[Congressional Record Volume 155, Number 172 (Thursday, November 19, 2009)]
[Senate]
[Pages S11523-S11544]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




      CAREGIVERS AND VETERANS OMNIBUS HEALTH SERVICES ACT OF 2009

  The PRESIDING OFFICER. Under the previous order, the Senate will 
proceed to the consideration of S. 1963, which the clerk will report.
  The assistant bill clerk read as follows:

       A bill (S. 1963) to amend title 38, United States Code to 
     provide assistance to caregivers of veterans, to improve the 
     provision of health care to veterans, and for other purposes.

  The PRESIDING OFFICER. The Senator from Oklahoma.


                           Amendment No. 2785

  Mr. COBURN. Mr. President, I call up amendment No. 2785.
  The PRESIDING OFFICER. The clerk will report.
  The assistant bill clerk read as follows:

       The Senator from Oklahoma [Mr. Coburn] proposes an 
     amendment numbered 2785.

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

   (Purpose: To transfer funding for United Nations contributions to 
 offset costs of providing assistance to family caregivers of disabled 
                               veterans)

       On page 177, after line 10, add the following:

     SEC. 1003. REQUIREMENT TO TRANSFER FUNDING FOR UNITED NATIONS 
                   CONTRIBUTIONS TO OFFSET COSTS OF PROVIDING 
                   ASSISTANCE TO FAMILY CAREGIVERS OF DISABLED 
                   VETERANS.

       The Secretary of State shall transfer to the Secretary of 
     Veterans Affairs, out of amounts appropriated or otherwise 
     made available in a fiscal year for ``Contributions to 
     International Organizations'' and ``Contributions for 
     International Peacekeeping Activities'', such sums as the 
     Secretaries jointly determine are necessary to carry out the 
     provisions of this Act and the amendments made by this Act.

     SEC. 1004. MODIFICATION OF ELIGIBILITY FOR FAMILY CAREGIVER 
                   ASSISTANCE.

       (a) Limitation.--Section 1717A(b), as added by section 102 
     of this Act, is amended--
       (1) in paragraph (1), by striking ``and'' at the end;
       (2) in paragraph (2)(C), by striking the period at the end 
     and inserting ``; and''; and
       (3) by adding at the end the following new paragraph:
       ``(3) who, in the absence of personal care services, would 
     require hospitalization, nursing home care, or other 
     residential care.''.
       (b) Expansion.--Such section 1717A(b) is further amended, 
     in paragraph (1), by striking ``on or after September 11, 
     2001''.

  Mr. COBURN. Inquiry, Mr. President. It is my understanding I am going 
to have 2 hours during this period of time under unanimous consent.
  The PRESIDING OFFICER. The Senator is correct.
  Mr. COBURN. I reserve the remainder of my time and yield to the 
chairman and ranking member.
  The PRESIDING OFFICER. The Senator from Hawaii.
  Mr. AKAKA. Mr. President, I ask unanimous consent that I be permitted 
to use my time on the bill and my time on the amendment as necessary.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. AKAKA. Mr. President, as chairman of the Senate Committee on 
Veterans' Affairs, I had the honor of speaking at the World War II 
Memorial this past Veterans Day. As I stood there remembering my own 
comrades and their families, I thought of what the brave men and women 
in the service give up every day so we can enjoy the freedoms that come 
with American citizenship.
  It is in that spirit that I urge this body to pass S. 1963, the 
Caregivers and Veterans Omnibus Health Services Act of 2009 without 
further delay.
  The Nation's young veterans coming home from Iraq and Afghanistan 
have faced a new and terrifying kind of warfare, characterized by 
improvised explosive devices, sniper fire, and counterinsurgencies. 
Military medicine, fortunately, is saving more of these young 
servicemembers' lives than ever before.
  In World War II, 30 percent of Americans injured in combat died. In 
Vietnam, 24 percent died. In the wars in Iraq and Afghanistan, about 10 
percent of those injured have died.
  As more of the catastrophically disabled are surviving to return 
home, more will require a lifetime of care. With our decision on S. 
1963, we decide whether that care will be in their homes with the help 
of their family members or in institutions. If we want that care to be 
in the home, we need to help the families shoulder the burden of 
providing it.
  During the prior administration, the President's Commission on Care 
for America's Returning Wounded Warriors--known as the Dole-Shalala 
Commission--found that 21 percent of Active Duty, 15 percent of 
Reserves, and 24 percent of retired or separated servicemembers who 
served in the Iraq or Afghanistan conflicts said friends or family 
members gave up a job to be with them or to act as their caregiver. By 
giving up a job, caregivers often give up health insurance, when they 
need it the most.
  Studies also show family caregivers experience an increased 
likelihood of stress, depression, and mortality, compared to their 
noncaregiving peers.
  Without a job, without health insurance, and in very stressful 
situations, family caregivers have worked to fulfill the Nation's 
obligation to care for its wounded warriors.
  S. 1963 would give these caregivers health care, counseling, support, 
and a living stipend. The bill would provide caregivers with a stipend 
equal to what a home health agency would pay an employee to provide 
similar services. It would give the caregivers health care and make 
mental health services available to them. The bill also provides for 
respite care so caregivers can return to care for these veterans with 
renewed vigor and energy. It lets these young veterans return to their 
families and not to a nursing home.
  While the caregiver program in this legislation will be limited at 
first to the veterans of the Iraq and Afghanistan wars, other 
provisions of the bill improve health care for all veterans.
  There are provisions which make health care quality a priority, 
strengthen the credentialing and privileging requirements of VA health 
care providers, and require the VA to better oversee the quality of 
care provided in individual VA hospitals and clinics.
  The bill will also improve care for homeless veterans, women 
veterans, veterans who live in rural areas, and veterans who suffer 
from mental illness.
  About 131,000 veterans are homeless. S. 1963 would help these 
veterans obtain housing, pension benefits, and other supportive 
services. It would provide financial assistance to organizations that 
help homeless veterans.
  Seventeen percent of servicemembers are now women. This legislation 
contains a number of provisions which are designed to improve the care 
and services provided to women veterans.
  It would provide for the training of mental health professionals in 
the treatment of military sexual trauma and provide care for the 
newborn children of servicewomen. It would give women veterans a 
quality of care they have earned through their service to this country.
  The bill also provides new assistance to veterans who live in rural 
areas. According to the VA, of the 8 million veterans enrolled in VA 
health care, about 3 million live in rural areas. This legislation 
would bring more services into rural communities through telemedicine 
and increased recruitment and retention incentives for health care 
providers. It also would increase the VA's ability to use volunteers at 
vet centers and create centers of excellence for rural health.
  Finally, S. 1963 addresses the signature injuries of this war--PTSD 
and traumatic brain injury. According to a recent RAND report, one-
third of veterans returning from Iraq and Afghanistan will develop 
post-traumatic stress disorder. Countless others will suffer from 
traumatic brain injury and face

[[Page S11524]]

significant problems in readjusting to life at home. Many studies have 
shown the importance of early intervention to the effective treatment 
of these invisible wounds.
  This legislation contains provisions that allow Active-Duty military 
to seek mental health services at vet centers and increase access to 
care for veterans with traumatic brain injury.
  Before concluding, I wish to share one of the many stories I have 
heard as I have worked to move this legislation through the Senate.
  SGT Ted Wade sustained a severe brain injury after his humvee was hit 
by an improvised explosive device in Iraq. His right arm was completely 
severed above the elbow, and he also suffered a fractured leg, broken 
right foot, and visual impairment, among other injuries.
  His wife Sarah Wade became his caregiver and a dedicated advocate for 
her husband, as well as for others who are providing caregiver 
services.
  In testimony before the House Veterans' Affairs Committee earlier 
this year, Ms. Wade made the point that:

       Young veterans with catastrophic injuries need support that 
     will be around as long as the injuries they sustained in 
     service to their country. Just like servicemembers need a 
     team in the military to accomplish the mission, they need a 
     team at home for the longer war.

  I agree completely with that view. Veterans need all the support we 
can provide. We, as a country, can give them options that veterans of 
my generation never had. We can give them the option to really come 
home.
  To those who are concerned about the cost of this legislation, I say 
we cannot now turn our back on the obligation to care for those who 
fought in the current wars. When we as a body vote to send American 
troops to war, we have promised to care for them when they return.
  I firmly believe the cost of veterans benefits and services is a true 
cost of war and must be treated as such.
  I ask that our colleagues accept no more delays and act on this 
important legislation.
  Mr. President, I reserve the remainder of my time and yield the 
floor.
  The PRESIDING OFFICER. The Senator from North Carolina.
  Mr. BURR. Mr. President, I thank and congratulate the chairman of the 
VA Committee. This is important legislation in front of this body. It 
is my belief that this will move very quickly, as we can see from the 
short time agreement: one amendment--one amendment that I think is 
extremely important for all Members of the Senate to consider.
  I rise in support of S. 1963, the Caregivers and Veterans Omnibus 
Health Services Act of 2009. This is actually the combination of two 
bills reported out of the Veterans' Affairs Committee this year, and it 
did enjoy bipartisan support.
  The centerpiece of the legislation is the support it would provide to 
caregivers of severely injured veterans of current wars. The bill would 
provide counseling, support, living stipends, and health care for those 
caregivers.
  As my colleagues know, family caregivers play an extremely important 
and, I might say, unique role in helping to meet the severely injured 
veterans' personal care needs. For some veterans, family members serve 
as their primary caregiver, some of whom have lost their jobs but, more 
importantly, have lost their health care as a result of that commitment 
to that family member.
  As the chairman spoke about a servicemember he had remembered in 
this--Ted Wade is a North Carolinian--he made the same impression with 
me. I also think about caregivers Edgar and Beth Edmundson from North 
Carolina as well, the parents of Eric Edmundson, a severely injured 
veteran from Operation Iraqi Freedom. They have been caring for Eric 
since the day they took him out of the VA hospital--out of a VA 
hospital because the VA basically had come to the point where they said 
they could not improve Eric's life.
  After Eric was injured on patrol along the Iraqi/Syrian border, he 
went into cardiac arrest while he was awaiting transport to Germany. It 
was in fact that cardiac arrest, that traumatic brain injury, that put 
Eric in a situation where he couldn't walk and he couldn't talk. As he 
lay in that long-term care provided by the Veterans' Administration, he 
got no better. He couldn't walk and he couldn't talk.
  Eric's father stepped to the plate and immediately began researching 
all the options for Eric's treatment. Despite being told his son would 
not emerge from his vegetative state, Ed Edmundson pushed on. He sold 
his business, he cashed in his savings and retirement pay, all in an 
effort to provide Eric 24-hour care as a father.
  Under his father's constant attention and relentless pursuit of new 
options, Eric received the treatment he needed. Without his dad's 
commitment, without the commitment of the rest of Eric's family--who 
basically dropped everything else important in life to focus on his 
needs--Eric would not be doing as well as he is today. I might say he 
walks and he talks and he continues to make progress every day because 
his most important caregivers, his parents, believed in him and they 
believed in what they could accomplish.
  Let me tell you the rest of the story. Beth, Eric's mom, recently 
suffered a compound fracture of her ankle while caring for Eric's 
daughter Gracie. Because Beth and Ed have no health insurance, they are 
on the hook for $36,000 worth of medical bills. Had Eric chosen Beth, 
his mother, as his caregiver, and this legislation was in effect, we 
would have provided coverage for Beth to have health care coverage. I 
believe that is what this legislation is about--recognizing the 
individuals who make life-altering commitments to members of their 
family or servicemembers who, without that commitment, might not have 
the quality of life they have.
  As I mentioned, assistance to caregivers is just one part of this 
bill. Other provisions would remove barriers to emergency care provided 
to veterans at non-VA facilities. It would expand health care services 
for women veterans, provide additional outreach to veterans in rural 
communities, provide additional improvements in mental health care 
services provided to veterans, enhance services to homeless veterans, 
improve the ability of VA to recruit and retain the needed health care 
professionals, authorize major medical facility construction projects, 
test a concept I introduced of providing veterans and their survivors 
with dental coverage, and much more.
  This is a good bill. It is not perfect. It can be better. I urge my 
Senate colleagues to strongly consider supporting the amendment of 
Senator Coburn, and let me explain why.
  When the committee passed this bill, we did not limit it to current 
veterans of current wars; we extended it to all veterans. Since it came 
out of committee in a bipartisan way, we have narrowed it down not to 
include all veterans. The amendment of Senator Coburn expands it to all 
veterans.
  When the committee considered the caregiver bill, we considered it 
because we wanted to keep veterans out of nursing homes. That was the 
goal, to give them an alternative because the traditional role of the 
nursing long-term care facilities had not worked at improving the 
quality of care and the quality of life for these veterans. That was 
our goal.
  Senator Coburn brings some definition to who is eligible for this 
based upon the fact that they would be headed toward a nursing home. We 
may tinker a little bit with the definition as to whether it is 
exclusive or totally as inclusive as we would like, but make no 
mistake, it is not different from the intent of the committee as to why 
the committee passed the caregivers act.
  Let me mention one probably even more important piece of the 
amendment of Senator Coburn. It actually pays for what we are doing. We 
say the Secretary ``shall''--that means he has to implement everything 
in the caregiver bill. The amendment of Senator Coburn is going to say: 
You know what. We are going to take some money out of the funds that we 
pay to the U.N., and we are going to fund our veterans. I, for one, am 
tired of coming to the floor and spending money we don't have.
  Why don't we take some of the money we have already appropriated and 
let's shift it? This is something novel for the Senate, but it is 
called prioritizing. Let's prioritize where the Federal investment 
should go. Let's make sure we pass the Caregivers and

[[Page S11525]]

Health Care Act. Let's make sure we pay for it with the Coburn 
amendment, and let's pull that money out of already-appropriated funds 
so we can not only look at our veterans, but we can look at our 
children and tell them this is a good bill.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Hawaii.
  Mr. AKAKA. Mr. President, I yield 10 minutes to the Senator from 
Washington, Mrs. Murray.
  The PRESIDING OFFICER. The Senator from Washington is recognized.
  Mrs. MURRAY. Mr. President, last week many of us spent time back home 
celebrating our veterans and honoring the great sacrifices they made 
for our country. I had the opportunity to commemorate Veterans Day at 
the Tahoma National Cemetery in Kent, WA. It was truly an honor to 
stand with veterans and their families as we paid tribute to their 
service.
  This recognition is important, it is certainly deserved, but it is 
not enough. We owe it to our veterans to make sure our commitment to 
them extends beyond Veterans Day and that they have access to the 
health care and services they have earned.
  Growing up, I saw firsthand the many ways that military service can 
affect both veterans and their families. My father served in World War 
II. He was one of the first soldiers to land in Okinawa. He came home 
as a disabled veteran, and he was awarded the Purple Heart.
  Like many soldiers of his generation, my dad did not talk about his 
experiences to us when he came home. In fact, we only learned about 
them by reading his journals after he passed away. That experience 
offered me a much larger lesson about veterans in general.
  They are reluctant to call attention to their service. They are 
reluctant to ask for help. That is why we have to publicly recognize 
their sacrifices and contributions. It is up to us to make sure they 
get the recognition they have earned. Our veterans held up their end of 
the deal, now we have to hold up ours.
  As a member of the Veterans' Affairs Committee, I am keenly aware 
that we have a lot of work to do for the men and women who served us. 
Not only must we continually strive to keep up our commitments to 
veterans from all wars, but we have to also respond to the new and very 
different issues facing veterans who are returning from Iraq and 
Afghanistan today, wars that are being fought under conditions that are 
very different from those in the past. That is precisely what the 
caregivers and veterans omnibus health bill that is before us today 
aims to do.
  One of the changes we have seen in our veterans population recently 
is the growing number of women veterans who are seeking care at the VA. 
Today more women are serving in the military than ever before, and over 
the next 5 years, in fact, the number of women seeking care at the VA 
is expected to double. Not only are women answering the call to serve 
at unprecedented levels, they are also serving in a very different 
capacity.
  In Iraq and Afghanistan, we have seen wars that do not have 
traditional front lines; therefore, all of our servicemembers, 
including women, find themselves on the front lines. So whether it is 
working at the check points or helping to search and clear 
neighborhoods or supporting supply convoys, women servicemembers face 
many of the same risks from IEDs and ambushes as their male 
counterparts.
  But while the nature of their service has changed, the VA has been 
very slow to change the nature of the care they provide for these women 
when they return home. Today at the VA there is an insufficient number 
of doctors and staff with specific training and experience in women's 
health issues, and even the VA's own special studies have shown that 
women veterans are underserved. That is why included in this veterans 
health bill we are talking about today is a bill I introduced that will 
enable the VA to better understand and ultimately treat the unique 
needs of our female veterans. That bill authorizes several new programs 
and studies, including a comprehensive look at the barriers women 
currently face in accessing care through the VA. It is a study of women 
who have served in Iraq and Afghanistan to assess how those conflicts 
have affected their health.

  There is a requirement that the VA implement a program to train and 
educate and certify VA mental health professionals to care for women 
with sexual trauma, and there is a pilot program that provides 
childcare to women veterans who are seeking mental health services at 
the VA.
  This bill is the result of many discussions with women veterans on 
the unique and very personal problems they face when they return from 
war. Oftentimes after veterans meetings I held in which male veterans 
would speak freely about where they believed the VA wasn't meeting 
their needs, women veterans would approach me afterwards and walk up to 
me very quietly and whisper about the challenges they face.
  Some of these women told me they don't view themselves as a veteran 
even though they served, and therefore they don't seek care at the VA. 
Others told me how they believed the lack of privacy at their local VA 
was very intimidating, or about being forced into a caregiving role 
that prevented them from seeking care as they would often have to 
struggle to find a babysitter just in order to keep an appointment. To 
me and to the bipartisan group of Senators who have cosponsored my 
women veterans bill, these barriers to care for women veterans were 
unacceptable.
  As more women now begin to transition back home and step back into 
careers and their lives as moms and wives, the VA has to be there for 
them. This bill we are talking about today will help the VA modernize 
to meet their needs.
  Another way this bill meets the changing needs of our veterans is in 
the area of assisting caregivers in the home. As we have all seen in 
Iraq and Afghanistan, medical advances have helped save the lives of 
servicemembers who, as we know, in previous conflicts would have 
perished from the severity of their wounds. But these modern miracles 
also mean many of those who have been cast catastrophically wounded 
need round-the-clock care when they come home. In many of our rural 
areas, where access to health care services is limited, the burden of 
providing care often falls on the families of those severely injured 
veterans.
  For these family members, providing care for their loved ones becomes 
a full-time job. Oftentimes we hear they have to quit their current 
job, forfeiting not only their source of income but often their own 
health care insurance as well. That is a sacrifice that is far too 
great, especially for families who have already sacrificed so much. 
That is why this underlying bill provides those caregivers with health 
care, with counseling, with support, and, importantly, a stipend.
  This bill also takes steps to provide dental insurance to our 
veterans and survivors and their dependents.
  It improves mental health care services and eases the transition from 
active duty to civilian life. It expands outreach and technology to 
provide better care to veterans who live in rural areas. It initiates 
three programs to address homelessness among veterans at these 
especially difficult economic times.
  This is a bill that is supported by numerous veterans service 
organizations, by the VA, and it is supported by many leading medical 
groups. It was passed in the Senate Veterans' Affairs Committee with 
broad bipartisan support, after hearings with health care experts and 
VA officials and veterans and their families. Like other omnibus 
veterans health care bills before us, bills that have often passed on 
the floor with overwhelming support, it puts veterans before politics. 
It is a bipartisan bill designed to move swiftly so its programs can be 
implemented swiftly. It is a bipartisan bill designed to make sure our 
veterans do not become political pawns. Yet we have faced a lot of 
delays in getting here. Those delays are all too common here in the 
Senate. We have seen bipartisan nominations stalled, funding bills 
slowed down to a crawl. It has taken us months to pass a simple 
extension of unemployment benefits for people who are out of work.
  Providing for our veterans used to be one area where political 
affiliation and bipartisan bickering fell to the wayside. I hope those 
days are not behind us. Our aging veterans and the brave men and women 
who serve in Iraq and

[[Page S11526]]

Afghanistan need our help now. How we treat them at this critical time 
is going to send a signal to a generation of young people who today 
might be considering military service.
  As I have said many times, it is so important that we keep our 
promise to veterans, the same promise Abraham Lincoln made to America's 
veterans 140 years ago, ``to care for the veteran who has borne in 
battle, his widow and his orphan.''
  Our veterans have waited long enough for many of the improvements in 
this bill. We cannot ask them to wait any longer.
  I spoke last week on the floor on the eve of Veterans Day urging 
colleagues to move quickly on this bill. I am so glad progress is now 
being made toward making that happen. As we wait to pass this bill, our 
promise goes unfulfilled to many of our Nation's heroes. I urge my 
colleagues to pass this bill quickly so we can get to the work of 
providing our veterans with the support and services they have earned.
  I thank the Chair.
  The PRESIDING OFFICER. The Senator from Oklahoma.
  Mr. COBURN. Mr. President, the reason we are having the debate now is 
because nobody would have the debate earlier. It is important for the 
American people. I don't have any opposition to veterans care. As a 
matter of fact, I support keeping our commitments. But as this thing 
wound out, on October 28 it came to the floor. Part of my amendment, 
when it actually came out of committee, was in the bill. It was taken 
out before it came to the floor, not by the members of the committee. 
It was taken out. But the very fact that we make an issue, because 
somebody wants to debate a bill and offer amendments on a bill, and 
then we are supposedly antiveteran because we think maybe we ought to 
pay for some things we do around here, so because we want to pay for 
it, we are cast aspersions that we don't want it to be debated. The 
worst thing that happens in this body is we pass bills that the 
American people have no idea about because we refuse to debate them.
  I apologize to no one for having put a hold on this bill for a very 
good reason. The very good reason is this: Our veterans demonstrate 
courage greater than we ever demonstrate in this body. We ought to 
model that same courage. What is the courage I am talking about? The 
courage to make priorities, to make sure we keep those commitments. 
This bill, as it is written now, will cost $3.7 billion over the next 5 
years. I think we ought to do that for these veterans. But I also think 
their sacrifice should not be in vain and stolen and paid for by their 
grandchildren. I believe we ought to pay for what we are going to do.
  It is interesting that the Senator from Hawaii mentioned speaking at 
the World War II memorial. This bill, as written, excludes World War II 
veterans from the benefit. It excludes gulf war veterans from the 
benefit. What about them? Is the reason the other veterans, the Vietnam 
war veterans, the Korean war veterans were not included is because we 
thought we couldn't afford it? I think that is probably the reason. 
Which begs the question, if in fact we want to honor veterans, we ought 
to treat them the same, one, and we ought to have the courage to make 
hard choices about how we pay for it.
  It is easy to charge this money to our grandkids. I have no doubt 
that is what we will end up doing. But the biggest threat facing our 
country today is not Islamic fascism and Islamic terrorism. The biggest 
threat facing the country today is the fact that every young child born 
today will encounter $400,000 worth of debt for benefits they will get 
nothing from. When we calculate the interest cost on that, by the time 
they are 25, they will have been carrying a debt load of $1,119,000.
  As I look at my colleagues who want to do this but don't want to pay 
for it, I am bewildered to think that we can call and honor the courage 
and service of our veterans without taking some of the same courage to 
make some hard choices about funding of other things that are not 
nearly as important as our veterans. We can't do both. We can't 
continue down the road we are on. We can't continue to spend the money 
we are spending and borrowing, 43 cents of every dollar we spent this 
last year, borrowing it from our grandkids. It won't work. We will fail 
as a nation.
  Look at President Obama's recent trip to China. What was the message 
that emerged? They are worried about us financially. They are worried 
about our deficit spending. Why are they worried? Because they own 
close to $1 trillion worth of our debt. They now impact our foreign 
policy decisions only by the fact that they own so much of our debt.
  Can we continue to do this and have a free America? Can we continue 
to do this and our children have opportunity, at least to the level we 
have experienced? What are our veterans fighting for? Why did they put 
their bodies at risk, if it is not for a greater future for the 
country?
  When we think about this past year--and it will be worse next year, 
it will be 44, 45 cents borrowed of every dollar we spend--do we not 
have an obligation to our grandchildren as well as our veterans? This 
isn't even a hard vote. Our entire contribution to the United Nations 
is wasted in the fraud of the peacekeeping we contribute to. We 
contribute 25 percent of the United Nations money, and we have reports 
and studies and leaked documents that show the vast majority of the 
money we put in the United Nations gets defrauded from the United 
Nations.
  We are going to get to make a choice with this amendment. We will say 
we will treat all veterans the same, No. 1, and we are actually going 
to pay for it by saying it is a greater priority to take care of our 
veterans than to fund a corrupt, fraudulent peacekeeping force as run 
through the United Nations. That is what we are going to say.
  If this amendment passes, it will send a wonderful signal to the 
United Nations to clean up their act. It will send a wonderful message 
to our children and grandchildren that we will finally start acting 
responsibly, and it will send a great message to veterans that we do 
care and we care enough to make sure the sacrifice they made will not 
be squandered by us not making hard choices.
  We owe a lot to our veterans. The No. 1 thing we owe them is to make 
sure what they fought for and the future we have is secure in our 
children and grandchildren's generation. It is not secure today, based 
on the fiscal situation we find ourselves in.
  I reserve the remainder of my time.
  The PRESIDING OFFICER (Mrs. Murray). The Senator from Hawaii.
  Mr. AKAKA. Madam President, I yield 5 minutes to the Senator from 
Alaska, Mr. Begich.
  The PRESIDING OFFICER. The Senator from Alaska.
  Mr. BEGICH. Madam President, I rise in support of S. 1963, the 
Caregivers and Veterans Omnibus Health Services Act of 2009. I am 
pleased we are now considering this bill. S. 1963 is comprehensive 
legislation that addresses many of the needs of our veterans and our 
Nation's heroes. The bill before us is a compilation of two earlier 
bills introduced by Chairman Akaka to improve veterans health care and 
provide much needed benefits to their caregivers. I thank the chairman 
of the Veterans' Affairs Committee for his leadership on this bill and 
in committee. He understands the importance of providing the Department 
of Veterans Affairs the necessary tools and policies to serve the needs 
of veterans.
  This legislation ensures that wounded warriors returning from Iraq 
and Afghanistan can receive care in their home by providing caregivers 
the necessary benefits to stay at home and care for them full time. 
This is especially important in rural States such as my State of Alaska 
where obtaining a caregiver from remote areas is extremely challenging. 
In those areas, families take care of their injured servicemembers. To 
further help rural veterans, this bill will allow servicemembers who 
are severely disabled or require emergency care to seek medical 
attention at non-VA facilities without being billed. For a veteran in 
one of the many remote villages of Alaska, this is especially 
important, for they already face many economic challenges.
  The bill takes other steps to alleviate shortfalls in rural veterans 
health care. Telemedicine progam expansion, authority to collaborate 
with Indian Health Services and community organizations are just some 
of the additional efforts taken.
  In addition to providing for caregivers and improving health care for

[[Page S11527]]

rural veterans, S. 1963 will finally require the Department of Veterans 
Affairs to identify and take action on shortfalls in health care for 
women veterans, mental health care, and outreach to homeless veterans.
  Thirteen veteran organizations support S. 1963 as introduced by 
Chairman Akaka. Unfortunately, one of my Senate colleagues disagrees 
with me and my other Senate colleagues and the 13 veteran organizations 
about this initiative and this bill and whom they serve. My Senate 
colleague has offered an amendment that almost doubles the cost. 
Although he claims the bill is discriminatory against veterans from 
previous wars, the expansion of rural, women's health, mental health, 
and homeless initiatives are not limited to any particular group of 
veterans. Additionally, my colleague's amendment offsets the cost of 
the bill by requiring the Department of State to transfer money to the 
Department of Veterans Affairs from the United Nations.
  Sitting here for a few minutes listening to my colleague, I have to 
say a couple comments that are not written here. First, my colleague, 
who voted for the war supplementals that had no funding at all other 
than to make the cost there and no offset to them, sent people to war. 
When you do that, you have to also remember the costs associated over 
the long term. I wasn't here during those votes. I wasn't here when $1 
trillion went to the richest of the rich for tax breaks that had not 
one dime of offset. I am paying for that. My son is paying for that. So 
it is interesting to hear this debate now.
  We have to think long term. We have to think when we go to war, there 
are costs. If we don't fund them on the front end, we have to deal with 
them on the back end. That is what we are doing now.
  I think his amendment is worthy to a certain degree, but I disagree 
with the funding source. Listening for the last 2 minutes as a new 
Member surprises me. My Senate colleague is forcing us to make an 
inappropriate choice with this amendment that will cost us more in the 
long run. He is asking us to choose between providing for veterans and 
maintaining America's essential role in the world. His amendment pays 
for this bill by breaking U.S. international obligations. If his 
amendment passes, it would threaten ongoing peace operations in Haiti, 
Sudan, and Lebanon.

  By breaking our international promises, we undermine our national 
security by opening opportunities for instability, conflict, and 
strife. If there is instability, conflict, and strife, then it means 
more troops will have to serve and more come home wounded. Then we will 
have to pass another bill to pay for those troops and their care when 
they return.
  U.N. peacekeeping operations are eight times less expensive than U.S. 
forces, according to a GAO study in 2006. If my Senate colleague were 
truly concerned about costs, he would not have chosen, as I mentioned, 
to cut accounts, which undermines our national security and breaks 
international obligations. His amendment just does not make sense. It 
is fiscally and politically irresponsible. I urge him to withdraw this 
amendment and to remember he has voted for billions of dollars in 
funding that was not offset for these wars. Funding the wars is just as 
important as fulfilling our promises to our veterans when they return.
  So many issues facing our veterans today are addressed in S. 1963. 
Passage of this legislation and its enactment into law will improve and 
increase services for our veterans and acknowledge the sacrifice of 
their caregivers.
  I urge my colleagues to vote no on the amendment and support passage 
of S. 1963 as it has been introduced.
  Again, I thank the chairman, Senator Akaka, for his unwavering 
support and advocacy for our veterans.
  Madam President, I yield the floor.
  The PRESIDING OFFICER. Who yields time?
  Mr. AKAKA. Madam President, I yield 3 minutes to the Senator from 
Montana, Mr. Tester.
  The PRESIDING OFFICER. The Senator from Montana is recognized.
  Mr. TESTER. Thank you, Madam President, and I thank Chairman Akaka.
  Madam President, I rise this morning to urge the Senate to pass the 
Caregivers and Veterans Omnibus Health Services Act of 2009. Chairman 
Akaka has done a great job of explaining the particulars of this bill. 
I thank him and Senator Burr for their leadership in our committee.
  I could also echo Senator Akaka in explaining the reasons to vote for 
better health care for this county's veterans. But, instead, I am going 
to boil it down to one reason. Madam President, we promised it--we 
promised it--to all the men and women who served in our military. We 
promised it, just as we promised our troops the resources they need 
when they are in battle. This is not a vote about politics or 
partisanship; it is about living up to the pledge we made to all our 
veterans.
  Montana is a rural State, which means that all 100,000 veterans there 
are rural veterans. Many of them live in frontier communities. Sadly, 
that means they have a tougher time getting the health care they have 
earned. Many of them still have to pay out-of-pocket travel expenses to 
get to a VA hospital for their health care. According to some studies, 
veterans who live in rural America do not live as long as veterans who 
live in urban places. That is not only sad, it is disgraceful, and it 
is unacceptable.
  This bill contains provisions I included with the help of rural 
veterans and veterans service organizations in Montana. A vote for this 
bill is a vote to give veterans in rural America and frontier 
communities better access to health care. A vote for this bill will 
lock in an acceptable VA mileage reimbursement rate for disabled 
veterans who have long distances to travel to get to a VA hospital. A 
vote for this bill will authorize the VA to award grants to veterans 
service organizations that drive veterans to their medical 
appointments. In a place such as Montana, we would be in pretty tough 
shape without the dozens of volunteers who make that sort of thing 
happen. A vote for this bill will also improve health care in Indian 
country, and it will improve mental health care for rural veterans.
  Last week, over Veterans Day, I had the honor of attending events 
across Montana. I had the opportunity to say thank you to our veterans, 
as we should do every day. A lot of veterans to whom I spoke last week 
made it clear--made it clear to me--we still have a lot of work to do 
to live up to the promises we have made to our fighting men and women.
  This legislation is not the be-all and end-all, but it is a big step 
forward that is the result of putting politics aside and working 
together to do right by all of the men and women who have served our 
country.
  Passing this legislation is living up to a promise. It is common 
sense. That is why I urge my colleagues to support it.
  With that, Madam President, I yield the floor.
  The PRESIDING OFFICER. Who yields time?
  The Senator from Oklahoma.
  Mr. COBURN. Madam President, may I inquire how much time I have 
remaining?
  The PRESIDING OFFICER. The Senator from Oklahoma controls 112 
minutes.
  Mr. COBURN. Thank you, Madam President.
  I want to go back to the start of this again. The American people 
need to know what a hold is. What is a hold? A hold says that a bill is 
trying to go through the Senate without debate, without discussion, 
that by unanimous consent everybody agrees we ought to pass a bill the 
way it is. Unfortunately, 70 percent of the bills that go through the 
Senate pass that way. The American people get to hear no debate, get to 
have no knowledge about what is in the bill, whether there is 
controversy about what is in it. As a matter of fact, they do not know 
that the bill on the floor is actually different from the bill that 
passed out of committee. It has been modified, not with the vote of the 
committee but with the direction of the chairman only.
  So the purpose of our holds is either you are against the bill--and I 
have no secret holds. Everybody here knows that. When I hold a bill, 
everybody knows the bills I hold, and I give a reason for why I hold 
them. I do not hold them sheepishly. The purpose for a hold is to 
develop debate, to have the very discussion we are having on the floor.
  This bill was filed October 28. It was brought to the floor the week 
before

[[Page S11528]]

last without the ability to amend it, debate it, or discuss it. So the 
reason we are here today is so we can do just that.
  I have stated numerous times--I have stated it to the chairman of the 
committee and the ranking member of the committee and others--I do not 
oppose--as a matter of fact, I am for providing for our veterans. What 
I am opposed to is us sinking our grandchildren in debt.
  The Senator from Alaska makes the claim or insinuates that I was here 
when the tax cuts came through. I was not. I believe when you do tax 
cuts you match them with spending cuts.
  There is $350 billion a year in waste, fraud, and abuse that goes 
through this government every year. Not one amendment out of over 600 
that have been offered has been agreed to by this body to eliminate 
some of that waste--not one.
  Everybody who has spoken against this amendment or for this bill, 
with the exception of Senator Burr, has a 100-percent voting record for 
spending money. Not once do they vote against any spending bills, not 
once since I have been in the Senate--5 years. Not one of those who are 
opposed to paying for this has said: I see something wrong with this 
spending bill. It is not a priority. We ought to cut it. Therefore, I 
am not going to vote for it.
  I have had criticism because the first year I was here I actually 
voted for a war supplemental. But at that time, we had a deficit of 
$110 billion, not $1.4 trillion. At that time, we had an economy that 
was growing, not an economy on its back. At that time, we had not 
totally mortgaged our children's future.
  It is time for all of us to change. It is time for all of us to make 
the same decisions everybody outside of Washington has to make every 
day, which means you have to make a choice. You get to make a choice on 
what is a priority and what is not. For, you see, our body, the 
supposed most deliberative body in the world, has a bias. The bias is 
this: Offend no one. Offend no one. How do you do that? How do you 
offend no one? You offend no one by taking the government credit card 
out of your pocket and putting it into the machine and saying: We do 
not have to make those hard choices. We are not going to offend anybody 
by cutting programs. We are not going to offend anybody with the $50 
billion a year of waste at the Pentagon. The fact is, 2 years ago the 
Pentagon paid out performance bonuses of over $6 billion to companies 
that did not meet the performance requirements.

  Sadly, not one American, not the Federal Government, got any of that 
money back. None of it came back because the other side of the story 
is, we fail to do oversight. We fail to do the hard work that does not 
give you a headline. That is very hard work to hold the executive 
branch and agencies accountable. So our veterans do sacrifice.
  I am for the Caregivers Act. I am for us doing all these things. But 
I am only for them if, in fact, we will start making the same hard 
choices our veterans make, the same hard choices everybody else in this 
country makes when it comes to making a decision about the future.
  You see, a lot of people in our country today are underwater on their 
mortgages. They are underwater on their mortgages. Guess who else is. 
We are as a nation. We are underwater. Let me show with this chart, for 
example, what the financial situation is with our country.
  Medicare is broke. Part A will run out of money in 2017. We have 50 
million baby boomers--I am one of them--who are going into Medicare in 
the next 8 to 10 years. So not only is the cost per Medicare patient 
going to go up, but we are going to add 50 million to it. It is broke.
  Medicaid. It is broke. It comes out of your general tax revenue. But 
the States are broke over their share of Medicaid.
  The census. It is broke. It is going to cost 2\1/2\ times what the 
last one did. It is total mismanagement by the Federal Government.
  Fanny Mae and Freddie Mac--broke to the tune of $200 billion of your 
money, each one of them; $400 billion that your kids get to pay back, 
your grandkids. They do not get the opportunities because they are both 
broke. We have done such a wonderful job.
  Social Security. It is the easiest to fix, but it is essentially 
broke because we have stolen $2.6 trillion from it. And then we are not 
being honest with the American public about what our true deficit is 
because when I said a minute ago that our deficit was $1.43 trillion, 
that is not true. That is Enron accounting. That is Washington 
accounting. The real deficit is well over $1.5 trillion because we 
stole more money from Social Security. Guess what. Next year, for the 
first time in the history of Social Security, more money will be paid 
out than will be paid in. For the first time, it runs in the red next 
year. We owe money, so technically it is not broke yet--until some of 
that $2-plus trillion goes back into it--but it is essentially broke.
  How about the post office? They just announced their loss for this 
year. They are going to have a bigger loss next year. It is broke.
  Cash for clunkers. That was broke when it started.
  The highway trust fund. It is broke. We do not have enough money for 
what we are obligated to pay out. It is broke.
  Now we are talking about government-run health care? A $2.5 trillion 
program? That is what the real number is on it when you get the Enron 
accounting out of the bill that Senator Reid introduced last night--
$2.5 trillion.
  And now we are saying we do not have the courage to pay to take care 
of our veterans. I do not think the American people are going to 
tolerate this much longer, nor do I think they should tolerate it--that 
we will continue to steal the opportunity and future of our children.
  I think the Senator from Alaska can be forgiven for not knowing all 
the abuse, fraud, and waste in the U.N. because in every country he 
mentioned, U.N. peacekeepers have been accused of rape and pillaging 
the very people they were supposed to have been protecting. In every 
country he mentioned, U.N. peacekeepers we paid for are raping the very 
citizens they are supposed to be protecting. Yet we do not have the 
courage to say: Time out. We are not sending you any more money until 
you clean up the mess. No, we are not going to do that. We are not 
about to do that. What we are going to do is we are going to say we 
will take the money for the veterans from our grandchildren and we will 
not make the hard choice. I think it would be a wonderful message to 
send to the United Nations that maybe they ought to start being 
transparent about where the money goes. Do you realize nobody can know 
where the money goes? You don't get to know. I, as a Senator, don't get 
to know. The President pro tempore doesn't get to know where the money 
goes. Yet your country puts $5 billion a year into that and you have no 
idea. The only way we find out is occasional leaks.

  By the way, of all those U.N. peacekeepers who have raped and 
pillaged, not one of them has been convicted. Not one of the agencies, 
in terms of their eight programs that have been incompetent and wasted 
money, have been convicted. They are immune to conviction. The waste, 
fraud, and abuse of this country is only exceeded by one organization, 
and that is the United Nations. Yet we don't have the courage because 
the State Department is against this amendment, and they sent a letter 
outlining why they are against it. I am going to put into the Record 
why they are wrong. I ask unanimous consent that at the end of these 
remarks, my rebuttal statement in response be printed in the Record.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  (See exhibit 1.)
  Mr. COBURN. The State Department Bureau of Legislative Affairs 
opposes this amendment. It lists a number of programs as reasons to 
support the U.N. and oppose the Coburn amendment. Many of the programs 
and activities the State Department listed have experienced severe 
problems in execution or are taking credit for activities by national 
governments or private entities.
  Let's take the recent elections in Afghanistan. The United Nations 
cannot account for tens of millions of dollars provided to the Afghan 
election commission, according to two U.N. audits--these are 
confidential; they weren't released; we just happened to be fortunate 
enough to have people who would give them to us--and interviews with

[[Page S11529]]

current and former senior diplomats. The Afghan election commission, 
with over $20 million in U.N. funding and hundreds of millions of 
dollars in U.S. funding, facilitated and helped mass election fraud and 
operated ghost polling places.
  Should we keep sending them money for incompetence, waste, and fraud?
  ``Everybody kept sending money'' to the elections commission, said 
Peter Galbraith, the former deputy chief of the U.N. mission in 
Afghanistan.

       Nobody put the brakes on. U.S. taxpayers spent hundreds of 
     millions of dollars on a fraudulent election.

  This is a deputy to the senior U.N. official in Afghanistan. He was 
fired last month. He protested the fraud and he got fired by the U.N., 
that wonderfully competent organization.
  As of April 2009, the U.N. had spent $72.4 million supporting the 
electoral commission, with $56.7 million of that money coming from the 
U.S. Agency for International Development. The Special Inspector 
General for Afghanistan Reconstruction states that the United States 
provided at least $263 million in funding for that election.
  In one instance, the United Nations Development Programme paid $6.8 
million for transportation costs in areas where no U.N. officials were 
present. We paid transportation costs, but no U.N. officials were 
present. Why did we pay it? Where did that money go? Where is the 
money?
  Overall, the audits found that U.N. monitoring of U.S. taxpayer funds 
was ``seriously inadequate.''
  In other words, it is there, they send it out, they don't have any 
idea, but you can bet well-connected people at the U.N. are making 
millions off U.S. dollars.
  How about the monitoring of nuclear programs in North Korea and Iran? 
In 2002, the North Korean Government used United Nations Development 
Programme money--UNDP money or aid--to purchase--this is aid for them 
for development from the U.N.--they purchased conventional arms and 
ballistic missiles. With money we gave the U.N., the U.N. turns around, 
gives it to North Korea, and they buy missiles and arms. There is a 
real problem at the U.N. We will not face up to it.
  It also transferred millions of dollars in cash to the Government of 
North Korea, with no oversight on how the money was spent--no 
oversight, just handed them millions of dollars in cash.
  In September 2009, North Korea announced to the United Nations 
Security Council that it was almost complete in weaponizing nuclear 
materials from its nuclear reactor. Last week, North Korea announced 
the processing was complete.
  We helped finance it through the United Nations. We helped finance it 
through the United Nations.
  As of this morning, Iran had rejected the U.N. offer to send enriched 
uranium out of the country to prevent it from developing nuclear 
weapons.
  We don't know how much U.N. money has gone in there yet, but I 
promise I will try to find out. But I can guarantee that millions of 
our dollars have been wasted that could pay for our veterans or we can 
borrow it from our children.
  U.N. contribution: Funding 17 U.N. peacekeeping operations, including 
those in Haiti, Liberia, Lebanon, Darfur, and the Democratic Republic 
of Congo.
  U.N. peacekeeping operations are plagued by rape and sexual 
exploitation of refugees. From 1994 forward, 68 separate instances of 
rape, prostitution, and pedophilia--68 separate times--and we pay half 
the U.N. peacekeeping costs. We don't manage the money; the U.N. 
manages the money.
  What would happen if U.S. troops were doing that? Yet we have no 
control.
  In 2006, reported BBC News: Peacekeepers in Haiti and Liberia were 
involved in exploitation of refugees. You can read that in the BBC News 
of November 30, 2006, if you want to look it up.
  In 2007, leaked reports indicate the U.N. has caught 200 peacekeepers 
for sex offenses in the past 3 years, ranging from rape to assault on 
minors. Not one of them has been prosecuted, not one.
  Just this month, Human Rights Watch reported that Congolese Armed 
Forces, supported by U.N. peacekeepers in the eastern Democratic 
Republic of Congo, have brutally killed hundreds of civilians and 
committed widespread rape in the past 3 months in a military operation 
backed by the United Nations. That is this month. Yet we continue to 
send billions of dollars every year to the United Nations.
  Mr. DURBIN. Madam President, will the Senator from Oklahoma yield for 
a procedural question?
  Mr. COBURN. I will be happy to yield for a procedural question.
  Mr. DURBIN. I am interested in speaking on behalf of the bill, and I 
know the Senator has time allocated under the unanimous consent 
request. I wish to ask him at his convenience if he has a time when he 
would be able to yield to this side or is he going to speak and use all 
his time?
  Mr. COBURN. I do not plan on consuming all of it at this time. I have 
about 10 or 15 minutes more to go, and I will be happy--is the Senator 
wanting time?
  Mr. DURBIN. Could I ask unanimous consent that when the Senator 
breaks or prepares to yield the floor, at least temporarily, that I be 
recognized next?
  Mr. COBURN. I have no objection to that.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. DURBIN. I thank the Senator.
  Mr. COBURN. Going back to the Congolese, most of the victims were 
women, children, and the elderly. Some were decapitated. Remember, 
these are U.N. peacekeeping forces--peacekeeping. Others were chopped 
to death by machete, beaten to death with clubs as they tried to flee.
  They may not have been actual U.N. officers, but the U.N. was 
supplying all the logistics, all the transportation for this group of 
people. Where is the oversight?
  U.N. contribution: Compiling forecasts of global agriculture 
production and identifying areas of likely famine and the risk of 
severe hunger, to facilitate food assistance. We make a contribution to 
the U.N. The Food and Agriculture Organization is currently hosting a 
U.N. conference, a food summit in Rome, where the opening speaker is 
Zimbabwe President Robert Mugabe who has literally destroyed his 
Nation, which used to be the bread basket of Africa and which is now 
dependent on food imports. We are helping to pay for President Mugabe--
who can't travel hardly anywhere else in the world because he is such a 
rogue dictator--we are sponsoring, through our dollars, meetings where 
he is the headline speaker.

       The meeting was branded a failure within a couple of hours 
     of its start after the 192 participating countries 
     unanimously rebuffed the United Nations' appeal for 
     commitments of billions of dollars in yearly aid to develop 
     agriculture in poor nations.

  It is not because they don't care about people having problems with 
food; it is they recognize the U.N. is ineffective at doing that and 
they are not going to commit more money, but we continue to commit more 
money.
  The U.N. Environment Programme spends $1 billion a year--20 percent 
of it our money--on global warming and its effect on agriculture.
  The U.N. has coordinated efforts by the global shipping industry and 
governments to prevent and respond to acts of piracy on the high seas.
  It was totally ineffective. Do you know why we decreased the amount 
of piracy on the high seas? It is because of Task Force 51, which was 
formed by the U.S. Navy because the United Nations was totally 
ineffective in accomplishing that purpose.
  I could go on and on. But the fact is, the United Nations is not only 
morally bankrupt in its leadership and efficiency, it is filled with 
fraud, waste, and, as noted, tremendous acts of violence through the 
peacekeeping armies it sends throughout the world. Yet we are going to 
have people say we shouldn't take some of that money away. We are not 
taking all the money away with this amendment anyway; we are just 
taking a small portion to pay for our bill.
  We are going to have people actually vote to continue to do these 
things, instead of taking care of our veterans and not steal it from 
our children.
  I heard Senator Tester speak about the wonderful things in this bill 
to help people who drive to VA clinics and VA hospitals. There is a 
better idea. If a veteran is deserving of care, give him a card. Let 
them go wherever they want.

[[Page S11530]]

Why should they have to drive 160 miles, when they can get the care 
right down the street from somebody they trust and they know. But 
instead we say: We are going to promise you health care, but you can 
only get it here. Real freedom for our veterans--real health care for 
our veterans is to honor their commitment by saying: Here is your card, 
you served our Nation, go get your health care wherever you want. If 
you want to get it next door or if you want to go to the M.D. Anderson 
or Mayo Clinic, you can. You can go wherever you want because we are 
going to honor your commitment.
  I recognize our VA hospitals have done a magnificent job in improving 
their care, but I will tell you the test for the VA hospital system is 
this: Go ask any doctor coming out of training who experienced part of 
their time in a VA hospital and ask them to choose for their family: Do 
you want your family treated at a VA hospital or somewhere else where 
you trained? Nary a one will pick a VA hospital because the care isn't 
as good. It is better, and it is getting better all the time, but it is 
not as good. So we are saying to veterans: Here is where you have to 
go, when what we should say is: Thank you for your service. Here is 
what we owe you. Go get care wherever you want to get it or wherever 
you think you can get the best treatment.
  On prosthetics, the VA is the best in the world. Nobody compares. On 
post-traumatic stress disorder, they are the best in the world. Nobody 
can compare. They are underfunded in those areas. This bill is right on 
that. But the real commitment is to give the choice. The veteran fought 
for freedom. Give them the choice, the freedom to choose what they want 
for them.
  Why is it important we change how the Senate operates in terms of 
making hard decisions? The reason it is important is there are millions 
of these little girls out there. I have five of them, five grandkids 
just like her. She has a little sign around her neck. She says: ``I am 
already $38,375 in debt and I only own a dollhouse.'' Of course, when 
you divide up the $12 trillion which we passed this week in directly 
owned debt; it doesn't count the billions--I mean the trillions--we 
have borrowed from Social Security and the other trust funds, such as 
the waterway trust fund and all these other organizations we have 
stolen from, it doesn't include that. But that is for every man, woman, 
and child in this country. It is over $30,000 now, this year. I think 
when you look at her, you have to say, certainly, we ought to be making 
some changes. By the way, between now and 2019, that number goes to 
over $96,000 per man, woman, and child. But she is a child. This 
doesn't apply to veterans, but it applies to almost everything else we 
are doing.

  This is what Thomas Jefferson said:

       The democracy will cease to exist when you take away from 
     those who are willing to work to give to those who would not.

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

                               Exhibit 1

  Rebuttal of State Department Talking Points on Coburn Amendment 2785

       The State Department Bureau of Legislative Affairs opposes 
     the Coburn amendment to S. 1963, the Caregivers and Veterans 
     Omnibus Health Services Act of 2009 (S. 1963). In its formal 
     opposition, it lists a number of programs as reasons to 
     support the U.N. and oppose the Coburn amendment.
       Many of the programs and activities that the State 
     Department listed have experienced severe problems in 
     execution or are taking credit for activities by national 
     governments or private entities. (Their document is after the 
     rebuttal).
       Below is a list of those ``accomplishments'' and facts that 
     should be considered.
       U.N. Contribution: Facilitating and holding elections in 
     Afghanistan and Iraq (U.N. Secretariat).
       Response: The United Nations cannot account for tens of 
     millions of dollars provided to the troubled Afghan election 
     commission, according to two confidential U.N. audits and 
     interviews with current and former senior diplomats.
       The Afghan election commission, with tens of millions in 
     U.N. funding and hundreds of millions in U.S. funding, 
     facilitated mass election fraud and operated ghost polling 
     places.
       ``Everybody kept sending money'' to the elections 
     commission, said Peter Galbraith, the former deputy chief of 
     the U.N. mission in Afghanistan. ``Nobody put the brakes on. 
     U.S. taxpayers spent hundreds of millions of dollars on a 
     fraudulent election.'' Galbraith, a deputy to the senior U.N. 
     official in Afghanistan, was fired last month after 
     protesting fraud in the elections.
       As of April 2009, the U.N. spent $72.4 million supporting 
     the electoral commission with $56.7 million coming from the 
     U.S. Agency for International Development. The Special 
     Inspector General for Afghanistan Reconstruction states that 
     the United States provided at least $263 million in funding 
     for the election.
       In one instance, the United Nations Development Program 
     paid $6.8 million for transportation costs in areas where no 
     U.N. officials were present. Overall the audits found that 
     U.N. monitoring of U.S. taxpayer funds was ``seriously 
     inadequate.''
       U.N. Contribution: Monitoring nuclear programs in North 
     Korea and Iran.
       Response: In 2002, the North Korean government used United 
     Nations Development Program, UNDP, aid to purchase 
     conventional arms, ballistic missiles. It also transferred 
     millions of dollars in cash to the government of North Korea 
     with no oversight of how the money was spent.
       In September 2009, North Korea announced to the United 
     Nations Security Council that it was almost complete in 
     ``weaponizing'' nuclear materials from its nuclear reactor. 
     Last week, North Korea announced the processing was complete.
       As of this morning, Iran had rejected the U.N. offer to 
     send enriched uranium out of the country to prevent it from 
     developing nuclear weapons.
       U.N. Contribution: Funding 17 U.N. Peacekeeping Operations, 
     including those in Haiti, Liberia, Lebanon, Darfur and the 
     Democratic Republic of Congo.
       Response: U.N. Peacekeeping operations plagued by rape and 
     sexual exploitation of refugees--In 1994, a draft U.N. report 
     was leaked detailing how peacekeepers in Morocco, Pakistan, 
     Uruguay, Tunis, South Africa and Nepal were involved in 68 
     cases of rape, prostitution and pedophilia. The report also 
     stated that the investigation into these cases is being 
     undermined by bribery and witness intimidation by U.N. 
     personnel.
       In 2006, it was reported that peacekeepers in Haiti and 
     Liberia were involved in sexual exploitation of refugees.
       In 2007, leaked reports indicate the U.N. has caught 200 
     peacekeepers for sex offenses in the past three years ranging 
     from rape to assault on minors. In all of these cases, there 
     is no known evidence of an offending U.N. peacekeeper being 
     prosecuted.
       Just this month, Human Rights Watch reported that Congolese 
     armed forces, supported by U.N. peacekeepers in the eastern 
     Democratic Republic of Congo have brutally killed hundreds of 
     civilians and committed widespread rape in the past three 
     months in a military operation backed by the United Nations.
       Most of the victims were women, children, and the elderly. 
     Some were decapitated. Others were chopped to death by 
     machete, beaten to death with clubs, or shot as they tried to 
     flee.
       The U.N. peacekeeping mission provides substantial 
     operational and logistics support to the soldiers, including 
     military firepower, transport, rations, and fuel.
       The attacking Congolese soldiers made no distinction 
     between combatants and civilians, shooting many at close 
     range or chopping their victims to death with machetes. In 
     one of the hamlets, Katanda, Congolese army soldiers 
     decapitated four young men, cut off their arms, and then 
     threw their heads and limbs 20 meters away from their bodies. 
     The soldiers then raped 16 women and girls, including a 12-
     year-old girl, later killing four of them.
       The U.S. now pays 27 percent of all U.N. peacekeeping 
     operations. Reducing our contribution to these wasteful 
     efforts could help ensure that U.N. peacekeepers are not 
     funding widespread rape and exploitation of refugees.
       U.N. Contribution: Compiling forecasts of global 
     agricultural production, identifying areas of likely famine 
     and risk of severe hunger, to facilitate emergency food 
     assistance (FAO).

[[Page S11531]]

       Response: The FAO (Food and Agriculture Organization) is 
     currently hosting a U.N. food summit in Rome, where the 
     opening speaker is Zimbabwe President Robert Mugabe. Mugabe 
     is barred from travel to most Western countries because of 
     his atrocious human rights record, but receives an exception 
     for U.N. sponsored events. No G-8 leader attended the event 
     save the Prime Minister of Italy, the host nation.
       ``The meeting was branded a failure within a couple of 
     hours of its start after the 192 participating countries 
     unanimously rebuffed the United Nations' appeal for 
     commitments of billions of dollars in yearly aid to develop 
     agriculture in poor nations.''
       The U.N. Environment Program spends over $1 billion 
     annually on global warming initiatives (and weighs in on its 
     effect on agriculture) but there is almost no auditing or 
     oversight being conducted. The U.N. Environment program has 
     one auditor and one assistant to oversee its operations. 
     According to the task force it would take 17 years for the 
     auditor to oversee just the high-risk areas already 
     identified in UNEP's work.
       U.N. Contribution: Coordinating tsunami and earthquake 
     relief projects in Indonesia and Pakistan (U.N. Secretariat/
     OCHA).
       Response: The United States is the top contributor to the 
     Office for the Coordination of Humanitarian Affairs (OCHA) 
     for funding disasters after they occur. In addition to 
     billions in supplemental funding (above and beyond normal 
     U.N. contributions) the United States military expends 
     tremendous resources in money and personnel to be the first 
     response for disaster aid.
       U.N. Contribution: Coordinating efforts by global shipping 
     industry and governments to prevent and respond to acts of 
     piracy on the high seas (IMO).
       Response: The key deterrence factor in combating piracy in 
     Somalia is the creation of Task Force 151, which was formed 
     by the United States Navy.
       The United Nations has pushed the U.S. to ratify the United 
     Nations Convention on the Law of the Sea. However, the 
     convention has no way to address piracy issues coming from 
     failed states such as Somalia. Fighting piracy is being 
     conducted by individual states patrolling their own waters 
     and working with other nations to protect sea lanes that are 
     in their national interest.
       U.N. Contribution: Creating and maintaining systems to 
     protect the intellectual property rights of American 
     entrepreneurs (WIPO).
       Response: Until last year, the Director General of the 
     World Intellectual Property Organization, WIPO, was run by 
     Dr. Kamil Idris, who was appointed to that position in 1997. 
     According to an internal investigation, he falsified his U.N. 
     personnel file to drop nine years from his age--making it 
     possible to extend his time at WIPO and to extend his ability 
     to obtain a lucrative benefit package, including a possible 
     payout of more than $500,000. The scandal was first reported 
     in a leaked U.S. State Department cable authored by former 
     Secretary of State Rice. The cable also states that this 
     official is suspected of using U.N. funds for personal items 
     such as the construction of a swimming pool at his residence.
       WIPO has also been criticized for its working culture under 
     Dr. Idris's leadership, with a report by accounting firm 
     Price Waterhouse Coopers citing high levels of absenteeism, 
     incompetence and inadequate disciplinary measures.
       U.N. Contribution: Enabling the delivery of mail around the 
     world (UPU).
       Response: The Universal Postal Union, UPU, which 
     coordinates international postal policies among nations, was 
     created in 1874 (renamed in 1878). Its creation predates the 
     United Nations by 72 years.

                         United Nations Funding


 Caregivers and Veterans Omnibus Health Services Act of 2009 (S. 1963)

       Senate Amendment: Senate Amendment No. 2758 submitted by 
     Senator Coburn to S. 1963. To transfer funding for United 
     Nations contributions to offset costs of providing assistance 
     to family caregivers of disabled veterans.
       Department Position: Oppose amendment.
       Talking Points: U.N. assessed contributions fund a wide 
     range of U.N. activities that support high U.S. foreign 
     policy priorities. Some examples include:
       Facilitating and holding elections in Afghanistan and Iraq 
     (U.N. Secretariat);
       Monitoring nuclear programs in North Korea and Iran (IAEA);
       Funding 17 U.N. Peacekeeping Operations, including those in 
     Haiti, Liberia, Lebanon, Darfur and the Democratic Republic 
     of Congo;
       Compiling forecasts of global agricultural production, 
     identifying areas of likely famine and risk of severe hunger, 
     to facilitate emergency food assistance (FAO);
       Coordinating tsunami and earthquake relief projects in 
     Indonesia and Pakistan (U.N. Secretariat/OCHA);
       Detecting outbreaks of avian flu and H1N1 and other 
     infectious diseases and defending against a world pandemic 
     (WHO, FAO);
       Creating and maintaining systems to protect the 
     intellectual property rights of American entrepreneurs 
     (WIPO);
       Enabling the delivery of mail around the world (UPU);
       Coordinating international aviation safety standards 
     (ICAO);
       Coordinating global use of electronic communications 
     frequencies to ensure essential global telecommunications 
     function smoothly (ITU);
       Coordinating efforts by global shipping industry and 
     governments to prevent and respond to acts of piracy on the 
     high seas (IMO).
       Furthermore, the President has stated his commitment to 
     paying U.S. dues to international organizations in full.
       As Ambassador Rice has said, we meet our obligations. As we 
     call upon others to help reform and strengthen the U.N., the 
     United States must do its part--and pay its bills. Our dues 
     to the United Nations and other international organizations 
     are treaty obligations, and we are committed to working with 
     Congress to pay them in full.
       With the support of Congress, the U.S. has just cleared our 
     arrears which accumulated over the past decade. The full 
     payment of assessed contributions affects the standing and 
     influence that the U.S. has at these organizations.
       Going into arrears undermines U.S. credibility, 
     particularly on matters dealing with budget, finance, and 
     management of IOs, and negatively influences world opinion 
     regarding U.S. respect and appreciation for the role of 
     multilateral organizations that support and advance U.S. 
     foreign policy. Arrears also have a real impact on the 
     organizations, making it more difficult for these 
     organizations to manage cash flows and execute budgets, and 
     thus accomplish their missions.

  The PRESIDING OFFICER (Mr. Burris). The Senator from Illinois is 
recognized.
  Mr. DURBIN. Mr. President, I thank my friend and colleague from 
Oklahoma. Although we disagree on many things, we also agree on many 
things. We work together and will continue to do so.
  We have a difference of opinion on the matter before us. This bill, 
S. 1963, is the most important piece of veterans legislation this year 
for several reasons. I congratulate Chairman Akaka and Ranking Member 
Burr for bringing this matter to the Senate with a unanimous vote in 
committee, with both Democrats and Republicans supporting it, and for 
good reason.
  In addition to the provision that was part of an earlier bill I had 
introduced, there is dramatic change in the law to help women veterans. 
More and more returning veterans from Iraq and Afghanistan and around 
the world need special care. Unfortunately, the VA system wasn't 
providing that care as we believed it should. This bill takes care of 
that. It is the most dramatic expansion for women veterans and their 
health needs we have seen.
  The same is true for rural health care. I know that. The Presiding 
Officer is from downstate Illinois, as I am, and he knows the Marion VA 
Center is a critical part of the treatment of veterans in southern 
Illinois and the surrounding States. Literally thousands of hard-
working people there provide care for veterans, which they desperately 
need, close to their homes. This bill addresses the enhancement and 
improvement of rural care for veterans.
  The same is true for mental health issues. It is an excellent bill. 
The part of the bill that is near and dear to me relates to caregivers 
assistance. It relates to the fact that many veterans who come home are 
not in institutional settings, not in a hospital, not in a convalescent 
center; they are home. But they survive every day because of the loving 
care of a member of their family--a wife, a husband, a mother, a 
father, a sister, or a brother--who gets up every morning and worries 
about that veteran and makes sure that veteran receives the medical 
care needed to survive another day. They are in the setting of their 
home where they feel secure and happy.
  Great sacrifice takes place. I cannot tell you exactly how many of 
these caregivers there may be. Estimates range as high as 6,000 or 
8,000. I have met some of them, and I know them personally. I have 
heard their stories. They are heroic--just as heroic as the veteran who 
needs their care. They are literally giving their lives to keep that 
veteran alive, healthy and happy, at great personal sacrifice. Many 
times they cannot go to work. Many times they give up a business 
because they want to stay home with that husband they love.
  A young woman came into my office the other day who is moving from 
North Carolina back to the Chicagoland area after more than 5\1/2\ 
years. She has been the caregiver for her husband who was the victim of 
a traumatic brain injury in Iraq. For this young woman, who is in her 
thirties, it is an amazing show of love and sacrifice on her part.
  We have also spoken of the family in North Carolina we know very 
well--the

[[Page S11532]]

family of Eric Edmundson, a young soldier who was the victim of a 
traumatic brain injury. He is alive today--I can say this without 
contradiction--because his dad quit his job, sold his business, and 
cashed in the value of his home. With his wife, they moved in to take 
care of their son and little granddaughter. That is the most loving 
family I can remember seeing, and they are doing it for the son they 
love, but they are doing it, as well, for a veteran who served our 
country.
  The purpose of this bill is to give these caregivers a helping hand 
and the medical training they need so they can do what is necessary to 
keep that veteran alive and as well as possible, improving if possible. 
It is also to give them a respite maybe for a week or two each year so 
they can go on vacation and have a visiting nurse or someone who will 
come and provide assistance. They need that with the stress and burden 
they are carrying. That needs to be lifted--at least temporarily--so 
they can recharge their battery and come home and be dedicated once 
again.
  In the discretion of the Veterans' Administration, it can give a 
monthly stipend or health care as well. The first thing the Edmundson 
family found when they sold the business was that they couldn't afford 
to buy health insurance. Mom and dad are taking care of their son under 
the care of the Veterans' Administration, and they have no health 
insurance.
  We are trying to find a way to provide health insurance for these 
caregivers. In my mind, it is simply fair and right that we would do 
this. That is why I thank Senator Akaka and Senator Burr for including 
it in this bill.
  I also want to address the issue before us, the pending amendment by 
the Senator from Oklahoma. The Senator from Oklahoma has come to the 
Senate floor several times and expressed his opposition to this bill, 
primarily for budgetary reasons. I understand that. But I say to him I 
was worried this day would come. I was worried the day would come when 
the war, which we paid for by borrowing money, would generate victims 
and veterans who needed care, and when it came time to give them the 
care many of the people who voted to fund the war by going into debt 
would say: But we can't help the veterans unless we pay for it.
  In my mind, it is all the same. If we vote to go to war, we vote to 
accept the consequences of war. That means an obligation that we have 
to these veterans. It is a solemn promise we gave them. We said to 
these men and women if they would hold up their hand, take an oath to 
defend the United States and risk their lives, we would stand by them 
when they come home. If they are injured, we will be there. If their 
family is disadvantaged, we will do our best to help them too. I think 
that is part of our solemn obligation to these veterans.
  Now the question is raised as to whether we can afford to do that, 
unless we come up with a sum of money to pay for it at this moment. I 
say to the Senator from Oklahoma, and those who take his position, if 
we paid for this war to start with by borrowing money, how can we turn 
our backs on the veterans and caregivers who keep them alive arguing 
that it is simple budgetary justice? It is just not. It doesn't track. 
I don't believe those two approaches are acceptable.
  Also, the Senator from Oklahoma does two things in this amendment I 
wish we could do--one I wish we could do. I have talked to him about it 
on the Senate floor--and that is to expand coverage for caregivers of 
those who served before 9/11. I would like to do that. Currently, we 
believe there are about 2,000 caregivers who would qualify for this 
caregiver amendment, this demonstration project. If we expand it to all 
veterans caregivers, the number rises to over 52,000. It is a just 
thing to do. It is something we may ultimately do. But, clearly, if we 
are going to make that commitment, it is a dramatically larger 
commitment than this demonstration project, this bill for those who 
suffered serious injuries since 9/11. To increase the scope of it from 
2,000 caregivers to 52,000 caregivers is to increase the cost of it 
dramatically. That is something we have to measure and decide at some 
point--whether we want to do that.
  I will work with the Senator from Oklahoma to expand that. I think 
all veterans' caregivers deserve this. I hope we can prove with this 
approach that it is a reasonable thing to do--that keeping these 
veterans home where they want to be, in a safe, happy surrounding, is 
not only right but it is cheaper than institutionalization.
  The second part of Senator Coburn's amendment related to this 
provision says the money would be available for caregivers if the 
veteran would otherwise be institutionalized. I think that may be 
drawing a line that is too harsh. I think there are those who need the 
help of a caregiver but may not technically need to be 
institutionalized. I think those who are suffering from post-traumatic 
stress disorder, a traumatic brain injury with seizures--to say they 
need to be institutionalized may be overstating. To say they need the 
help of a caregiver and then move forward to treatment, I understand 
that may happen. On the one hand, I think the Senator from Oklahoma 
expanded this bill from 2,000 to 52,000. On the other hand, he draws a 
line on institutionalization that may go too far. I think what we ought 
to do in this demonstration project is give the VA the authority to 
measure this and see what is appropriate. I think there are so many 
individual cases that, when we generalize like this, it is a mistake.
  The Senator from Oklahoma believes the money to pay for this should 
come from the money set up for international peacekeeping through the 
U.N. I will not stand here in defense of every decision made by the 
U.N. It is hard to do that. We make mistakes in the United States, and 
the U.N. does too. They have been caught and so have we. I want to make 
sure money is not wasted. We should be vigilant, whether it is money 
being spent by our government or agencies we support. I worry that the 
proposal before us by Senator Coburn is going to cut back on 
international peacekeeping in areas of the world where I think it is 
critical.
  I visited the Democratic Republic of Congo 2 years ago with Senator 
Brownback of Kansas. But for the U.N. peacekeeping forces there, the 
massacres of innocent people would go unchecked.
  This has been going on for over a decade. During this period of time, 
innocent men, women, and children have been literally hacked to death 
and killed. The international peacekeepers make a difference there. 
They make a difference in Haiti where I visited twice and have seen 
firsthand the degraded poverty in our own hemisphere and, 
unfortunately, the fact they are on the verge of violence almost every 
moment.
  I also think it is a mistake for us to cut back on those 
international agencies that monitor the spread of nuclear weapons. If 
we want to keep an eye on Iran and make sure they don't develop nuclear 
weapons to threaten their neighbors in the Middle East and the rest of 
the world, we need this international force to come in and do its 
inspection work. They are the only credible third parties that can come 
in and decide whether the Iranians have gone too far. Their judgment 
through the United Nations is one that is credible to other nations. To 
cut back in their efforts at monitoring the spread of nuclear weapons 
is, in my mind, shortsighted and invites instability in a world that is 
already too dangerous.
  I urge my colleagues to defeat the Coburn amendment. I say to my 
friend from Oklahoma, at the end of the day, after we start this 
program, if the Veterans Administration can find the resources through 
the appropriations to move it forward, I am open to working with him to 
expand it to caregivers from previous generations of veterans and to 
see if there is a way to make sure it is spent exactly where it is 
needed and as we have described it.
  That is the nature of this work. We are not perfect in what we do, 
but we start with good intentions and hard work and try to put the 
language together. But at this moment, I say to the Senator from 
Oklahoma, first, I am glad he no longer put a hold on this bill. It is 
an important bill. I am glad he has had his chance to offer his 
amendment. I urge my colleagues to defeat it, but I say it in good 
faith to my friend from Oklahoma.
  I will work with him if this bill, in fact, is enacted into law and 
implemented to make sure it meets the goals we both share--fairness to 
all veterans and providing care to those who need

[[Page S11533]]

it. This is a good start, but let us promise to work together, if it is 
enacted, to make sure we continue in that vein.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Oklahoma.
  Mr. COBURN. Mr. President, the majority whip is a formidable orator 
and he is appreciated in lots of ways. We work together on 
subcommittees on the Judiciary Committee. I have a fondness for him. 
Although one area he did not agree to work with me is to pay for it.
  Never have I said I don't want us to do this for our veterans. Not 
once. The reason we are on the floor, the only reason we are on the 
floor having this debate is because of my hold; otherwise, we would 
never have gotten here to have the debate which I think is valuable for 
the people in this country.
  But there has to come a time--every time I offer an amendment on this 
floor is never a good time--to start making our choices. That is what 
we hear all the time. Over 600 times in the last 4\1/2\ years, it is 
never a good time to start making hard choices. That is just what we 
heard.
  The Senator from Illinois referenced Congo. Just this month the 
Congolese army, with the assistance of the United Nations, slaughtered 
a bunch of people. And we are supposed to continue?
  I put two other things out there. Under Federal law, the 
Accountability and Transparency Act, the United Nations is required to 
tell the American people how our money is spent because the State 
Department is required to find it out and put it online. They have 
refused to do it. So we have no idea what it is.
  Two years ago in the Foreign Ops bill, an amendment was agreed to by 
100 Senators that there would be transparency. Our money going to the 
United Nations would be conditioned on the fact that the United Nations 
would be transparent on how it was spent. That was voted 100 to 0 in 
the Senate.
  Guess what happened on the way to the bank coming out of the 
conference committee. It was eliminated. So now we send over $5 billion 
directly, $5.2 billion, plus billions more through USAID through the 
United Nations, and we do not have any idea how it is spent.
  What we do know is that the United Nations is fiscally and morally 
bankrupt. It is loaded with fraud, loaded with duplication, and loaded 
with excess.
  It would be a wonderful thing to send the United Nations a wonderful 
fire shot across the bow that they have to start being accountable for 
the dollars that the American taxpayer, that this little girl is 
sending them out of her future every year. It would be a wonderful 
thing for us to say that.
  It is unfortunate, every time when we get down to the point where we 
have to make a hard choice, we always choose not to make the hard 
choice. That spells disaster for our country, and it also spells a 
total lack of leadership on our part to recognize what the real 
problems are that are confronting this country.
  Our veterans deserve us to take care of them. I am for that. Our 
children deserve for us to do it in a way that protects their future--
the very thing for which our veterans serve.
  Unfortunately, we will not do that with this amendment or any other 
time until the American people decide they have had enough of the 
careerism, the elitism, the lack of integrity, the lack of courage that 
is so often represented in the votes we cast in this body.
  I reserve the remainder of my time, and I yield in my absence any 
time the Senator from North Carolina wishes to take from my time.
  The PRESIDING OFFICER. The Senator from North Carolina.
  Mr. BURR. Mr. President, I wish to be recognized under the 6 minutes 
I currently have available to me, and if the clerk will notify me at 
the end of that time, then I will go into Senator Coburn's allotted 
time.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. BURR. Mr. President, I wish to reiterate, as the ranking member 
of the Veterans' Affairs Committee, this bill was reported out 
unanimously. I think it will receive unanimous support in its passage 
later this afternoon in the Senate.
  Let me restate for Members, when the committee passed this bill out, 
we passed it out with all caregivers being included. It was after the 
committee reported it out that we narrowed it to OEF and OIF veterans 
and their caregivers. It was the intent of the committee to include all 
the people Senator Durbin, the majority whip, said we might consider 
later on but not now. The committee's intent was let's do it in the 
bill now.
  It was also the committee's intent that these were individuals who 
were targeted for us to provide this caregiver benefit to so we can 
keep them out of nursing homes because of the Ted Wades, because of the 
Eric Edmundsons.
  Senator Coburn's amendment is consistent with the bill that was 
passed out of committee unanimously. The bill says the Secretary 
``shall;'' therefore, it means he has to. The Secretary will then have 
to prioritize spending within the Veterans Administration to fund these 
programs. The third piece of what Dr. Coburn's amendment does is rather 
than force the Secretary to prioritize within just VA programs, meaning 
there are going to be veterans who win and veterans who lose, why not 
say as a Congress: Why shouldn't we do what we are supposed to do? Why 
should we not prioritize the spending here?

  What my good friend from Illinois suggested was why should we 
prioritize for the United Nations? Let me say the answer is quite 
simple: It is our money. The suggestion that the Congress doesn't have 
a fiduciary responsibility to fund programs we implement at a time we 
are borrowing 50 cents of every dollar we spend is ridiculous on its 
face.
  To suggest that the Senate, the Congress can operate any differently 
than a family in America suggests that we ignore the input of everybody 
who asked us to represent them. We do represent the American people, 
100 individuals who represent the entire country. How can we do it 
differently than any family who is out there struggling to meet their 
end-of-the-month obligations and when their revenue does not meet their 
expenses? What do they do? They either cut back their expenses or they 
find a place to raise more revenue.
  Let me suggest this is as simple as, Is it time for us to prioritize 
where we are placing money? Members will have to decide: Is pulling 
money from the United Nations an appropriate place for us to pull money 
from to then spend on our country's veterans?
  I believe we have an obligation, I believe we have a promise, even 
for programs that did not exist prior to this time, that when we see it 
is in the best benefit of the quality of life of our troops, that we 
provide that benefit for them. But I believe we also have an obligation 
to this generation and the next one and the next one to pay for it.
  This is not a choice that is tough for Members. If you support the 
Coburn amendment, you support practically everything the committee 
supported when we passed the bill out by unanimous consent. If you 
support the Coburn amendment, you believe we have an obligation to pay 
for it. The only reason you would vote against the Coburn amendment is 
because you don't think it is appropriate for us to deprive the United 
Nations of this money to use as they see fit.
  I suggest this is where the disconnect is with the majority of 
America. They would prefer the Senate to decide where that money went 
and to use it on these caregivers and these veterans programs.
  I encourage my colleagues to support the Coburn amendment, support 
passage of this bill this afternoon when we take it up.
  I wish to shift gears slightly because I think it is somewhat ironic 
that we are talking about expansion of services to our Nation's 
veterans at a time when some herald the introduction of a bill that, in 
all likelihood, will deprive other Americans of the ability to have 
affordable health care.
  We have gone through several months of debate now about health care 
being accessible and affordable for all Americans. We have talked about 
reforms; let's change the system; let's reform the system; let's make 
it accessible and affordable; let's bend the cost curve down. In the 
last 24 hours, some have come and said we have accomplished that, it is 
amazing.
  Let me remind my colleagues, we have all said health care is

[[Page S11534]]

unsustainable in its current level of investment, 17 percent of our 
gross domestic product. I find it somewhat odd that we would start the 
debate given that it is unsustainable in its current financial 
investment with how much more money does it cost to reform health care. 
The obvious answer to me is it should cost zero. If you are already 
spending too much, we should look at the reforms before we look at the 
coverage expansion.
  I agree every American ought to be covered. As a matter of fact, Dr. 
Coburn and I have offered comprehensive bills to do that. But it is 
matched with real reform.
  What was heralded in the last 24 hours is, in fact, a $2.5 trillion 
health care bill--$2.5 trillion--over a 10-year period of collecting 
the revenues and paying out the expenses. This is where gimmicks, smoke 
and mirrors--whatever you want to call it--are used in Washington. If 
you collect revenue for 10 years but you only pay benefits for 6 years, 
you don't get a true picture of what it is going to cost over 10 years. 
You get a true impact of the revenue stream which is over $800 billion.
  From where will that $800 billion in new revenue appear? Taxes. They 
go up $493.6 billion--$493.6 billion. We will cut $464.6 billion out of 
Medicare. A $\1/2\ trillion we are going to take from a program with a 
designated population of beneficiaries of our Nation's seniors and 
those who are classified as disabled and we are going to take $\1/2\ 
trillion from Medicare and shift it over to meet the new burden of a 
health care plan yet to be constructed.
  Why is this problematic? It is $1,063 per Medicare beneficiary every 
year. Over the 10-year cycle of this health care plan, we are going to 
steal from every senior in this country $10,363 worth of health care 
money. We are going to take it from their program, and we are going to 
put it over in this new program because it is paid for. Legitimately, 
when you raise taxes, when you raise fees, when you raise revenue, you 
are making tough choices. I think when you go in and tax health plans 
and that raises $149.1 billion; when you increase a penalty for a 
nonqualified health savings account and you get $1.3 billion--these are 
revenues. They are legitimate.

  It is no smoke and mirrors. I don't think the American people believe 
for a minute this is deficit neutral. I don't believe for a minute they 
believe we are going to take $464 billion out of Medicare. If they do 
believe it, they know we are going to pay it back with future taxes on 
the American people.
  That is fine, if that is the way we want to prioritize. But health 
care reform affects every American. This is a very personal issue for 
every American and every family. It touches them unlike anything else 
we do. The truth is, they know if you take it and you put it in one 
pocket and you take it out of the other pocket, the effect on them 
either has not changed or it is negative.
  Let me suggest to my colleagues this bill is 2,074 pages. I will 
admit--I may be the only one--I have not read it since it was 
introduced at 6 o'clock last night. I am not sure there are many 
Members who have or could have. But let me suggest there will be a 
question about whether, for the first time, we use taxpayer money to 
perform abortions. Personally, I believe that is wrong. I will not 
support a piece of legislation that does that. This bill does that.
  An employer mandate, at a time when American companies are trying to 
be competitive in a global marketplace? We raised $28 billion in 
employer mandates. I am not sure that is making U.S. companies more 
competitive in a global marketplace. I think the economy is the No. 1 
challenge we have in America. I think 10.2 percent unemployment and 
going up--if it were a disease, we would be on the floor of the Senate 
calling it an epidemic and we would be doing whatever and spending 
whatever to help turn it around. But we are doing nothing. As a matter 
of fact, we are doing everything we can to try to drive up 
unemployment, to dry up the economy, and to make companies less 
competitive in a global market.
  The President said one of the objectives of health care reform was we 
need to bend the cost curve down, we need to make sure there are cost 
savings in health care for every American. Let me tell you what the 
Congressional Budget Office says:

       Under the legislation, federal outlays for health care will 
     increase during the 2010-2019 period, as would the federal 
     budgetary commitment to health care.

  That is Washington language for: You know what. Our expenditures on 
health care are going to go up. What happens when Federal expenditures 
go up? Everybody's go up. That is a known fact by the American people. 
The coverage expansion would drive a new increase in government 
spending on health to the tune of $160 billion over 10 years. Make no 
mistake, this does not bend the curve down, it bends the curve up. We 
spend more money.
  CBO scored the bill as reducing the deficit by $130 billion over 10 
years, 2010-2019. What does it take into account, to come to that 
calculation? It assumes doctors are going to get cut 23 percent in 
their reimbursements in 2011. We have less than 1 million doctors to 
serve 300 million people. Does anybody believe for a minute we are 
going to allow a 23-percent cut to go in at a time when we are 
starved--trying to attract people to go into medicine as a profession? 
If it does go in, we are going to take $247 billion out of the pockets 
of doctors we rely on to perform the surgeries, to make the diagnosis 
for us and everybody else in this country.
  The new creation of the CLASS Act, long-term care policy, shows in 
the CBO score a $72 billion savings. Let me explain it like this: 
Nobody qualifies today because it doesn't exist. People are going to 
pay premiums to be eligible for this long-term benefit. It takes about 
20 years of paying in before somebody is going to be eligible to pull 
out. It is not similar to Medicare, when we created it, where, even if 
you never paid in, you started on day one. We are collecting revenues 
for 20 years before we ever pay out the first dime. It is not hard to 
understand why you would have a $72 billion surplus out of this.
  Let me ask, what happens after that? What happens after you get past 
that 20-year number? The truth is, it starts to get into the trillions 
and trillions of dollars for which the Federal Government is obligated, 
based upon the premiums and the benefits people have assigned to it, 
that they pay out.
  If you eliminated these two gimmicks, just on its face this bill 
would be $189 billion out of balance, in the red. It would not be paid 
for.
  I suggest that is just two smoke-and-mirror tools. The start date was 
moved from 2013 to 2014. No longer is our focus on how do we get care 
delivered as quickly and as efficiently. We just pushed it off a year 
because we said the Congressional Budget Office says we are short on 
raising money, and we have raised all we can in fees and taxes. Maybe 
not all. I think they probably have some things targeted that are still 
yet to come out. The key thing is, even if you did implement it, there 
are 24 million Americans who are still without insurance. The objective 
to cover everybody was not met. There are $25 billion worth of unfunded 
mandates to our States. I don't know of a State that is in financial 
health today. There may be one or two.
  My State of North Carolina was $4 billion out of balance. Last year, 
the Federal stimulus was $2 billion of closing the gap. That $2 
billion, by the way, we didn't have. We borrowed to give to North 
Carolina and other States to create jobs. It was used to close budget 
gaps so they didn't have to make tough decisions. As a matter of fact, 
we found out this week, on one of the news channels, there is $98 
billion that didn't have anything to do with stimulus.
  We are the laughingstock of the world on the way we applied the 
stimulus package. But the sad part is not the fact that it has been 
uncovered, it is that it didn't do anything to put Americans to work. 
Now we are saying to the States we are going to put another $25 billion 
on you.
  In Medicare, we are going to cut from the fee-for-service payments 
$192 billion. So we already have $247 billion over here that we are 
getting from doctors if we go through with the payment cuts. Now we are 
targeting another $192 billion out of Medicare reimbursements, right 
out of the pockets of doctors and hospitals. Is there a community 
hospital in America that will be able to survive, given the cuts that 
are getting ready to hit them? We cut Medicare Advantage $118 billion. 
Some

[[Page S11535]]

cheer that. I tell you who doesn't cheer it: the 20 percent of 
America's seniors who chose Medicare Advantage as their preferred 
choice to traditional Medicare because it required of them less out-of-
pocket obligation, it didn't hit them for $750 deductible the day they 
walked into a hospital. What about those 20 percent of our Nation's 
seniors when they lose Medicare Advantage?
  What about the $43 billion in DSH, disproportionate share payments, 
we pay the hospitals to make up for the uncompensated care they 
deliver? I guess the authors of the bill would say we are covering 
everybody so there is no uncompensated care. Wrong; 24 million are 
still without insurance. There is going to be uncompensated care, and 
we are taking away the money we are providing the hospitals to make up 
for the uncompensated care they delivered, meaning it is coming right 
out of their hide, that local hospital in the community we live in; $23 
billion in unspecified cuts by the Medicare Advisory Board. Is America 
comfortable with us turning to another advisory board to cut $23 
billion? We just had an advisory board say: If you are 40 to 50 and you 
are female, you don't need to worry about your breasts, don't need to 
go get a mammogram, don't need to do self-examinations--trust us.
  One of the reasons the health care system in America is the best in 
the world is because we spend money to innovate. We hope companies find 
breakthroughs. We look at diagnostic abilities in an effort to try to 
detect early, so the options are greater and so the cost is less. But 
now, all of a sudden we are saying that is not important.
  There are 162 million Americans who currently have employer-based 
health care. In this bill, regardless of what that employer does, they 
will not be eligible for subsidy. If they currently have coverage but 
they may be below income and for some reason their employer has to drop 
their health care or cut back on the plan because--maybe they are not 
competitive after this in the global marketplace--even though they 
would qualify from an income standpoint, they will not qualify because 
they were provided health care before. Our favorite, the IRS says it 
will take another $5 to $10 billion so they can actually go out and 
collect these fees and taxes.
  The cost of the subsidies alone in the exchange is estimated by CBO 
to grow at 8 percent a year. I ask you, if the reason we have gotten 
into this discussion, had this debate, was we are trying to turn the 
cost curve down on health care, and we have quoted a 6-percent increase 
a year and a 5.5-percent increase a year and a 7-percent increase a 
year, why in the world would we be considering a plan that CBO tells us 
is going to have a cost increase for the subsidy of 8 percent a year? I 
would hope, if we had real reforms that worked, the cost of the subsidy 
would decline 8 percent a year.
  I know there are others seeking time. I will not belabor this point. 
I ask Members: Support the Coburn amendment on the veterans bill. 
Support passage of the veterans bill. Read the health care bill. Be 
prepared to debate the health care bill for a very long time and be 
prepared to stand for the American people on what is right.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Texas is recognized.
  Mrs. HUTCHISON. Mr. President, as has been mentioned several times, 
the majority leader unveiled the Democrats' health care reform bill 
yesterday around 5 o'clock. This bill was drafted behind closed doors. 
There was no Republican input. It didn't have any transparency until 
yesterday at 5 o'clock, despite the promises we have heard that 
government would be more transparent in this new administration. The 
2,000-page bill released yesterday is expected to have a vote to 
proceed to it within the next 2 days. The bill is 354,654 words. To put 
it in perspective, the Bill of Rights is stated in 463 words; Lincoln's 
Gettysburg Address contained 266 words; the Ten Commandments has 297 
words. This is over 350,000 words.
  Why don't we have time to read this bill, digest it, allow our 
amendments to be put in the bill language, because, clearly, this bill 
will need amendments?
  The health care of our citizens may be the most personal of all 
things to every person and every family. We are a democracy and the 
American people have a right to be heard on all issues but especially 
on this type of issue. We should be given the opportunity to read and 
hear what is in this bill, to hear it discussed, to hear from our 
constituents because it ought to be on the Internet. That is why we 
have the Internet access to bills that are introduced in the Senate. 
But by the time our constituents have a chance to read it, we will 
already have had a vote on whether to proceed to the bill.
  Even after a cursory review, I know this bill includes changes that 
are disastrous to families, health care providers, and the economy. 
Higher taxes, mandates--especially for small businesses--penalties, 
cuts to Medicare, higher premiums, restricted choices, a government 
plan--the list goes on. The bill includes almost $1 trillion in taxes, 
including a new Medicare payroll tax; $8 billion in taxes on 
individuals who don't buy coverage; $149 billion in taxes on employers 
who don't offer the right percentage of coverage to employees; $102 
billion in taxes on insurance plans, pharmaceutical companies, and 
medical device companies which study after study have shown will be 
passed on to the people who get these services and equipment.
  To make matters worse, the bill includes almost $1 trillion in cuts 
to Medicare. It is guaranteed to reduce choices and coverage for 
seniors. In my State of Texas, 400,000 people love their Medicare 
Advantage, or at least they have it and are satisfied. They will lose 
Medicare Advantage under this bill. The Democrats are touting the cost 
of the bill as meeting the President's goal of being under $1 trillion 
because CBO scored it at $849 billion. But this is a budgetary sleight 
of hand, because what is actually being scored is the years 2010 to 
2019. The actual spending in this bill won't take effect until 2014. 
They are taking the 10 years with 4 years where the bill is not 
spending anything. If you score it for the 10 years following when it 
actually comes into being, 2014 to 2023, the bill costs $2.5 trillion, 
not $849 billion.
  Given more time to analyze this bill, who knows what else we would 
discover? If the Democrats think this is the reform Americans wanted, 
why rush the bill through the Senate? Why rush it through before we 
have the ability to review details?
  The right approach is available. My colleagues and I have proposed 
commonsense and fiscally responsible ways to improve affordable access 
to health care. We need to do that. We have never said we don't need 
reform. What we have said is we need reform that will give more 
affordable access for coverage to Americans who do not have that access 
today.
  We should reassess the goals of health care reform and implement 
policies that we know will reduce costs. For sure, reducing frivolous 
lawsuits. Study after study has shown the benefits of medical 
malpractice reform. In Texas, we have tort reform. We have seen a 
dramatic increase in physicians who are willing to practice medicine. 
It has lowered the cost of medical malpractice premiums, and doctors 
have been able to do their work with their patients with much more 
freedom, knowing they do not need to order unnecessary tests just to 
cover themselves in case they get sued. The majority insists on 
rejecting this suggestion that we have medical malpractice reform in 
the bill. Yet there is probably not anything that will save as much 
money as medical malpractice reform, that puts commonsense standards in 
place for frivolous lawsuits or lawsuits at all.
  I will offer an amendment, or at least prepare one and hope to be 
able to offer it, that would cap damages, reduce malpractice premiums, 
and encourage doctors to practice in medically underserved areas. So 
many of our underserved areas, especially rural areas, have no doctors. 
There are counties in Texas that don't have a doctor within hundreds of 
miles and several counties. That is because the medical malpractice 
premiums are so high, they cannot afford to do it.
  The small business premiums are going to go up, if this bill is 
passed. Small businesses already have a hard time offering coverage to 
their employees. Why would we make the problem worse, especially when 
we have the highest unemployment in decades? We should be allowing 
small businesses to pool together and buy plans. We have

[[Page S11536]]

championed that proposal for years in the Senate, but we have never 
been able to get over the hurdles to pass a small business health plan. 
If we could do that, we could spread the risk. The bigger risk pools 
would produce lower premiums and allow more small businesses to have 
access to and offer their employees affordable health care coverage. 
Allowing businesses to pool doesn't cost the government anything. 
Therefore, it would not require tax increases, as we see in the bill 
before us.
  The Democrats are trying to address the problem of unaffordable 
insurance by offering credits to small businesses to offset the cost of 
premiums. But the credit only lasts for 2 years. That is hardly 
anything that is going to encourage businesses to take on the added 
cost when the credit lasts for 2 years. I will be preparing amendments 
that at least double that to 4 years, expand the eligibility and 
duration of these credits so we can help small business people. But 
even 4 years is not enough. We should offer credits all the way 
through.
  Offering tax incentives. There are small businesses and individuals 
in this country who have no access to affordable coverage. Why not give 
every individual who purchases their own health insurance the same tax 
break a corporation gets for offering health care coverage to their 
employees? Employees who receive insurance through their place of 
employment do not pay taxes on the premiums they spend for insurance. 
Why should individuals who purchase their own health care coverage be 
treated differently? I have a bill, with Senator DeMint, that will help 
provide insurance for more Americans through tax credits and 
competition. Our approach would be a tax credit for every individual, 
$2,000 per year, and for families $5,000 per year for their purchase of 
health insurance. This would allow individuals to purchase their 
policies and own them so they would not have to be affected by what 
their employer offers or if they change jobs. This is the kind of 
reform that could make a difference.
  How about creating a transparent marketplace online for consumers to 
go in and shop and hopefully have bigger risk pools, more competition, 
bringing the cost down? That is not the kind of marketplace that is in 
this bill. This exchange has so many mandates on the plans that, like 
the Massachusetts exchange, it would raise the cost of premiums and 
would not help in any way bring the cost down so that premiums are more 
affordable.
  These are the ideas that would improve competition in the 
marketplace.
  I can tell you, from the input I have received from my constituents 
since the bills have been out of committee, before the bill came to the 
floor or is on its way to the floor yesterday, because there were two 
committees that wrote bills that were put together and released 
yesterday, I have listened to what people say. I can tell you they 
don't want Medicare cuts. They don't want more taxes. Small businesses 
certainly don't want more mandates. They don't want government-run 
insurance. They know that a government plan is eventually going to 
crowd out the private insurance company plans throughout the country.
  I am going to be preparing an amendment that will allow States to opt 
out without penalties, not just of the government insurance plan but of 
all the harmful measures. Why would we have a government opt-out by 
States, if they are going to still have to pay the higher taxes, if 
they are going to have to pay higher premiums to pay for the other 
States that have the plan? States should not be forced to participate 
in the government plan, nor subsidize and pay for such a plan through 
increased taxes.
  I will prepare amendments that will exempt individuals and employers 
from the mandate to buy insurance, if this bill causes premiums to rise 
above their currently projected values.
  The solution to health care issues is not to give more power to the 
government. The solution is to give more power to the American people. 
They deserve a system that assures that America will have the best 
health care in the world.
  Which brings me to the new government task force that came out this 
week that is causing confusion at best and outrage at worst. That is 
the guidelines regarding screening for breast cancer. Breast cancer is 
the second leading cause of death in women in this country. Whether and 
when to screen for breast cancer has been debated for decades. In 1993, 
the Clinton administration proposed the government takeover of health 
care. In that proposal put forward by the Clinton administration, there 
would be no payment for mammograms for women under the age of 50. After 
the age of 50, there would be payment in the government plan for a 
mammogram every 2 years, exactly what has just been recommended by the 
Federal task force.
  Since we have had the guidelines, which have been in place for many 
years, death rates from breast cancer have been declining. Since 1990, 
there are larger decreases seen in women younger than 50. The American 
Cancer Society states that these decreases are believed to be the 
result of early detection and increased awareness. The evidence has 
repeatedly shown that screening and early detection save lives.
  Unbelievably, the United States Preventive Services Task Force has 
recommended against routine mammograms for women under 50, saying it is 
not worth subjecting some patients to unnecessary biopsies, radiation, 
and stress. The task force also recommended against teaching women to 
do regular self-exams. We have to ask the questions: Why this change? 
Why now? Nothing substantial in the clinical evidence, but the panel 
decided to review the data with health care spending in mind. Nearly 
everyone realizes that fewer screenings mean insurance plans, including 
a government-run plan, will save money.
  This is how rationing begins. I hope America wakes up. This is how 
rationing begins.
  In an article by the Wall Street Journal today, they recognized that. 
It reads:

       Every Democratic version of ObamaCare makes this Task Force 
     an arbiter of the benefits that private insurers will be 
     required to cover as they are converted into government 
     contractors. What are now merely recommendations will become 
     de facto rules, and under national health care these kinds of 
     cost analyses will inevitably become more common as 
     government decides where finite tax dollars are allowed to 
     go.

  That is a quote from the Wall Street Journal today.
  The American Cancer Society came out after this incredible 
recommendation and said, with its new recommendations, the task force 
is essentially telling women that mammography at age 40 to 49 saves 
lives, just not enough of them. So if the screening is going to save 
your life or your mother's or your sister's or your wife's, would that 
screening be worth it?
  Decisions about care must be between a doctor and a patient, not a 
doctor who has a loyalty to anyone but the patient, not a doctor who is 
working for the government and having to maintain government task force 
guidelines, such as the one we have just seen.

  That is the crux of the debate on this health care bill that has been 
released in the last 15 hours. I am so worried we are now beginning to 
see the handwriting on the wall. The President said once there is no 
reason we should not be catching diseases such as breast cancer and 
colon cancer before they get worse. It turns out, there is a reason: 
cost.
  The insurance companies have sort of said in the last day or so that 
they are not going to stop the coverage of mammograms for women 
starting at the age of 40. But when the government plan comes into 
effect, you know that every insurance company is going to say: If we 
are going to be competitive, we must adhere to the same standards as 
the government plan. It is going to happen.
  We must have time to look at this bill. We must have time to look at 
what is happening to the choices, to the health care, to Medicare. The 
cuts in services, the taxes, the mandates are going to overhaul the 
health care of our country. We must have time to look at this bill 
before we have a motion to proceed. We must have time to study it. We 
must let our constituency study it because they will catch things they 
care about and they will inform us, and that is why we are here.
  So I am very concerned that we are pushing too fast on something we 
should be taking slowly and carefully to assure we are not going to do 
something we are not sure is right, and

[[Page S11537]]

where we have the chance, to change what we see is wrong.
  Thank you, Mr. President.
  The PRESIDING OFFICER (Mr. Udall of New Mexico). The Senator from 
Arizona.
  Mr. KYL. Mr. President, I wish to compliment the Senator from Texas 
for sounding this warning. Being from Texas, she is undoubtedly aware 
of a great country-western song out right now by Brad Paisley called 
``Welcome to the Future.'' I think we have seen a glimpse of the future 
under Obamacare here by this pronouncement of the U.S. Preventive 
Services Task Force recommending against the routine screening of women 
between ages 40 and 49 for best cancer.
  I want to speak for about 60 seconds about this issue to go into the 
actual numbers from the study to which Senator Hutchison referred. The 
rationale of the study is that you would need to screen 1,339 women in 
their fifties to save 1 life, so screening is worthwhile. But since you 
would need to screen 565 additional women--in other words, 1,904, to be 
precise--in their forties to save 1 life, screening is not worthwhile. 
That is the kind of cost-benefit analysis that will result in 
rationing, and it is precisely Senator Hutchison's point that this is 
how rationing begins.
  Welcome to the future.
  Mrs. HUTCHISON. Mr. President, if the Senator will yield, I 
appreciate him giving us these statistics because it is 1 life out of 
1,904 to be saved, but the choice is not going to be yours; it is going 
to be someone else who has never met you, who does not know your family 
history.
  That was in the Clinton government reform, takeover of health care in 
1993, and it was soundly rejected. It was soundly rejected. It was part 
of the reason it was soundly rejected--this mammogram rationing before 
the age of 50--because we had hearings on this, and every woman in the 
Senate at the time rejected--rejected--that plan, rejected keeping 
women under the age of 50 from having mammograms paid for by insurance 
plans.
  So I thank the Senator from Arizona for connecting this and showing 
the statistics because this is not the American way of looking at our 
health care coverage. It is not the American way, and we must stop this 
government takeover of our health care.
  Mr. President, I yield the floor.
  Mr. KERRY. Madam President, I speak in opposition to amendment No. 
2785 to the Caregivers and Veterans Omnibus Health Services Act. This 
amendment, offered by Senator Coburn, would cut funding for 
international organizations, including U.S contributions to NATO and 
the United Nations. This would gravely undermine our vital national 
security interests at a critical time. We all strongly support 
strengthening medical care for our Nation's veterans, but Senator 
Coburn's amendment sets up a completely artificial choice between 
protecting the health of America's veterans and ensuring that our 
Nation meets its national security objectives and international 
obligations.
  To be clear, this amendment would cut funding from the contributions 
to international organizations account, which provides the assessed 
dues to the U.N. and NATO, APEC, OAS, OECD, and the OPCW, as well as 
take funding from the contributions to international peacekeeping 
operations account. That is why I will oppose this amendment, for 
several critical reasons:
  First, we obviously need as much support as we can get from our NATO 
allies for our joint mission in Afghanistan. We cannot, and should not, 
carry this burden alone and how can we ask NATO to do more while we are 
at the same time cutting our NATO contributions? This would seriously 
undermine our standing with NATO and with our NATO allies at a time 
when we can least afford it. We simply cannot allow that to happen.
  Several other international organizations are also threatened by this 
amendment. Funding for the Organization of American States, which 
addresses threats to hemispheric security, from terrorism to narcotics, 
would be cut. The Organization for Economic Cooperation and 
Development, which promotes economic growth in 30 member states and 
more than 70 other countries, would lose funding. The Asia-Pacific 
Economic Cooperation, which promotes trade, security, and economic 
growth throughout the Asia-Pacific region, and which the United States 
will host in 2011, would also be cut. The Organization for the 
Prohibition of Chemical Weapons, which ensures worldwide implementation 
of the Chemical Weapons Convention, as well as the World Trade 
Organization, which provides the stable framework for international 
trade that is so critical to the United States, would suffer funding 
cuts.
  Second, our United Nations contributions fund a wide range of U.N. 
activities in support of key United States foreign policy priorities. 
U.N. organizations are monitoring nuclear programs in North Korea and 
Iran. We need the best information possible about the nuclear programs 
in Iran and North Korea, and the last thing we need to be doing is 
cutting funding for the very organization that is doing on the ground 
monitoring. The U.N. is also providing vital assistance for the 
upcoming elections in Iraq, which will be critical to the future of 
democracy there. U.N. food and agriculture agencies are compiling 
forecasts of global agricultural production, identifying areas of 
likely famine and severe hunger, and facilitating emergency food 
assistance. U.N. health agencies are on the frontlines of detecting 
outbreaks of avian flu and H1N1 and defending against a world pandemic. 
In addition, we work through U.N. organizations to protect a range of 
U.S. interests, from the intellectual property rights of American 
entrepreneurs to coordinating international aviation safety standards.
  Third, passage of this amendment would directly threaten ongoing 
peacekeeping operations in nations essential to America's national 
security interests. There are now over 115,000 peacekeepers the second 
largest deployed military in the world serving in 17 missions in some 
of the most dangerous corners of the world. These U.N. peacekeeping 
operations are working to preserve peace and stability in fragile 
countries with grave humanitarian situations, including Darfur, 
Liberia, Lebanon, Haiti, and the Democratic Republic of Congo. U.N. 
peacekeeping is eight times less expensive than funding a U.S. force, 
according to the Government Accountability Office, and these 
peacekeeping operations help shoulder the burden with our military. 
U.N. peacekeeping missions also help end brutal conflicts, support 
stability, the transition to democratization, and bring relief for 
hundreds of millions of people. And if not for U.N. peacekeeping 
missions, some of these conflicts could require the presence of U.S. 
soldiers.
  Haiti is a good example. The U.N. force in Haiti has dramatically 
reduced the number of kidnappings that plague the nation and helped 
deliver food and medicine, clean streets, and maintain security after 
several successive tropical storms devastated the country. The mission 
in Haiti is in the midst of a successful transition from keeping the 
peace to enhancing security for the people of that country. In the 
1990s, Florida faced wave after wave of illegal Haitians trying to 
escape from the failed state. Should this mission be abandoned? Should 
we abandon the people of Darfur?
  Fourth, the President has stated his commitment to paying U.S. dues 
to international organizations in full. As Ambassador Rice has said, we 
must meet our obligations. As we call upon others to help reform and 
strengthen the U.N., the United States must do its part and pay its 
bills. Our dues to the United Nations and other international 
organizations are treaty obligations. The full payment of assessed 
contributions affects the standing and influence that the U.S. has at 
these organizations. Going into arrears undermines U.S. credibility and 
negatively influences world opinion regarding U.S. respect and 
appreciation for the role of multilateral organizations that support 
and advance U.S. foreign policy.
  We all want our veterans and their families to receive the best care 
possible--they have earned it many times over--but this amendment 
presents us a false choice between caring for our veterans and 
protecting our global interests: we must do both. It is for these 
reasons I oppose Senator Coburn's amendment and urge fellow Members to 
oppose the amendment as well.
  Mrs. BOXER. Mr. President, I rise today in opposition to amendment 
No.

[[Page S11538]]

2785 to the Caregivers and Veterans Omnibus Health Services Act of 
2009.
  This is a deeply flawed amendment that may hurt certain veterans of 
the wars in Iraq and Afghanistan. And for that reason, I must vote 
against it.
  Severely injured or disabled veterans often need someone to care for 
them in the home. The family members of these veterans often shoulder 
the burden of this care, which can take a significant financial, 
psychological and emotional toll. This bill would provide a family 
member caregiver with health care, counseling, support and a monthly 
stipend.
  But amendment No. 2785 actually seeks to shut certain Iraq and 
Afghanistan veterans out of this new benefit by mandating that only 
those who require ``hospitalization, nursing home care, or other 
residential care'' are eligible.
  The Wounded Warrior Project characterized the impact of the amendment 
as such, stating that it would ``set a much higher bar'' by requiring 
that the ``veteran be so helpless as to require institutional care if 
personal care were not available.''
  This would potentially shut out veterans suffering from severe mental 
illness, or those learning to adapt to life at home with blindness or 
amputations.
  The Disabled American Veterans also echoed this concern as a reason 
for opposing this amendment, writing that the amendment's ``new 
restrictive eligibility language could actually reduce the number of 
severely wounded and disabled veterans returning home from the wars in 
Iraq and Afghanistan eligible for such services.''
  For these reasons, I urge my colleagues to defeat this amendment, 
which is also opposed by the American Legion, the Iraq and Afghanistan 
Veterans of America and Swords to Plowshares.
  It is long past time to pass the underlying bill. This legislation is 
too important to our veterans to sit in Congress because of the stall 
tactics of one lone senator.
  It includes important health care improvements for women veterans 
including requiring the Department of Veterans Affairs to train mental 
health care specialists on how to better treat military sexual trauma. 
It also implements pilot programs to provide child care to women 
veterans who require medical care.
  In addition, the bill includes two important provisions from 
bipartisan legislation that I authored with Senator Bond.
  The first gives active duty servicemembers access to vet centers, 
which are community-based counseling centers run by the Department of 
Veterans Affairs where veterans can receive mental health care 
services.
  The second provision authorizes vet centers to counsel former 
servicemembers on their rights to present their medical records for 
review to ensure that the discharge process they underwent was fair. 
This is particularly important for servicemembers who may have been 
discharged improperly with a personality disorder and therefore are not 
entitled to benefits when in fact they suffer from a combat-related 
condition such as post-traumatic stress disorder.
  We owe our veterans an enormous debt of gratitude, and the best 
possible treatment and care for injuries sustained in service to our 
country. This bill is an important step toward fulfilling that 
obligation.
  The PRESIDING OFFICER. The Senator from Hawaii.
  Mr. AKAKA. Mr. President, can you tell me how much time I have 
remaining?
  The PRESIDING OFFICER. Remaining on the Senator's side is 31 minutes 
33 seconds; on the other side, 42 minutes 15 seconds.
  Mr. AKAKA. Mr. President, let me make further comments about the 
pending bill on the floor and speak particularly about the cost of war.
  To those who are concerned about the cost of this legislation, let me 
say I firmly believe we cannot renege on the obligation to care for 
those who honorably serve our country. When we as a nation vote to send 
American troops to war, we are promising to care for them when they 
return. The cost of veterans health care is a true cost of war and must 
be treated as such. The cost associated with the underlying bill does 
not need to be offset. The price has already been paid many times over 
by the service of the brave men and women who wore our Nation's 
uniform.
  Regardless of what my colleagues may think about the United Nations 
and its role in international affairs, this is not the time or place to 
be debating those issues. At this moment, we are talking about meeting 
veterans' needs.
  Iraq and Afghanistan Veterans of America agrees. IAVA writes that:

       The amendment to S. 1963 brought to the floor is just the 
     latest in a long series of delaying tactics that plays 
     political games with veterans' health care and services.

  This bill would provide family caregivers--who typically have full-
time jobs--with health care, counseling, support, and a living stipend. 
This modest stipend would be equal to what a home health agency would 
pay an employee to provide similar services.
  To assert that this legislation requires excessive spending is simply 
wrong. This spending is critical when taking into account the 
sacrifices these men and women have made for the Nation.
  The sponsor of the amendment we are considering has expressed the 
view that S. 1963 unfairly discriminates against veterans because its 
caregiver assistance provisions focus on OEF and OIF veterans. While it 
is correct that the caregiver provisions target the veterans of the 
current conflicts, I do not believe that constitutes discrimination. 
The reasons for this targeting, at the least, are three: one, the needs 
and circumstances of the newest veterans in terms of the injuries are 
different--different--from those of veterans from earlier eras; two, 
the family situation of the younger veterans is different from that of 
older veterans; and three, by targeting this initiative on a specific 
group of veterans, the likelihood of a successful undertaking is 
enhanced.
  I note that most major veterans groups support this bill and the 
caregiver provisions. I do not believe they would do so if they felt it 
was discriminatory.
  As my colleagues know, I am a veteran of World War II. If we can 
provide help to the newest veterans in ways that were not available to 
the veterans of my generation, I support that 100 percent.
  Veterans from Iraq and Afghanistan are returning home today to face 
new and different challenges. In World War II, a third of those injured 
on the battlefield did not make it home. Today, 90 percent of those 
injured make it home but often with catastrophic and life-threatening 
injuries. Some of these injuries leave invisible wounds. Unprecedented 
rates of post-traumatic stress disorder and other mental illnesses are 
affecting these young men and women. These veterans will be cared for 
somewhere, and by what we do today, we may decide whether that care 
occurs in a nursing home or in their own home. The soldiers of my 
generation had no such choice. I say, let's help the Nation's newest 
veterans to really come home, and let's help their families.
  According to a report from the Center for Naval Analyses, 84 percent 
of caregivers for veterans were either working or in school prior to 
becoming a caregiver. An employed caregiver will lose, on average, more 
than $600,000 in wages, pension, and Social Security benefits over a 
``career'' of caregiving. The younger the veteran's family, the more 
wages a caregiver will lose. We can no longer ask our newest generation 
to bear the cost of the Nation's obligation to care for its wounded 
warriors.
  The premise of the amendment seems to be, if it is good for some, it 
is good for all. But the needs of veterans are not the same, and 
expanding a benefit to any veteran who might benefit could endanger the 
entire program. The underlying bill already includes a provision 
directing VA to report to Congress within 2 years after the law's 
enactment on the feasibility of expanding the provision of caregiver 
assistance to family members of veterans of prior service. Such an 
approach is not discriminatory; it is the responsible way to approach 
the issue.
  I note that other health care improvements which would result from 
this bill help virtually every group of veterans, including women 
veterans, homeless veterans, and veterans who live in rural areas.

[[Page S11539]]

  I urge this body to reject the amendment and pass S. 1963 today for 
the sake of all our Nation's veterans.
  Questions have been raised about the scope of the caregiver 
provision. When the bill came out of the Veterans' Affairs Committee, 
it included a 2-year delay before the caregiver benefit could have been 
expanded. The bill as reported said the Secretary of VA could have 
expanded it to all veterans if it made sense. Under the bill now before 
us, the Congress will continue to have the opportunity to expand it 
beyond OEF and OIF veterans. Nothing has changed. Once VA has 
experience with the proposed new program, it can be expanded to all 
veterans.
  Mr. President, I yield the floor and reserve the remainder of my 
time.
  The PRESIDING OFFICER. The Senator from Florida is recognized.
  Mr. LeMIEUX. Mr. President, 25 years ago--I will never forget this--I 
came home to my house, I was 15 years old, I was in high school, and my 
mom and my dad sat me down and my mom told me that she had breast 
cancer. After that, as any kid would, I worried about whether my mom 
was going to live and what life would be like without a mother. It was 
a very difficult time for our family.
  The good news is that my mom, through self-examination, found a lump, 
and she is today, 25 years later, a breast cancer survivor. But I am 
not sure I could tell this story today and tell about the positive 
result that occurred if she had not undertaken that self-exam, if she 
had not received the care she was given so quickly and so effectively 
because she found the lump after having been trained and encouraged to 
do self-exams.
  So she is a success story, and millions of women across this country 
are success stories because they have heeded the advice of preventive 
medicine. They have heeded the advice for many years now from the 
American Cancer Society and other experts that self-exams and 
mammograms for women in their forties prevent breast cancer, and they 
prevent us from losing our moms and our sisters and our daughters. But 
this week, a task force, a government task force, kind of ironically 
named the ``U.S. Preventive Services Task Force,'' contradicted their 
previous recommendations and said women in their forties shouldn't be 
doing self-exams; that women in their forties shouldn't be having 
mammograms on a regular basis. That makes absolutely no sense.
  We are in a world where everyone agrees the way to reduce health care 
costs and to increase longevity of our people is through preventive 
medicine. We know through the success we have had in recent years that 
self-exams and mammograms save women's lives.
  There are going to be what they call false positives, women who find 
something that turns out not to be a lump. And, sure, they are going to 
be anxious during that time period while it gets checked out. But would 
you rather have your mom, your sister, your daughter be anxious for a 
couple days and get a good result or would you rather have them, on the 
other hand, not do the self-exam, not get the mammogram, and get cancer 
and potentially die? It makes no sense.
  We know these mammograms for women in their forties save lives. We 
know self-exams save lives. It is not just me saying it; the facts show 
it. The American Cancer Society notes that deaths for breast cancer 
since 1990 declined by 2.3 percent, and they have declined 3.3 percent 
for women in their forties and fifties. Lives are being saved.
  So why would this government task force that is supposedly focused on 
prevention want to do away with self-exams and mammograms on a regular 
basis for women in their forties? What could be the reason?
  The reason, as my colleague from Texas so eloquently stated, is cost. 
It doesn't make sense anymore because we are not saving enough lives 
for the money that it is costing for mammograms. Our moms and our 
daughters and our sisters are worth that cost.
  If you want to get a picture of where we are going with this new 
health care proposal and you want to know what the future is for how 
the government and your insurance company are going to view your health 
care, just take a look at this recommendation. Are they next going to 
say the same thing about men getting prostate exams in their forties? 
Are we going to start making these cost-based decisions or really 
furthering them to a degree that we haven't seen before? Are we going 
to lose our family members because we are rationing health care? These 
are big issues.
  The American people, as my colleague from Texas said, need to wake up 
and they need to watch what is going to happen in this Senate, this 
great body that debates the important issues. Never has there been an 
issue as important in modern times as what is going to happen over the 
next month or 6 or 8 weeks as we discuss these issues that are going to 
affect our health and our families' well-being.
  I sent a letter to Secretary Sebelius yesterday on this issue. I saw 
her comments yesterday where she disagrees with this panel. I commend 
her for that. Women do not need to get the message now that they 
shouldn't be doing self-exams. Women should not be getting the message 
that they shouldn't be getting regular mammograms in their forties. 
They need to do both things because it is going to help save their 
lives. No government task force, based on lack of any new information, 
should contradict its prior recommendations that they do just that.
  I had a chance to speak with the surgeon general of the State of 
Florida, Dr. Ana Viamonte-Ros, yesterday about this issue, and she 
concurs with me, as does the American Cancer Society and other groups, 
including the American College of Obstetricians and Gynecologists, that 
women should still do self-exams, and they should still get mammograms 
on a regular basis in their forties.
  I wish to read for this Chamber a letter--an e-mail, actually--I 
received today from a friend of mine down in Broward County from my 
home State of Florida. She writes:

       Please thank the Senator for his efforts on this important 
     issue. I am a breast cancer survivor who was first diagnosed 
     before 50 years of age having a mammogram. Subsequent to the 
     mammogram, my tumor was removed surgically. Unfortunately, 
     within 5 years, I was diagnosed again with breast cancer in 
     the other breast and had to undergo surgery and chemotherapy. 
     The second time I found the tumor through self diagnosis. 
     Every day I thank God that I had a lifesaving mammogram and 
     that my doctor showed me how to do a self examination.
       Just recently I learned through TV that there are also 
     recommendations that women should not utilize self exam as a 
     way to detect breast cancer. It's too unreliable. More 
     hogwash. Most of my breast cancer sisters found their tumors 
     through self exam. Please ask the Senator to dispel any 
     efforts or notions that self exam is not a good means of 
     detection.

  This is an important issue. We need to get the message out to the 
women of America that these recommendations are wrong. I only can stand 
here today with this good story about my mom because if she wouldn't 
have done that self-exam, she might not be here with us.
  So I hope the American people will, as my colleague from Texas said, 
wake up and see what this means and what this portends for the future.
  With that, I yield the floor.
  The PRESIDING OFFICER. The Senator from Hawaii is recognized.
  Mr. AKAKA. Mr. President, I wish to make further comments on some of 
the concerns our speakers have had.
  The sponsor of the amendment has stated his primary goal is to 
increase veteran eligibility for caregiver assistance. It appears, 
however, that the amendment could well have the opposite effect and 
deny caregiver assistance to many OEF/OIF veterans by significantly 
narrowing the eligibility criteria for caregiver assistance.
  The amendment would add a provision that would require that in 
addition to sustaining a serious injury and requiring personal care, a 
veteran would have to be so helpless as to require institutional care 
if personal care services were not available. This proposed 
modification is problematic because not all veterans in need of 
caregiver assistance would be appropriate for, or in need of, 
institutional care.
  To illustrate, consider the example suggested by the Wounded Warrior 
Project, one of the principal advocates for the caregiver legislation: 
A veteran who is recovering from severe wounds, suffers from PTSD and 
depression, and needs help with feeding, dressing, and getting to the 
bathroom, under the provisions in S. 1963 this veteran would

[[Page S11540]]

be eligible for caregiver assistance. However, since the veteran in 
this example would not necessarily benefit from or require 
institutional or residential care, the veteran would not be eligible 
for caregiver assistance under the changes proposed by the amendment. 
Given the veteran's co-occurring PTSD and depression, however, the VA's 
failure to provide that assistance could have a severe impact on the 
veteran's mental health and well-being. PTSD, one of the signature 
wounds of the current war, is a condition which many long-term 
institutional care settings and nursing homes are not prepared to 
handle or treat. As a result, the inclusion of this new eligibility 
condition would exclude many veterans in critical need of caregiver 
assistance.
  There is another problem raised by the amendment's proposed expansion 
of the caregiver assistance to all veterans. By expanding eligibility 
for caregiver assistance to all severely injured veterans, the 
amendment would convert a manageable initiative targeted on the 
veterans of the current conflicts into a huge undertaking that would 
surely encounter many problems.
  The reasoning behind initially administering services to a smaller 
pool allows for greater efficiency and the opportunity to improve 
before expanding such services to a larger universe of veterans.
  I note that the Disabled American Veterans argues against the pending 
amendment because of its potential impact. DAV writes, and I quote:

       While the amendment proposed by Senator Coburn seeks to 
     extend caregiver services to veterans from all eras, its new 
     restrictive eligibility language could actually reduce the 
     number of severely wounded and disabled veterans returning 
     home from the wars in Iraq and Afghanistan eligible for such 
     services. For this and other reasons, DAV does not support 
     the Coburn amendment to S. 1963.

  I ask unanimous consent that this letter be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                   Disabled American Veterans,

                                                November 19, 2009.
     Hon. Daniel K. Akaka,
     Chairman, Senate Veterans' Affairs Committee, Russell Senate 
         Building, Washington, DC.
       Dear Chairman Akaka: On behalf of the Disabled American 
     Veterans (DAV), thank you for introducing and quickly 
     bringing to the floor S. 1963, ``The Caregiver and Veterans 
     Omnibus Health Services Act of 2009.'' DAV strongly supports 
     Senate approval of this legislation as introduced, and urges 
     all Senators to support its passage.
       S. 1963 combines the content of two prior measures (S. 252 
     and S. 801) into a single VA health care omnibus bill that 
     would make significant enhancements in VA health care 
     services. This legislation contains vital provisions to help 
     assure equal access to and quality of medical care for women 
     veterans. S. 1963 would also provide desperately needed 
     support to family caregivers of severely disabled veterans, 
     particularly those returning from Iraq and Afghanistan, as 
     well as expand mental health services, improve traumatic 
     brain injury care and aid homeless veterans.
       As we have shared with you in testimony earlier this year, 
     DAV believes that disabled veterans of all eras could benefit 
     from family caregiver support services. While the amendment 
     proposed by Senator Coburn seeks to extend caregiver services 
     to veterans from all eras, its new restrictive eligibility 
     language could actually reduce the number of severely wounded 
     and disabled veterans returning home from the wars in Iraq 
     and Afghanistan eligible for such services. For this and 
     other reasons, DAV does not support this Coburn amendment to 
     S. 1963.
       Mr. Chairman, we look forward to continuing to work with 
     you, Ranking Member Burr, your counterparts in the House and 
     others to craft and enact the most expansive and effective 
     caregiver assistance program that we can achieve. Again, 
     thank you for your vigorous leadership on this legislation 
     and for all you have done to support disabled veterans and 
     their loved ones who care for them.
           Sincerely,
                                               Joseph A. Violante,
                                    National Legislative Director.

  Mr. AKAKA. Mr. President, the proponent of this amendment has 
expressed the view that this veterans omnibus bill should be paid for 
and seeks to do so by directing a transfer from the State Department to 
VA of funds appropriated for ``Contributions to International 
Organizations'' and ``Contributions for International Peacekeeping 
Activities,'' both of which are categories of huge U.S. payments to the 
United Nations.
  Regardless of any Senator's beliefs about the role of the United 
Nations or U.S. support for the U.N., this is neither the time nor 
place to be debating those issues. For that reason alone, I believe the 
amendment should be rejected.
  I understand from CBO, however, this amendment does not even 
accomplish what I believe the amendment's author intends. According to 
CBO, the cost of the bill would still be estimated at the same level. 
According to CBO, having the State Department transfer funds to the VA 
is no different than having VA fund it through its own appropriations 
accounts.
  It also appears that the amendment would change nothing with respect 
to U.S. payments to the U.N. Again, according to CBO, if the 
amendment's author wishes to have the State Department transfer funds 
to VA instead of contributing to the U.N., the amendment would have to 
be made to the State, Foreign Operations, and Related Programs 
Appropriations Act, and not to the pending measure which is an 
authorization bill.
  This legislation has been delayed too long. To continue to obstruct 
this vital veterans bill while attempting to link it completely to 
unrelated U.N. spending is simply unacceptable.
  This amendment should be rejected and S. 1963 should be passed by the 
Senate.
  I yield the floor and reserve the remainder of my time.
  The PRESIDING OFFICER. The Senator from Oklahoma is recognized.
  Mr. COBURN. Mr. President, I listened very carefully to the chairman 
of the Veterans' Committee. He misses one major point: If, in fact, we 
don't send the money to the U.N., we will have money to pay for the 
veterans--if we don't send the money.
  That is what this amendment does. It precludes that money from going 
from the State Department's budget to the U.N. I admit it is fungible, 
but that is money we will not send to something that is low priority, 
that is wasteful, that is nontransparent, and that the vast majority of 
Americans agree we get very little value from when we send that money 
to the U.N.
  I also take issue with my friend's words that it is time. I think the 
chairman will agree that this bill was not noticed until October 28. 
That is when this bill was noticed. When the bill was noticed, the next 
day a unanimous consent request came through to say pass this without 
any debate, without any discussion, pass it through the Senate. I said, 
no, we ought to have a debate. At that time, we offered the Veterans' 
Committee a list of some 20 options of things that are lower priority 
than helping our veterans. They were rejected out of hand, which is the 
problem I have been describing on the floor earlier.
  Every time it comes down to making a choice, the majority of this 
body chooses not to make a choice, not to choose a priority, not to do 
what we get paid to do, not to do what is in the best interests of the 
Nation. They choose to not choose. But by choosing not to choose 
priorities, we still choose, because what we choose is to take the 
money from our children. We choose to lower the standard of living of 
our children.
  I want to tell you about veterans with whom I have spoken. I have had 
a lot of calls on this, because how dare somebody hold up a veterans 
bill before Veterans Day. The vast majority of the calls say we think 
you ought to support veterans, but we also think you ought to pay for 
it. Our country can't keep doing what we are going to do. So on the 
last appropriations bill through this body, I gave you an opportunity. 
We have heard three Senators today say there is no price we should not 
give to support our veterans. Direct quotes. ``No price is too great''? 
There is one price that is too great, because all three of those 
Senators who spoke those words refused to give up their earmarks to pay 
for veterans in the VA-MILCON bill. They all voted against paying for 
it in the MILCON bill by eliminating the unrequested items they had 
earmarked for them in the VA-MILCON bill. So, yes, there is a price 
that is too great--the price of helping yourself and your own 
constituency on a parochial basis and putting that ahead of the best 
interests for our veterans. So the words ``there is not a price too 
great'' ring hollow. We put our parochialism ahead of it.
  I ask unanimous consent to add Senators Inhofe and Burr as cosponsors 
of my amendment.

[[Page S11541]]

  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. COBURN. Mr. President, as we talk about this debate, as my 
colleagues know me very well, the debate isn't about veterans; it is 
not about the veterans bill. It is about reestablishing some fiscal 
sanity in Washington of which we have none. This bill here--the health 
care bill that was released last night--over the next 10 years will 
spend $2.5 trillion. That is what it will spend. We don't know the 
accuracy of CBO. They certainly haven't done very well in the past on 
health care, as to whether it saves money. What we do know is that it 
doesn't cut the cost of health care, which is the problem. It transfers 
$2.5 trillion under the guise of the control of the Federal Government, 
which is not efficient.
  I have not heard one colleague defend the United Nations. Nobody will 
get up in this body and defend the atrocities, the waste, and the fraud 
of the U.N. Nobody will say that. But those same people who actually 
agree with it but won't do anything about it will vote against this 
amendment. They will vote against the amendment. They won't defend what 
has very accurately been described as the behavior, the lack of fiscal 
sanity, the fraud and theft, the rape and pillage by the peacekeepers, 
the lack of oversight, and the total lack of transparency. They won't 
defend that with their words, but they will defend it with their vote. 
They are going to absolutely defend it with their vote. Once again, 
they are going to refuse to make the hard choice. Most of them 
listening to this agree, but it is the wink and nod that we play around 
this body. They know the U.N. is a big mess. They know it is a big 
problem. But they won't do anything to fix it. They will vote for 
complete transparency and vote to condition our funds on transparency, 
and when they get to conference, they will take it out. They will look 
good on the outside, but the inside of the cup will be absolutely 
filthy.
  When is it we will see a turnaround in Washington that will match the 
courage of our veterans and meet the expectation of the citizens of 
this country? When is that going to happen? I will tell you when it is 
going to happen: It is going to happen when the Chinese start selling 
our bonds or quit buying them. That is when it will happen. Then we are 
not going to be able to make those decisions based on our choice. They 
are going to be dictated to us. They are going to be rammed down our 
throats.
  The fact is that $3.7 billion is a lot of money. It is $3,700 
million. That is hard to think about when you start talking about 
billions. Yet we are going to pass it. By the way, this bill that is so 
critical to get passed right now has no money in it for veterans for 
this process. Would the chairman agree with that? There is no money 
there now? It is not going to happen until a year from now, unless we 
put it in some supplemental program between now and next September 30. 
So what we are promising isn't going to come due, because we turned 
down an amendment on the VA-MILCON bill that would have allowed money 
to be available as soon as the VA-MILCON bill passed the conference 
committee and the President signs it.
  How hollow does that sound? We claim one thing but our actions are 
totally different. And the VA says, by the way--at least intimated--
once they get this bill and the money, it will take at least 180 days 
to implement it. So add 18 months to right now to when our first 
veterans will see the benefit, especially the caregivers. And we could 
have, with the VA-MILCON amendment I offered--which was rejected--made 
that happen next month--at least the planning in the first 6 months of 
that--so that by March or April caregivers could actually start 
receiving this money.
  I have tremendous worry for our Nation. If you open your eyes, you 
will too, because we cannot keep doing what we are doing.
  Just some statistics. These are accurate, based on GAO, OMB, and 
Congressional Budget Office:
  Ending September 30, not counting the supplemental, the Federal 
Government spent $33,880 for every household in this country. But we 
only collected an average of $18,000 per family. We borrowed, per 
family, $15,603 last year. Those numbers are going to be bigger next 
year. We are going to spend more, we are going to borrow more, and we 
are going to collect less. What is the implication of that? What is the 
implication of borrowing money we don't have and spending it on things 
that are not a priority, such as caring for veterans? The implication 
is that it will come to an abrupt halt in a very damaging and painful 
way--maybe not for us in this body but certainly for my children and my 
grandchildren, and certainly for those who follow us.
  There is a bigger worry than the financial aspect of it. It is that 
we are losing, as we do this, the very integral part of what makes our 
Nation great. It is called ``sacrifice.'' That is why we honor our 
veterans. It is because they sacrifice, they put themselves on the 
line. Our heritage has been, from the founding of this country, to the 
very people who risk their lives and fortunes to initiate this 
country--the heritage has been of one generation sacrificing so the 
next generation can have greater opportunity and greater freedom and 
greater liberty.
  As I said earlier, when we come back and get down to the actual 
voting on this amendment, most people will say: We can't do that. It is 
not time to make a hard choice.
  I want to tell you, those veterans who have closed-head trauma made a 
hard choice. Those veterans who lost their lives and family made a hard 
choice. Those veterans who have severe disability and their families 
made a hard choice.
  In a little while, we are going to dishonor that, because we are 
going to refuse to make a hard choice and rationalize in a way that it 
isn't going to do any good or make any difference, and we are not going 
to even attempt to get the out-of-control spending in Washington under 
control. We will reject the notion that you can, in fact, look at 
something and see what it is like, such as the corruption, such as the 
waste, such as the rape and pillaging of the U.N. peacekeeping troops, 
and we are going to say that is not important, and what is important is 
that we keep doing it the way we have always done it. We will continue 
to do it the way we have always done it.
  The way we have always done it for the past 20 years does not honor 
what built this country. It doesn't honor making that sacrifice. It 
does not honor saying I will make a tough vote, even though the 
administration doesn't want me to make this vote. I will make a vote 
that is right for the country, right for the future, right for our kids 
and our grandkids. I will make that vote.
  We will not see that today. We will not see the courage mustered up 
to choose between veterans and a sloppy, ill-run organization into 
which this country pours billions of dollars every year and continues 
unabated and uncontrolled and without oversight because we refuse to 
make a choice.
  So my colleagues get a choice. Here is the choice: Ignore with a 
blind eye the absolute tragedies that are going on at the United 
Nations, the absolute waste, the incompetency, the favoritism, the 
theft that is going on and say you did something good for veterans.
  The fact is, the reason our veterans have such severe injuries is 
because they protect our liberty, protect our freedom, and protect our 
future. We are not going to choose that today. We are going to choose 
the opposite. We are going to do the status quo. We are going to say 
this amendment does not make sense.
  When will we muster the courage to make a real choice, to go out and 
defend that veterans are worth more than the waste at the United 
Nations? We will not make the choice because we know we can vote 
against this amendment and still tell the veterans we did it and we 
don't have to speak to our grandchildren and children. We will be gone. 
We will be out of here.
  When their standard of living is 35 percent below the standard of 
living we experience today--by the way, that is what is forecast as the 
government takes over 40 percent of the GDP of this country and as we 
end up with interest costs in excess of $1 trillion a year just to fund 
the excesses of what we are doing today, which is less than 5 years 
away, and we will be spending $1 trillion a year on interest--we will 
have no recollection of this vote. We will have no recriminations 
against us. We will have just voted and said that is

[[Page S11542]]

another amendment to try to make us make a choice, but we refuse to 
make one.
  By voting against this amendment, you are defending the audacity, 
corruptness, inefficiency, and fraudulent behavior of the United 
Nations. That is what you are doing. Nothing can be cut. Have you 
noticed that? Nothing is not important to the politicians of this city. 
Everybody has an interest group. Oh, we can't go against that. That is 
an absolute formula for disaster for our country.
  I wish to enter into the Record some additional information on the 
United Nations. I only touched the surface on the amount of outlandish 
things that have gone on in the United Nations. I did not mention Oil 
for Food, billions of dollars, and of the people who took all that 
money, none of them got prosecuted. The U.N. Headquarters renovation is 
going to cost $2 billion. It should cost about $800 million. I did not 
talk about that or the lack of transparency in terms of the State 
Department, in terms of reporting how our money is spent at the United 
Nations.
  I ask unanimous consent to have printed in the Record this 
information.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                             Amendment 2785


  Redirect U.S. dues to the United Nations to the Veterans Caregiver 
                                Program

       The United States taxpayer is the single largest 
     contributor to the United Nations providing over $4 billion 
     annually to the entire United Nations system that is 
     estimated to be at least $20 billion. No one knows for sure 
     how big the U.N. really is--not even the U.N. itself since it 
     operates in an opaque, unaccountable fashion, refusing even 
     the most basic of transparency requests.
       The U.S. federal budget that is rife with waste, fraud, and 
     abuse, but the U.N. budget is far worse. Its funding is 
     complicated by diplomatic immunities, spends across 
     international borders, is impossible to audit, and spent by 
     U.N. agencies that levy taxes and fees on each other.
       This amendment to the Veterans' Caregivers Bill reduces the 
     contributions that the United States makes to the United 
     Nations by a sufficient amount to provide caregiver benefits 
     to ALL severely disabled wartime veterans, not just veterans 
     injured after September 11, 2001. The current bill 
     discriminates against veterans injured prior to that as it 
     does not offer the same care it would provide to individuals 
     after that date.
       The national debt just passed $12 trillion and the Congress 
     must pass a debt limit increase. Passing the veterans 
     caregivers bill without having the increased spending offset 
     elsewhere is completely irresponsible and further condemning 
     our grandchildren to a lower standard of living.
     UN tainted with fraud, waste, and abuse
       According to internal U.N. reports, U.N. procurement 
     programs suffer from serious fraud and mismanagement problems 
     that taint almost half of the contracts that were audited. 
     The report from the U.N. procurement task force found that 
     43% of UN procurement investigated is tainted by fraud. Out 
     of $1.4 billion in contracts internally investigated, $630 
     million were tainted by ``significant fraud and corruption 
     schemes.''
       The U.N. Environment Program spends over $1 billion 
     annually on global warming initiatives but there is almost no 
     auditing or oversight being conducted. The U.N. Environment 
     program has one auditor and one assistant to oversee its 
     operations. According to the task force it would take 17 
     years for the auditor to oversee just the high-risk areas 
     already identified in UNEP's work.
       The United Nations Human Settlements program, knows as UN-
     Habitat, only has one auditor, and it would take him 11 years 
     to cover the high-risk areas alone. In cases where the U.N. 
     auditors and investigators found evidence of administrative 
     malpractice, the U.N. management has taken little if any 
     action. For example, the managers of the U.N. Department of 
     Economic and Social Affairs abused a $2.6 million trust fund 
     given by the government of Greece. The U.N. auditors 
     recommended that the program repay Greece, but so far, the 
     U.N. has ignored this recommendation.
       The U.N. spends $85 million annually for its Public Affairs 
     Office, the sole purpose of which is to promote a positive 
     image of the international body. Further, the $1 billion U.N. 
     Foundation is devoted, in part, to pro-U.N. advocacy efforts 
     all over the world.
     United Nations peacekeeping operations
       U.N. peacekeeping operations plagued by rape and sexual 
     exploitation of refugees--In 1994, a draft U.N. report was 
     leaked detailing how peacekeepers in Morocco, Pakistan, 
     Uruguay, Tunis, South Africa and Nepal were involved in 68 
     cases of rape, prostitution and pedophilia. The report also 
     stated that the investigation into these cases is being 
     undermined by bribery and witness intimidation by U.N. 
     personnel.
       In 2006, it was reported that peacekeepers in Haiti and 
     Liberia were involved in sexual exploitation of refugees.
       In 2007, leaked reports indicate the U.N. has caught 200 
     peacekeepers for sex offenses in the past three years ranging 
     from rape to assault on minors. In all of these cases, there 
     is no known evidence of an offending U.N. peacekeeper being 
     prosecuted.
       Just this month, Human Rights Watch reported that Congolese 
     armed forces, supported by U.N. peacekeepers in the eastern 
     Democratic Republic of Congo have brutally killed hundreds of 
     civilians and committed widespread rape in the past three 
     months in a military operation backed by the United Nations.
       Most of the victims were women, children, and the elderly. 
     Some were decapitated. Others were chopped to death by 
     machete, beaten to death with clubs, or shot as they tried to 
     flee.
       The UN peacekeeping mission provides substantial 
     operational and logistics support to the soldiers, including 
     military firepower, transport, rations, and fuel.
       The attacking Congolese soldiers made no distinction 
     between combatants and civilians, shooting many at close 
     range or chopping their victims to death with machetes. In 
     one of the hamlets, Katanda, Congolese army soldiers 
     decapitated four young men, cut off their arms, and then 
     threw their heads and limbs 20 meters away from their bodies. 
     The soldiers then raped 16 women and girls, including a 12-
     year-old girl, later killing four of them.
       The U.S. now pays 27% of all UN peacekeeping operations. 
     Reducing our contribution to these wasteful efforts could 
     help ensure that UN peacekeepers are not funding widespread 
     rape and exploitation of refugees.
     U.N. wastes millions in funds for critical Afghan 
         presidential election
       The United Nations cannot account for tens of millions of 
     dollars provided to the troubled Afghan election commission, 
     according to two confidential U.N. audits and interviews with 
     current and former senior diplomats.
       The Afghan election commission, with tens of millions in 
     U.N. funding and hundreds of millions in U.S. funding, 
     facilitated mass election fraud and operated ghost polling 
     places.
       ``Everybody kept sending money'' to the elections 
     commission, said Peter Galbraith, the former deputy chief of 
     the U.N. mission in Afghanistan. ``Nobody put the brakes on. 
     U.S. taxpayers spent hundreds of millions of dollars on a 
     fraudulent election.'' Galbraith, a deputy to the senior U.N. 
     official in Afghanistan, was fired last month after 
     protesting fraud in the elections.
       As of April 2009, the U.N. spent $72.4 million supporting 
     the electoral commission with $56.7 million coming from the 
     U.S. Agency for International Development. The Special 
     Inspector General for Afghanistan Reconstruction states that 
     the United States provided at least $263 million in funding 
     for the election.
       In one instance, the United Nations Development Program 
     paid $6.8 million for transportation costs in areas where no 
     U.N. officials were present. Overall the audits found that 
     U.N. monitoring of U.S. taxpayer funds was ``seriously 
     inadequate.''
     Oil for Food
       In 1996, the United Nations (UN) Security Council and Iraq 
     began the Oil for Food program to address Iraq's humanitarian 
     situation after sanctions were imposed in 1990. More than $67 
     billion in oil revenue was obtained through the program, with 
     $31 billion in humanitarian assistance delivered to Iraq.
       The Oil for Food program had weaknesses in the four key 
     internal control standards--risk assessment, control 
     activities, information and communication, and monitoring--
     that facilitated Iraq's ability to obtain illicit revenues 
     ranging from $7.4 billion to $12.8 billion. In particular, 
     the UN did not provide for timely assessments to address the 
     risks posed by Iraq's control over contracting and the 
     program's expansion from emergency assistance to other areas.
       According to GAO, the Oil for Food program was flawed from 
     the outset because it did not have sufficient controls to 
     prevent the former Iraqi regime from manipulating the 
     program.
       GAO identified over 700 findings in these reports. Most 
     reports focused on U.N. activities in northern Iraq, the 
     operations of the U.N. Compensation Commission, and the 
     implementation of U.N. inspection contracts. In the north, 
     OIOS audits found problems with coordination, planning, 
     procurement, asset management, and cash management. For 
     example, U.N. agencies had purchased diesel generators in an 
     area where diesel fuel was not readily available and 
     constructed a health facility subject to frequent flooding. 
     An audit of U.N.-Habitat found $1.6 million in excess 
     construction material on hand after most projects were 
     complete. OIOS audits of the U.N. Compensation Commission 
     found poor internal controls and recommended downward 
     adjustments totaling more than $500 million.
     UN headquarters renovation
       In 2008, the United Nations began construction associated 
     with its Capital Master Plan (CMP) to renovate its 
     headquarters complex in New York City. As the UN's host 
     country and largest contributor, the United States taxpayer 
     has a vested interest in the way funds are spent in 
     renovating these buildings.
       The United Nations headquarters renovation, now estimated 
     to cost $2 billion from its original $1.2 billion price tag, 
     was found to be almost $100 million over its budget before 
     breaking ground on the project. Part of

[[Page S11543]]

     the cost increase is due to previously hidden ``scope 
     options'' for ``environment friendly'' options like planting 
     grass on the roof and electricity-producing wind turbines.
       First, the U.N. failed to adequately maintain its complex 
     after 50 years of deterioration and decay. The U.N. paid 
     millions of dollars to an Italian design firm that had to be 
     fired under intimations of corruption after never producing a 
     single workable plan for the renovation project.
       The UN renovation project is just another example of UN 
     spending out of control. The UN's purported $2 billion 
     renovation budget includes over $550 million for expected 
     increased costs and other ``contingencies.''
       U.S. Taxpayers are responsible for at least $485 million in 
     the renovation of the U.N. buildings. However, this figure is 
     likely to rise as GAO has assessed that there exists a high 
     risk that the project will cost much more than anticipated.
       Unfortunately, the U.N. renovation program is carried out 
     by the same system responsible for the Oil-for-Food scandal. 
     The U.N.'s own internal audits suggest that the entire 
     procurement system is plagued by corruption.
       The current cost of the UN renovation is as follows: $890 
     million for construction, $350 million budgeted future 
     escalation in costs, $200 million ``contingencies,'' $75 
     million for redundancies (extra generators, additional fiber 
     optic lines, etc), $40 million ``sustainability'' (wind 
     turbines, grass on roof, etc).
     UN European ``palace'' renovation
       In addition to housing a massive bureaucracy in New York, 
     the United Nations also keeps a European headquarters, in 
     scenic Geneva, Switzerland. The similarity is striking, as 
     this 70 year old building that used to house the League of 
     Nations is reportedly in need of a billion dollars to fully 
     renovate the ``Palais de Nations,'' as the U.N. building is 
     known, because the building suffers from 70 year old wiring, 
     fire hazards, rusty pipes, asbestos, and a roof caving in.
       For cost comparison, $1 billion could build 407,244 square 
     meters of office space in Geneva. That's one and a half times 
     the size of the Empire State Building, and five times the 
     size of the main building at the Palais des Nations.
       Keeping the Palais des Nations could cost more than double 
     what it would take to build a new home from scratch.
       That $1 billion, relief groups said, is also larger than 
     the entire humanitarian action appeal for all countries 
     served by UNICEF, the United Nations Children's Fund, which 
     requested $850 million to address 39 humanitarian emergencies 
     around the world in 2008.
       $1 billion could also go a long way to feed the hungry. 
     Oxfam America reports on its Web site that ``$1,000 brings 
     potable water to 22 families in the Rift Valley of 
     Ethiopia,'' and that ``$20 buys enough maize to feed a family 
     of four'' there for six months--enough food and water to feed 
     millions and flood the valley.
       The Director General in Geneva renovated his office this 
     year, though the U.N. would not say how much the changes cost 
     and did not specify whether a member state paid for the work. 
     A spokeswoman said that his office was often overheated by 
     the sun, and he had an air conditioner installed to cool it.
       As the United States is responsible for 22% of the U.N.'s 
     budget, it is entirely reasonable to expect that the U.S. 
     taxpayer would be responsible for at least $220 million in 
     the renovations of the U.N.'s Geneva offices.
       Any major work on the Palais de Nations would likely come 
     after the $1.9 billion renovation of the U.N.'s New York 
     headquarters is complete, which is at least 4 years away 
     barring further delays. The director general's figure of one 
     billion dollars isn't on the U.N. budget yet and is an 
     estimate that would have to be evaluated by a team of 
     architects.
     Largest money grab in U.N. history while ignoring reforms
       Despite these and the dozens of other examples of U.N. 
     mismanagement and fraud and exhortation by the U.N.'s largest 
     donor, the United States, the U.N. refuses to stop wasting 
     U.S. taxpayer dollars. Instead, the U.N. is receiving even 
     increasing amounts of new funding from the U.S. and other 
     donors.
       According to the State Department, the U.N. 2008/2009 
     biennial budget represents the largest increase for a funding 
     request in the U.N.'s history.
       The 2008/2009 UN budget is in excess of $5.2 billion. This 
     represents a 25% jump from the 2006/2007 budget that was only 
     $4.17 billion and a 193% increase from the 1998/1999 budget.
       The overwhelming majority of the U.N. budget goes to staff 
     salaries and common staff costs including travel to resorts 
     to discuss global warming--rather than direct humanitarian 
     assistance or conflict prevention.
       The U.N. has never identified offsets in existing funding 
     in order to pay for new U.N. spending, a position that is 
     supported by a U.N. General Assembly resolution.
       Following the U.N. Secretariat's poor example, the \3/4\ of 
     the U.N. not covered by the U.N. budget have experienced 
     massive budget growth due to a complete inability to control 
     spending. Peacekeeping is growing by 40%, the U.N. tribunals 
     by 15% and numerous other Funds and Programs are no better 
     off.
     The State Department is willfully ignoring the law in 
         reporting transparency on U.S. contributions to the 
         United Nations
       The U.S. taxpayer should not give billions in funding to 
     the United Nations and then be refused basic information 
     about that contribution. The Office of Management and Budget 
     and the State Department are willfully ignoring the law 
     regarding congressional reporting requirements for U.N. 
     contributions.
       In the National Defense Authorization Act of 2007 and the 
     National Defense Authorization Act of 2010, the Director of 
     the Office of Management and Budget (OMB) is now required by 
     law to report annually to Congress the total cash and in-kind 
     contributions to the U.N. from the United States. OMB has 
     passed this responsibility to the State Department, and 
     unfortunately, our lead agency on U.N. matters ignored this 
     law in 2007, and when it finally provided the required 
     funding reports in 2008, it appears that the reports are 
     missing over $1 billion worth of funding information. The 
     State Department has not submitted its report for 2008.
     Ranking Member Ileana Ros-Lehtinen of House Foreign Affairs 
         Committee comments on the U.N. lobbying for more 
         contributions from the U.S.
       ``Last year, American taxpayers ponied up nearly $5 billion 
     for the UN system. The U.S. is by far the world's largest 
     donor to the UN. The U.S. provides other assistance for 
     peacekeeping operations. The U.S. responds to emergency 
     appeals. We are always on deck.
       ``Yet, the head of the UN comes to Congress and scolds us 
     for not doing enough? He demands yet more money from us while 
     making little progress in cleaning up the badly-broken UN?
       ``The UN's ineffectiveness is not from a lack of cash, but 
     the result of a corrupt system which wastes money and 
     apologizes for dictatorships.
       ``The UN has been hijacked by a rogues' gallery that uses 
     our funds to undermine peace and security. Dictatorships use 
     the Human Rights Council and Durban 2 conference process to 
     restrict universal freedoms and protect extremists. The UN 
     Relief and Works Agency (UNRWA) aid violent Islamists and 
     partners with money-laundering banks under U.S. sanctions or 
     under U.S. investigation for financing Islamist militants. 
     The UN Development Program (UNDP) pays the legal fees of its 
     corrupt officials but refuses to protect whistleblowers.
       ``While Iran, Syria, and North Korea endanger the entire 
     world, the UN is preoccupied with condemning democratic 
     states like the U.S. and Israel.
       ``The American people are facing serious economic 
     challenges here at home. How can a morally bankrupt UN ask 
     our taxpayers to bail them out?''

  Mr. COBURN. Mr. President, I will finish and give the chairman the 
last word. What the chairman and his committee are attempting to do is 
honorable. It is the right thing to do to help our veterans and to 
secure and help those who are helping our veterans. I agree. However, I 
don't agree that we ought to do that on the backs of our children. I 
think we ought to do it on our backs. We ought to carry that load. Our 
children and our grandchildren should not have to carry that load. We 
ought to be forced to make the sacrifices to pay for the sacrifices 
they have made for us. This bill does not do that.
  This bill takes the easy route. It says you do not have to pay for 
it, it is not required. There is not anything we can get rid of, after 
I offered all these options to the committee in terms of what they 
could get rid of that would pay for it.
  If we don't pay for it from what I offered, then get rid of our own 
earmarks, the things that make us look good. We chose to keep our 
earmarks and charge it to our grandkids. It is a wonderful choice and a 
wonderful thing for the American people to see.
  On this vote, they are going to see three things. They are going to 
see all the people who voted to keep their earmarks vote against this 
amendment. The first thing they are going to say is: My earmarks are 
more important than paying for veterans, caregivers, and everything 
else expanded in this bill.
  The second thing they are going to see is that we do not have the 
courage to take on fraud, waste and abuse and lack of transparency at 
the United Nations. They are going to see us fail to live up to the 
expectations they have for us.
  Everybody in America knows we are in trouble financially. They know 
the Federal Government is too big. They know the Federal Government is 
inefficient. They know we can do better. They are just wondering when 
we are going to start. When will it start? When will be the first time 
we make a hard choice? I regret it is not going to be on this bill 
because it is symbolic. If there ever was a bill on which we should 
start to make the hard choices, it should be on a bill that honors and 
takes care of the people who have made hard choices for us, the people 
who have sacrificed their lives and their future and their families for 
us.

[[Page S11544]]

  The third thing, regrettably, that they are going to see is that we 
are going to continue to play the game the way it has been played: Get 
the votes to defeat the amendment; we will take a little bit of heat; 
maybe somebody will notice. I will guarantee you, 20 years from now, 
our kids are going to notice, our grandkids are going to notice.
  One final thought. If you are under 25 in this country, pay attention 
to me right now. If you are under 25--there are 103 million of you. 
Twenty years from now, you and your children will each be responsible 
for $1,919,000 worth of debt of this country for which you will have 
gotten no benefit--none. The cost to carry that will be about $70,000. 
That is not per family, that is per individual. The cost to carry that 
will be about $70,000 a year before you pay your first tax.
  Ask yourself if you think we are doing a good job when we are going 
to take away your ability to get a college education, we are going to 
take away your ability to educate your children, when we are going to 
take away your ability to own a home, and we are going to take away 
your ability to have the capital formation to create jobs in this 
country. Watch and see. That number is going to grow every time we do 
something like this without paying for it, without offsets, without 
getting rid of something less important.
  I yield back the time and yield the remainder of my time to the 
chairman of the committee.
  The PRESIDING OFFICER. The Senator from Hawaii is recognized.
  Mr. AKAKA. Mr. President, I wish to make a point of clarification. 
This bill, the pending measure, is made up of two bills which is now S. 
1963. It was S. 252, which was reported in July, and S. 801, which was 
reported in mid-October. Both bills were held at the time they went 
onto the calendar. No amendment was prepared to either bill. The first 
amendment was proposed on Monday of this week, 2 weeks after the bills 
were combined as S. 1963.
  In closing, the debate about the United Nations is not one which 
belongs on a veterans bill. The underlying bill is a bipartisan 
approach to some of the most urgent issues facing all veterans--for 
women veterans, for homeless veterans, to help with quality issues, to 
help rural veterans.
  This bill, by the way, also includes construction authorization for 
six major VA construction projects already funded by the VA spending 
bill.
  I urge our colleagues to reject the amendment to S. 1963.
  Mr. AKAKA. I yield back my time.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER (Mr. Franken). The clerk will call the roll.
  The bill clerk proceeded to call the roll.
  Mr. LEAHY. 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. LEAHY. I thank the Chair.

                          ____________________