Congressional Record, Volume 160 Issue 145 (Tuesday, December 2, 2014)

[Congressional Record Volume 160, Number 145 (Tuesday, December 2, 2014)]
[House]
[Pages H8267-H8272]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

ALZHEIMER'S

The SPEAKER pro tempore (Mr. Bridenstine). Under the Speaker's
announced policy of January 3, 2013, the gentleman from California (Mr.
Garamendi) is recognized for 60 minutes as the designee of the minority
leader.
Mr. GARAMENDI. Mr. Speaker, tonight, I want to spend some time with
my colleagues discussing something that we actually can do for every
American family, something that the Congress of the United States can
take action on soon, like this week, when we pass our appropriations
bill or, perhaps, next week if we fail to get the job done this week.
We can help every American family tomorrow, the next day, and on into
the years out ahead if we take action. The subject matter of tonight is
about an issue that affects every American family wherever you are out
there--my own family, your family, the families of my staff, perhaps
even the families of those who are working with us tonight.
This is an illness. This is an illness that has become the most
expensive and will soon become the most pervasive illness in America.
It is Alzheimer's. It is dementia associated with Alzheimer's. It is a
devastating illness.
It is one that robs individuals of their mental abilities. It robs
them of their memories of their families, of their work, of their
lives. It confuses and muddles their thoughts, and eventually, it will
destroy that individual, so tonight, we talk about Alzheimer's.
Is there anyone out there, any family, any individual, who hasn't
seen this illness? I think we all have.
Let's get into it in some detail. A little later, as my colleagues
join us, we will continue the discussion and talk about what we can
do--your Representatives. There are 535 of us--435 here in the House of
Representatives from every part of this Nation and from every walk of
life and from every community, and there are the 100 Senators from
every State. Let's use some of these charts to see if we can get a
better fix on what we are actually facing here in America.
Let's see. Alzheimer's is the most expensive disease in America. One
in five Medicare dollars is currently spent on people with Alzheimer's,
20 percent of every Medicare dollar. In fact, the total cost of
Alzheimer's today--this year, 2014--is over $215 billion--a quarter of
a trillion dollars. More and more of that money will come from Medicare
as the baby boom population begins to move into its more senior years.
This illness is not just found in seniors. We are also learning about
the early onset of Alzheimer's, men and women in their thirties and
forties--early Alzheimer's. Of course, it extends on, mostly in the
more senior population, 60-65 and above.
This is an illness that is also associated with genetics. If you have
Alzheimer's in your family, there is a higher probability that you will
have Alzheimer's yourself, but it is also an illness that is associated
with brain damage that can occur from concussions.
I think we have all heard about the National Football League players
who have suffered with one form of dementia or another and who have
died early because of it. We also know that traumatic brain injuries
are the most common injuries found among our troops who have returned
from Afghanistan and Iraq.
Alzheimer's, it is there. It is very expensive.
What can we look forward to in the future? Let's see. This is
Medicare and Medicaid--the Federal Government expenditures--not the
family expenditures, not the expenditures by health insurance
companies. This is just the Federal Government.
Today, it is about $122 billion. By the end of this decade, it will
be $195 billion. As this wave of baby boomers passes through our
demography and through our society, we expect, by the year 2050, that
the Federal Government will be spending over $880 billion--$120 billion
short of $1 trillion--on this illness, and this may be just two-thirds
of the total cost. Well over $1.2 trillion will be spent in about 35
years on this illness.
Do you want to bust the budget? Do you want to see the deficits of
America soar almost uncontrollably? Then look to Alzheimer's and
dementia and the effect that they will have on the Federal budget
deficit. Pay attention to these numbers because these numbers are the
story of the American Federal budget and of the personal budgets of
families across this Nation--Alzheimer's and dementia, $880 billion of
Medicare and Medicaid money by 2050.
There is another way of looking at it. It is a different graph but
the same story. The already high cost of Alzheimer's will skyrocket as
the baby boom moves through the population. There it is: the same
numbers, the same graph, the same extraordinary challenge facing
America.
I should also mention that this is not just an American issue; this
is an issue for every advanced economy in the world. If you are able to
avoid the childhood illnesses--the illnesses that kill so many in the
developing world--then those economies that have advanced to the more
developed economies face the exact same population surge and costs
associated with Alzheimer's and dementia.
What can we do about it? We can actually do a lot. I suspect, if you
are looking at this on your TV screens or are here in the audience, you
really only see the green line. This speaks of the treatment for
Alzheimer's: today, $250 billion by Federal and local and private.
On this one over here is research, treatment versus research. It is
the old adage: You spend it now or spend a lot more later. A penny
saved is a penny earned.
What does research amount to? I have to pull this up close--oh, here
it is. We are spending $122 billion to $150 billion or so of Federal
and State money. What are we spending on research? $566 million.
Billions? Millions? What does research amount to? It actually works.
Research actually will solve problems, medical research.
How long have we been at polio? I remember growing up around the
issues of polio. It was very common in our communities, then some money
was spent on research and a polio vaccine. You don't see polio in our
communities anymore.
The research worked with the development of the Salk vaccine,
followed by other vaccines to treat polio. It is essentially wiped out
in America. It only exists in a few very isolated places in the world.
If we were to spend the money on a vaccination in those areas, we would
see polio disappear from our world. The same thing happened with
smallpox.
I want to show you something more of today. Let's look at the
research budgets for those programs that are active today: investments
in health research at the National Institutes of Health, $2,014; cancer
research, $5.4 billion on cancer research.
Enough? Probably not. We probably could and should spend more on
cancer research. Should we do so, I would suspect that we would see
even more success in treating cancer in its earliest stages.
HIV/AIDS, nearly $3 billion on HIV/AIDS--have we solved the problem?
No, but we have certainly figured out how people can live with HIV/
AIDS, and we are probably going to see a vaccine sometime in the near
future. This is what we are currently spending--nearly $3 billion--on
HIV/AIDS.
Cardiovascular issues--stroke, heart attacks, other kinds of
cardiovascular illnesses--just around $2 billion or slightly more is
spent on that.
The most expensive, the most prevalent of all of the illnesses is
Alzheimer's, $566 million. It's not billions--not $2 billion, not $3
billion, not $5.5 billion--but $566 million.
What is the result of all of this? What does it mean when you spend
this kind of money on research? It really means something very good
happens, that something really, really good happens when you spend
money on research. With polio research and a polio vaccine, polio is no
longer found in the United States.

[[Page H8268]]

Let's look at these major illnesses. What does it mean? What does it
mean when we spend money on cancer research? Let's take a look here at
deaths from major diseases and the change in the number of deaths from
2000 to 2012: breast cancer down 2 percent, prostate cancer down 8
percent.
What happens when you spend $5.5 billion a year on cancer research?
Cancer deaths fall--success. On heart disease--cardiovascular
illnesses--we spend about $2 billion a year, and we see heart disease
dropping by some 16 percent. That is deaths from heart disease dropping
by 16 percent and stroke dropping by 28 percent.

{time} 1730

So what is the use of research? Well, if you want to live, it is a
pretty good thing to spend money on, particularly if you are thinking
about getting cancer or any of the cardiovascular illnesses: heart
disease, stroke, heart attacks and the like.
HIV/AIDS, do you remember that number? HIV/AIDS, nearly $3 billion
was spent on HIV/AIDS, and deaths from HIV/AIDS are down 42 percent in
the United States.
So what does it mean when you spend money on research? It means
really good things for Americans, and around the world a similar
result. You spend that money on the research dealing with these major
illnesses, and you will see the death rates drop all across this
Nation.
HIV/AIDS is down by 42 percent, spending $3 billion a year;
cardiovascular, $2 billion a year.
And this purple line over here, what happens when you spend $566
million a year on research for Alzheimer's? Alzheimer's deaths from
2000 to 2010 were up, increased by 68 percent. There is a story here.
There is a lesson here. There is something that 535 of your
Representatives, the American people's Representatives, should be
paying attention to; and that is, if we want to deal with the most
devastating, the most expensive, and, increasingly, the most common
illness in America--the one that always will lead to death, the one for
which there is no cure presently, the one for which there is not the
kind of support needed for those people that suffer from Alzheimer's--
then and we had better start talking about solutions. Research is a
part of it.
How much do we think could be spent this year in the appropriation
bills that are now coming before us? What if we were to add $200
million, about a 40 percent increase? What would it mean? It means that
we will probably, over the next couple of years, begin to see profound
knowledge about the human brain, about how it functions, about the
diseases of the human brain, and about how we can attack Alzheimer's.
I don't expect it to be done in 2 years, but I know that out there,
in the mind institutions at the University of California-San Francisco,
University of California-Davis, down at UCLA and in other research
institutions around this Nation, we are learning how the brain
functions. We are learning about the diseases of the brain. And if we
were to invest this year an additional $200 million, we would see a
flourishing of knowledge. And maybe, maybe in one of those research
institutes, they would find the key to solving the Alzheimer's puzzle.
And if they were to do so, we would see a profound reversal in these
numbers; and this blue dramatic increase of 68 percent more deaths from
Alzheimer's over the last decade, we would see that reverse, and
hopefully we would see it go down.
I would like to continue our discussion here with my colleagues. I
have noticed that my colleague from California, Jackie Speier,
representing the Peninsula, has arrived.
I think your district comes very close to that great research
institution, the University of California-San Francisco. I am not sure
if it is in your district, but I know it is on the border of your
district, if not in your district.
Ms. Speier, if you would join us to talk about this issue, I know it
has been on your mind and in your heart. You have been a leader in
California and back here in Washington on this issue. So thank you so
very much for joining us in our discussion about the most prevalent and
the most expensive of all diseases in America.
Ms. SPEIER. I thank the gentleman from California.
You are right. For more than 25 years, I have actually represented
UCSF in the State legislature and then here in Congress, except as a
result of reapportionment in the last 2 years. So I no longer
technically represent the institution.
Mr. GARAMENDI. Well, I get to represent the University of California-
Davis, and it is in my district, although the hospital and the research
center are not. So I guess we share the same sadness.
Ms. SPEIER. Yes, and the same real joy in knowing that there is
extraordinary research going on at both of those institutions.
I thank the gentleman for drawing such laser focus on the issue of
Alzheimer's disease and why it is, in fact, the number one most
prevalent disease in this country.
I brought down this Alzheimer's Association sash that many of us wore
when our constituents came into town, pleading with us to do more about
Alzheimer's research. Many of us took pictures with them and said, yes,
we are very supportive, but it is really time for us to put our money
where our mouth is. It is not good enough to wear a purple sash and say
that you are supportive of Alzheimer's research when, in fact, what we
are spending in terms of Alzheimer's research is so much less than it
is with every other disease.
As you were pointing out with your chart--I have a very similar chart
as well--we are spending $566 million a year on Alzheimer's disease.
Good. There is no question about it. But it is not good enough. It is
not good enough in comparison to what we are spending on cardiovascular
disease, on HIV/AIDS, or on cancer--$5 billion, $5.5 billion on cancer
research.
But let's talk about the big elephant in the room. I mean, we already
know that we are not spending nearly as much money on Alzheimer's
research as we are on other conditions and we need to pump that up, but
let's talk about the elephant in the room. The elephant in the room is
not the Republican elephant. It is the elephant on the issue of
Alzheimer's.
Why is it so important for you and me and every American to be
concerned about Alzheimer's research? Because it is going to choke us
financially in a very short period of time. We are now spending about
$214 billion a year on the cost of health care. Now, that is $150
billion in costs for Medicare, and then another $37 billion in costs
for Medicaid.
So it is costing us a lot of money today, but the real choker is how
much it is going to cost us in 2050. In 2050, it is going to cost us
over $1.2 trillion. So we owe it to our families, we owe it to our
constituents; we owe it to the American people, we owe it to the
Medicare system and the Medicaid system to find a cure or find a way to
early detection and then to slow the process of this particular
disease.
Now, in my county, we have about 15,000 people living with
Alzheimer's right now and more than 45,000 caregivers. Nationally, in
2012, 15.5 million caregivers provided an estimated 17 billion hours of
unpaid care, valued at $220 billion, which brings me to my next point,
and it is about women.
This issue is a women's health issue. Now, it is true that women--60
percent of Alzheimer's and dementia caregivers are women. They are
often unpaid in providing those services. But nationally, a woman in
her sixties has an estimated lifetime risk for developing Alzheimer's
of something like 1 in 6. For breast cancer, what we have been so
focused on, it is 1 in 11.
Here is the most stunning figure of all. Two-thirds of the 5 million
seniors with Alzheimer's disease in this country are women. Two-thirds
are women. So this is, indeed, a women's health issue and one that we
have to take very seriously.
So with that, Mr. Garamendi, I know you have other participants in
this, and I thank you for yielding.

Mr. GARAMENDI. Thank you very much, Ms. Speier. I really appreciate
you bringing the women's issue to this.
The last 3 years of my mother-in-law's life were spent in our home as
she went through the process of Alzheimer's. And it is, indeed, a
women's issue. Two-thirds, as you say, are women. And we experienced
that. Fortunately, for us, it worked out very well for us and our
family.
But we are not unique, and while our experience was sad but good in
some

[[Page H8269]]

ways, that is not always the case. This is a huge, huge burden. Not
only are the women the ones who suffer, but the women are often the
ones who care for those who have it.
So I thank you so much.
I notice my friends from the east coast have joined us. We often do
an east-west thing here. My two friends are debating who is going to go
first.
Mr. Fattah, why don't you go first, and we will go from there.
Mr. FATTAH. Thank you. I appreciate that.
We were together just recently in your district at the Staglin
Scientific Symposium, focusing on some of the challenges related to
diseases and disorders of the human brain. This issue that you raise on
the floor tonight is the most dominant challenge that we face in terms
of a degenerative brain disease.
It is not by accident that Prime Minister David Cameron, when leading
the G7, said that dementia was the world's global challenge. It is not
by accident that here in our own country we have created, through the
great work of Members like yourselves and others, a major focus now on
Alzheimer's as one of the brand-name dementias that has affected
millions of Americans and will affect millions going forward.
I have led an effort in the appropriations process focusing on the
human brain, both mapping the brain and challenging and chasing cures
and treatments for diseases. This neuroscience initiative, Fattah
Neuroscience Initiative, has been focused on the fact that these 600-
plus diseases of the brain affect over 50 million Americans; but there
is none more costly than Alzheimer's, none that are affecting more
families than Alzheimer's. And it is so important.
We just had an incident the other day of a very prominent restaurant
owner here in Washington who was said to have gone missing in New York
City because she is suffering from this disease.
I was happy to be at the launch of the Give To Cure effort, which is
an effort to build support so that the ``valley of death,'' as it is
called, in terms of major research that needs to go forward to clinical
trials, working with my good friend Rafi Gidron from the Israel Brain
Technologies and so many others.
This morning I met with the new president of Cal Tech and talked
about the efforts there at a great university in your State, and they
received well over 10 percent of the initial awards in the BRAIN
Initiative from NIH because of the leading research. I have been--and
some of the people think I may have some designs on retiring to
California. I have spent some time there now with Stanley Prusiner, who
is a Nobel laureate in neurology. He was the first one working with
people like Virginia Lee and John Trojanowski to begin to really
understand the early formation of this disease and how it affects
people.
I want to talk just for a minute about how this affects families--and
then I will yield--not about the science of it. There are significant
scientific hurdles, with over 100 billion neurons, tens of trillions of
connections. We do not now know how the brains of human beings work,
but we don't have a good understanding yet of how the brains of much
smaller insects or animals actually function. This is a great
scientific challenge. I think it is the most important frontier for all
of science to focus on, and that is why I am so dedicated to it.
When it comes to families--and I heard you speak about your own--this
is something that has a tremendous impact. And dementia is something
that, as people are healthier, their bodies are healthier, their brains
are degenerating. We are going to face more and more of this.
We had a former Speaker of the House, Newt Gingrich, talk about, if
we could just reverse for a few years the onset of Alzheimer's, it
could save our country trillions of dollars. But put the dollars aside.
What this is really about is valuing families and understanding that as
much as science is something that we all take a great interest in, that
what should focus us is to make sure that our scientific endeavors are
focused on how to improve the life chances of the people who we
represent.

{time} 1745

So the World Health Organization says there are a billion people
worldwide, NIH says 50-plus million Americans suffering from brain
illnesses. We know that you have your finger on the pulse, Mr. Speaker,
and I thank you for conducting this Special Order.
I know that so many members want to participate, I am going to now
yield back my time, but you can count on us as we go forward to
continue to work with you and to work with the pharmaceutical industry
and to work with our academic enterprises, and we are going to have
even more success going forward not just in finding treatment but we
have to put as our goal finding a cure. So thank you.
Mr. GARAMENDI. Thank you so very much, Mr. Fattah, and thank you for
your role on the Appropriations Committee trying to move the money into
this research so that we can address this. You mentioned the Staglins
out in California and their project, which is the One Mind project, our
former colleague Mr. Kennedy involved in that project, trying to pull
together the research from around the world and here in the United
States specifically, so that there is a sharing of knowledge back and
forth from these various research centers, so that the synergy would
come from the knowledge that may exist at Cal Tech or New York, which
we will undoubtedly hear about in a few moments, or in your country out
in Pennsylvania.
Mr. FATTAH. If the gentleman would yield for just a second.
Mr. GARAMENDI. Sure.
Mr. FATTAH. I met just a few days ago with Henry Markram with the
European Human Brain Project, where the EU has put now a billion-and-a-
half euros on the table to help with the mapping of the brain. One of
the things that we talked about and what is clear is that we have to
bring these global efforts together and connect them. This is not about
one researcher somewhere discovering the solution to this. This is
going to take a combined effort, and we have to have a certain urgency
about it, and we have to demand that it be done now. Thank you.
Mr. GARAMENDI. Well, thank you so very, very much. I am going to turn
to my colleague from our normal East-West dialogue here that we have
done so many days, so many times over the last few years.
Mr. Tonko, thank you so very much for joining us once again as we
talk this time about--we usually talk about jobs and the economy and
how we can build it, but this time we are talking about Alzheimer's, so
please.
Mr. TONKO. Well, thank you, Representative Garamendi, for leading us
in a very important discussion during this Special Order. There is no
denying that all of us, Members of the House and beyond, if you are to
ask individuals out there across this country if Alzheimer's or
dementia issues have impacted their family, the immediate response is
absolutely.
I think all of us have been touched by those devastating impacts,
those outcomes that befell our loved ones, and the ripple effect onto
that circle of family and friends. It is devastating. You in a sense
lose that individual, and it is a very painful process certainly for
those individuals living with Alzheimer's and dementia, and for their
immediate families and loved ones and caregivers who watch as they
painfully travel the journey with those individuals. So I think for us
to take that human element, that impact and that dynamic, and put it
into working order, we would be well served to acknowledge that
Alzheimer's is the most expensive disease in America. It is driving
bankruptcy if it goes unaddressed. And when one in every five Medicare
dollars is spent on a person with Alzheimer's or dementia, the warning
signals should be out there for sounder budgeting, to put our focus on
a cure, on research, on developing those opportunities that will bend
the cost curve, so to speak, that will enable us to address with
dignity and common sense and economic sustainability the issues of
Alzheimer's and dementia.
The impact upon our culture is so much so the economic drain is at
about $214 billion in 2014. That is an immense economic toll that is
placed upon budgets, be they Medicare, Medicaid, local budgets, or not-
for-profits that make it their goal to best serve individuals,
especially in their elderly years, and to be able to assist in that
effort by advancing the efforts of the study of the

[[Page H8270]]

brain that have been initiated by this President, by President Obama
and his administration, is a very, very worthy investment.
It will tell us much about several diseases out there and allow us to
again approach an issue with dignity and facts at our fingertips that
will then provide for the best prioritization of how to respond to
those issues.
Now, much has been said about research here tonight, and rightfully
so. It is very critical that we, you know, grow the investment on
research. I have participated in our annual town halls that are called
for in the National Alzheimer's Project Act, and that National
Alzheimer's Project Act requires that we gather together to understand
how well the services are coming together, what the needs are, and how
we plan appropriately for ongoing budgets.
There you receive, all of us, the very disturbing testimony that
reaches us, impacts our thinking, and certainly speaks to our hearts
and souls about what we need to do, painful journeys that individuals
have made. I can vividly recall a high school friend mentioning that
her husband no longer knew her name but knew her voice. These are
painful bits of testimony to absorb, and they motivate us. They ought
to motivate us and challenge us to move more quickly in this effort to
fund research and find a cure and find better treatments.
The efforts that I think are important here that follow the National
Alzheimer's Project Act is to put together a more clinical response,
and I think the Alzheimer's Accountability Act, which I have
cosponsored, allows for H.R. 4351 to respond to the Alzheimer's
planning in a way that clinicians and those directly involved in the
service delivery system to the Alzheimer's community, they will advise
what those budgeted amounts should look like in an annual effort from
here to the threshold year of 2025. That is an absolute essential.
I applaud our efforts here in the House with Representative Guthrie
and others--as I said, I am a cosponsor--looking to make certain that
we have a much more accountable, logistic, well-planned, and
professional-driven estimate that will move us forward with each and
every budget year to respond to this crisis in America, and it indeed
is at crisis proportion.
So Representative Garamendi, these are efforts that I think need to
be made. The commitment that starts with the human element, the
compassion that needs to be expressed on behalf of the people of this
country via this House, via Congress, both Houses speaking to a
legitimate request that authorizes the investment in research, that
puts together a plan that is run by clinicians that advise the United
States Government as to how to best respond, what those levels, those
thresholds should be from now to the benchmark year of 2025, and to
make certain that we do it all within our professional capacity in
harnessing the resources that are required.
We grow, we cultivate an intellectual capacity in this country of
which we are very proud, and one that should serve us abundantly well,
and it is important to have our hearts and souls measure that
opportunity, to put together the best blueprint for addressing this
crisis. Let's move forward with a sound, resounding commitment of
support to these individuals and their caregivers.

You know, when we look at the statistics out there, one in nine over
the age of 65 is impacted by Alzheimer's, one in three in age category
85-plus. And guess what? That is the fastest-growing age demographic in
our country. So in order to plan and plan well for the onslaught of
baby boomers who will enter into these given demographics, we need to
make commitments, and we need to again bend that cost curve by
investing now in research, preventative therapies, and certainly study
of the brain, efforts that are promoted by the President and the
administration to make certain that we can move forward effectively and
compassionately and allow for the best choices to be made.
So I thank you for leading us in this very important discussion,
Representative Garamendi, and I am convinced that with the facts at our
fingertips and with the elements of compassion and dignity that should
respond to the Alzheimer's community, we can get these important
measures achieved.
Mr. GARAMENDI. Mr. Tonko, thank you so very much for your bringing to
us the information about actions that have already been taken. The
Alzheimer's plan that you discussed lays out a process by which the
National Institutes of Health will develop a program of research, bring
it directly to Congress so that we can then analyze it and hopefully
fund that research. It is the pragmatic way of dealing with it. As you
said, it is based upon a studied step-by-step process to get to the
solution of Alzheimer's.
There is also other legislation. Our former colleague, now Senator
Markey, put together a bill that is called the HOPE Act, and that is
one that would require that Medicare take specific account of
Alzheimer's, and that in the Medicare program, there be a method for
Medicare to fund early diagnosis of Alzheimer's and then the early
treatment. As was said by one of our colleagues earlier, a delay of a
couple of years or 3 or 4 years in the onset of serious Alzheimer's is
extraordinarily beneficial to the individual and to the family, and, in
a larger context, to the budget of the individual family, their
insurance company, as well as the Federal government through Medicare
and Medicaid.
So that program also speaks to the caregiving that is necessary and
Medicare picking this up. It is clearly going to be the illness that
will bust the bank unless we can get ahead of it, and that is where the
research comes into focus and into play. We can do this.
There is another angle to this. I was going to take this up with Mr.
Fattah when he was here. He was talking about other agencies and other
governments that are involved in dealing with this. About a month ago I
had the opportunity to spend about an hour with the new Secretary of
Veterans Affairs, Mr. McDonald, and we were talking about the various
challenges that the Department of Veterans Affairs has dealing with all
of the veterans, and it wasn't long before the conversation turned to
traumatic brain injury and PTSD, post-traumatic stress syndrome, both
of which are illnesses or problems of the human brain.
We were discussing how the Department of Veterans Affairs is dealing
with this. It turns out that they also have a research budget, and we
know that he was unaware of some of the research that was going on both
at the NIH and what Mr. Fattah talked about, the One Mind program that
our former colleague Mr. Kennedy is involved in in pulling together the
research that is available around the world, bringing that research
together so that the synthesis of it could be a much more rapid
solution to the problems that Mr. McDonald faces in the Veterans
Administration dealing with post-traumatic stress illnesses as well as
traumatic brain injury.
So all of these things come together, and in dealing with it,
ultimately we carry a heavy burden of responsibility here in Congress.
Mr. TONKO. Absolutely. You talked too about the caregivers, and it is
theorized that nearly 60 percent of those caregivers who respond to
Alzheimer's patients and those living with dementia are impacted with
tremendous emotional stress, and they rate that as high or very high.
And then of that 60 percent of caregivers, literally one-third is
suffering from some order of depression. So the impacts here continue
to sprawl and cause greater expenditure for those who are doing their
good deed, responding to the needs of loved ones or friends or the
patient population out there, and then they are impacted by this order
of depression.

{time} 1800

It is assumed that has added additional cost to the system of our
health care drain, and that is at $9.3 billion. That estimate goes over
the year of 2013, so it is very easy to begin to do the calculus here
on the cost of status quo, of not responding in deep measure or in wise
capacity, so as to put together the sort of research that we require
and the respite relief programs that are essential.
Having talked to a number of caregivers during my tenure here, now
closing out my third term, but before that in the State Assembly of New
York, I would routinely hear from folks who would deal with these
situations, these family issues in ways that they never imagined would
be possible.

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I know of some spouses that indicated to me that, while they stayed
home full time being the caregiver, they eventually sought employment
and used every bit of that salary that came from that new employment to
go toward the cost of caregivers. Now, they did that in order to save a
relationship.
It was a tremendous emotional drain on their relationship because it
is not easy serving as a caregiver. Individuals have told me, as
spouses, that they have gone out and sought full-time employment and
again passed over that salary to the respite person.
That is the sort of painful pressure under which individuals and
couples--families--are living. It is a very difficult assignment many
have chosen to keep their loved one at home.
There are issues of safety, economic duress, and certainly our system
has to respond to that, so the sooner we set our sights on a cure, on
funding that is adequate and effective for research purposes and for
developing the responsiveness of the medical teams out there, via
perhaps pharmaceutical assistance and development there, the better our
economic situation will be in regard to these struggles.
Here is a chance for Congress to respond in very magnanimous terms
that will allow us to state cumulatively that we get it, that we are
there in order of compassion, that we understand it is about a dignity
factor, it is about quality of life, and it is about providing hope to
situations that may be rendered hopeless.
Isn't that the best element of work that we can do here to bridge
that order of hope to those who have been so stressed and who have been
given a walk in life, a journey that is powerfully painful?
I just appreciate the fact that we are utilizing these opportunities,
such as this Special Order, to bring to the attention of those
concerned with these issues to a laser-sharp focus and to allow for
people to speak out there as the general public in support of measures
that can be taken, of budget appropriations that can be secured, of
opportunities that come in securing the resources essential to go
forward and offer the fullest response that we can.
Again, health care situations are driven by this. There are huge
costs if we don't respond to the needs of individuals living with
Alzheimer's, and then there is that ripple effect that is happening all
too frequently for the caregiver community that is also worn thin
because of this assignment, because of this mission that they embrace.
It is honorable that they do these things, but we also have to work
the system here on the Hill in Washington, to respond to them with a
degree of reverence and common sense and fully acknowledge that there
are efforts that can be made here that bend that cost curve and speak
to the situations at hand in the most effective manner.
Representative Garamendi, I thank you for bringing us together on
this evening of thoughtfulness here concerning dementia and Alzheimer's
as a particular stress.
Mr. GARAMENDI. Thank you, Mr. Tonko, for joining us in this Special
Order hour. Working with you has always been a pleasure. I think this
subject is one that you and I and our colleagues will want to take up
as the days go forward.
In the spring, the 2015 Alzheimer's Day will occur once again here in
Washington, DC. There will be thousands of people coming to Congress,
knocking on our doors, grabbing our lapels, and asking us to pay
attention to this illness.
I want to review some of the costs, and then basically wrap this up.
You talked about home care. There are articles that appeared recently
in The Sacramento Bee about elderly people taking care of each other, a
wife taking care of her husband in their 50th year of marriage with
severe Alzheimer's, the love that is so apparent, but also the
difficulty of an elderly person taking care of another elderly person.
We can address that. That is what the HOPE legislation is all about,
bringing Medicare into this.
The research thing that we talked about earlier, I am going to put up
very, very quickly a couple of charts. This one, what is going to
happen to the Federal budget if we do not address Alzheimer's, it is
$122 billion today; in 35 years or 40 years, we are going to look at
over $800 billion, and that doesn't include the private sector. It is
going to be $1.2 trillion spent on this, so we are going to bust the
budget. If you are a deficit hawk, you should be paying attention to
this.
What do we need to address it? Well, we certainly need care for the
caregivers. We have talked about that. We also need research. The plan
that was in the earlier legislation laying out the Alzheimer's plan
called for an additional $200 million this year on top of the $566
million that we are currently spending.
Keep in mind that, for cancer, it is nearly $5.5 billion; for HIV/
AIDS, nearly $3 billion; and cardiovascular illnesses, just about $2
billion annually spent in research at the National Institutes of
Health.
They are very good, it is very important, and not a nickel should be
taken away from that, but we should add $200 million this year as we
complete the appropriation process right now.
People ask, ``Where can we find the money?'' Well, let's see. We just
said we are going to spend $5.6 billion in Syria and Iraq--new money. I
know that my work on the Armed Services Committee--I am on the
Strategic Forces Subcommittee. We are talking about more than $12
billion over the next 6-7 years rebuilding a nuclear bomb that nobody
knows what to do with.
Maybe there are choices that we can make. Would America be better off
with a new nuclear weapon or rebuilt nuclear weapon, spending $12
billion or so on that, or maybe spending it on Alzheimer's research?
Our work is about choices, Mr. Tonko. How are we going to allocate
the resources of this Nation? My suggestion is we go where every family
in America will be affected, every family, either directly as my family
has been directly impacted by this. My mother-in-law lived with us the
last 3 years of her life, dying at the age of 92; yes, we were
affected.
We know the genetic issues. My grandchildren are looking out there
and saying, ``This is a genetic thing, Papa. What about me?'' So that
worry carries through our family, and I suspect it carries through
every family in America, either directly or indirectly.
Let's make a choice. Let's make a choice to attack with research,
with care, with funding the most expensive, most common, most deadly
illness in America and in other developed countries: dementia and
Alzheimer's.

We can do it. This is not an impossible task. This is simply a task
of focusing like a laser on this issue, and when we do, we will find
the same success that we have seen with heart, cancer, and HIV/AIDS--
not cured, not stopped, but a very significant drop in the deaths
associated with those illnesses.
Mr. Tonko, I have completed my statements tonight. I think you have
another comment.
Mr. TONKO. I would just like to attach my comments to those you have
just closed your statement by.
This bankruptcy that is driven by certain catastrophic situations
with health care costs are impacting far too many families, and this
order of work here in the Congress is about prioritizations. We have
spent trillions on war, and we have really diminished the investment in
domestic programming, including health care.
We come up with all sorts of efforts called sequestration, which is a
hidden attack on investments in our domestic agenda. We have to be
cautious about how we are guiding those priorities that we are
establishing in our budgeting here in Washington, but if we were to
prioritize based on where the public demands are, let me suggest, in
closing, that I have gone to the Alzheimer's walk in my district for
the past several years, and every year, the same statement is made:
``This is the largest crowd ever assembled.''
It keeps growing. It tells me the consciousness of this country, that
we want something done for this dreadful disease, doing something that
will cure individuals who are walking and living with Alzheimer's and
dementia.
The people have asked for this by their participation in local
fundraising events. Is that the way that we respond to a crisis, by
hoping we have good weather on the walk day, that we reach our intended
goal that given year, as people are strapped with expenses of
caregiving and medications?

[[Page H8272]]

There is a better way to complement that, to lead the effort here in
Washington with the research, with the cure that can be found, with the
advancements in the pharmaceutical industry to be able to extend life
and enhance life and the quality of life. That is what I think is so
powerful about the opportunity we have here.
I believe we can be those agents of hope. I do believe firmly that
the priority here is to address this crisis that is devastating our
American families and our economy. Let's go forward and be those agents
of hope. Let's provide for a better tomorrow, and let's show people
that there is a compassion that accompanies the efforts here in
Washington.
Representative Garamendi, thank you for bringing us together on an
important discussion that needs to be followed up with resources and
public policy and certainly prioritization that brings us to the
threshold of responsiveness that is so needed and so deserved and is so
correct.
Mr. GARAMENDI. I thank you very much, Mr. Tonko, for joining us
tonight. I also thank my colleagues, Mr. Fattah from Pennsylvania and
Ms. Speier from California, for joining us on this important subject.
Mr. Speaker, I yield back the balance of my time.

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