazi
concentration camps and twice as long as the Soviet Gulag.
Although precise numbers are impossible to obtain, Western
governments and human groups estimate that hundreds of
thousands of people have died in the North Korean camps.
North Korea officially says the camps do not exist. It
restricts movements of the few foreigners it allows into the
country and severely punishes those who sneak in. U.S.
reporters Laura Ling and Euna Lee were sentenced last month
to 12 years of hard labor, after being convicted in a closed
trial on charges of entering the country illegally.
North Korea's gulag also lacks the bright light of
celebrity attention. No high-profile, internationally
recognized figure has emerged to coax Americans into
understanding or investing emotionally in the issue, said
Suzanne Scholte, a Washington-based activist who brings camp
survivors to the United States for speeches and marches.
``Tibetans have the Dalai Lama and Richard Gere, Burmese
have Aung San Suu Kyi, Darfurians have Mia Farrow and George
Clooney,'' she said. ``North Koreans have no one like that.''

Executions as Lessons

Before guards shoot prisoners who have tried to escape,
they turn each execution into a teachable moment, according
to interviews with five North Koreans who said they have
witnessed such killings.
Prisoners older than 16 are required to attend, and they
are forced to stand as close as 15 feet to the condemned,
according to the interviews. A prison official usually gives
a lecture, explaining how the Dear Leader, as Kim Jong Il is
known, had offered a ``chance at redemption'' through hard
labor.
The condemned are hooded, and their mouths are stuffed with
pebbles. Three guards fire three times each, as onlookers see
blood spray and bodies crumple, those interviewed said.
``We almost experience the executions ourselves,'' said
Jung Gwang Il, 47, adding that he witnessed two executions as
an inmate at Camp 15. After three years there, Jung said, he
was allowed to leave in 2003. He fled to China and now lives
in Seoul.
Like several former prisoners, Jung said the most arduous
part of his imprisonment was his pre-camp interrogation at
the hands of the Bowibu, the National Security Agency. After
eight years in a government office that handled trade with
China, a fellow worker accused him of being a South Korean
agent.
``They wanted me to admit to being a spy,'' Jung said.
``They knocked out my front teeth with a baseball bat. They
fractured my skull a couple of times. I was not a spy, but I
admitted to being a spy after nine months of torture.''
When he was arrested, Jung said, he weighed 167 pounds.
When his interrogation was finished, he said, he weighed 80
pounds. ``When I finally got to the camp, I actually gained
weight,'' said Jung, who worked summers in cornfields and
spent winters in the mountains felling trees.
``Most people die of malnutrition, accidents at work, and
during interrogation,'' said Jung, who has become a human
rights advocate in Seoul. ``It is people with perseverance
who survive. The ones who think about food all the time go
crazy. I worked hard, so guards selected me to be a leader in
my barracks. Then I didn't have to expend so much energy, and
I could get by on corn.''

Defectors' Accounts

Human rights groups, lawyers committees and South Korean-
funded think tanks have detailed what goes on in the camps
based on in-depth interviews with survivors and former guards
who trickle out of North Korea into China and find their way
to South Korea.
The motives and credibility of North Korean defectors in
the South are not without question. They are desperate to
make a living. Many refuse to talk unless they are paid.
South Korean psychologists who debrief defectors describe
them as angry, distrustful and confused. But in hundreds of
separate interviews conducted over two decades, defectors
have told similar stories that paint a consistent portrait of
life, work, torment and death in the camps.
The number of camps has been consolidated from 14 to about
five large sites, according to former officials who worked in
the camps. Camp 22, near the Chinese border, is 31 miles long
and 25 miles wide, an area larger than the city of Los
Angeles. As many as 50,000 prisoners are held there, a former
guard said.
There is a broad consensus among researchers about how the
camps are run: Most North Koreans are sent there without any
judicial process. Many inmates die in the camps unaware of
the charges against them. Guilt by association is legal under
North Korean law, and up to three generations of a
wrongdoer's family are sometimes imprisoned, following a rule
from North Korea's founding dictator, Kim Il Sung: ``Enemies
of class, whoever they are, their seed must be eliminated
through three generations.''
Crimes that warrant punishment in political prison camps
include real or suspected opposition to the government. ``The
camp system in its entirety can be perceived as a massive and
elaborate system of persecution on political grounds,''
writes human rights investigator David Hawk, who has studied
the camps extensively. Common criminals serve time elsewhere.
Prisoners are denied any contact with the outside world,
according to the Korean Bar Association's 2008 white paper on
human rights in North Korea. The report also found that
suicide is punished with longer prison terms for surviving
relatives; guards can beat, rape and kill prisoners with
impunity; when female prisoners become pregnant without
permission, their babies are killed.
Most of the political camps are ``complete control
districts,'' which means that inmates work there until death.
There is, however, a ``revolutionizing district'' at Camp
15, where prisoners can receive remedial indoctrination in
socialism. After several years, if they memorize the writings
of Kim Jong Il, they are released but remain monitored by
security officials.

South's Changing Response

Since it offers a safe haven to defectors, South Korea is
home to scores of camp survivors. All of them have been
debriefed by the South Korean intelligence service, which
presumably knows more about the camps than any agency outside
of Pyongyang.
But for nearly a decade, despite revelations in scholarly
reports, TV documentaries and memoirs, South Korea avoided
public criticism of the North's gulag. It abstained from
voting on U.N. resolutions that criticized North Korea's
record on human rights and did not mention the camps during
leadership summits in 2000 or 2007. Meanwhile, under a
``sunshine policy'' of peaceful engagement, South Korea made
major economic investments in the North and gave huge,
unconditional annual gifts of food and fertilizer.
The public, too, has been largely silent. ``South Koreans,
who publicly cherish the virtue of brotherly love, have been
inexplicably stuck in a deep quagmire of indifference,''
according to the Korean Bar Association, which says it
publishes reports on human rights in North Korea to ``break
the stalemate.''
Government policy changed last year under President Lee
Myung-bak, who has halted unconditional aid, backed U.N.
resolutions that criticize the North and tried to put human
rights on the table in dealing with Pyongyang. In response,
North Korea has called Lee a ``traitor,'' squeezed inter-
Korean trade and threatened war.

An Enforcer's View

An Myeong Chul was allowed to work as a guard and driver in
political prison camps because, he said, he came from a
trustworthy family. His father was a North Korean
intelligence agent, as were the parents of many of his fellow
guards.
In his training to work in the camps, An said, he was
ordered, under penalty of becoming a prisoner himself, never
to show pity. It was permissible, he said, for bored guards
to beat or kill prisoners.
``We were taught to look at inmates as pigs,'' said An, 41,
adding that he worked in the camps for seven years before
escaping to China in 1994. He now works in a bank in Seoul.
The rules he enforced were simple. ``If you do not meet
your work quota, you do not eat much,'' he said. ``You are
not allowed to sleep until you finish your work. If you still
do not finish your work, you are sent to a little prison
inside the camp. After three months, you leave that prison
dead.''
An said the camps play a crucial role in the maintenance of
totalitarian rule. ``All high-ranking officials underneath
Kim Jong Il know that one misstep means you go to the camps,
along with your family,'' he said.
Partly to assuage his guilt, An has become an activist and
has been talking about the camps for more than a decade. He
was among the first to help investigators identify camp
buildings using satellite images. Still, he said, nothing
will change in camp operations without sustained diplomatic
pressure, especially from the United States.

Inconsistent U.S. Approach

The U.S. government has been a fickle advocate.
In the Clinton years, high-level diplomatic contacts
between Washington and Pyongyang focused almost exclusively
on preventing the North from developing nuclear weapons and
expanding its ballistic missile capability.
President George W. Bush's administration took a radically
different approach. It famously labeled North Korea as part
of an ``axis of evil,'' along with Iran and Iraq. Bush met
with camp survivors. For five years, U.S. diplomats refused
to have direct negotiations with North Korea.
After North Korea detonated a nuclear device in 2006, the
Bush administration decided

[[Page S7760]]

to talk. The negotiations, however, focused exclusively on
dismantling Pyongyang's expanded nuclear program.
In recent months, North Korea has reneged on its promise to
abandon nuclear weapons, kicked out U.N. weapons inspectors,
exploded a second nuclear device and created a major security
crisis in Northeast Asia.
Containing that crisis has monopolized the Obama
administration's dealings with North Korea. The camps, for
the time being, are a non-issue. ``Unfortunately, until we
get a handle on the security threat, we can't afford to deal
with human rights,'' said Peter Beck, a former executive
director of the U.S. Committee for Human Rights in North
Korea.

A Family's Tribulations

Kim Young Soon, once a dancer in Pyongyang, said she spent
eight years in Camp 15 during the 1970s. Under the guilt-by-
association rule, she said, her four children and her parents
were also sentenced to hard labor there.
At the camp, she said, her parents starved to death and her
eldest son drowned. Around the time of her arrest, her
husband was shot for trying to flee the country, as was her
youngest son after his release from the camp.
It was not until 1989, more than a decade after her
release, that she found out why she had been imprisoned. A
security official told her then that she was punished because
she had been a friend of Kim Jong Il's first wife and that
she would ``never be forgiven again'' if the state suspected
that she had gossiped about the Dear Leader.
She escaped to China in 2000 and now lives in Seoul. At 73,
she said she is furious that the outside world doesn't take
more interest in the camps. ``I had a friend who loved Kim
Jong Il, and for that the government killed my family,'' she
said. ``How can it be justified?''

Exhibit 2

[From the Washington Post, July 21, 2009]

Clinton: U.S. Wary of Growing Burmese, North Korean Military
Cooperation

(By Glenn Kessler)

Bangkok, July 21--The Obama administration is increasingly
concerned that nuclear-armed North Korea is building
mysterious military ties with Burma, another opaque country
with a history of oppression, Secretary of State Hillary
Rodham Clinton said Tuesday.
``We know that there are also growing concerns about
military cooperation between North Korea and Burma, which we
take seriously'' Clinton told reporters after talks in the
Thai capital. ``It would be destabilizing for the region. It
would pose a direct threat to Burma's neighbors.''
U.S. officials traveling with Clinton, who is in Thailand
to attend a regional security forum, said the concerns about
Burma and North Korea extend to possible nuclear cooperation.
North Korea has a long history of illicit missile sales and
proliferation, including secretly helping to build a Syrian
nuclear reactor that was destroyed in 2007 by Israeli jets.
``This is one of the areas we'd like to know about,'' said
one official. ``We have concerns, but our information is
incomplete.''
Burma, also known as Myanmar, is regarded as one of the
world's most oppressive nations, run by generals who have
enriched themselves while much of the country remains
desperately poor. North Korea is an equally grim country,
with vast prison camps and an ailing dictator, Kim Jong Il.
The evidence of growing Burmese-North Korean cooperation
since formal ties were restored in 2007 is extensive, but the
full extent of the military relationship is unclear.
The nuclear connection is even murkier, but intelligence
agencies have tracked suspicious procurement of high-
precision equipment from Europe, as well as the arrival in
Burma of North Korean officials associated with the company
connected to the Syria reactor, according to David Albright,
director of the Institute for Science and International
Security in Washington.
``Something may be going on, but no one has any proof. It
is a mix of suspicions and concerns,'' Albright said, adding
that close examination of satellite imagery of suspected
nuclear sites has turned up no evidence. But he said that the
purchases of high-precision equipment were especially
troubling because the equipment did not make sense for use in
missiles and it was shipped to educational entities that had
connections to Burmese nuclear experts.
Japanese officials last month also arrested three people
for attempting to illegally export dual-use equipment to
Burma, via Malaysia, under the direction of a company
involved in the illicit procurement for North Korean military
programs.
Moreover, Albright said, European and U.S. intelligence
agencies have identified people associated with Namchongang
Trading Corp., a North Korean company also known as NCG, as
working in Burma. NCG reportedly provided the critical link
between Pyongyang and Damascus, acquiring key materials from
vendors in China and probably from Europe and secretly
transferring them to a desert construction site near the
Syrian town of Kibar.
The State Department last month cited NCG for being
``involved in the purchase of aluminum tubes and other
equipment specifically suitable for a uranium enrichment
program since the late 1990s.''
U.S. officials have observed other troubling connections.
The U.S. Navy last month closely tracked Kang Nam 1, a rusty
North Korean freighter, after the government in Pyongyang
tested a nuclear weapon. Although U.S. officials were never
completely certain the ship was headed to Burma, the ship
returned to North Korea after the United States, China and
other countries put pressure on Burma to respect a United
Nations resolution barring most North Korean weapons exports.
Photographs that have emerged in recent weeks also show an
extensive series of 600 to 800 tunnel complexes and other
underground facilities built in Burma with North Korean
technical assistance near its new capital, Naypyidaw. North
Korean officials can be spotted in the photos, which were
taken between 2003 and 2006 and posted on the Web site of
YaleGlobal Online by journalist Bertil Lintner, an expert on
Burma.
Burma has uranium deposits, but as a signatory to the
nuclear Non-Proliferation Treaty, it is required to allow
inspections of any nuclear facilities. Russia in 2007 agreed
to help build a 10-megawatt light-water reactor in Burma, but
little appears to have come of the project.
At the news conference, Clinton also strongly criticized
the Burmese government for its well-documented use of gang
rape as a military tactic, organized by Burmese officers,
against ethnic minorities. A new offensive against the Karen
ethnic group has sent more than 4,000 refugees fleeing across
the border into Thailand in recent weeks.
``We are deeply concerned by reports of continuing human
rights abuses within Burma, particularly by actions that are
attributed to the Burmese military concerning the
mistreatment and abuse of young girls,'' Clinton said.
The Obama administration is conducting a review of its
Burma policy, which Clinton said has been placed on hold
while Washington awaits the outcome of the trial of Nobel
Peace Prize laureate Aung San Suu Kyi.
``We have made clear we expect fair treatment of Aung San
Suu Kyi, and we have condemned the way that she has been
treated by the regime in Burma, which we consider to be
baseless and totally unacceptable,'' Clinton said.
The National League for Democracy, Suu Kyi's party, won a
landslide electoral victory in 1990, but the military
leadership refused to accept it. Since then, she has been
under house arrest for most of the time, as have hundreds of
her supporters.
In May, just days before Suu Kyi's six-year term under
house arrest was due to expire, the government put her on
trial for an incident involving a U.S. citizen who swam
across Rangoon's Lake Inya to reach Suu Kyi's lakefront
bungalow and allegedly stayed there one or two nights.
Suu Kyi was taken to Rangoon's notorious Insein Prison on
charges of violating the terms of her detention by hosting a
foreigner, which could bring a three- to five-year prison
term, according to Burmese opposition officials. Suu Kyi, 63,
is said to be in poor health and has recently been treated
for dehydration and low blood pressure.
``Our position is that we are willing to have a more
productive partnership with Burma if they take steps that are
self-evident,'' Clinton said. She called on Burmese
authorities to ``end the violence against their own people,''
including ethnic minorities, ``end the mistreatment of Aung
San Suu Kyi'' and release political prisoners.

The PRESIDING OFFICER. The Senator from Rhode Island.
Mr. REED. Mr. President, the chairman of the Foreign Relations
Committee, Senator Kerry, is prepared to comment and speak. I ask
unanimous consent that at the conclusion of his remarks, the Senator
from Delaware be recognized as in morning business.
The PRESIDING OFFICER. Without objection, it is so ordered.
The Senator from Massachusetts.
Mr. KERRY. Mr. President, obviously North Korea's actions in recent
weeks--months, really; testing a nuclear device on May 25 and launching
ballistic missiles on July 4--received the appropriate objection in
many different ways of China, Japan, South Korea, the United States,
and many other countries. Clearly, those actions threaten to undermine
the peace and security of northeast Asia, and the U.S. response to
those actions ought to be and, I believe, is already resolute. China
responded very clearly. The sanctions have been toughened--individual
sanctions for the first time. A number of steps were taken by both the
United Nations and China. China, incidentally, has been unprecedented
in the personalization of some of the sanctions that it has put into
place.
I know the Senator from Kansas cares, obviously, enormously about the
underlying issue here. But I have to say this amendment, while well
intended, simply does not do what it is supposed to do. It has no
impact other than the sense of the Senate: sending a message which at
this particular moment, frankly, works counterproductively to other
efforts that are underway.

[[Page S7761]]

Right now, the Secretary of State is meeting at ASEAN. Right now, the
various countries involved in this delicate process are working to
determine how to proceed forward with respect to getting back to talks
and defusing these tensions. For the Senate just to pop on an amendment
like this at this moment in time not only sends a signal that
complicates that process, but I think it also, frankly, will make it
more difficult to secure the return of two American journalists, Laura
Ling and Euna Lee.
It simply is an inappropriate interference without a foundation, I
might add--without a foundation--in the law. Let me be very specific.
When President Bush lifted the designation of terrorism--in fact,
nothing that the Senator from Kansas has laid out here actually is
supported either by the intelligence or by the facts. I could go
through his amendment with specificity. Let me give an example. This is
from the findings in his amendment:

On March 17, 2009, American journalists . . . were seized
near the Chinese-North Korean border by agents. . . .

He is citing that as a rationale for putting them back on the list.
Well, the fact is, the families themselves, as well as the two
journalists--but the families--have acknowledged that they, in fact,
were arrested for illegally crossing the border. So that is
inappropriate. But not only is it inappropriate to cite a fact that is
not a fact, but it is not a cause for putting somebody on the terrorism
list.
Nowhere do any of the actions cited here fit into the statutes that
apply to whether somebody is designated as appropriately being on the
terrorism list. Let me be more specific about that. When President Bush
took them off the list, here is what they said. This is the President's
certification:

The current intelligence assessment satisfies the second
statutory requirement for rescission. Following a review of
all available information, we see no credible evidence at
this time of ongoing support by the DPRK for international
terrorism, and we assess that the current intelligence
assessment, including the most recent assessment published
May 21, 2008, provides a sufficient basis for certification
by the President to Congress that North Korea has not
provided any support for international terrorism during the
preceding 6-month period.

There is no intelligence showing to the contrary, as we come to the
floor here today, and it is inappropriate for the Senate simply to step
in and assert to the contrary.
Moreover, the President said:

Our review of intelligence community assessments indicates
there is no credible or sustained reporting at this time that
supports allegations (including as cited in recent reports by
the Congressional Research Service) that the DPRK has
provided direct or witting support for Hezbollah, Tamil
Tigers, or the Iranian Revolutionary Guard. Should we obtain
credible evidence of current DPRK support for international
terrorism at any time in the future, the Secretary could
again designate DPRK a state sponsor of terrorism.

Well, we have not. It simply does not fit under the requirements.
We need to use the right tools. This amendment is flawed and I am
convinced could actually undermine what I know is going on right now in
terms of efforts by a number of different parties to try to move this
process forward. This is not the way a responsible Senate ought to go
about trying to deal with an issue with this kind of diplomatic
consequence.
The relisting, incidentally, has no practical effect in terms of
anything it would do with respect to our current policy other than
raise the issue with respect to the Senate at this moment but, as I
say, inappropriately with respect to the statutes it concerns.
President Bush actually preserved all the existing financial
sanctions on North Korea at the time he lifted the terror designation,
and he kept them all in place by using other provisions of law.
The fact is, this administration has, in fact, responded in order to
put real costs on North Korea for its actions. We led the international
effort at the United Nations Security Council, and we did enact
sweeping new sanctions on North Korea, and by all accounts they are
biting.
The U.N. Security Council resolution 1874, passed unanimously,
imposed the first ever comprehensive international arms embargo on
North Korea. Those sanctions are now beginning to take effect. A North
Korean ship suspected of carrying arms to Burma turned around after it
was denied bunkering services in Singapore, and the Government of Burma
itself warned that the ship would be inspected on arrival to ensure
that it complied with the U.N. arms embargo. So that is real. That is
happening. Significantly, China has agreed to impose sanctions both on
North Korean companies and individuals involved in nuclear and
ballistic missile proliferation.
So the sanctions that were recently imposed by the Obama
administration, in concert with the international community, are having
a real impact. So I think we ought to give them time to work. I do not
think we ought to come in here and change the dynamics that, as I say,
I know are currently being worked on by the Secretary of State. As we
are here in the Senate today, those meetings are taking place. It is
better for the United States and the international community to focus
our efforts on concrete steps rather than resort to a toothless and
symbolic gesture. This will have no impact ultimately because we are
still going to go down our course, but it can ripple the process which
the administration has chosen to pursue.
I might also point out, the President and Secretary of State have
been closely communicating with allies and with partners in the region.
They are currently involved in discussions with China, Russia, South
Korea, and Japan on this issue. Even as we debate the issue here, the
effort at the ASEAN Forum is specifically geared to try to coordinate
our approach with our treaty allies and with others. We ought to give
the administration the opportunity to succeed.
Third, obviously all of us reject the recent actions taken by North
Korea. There is no doubt about that. But it was not so long ago that we
were actually making some progress on the denuclearization effort. And
observers of the region--those who are expert and who follow it
closely--are all in agreement as to the rationale which has driven
North Korea to take some of the actions it has taken.
I was in China about a month and a half ago. I spent some time with
Chinese leaders on this issue because one of the tests took place while
I was there and I saw the Chinese reaction up close and personal. I saw
the degree to which they were truly upset by it, disturbed by it, and
took actions to deal with it. The fact is that they explained it, as
have others, as a reaction by North Korea to perhaps three things: No.
1, the succession issues in North Korea itself; No. 2, the policies of
the South Korean Government over the course of the last year or so; and
No. 3, the fact that while they had nuclear weapons and had been
engaged in a denuclearization discussion with the United States, most
of the focus appeared to have shifted to Iran, and there was some sense
that the focus should have remained where those nuclear weapons
currently exist.

So I believe we need to preserve diplomatic flexibility in the weeks
and months ahead. There is an appropriate time for the administration
to come to us. There is an appropriate way for us to deal with this
issue, to sit down with the administration, to make it clear to them
that we think we ought to do this, to talk with them about it, to
engage in what the rationale might be under the law. But as I say, none
of the reasons that are legitimate under the law for, in fact, a
designated country as going on the terrorist list is appropriate or fit
here. I think that is the most critical reason of all.
I yield the floor.
The PRESIDING OFFICER. The Senator from Delaware.
Mr. CARPER. Mr. President, thank you very much. I thank the floor
manager on the majority side for this unanimous consent which allows me
to proceed now under morning business.
I wish to say a word or two about the Defense authorization bill
which is before us, and then I want to pivot. I will talk about the
health of our Nation's defense, but also about the health care of our
people.
Let me start off by extending my thanks to the leaders of the Armed
Services Committee, Senator Levin and Senator McCain, and their staffs
for the good work they have done. I wish to thank Senator Reed of Rhode
Island for his contributions as well. Standing here on the floor, I am
looking at Senator Reed, a graduate of the

[[Page S7762]]

Military Academy at West Point, and right across the aisle, at Senator
McCain, a graduate of the Naval Academy. It is great to have that kind
of experience here in the Senate. They are sitting on opposite sides of
the aisle, coming from schools that are sometimes thought to be rivals,
but they are able to work together when we need them to.
I wish to express my thanks to the President and to the Secretary of
Defense Bob Gates. We have learned that in the last 7 years, cost
overruns from major weapons systems in this country grew from about $45
million in 2001 to last year almost $300 billion, a growth over 7 years
in cost overruns for major weapons systems in 2001 of $45 million and
last year almost $300 billion. What we need is for the administration
as well as the Secretary of Defense and the Joint Chiefs to say to the
folks on the Armed Services Committee, but also to say to us in the
Senate and in the House: These are the weapons systems we need, these
are the threats we believe we face as a nation, and to give us some
sense of priorities of the weapons systems we should support and fund,
the troop levels we need and, frankly, the weapons systems we don't
need and the troop levels we don't need.
I was privileged to follow on the heels of the Presiding Officer,
Senator Kaufman, about a month and a half ago to Afghanistan and
Pakistan. He and Senator Reed, I think, led that CODEL and shared with
us our needs in that part of the world. We need a military strategy and
we also need a civilian strategy in Afghanistan, and I think this
administration has given us a good two-pronged approach. We have good
new leadership there on the military side. Basically, though, they said
our job here is counterinsurgency. We need more troops, more trainers
to train the Afghans and to train the military side, and then the
civilian side. We also need mobility in terms of a lot of additional
helicopters, about 150 new helicopters or additional ones coming in to
provide the mobility to move our men and women all over the southern
part of Afghanistan, and to meet the Taliban threat.
The kind of weapon we don't use there or don't need there, I will be
very blunt, is the F-22 which we discussed and debated here for the
last several days, a fighter aircraft that has been around for a dozen
or so years. We are still building more of them, but they have never
flown a flight mission in Iraq and never flown a flight mission in
Afghanistan either. The F-22 is limited in what it can do. It basically
is a fighter, air-to-air combat. The Afghans, the Taliban, don't have
fighter aircraft. In Iraq, the folks we are fighting there don't have
aircraft. Meanwhile, we have F-15s, F-16s, F-18s. We are going to build
2,500 F-35s, for less than half the price of the F-22, which not only
do dog fights but can also do ground-to-air support and a variety of
different functions that the F-22 cannot for a lot less money. The
administration, I think wisely, said as hard as it is sometimes to stop
the production line on aircraft, in this case the F-22, in terms of
what is cost effective, we need to refocus on the F-35 and on
counterinsurgency, preparing for those kinds of challenges we face. We
voted to do that, a 58-to-40 vote. I was very pleased with the vote and
I commend everyone who voted as they did, and, frankly, the people who
took the opposite view. There were some tough issues to deal with, I
know particularly from folks in whose States the aircraft are being
produced and systems for those aircraft are being produced. I know it
is difficult to accept. But I am encouraged by that vote.
My hope is we will pay heed to some of the priorities sent to us by
the Secretary of Defense, which are designed to make sure we spend
money on weapons systems that we are likely to need in the 21st
century--certainly in the next decade or two or three--and I think with
today's vote, we are on a better path to do that.

Health Care Reform

Sort of pivoting, if I can, after having said a word about the health
of our Nation's defense, let me talk about the health of the people in
our country. Some of my colleagues are probably getting tired of
hearing me say this, but when talking about health care, I mention four
things: No. 1, we spend more money for health care than any other
nation on Earth. No. 2, we don't get better results. No. 3, we have
14,000 people in this country today losing their health care. No. 4,
some 47 million Americans today don't have health insurance, don't have
health care. We have to do better than this. We have to do better than
this. I believe we can.
There has been a big focus, as there should be, on extending health
care coverage to 47 million folks who don't have it, and we need to
address that, obviously. Having said that, the other concern we need to
address is reining in the growth of health care costs. We are getting
clobbered as a nation in terms of being able to compete with the rest
of the world where we pay so much more money for health care than any
other nation, and employers pay, and we are getting clobbered as a
Federal Government with the cost of Medicare and Medicaid, and State
governments trying to bear their share of the cost of Medicaid. They
see enormous pressures on their State budgets.
Over lunch today, I said to my colleagues in our caucus meeting that
wouldn't it be great if somehow we could have our cake and eat it too.
I said that with a piece of chocolate cake staring me right in the
face. But as it turned out, there are delivery systems, if you will, of
health care in this country where they are not necessarily having their
cake and eating it too, but where they are able to provide better
health care, better outcomes, at a lower price. Think about that:
better health care, better outcomes, better quality of health care at a
lower price.

The names are beginning to become familiar to us. Some are already
familiar: Mayo in Minnesota, and now they have an operation down in
Florida too to see if that model will work in Florida, and it has;
Kaiser Permanente in northern California, an outfit called
Intermountain Health--all of these are nonprofits--Cleveland Clinic in
Cleveland, OH, an outfit called Geisinger in Hershey, PA; there is what
is called a health care cooperative in the State of Washington, I
believe it is around Puget Sound, called Puget Sound Cooperative where
they have been able to emulate this interesting result of better
quality outcomes, better health care, lower prices.
What we need to do is to attempt not only to extend health care
coverage to folks who don't have it--47 million--but to rein in the
growth of health care costs. The idea that health care costs grow at 2
or 3 or 4 percent over the consumer price index, to continue to do that
is going to cripple us economically and competitively as a nation. It
is going to cripple our ability to rein in our large and growing
deficits.
In the last 8 years in this Nation we ran up as much new debt as we
did in the first 208 years of our Nation's history. Think about that:
In the last 8 years, we ran up as much new debt in this country as we
did in our first 208 years as a nation. This year we are on track to
have the biggest single-year deficit we have ever had. We are also in
the worst economic downturn since the Great Depression, and we are
trying to stimulate the economy and get it moving. I am encouraged that
it is starting to move, but that is a huge deficit, coming on the heels
of, frankly, 8 years where we spent like drunken sailors, and I know
how drunken sailors spend. It is not a pretty sight, and this is,
frankly, not a pretty sight either.
We need to go to school on the Mayos, the Geisingers, the Cleveland
Clinics, the Kaiser Permanentes, the Puget Sounds, the Intermountain
Healths, and see what we can learn from them. What is their secret? How
are they able to do this, better outcomes, less price?
As it turns out, there are a number of things they do in common. I
wish to mention a few of them today. Among the things they do, they
have literally brought on to their staff the doctors at Cleveland
Clinic, for example, who provide health care. They are on staff at the
Cleveland Clinic. The same is true at Mayo and these other nonprofits.
I saw an interesting special on CNN a couple of weekends ago. They
were interviewing a number of people who worked at the Cleveland
Clinic. They interviewed a fellow who is a doctor, a cardiologist, as I
recall. He used to be in private practice. He said, in the old days
when I was on my own in private practice or group practice, I got paid,
compensated, for the number of hearts I operated on. If somebody came
to me

[[Page S7763]]

and they had a heart problem and it could be addressed by diet or
exercise or medicine, he said, usually I didn't prescribe those things.
I didn't get paid for doing that. If they needed to have a heart
operation and we could address their problem with an operation, he
said, I got paid for that. As a result, I was more inclined to operate
on people's hearts than to use some approaches that were arguably more
cost effective. He went on to say, now I work for the Cleveland Clinic.
I am a staff doc here. I don't have to operate on people's hearts to be
compensated. I can provide good advice, help people with their diet
problems, their exercise problems, their weight problems. I can help
people better understand what their opportunities are with medicine. I
still get paid. Bingo.
So a light went off for me. Some of us are hearing quite a bit the
need to get away from these fee-for-service deals where we basically
incentivize doctors, hospitals, and nurses to ask for and order more
visits, more procedures, more MRIs, more lab tests, for imaging, more
x-rays, because they get paid for it, because they know that by doing
more of everything, they reduce the likelihood that they are going to
be sued. That sort of gets us in this conundrum where we overuse health
care. If we are going to have real success in drawing down the costs of
health care, part of it will be addressing the issue of fee for
service, get away from that practice, and get away from the
overutilization of the health care we have.
Let me mention some of the things they are doing at these five or six
entities I mentioned, these nonprofits. Among the things they do is
coordinate care. I use my mom as an example. My mom is now deceased.
She lived in Florida for roughly the last 30 or so years of her life.
She had dementia; she had congestive heart failure; she had arthritis.
She had five doctors. The last years of her life that she was down
there, my sister and I would go down to visit my mom about every other
month or so. We would take turns, and we would go with our mom to visit
her doctors. These five doctors my mom had never talked to each other.
In fact, I don't think they knew that the other doctors existed. They
were all in the aggregate prescribing something like 15 different kinds
of prescription medicines. We kept them at her home in what looked like
my dad's old fishing tackle box. It was compartmentalized with
medicines to take before breakfast, during breakfast, after breakfast;
before lunch, during lunch, and throughout the day. Some of those
medicines my mom was prescribed, she didn't need to take. Somebody
needed to know what she was taking and say, You shouldn't be taking
these two medicines in combination; they are hurting you. We didn't
have good coordination of care of my mom.
One of the things these nonprofits do is coordinate the care that is
provided to my mom or anybody's mom or dad. Another thing that would
have been very helpful for my mom or other people in that situation is
to have electronic health records. If my mom had an electronic health
record such as we have in the VA and like we are developing in Delaware
and some other States, when my mom went from doctor's office to
doctor's office they would know in each office who else she was seeing
and the medicines she was being prescribed, the lab tests and
everything. They would have it right there for her when she came for
her regular visit.
We have a great ability to harness information technology or
electronic health care records, which are a big part of that. Our
nonprofits I have talked about--the half dozen or so--have that in
common. On wellness and prevention, we know it is not just from
nonprofits but out in California is Safeway, and these people have
supermarkets all over America and several hundred thousand employees.
Their health care costs from 2004 to 2008 have been level and flat.
They have incentivized employees to do the right thing for themselves,
in terms of holding down their weight, helping them get off tobacco, to
fight obesity and lethargy, to get off the sofa, and to eat what is
right; and there are antismoking campaigns and all kinds of stuff. So
we have a good model there to perform.
It is not just the nonprofits but a lot of employers are starting to
get into this as well.
There are another one or two points I will mention on the nonprofits.
On chronic disease management, such as heart disease and diabetes, I am
told that about 80 percent of the cost of these chronic diseases can be
controlled by four factors: diet, exercise, overweight/obesity, and
smoking. Those four factors control about 80 percent of the cost of our
expenditures on chronic care. If we work with those four items, we will
help reduce the costs and provide better outcomes for people. We will
also hold down our costs. There are a couple lessons from the
nonprofits and others. Part of it is pharmacy--making sure people who
need pharmaceutical medicines, small and large molecules, are taking
those, and somebody is checking to make sure they are taking what they
need.
Focusing on primary care, many of those people coming out of medical
schools want to be specialists. They are not interested in being
primary care doctors. We need more primary care doctors. We need to
change the incentives to get more primary care doctors, which is what
we need. Another idea is for us to pool insurance costs. As my
colleagues know, we have the Federal Employee Health Benefit Plan. We
have an insurance pool where we pool all the Federal employees and
their dependents and the retirees and their dependents into one large
pool to purchase health insurance. They get it at a not cheap price but
a pretty good price. One of the reasons why is, when you have a lot of
people in the purchasing pool, you get a good variety and much better
costs. If you think about the administrative costs for health
insurance, as a percentage of premiums, I am told, in the Federal
Employee Health Benefit Program, it is about 10 percent. When it comes
to people buying individual policies and small businesses, their
administrative costs as a percentage of premiums are about 30 percent.
So the idea of creating large purchasing pools makes a whole lot of
sense.
I will close here. The idea that we would pass health care
legislation and stop extending coverage for people who don't have it--
if that is all we do, we have failed the American people. We have to do
at least two things. One is extend coverage but also make sure the
coverage we extend provides better coverage, better quality outcomes
and better health care and that we do so at a price that is diminished
and does not continue to expand by several times the rate of inflation.
We can do that going forward. That is what we need to do.
My friends have been generous in allowing me to proceed. I see
several Senators are anxious to get back into the debate.
I yield the floor.
The PRESIDING OFFICER. The Senator from Arizona is recognized.
Mr. McCAIN. Mr. President, I rise in support of the amendment offered
by the Senator from Kansas concerning North Korea.
I must say I was entertained by the outlook--as far as North Korea's
behavior is concerned--by the distinguished chairman of the Foreign
Relations Committee. I can't remember when I have disagreed more.
The State Department's 2008 Country Reports on Terrorism stated that
``as part of the six-party talks process, the U.S. reaffirmed its
intent to fulfill its commitment regarding the removal of the
designation of the DPRK as a state sponsor of terrorism in parallel
with the DPRK's actions on denuclearization and in accordance with
criteria set forth by law.''
They certainly haven't taken any action on denuclearization, and it
certainly hasn't been in accordance with the criteria set forth by law.
There was a problem with this trade, however. We delisted North
Korea, and we got something worse than nothing. Facts are stubborn
things. In response to our action, Pyongyang has embarked on a pattern
of astonishing belligerence and has reversed even the previous steps it
had taken toward the denuclearization prior to its removal from the
terrorism list.
A few facts. In December 2008--just 2 months after the United States
removed Pyongyang from the list--North Korea balked at inspections of
its nuclear facilities and ceased disablement activities at the
Yongbyon reactor. In March, the regime seized two American

[[Page S7764]]

journalists near the China-North Korean border and subsequently
sentenced them to 12 years of hard labor in the North Korean gulag.
These are two American citizens who may have strayed over a border.
Does that mean they are sentenced to 12 years of hard labor in the most
harsh prison camps in the world? What are we going to do about it? It
is remarkable. Two weeks later, it tested a long-range ballistic
missile, in violation of U.N. Security Council resolutions, and then
announced it was expelling international inspectors from Yongbyon,
reestablishing the facility, and ending North Korean participation in
disarmament talks. In May, Pyongyang conducted its second nuclear test;
in June, a North Korean ship suspected of carrying illicit cargo
departed North Korea in likely defiance of U.N. Security Council
obligations; and earlier this month, Pyongyang again launched short-
and medium-range missiles into the Sea of Japan, including on the
Fourth of July.
All these are indications that the North Koreans somehow should not
be listed as terrorists? I think we ought to, frankly--I respect and
appreciate my friend from Kansas. Maybe we ought to have a binding
resolution, rather than a sense of the Senate. It is remarkable that
these events have taken place against a backdrop of belligerence and
intransigence by North Korea. Pyongyang has never accounted for or even
acknowledged its role in assisting the construction of a nuclear
reactor in Syria, which the Israelis had to bomb. Similarly, it has
refused to provide a complete and correct declaration of its nuclear
program. Of course, something we all know, which is one of the great
tragedies in the history of the world, is this is a gulag of some
200,000 people, where people are regularly beaten, starved, and
executed. According to the Washington Post, most of them work 12- to
15-hour days until they die of malnutrition-related illnesses, usually
at around the age of 50. They are allowed just one set of clothes. They
live and die in rags, without soap, socks, underclothes or sanitary
napkins. It is a horrible story.
It is not an accident that the average South Korean is several inches
taller than the average North Korean. This regime may be the most
repressive and oppressive and Orwellian in all the world today. So the
Chinese have been serious--according to Mr. Kerry, the Senator from
Massachusetts, the Chinese have been resolute on the issue of the ship
inspections. The U.N. Security Council resolution calls for monitoring
and following of the ship, and if the decision is made that they need
to board a North Korean ship, if the North Koreans refuse, then the
following ship cannot board but can follow them into a port, where the
port authorities are expected to board and inspect the vessel. And then
that violation is reported to the U.N. Security Council. That ought to
rouse some pretty quick action. I don't share the confidence of the
Senator from Massachusetts that if a North Korean ship goes into a port
at Myanmar, you will see likely action, except maybe the offloading of
whatever materials are being bought by Myanmar.
Look, the North Koreans have clearly been engaged in selling anything
they can to anybody who will buy it because they need the money--
whether it be drugs, counterfeit currency, nuclear technology or
missiles. Every time we have held onto the football, like Lucy, they
have pulled it away.
I think this is a very modest proposal of the Senator from Kansas. I
point out that years and years of six-party talks, different party
talks, negotiations, conversations, individuals who have been assigned
as chief negotiators who then end up somehow negotiating, with the end
being further negotiations, has failed.
If the North Koreans continue to test weapons, test missiles, sooner
or later, they will match a missile with a weapon that will threaten
the United States of America. Right now, those missiles they are
testing go over Japanese territory. I think it is pretty obvious we are
dealing with a regime of incredible and unbelievable cruelty and
oppression of their own people. The newly published Korean bar
association details the daily lives of the 200,000 political prisoners
estimated to be in the camps. Eating a diet of mostly corn and salt,
they lose their teeth, their gums turn black, their bones weaken and,
as they age, they hunch over at the waist.
This is a regime that, in any interpretation of the word, is an
outrageous insult to the world and everything America stands for and
believes in. I believe they will pose a direct threat, over time, to
the security of not only Asia but the world. They were able to export
technology all the way to Syria, obviously. Why should they not be able
to export that to other parts of the world?
I urge my colleagues to vote in support of the amendment by the
Senator from Kansas, and I hope we can vote on that sooner rather than
later.
I yield the floor.
The PRESIDING OFFICER. The Senator from Kansas is recognized.
Mr. BROWNBACK. Mr. President, I ask unanimous consent to add Senator
Bennett from Utah as a cosponsor of the amendment.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. BROWNBACK. I thank my colleague from Arizona. I think he
understands more than anybody in this body the situation and what
happens in a gulag-type situation. That has drawn me to the topic of
North Korea for a couple years--the human rights abuses. Hundreds and
thousands of North Koreans are fleeing to be able to simply get food,
and a couple hundred thousand of them are in the gulag system. It is
unbelievable that this can happen in 2009. We have Google Earth that
can even show this. But we just say: OK, that is the sort of thing that
happens there. It is mind-boggling to me that we wouldn't act
resolutely.
I appreciate the chairman of the Foreign Relations Committee, the
Senator from Massachusetts, who is a distinguished Senator and is very
bright and experienced in foreign policy. I could not disagree with him
more about North Korea. We have had an ongoing dialog and discussion
about this. He makes the point that we should not pop this on the bill.
I have been trying for months for us to relist them as terrorists.
They should not have been delisted in the first place. It was a
terrible process move on the Bush administration to try to move the
talks forward, saying we are going to delist you and you are going to
do something for us. Pyongyang and Kim Jong Il said thank you very
much, and now we are going to stick it in your face, which is what they
have continued to do. I have listed the things, as the Senator from
Arizona has mentioned as well.

The thought that we are acting resolutely, to me, is an insult to the
people in North Korea who have lived under this oppressive regime. We
are not acting resolutely toward North Korea. We are not putting any
sanctions on them. We have asked for international sanctions, but why
aren't we willing to put sanctions on ourselves? If we think this is
such a proper course to follow, and we are willing to push it on an
international body, why wouldn't we be willing to do it ourselves? Why
wouldn't we be willing to list them as a terror nation, as a state
sponsor of terror? I don't understand that; why, if it is good in the
international arena, we wouldn't do it ourselves.
Plus, we need to have teeth into this. This is a modest--a modest--
proposal. It is a resolution, a sense of the Senate that North Korea
should be relisted as a state sponsor of terrorism. We are not
relisting them. That is an administration call. We are saying we, as a
body, given the provocative actions that have taken place since they
have been delisted clearly merits the relisting of North Korea as a
state sponsor of terrorism. That is our opinion, and that is what we
are saying to the administration.
Without a foundation in the law, it is clearly--as I read
previously--allowed for the Secretary of State to determine that the
government of that country has repeatedly provided support for acts of
international terrorism. That is the actual wording of the law in the
Arms Export Control Act. Clearly, they have acted to sponsor
international terrorism with their relation with Burma, with the
missiles, with the nuclear weapons, and with the proliferation they
have done and continue to do.
He says, and is suggesting, that delisting has no practical effect. I
believe it does have a practical effect, and it certainly does on the
administration's stance toward North Korea

[[Page S7765]]

and their international posture toward North Korea. Plus, it has a
practical effect on what we can provide for as far as aid from the
United States to North Korea. We shouldn't be providing aid to the
North Koreans. We should provide food aid, if we can monitor it. We
shouldn't be giving oil to the North Koreans. That should be limited so
the administration cannot do that. They would not be able to if they
are listed as a state sponsor of terrorism.
Mr. President, it will hurt the people of North Korea and those who
are in the North Korean gulags if we don't relist them. It recovers any
vestige of hope they might have that at some point in time somebody of
enough stature, such as the United States Government, is going to take
enough notice that they are going to put pressure on the North Korean
regime. I have talked with some people who were refuseniks in the
Soviet Union, in a Soviet gulag during an era where we had far less
communication capacity than we do today, and yet they were able to get
messages at that point in time into the Soviet gulag that the Americans
were putting pressure on the Soviet Union and the lack of human rights
in the Soviet Union, and it gave them hope. It gave them hope in the
Soviet gulag.
If we can pass this, it can give people in the gulags in North Korea
hope that somebody is at least paying enough attention to put pressure
on this, and maybe they may be able to live longer, or actually live at
all. It can give them hope, instead of ``abandon hope all ye who enter
here,'' as it says at the entrance to Inferno and as it is in the gulag
system in North Korea.
So it is a modest resolution, and I would hope my colleagues would
vote overwhelmingly for this resolution to relist North Korea as a
state sponsor of terrorism.
I yield the floor.
The PRESIDING OFFICER. The Senator from Connecticut.

Amendment No. 1528

Mr. LIEBERMAN. Mr. President, I ask unanimous consent that the
pending amendment be set aside and that amendment No. 1528 be called
up.
The PRESIDING OFFICER. Without objection, it is so ordered. The clerk
will report the amendment.
The bill clerk read as follows:

The Senator from Connecticut [Mr. Lieberman], for himself,
Mr. Graham, Mr. Begich, Mr. Cornyn, Mrs. Hutchison, and Mr.
Thune, proposes an amendment numbered 1528.

Mr. LIEBERMAN. Mr. President, I ask unanimous consent that further
reading of the amendment be dispensed with.
The PRESIDING OFFICER. Without objection, it is so ordered.
The amendment is as follows:

(Purpose: To provide authority to increase Army active-duty end
strengths for fiscal year 2010 as well as fiscal year 2011 and 2012)

Strike section 402 and insert the following:

SEC. 402. ADDITIONAL AUTHORITY FOR INCREASES OF ARMY ACTIVE-
DUTY END STRENGTHS FOR FISCAL YEARS 2010, 2011,
AND 2012.

(a) Authority to Increase army Active-Duty End Strength.--
(1) Authority.--For each of fiscal years 2010, 2011, and
2012, the Secretary of Defense may, as the Secretary
determines necessary for the purposes specified in paragraph
(2), establish the active-duty end strength for the Army at a
number greater than the number otherwise authorized by law up
to the number equal to the fiscal-year 2010 baseline plus
30,000.
(2) Purpose of increases.--The purposes for which an
increase may be made in the active duty end strength for the
Army under paragraph (1) are the following:
(A) To increase dwell time for members of the Army on
active duty.
(B) To support operational missions.
(C) To achieve reorganizational objectives, including
increased unit manning, force stabilization and shaping, and
supporting wounded warriors.
(b) Relationship to Presidential Waiver Authority.--Nothing
in this section shall be construed to limit the authority of
the President under section 123a of title 10, United States
Code, to waive any statutory end strength in a time of war or
national emergency.
(c) Relationship to Other Variance Authority.--The
authority in subsection (a) is in addition to the authority
to vary authorized end strengths that is provided in
subsections (e) and (f) of section 115 of title 10, United
States Code.
(d) Budget Treatment.--
(1) In general.--If the Secretary of Defense increases
active-duty end strength for the Army for fiscal year 2010
under subsection (a), the Secretary may fund such an increase
through Department of Defense reserve funds or through an
emergency supplemental appropriation.
(2) Fiscal years 2011 and 2012.--(2) If the Secretary of
Defense plans to increase the active-duty end strength for
the Army for fiscal year 2011 or 2012, the budget for the
Department of Defense for such fiscal year as submitted to
Congress shall include the amounts necessary for funding the
active-duty end strength for the Army in excess of the
fiscal-year 2010 baseline.
(e) Definitions.--In this section:
(1) Fiscal-year 2010 baseline.--The term ``fiscal-year 2010
baseline'', with respect to the Army, means the active-duty
end strength authorized for the Army in section 401(1).
(2) Active-duty end strength.--The term ``active-duty end
strength'', with respect to the Army for a fiscal year, means
the strength for active duty personnel of Army as of the last
day of the fiscal year.

Mr. LIEBERMAN. Mr. President, I am pleased and proud to introduce
this amendment with a bipartisan group of cosponsors. To state it
briefly, it extends the authorized end strength of the U.S. Army by
30,000 over the next 3 years, effective with the commencement of fiscal
year 2010. It doesn't mandate this increase, but it expands the
authority of the Secretary of Defense, obviously, with the support and
authorization of the President of the United States, the Commander in
Chief, to extend the end strength of the U.S. Army. End strength means
how many soldiers can the U.S. Army have. Of course, it does this to
reduce the tremendous stress on the U.S. Army, which is carrying the
burden of combat in two wars, in Iraq and Afghanistan today, and over
the next year or 18 months will be in this unique position.
Progress has been made, thank God, in Iraq, and the Iraq Security
Forces are progressively taking over responsibility for keeping the
security in their country. The drawdown of American soldiers is
happening in a methodical and responsible way, and I again express my
appreciation to President Obama that it is happening in that way. At
the same time, we are increasing our troop presence in Afghanistan.
Bottom line: The demand for members of the U.S. Army on the battlefield
over the next year, 18 months, at the outside 2 years, is going up. If
the supply remains constant, that means the stress on every soldier in
the U.S. Army and his or her family will not be reduced. As a matter of
fact, it will go up. The term for this--which I will get to in a
minute--in the Army is ``dwell time.''
This is an amendment that began with members of the Senate Armed
Services Committee, and a comparable amendment in the House Armed
Services Committee, recognizing, as we all do, the tremendous stress
that our Army is under, the extraordinary job they are doing in Iraq
and Afghanistan.
This is really the next great generation of the American military.
But we see in it some tough statistics: the increase in mental health
problems, the increase in divorces of members of the service, and,
worse, of course, the increase in suicides.
There are many things we have supported in this Senate and the
Congress--and the administration has--to respond to each one of those
problems. But in a way, the most direct thing we can do is to increase
the size of the U.S. Army so there is less pressure on every soldier in
the Army, in this sense. Every time we add another soldier to the U.S.
Army--and we are talking about authorization to add 30,000 more--it
means that much more time every other member of the U.S. Army can spend
back at base retraining, preparing and, most important of all, spending
time with their families.
As I know the Presiding Officer knows--and I know the President of
the United States knows it too--the good news is that the Secretary of
Defense, Bob Gates, who has done and is doing an extraordinary job for
our country with, of course, the support and authorization of President
Obama, yesterday announced that he would be temporarily increasing the
Active-Duty end strength of the U.S. Army by 22,000 soldiers over the
course of the next 3 years.
I cannot sufficiently express my words of appreciation for Secretary
Gates's decision. He acted by employing the emergency authority he has
in an authorization of the use of force and a built-in statutory waiver
he has up to 3 percent of existing end strength to expand the size of
the Army. This amendment, which had been planned,

[[Page S7766]]

and was in the committee before this great action by Secretary Gates
yesterday, is now before us, and I am honored to offer this amendment
with a bipartisan group of cosponsors who are listed on this amendment
as a way to do two things: The first is that it literally increases
from 547,000 to 577,000-plus the authorized end strength of the U.S.
Army, and to leave that authority there in case there is a need that
Secretary Gates and the President see in the coming 3 years to raise
the number.
Mr. McCAIN. Mr. President, will the Senator yield for a question?
Mr. LIEBERMAN. I will be happy to yield.
Mr. McCAIN. It is my understanding that the amendment authorizes the
additional forces Secretary Gates said yesterday in his speech that we
need--or the day before yesterday. Why do we need to put this into the
bill?
Mr. LIEBERMAN. Two reasons. The first is that it is a bit beyond what
Secretary Gates did. He authorized using the extraordinary powers he
possesses as Secretary in this time of conflict up to 22,000 for the
next 3 years. The amendment authorizes--doesn't mandate, doesn't
appropriate--30,000 for the next 3 years. So it gives some latitude,
depending on how conditions go in Iraq and Afghanistan, to go a bit
further--8,000 more, if necessary, over the next 3 years.
Second, I say to my friend from Arizona, when this amendment started,
we didn't know Secretary Gates was going to do this. I am grateful he
did, but this amendment now--frankly, as Secretary Gates himself said
to me yesterday, and I appreciate it and I don't think he would mind if
I repeated it on the Senate floor--gives the Senate and Congress the
opportunity to essentially vindicate and support the step that the
Secretary has made and, as he put it, send a message from the Senate to
the members of the U.S. Army that help is on the way.
Mr. McCAIN. And there is no doubt that the Army very badly needs the
help now and in the foreseeable future.
Mr. LIEBERMAN. My friend from Arizona is absolutely right. There is
no doubt, based on the demand, certainly temporarily, over the next 18
months, perhaps 2 years, as we are drawing down in Iraq, but not as
rapidly as we are adding forces in Afghanistan, that there is at least
a temporary need for more than the authorized 547,000 members of the
U.S. Army.
Mr. McCAIN. And if I could question the Senator further, perhaps this
would illuminate any requirement for stop loss or for involuntary
extensions in a combat area.
Mr. LIEBERMAN. Absolutely. As a matter of fact, one of the reasons
Secretary Gates gave yesterday I will read:

The decision to eliminate the routine use of ``stop loss''
authority in the Army requires a larger personnel flow for
each deploying unit to compensate for those whose contract
expires during the period of deployment.

So, yes, this makes it possible to end the use of stop loss, which is
essentially, in layman's terms, a way to require people to stay
actively deployed longer than they originally were going to be
deployed.
Mr. McCAIN. I thank the Senator.
Mr. LIEBERMAN. I thank my friend from Arizona. We have illuminated
most of the reasons in our exchange why this amendment is important. I
will simply add a few more things Secretary Gates said yesterday, which
is:

The army has reached a point of diminishing returns in
their multiyear program to reduce the size of its training
and support ``tail.''

That is the training and support which supports the Active-Duty Army.

The cumulative effect of these factors is that the Army
faces a period where its ability to continue to deploy combat
units at acceptable fill rates is at serious risk.

Here is the point I just made in response to Senator McCain's
question.

Based on current deployment estimates, this is a temporary
challenge--

A temporary point of stress. We hope and pray that is true. It
certainly looks like it is--

which will peak in the coming year and abate over the course
of the next 3 years.

Mr. President, in addition to the Secretary of Defense, we heard from
the Army's Chief of Staff, GEN George Casey, and Secretary of the Army
Pete Geren, who have been advocates within the Pentagon for this
increase in end strength, and I thank them for that. Admiral Mullen,
Chairman of the Joint Chiefs, told our Armed Services Committee earlier
this year that the light at the end of the tunnel, as he put it, is
still more than 2 years away, and that is only if everything goes
according to plan, which in combat, obviously, often does not.
Again, I say this is an authorization; it is not a mandate. I will
add that Secretary Gates announced yesterday that he will find a way to
fund the additional troops in this year and fiscal year 2010--the one
that begins October 1--by reprogramming other funds appropriated to the
Pentagon for fiscal year 2011, which is the budget that will be
presented to us next year, if it is probable that the Department of
Defense will require funding as part of its normal operations, and more
likely as part of the OCO fund--the overseas contingency operation
fund--which supports our presence in Iraq and Afghanistan.
I cannot say enough, I know all of us in the Senate believe we cannot
say enough, in gratitude to the members of the U.S. Army who are
leading the battle for us against the Islamic extremists and terrorists
who attacked us on 9/11/01. We owe them a debt we can never fully
repay.
One thing we can do, that Secretary Gates did yesterday and the
Senate can do in this amendment, is to send a message to our troops in
the field that help is on the way in the most consequential way, which
is additional members of the Army.
I ask that when the vote be taken, it be taken by the yeas and nays.
The PRESIDING OFFICER. Is there a sufficient second?
There is a sufficient second.
The yeas and nays were ordered.
Mr. LIEBERMAN. Again I say to my colleagues I am doing that, although
I expect there will be very strong support for this, because I believe
it is the most visible way for this Senate to send the message to the
U.S. Army of appreciation and gratitude, to them and their families,
that help is on the way.
I yield the floor.
The PRESIDING OFFICER. The Senator from Michigan is recognized.
Mr. LEVIN. Mr. President, let me commend Senator Lieberman and others
who support this amendment. We in the Armed Services Committee are very
supportive of previous increases; indeed, we led the way on some of
them. Because of the stress on the Army and the number of commitments
which had been made in Iraq and Afghanistan, we must give the kind of
support to our troops they deserve and the American people want us to
give.
One of the ways we can reduce some of the stress is by increasing the
end strength so the dwell time is more sufficient and there are other
positive spinoffs as well from this kind of increase in the authorized
end strength.
The Secretary made a very powerful speech the other day when he
called for an increase of 22,000, I believe, in the end strength. That
end strength is temporary, it is almost as large as this--not quite;
this is 30,000, but this is surely in the ballpark. It is appropriate.
It is authority, it is not mandatory, and I think it is a very positive
signal to send to our men and women in uniform and to their families. I
very much support the amendment.
The PRESIDING OFFICER. The Senator from Connecticut is recognized.
Mr. LIEBERMAN. Mr. President, briefly I thank Senator Levin, the
chairman of the Armed Services Committee, not just for his strong
statement of support now but for the support he has given during our
committee's deliberations to the goal of achieving an increase in Army
end strength.
I yield the floor.
Mr. CARDIN. Mr. President, I suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The bill clerk proceeded to call the roll.
Mr. CARDIN. Mr. President, I ask unanimous consent the order for the
quorum call be rescinded.
The PRESIDING OFFICER (Mr. Begich). Without objection, it is so
ordered.

Amendment No. 1475

Mr. CARDIN. Mr. President, I am going to talk about an amendment we

[[Page S7767]]

have not yet cleared unanimous consent for it to be brought up. I am
hopeful that will come. But in order to advance the issue, I intend to
talk about my amendment, No. 1475, without offering it at this time. I
think it is an appropriate amendment to talk about at this point
following Senator Lieberman's amendment because his amendment deals
with increasing our forces.
One of the reasons it is important to do that is the stress that the
restricted numbers provide on our military personnel. Senator Lieberman
mentioned, and I will repeat, the number of suicides and attempted
suicides by our young men and women serving in the military has
increased and one of the reasons, frankly, is that the repeated
deployments and the length of the deployments have added to the stress
of our servicemen.
Health experts agree that there is most likely a combination of
factors leading to this increase in suicides. Many of these factors are
simply the results of the prolonged conflict that our Nation finds
itself in, including multiple deployments, extended separations from
family and loved ones, and the overwhelming stress of combat
experiences; each placing a unique and tremendous strain on the men and
women of our all-volunteer force.
But while Congress has recognized these strains, and acted to help
provide relief by increasing the size of our forces and thereby
reducing the number and frequency of deployments, we cannot as easily
remedy the stress or mental trauma created by combat experience.
For those who have had to witness the ugliness and devastation of war
first-hand, they have encountered something very unnatural for the
human mind to comprehend or accept. For these service members,
recovering from these experiences involves a long and arduous journey
in learning to identify, control and cope with a wide array of
emotions. And this learning process is often only accomplished with the
guidance and management of highly trained mental or behavioral health
specialists.
In this light, we in Congress have acted to increase funding for more
mental health providers and improved access for our troops and their
families, and we have sharpened the focus of the military on addressing
these care needs. That is very positive and has had a very positive
effect.
What we must now focus on, and direct the military's attention to, is
the potentially harmful practice of administering antidepressants to a
population that frequently moves throughout a theatre of war and is
therefore susceptible to gaps in mental health management. We are not
certain they are getting the follow-up care they need.
A 2007 report by the Army's fifth Mental Health Advisory Team
indicated that, according to an anonymous survey of U.S. troops, about
12 percent of combat troops in Iraq, and 17 percent of combat troops in
Afghanistan, are taking prescription antidepressants or sleeping pills
to help them cope with this stress. This equates to roughly 20,000
troops on such medications in theatre right now.
What I find particularly troubling, when reviewing these figures, is
that the Pentagon has yet to establish an official clearinghouse that
accurately tracks this kind of data. In fact, the Army's best reported
estimate can only tell us that the authorized or prescribed drug use by
troops in Iraq and Afghanistan is believed to be evenly split between
antidepressants--mainly selective serotonin reuptake inhibitors, or
SSRIs--and prescription sleeping pills. My amendment would provide us
with the information so we know what is happening with the use of these
drugs.
Providing that this best estimate contains some degree of accuracy,
it is important for us to also recognize that many of these same
antidepressants, after strong urging by the FDA, recently expanded
their warning labels to state that young adults--ages 18-24 years old--
may be at an elevated risk of suicidal thoughts and behavior while
using the medication. This same age group--18-24 years old--represents
41 percent of our military forces serving on the front lines in Iraq
and Afghanistan.
While keeping this warning label in mind, it is imperative that my
colleagues understand that nearly 40 percent of Army suicide victims in
2006 and 2007 are believed to have taken some type of antidepressant
drugs--and overwhelmingly these SSRIs. And as I mentioned at the
beginning of this statement, the number of Army suicides reported each
month are outpacing each preceding month.
This class of antidepressants--these SSRIs--are unlike most earlier
classes of psychiatric medications in that they were, from their
inception, specifically designed for use as an antidepressant --that
is, they were engineered to target a particular process in the brain
that plays a significant role in depression and other anxiety
disorders. More significantly, however, these SSRIs are unlike most
other antidepressant medications because they are still allowed by
Department of Defense policy to be prescribed to service members while
they are deployed and directly engaged in overseas operations.
Now, to be fair, there is widespread consensus in the community of
professional mental health providers, and empirical evidence to
support, that SSRIs do offer significant benefit for the treatment of
posttraumatic stress and some forms of depression. And although there
are some side effects, they are reportedly much milder and shorter in
duration than other antidepressants. Additionally, SSRIs are also
believed to potentially prevent, or at least some believe, lesson the
more harmful long-term effects of posttraumatic stress disorder.
My concern, however, and hopefully that of my Senate colleagues, is
not the long-term efficacy of these SSRIs, but more pointedly the
volume and manner in which these drugs are being administered to our
service men and women overseas.
You see, unlike medications that work on an as-needed basis, SSRIs
only begin to work after having been taken every day--at a specific
dosage--for a significant period of time. This frequently translates to
a 3 to 6 week latency period before the therapeutic effect materializes
and patients begin to feel improvement. In light of the population I
have been discussing, there are two very readily apparent problems with
this shortcoming--first, is that service members serving in forward
operating areas, such as Afghanistan and Iraq, are quite frequently
subject to moving between bases or into other areas--some so remote
that there may be no trained mental health provider available to
administer the treatment and to make sure it is effective.
Second, and more importantly, is that this initial period is when
patients, particularly younger patients, often suffer an escalation in
the severity of depression and/or anxiety.
In essence, DOD may be prescribing SSRIs to its service members,
without the assurance that they will remain in a capacity to be
observed by a highly trained mental health provider. Worse yet, these
same patients may very likely find themselves ordered off to conduct
combat operations during this same latency period.
Let's return our focus back to the alarming increase in the number of
military and veteran suicides reported in 2008 and 2009.
At what point do we step forward to direct that action be taken by
DOD to capture, track and report this data? And at what point do we
ensure that DOD is properly prescribing, dispensing and administering
these drugs to our troops without having in place the necessary
controls and or patient management practices?
As a first step in this direction, the amendment I intend to
introduce will accomplish a better understanding as to the potential
magnitude of this issue. This amendment directs the Department of
Defense to capture, at a macro level--at a macro level, not individual
information, without divulging or violating any protected patient
health information--the volume and types of antidepressants,
psychotropics or antianxiety drugs being prescribed to our men and
women serving in Iraq and Afghanistan. It will also require DOD,
beginning in June of 2010 and then annually thereafter through 2015, to
report to Congress an accurate percentage of those troops currently and
previously deployed to Iraq and Afghanistan since 2005 who have been
prescribed these types of drugs.
I wish to reiterate that this measure specifically directs the
disclosure of

[[Page S7768]]

this information by DOD to be done in such a way as to not violate the
individual patient privacy rights of our service men or women as
defined by HIPAA.
This legislation further directs DOD to contact the National
Institute of Mental Health and provide any and all data as determined
necessary by the Institute to conduct a scientific peer reviewable
study to determine whether these types of prescriptions, and/or the
method in which they are being prescribed and administered by DOD, are
in any way contributing to the rising number of suicides by
servicemembers or Iraq or Afghanistan veterans.
I want to specifically address one issue I have heard from some who
express concern about this amendment by saying it would stigmatize, in
the eyes of our troops, those seeking mental health care. Nothing could
be further from what this amendment does. This amendment would collect
information in an anonymous manner, and it will be invisible to the
servicemembers serving on the front line.
The men and women serving in our military, and equally so their
families, deserve our utmost assurance that we are doing everything in
our power to see that our Nation's warfighters are provided the best
medical care available. An integral part of our commitment must also be
to ensure that these service men and women volunteering to serve our
Nation are not being exposed to what may potentially endanger them when
they seek medical care and mental health service.
This amendment is very simple. It asks us to gather information so we
can make a judgment in a macro sense, without violating the individual
privacy of our service men and women. It allows us to gather the
information, to have the best information. This Congress has a proud
record of providing the necessary resources for the health care of our
warriors and their families.
This amendment will complement that by making sure that we have the
analytical tools to make sure we are providing the right type of mental
health services to our service men and women who are in theater. It
gets us the information in order to judge what is being done today.
I would hope my colleagues would agree that we would want to have
this information, and I hope at a later time I will have the
opportunity to actually offer the amendment.
I yield the floor.
The PRESIDING OFFICER. The Senator from Michigan.
Mr. LEVIN. First of all, let me commend the Senator from Maryland on
his amendment. I support it. I hope it can be cleared or placed in
order so that we can adopt it on a rollcall if it cannot be cleared.

Amendment No. 1528

I ask unanimous consent that we now proceed to a vote on the
Lieberman amendment, a rollcall vote on the Lieberman amendment.
Mr. McCAIN. I ask for the yeas and nays.
The PRESIDING OFFICER. The question is on agreeing to the amendment.
The yeas and nays have been ordered. The clerk will call the roll.
The bill clerk called the roll.
Mr. DURBIN. I announce that the Senator from West Virginia (Mr.
Byrd), the Senator from Massachusetts (Mr. Kennedy), the Senator from
Maryland (Ms. Mikulski), the Senator from Pennsylvania (Mr. Specter),
and the Senator from Virginia (Mr. Webb) are necessarily absent.
Mr. KYL. The following Senator is necessarily absent: the Senator
from Idaho (Mr. Crapo).
The PRESIDING OFFICER. Are there any other Senators in the Chamber
desiring to vote?
The result was announced--yeas 93, nays 1, as follows:

[Rollcall Vote No. 236 Leg.]

YEAS--93

Akaka
Alexander
Barrasso
Baucus
Bayh
Begich
Bennet
Bennett
Bingaman
Bond
Boxer
Brown
Brownback
Bunning
Burr
Burris
Cantwell
Cardin
Carper
Casey
Chambliss
Coburn
Cochran
Collins
Conrad
Corker
Cornyn
DeMint
Dodd
Dorgan
Durbin
Ensign
Enzi
Feinstein
Franken
Gillibrand
Graham
Grassley
Gregg
Hagan
Harkin
Hatch
Hutchison
Inhofe
Inouye
Isakson
Johanns
Johnson
Kaufman
Kerry
Klobuchar
Kohl
Kyl
Landrieu
Lautenberg
Leahy
Levin
Lieberman
Lincoln
Lugar
Martinez
McCain
McCaskill
McConnell
Menendez
Merkley
Murkowski
Murray
Nelson (NE)
Nelson (FL)
Pryor
Reed
Reid
Risch
Roberts
Rockefeller
Sanders
Schumer
Sessions
Shaheen
Shelby
Snowe
Stabenow
Tester
Thune
Udall (CO)
Udall (NM)
Vitter
Voinovich
Warner
Whitehouse
Wicker
Wyden

NAYS--1

Feingold

NOT VOTING--6

Byrd
Crapo
Kennedy
Mikulski
Specter
Webb
The amendment (No. 1528) was agreed to.
Mr. LEVIN. I move to reconsider the vote, and I move to lay that
motion on the table.
The motion to lay on the table was agreed to.
The PRESIDING OFFICER. The Senator from Michigan.
Mr. LEVIN. Mr. President, I ask unanimous consent that Senator Leahy
be added as a cosponsor on the amendment which we just adopted, the
Lieberman amendment.
The PRESIDING OFFICER. Without objection, it is so ordered.

Amendment No. 1688

Ms. SNOWE. Mr. President, as ranking member of the Senate Committee
on Small Business and Entrepreneurship, I rise in support of this vital
amendment in order to correct disparities among the Small Business
Administration's, SBA, small business contracting programs. Building on
my efforts to bring true parity to the programs, this amendment will
create a more equitable and flexible method for Federal agencies to
fairly allocate Federal procurement dollars to small business
contractors across the Nation. Earlier this year, I offered an
amendment, cosponsored by my colleague from Maine, Senator Collins, to
create parity as part of S. 454, the Weapon Systems Acquisition Reform
Act of 2009. Unfortunately, that amendment was not accepted.
For years it has been unclear to the acquisition community what, if
any, is the true order of preference when determining which small
business contracting program is at the top of the agency's priority
list. The SBA's regulations state that there is parity among the
programs, and this had been the general practice in effect until two
Government Accountability Office decisions were released on September
19, 2008, and May 4, 2009.
The decisions stated that the Historically Underutilized Business
Zone--HUBZone--program had preference over all other small business
contracting programs. While the interpretation benefits HUBZone
businesses, it comes at the expense of other vital small business
contracting programs. This targeted amendment provides equity for the
SBA's small business contracting programs.
The amendment provides Federal agencies with the necessary
flexibility to satisfy their government-wide statutory small business
contracting goals. This amendment makes clear to purchasing agencies
that contracting officers may award contracts to HUBZone, service-
disabled veterans, 8(a), or women-owned firms with equal deference to
each program. It would provide these agencies with the ability to
achieve their goaling requirements equally through an award to a
HUBZone firm, a service-disabled veteran-owned small business, and a
small business participating in the 8(a) business development program.
And of course this list will also include women-owned small businesses
once the women's procurement program is fully implemented by the SBA.
In addition, this amendment brings the SBA's contracting programs
closer to true parity by giving HUBZones a subcontracting goal.
HUBZones are the only small business contracting program without a
subcontracting goal. In addition, the amendment authorizes mentor
protege programs modeled after those used in the 8(a) program for
HUBZones, service-disabled veteran and women-owned firms.
The essence of true parity is where each program has an equal chance
of competing and being selected for an award. During these difficult
economic

[[Page S7769]]

times, it is imperative that small business contractors possess an
equal opportunity to compete for federal contracts on the same playing
field with each other.
I urge my colleagues on both sides of the aisle to support this
amendment.

amendment no. 1500

Mr. GRASSLEY. Mr. President, I rise today to support the section 1072
of S. 1390, National Defense Authorization Act of 2010. This section
authorizes the Comptroller General of the United States to assess
military whistleblower protections.
As everyone knows, I strongly believe whistleblowers play an
important role in the accountability of all government. This should
also be true for the men and women who wear uniforms and serve in the
Armed Forces.
In 1988, Congress passed legislation that gave members of the armed
services unique whistleblower protections. Despite this military
whistleblower law, I have concerns that military whistleblowers could
be underserved by the regulations and processes created by the
Department of Defense, DOD, and the DOD, Office of Inspector General,
OIG.
During the course of my own investigation of several military
whistleblower cases, I learned some matters which may question how
effectively military whistleblower reprisal cases are handled by the
DOD and DOD OIG. The Government Accountability Office, GAO, has noted
in its past work that the effectiveness of the Federal protection for
military whistleblowers rests principally on a two-stage process of
investigation and administrative review. The first stage involves a
DOD, service, or guard inspector general's investigation of the
specific facts and interpretation of issues associated with a
whistleblower reprisal allegation. In the second stage of the
investigation/administrative review process, the DOD OIG reviews and
approves the findings of the service or guard inspectors general. This
review is designed to provide assurance that the findings and
recommendations in a report were made in compliance with applicable
investigatory guidelines and meet legal sufficiency. The second stage
of this procedure is crucial for the military whistleblower process to
work as intended.
In addition to the tasking included in S. 1390, the military
whistleblower reprisal appeal process should be examined by the GAO as
well. The military whistleblower law, 10 USC Sec. 1034, gives the
Boards for the Correction of Military Records--BCMR--of each armed
service the appeal authority in these often unique and complex matters.
I believe the report requested by the underlying bill is important and
I support its inclusion. However, it is important for the GAO to also
study the effectiveness of the BCMR appeal process to ensure military
whistleblowers are afforded a fair administrative process to combat
reprisal.
Last year, I first introduced the idea of a GAO military
whistleblower study when I requested this work of the Acting
Comptroller General Gene L. Dodaro in a letter dated July 18, 2008. I
followed up on my letter to the GAO with a legislative proposal through
a filed amendment to the Defense Department appropriations bill for
2009 which instructed the GAO to conduct a comprehensive analysis of
this issue. Unfortunately, that amendment did not make it through the
legislative process. I thank Chairman Levin and Ranking Member McCain
for including this sensible military whistleblower study in the current
bill.
Accordingly, I offer this latest amendment to include a review and
analysis of the military whistleblower reprisal appeals heard by the
Boards for the Correction of Military Records.
Mr. DURBIN. Mr. President, the National Defense Authorization Act for
Fiscal Year 2010 authorizes almost $680 billion for the Department of
Defense and the national security programs of the Department of Energy.
The bill provides pay and health care to servicemembers and their
families; funds troops with the equipment and resources they need to
fight and provide security; strengthens our ability to train foreign
militaries and protect against IEDs and rogue nuclear threats; and
terminates questionable weapons programs.
It also includes legislation to complete the James A. Lovell Federal
Health Care Center in Illinois.
It gives the VA and the Navy the authority they need to finalize a
model partnership between the North Chicago VA Medical Center and the
Naval Health Clinic Great Lakes.
This is a model that the Departments hope can be replicated around
the country.
Combining separate Federal hospitals will provide better care for our
servicemembers and veterans while saving valuable taxpayer dollars.
Given the conflicts we face abroad, this bill provides the right
amount to spend in support of our troops. Today, the United States is
the world's leader in defense spending. Last year, U.S. military
spending accounted for almost half of the world's total military
spending. We spend more than the next 46 countries combined. U.S.
military spending, combined with that of our close allies, makes up 72
percent of all military spending in the world. Our defense budget is
six times larger than China's and 100 times larger than Iran's.
These funds make good on a promise to our men and women in our
military. Our troops continue to do everything we ask of them in the
wars in Iraq and Afghanistan. These conflicts have taken an
extraordinary toll on servicemembers and their families that we cannot
forget.
The Armed Forces, particularly the Army and the Marine Corps, will
continue to be heavily stressed, even as we start to redeploy our
forces from Iraq. Servicemembers still do not have enough dwell time
between deployments and the Army has seen a troubling rise in the
number of suicides. These are indications of the strain that multiple
and continued deployments are taking on the force. The President
requested increasing the size of the Army to 547,400 soldiers and
increasing the Marine Corps to 202,100 Marines, while preventing cuts
in Navy and Air Force personnel. This bill supports the President's
request. It also authorizes an additional 30,000 soldiers in 2011 and
2012, should the Secretary of Defense believe such troops are
necessary. Additional soldiers and marines will help ease the burdens
caused by multiple deployments.
More personnel will give each service more breathing room to care for
its wounded warriors. Others can continue the fight while injured and
ill servicemembers can recover in wounded transition units.
This legislation creates a task force to assess the policies and
programs that support the care and transition of recovering wounded and
seriously ill members of the Armed Forces. The task force will consider
whether servicemembers have sufficient access to care for posttraumatic
stress disorder and traumatic brain injury, the signature injury of the
wars. It will look at how well we help injured warriors transition from
the Department of Defense to the Department of Veterans Affairs.
The task force will also review the support available to family
caregivers as they care for recovering injured and seriously ill
members of the Armed Forces. For every servicemember successfully
recovering from a serious injury or illness, there is often a family
member who has put the brakes on his or her life to care for that
person.
Last week, my office received a call from the family of Jordan Hoyt,
a soldier from Barry, IL. He was seriously injured in Afghanistan and
is receiving care at Walter Reed Army Medical Center here in
Washington. His wife Haley has moved to Washington to be near Jordan
while he goes through months of surgery and rehabilitation. She has
brought with her their infant child, who was born while Jordan was away
serving his country. Haley is from Quincy. She has left her family
behind to help Jordan recover from his injury. She has also delayed her
educational plans to study criminal justice. Haley is 19 years old.
After Jordan leaves Walter Reed, the couple will return to Quincy to
live with her mother, who has already provided them with incredible
support. While taking care of wounded servicemembers is our basic
responsibility, we also need to support the families whose lives have
been up-ended by the wars. I commend the committee for including this
task force to look at the needs of family caregivers.
This President inherited many challenges at home and abroad,
including two wars and a challenging situation in

[[Page S7770]]

Pakistan. This bill supports President Obama's new direction in
addressing these priorities. In June, our military redeployed from
Iraq's cities under the Status of Forces Agreement concluded by the
government of Iraq and the previous administration. The Iraqis must
continue to take responsibility for their own future.
I commend the President's increased focus on defense and development
in Afghanistan; preventing the reemergence of the Taliban and al-Qaida;
and strengthening economic, agricultural, educational, and democratic
development. These goals are important to development in Afghanistan,
but they are essential to our military's strategy. I support the
National Defense Authorization Act and commend Chairman Levin and
Senator McCain for their leadership.
Almost 3,000 soldiers from the Illinois Army National Guard are
currently deployed to Afghanistan. Members of the Illinois Guard's 33rd
Infantry Brigade Combat Team are helping train the Afghan National
Police and providing force protection at military bases. It has been a
difficult deployment, with many casualties. Gen William Enyart, the
Adjutant General of Illinois, has had to attend the funerals of too
many of his soldiers. He sent me an article he had written this spring.
Why do the young soldiers serve, he asked? This is what he wrote. They
serve because:

They are our kids, they are our protectors. They are what
stand between us and chaos. They don't have to be asked to
serve. They don't have to be asked to go into danger. They do
it, not out of hate, not out of vengeance, but out of love.
Love of family, love of community, love of fellow soldier.

I think he is right. Members of the Armed Forces and their families
make these sacrifices to keep our country safe. We owe them much in
return. This bill takes one step by providing them the resources they
need. I ask my colleagues to support this legislation and to send it to
the President for his signature.

____________________