[Congressional Record (Bound Edition), Volume 149 (2003), Part 10]
[Senate]
[Pages 13229-13231]
[From the U.S. Government Publishing Office, www.gpo.gov]




                GLOBAL HEALTH AND THE PRESIDENT'S BUDGET

  Mr. LEAHY. Mr. President, I rise to speak on a far more serious 
matter. I listened to the speech the President gave at the Coast Guard 
Academy a few days ago. I must say that this Democrat agrees with so 
many of the things the President said. I was especially pleased to hear 
him speak about the importance of foreign aid to America's security. 
But I became concerned after I looked behind the rhetoric of the 
President's speech. I wanted to see if the President's own budget 
request reflected his words. It does not.
  At the Coast Guard Academy, the President spent a good deal of time 
talking about the global AIDS crisis, the worst public health threat in 
human history. I commend President Bush for that. He has shown great 
leadership on AIDS, although a bipartisan group in Congress has been 
pushing for action on AIDS for years.
  The bill we passed last week, an authorization bill, authorized $15 
billion over 5 years to combat AIDS , tuberculosis and malaria. It is 
an important step forward. It showed that we are beginning to take the 
AIDS pandemic seriously. But before we all applaud ourselves and pat 
ourselves on the back, let's have a dose of reality. This was an 
authorization bill. It does not appropriate any money.
  For all intents and purposes, it is like writing a check without 
enough money in the bank. I can recall a meeting on a different subject 
where someone was offering a pledge of close to $1 billion to fund an 
initiative. Kidding around, I said: I will double that. I will give you 
my check for $2 billion. In fact, I had $138 in a checking account.
  That is what we have done here. By passing the AIDS authorization 
bill, we have promised to write a check without enough money in the 
bank.
  Let me explain. The President's budget request contains only about 
half of the $3 billion authorized for AIDS for fiscal year 2004. It 
remains to be seen whether the promise of that bill--a promise with 
which I agree--will be fulfilled. To do that, the President is going to 
have to submit a budget amendment for the balance of these funds.
  It also remains to be seen whether the Foreign Operations 
Subcommittee will get the allocation that supports that amount.
  The bill we passed also authorized $1 billion for the global fund to 
fight AIDS and TB and malaria. Again, another promise. For fiscal year 
2004, the President has only budgeted $200 million for the Global Fund, 
that is one-fifth of the amount we authorized. In addition, it is a cut 
of $150 million from what was appropriated last year.
  There is another problem. While the President's fiscal year 2004 
budget for foreign operations does include approximately $1.2 billion 
to combat HIV/AIDS, it robs Peter to pay Paul to pay for increases in 
HIV/AIDS programs, as the President's budget cuts other essential 
international health programs anywhere from 5 to 63 percent.
  Let's take a look at the chart. The information on this chart, 
incidentally, is from the United States Agency for International 
Development.
  Child survival and maternal health programs are cut by 12 percent. 
These are the programs that provide lifesaving child immunizations. 
They also help to reduce needless pregnancy-related deaths each year. 
People will be astounded when they hear how many of these types of 
deaths occur each year. Six hundred thousand deaths. Many of these 
deaths could be easily prevented if we just put more resources into 
these programs. Instead, the President's budget cuts these programs by 
12 percent.

[[Page 13230]]

  It would cut programs for vulnerable children by 63 percent.
  It would cut programs to combat other infectious diseases such as 
measles.
  Measles kill 1 million children--not 100,000 or 200,000--but 1 
million children a year. Again, this is something which is easily 
preventable. Every one of us can just go to the doctor's office and get 
our children and grandchildren immunized against measles. In many poor 
nations, parents and grandparents do not have that luxury. They need 
our help.
  Does the President's budget show leadership on this issue? No. It 
cuts the programs which help combat measles, as well as polio, SARS, 
and other deadly diseases by 32 percent.
  These are not my numbers, these are the administration's numbers. 
These numbers are in the President's budget.
  Are we in favor of stopping children in poor countries from dying of 
measles? Of course we are. Are we in favor of fighting SARS? Of course 
we are. Are we in favor of fighting polio? Of course we are. Who is 
going to say they are against it? No one.
  But, when you look at this budget, there are cuts to these and other 
critical international health programs. These cuts also include 
programs for disease surveillance. In the past, these funds for disease 
surveillance have been used to strengthen the World Health 
Organization's ability to respond quickly to outbreaks like SARS.
  Everybody in this Chamber knows we will have another outbreak of 
either SARS or, perhaps, something far worse. There is no question that 
we need disease surveillance programs, because every one of these 
diseases is just one airplane trip away from the United States. Why 
would we want to cut funds for these programs?
  The President's budget would also cut funds for drug resistance, 
which is a looming public health crisis. Many lifesaving antibiotics 
are already virtually useless because of resistance caused by the 
misuse of these drugs. The President's budget cuts funds to combat drug 
resistance.
  While the President's budget would increase funding to combat AIDS--
although nowhere near the amount promised in the bill we passed last 
week--it does so by cutting the budget for other global health 
programs.
  These cuts will hurt children the most in countries where vaccines 
costing a few pennies make the difference between life and death. That 
is not acceptable.
  If somebody said to us, look at those five children, you can save 
their lives by spending a dollar, would we do it? Of course, we would 
do it. Why then does the President's budget do the opposite by cutting 
these programs? I find this deeply troubling.
  These are not Democratic or Republican programs. I have been joined 
time and again by colleagues on the other side of the aisle who support 
these initiatives in both the Senate and the House.
  Mr. President, anyone who knows anything about public health knows 
that building the health infrastructure in developing countries is 
essential if you are going to effectively combat AIDS. It is the same 
thing with child nutrition. It is the same thing with maternal and 
reproductive health. You don't fight AIDS in a vacuum. It isn't an 
either/or proposition. People who are malnourished, who are in poor 
health, who have weak immune systems, who are at risk of other 
infections, are far more vulnerable to AIDS. It is common sense.
  In addition to helping to combat AIDS, these international health 
programs are vitally important for their own sake. They save millions 
of lives for very little money. They fight diseases that we eradicated 
in the U.S. years ago. When I was growing up, the municipal pool would 
close in the summer because of polio. You never hear of such things 
anymore. We should be doing the same thing overseas with these types of 
diseases--making them a thing of the past.
  Over the past 5 years, we have built up these global health programs, 
and each year they yield more and more results. It would be 
unconscionable to cut these programs. But that is exactly what the 
President is asking Congress to do--cut these programs.
  Last week, Republicans opposed our amendments to correct some serious 
problems in the AIDS bill--problems they acknowledged. They said we 
could not take time to get the bill right, because we needed to act 
quickly so the President could point to this bill as a sign of U.S. 
leadership at the Group of Eight meeting in France next month.
  Let's be serious. If the White House had wanted, they easily could 
have supported those amendments and made this a better bill. We also 
could have made sure that this bill got to the President's desk in 
plenty of time. It is clear to me that the other side's opposition had 
a lot more to do with political ideology than the President's travel 
schedule. And, that is simply not enough to justify the provisions in 
the bill that are going to make it more difficult to prevent the spread 
of AIDS. As a result, the President will go to France with an AIDS bill 
that is only half funded.
  In addition, he is going to use that bill to urge other nations to do 
more to fight AIDS. Now, I agree that other nations should do more. 
This is not something the U.S. could or should do alone. But the world 
should ask the President, the leader of the wealthiest nation on earth, 
whether he is going to back up his own words with deeds.
  When he asks others to do more, as he should, his own budget should 
not slash funding for the Global Fund to Fight AIDS and for other 
international health programs. The world should also ask why the United 
States is spending less than 1 percent on programs to combat poverty, 
including global health. After all, we are the wealthiest Nation on 
Earth. It is not only in our security interests, but also our moral 
responsibility, to do more.
  Mr. President, at the Coast Guard Academy, President Bush spoke about 
other important foreign aid programs, such as the Peace Corps, Famine 
Fund, and the Millennium Challenge initiative. Not surprisingly, these 
are some of the programs his foreign aid budget favors.
  But he did not mention that his budget not only slashes funding for 
global health but also for development assistance, which pays for 
everything from children's education, to agriculture research, to 
democracy building. His budget cuts food aid and assistance to 
refugees--the world's most vulnerable people. And, we have all seen the 
images of refugee camps around the world. People pushed from their 
homes because of famine or war or natural disasters often end up living 
in horrendous conditions.
  This is not compassionate conservatism. It may conserve money, but it 
is not compassionate. It is shameful.
  More to the point, the President's national security strategy 
recognizes the essential role of foreign aid. While we read about the 
importance of foreign aid in his national security strategy, we don't 
see it in his budget request.
  Look at this chart. Food aid is cut by 17 percent. International 
disaster assistance for floods and earthquakes and wars is cut by 18 
percent.
  We hear a lot of speeches on the floor talking about our moral 
responsibility to the rest of the world.
  While we may feel good about giving these speeches, I do not feel 
good about the lofty rhetoric that bears little resemblance to reality. 
And, unfortunately, we have another great example of this in the 
President's budget request. Great speeches, bad reality.
  The President should do what he says. He should do what he is asking 
others to do. He should submit a budget amendment for the $3 billion 
authorized to fight AIDS. He also should request the funds to prevent 
the cuts to other vital global health programs.
  Most importantly, he should start treating foreign aid for what it 
is: a critical investment in America's security. Less than 1 percent of 
the Federal budget is used to combat the conditions that cause poverty 
and conflict around the world. This is woefully inadequate. It 
shortchanges America's future. It invites insecurity.
  One would have thought that if September 11 taught us anything, it 
was that business as usual is no longer tolerable. As I have said 
before, the President deserves credit for his Millennium

[[Page 13231]]

Challenge initiative. It provides some additional foreign aid funds.
  But, I ask Senators to look behind the curtain to see how it is 
funded. Some is new money. Sadly, the rest is from cuts to other 
essential programs.
  And let's keep things in perspective. Before we congratulate 
ourselves too much, let's remind everyone that the Millennium 
Challenge, on an annual basis, amounts to less than what my own little 
State of Vermont of 600,000 people spends on public education. That is 
not a serious response to the challenges we face.
  I also credit the President for his famine fund initiative, but I 
question what the real point is. He already has the authority he needs 
to respond to famines. The problem is that his fiscal year 2004 budget 
would cut title II food aid by more than the amount the famine fund 
would add. Again, robbing Peter to pay Paul. Unfortunately, both Peter 
and Paul are starving.
  If we are going to lead, and especially if we are going to ask others 
to do more, we are going to have to stop playing shell games with the 
foreign aid budget. Leadership is good policy. Leadership means 
resources. Leadership means ideas. Leadership is not a press release.
  Senator Feinstein, Senator Hagel, Senator Smith, and so many others, 
Democrats and Republicans, have spoken out about the need for 
substantially more resources to protect America's interests abroad. 
When are we going to stop talking and start acting?
  As I have told the President before, I would strongly support him on 
these issues. But, I am not going to support empty rhetoric. I want to 
see the money. It is one thing to go on foreign trips and talk to 
leaders and say: Look at this AIDS authorization bill I have. But, it 
does not make much sense if the money is not there. And, in this 
budget, the money is not there.
  I call on the President: Let's forget the politics. Let's come up 
with the right ideas on AIDS. Let's come up with the right ideas on the 
Millennium Challenge Account. But, once we have the right policies, 
let's put real resources behind these policies. And, to pay for these 
increases, we should not cut programs for global health, disaster 
assistance, refugees, food aid, development assistance, and 
immunizations.
  Let's get rid of the rhetoric. Let's put some reality in there. If we 
do that, then the United States can show the promise and the moral 
leadership a great Nation should show.
  Mr. President, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. FRIST. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.

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