[Congressional Record (Bound Edition), Volume 152 (2006), Part 18]
[Senate]
[Pages 23471-23476]
[From the U.S. Government Publishing Office, www.gpo.gov]




                   LIFESPAN RESPITE CARE ACT OF 2006

  Mr. ENZI. I ask unanimous consent the Senate proceed to the immediate 
consideration of H.R. 3248, which was received from the House. I ask 
unanimous consent there now be up to 60 minutes of debate equally 
divided between Senators Enzi and Coburn or their designees with no 
amendments in order, and that following the use or yielding back of the 
time the bill be read a third time and the Senate proceed to a vote on 
passage without any intervening action or debate.
  The PRESIDING OFFICER. Without objection, it is so ordered. The clerk 
will report the bill by title.
  The assistant legislative clerk read as follows:

       A bill (H.R. 3248) to amend the Public Health Service Act 
     to establish a program to assist family caregivers in 
     accessing affordable and high-quality respite care, and for 
     other purposes.

  There being no objection, the Senate proceeded to consider the bill.
  The PRESIDING OFFICER. The Senator from Wyoming.
  Mr. ENZI. Mr. President, I would like to make a few brief comments. 
Then there will be others who will join me and Senator Coburn as well.
  Currently there are over 40 million caregivers in the United States 
providing informal care or support to a disabled elderly relative. This 
represents about one out of every five homes in the United States. The 
Lifespan Respite Care Act would help these caregivers by authorizing 
competitive grants to aging and disability resource centers in 
collaboration with State respite coalitions and organizations. That 
would make quality respite care accessible to family caregivers 
regardless of age or disability.
  Respite care provides family caregivers with the time to maintain 
their own health, bolster family stability, and keep marriages intact. 
It also allows family caregivers to avoid or delay police intervention 
and nursing home or foster care placements.
  Over 180 national and State organizations have endorsed this 
important legislation, including the Alzheimer's Association, the MS 
Society, Easter Seals, Christopher Reeve Paralysis Foundation, the ALS 
Association, and the National Patient Advocate Foundation, to mention 
but a few.
  The House of Representatives passed the Lifespan Respite Act by voice 
vote without objection on December 5, 2006. In the Senate, a similar 
version passed unanimously in 2003 and has twice passed the Health, 
Education, Labor and Pensions Committee in previous Congresses. The 
bill has strong bipartisan support in the Senate.
  I thank my good colleague, Senator Warner, for his leadership and 
work on this important legislation during this Congress and previous 
Congresses. It was his bill that we moved through the Health, 
Education, Labor and Pensions Committee. Without his perseverance we 
would not be here today to pass this bill and send it to the President 
for his signature.
  I would also like to thank Senator Clinton, the cosponsor of this 
important legislation, who has worked diligently on it.
  I respectfully ask my Senate colleagues to approve this legislation 
and send it to the President to be signed into law.
 Mr. WARNER. Mr. President, I rise in support of the Lifespan 
Respite Care Act.
  I have long been a major supporter of providing community-based 
respite care services for family caregivers of children and adults with 
special needs. In fact, as the lead Republican sponsor of the Senate 
bill for several years, I am pleased that in previous years the bill 
has been approved by the HELP Committee twice and by the full Senate 
once.
  This legislation was first brought to my attention by a number of 
Virginians suffering from ALS, also known as Lou Gehrig's disease, and 
by their family caregivers. The Lifespan Respite Care bill is important 
because diseases such as ALS, MS, Alzheimer's, cancer, and others 
afflict far too many Americans.
  While substantial investments have been made to help find cures for 
these diseases, we all know that until cured, these diseases will 
continue to have a substantial effect on far more people than the 
individuals who are diagnosed with them. ALS, MS, Alzheimers, and other 
diseases all have a tremendous impact on the family and particularly on 
family members who, out of love and compassion, take care of their 
loved ones who are terminally ill.
  Serving as a family caregiver, though, often results in substantial 
emotional, physical, and financial hardship. It can take a tremendous 
toll on the family. Respite care services can provide assistance.
  Currently, the Federal Government does provide some respite care 
assistance to some family caregivers. However, these programs are 
directed primarily at lower-income populations and at family caregivers 
of older Americans. Thus, existing programs of respite care are 
insufficient to meet the need. This legislation is intended to fill the 
gap.
  This important legislation will authorize competitive grants to Aging 
and Disability Resource Centers in collaboration with a public or 
private nonprofit State respite coalition to make quality respite 
available and accessible to family caregivers, regardless of age or 
disability.
  In so doing, this bill will be a win-win-win for everybody involved. 
Patients will be able to receive care in the home from loving, caring 
family members rather than in a nursing home. Family members will be 
even further encouraged to serve as a family caregiver knowing that 
services will be available to assist them. And, finally, the Federal 
Government and our health care system will recognize fiscal savings 
as--more care will be given in the home by a family member rather than 
in the more costly nursing home setting. As we all know, given the 
aging baby boomer generation, the cost of Medicaid nursing home care is 
expected to be a primary reason of increased healthcare costs in the 
years to come. The Lifespan Respite Care bill is one step in the right 
direction towards controlling these costs.
  I would like to thank Republican Congressman Mike Ferguson of New 
Jersey for his work and dedication to this cause. He has been a 
champion on this issue for years and recognizes its importance based on 
his very personal experience, as he witnessed his father serve as a 
family caregiver. I would also like to thank the National Respite Care 
Coalition and its Chair, Jill Kagan, who has worked tirelessly on 
behalf of the Nation's family caregivers on this issue.
  I also thank Senator Snowe, Senator Enzi, and Senator Gregg for their 
support. Finally, I thank Senator Clinton and her professional staff 
for

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partnering with me and my staff for the past 5 years on this important 
legislation.
 Mr. HATCH. Mr. President, I rise in strong support of S. 1245, 
the Gynecologic Cancer Education and Awareness Act, better known as 
Johanna's Law. This bill needs to be signed into law as quickly as 
possible.
  Johanna's Law creates a national public awareness campaign to 
increase the knowledge of both women and their health care providers 
concerning gynecologic cancers. This national campaign will include 
written materials for the public on gynecologic cancers and public 
service announcements to encourage women to discuss with their 
physicians their risks of gynecologic cancers. In addition, women will 
be directed on where to get additional information on the early warning 
signs and risk factors associated with gynecologic cancers.
  The legislation also requires the Secretary of Health and Human 
Services, HHS, to submit a report to Congress on the past and present 
activities of the agency to increase awareness on all cancers, 
including gynecologic cancers. The report also would include 
information on what HHS is doing to educate health care professionals 
on these cancers. Once this report is submitted to Congress, the 
Secretary of HHS is required to develop and submit a strategy for 
improving efforts to increase awareness and public knowledge on 
gynecologic cancers. When developing this strategy, the Secretary is 
encouraged to consult with qualified public sector groups, including 
non-profit organizations.
  Finally, this legislation authorizes $16.5 million to be appropriated 
for this program from fiscal year 2007 through fiscal year 2009.
  I am extremely supportive of this legislation, and have worked to see 
its enactment this week.
  Why is this bill important?
  The stories of two very special women will answer that question. They 
have, I believe, made a huge difference in passing this legislation.
  The first person is Grace Warren, who handled health care issues with 
great skill for Congressman Ralph Hall of Texas for many years. Ms. 
Warren is one of those Hill staffers who is well known for her 
institutional knowledge and her professionalism. She is widely 
respected and loved on both sides of the aisle.
  Unfortunately, Grace's career on Capitol Hill was cut short in 
November 2003, when she was diagnosed with ovarian cancer. She retired 
from the House of Representatives last year, and passing this 
legislation became her passion.
  Ms. Warren made a compelling case to both my office and the Senate 
HELP Committee on why this legislation needs to be signed into law this 
year. While Ms. Warren believes that this bill won't do anything for 
those women who have already been diagnosed with gynecologic cancers, 
she recognizes that it will make a huge difference for other women 
because it will help educate them on the early warning signs of 
gynecological cancers, such as abdominal swelling, gastrointestinal 
disturbances, lower back pain and abnormal bleeding.
  The second person whom I would like to acknowledge is Ms. Fran 
Drescher who also must deserve great credit for getting this 
legislation through the Congress. Her commitment to having this bill 
signed into law has been very impressive to me.
  Ms. Drescher has tirelessly visited with Members of Congress this 
entire week and will be staying in town until this legislation is 
passed by both Houses of Congress.
  While I have known Fran for many years, it was gratifying to be 
reminded of her tremendous enthusiasm and her commitment to women's 
health. Ms. Drescher is extremely articulate when she is advocating for 
Johanna's law. And that is because as a cancer survivor herself, she is 
strongly committed to educating women about awareness and early 
detection of gynecologic cancers.
  It was painful for me to hear her story. Over a period of 2 years, 
Ms. Drescher tried to get a diagnosis for her symptoms. She saw eight 
doctors before being told that she had uterine cancer.
  This should never happen.
  Ms. Drescher recognizes that women must know the early warning signs 
of all gynecologic cancers and which tests are available because women 
cannot assume that these tests will be offered to them.
  In addition, she is the author of the book Cancer Schmancer which 
discusses how she beat uterine cancer. Her dedication and commitment 
have made a tremendous difference and we all greatly appreciate her 
efforts.
  Both Ms. Warren and Ms. Drescher are truly amazing women who have 
shown a selfless dedication to making a difference in the lives of 
others.
  It is for Grace Warren, and Fran Drescher, and the many, many other 
women who will be challenged by gynecological cancers that we must pass 
this legislation.
  I strongly support this bill because I want women and their health 
care providers all to be educated about the early warning signs of 
these cancers.
  I want a screening test to be developed so that it will be easier to 
diagnose gynecological cancers in the early stages of the disease.
  I am tired of women having limited health care options because of 
late stage diagnosis. This must change.
  But, I am hopeful that we can start to make a difference in the lives 
of all women the minute that this bill is signed into law. I urge my 
colleagues to support Johanna's Law.
  The PRESIDING OFFICER. The Senator from New York is recognized.
  Mrs. CLINTON. Mr. President, I am proud that we are finally sending 
the Lifespan Respite Care Act to the President for his signature. After 
4 years of bipartisan efforts, we are delivering a great victory for 
millions of American families providing care to a parent, child, or 
loved one.
  Thank you to Senator Snowe who was the first lead Republican on the 
legislation and has been a champion for this bill and family 
caregivers.
  Thank you to Senator Warner for his efforts on the bill. Your 
leadership will make a difference in the lives of so many American 
families.
  I want to express my appreciation to Representatives Mike Ferguson as 
the primary sponsor of the House bill as well as Congressman Langevin. 
We would not be on the verge of enacting this bill without their work.
  Deep appreciation and thanks to the Lifespan Respite Task Force, a 
coalition of 180 national, state, and local organizations under the 
direction of the National Respite Coalition. A special thank you to 
Jill Kagan of the National Respite Coalition for her leadership and 
invaluable assistance.
  Today's passage represents a tremendous win: for ailing seniors, 
children, and loved ones being cared for at home; for family members 
providing a time-consuming, emotionally exhausting, and physically 
demanding labor of love; for our health care system; for our values; 
and for decisions based on evidence, not ideology.
  Each year, 44 million Americans care for an adult family member who 
has a chronic illness or disability. Almost 4 million Americans with 
developmental disabilities, of all ages, live at home with their 
families.
  These are our friends, neighbors, coworkers, loved ones; their work 
represents real struggle and hardship; extraordinary acts of love and 
generosity that we have a duty to honor and support.
  This legislation will expand and enhance access to respite care 
services to provide support and relief to these families providing 
care; to help ailing loved ones stay in their homes longer; and to 
control health care costs as respite care allows families to postpone 
or prevent expensive hospitalization and nursing care.
  Today, the fastest growing illnesses in our country are chronic 
illnesses. And our health care system--already burdened by rising 
costs, aging infrastructure, a growing population of elderly, and 
upside-down incentives--is struggling to adapt systems designed to 
provide acute and immediate care.
  Families have stepped into this breach. Family caregivers provide 80

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percent of all long-term care in the U.S.--work that is virtually 
always unpaid but valued at more than $300 billion annually. That is 
more than the entire amount we spent on Medicare in 2004.
  Today, we are sending a message to family caregivers: through 
extraordinary sacrifice, in a system plagued by problems, you are part 
of the solution--and today, finally, Congress is part of the solution, 
too.
  Because of their responsibilities at home, studies have shown us that 
it is much more difficult for caregivers to find and maintain jobs. 
Many caregiving families are struggling to stay afloat. The cost to 
businesses is estimated in the tens of billions of dollars, including 
the cost for employees who leave jobs due to overwhelming 
responsibilities at home.
  This labor of love often results in substantial physical and 
psychological hardship. Research suggests that caregivers often put 
their own health and well-being at risk while assisting loved ones. 
Many caregivers are exhausted and are more prone to illness themselves. 
One study found that caregivers are 51 percent more likely to 
experience sleeplessness and 61 percent more likely to experience 
depression.
  Caregiving stress can even lead to marital discord and divorce.
  Often, this incredible struggle--with little support despite the 
heroic efforts of the organizations advocating for and providing 
respite care--leads to more costly out-of-home placements as a family's 
only alternative.
  Across our country quality respite care remains hard to find. Where 
community respite care services do exist, there are often long waiting 
lists. And until the Lifespan Respite Care Act, no Federal plan has 
focused on respite care to coordinate among disparate and fragmented 
services.
  Now, after years of work on both sides of the aisle and between the 
Senate and House, we are finally going to begin meeting the growing 
needs of family caregivers.
  Respite care provides some much needed relief--for a few hours or a 
few days--from the daily demands of caregiving, which are vast. And we 
know respite care works.
  In one study, 88 percent of caregivers said that respite care allowed 
loved ones to remain at home.
  Nearly 100 percent believed respite care made them better caregivers 
and helped them manage the stress of this incredible responsibility and 
80 percent even said respite care helped their marriages.
  This act is about real family values and it is exactly what we should 
be doing in this chamber--no partisanship; understanding hardships and 
taking steps to help; common sense solutions that put families in 
charge, that provide the tools to improve their own lives and honor 
their loved ones, that serve our health care system and our values.
  Families have stepped into the breach--and now with the Lifespan 
Respite Care Act, Congress is sending these families a lifeline.
  This legislation will expand access to respite care; improve local 
coordination of services; and help families find out about what is 
available and how to get the care they need.
  This legislation will make respite services equally available to all 
age groups and prioritize those with special needs who do not qualify 
for any other respite services or who cannot find appropriate quality 
respite care in their communities.
  It is critical that HHS ensures that the funds provided by this act 
are used by State agencies and ADRCs--which to date have primarily 
served the aging population--to serve all age groups and disability 
categories equally and without preference and without waiting periods 
or a phase in of age specific groups.
  This legislation will also facilitate a coordinated approach at the 
Federal level. To ensure this critical component and maximize our 
investment, the grantees selected to implement Lifespan programs must 
be able to demonstrate unequivocally that they are working 
collaboratively at every level--with agencies in HHS that have respite 
resources, including the Administration on Aging, the Maternal and 
Child Health Bureau, other public health programs in the Health 
Resources and Services Administration, the Substance Abuse and Mental 
Health Administration, the Centers for Medicaid and Medicare, the 
Administration on Developmental Disabilities, and the Administration on 
Children and Families.
  But improving the services at the local, State, and Federal levels is 
not enough. All family caregivers, regardless of the age, disability, 
or chronic condition of their loved ones, should be able to access 
information on how and where to find a respite provider that meets 
their needs and on how to pay for services. The lifespan respite 
program grantees will identify all the current respite funding streams 
in the State and assist a family in determining, their eligibility for 
any existing private, State or federally funded respite program. If 
that family does not qualify for any existing services, the lifespan 
respite program may use its funds to help families pay for respite. No 
family should struggle to obtain information on how or where to find or 
pay for respite care.
  I thank chairman Senator Enzi for his leadership on the HELP 
Committee. It has been a privilege serving under him over these last 
several years, and I am very grateful to him for pushing forward a very 
positive agenda for the people of our country.
  I am very proud that we are finally able to reach agreement on the 
Lifespan Respite Care Act and send it to the President for his 
signature. This has been a bipartisan effort from the very beginning. I 
am grateful to Senator Warner who has made a real difference in his 
leadership on behalf of this bill. I am grateful to Senator Snowe who 
was the first lead Republican on this legislation and has been a 
champion. I want to express my appreciation to Representative Mike 
Ferguson as the primary sponsor of the House bill, as well as 
Congressman Jim Langevin. We would not be here on the verge of enacting 
this bill without their work.
  Deep appreciation and thanks is due to the Lifespan Respite Task 
Force, a coalition of 180 national, State, and local organizations 
under the leadership and direction of the National Respite Coalition. A 
special thanks to Jill Kagan of the National Respite Coalition for her 
leadership and invaluable assistance.
  As Senator Enzi said, this bill represents a tremendous 
acknowledgment of the families who are caring for their loved ones--for 
failing seniors, for children with disabilities, for a spouse who has 
been incapacitated by accident or chronic condition. Family members 
provide most of the support and the time-consuming physical labor and 
the emotionally exhausting input that really makes it possible to keep 
people at home.
  You know, each year 44 million Americans care for an adult family 
member who has a chronic illness or disability. Almost 4 million 
Americans with developmental disabilities of all ages live at home with 
their families. Senator Coburn and I were talking earlier today--this 
is such a human issue that affects the lives and the fortunes and the 
feelings of so many of our fellow Americans.
  What this legislation does is to expand and enhance access to respite 
care services. What are those for? Those are to give that wife who is 
caring for her ailing husband a few hours off a week. Those are for 
that father who devotes himself to his child with a disability, to have 
someplace to go to get a little bit of respite while his child is still 
well cared for.
  Family caregivers provide 80 percent of all long-term care in the 
United States. But as Senator Coburn and I were discussing, you don't 
get real financial help unless you put your loved one in a nursing 
home. There is something wrong with that. That doesn't reflect our 
deepest values. The work that our loved ones do for all of us is unpaid 
but valued at more than $300 billion a year. That is more than the 
entire amount of money we spent on Medicare in 2004.
  Today our Congress is sending a message to family caregivers: We 
recognize

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and we honor your commitment and in many instances your sacrifice. We 
know that because of this care many caregivers cannot keep their jobs.
  It becomes too much of a burden. They struggle to stay afloat. They 
start selling off assets. This is a labor of love that often undermines 
the health of the very people who are providing it.
  We found that many caregivers suffer physical symptoms, 
sleeplessness, depression. They feel like they are all alone.
  This incredible struggle is one that we will see more and more of in 
our country because of our aging population. I am grateful that we are 
going to be passing this legislation and giving some assistance to 
these courageous men and women, these parents, these children, these 
grandparents, these spouses.
  I hope, also, that in the new Congress we will address something else 
I talked to Senator Coburn about--that we can address this issue of 
caregiving, and particularly how to rearrange the incentives within our 
health care system, particularly through Medicaid, where 80 percent of 
the money is spent on 20 percent of the recipients; and that is mostly 
for long-term nursing care at the end of life. Many people would rather 
be home or rather be in a less-restrictive setting. If this is a 
statement of our concern, we need to follow that up.
  This will provide what has been missing, improved coordination at the 
local level of services, helping families understand more about how to 
shoulder these burdens.
  It is critical that Health and Human Services ensure that we serve 
all age groups, all disability categories, without preference, and that 
we begin to not just honor the love that we see and the sacrifices that 
are too often accompanying it but really provide some support.
  I am deeply appreciative of all who have worked over the last year to 
make this legislation possible. I look forward to working with my 
colleagues on both sides of the aisle to continue to address these 
long-term needs and address how to help people stay at home, how to 
support their families who are doing the most important work there is.
  The PRESIDING OFFICER. Who seeks time?
  Mr. ENZI. Mr. President, I yield 8 minutes to the Senator from Maine.
  The PRESIDING OFFICER. The Senator from Maine is recognized.
  Mrs. SNOWE. Mr. President, I thank Senator Enzi for the opportunity 
to speak today on this critical piece of legislation, as well as to 
commend the Senator from New York, Senator Clinton, for her advocacy 
and leadership on this most critical issue which is paramount to 
millions of families across this country, and to Senator Warner, who 
has also been a leading advocate and champion of this legislation. I 
certainly want to commend them both for making sure this legislation is 
coming to the forefront of the Congress in the final days and which, 
ultimately, will lead to its passage.
  I, also, want to express my commendations to the sponsor in the House 
of Representatives, Congressman Mike Ferguson, because this is clearly 
a very critical issue. He understands firsthand, personally, from his 
own family circumstances, how important care giving and respite 
services are for caregivers and how it is so essential and vital to our 
Nation's families.
  I know how important this is. In fact, I introduced the first 
legislation recognizing National Family Caregivers Week back in 1986. 
It is more than 20 years that I have been involved in such endeavors. 
There is no question--and it has been irrefutable across this country--
about the necessity of providing more support to those who provide 
support to families, to ailing family members. The fact is the need is 
more than $300 billion a year. We, also, know that it takes a 
tremendous toll on families to provide that care day in and day out.
  That is why I think we do have a Federal responsibility and 
obligation to ensure that we can coalesce those resources that can make 
it easier and to mitigate the impact on those family members who are 
providing around-the-clock care.
  When I first became involved in this issue in the House more than 20 
years ago, I took it upon myself to visit homes throughout my 
congressional district in the State of Maine. What I saw was 
incredible. I saw 80-year-olds taking care of 80-year-olds, doing the 
most incredible things, medically and otherwise, to provide round-the-
clock care to their ailing family members. It was clear to me then that 
we needed to do more to provide the respite support for family members 
so they can have the ability to have support outside the family which 
is critical for them, so they can continue to keep their ailing family 
member at home but at the same time having the kind of care which is so 
essential to help them get better.
  That is what this is all about. It is helping those who need our 
help. Certainly, to have the support of the type of facilities and 
services that exist in a particular community which can address their 
needs and who they can turn to for advice is absolutely instrumental. 
It, also, leads to a higher quality of life for many because they can 
be at home, where they can be provided home care. They can be at home 
and get the kind of support that otherwise would be necessary if they 
had been institutionalized or hospitalized.
  In addition, such care can also result in substantial cost savings to 
the family, to the Government, and to the community, in fact.
  I think it is in our national interest to provide these benefits. I 
think, frankly, the support of such care has been all too limited. This 
is long overdue. That is why I commend Senator Clinton and Senator 
Warner and some others who have given their support to this type of 
initiative.
  We, clearly, have a Federal obligation and responsibility to focus on 
the kind of respite care that is so essential for allowing people to 
take care of their ailing family members in a home setting. It 
certainly eases and mitigates the impact on the Federal costs, whether 
it is on Medicaid or Medicare. It can save families thousands of 
dollars a year.
  This is something that is in our national interest. I think it is 
also crucial that we ease the burden of this responsibility which is 
placed on caregivers as well. It is critical that they have access to 
better information on services and be able to provide it. They are 
heroes in every sense of the word.
  We think about life expectancy today and how many years caregiving 
will be provided by the American family. It can be 17 years, at the 
minimum, for an elderly parent. I think it gives a dimension to the 
issue and the problems that are at stake if we fail to provide the kind 
of support which is necessary.
  That is why I have introduced legislation, the Refundable Dependent 
Care Tax Credit. For example, I think we should provide the type of 
incentives and support to families that enables them to take care of 
their loved ones at home.
  When I first visited homes where people were providing this kind of 
care, I was absolutely astonished at the level of care these 
individuals were providing their family members. It occurred to me 
then, and it is one that has remained with me ever since, that we have 
to do everything conceivably possible to amass the resources and the 
support for these family caregivers.
  When you think of the dimensions of the problem, when you think about 
the demographics in America and the life expectancy, it is all the more 
crucial that the Federal Government play a role. That is exactly what 
this legislation is all about. It will provide the kind of resources 
that are going to be important, it will provide grant support, it will 
increase the availability of appropriately trained respite care 
providers and volunteers--again, another aspect to the entire spectrum 
of resources I think we need to provide these families who are 
providing the caregiving support.
  Frankly, we need to have more respite care providers. It eases the 
burden on these family members so they can do other things in the day, 
what is required in daily living, that they have the ability to know 
they can fall back

[[Page 23475]]

on the type of support which will provide the continuity of care and 
the level of care their family members certainly deserve. I think this 
legislation goes a long way in providing that kind of support and eases 
the burden on those family members who are so devoted to their loved 
ones.
  I think, frankly, we will have to do more. That is why, as we are 
looking at a tax incentive in the overall tax package, we have to give 
some review to the notion of having a tax credit that is refundable for 
providing this kind of dependent care. I think it is going to be a wave 
of the future, frankly, given the dimensions of this problem which is 
certainly lurking on the horizon.
  I want to, again, commend Senator Clinton for her leadership in 
making this possible and to Senator Warner and, of course, Congressman 
Ferguson, in the House, and all those who supported it--and Chairman 
Enzi, as well, for his leadership in making sure that the passage of 
this legislation will become a reality when you consider I think the 
enormity and the magnitude of the care and support that it will give to 
families who most deserve it.
  I yield the floor.
  The PRESIDING OFFICER. Who yields time? The Senator from Oklahoma.
  Mr. COBURN. Mr. President, I was asked to allow this bill to come up 
at this late hour in the Congress. This bill is going to pass. The 
goals of this bill are very worthy. As a practicing physician, and 
knowing the families whom I take care of and the family members they 
have, I know the burden that is placed on multitudes of people. When 
they do the better thing of keeping their loved ones in their own 
homes, in terms of quality of life, I have no argument with the intent 
and background of what is trying to be accomplished. But I want to make 
three points.
  One is how this place operates. What we do at the end of the session 
is we try to run hundreds of bills through that very few people have 
thoroughly looked at, that drives all sorts of new spending, that does 
not get the privilege of the debate that the American people deserve on 
the priorities of how we spend their money. That needs to change. It is 
a terrible way to govern. It is inappropriate in the way we do it. It 
has more to do with the rules that we operate the Senate under than 
anything else. That ought to be changed. There is no question I am 
known for my desire to try to get our fiscal house in order. For 
example, this bill is great, but what the American people are never 
going to ask out of the almost $350 million that this bill authorizes, 
where is the money going to come from to pay for it? What priority is 
going to be decreased so that priority can be increased?
  We have in the Social Security account a surplus this year. We have a 
$344 billion deficit. A lot of my friends would say that reflects the 
fact that we need to have pay-go and increase taxes. But during the 
last 2 years, I have held 49 hearings in the Federal Financial 
Subcommittee of the Committee on Governmental Affairs, where we have 
identified a pure $100 billion worth of waste, fraud or duplication in 
this Government, and no one wants to change that. It is easy for us to 
come out here and spend $300 million on a new program. But it is very 
hard for us to get together and do the hard work of eliminating the 
fraud, waste, and duplication.
  There are two other programs that have money in them available for 
this, not the correct way, and not done as good as this bill does it. 
We haven't done anything in this bill to change those programs to 
redirect any of that money through. So now we are going to have three 
programs that have an impact in this area. Representative Ferguson has 
done a great job of bringing this up. But unless we change the culture 
of how we operate, we are going to enhance what we call the birth tax. 
When you are born today in this country, counting the unfunded 
liabilities for Medicare, Medicaid, and Social Security, you are born 
having liabilities of $435,000 on you the day you are born. We are 
adding a little bit to that. We are adding a little bit more and a 
little bit more.
  Until we get together and say we are going to review this Government 
and get rid of the waste, fraud, and abuse, we are going to care as 
much about the person who is born today as we care about those who need 
some respite care, legitimate rest from the care of parents of those 
people they love, we will do a great disservice. We are doing a great 
disservice in this country.
  Two weekends ago, I delivered a 9 pound 4 ounce baby to a woman whom 
I had delivered a baby to before. I had very well controlled her 
gestational diabetes. She had delivered a 9-pound baby before that. I 
thought about the 2\1/2\ minutes it took me, from the time I decided I 
couldn't deliver a baby in a normal way for her. It took me 2\1/2\ 
minutes from the time of that crunch when there was no way to get a 
baby out, with a heartbeat of 50 beats per minute--which is about 40 
percent of what it should be--we have a baby in trouble; it took me 
about 2\1/2\ minutes to go around and get that baby out of that momma. 
We saved that baby's life.
  Now, the corollary is, I had warning signals. I had indications that 
said things aren't going right. And this body, this Congress, this 
Government is not paying attention to the warning signals. The baby is 
going to die. Our country is going to drown in debt.
  The processes by which we operate include not paying attention to the 
waste, fraud, and abuse and not making the hard choices on priorities, 
not offsetting, not deauthorizing something else that is not working 
where there are billions of things that are not working, and adding 
another problem. We are adding to that.
  As a Senate, we are not ill-intentioned; we just are not paying 
attention to the warning signs. We are not paying attention to the 
fetal monitor of our country and the future for the next generations. 
It is just as laudable to care as much about the next two or three 
generations that come down the road as we care for those who need our 
help today, except this bill doesn't do that.
  This bill is going to go by voice vote--and I have allowed it; I will 
not even vote against it--but I wanted this time to make this 
statement.
  What will follow this bill today is a tragedy. We are going to spend 
another $17.5 billion on the tax-extender package that is getting ready 
to come through this place. We are going to pick up the bills mining 
companies owe and we are going to charge that to the rest of the people 
in this country. We are going to overspend on lots of things. We are 
not going to cut doctor's fees--and I am a doctor--but we are not going 
to pay for it. We are going to pay for it through gimmicks, and we are 
going to tell everybody that we are doing great things. In fact, we are 
being dishonest.
  There are two cultural problems that have to change: We have to quit 
authorizing new programs unless we deauthorize other programs, and we 
have to reach across the aisle and say that we need to review 
everything we have, and whatever is duplicative, let's get rid of it 
and save these costs. If one does not work as well, put the money in 
the other and save the money.
  Let's get rid of the fraud. We are paying out $38 billion a year to 
things we should not be paying for right now, and that is an 
underestimate because we have only looked at 60 percent of the 
Government in terms of improper payments. We still have a law that is 
not being followed by 40 percent of the agencies. They are not 
reporting their improper payments. We had a Pentagon that paid $6 
billion in the last 5 years for contractors for performance bonuses, 
and they did not come close to reaching the performance basis for the 
bonus. That is our fault. That is us. We are charged with the 
responsibility of doing what is necessary.
  The final point I wish to make is that if we keep nibbling around the 
edges on health care, we are going to find ourself in the biggest jam 
in the world. We have two choices: We are going to either have 
government-run health care or we are going to control the costs by 
basically allocating it at end of life and telling people what they 
cannot have. That is how most other countries do it. Or we will fix 
health care. We spend

[[Page 23476]]

16.3 percent of our GDP on health care, and $2.2 trillion is what we 
will have spent at the end of this year. That is 16 percent of our GDP. 
The closest country in the world spends 11 percent of GDP on their 
health care, and they don't have a government-run health care program.
  Fully $1 out of every $3 we spend on health care today does not go to 
help somebody get well or keep them healthy. Our prevention programs, 
which is the key to our success in solving our health care problems, 
are abysmal. They are wasteful. They are not effective. We talk about 
diabetes, we talk about obesity, but we are inept in any type of 
consensus as to where we can make a difference in prevention. We have 
to address that issue, and I believe this is a fix around the edge. We 
need a comprehensive fix and a look at health care in America. We need 
to do it knowing the motivation.
  Most people are surprised to learn that out of that $2.2 billion we 
spend on health care every year, $152 million is spent on things that 
nobody needs except providers to protect themselves from lawsuits. Now, 
we need a good trial bar. We need to be held accountable. But it has 
gotten so far out of hand that we are adding to the birth tax.
  I beg my colleagues and the American people who are listening to 
this, let's get our act together. Let's start not just authorizing, 
let's deauthorize before we authorize. Let's fix health care. Let's do 
oversight in a way that saves money for the future. If we have 
eliminated the waste, we have eliminated the fraud, we have eliminated 
the duplication in this Government, we have to go to the American 
people and say: Shouldn't we pay a little more taxes now rather than 
ask for this birth tax?
  Remember, the birth tax is over $400,000 per baby right now. Every 
baby I deliver, the first thing I see is a beautiful young child, and 
then in the back of my mind I wonder, how are you ever going to get out 
of this mess we have left you?
  I appreciate the concern and the intent of those supporting this 
bill. This bill has come to the Senate in the wrong way. This bill 
should have had its authorization offset. This bill does address a very 
real need, but there are a lot of very real needs out there that we 
need to do that we cannot do and we cannot fund because we are not 
doing our job.
  Our country is at a crossroad. The fetal monitoring alarm is on. The 
baby's heartbeat is low. It is time to do what is necessary. The debt 
burden cannot be swallowed, the unfunded liabilities cannot be handled. 
It is up to us to change that. Let's lower that birth tax. Let's get 
rid of that. Let's work together to do the things we can do to lessen 
that impact on the generations to come.
  I reserve the remainder of my time.
  The PRESIDING OFFICER (Mr. DeMint). The Senator from Wyoming.
  Mr. ENZI. I am not aware of anyone on our side who wishes to speak.
  I thank the Senator from Oklahoma, Mr. Coburn, for his concise and 
important comments, the warning signs he has given. I congratulate him 
for the times he has already constrained spending. He mentioned the 
preventive care doctors take. Maybe his comments have already resulted 
in people taking on a little bit more regarding preventive care. There 
is a lot more that can and should be done. I urge Members to review his 
words.
  I thank the Senator for the cooperation on different bills as they 
have gone through and made changes.
  I yield back the remainder of my time.
  Mr. COBURN. I yield back the remainder of my time.
  The PRESIDING OFFICER. All time is yielded back.
  The question is on the third reading and passage of the bill.
  The bill (H.R. 3248) was ordered to a third reading, was read the 
third time, and passed.
  Mr. ENZI. I move to reconsider the vote.
  Mrs. CLINTON. I move to lay that motion on the table.
  The motion to lay on the table was agreed to.

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