[Congressional Record (Bound Edition), Volume 160 (2014), Part 12]
[House]
[Pages 16384-16389]
[From the U.S. 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

[[Page 16385]]

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, 2014 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.
  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

[[Page 16386]]

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 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

[[Page 16387]]

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 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

[[Page 16388]]

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.
  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.

[[Page 16389]]

  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?
  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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