Richard Burr

Mr. BURR

Mr. BURR. Mr. President, I ask unanimous consent to speak for 15 minutes.

Mr. BURR. Mr. President, it is my understanding the Senate is in morning business?

Mr. BURR. Mr. President, I ask unanimous consent that the order for the quorum call be rescinded.

Mr. BURR. I yield the floor and suggest the absence of a quorum.

Mr. BURR

Mr. BURR. We have heard a number of people claim that the foreign targeting authorized under the Intelligence Committee's bill contains inadequate protections for U.S. persons. What specific protections are included for innocent Americans?

Mr. BURR. What happens when the intelligence community does become interested in the communications of a person inside the United States?

Mr. BURR. Mr. President, I thank the ranking member, Senator Bond. We have heard some people claim that the Intelligence Committee's bill will allow dragnet surveillance that will sweep up communications of innocent Americans. Is this accurate?

Mr. BURR. I thank the Senator.

Mr. BURR. Mr. President, I see that the senior Senator from Virginia is here and I know he has some questions he wishes to ask, so I will limit myself to one more. What happens if a provider refuses to comply with the directive you just talked about?

Mr. BURR. The Intelligence Committee bill allows the Attorney General and the DNI to direct a communications provider to assist the Government with a foreign targeting acquisition. What protections does this bill give to any provider who believes there is a problem with the directive?

Mr. BURR. It is my understanding that the FISA Court recently issued an opinion where it commented on the expertise of the executive branch over the court in national security and foreign intelligence matters. Shouldn't we heed the court's own words?

Mr. BURR. There is an amendment already filed, and the amendment is filed to the Intelligence Committee bill, that allows the FISA Court to assess the Government's compliance with the minimization procedures. Why shouldn't we have the court do this?

Mr. BURR

Mr. BURR. Mr. President, I have sought recognition to comment on legislation I am introducing today that will hopefully chart a new course for veterans with mental illness--the Veterans Mental Health Treatment First Act. As the title suggests, the bill proposes to advance a commonsense concept: Providing medical treatment for mental illness as a first priority will lead to a better quality of life for tens of thousands of veterans. It is a simple concept with which few would disagree. The problem is that the Government agency tasked with advancing that concept--the Department of Veterans Affairs--lacks the proper focus to actually deliver. Notice I didn't say VA lacked the tools to deliver. It has the tools--a world-class health care system, evidence-based therapies emphasizing recovery and rehabilitation, first-line medications, and the support of a dedicated group of clinical professionals. The problem is that, as an agency, VA doesn't coordinate the use of all of its resources--medical treatment, vocational rehabilitation, and disability compensation--to ensure what is universally agreed as the desired outcome of those with disabilities: wellness and a return to a productive life. Let me take a few minutes to lay out some of the facts for my colleagues. These facts have helped me get a better grasp of what the problem is, and they have truly informed my belief that a new approach to solving the problem is, in fact, necessary. Fact No. 1: There has been a steep increase in the number of veterans receiving disability compensation for post-traumatic stress disorder. In a 2005 report, the VA inspector general issued the following findings: During fiscal years 1999 through 2004, the number and percentage of PTSD cases increased significantly. While the total number of all veterans receiving disability compensation grew by only 12.2 percent, the number of PTSD cases grew by 79.5 percent, from 120,265 cases in fiscal year 1999 to 215,871 cases in fiscal year 2004. Sadly, the trend has not decelerated. Through September of 2007, 299,672--almost 300,000--veterans with PTSD were on the compensation rolls, a 39-percent increase since the VA inspector general's findings. Now, many might argue that it is only natural that we would see an increase in PTSD compensation given that we have been in a war on terror since the year 2001. However, today there are just under 30,000 veterans of the global war on terror on the disability compensation rolls for PTSD. Thus, the increase in PTSD rate represents a broad cross-section of the veterans community. No matter how far removed they are from military service, veterans are filing claims and being granted service-connected compensation for PTSD, and these staggering increases are occurring despite a decline--a decline--in the overall veteran population. Fact No. 2: Veterans with PTSD-related compensation appear never to get better, only to get worse. I just provided the sobering statistics about a 120-percent increase in PTSD disability rolls since 1999. Here is what the VA inspector general found in its 2005 review of veterans who have been added to the disability rolls: Based on our review of PTSD claim files, we observed that the rating evaluation level typically increased over time, indicating the veteran's PTSD condition had worsened. Generally, once a PTSD rating was assigned, it was increased over time until the veteran was paid at the 100 percent rate. This fact is even more disturbing than the first. It suggests a trend toward not only increasing sickness over time but also permanent sickness. It also suggests a certain sense of inevitability among those with lower disability ratings that the natural progression is for them to slip into total 100 percent. Then, as time wears on, total and permanent disability is, in fact, established. Mr. President, words have meanings. My greatest worry is that the message carried by an undesirable rating may lessen a veteran's resolve to seek treatment and to actually get better. They may feel themselves as beyond recovery, caught in the quicksand of permanent disability. If our current system encourages this kind of mindset, then we must change it. Fact 3: There is evidence that PTSD is treatable and that VA has the tools to do it. This may seem paradoxical, but it is true. The same agency that possesses disability claims showing veterans sliding toward increasing and permanent sickness is, in fact, the same agency that is recognized as having the tools necessary to successfully treat PTSD. On the question of whether PTSD is treatable, here is what the Institute of Medicine found in their 2007 report: The committee finds that the evidence is sufficient to conclude the efficacy of exposure therapies in the treatment of PTSD. The Institute of Medicine also recommended additional research regarding the efficacy of other forms of PTSD treatment, but at a minimum, it concluded that the evidence suggests that at least one form of treatment worked. What specific assets does the VA have to help veterans with PTSD? Well, let me list those assets, and let me also remind my colleagues that the VA health care system has been widely lauded by independent experts as one of the top health care providers in the United States. The VA has 215 readjustment counseling centers, or Vet Centers, which offer readjustment counseling for PTSD for afflicted veterans. The VA has PTSD clinic teams or specialists at each of its 153 medical centers across the country. The VA has 8 specialized PTSD inpatient units, 10 PTSD residential rehabilitation programs, 9 PTSD domiciliary programs, 7 women's trauma recovery programs, 10 day hospital outpatient programs, 10 substance use PTSD outpatient programs, and 22 women's stress treatment outpatient programs. These programs offer a full spectrum of therapies, including exposure therapies and medications to treat our veterans for PTSD. In total, VA is planning to spend more than $3 billion on health care services this year--roughly one-tenth of its total medical care budget. So how do we explain this paradox? Why does a look at the compensation rolls show us that veterans with mental illness are getting progressively worse even though the VA health system is recognized as having the tools to make them better? That question leads me to my fourth and final fact: There is a poor linkage between the arm of VA that treats PTSD--the Veterans Health Administration--and the arm of the VA that awards disability compensation--the Veterans Benefits Administration. One of VA's strategic objectives is to restore the capabilities of disabled veterans to the greatest extent possible. Most would agree with that objective, and most would conclude that restoring capability involves a focus on treatment and rehabilitation and not a rush to, in fact, award disability compensation. The problem is that the VA is inconsistent in how it measures whether it is achieving its objective. On the health care side, VA measures whether it is obtaining this objective by measuring meaningful outcome data regarding wellness and disease prevention. On the disability benefits side, it measures it by how fast and accurate a disability claim can in fact be decided. There is a serious disconnect here. One side emphasizes health and wellness, the other emphasizes a rush to award compensation confirming the existence of illness. There is no requirement that these two sides work together. Thus, disability compensation can be awarded and increased over the years without a veteran ever receiving medical treatment. To me, there is something backward about how this works. The Veterans Disability Benefits Commission honed in on this point in its 2007 report. There is little interaction between the Veterans Health Administration, which examines veterans for evaluation of severity of symptoms, and treats veterans with PTSD, and the Veterans Benefits Administration, which assesses disability ratings and may or may not require periodic reexamination. A further disconnect seen by the Veterans Disability Benefits Commission, the Senate Committee on Veterans' Affairs held a hearing last week at which the chairman of the Disability Commission, GEN James Terry Scott, testified. I asked General Scott specifically to expand on the Commission's findings and, more importantly, their recommendations. General Scott told me it was not his intent to offend anyone, but that we have been paying people with PTSD to go away; not to treat them, to go away. He went on to say that disability compensation has precluded, in the judgment of the Commission, any effort to make veterans with PTSD better, the No. 1 objective, I believe, of our system. General Scott then made the following statement that represents the heart of the Commission's findings on the link between PTSD compensation and treatment: It is our judgment that one of the principal goals of the VA and of the Commission, was that we want to make people better so they can return to the fullest extent possible, into ordinary lives without treatment. I do not see how we are fulfilling our obligation. These facts lead me, and I hope they will lead my colleagues as well, to the inescapable conclusion that the current approach to helping our veterans diagnosed with PTSD simply is not working. It is abundantly clear that we need to try something new. Again to quote the Veterans Disability Benefits Commission report: The Commission believes that PTSD is treatable, that it frequently reoccurs and remits, and that veterans with PTSD would be better served by a new approach to their care. The Veterans Disability Benefits Commission says: Veterans with PTSD would be better served by a new approach to their care. I believe the legislation I am introducing today is, in fact, that new approach. Before I describe the legislation and how it works, let me describe how the present system is working or, as the evidence suggests, not working. Let's say a young marine who is 2 years removed from his service in Iraq comes to the VA because he is suffering from PTSD-related flashbacks and cannot hold down a steady job. As a consequence, he is having trouble paying his bills. We all would. That veteran needs help immediately. First and foremost, he needs mental health treatment before his condition worsens, but he also needs short-term financial help during his treatment period. If we cannot address that, we cannot be assured that the correct amount of rehabilitation takes place. Under the current system, the veteran might first be counseled to file a disability claim with the Veterans Benefits Administration. And who could blame him. It is the source of money. He sees that as the quickest route to solving his immediate financial crisis. Although medical care would be made available at that time, the veteran cannot simply afford to put his life on hold to get well. We can all associate with this. After a 6-month wait, the average time it now takes to process a disability claim--average; some are sooner, more are later, but the average is 6 months--the veteran might be rated service connected due to disability. But by that time, a critical window of opportunity for wellness would have come and gone. The veteran's experience with the VA will have been one that emphasizes his sickness and the level of his disability rather than wellness through an aggressive treatment program. What would my legislation do? It would establish a program to refocus the existing system to one that emphasizes and incentivizes wellness. It would say to a veteran eligible for VA health care who suffers from service-related PTSD, depression, anxiety disorder, or related substance use disorder, that our focus is to make certain you are given the best efforts to get healthy and to feel better. It would do this by providing--get this--a wellness stipend, a wellness stipend for up to 1 year to any veteran diagnosed with these conditions so long as the VA diagnosing physician judges the conditions to be plausibly related to military service. All the veteran would have to do is to agree faithfully to attend the prescribed treatment regime, in other words, go get the services that are already provided, and hold off on filing disability for those illnesses until you have completed your rehab schedule. So if the rehab schedule the doctor prescribes is 6 months, we want you to hold off filing the disability claim for 6 months so we can give you the financial help you need to get through it, we can focus you into treatment, and at the end of the time you and the system can assess where you are. That is it. And we will do that for up to a year. Here is how it works for the marine whom I spoke about earlier. Upon diagnosis and treatment with the conditions of the program, an immediate $2,000 wellness stipend is made to him. All of a sudden the immediate financial crisis could be over; no lengthy claims process, no 6-month delay in getting needed financial help. With this immediate financial infusion, our marine can focus on getting well and not worrying about how he pays the next month's rent. More importantly, every 90 days that he participates, every 90 days that they can say ``he came to rehab,'' it translates into an additional $1,500 of a wellness stipend, a reward for continued participation. Finally, at the end of the treatment program, in this case the end of a year, a final $3,000 wellness stipend would go to the marine. Thus, in the total of a 1-year treatment program, we would pay the maximum wellness stipend of $11,000. Think about this. We are actually taking the most difficult piece, which is the financial obligation, and we are setting that aside so we can focus on what I believe is our obligation: to make sure that we provide the best course of rehab, of prevention, of wellness. I recognize treatment programs will vary depending on the medical needs of the veteran. My legislation gives the VA complete discretion to develop a recovery plan of an appropriate type and duration. Hence, if our marine only needs a 4-month program, he would receive $2,000 of wellness stipend up front, $1,500 after 90 days, and $3,000 at the end of the program, for a total of $6,500. Hopefully, at the conclusion of the treatment of our marine, he will then be healthy, or at least healthy enough to reenter society and move on to a productive life. If the opposite is true and the marine did not get well, his option to file a disability claim is still available in total. We have not deprived any veteran of their right to file disability claims. What we have asked is: Set it aside, let's focus on treatment, let's make sure you are not financially strapped, and at the end of intense treatment, focus on that treatment, let's get back together, and if you are still in a situation where you are disabled, then we file the disability claim. I know some might think this is a nonconcept, paying people to come in for what is basically free health care. But I think it is time for all of us to recognize what the Veterans Disability Benefits Commission and the Dole-Shalala commission have already recognized: treatment, rehabilitation, and recovery need to be the primary focus of our VA health and benefits system. And, more importantly, they need to be the focus of our mental health services. Let me quote the Disability Commission on this very point. The Commission believes that a new, holistic approach to PTSD should be considered. This approach should couple PTSD treatment, compensation, and vocational assessment. The Disability Benefits Commission felt so strongly about focusing on treatment for those with mental illness, particularly PTSD, that it recommended that we condition the receipt of compensation on the receipt of treatment. I am not proposing that we condition it as the Commission has proposed to Congress, but I want my colleagues to understand, you cannot have multiple commissions look at this issue and say: It is broken. It does not focus on the wellness our veterans need. It needs to be changed. Senator Dole and Secretary Shalala's commission recommended providing transition payments for injured service personnel while they receive treatment and rehabilitation services, and they recommended an incentive bonus payment designed to reward participants in a rehab program for achieving certain milestones, that if they actually accomplished a milestone that was set, we give them a financial incentive. Why? Because today's veteran, in many cases, has expectations that are unlike any generation before. Because of their age, because of the types of injuries they are exposed to, what their expectations are with an artificial limb--I lose no mobility, I am just as productive, I can play golf, I can run, I can play basketball, I can even pass a physical to stay in the Army. That is the reality. If we lose them up here, we have done them an injustice relative to their expectations for life. I think both commissions focused on an innovative approach to wellness, and the Disability Commission approach goes farther than mine in that it is a negative incentive as opposed to a positive one, but the underlying concepts are the same. The current system is not working. Let's try something new. I want to make a few points clear. First, under my legislation, no veteran would have to give up his or her right to receive disability compensation. Veterans can file a claim whenever they want. If they decide when they are presented this option right at the beginning that they want to file a disability claim and roll the dice on rehab, they can do that. If they get a month into rehab and they decide: I do not think this is working, they can file a disability claim. They will not get a financial stipend at the end of 90 days. They can drop out. They can continue to access VA benefits. They can continue to stay in rehab. But they may feel compelled to go ahead and file a disability claim. They can do that. The financial stipend ends, but we still continue the treatment, we just do not have an incentive for them to attend. The wellness stipend, as I said, will be paid only if the veteran agrees to stay faithful to the program and holds off on filing the claims during that treatment period of up to 1 year. Second, none of the nearly 300,000 veterans already in receipt of PTSD-related compensation and the thousands of others in receipt of compensation for depression and anxiety disorder would have to give up their compensation in order to participate in the treatment first program. For them, my legislation would pay a wellness stipend that is one-third the amount I mentioned earlier, so long as they agreed not to file a claim to increase their disability rating during this treatment period. Let me draw a distinction. For somebody who has already filed a disability claim, regardless of how old they are, and annually goes to be rerated, if they delay that rerating, if they go into an intense rehabilitation program, if, in fact, one has been identified by a medical professional within the Veterans' Administration for them to enter into, if they agree not to be rerated until the completion of that program, we will actually include them in the cash stipend, but it will be one-third the amount of somebody who enters the system for the first time. So whether you are a veteran who has never filed a claim before, a veteran with a claim pending, a veteran already in receipt of compensation, the treatment first program would be available to all. Finally, my legislation contains no requirement that disability compensation be reevaluated at the end of the treatment period. If treatment works--and the Institute of Medicine says it does--then veterans will have better lives because of it. That is the only goal of this legislation. I think we can all look at it, with what we know about the health care system, we can probably find a rationale to say, if we invest now in these veterans, we might save money on the back end for taxpayers in actual health care services that might be provided to somebody who drops out of the workforce who doesn't regard their health as important because they have now become locked into a monthly disability check for their livelihood. But for the ones who could end up there that we have now gotten into rehab successfully and increased or changed the quality of their life, the likelihood is the back end health care cost is minimal, if any. In conclusion, the status quo is not working. We need a new and bold approach. My legislation represents a direct challenge to all of us to think outside the box, to think about things that work elsewhere, but we haven't tried. Doing so sometimes requires taking steps that are a little unknown and a little bit unique. I am sure not only Members of the Senate but the veterans service organizations and, I am sure, the veterans themselves will look at this and say: Where is the cash? There is no cash. For once, we have a piece of legislation that is focused on how to make people better. We are willing to put our money where our mouth is because it is that important to a 19-year-old who comes back from Iraq who can truly be made well with the right type of rehab and who may, because of financial decisions in his own life, not choose to fully exhaust the rehabilitation needed to overcome that mental health challenge. This at least would give the American people the assurance that we have done everything possible for that 19-year- old to get the services he or she would need to lead a productive and fruitful life. I ask my colleagues for their support. It is time to put the treatment of our veterans with mental health illnesses first.

Mr. BURR

Mr. BURR. Mr. President, I have sought recognition to comment on legislation I am introducing today that will hopefully chart a new course for veterans with mental illness--the Veterans Mental Health Treatment First Act. As the title suggests, the bill proposes to advance a commonsense concept: Providing medical treatment for mental illness as a first priority will lead to a better quality of life for tens of thousands of veterans. It is a simple concept with which few would disagree. The problem is that the Government agency tasked with advancing that concept--the Department of Veterans Affairs--lacks the proper focus to actually deliver. Notice I didn't say VA lacked the tools to deliver. It has the tools--a world-class health care system, evidence-based therapies emphasizing recovery and rehabilitation, first-line medications, and the support of a dedicated group of clinical professionals. The problem is that, as an agency, VA doesn't coordinate the use of all of its resources--medical treatment, vocational rehabilitation, and disability compensation--to ensure what is universally agreed as the desired outcome of those with disabilities: wellness and a return to a productive life. Let me take a few minutes to lay out some of the facts for my colleagues. These facts have helped me get a better grasp of what the problem is, and they have truly informed my belief that a new approach to solving the problem is, in fact, necessary. Fact No. 1: There has been a steep increase in the number of veterans receiving disability compensation for post-traumatic stress disorder. In a 2005 report, the VA inspector general issued the following findings: During fiscal years 1999 through 2004, the number and percentage of PTSD cases increased significantly. While the total number of all veterans receiving disability compensation grew by only 12.2 percent, the number of PTSD cases grew by 79.5 percent, from 120,265 cases in fiscal year 1999 to 215,871 cases in fiscal year 2004. Sadly, the trend has not decelerated. Through September of 2007, 299,672--almost 300,000--veterans with PTSD were on the compensation rolls, a 39-percent increase since the VA inspector general's findings. Now, many might argue that it is only natural that we would see an increase in PTSD compensation given that we have been in a war on terror since the year 2001. However, today there are just under 30,000 veterans of the global war on terror on the disability compensation rolls for PTSD. Thus, the increase in PTSD rate represents a broad cross-section of the veterans community. No matter how far removed they are from military service, veterans are filing claims and being granted service-connected compensation for PTSD, and these staggering increases are occurring despite a decline--a decline--in the overall veteran population. Fact No. 2: Veterans with PTSD-related compensation appear never to get better, only to get worse. I just provided the sobering statistics about a 120-percent increase in PTSD disability rolls since 1999. Here is what the VA inspector general found in its 2005 review of veterans who have been added to the disability rolls: Based on our review of PTSD claim files, we observed that the rating evaluation level typically increased over time, indicating the veteran's PTSD condition had worsened. Generally, once a PTSD rating was assigned, it was increased over time until the veteran was paid at the 100 percent rate. This fact is even more disturbing than the first. It suggests a trend toward not only increasing sickness over time but also permanent sickness. It also suggests a certain sense of inevitability among those with lower disability ratings that the natural progression is for them to slip into total 100 percent. Then, as time wears on, total and permanent disability is, in fact, established. Mr. President, words have meanings. My greatest worry is that the message carried by an undesirable rating may lessen a veteran's resolve to seek treatment and to actually get better. They may feel themselves as beyond recovery, caught in the quicksand of permanent disability. If our current system encourages this kind of mindset, then we must change it. Fact 3: There is evidence that PTSD is treatable and that VA has the tools to do it. This may seem paradoxical, but it is true. The same agency that possesses disability claims showing veterans sliding toward increasing and permanent sickness is, in fact, the same agency that is recognized as having the tools necessary to successfully treat PTSD. On the question of whether PTSD is treatable, here is what the Institute of Medicine found in their 2007 report: The committee finds that the evidence is sufficient to conclude the efficacy of exposure therapies in the treatment of PTSD. The Institute of Medicine also recommended additional research regarding the efficacy of other forms of PTSD treatment, but at a minimum, it concluded that the evidence suggests that at least one form of treatment worked. What specific assets does the VA have to help veterans with PTSD? Well, let me list those assets, and let me also remind my colleagues that the VA health care system has been widely lauded by independent experts as one of the top health care providers in the United States. The VA has 215 readjustment counseling centers, or Vet Centers, which offer readjustment counseling for PTSD for afflicted veterans. The VA has PTSD clinic teams or specialists at each of its 153 medical centers across the country. The VA has 8 specialized PTSD inpatient units, 10 PTSD residential rehabilitation programs, 9 PTSD domiciliary programs, 7 women's trauma recovery programs, 10 day hospital outpatient programs, 10 substance use PTSD outpatient programs, and 22 women's stress treatment outpatient programs. These programs offer a full spectrum of therapies, including exposure therapies and medications to treat our veterans for PTSD. In total, VA is planning to spend more than $3 billion on health care services this year--roughly one-tenth of its total medical care budget. So how do we explain this paradox? Why does a look at the compensation rolls show us that veterans with mental illness are getting progressively worse even though the VA health system is recognized as having the tools to make them better? That question leads me to my fourth and final fact: There is a poor linkage between the arm of VA that treats PTSD--the Veterans Health Administration--and the arm of the VA that awards disability compensation--the Veterans Benefits Administration. One of VA's strategic objectives is to restore the capabilities of disabled veterans to the greatest extent possible. Most would agree with that objective, and most would conclude that restoring capability involves a focus on treatment and rehabilitation and not a rush to, in fact, award disability compensation. The problem is that the VA is inconsistent in how it measures whether it is achieving its objective. On the health care side, VA measures whether it is obtaining this objective by measuring meaningful outcome data regarding wellness and disease prevention. On the disability benefits side, it measures it by how fast and accurate a disability claim can in fact be decided. There is a serious disconnect here. One side emphasizes health and wellness, the other emphasizes a rush to award compensation confirming the existence of illness. There is no requirement that these two sides work together. Thus, disability compensation can be awarded and increased over the years without a veteran ever receiving medical treatment. To me, there is something backward about how this works. The Veterans Disability Benefits Commission honed in on this point in its 2007 report. There is little interaction between the Veterans Health Administration, which examines veterans for evaluation of severity of symptoms, and treats veterans with PTSD, and the Veterans Benefits Administration, which assesses disability ratings and may or may not require periodic reexamination. A further disconnect seen by the Veterans Disability Benefits Commission, the Senate Committee on Veterans' Affairs held a hearing last week at which the chairman of the Disability Commission, GEN James Terry Scott, testified. I asked General Scott specifically to expand on the Commission's findings and, more importantly, their recommendations. General Scott told me it was not his intent to offend anyone, but that we have been paying people with PTSD to go away; not to treat them, to go away. He went on to say that disability compensation has precluded, in the judgment of the Commission, any effort to make veterans with PTSD better, the No. 1 objective, I believe, of our system. General Scott then made the following statement that represents the heart of the Commission's findings on the link between PTSD compensation and treatment: It is our judgment that one of the principal goals of the VA and of the Commission, was that we want to make people better so they can return to the fullest extent possible, into ordinary lives without treatment. I do not see how we are fulfilling our obligation. These facts lead me, and I hope they will lead my colleagues as well, to the inescapable conclusion that the current approach to helping our veterans diagnosed with PTSD simply is not working. It is abundantly clear that we need to try something new. Again to quote the Veterans Disability Benefits Commission report: The Commission believes that PTSD is treatable, that it frequently reoccurs and remits, and that veterans with PTSD would be better served by a new approach to their care. The Veterans Disability Benefits Commission says: Veterans with PTSD would be better served by a new approach to their care. I believe the legislation I am introducing today is, in fact, that new approach. Before I describe the legislation and how it works, let me describe how the present system is working or, as the evidence suggests, not working. Let's say a young marine who is 2 years removed from his service in Iraq comes to the VA because he is suffering from PTSD-related flashbacks and cannot hold down a steady job. As a consequence, he is having trouble paying his bills. We all would. That veteran needs help immediately. First and foremost, he needs mental health treatment before his condition worsens, but he also needs short-term financial help during his treatment period. If we cannot address that, we cannot be assured that the correct amount of rehabilitation takes place. Under the current system, the veteran might first be counseled to file a disability claim with the Veterans Benefits Administration. And who could blame him. It is the source of money. He sees that as the quickest route to solving his immediate financial crisis. Although medical care would be made available at that time, the veteran cannot simply afford to put his life on hold to get well. We can all associate with this. After a 6-month wait, the average time it now takes to process a disability claim--average; some are sooner, more are later, but the average is 6 months--the veteran might be rated service connected due to disability. But by that time, a critical window of opportunity for wellness would have come and gone. The veteran's experience with the VA will have been one that emphasizes his sickness and the level of his disability rather than wellness through an aggressive treatment program. What would my legislation do? It would establish a program to refocus the existing system to one that emphasizes and incentivizes wellness. It would say to a veteran eligible for VA health care who suffers from service-related PTSD, depression, anxiety disorder, or related substance use disorder, that our focus is to make certain you are given the best efforts to get healthy and to feel better. It would do this by providing--get this--a wellness stipend, a wellness stipend for up to 1 year to any veteran diagnosed with these conditions so long as the VA diagnosing physician judges the conditions to be plausibly related to military service. All the veteran would have to do is to agree faithfully to attend the prescribed treatment regime, in other words, go get the services that are already provided, and hold off on filing disability for those illnesses until you have completed your rehab schedule. So if the rehab schedule the doctor prescribes is 6 months, we want you to hold off filing the disability claim for 6 months so we can give you the financial help you need to get through it, we can focus you into treatment, and at the end of the time you and the system can assess where you are. That is it. And we will do that for up to a year. Here is how it works for the marine whom I spoke about earlier. Upon diagnosis and treatment with the conditions of the program, an immediate $2,000 wellness stipend is made to him. All of a sudden the immediate financial crisis could be over; no lengthy claims process, no 6-month delay in getting needed financial help. With this immediate financial infusion, our marine can focus on getting well and not worrying about how he pays the next month's rent. More importantly, every 90 days that he participates, every 90 days that they can say ``he came to rehab,'' it translates into an additional $1,500 of a wellness stipend, a reward for continued participation. Finally, at the end of the treatment program, in this case the end of a year, a final $3,000 wellness stipend would go to the marine. Thus, in the total of a 1-year treatment program, we would pay the maximum wellness stipend of $11,000. Think about this. We are actually taking the most difficult piece, which is the financial obligation, and we are setting that aside so we can focus on what I believe is our obligation: to make sure that we provide the best course of rehab, of prevention, of wellness. I recognize treatment programs will vary depending on the medical needs of the veteran. My legislation gives the VA complete discretion to develop a recovery plan of an appropriate type and duration. Hence, if our marine only needs a 4-month program, he would receive $2,000 of wellness stipend up front, $1,500 after 90 days, and $3,000 at the end of the program, for a total of $6,500. Hopefully, at the conclusion of the treatment of our marine, he will then be healthy, or at least healthy enough to reenter society and move on to a productive life. If the opposite is true and the marine did not get well, his option to file a disability claim is still available in total. We have not deprived any veteran of their right to file disability claims. What we have asked is: Set it aside, let's focus on treatment, let's make sure you are not financially strapped, and at the end of intense treatment, focus on that treatment, let's get back together, and if you are still in a situation where you are disabled, then we file the disability claim. I know some might think this is a nonconcept, paying people to come in for what is basically free health care. But I think it is time for all of us to recognize what the Veterans Disability Benefits Commission and the Dole-Shalala commission have already recognized: treatment, rehabilitation, and recovery need to be the primary focus of our VA health and benefits system. And, more importantly, they need to be the focus of our mental health services. Let me quote the Disability Commission on this very point. The Commission believes that a new, holistic approach to PTSD should be considered. This approach should couple PTSD treatment, compensation, and vocational assessment. The Disability Benefits Commission felt so strongly about focusing on treatment for those with mental illness, particularly PTSD, that it recommended that we condition the receipt of compensation on the receipt of treatment. I am not proposing that we condition it as the Commission has proposed to Congress, but I want my colleagues to understand, you cannot have multiple commissions look at this issue and say: It is broken. It does not focus on the wellness our veterans need. It needs to be changed. Senator Dole and Secretary Shalala's commission recommended providing transition payments for injured service personnel while they receive treatment and rehabilitation services, and they recommended an incentive bonus payment designed to reward participants in a rehab program for achieving certain milestones, that if they actually accomplished a milestone that was set, we give them a financial incentive. Why? Because today's veteran, in many cases, has expectations that are unlike any generation before. Because of their age, because of the types of injuries they are exposed to, what their expectations are with an artificial limb--I lose no mobility, I am just as productive, I can play golf, I can run, I can play basketball, I can even pass a physical to stay in the Army. That is the reality. If we lose them up here, we have done them an injustice relative to their expectations for life. I think both commissions focused on an innovative approach to wellness, and the Disability Commission approach goes farther than mine in that it is a negative incentive as opposed to a positive one, but the underlying concepts are the same. The current system is not working. Let's try something new. I want to make a few points clear. First, under my legislation, no veteran would have to give up his or her right to receive disability compensation. Veterans can file a claim whenever they want. If they decide when they are presented this option right at the beginning that they want to file a disability claim and roll the dice on rehab, they can do that. If they get a month into rehab and they decide: I do not think this is working, they can file a disability claim. They will not get a financial stipend at the end of 90 days. They can drop out. They can continue to access VA benefits. They can continue to stay in rehab. But they may feel compelled to go ahead and file a disability claim. They can do that. The financial stipend ends, but we still continue the treatment, we just do not have an incentive for them to attend. The wellness stipend, as I said, will be paid only if the veteran agrees to stay faithful to the program and holds off on filing the claims during that treatment period of up to 1 year. Second, none of the nearly 300,000 veterans already in receipt of PTSD-related compensation and the thousands of others in receipt of compensation for depression and anxiety disorder would have to give up their compensation in order to participate in the treatment first program. For them, my legislation would pay a wellness stipend that is one-third the amount I mentioned earlier, so long as they agreed not to file a claim to increase their disability rating during this treatment period. Let me draw a distinction. For somebody who has already filed a disability claim, regardless of how old they are, and annually goes to be rerated, if they delay that rerating, if they go into an intense rehabilitation program, if, in fact, one has been identified by a medical professional within the Veterans' Administration for them to enter into, if they agree not to be rerated until the completion of that program, we will actually include them in the cash stipend, but it will be one-third the amount of somebody who enters the system for the first time. So whether you are a veteran who has never filed a claim before, a veteran with a claim pending, a veteran already in receipt of compensation, the treatment first program would be available to all. Finally, my legislation contains no requirement that disability compensation be reevaluated at the end of the treatment period. If treatment works--and the Institute of Medicine says it does--then veterans will have better lives because of it. That is the only goal of this legislation. I think we can all look at it, with what we know about the health care system, we can probably find a rationale to say, if we invest now in these veterans, we might save money on the back end for taxpayers in actual health care services that might be provided to somebody who drops out of the workforce who doesn't regard their health as important because they have now become locked into a monthly disability check for their livelihood. But for the ones who could end up there that we have now gotten into rehab successfully and increased or changed the quality of their life, the likelihood is the back end health care cost is minimal, if any. In conclusion, the status quo is not working. We need a new and bold approach. My legislation represents a direct challenge to all of us to think outside the box, to think about things that work elsewhere, but we haven't tried. Doing so sometimes requires taking steps that are a little unknown and a little bit unique. I am sure not only Members of the Senate but the veterans service organizations and, I am sure, the veterans themselves will look at this and say: Where is the cash? There is no cash. For once, we have a piece of legislation that is focused on how to make people better. We are willing to put our money where our mouth is because it is that important to a 19-year-old who comes back from Iraq who can truly be made well with the right type of rehab and who may, because of financial decisions in his own life, not choose to fully exhaust the rehabilitation needed to overcome that mental health challenge. This at least would give the American people the assurance that we have done everything possible for that 19-year- old to get the services he or she would need to lead a productive and fruitful life. I ask my colleagues for their support. It is time to put the treatment of our veterans with mental health illnesses first.

Mr. BURR

Mr. BURR. Mr. President, I rise today to honor a man who is my close friend but who, more importantly, is an American patriot and statesman. Today, we pay tribute to Trent Lott, whom many, including myself, consider an institution within this great institution. I have known Trent for a number of years. He has served as an able and well-accomplished leader, a great Republican whip, and a distinguished Congressman and Senator from the State of Mississippi. A man of impeccable character, Trent always shows the utmost respect for his colleagues and for Congress itself, always putting the interests of the country before his own. Trent Lott has a leadership style that I personally admire and I believe often went underappreciated. He loves this institution, and we respect him for that. During his tenure in Congress, Trent has been a legislative warrior fighting for commonsense solutions to our country's most difficult challenges. He does not seek credit for his achievements--they are too numerous to list--even though he has been instrumental in shaping our great democracy. Trent Lott is a modest and honest man who has made the United States a better place from where it was when he first took the oath to serve in Congress decades ago. He is a true gentleman, and I have no doubt that his impressive legacy will live on for generations to come. God bless Trent Lott and his beautiful family. Your service to this great Nation will certainly be missed but will never be forgotten.

Mr. BURR

Mr. BURR. I hope my colleagues here understand that the law, as currently written, works. It has served this country well and it has produced choice, it has produced quality, and it has fairly reimbursed all who entered into it. Let's not change it, and let's make sure the products that America has chosen and continues to choose in the marketplace are driven by the marketplace, not manipulated by this body in Washington.

Mr. BURR. Mr. President, I appreciate the generous offer from the ranking member. This is tough. Senator Tester is a friend, but he is misguided. The fact is that the law today has served us well in this country. I think it is vitally important for all Senators to realize that agriculture is a business that reacts and changes to market demands. We have put legislation into place that allows the markets to operate, and these laws serve as guidelines for farmers in how they make their business plans for the future. As a matter of fact, we are the envy of the rest of the world. The agricultural markets in this country, the hogs raised and sold and eaten, the chickens and the turkeys--and in North Carolina's case, we rank extremely high; we are No. 2 in hogs and turkey production. I daresay every person in the room, and even in America, has eaten pork from North Carolina at one point or another. One of the reasons hog farmers in my State have been able to grow and produce the best pork in the world is the regulatory forces that govern the livestock industry. What we are being asked to do in this amendment is to turn that on its head. Today, current law says if a producer wants to bring suit against a processor for injuries to the producer's business, they have to show that they have actually been injured. Let me restate that. Current law says if a producer wants to bring suit against a processor for injuries to the producer's business, they have to show they have actually been injured. That is a threshold that ought to be for everything that a suit is brought on. Let me put in practical terms exactly what the Tester amendment would do. It would say that a company that contracts with a producer, a grower, and because they have determined that that grower has exceeded the minimum standards, has done things that technologically enhanced the products they are going to purchase, that if they reward them by paying them more money because the product is better, they are now susceptible to a grower who may not be dealing with 10,000 hogs, he may be dealing with 10 hogs. He might not adapt his surroundings to the new technologies; therefore, the meat is not as good. But if they are not paid the same, he will go to court and sue that he should have been paid the same thing as the contract for 10,000. What is the net result of it? If I were in a State that had smaller producers who felt disadvantaged from a price, I might look at it differently, but what is the impact? The impact is that companies are not going to raise everybody's boat, they are going to lower everybody's boat. They are going to pay every producer less. There will be no incentive for new technologies to go into agriculture-- specifically hogs, turkeys, and chickens. There will be no choice for consumers between grades of products, some that taste better than others, because we will now dumb down to what this new standard is, and that standard will be to make sure you are not susceptible to lawsuits. Everybody, regardless of size, regardless of the quality of the product, will be paid the same. I will say that again. Regardless of the quality, regardless of the size of the purchase, because of this one little change, which is that you have to prove you were injured, producers will be obligated. You might say it is their choice; but if a choice is between being sued every time there are contracts that say different things, or accepting one standard and applying that to everybody, they are going to accept one standard and apply it to everybody because they cannot pass on the litigation costs of these foods. Please tell me when 1 minute is left.

Mr. BURR

Mr. BURR. Mr. President, today I wish to honor a man who is a close personal friend of mine but more importantly is admired by fans of the sport of golf around the world. I wish to highlight the career of professional golfer Curtis Strange, who on November 12, 2007, was formally inducted into the World Golf Hall of Fame. I first met Curtis as an undergraduate student-athlete at Wake Forest University where he earned the prestigious Arnold Palmer Scholarship to play golf. Curtis's college career was nothing short of remarkable. Many even consider the team that Curtis played on at Wake Forest to be the best collegiate golf team in U.S. history. In fact, Golf World called the 1975 Wake Forest team that featured Curtis Strange, Jay Haas, Bob Byman, and David Thore as ``the greatest of all-time.'' In 1974, Curtis won the Fred Haskins Award that goes to the Nation's top collegiate golfer and was awarded 1st Team All-American honors three years in a row. In 1974 and 1975, Curtis led the Demon Deacon golf team to two, back- to-back NCAA titles and earned the individual collegiate title in 1974, the same year he won the World Amateur Cup. Curtis turned professional after his junior year in 1976. Throughout his professional career and particularly in the 1980s, Curtis impressed PGA fans with his unmatched skills proving how excellent a golfer he really is, achieving feats that very few other golfers can say they have achieved. For instance, he posted 17 PGA Tour victories including back-to-back U.S. Open Championships in 1988 and 1989, becoming the first to do that since Ben Hogan in 1950-1951. He has been a member of five Ryder Cup Teams--1983, 1985, 1987, 1989 and 1995--and in 2002, he was captain of the Ryder Cup team. And Curtis Strange's impressive career has not ended. He currently plays on the senior PGA Tour. But perhaps one of the most honorable achievements of Curtis Strange was his gracious gift to Wake Forest University. He recently very generously established a golf scholarship fund at Wake Forest. This gesture should not go unnoticed. It shows that Curtis is the type of man who wants to give back to the community that helped him get to where he is today. He wants others to benefit from his success. Curtis Strange is a good man with a good heart. I congratulate Curtis on his induction into the World Golf Hall of Fame, I commend him for his outstanding achievements as an athlete, and I honor him as a person.

Mr. BURR

Mr. BURR. Mr. President, I thank my colleague, Senator Coburn. This is an important debate. I think some in the body have suggested this is sort of a dilatory tactic. It is not. I think the future of health care in this country is one of the single most important topics this body should talk about. Senator Coburn went down the list of earmarks we find in the bill. The incredible thing is it didn't seem odd hearing those on this floor because we hear it all the time. But to the American people, when you hear about a field trip costing $500,000 to the Chesapeake Bay, America thinks that is probably a field trip for Members of Congress. I am not sure we could find the Chesapeake Bay. I am not sure we can get outside of the 30-square miles surrounded by a reality called Washington, DC. Therein lies a lot of the problem. All we are asking our colleagues to do is express your view through a vote as to whether children are more important than the personal interests of the earmarks. I have some in this bill. I would give them up, as long as I know the money is going to where it can do some good. We have debated children's health, and I voted against the extension of the SCHIP bill. My Governor lobbied extremely hard for me to support that bill. Now, all of a sudden, we are talking about covering 177,000 kids in America with this bill. I haven't gotten a call from my Governor. The Governor is willing to take it if it is a lump sum with no conditions and they can use that however they want to, but when you target it on kids, what is this about? This is about prevention. This is about creating a medical home for kids versus delivery of care in the emergency room because both of them don't cost them anything. The misunderstanding about the American health care system today is that if you can't pay and you walk into an emergency room, every emergency room is required to provide that care for you. Well, that creates a tremendous cost shift, and for those of us who pay out of our pocket or we pay because we have insurance coverage, our insurance goes up. And the rate out of pocket goes up because we are having to compensate for the people who don't pay, who don't have coverage, for the people who we have not changed our health care system to reflect what their conditions are. We have an opportunity to begin to chip away at it. We have an opportunity to insure at least 170,000 people. If this were only North Carolina, the $2,300 Dr. Coburn talked about for the cost of a policy would be closer to $1,342. We could actually insure more children in North Carolina, and he probably could in Oklahoma. We know people will call and question our numbers, so we take the most expensive rate it could cost. I remind my colleagues that under the SCHIP program we passed, if the Federal Government is to provide this care, it was allocated somewhere between $3,400 and $4,000 per child. There is the reason you never want the Federal Government negotiating your health care. I came here 13 years ago. My insurance was with a company of just over 50 employees, and when I became a Federal employee and accessed my care with the same plan of coverage, only one thing changed: My premium went up because the Federal Government had negotiated my plan. I learned this last year when my oldest son turned 22. I got a notice from BlueCross BlueShield that the Federal plans drop our children at age 22 regardless of whether they are in school. My son happens to still be in school. I hope this year he will graduate. I was faced, like every Federal employee, with the fact that I had a child who was no longer going to be insured under my family plan. I thought for sure that if I called the Federal Government, they would tell me they had already negotiated a plan that I could step him right over into, and they had. It was the same BlueCross BlueShield plan he was under. What was the annual cost? It was $5,400 a year for a 22-year-old healthy bull. What did I do? I went back to North Carolina and checked with the school and said: Have you got a negotiated plan? They said: We have a negotiated plan with BlueCross BlueShield, which was identical to what he had under me--the one OPM negotiated, which was $5,400--and I paid $1,428 for that. It had the same deductible, same copay, same coverage, with one big difference: One was negotiated by the private sector, or by the university, and the other by the Federal Government. We don't negotiate deals in the best interest of the people we are trying to cover. That is one of the reasons expansion of SCHIP is a bad thing. Actually, changing the health care system to cover 47 million Americans--children and adults who today don't have insurance--is a good thing. I would vote today for the current SCHIP to be reauthorized, for us to put in enough money to make sure nobody is dropped from the rolls, to change the formula for the States so those who were cheated were treated fairly, and I would vote for it today. But why would I expand a program that pays 30 percent too much to 50 percent too much to cover our kids when the answer to health care is to fix the system? The reality is that we are here about this amendment. This amendment would force Congress to prioritize between children's health, rather than parochial pork projects of over 700 projects, almost $400 million, that we could redirect from this one appropriations bill and devote it fully to the 9.5 million uninsured children in this country. And 9.5 is the number in total; 3.9 of those have been without insurance for over a year. So, as you can tell, you have the majority of the children's population that is considered uninsured that at some point in the last 12 months has actually been insured. Going back to SCHIP expansion, one of the clear facts about expanding SCHIP--not just the numbers of kids who are on it but the income level--is that I don't think Americans believe that an income at $82,000 needs to be subsidized by the Federal Government. That is where they were driving the income limits for SCHIP. Probably more important than that is that we were actually taking kids off of their parents' insurance and putting them on the Federal Government's insurance. We were taking kids who ride for free on their parents' insurance and now paying $4,000 to put them on the Federal Government's plan. The taxpayers looked at us and thought we were crazy that we were even debating this. There wasn't an exclusion in the expansion that said we are going to take the ones who are only uninsured today; no, we are taking all of them. We will take the ones who are insured and flip them over, and clearly the only thing that achieves is growing the size of the Federal system. Mr. President, I hope when we come back on Monday that more of our colleagues will listen and that many will express their preference that we put children's health in front of projects. I actually believe that today, if it passed, it would never come out of conference, the earmarks would show back up, and children's health would go away, and it would happen at some point in that process. Quite honestly, who would lose? The kids. The kids are losing today because we are not debating what we should be debating, which is health care reform. The uninsured are losing today because we should be debating health care reform. Every American is losing today because, for those who are insured, those who have seen their premiums rise in high single and double digits every year for the past 10 years--and they have asked why. I can tell you why. It is because we won't fix health care. It is because your premium increase is reflective of those who are not covered. Tom Coburn and I are here today saying we should cover them and we have a plan to do it. It doesn't distinguish between adults and children. Through covering those 47 million--or whatever the number is--we will save $200 billion a year in cost shifting. That $200 billion a year will begin to bring everybody's premium in America down for the first time in the last decade. So it is not just an effect on the uninsured, an effect on children, an effect on adults; it is an effect on every American who currently has private insurance and the reality of the impact on their premium cost. I know the occupant of the chair today is a big proponent of prevention. He is outspoken on it. You cannot have prevention without coverage. You cannot have real prevention that individuals buy into unless there are rewards on the other end. The reward of healthy decisions is that you're less risky for illness. When you are less of a risk, your premium cost goes down. Eventually, I would like to see every American own their health insurance policy. I would like to see the ability to take an insurance policy from one employer to another because we have negotiated, not an employer. I would love to see every American in a position where they are not holding onto a job they hate in a location they dislike because they cannot afford to give up health insurance. I want to see them have ownership with health insurance, like with a 401(k) plan. They can make the decision about what is best for their family and future and occupation without health care being the pivotal piece of that decision. We are held hostage by the employer-based system. That is not to say I am proposing we get away from it. I am only suggesting that a partnership between individuals and employers, between individuals and insurance companies, an effort by Congress to restructure health care and reform insurance products, to provide America with an unlimited basket of options for coverage, is a good thing. We created Part D Medicare. For the first time, we extended prescription drug coverage to seniors in the country. It was not an oversight in 1965. Medications at that time weren't really used widely to treat patients. Today, it is part of every office visit--some type of medication. So we didn't know exactly where we were headed when we created Part D--something targeted just for Medicare individuals. Today, 84 percent of the population that is eligible has signed up. What is our experience in the first year? It is important to look at outcomes. Our experience is that premiums dropped 28 percent. This year, the costs every Medicare-eligible person paid last year dropped 28 percent, on average, for Part D coverage. What about the drug cost? What about the pills they are buying every month or every quarter? The first year, the reduction in the cost of services delivered and pharmaceuticals is 33 percent. Why? One, we extended the offer to all seniors. We didn't exclude anybody. Two, we created real competition, which means that if there is a Federal piece, we had private sector plans and options that competed. We made sure there was a robust basket of competition. Third, and probably most important, for the first time we forced transparency in health care. We actually made plans and pharmacies list the price of certain drugs online so that we could do what we do best in America: shop where the price was the most advantageous for what it was we wanted to purchase. You know what. We learned that seniors are very aggressive at it. I knew that about my grandparents before they died. I am finding out that, as my parents get older, they get a little tighter and they want to make decisions that are financially to their benefit. We have extended that opportunity to millions of Medicare-eligible individuals in this country. What are we talking about? Creating the same model, taking that positive experience we had with Part D and extending it over to the entire population that is under private insurance, giving them options--options that deal with real competition, transparency in dealing with prices, the opportunity for those covered by employers to have reductions in premiums, and over some period of time, for those Americans who want to take advantage of it, to actually have ownership in a plan they have negotiated that doesn't lock them into an employer, but they are able to use that in a portable way, to switch jobs without having to renegotiate their coverage. Well, I think I have presented to you where we are today and where I think we need to go over some period of time in the Senate. It won't happen if Members take this opportunity to insure 177,000 children who are currently uninsured, who currently cause a cost shift in America, who currently receive emergency care and are not provided prevention, who don't have a medical home to go to, a doctor they know they can call, whether it is for a sore throat or an earache or, Heaven forbid, the current staph infection that is going around, which has killed now one out of five individuals who have been infected with it. We live in a very dangerous world, which should take what is best about our health care system--and that is prevention and diagnosis--and make sure every American has it. You cannot have it without coverage. You have to start somewhere, and these 177,000 children is the perfect place for us to start. I yield the floor.

Mr. BURR

Mr. BURR. I would ask the Chair to notify me when I have 2 minutes remaining. Mr. President, I heard my good friend from Massachusetts talk about the Federal system. Let me take a minute to talk about the Federal system. I have been here for 13 years. The coverage I have is less and the cost is more than when I was in the private sector working for a company with 50 employees, but I accept that. Last year, I learned something new, though. When my oldest son became 22, I got a notice that under the Federal plan he automatically falls off our insurance. Well, it happens for every Federal employee, but what was my experience? That is what I wish to share with you. I called to find out what the Federal Government had negotiated so that my child could have health insurance. They said the exact same coverage would now be $5,400 for that individual--a 22-year-old college student, healthy as a bull. I decided I would go to North Carolina and I would negotiate to see if I couldn't find similar coverage. Not only could I find similar coverage, but I found the same coverage, and I found it with the same company. I now pay $1,500 a year for the same coverage with the same company my son was covered by under the Federal health care plan. Now, here is the glaring difference. From a standpoint of my insurance, the Federal Government still pays the same amount and I still pay the same amount. When you take a healthy person off insurance, the premium doesn't go down. So for the 6 million kids who are targeted in SCHIP expansion--and everybody agrees 3 million are uninsured and 3 million are currently insured--I don't want anybody to walk away and believe we are reducing the premium cost of the families who are currently privately insuring these kids. As a matter of fact, the CBO statistics prove exactly what happened with my son, in the fact that we will now transition to a private sector program for him. For those 3 million SCHIP kids, we could access health care coverage for an average of $1,130 a year. But in this legislation, it says we will be paying $3,950 a year for the same level of coverage for those kids. We will pay it for those who weren't insured and we will pay it for those who were insured. Their family insurance won't go down, and we will pay three times as much for the coverage than if we went to the private sector and we negotiated that coverage. To some up here, that makes unbelievable sense. To those of us who come out of business, to those of us who understand what the people in our States whom we represent struggle with day in and day out, it makes absolutely no sense. Forget the fact that adults will still be covered under this Children's Health Insurance Program; that private coverage will be replaced with government-run coverage; that within this bill, this children's health care bill, are hidden earmarks--earmarks that create a health care center in Memphis and earmarks that deal with the pension system in Michigan. My God, is this about kids and health care or is it about what we can hide in a bill and disguise and cover as a benefit to children? It overturns an administration rule targeting SCHIP for low- income children. The bill would overturn an HHS directive that requires States to focus first on covering low-income kids, thereby eliminating any State accountability to cover the neediest kids first. Well, most of us have done oversight work. If we could trust the States or people we give money to, we wouldn't need oversight committees. But they meet every day, all day long, because we can't trust any single entity to follow the rules. We are basically taking the rules and throwing them away. Will we cover adults? Sure, States will make decisions to cover adults. States will make decisions that will go far outside of low-income children. Now, the speaker prior to Senator Kennedy said this was not a debate about health care reform. He is right. It is one of the few things I have heard on the floor today that is accurate. But it should be. This should be about health care reform. It is the belief of some that we should feel good about overpaying for a program that will cover 3 million uninsured in this country and reassign 3 million who are insured to now be under the dole of the Federal Government and the American taxpayer when, in fact, we have 47 million uninsured in this country. That is exactly what we should be debating on the Senate floor today--how do we reform health care to where we cover the 47 million who are uninsured in this country. Well, when we debated SCHIP before it was conferenced, we talked about this incredible new plan that had been introduced by a number of us--the Every American Insured Health Act--a plan that covered 47 million uninsured. It did it in a budget-neutral way. It eliminated the cost shift that exists in our system today. We estimate saving $200 billion a year. That is for a plan that I suggest is very much targeted for 47 million uninsured, and the CBO will verify that it is budget neutral. For those who might not be one of those 47 million individuals, who might say I don't have skin in this game: If we are able, through the elimination of cost shifting because we are now providing primary care for people who today do not have insurance, who will not be in the emergency room accessing care at the most expensive, most inefficient place--who actually have preventive care, who have wellness access, who have a medical home, who have a doctor for the first time, and we are able to squeeze out $200 billion of waste that we can pump back into health care--an amazing thing happens. It brings everybody's premiums down. For a person in the country who might be sitting there saying, I have insurance, I am covered, I am OK; it doesn't make any difference to me whether they have this debate about insurance reform--it should matter to you because it is unsustainable to continue the inflation rate of health care at the rate it is going. If you want to see that end, if you want to see your premium come down, we have to reform health care, and I tell you it starts with insuring 47 million Americans, not 3 million kids. We should provide the resources so those 47 million can access their care in their State with the most competitive products they can find for the scope of coverage. This plan is out there. We introduced it. We didn't ask for a vote. We should have. But we have another opportunity and that opportunity is, let's reauthorize the current SCHIP plan, let's put the dollars in that are needed to make sure nobody falls off the system, but let's choose not to expand it to include, at three times the cost, 3 million kids and take 3 million kids off their parents' insurance and put them over on the Government insurance for the taxpayers to pay for. Rather than do that, why not engage in an honest, real debate on the floor and let's come up with a reform package that covers the 47 million. Let's come out with a bill on the Senate floor that doesn't leave anybody behind. If we are going to cover 3 million uninsured kids, what about the other millions we are not covering? The reason we do not go higher is because the higher you go, the larger the percentage of kids you are pulling off of their parents' insurance. What we have learned from my experience, and I think nobody would disagree with me: It saved me no money. The Federal Government's share of my health care today is more than it was when my first child was on my insurance plan. And in December, I have the great fortune that I am going to go through this again. I am going to have my second child who will become 22, and this arcane Federal guideline, statute, whatever it is at OPM, will kick in and they will say we will no longer cover your healthy 22-year-old son. I will go to North Carolina and I will access insurance, probably at $1,500 like his brother has. I will now have $3,000 a year in additional coverage, only to find out that the Federal Government, for my plan for me and my wife, is paying more money than we were before. There is a reason. It is because when you take healthy people out of the pool, the actuaries look at us old folks and say: You know, they are a greater risk to us. The reverse is true, too. If over time we allow adults to infiltrate, which we already have, the children's insurance program, amazing things are going to happen. The premium is going to go up because we are putting older folks, who are less healthy, in the pool. This makes a lot of sense to me because it works the same one way as it does the other. I think the sad thing today is I have to stand up and say I am not going to support an expansion of SCHIP, but I will support reauthorization of SCHIP with dollars that say nobody falls off. I will also commit today to be the most engaged Member of the Senate if we will come down here and have a health care reform debate. Bring the proposals to the floor. But don't come if you are not willing to prove you are going to insure 47 million uninsured in the country. Don't come unless you are willing to get all the cost shift out of the health care system. Don't come unless you are willing to take $200 billion and have that impact positively on everybody's premium in this country. Don't come to the floor unless you are willing to extend wellness and preventive care through the policies we are able to create. Don't come unless you are willing to reform insurance products so they are truly market based. Don't come if you don't want insurance products to be portable, when employees can take them from job to job just like the retirement benefits we have and that we fought so hard for. Today I am disappointed because we have an opportunity in this program. We can't extend this program, though, if in fact passing a bad bill is the result. I yield the floor.

Mr. BURR. Mr. President, it is my understanding I have 10 minutes.

Mr. BURR

Mr. BURR. Mr. President, I stand here with a heavy heart. Congress had the chance to reauthorize many important programs at the Food and Drug Administration and pass a targeted drug safety bill. Instead, we are passing a massive bill that triples FDA regulation and responsibility, puts clinical data out in the general domain that may be misleading to patients, and contains conflict of interest language that could harm participation on the FDA's advisory committees--a key part of the drug approval process. I will start with a good part of the bill. This bill reauthorizes many important programs at the FDA, including the pediatric exclusivity program. The Best Pharmaceuticals for Children Act was originally enacted as part of the Food and Drug Administration Modernization Act in 1997, legislation I sponsored on the House side and was reauthorized in 2002. The goal of BPCA is to encourage the study of more drugs in the pediatric population. BPCA provides that incentive by giving drug companies an additional six months of market exclusivity to a product, or pediatric exclusivity, in exchange for conducting voluntary studies of prescription drugs on children. Since its enactment, BPCA has been viewed as a highly successful program and has produced at least 132 completed studies, leading to approximately 120 pediatric label changes. According to the most recent General Accountability Office study on BPCA, issued March 22, 2007, prior to enactment of the Food and Drug Administration Modernization Act few drugs were studied for pediatric use. As a result, there was a lack of information on optimal dosage, possible side effects, and the effectiveness of drugs for pediatric use. Almost all the drugs--about 87 percent--that have been granted pediatric exclusivity under BPCA have had important labeling changes as a result of pediatric drug studies conducted under BPCA. Exclusivity is working. Senator Dodd tried to change the Best Pharmaceutical for Children Act by decreasing the exclusivity for some drugs. At a Health, Education, Labor, and Pension Committee hearing, witnesses expressed concern about Senator Dodd's idea and speculated whether it would decrease the number of drugs studied for pediatric indications. I am pleased that the final bill does not include that misguided change to the pediatric program. From the beginning of the HELP Committee's consideration of the drug safety issue I recognized the need to clarify existing authority or provide the FDA with a few new authorities in order to improve the interaction between the FDA and drug companies on safety issues. It was clear that labeling changes and clinical trials and studies were two key areas in which Congress should act. To that end, I offered an amendment during the committee markup that provided the Secretary with additional authority and control over a drug or biological product's approved labeling, including the authority to require the holder of an approved application to make safety-related changes following an accelerated labeling review process. Under the new procedures added by my language, if either the Secretary or the holder of an approved application became aware of ``new safety information'' that the party believed should be included in the labeling, the other party should be notified promptly, and discussions should be initiated regarding whether a labeling change is needed and, if so, the content of any such labeling change. That construct made sense to me and it made sense to Chairman Kennedy who passed the amendment by unanimous consent. Given that current practice today is for a company to call the FDA when they become aware of new safety information, I thought it was a good idea to put current practice into statutory law. I want companies and the FDA to talk to each other about drug safety issues. I support the safety labeling language in H.R. 3580, which reinforces the FDA's broad authority over prescription drug labels. These provisions allow the FDA to mandate changes to a drug's approved labeling whenever the FDA becomes aware of new safety information that it believes should be communicated in the labeling. Although the FDA already has broad authority over drug labeling and must approve all but the most minor labeling changes, this provision will enhance FDA's authority and help to ensure that labeling changes are made expeditiously using a process that facilitates dialogue between the drug company and the FDA. FDA has comprehensive authority over the regulation of drug products, particularly drug labeling, and this provision further accomplishes that goal. As I said earlier, I have three main concerns with H.R. 3580. First, the bill is a complex web of regulation. It is going to take months, if not years, for drug companies and the FDA to understand all of the new regulations. I supported improving the FDA's authority in two areas: safety labeling changes, and clinical studies and trials. This bill goes far beyond those two areas and sets up a structure called REMS-- Risk Evaluation and Mitigation Strategy. The REMS does not add any significant new authority. The FDA currently uses Risk Maps which do the same things as REMS. Now Risk Map regulations, which have never been studied for their effectiveness, are becoming law. It means more paperwork, deadlines, and checkpoints for drug companies, with no guarantee that it will improve patient safety. I do not support regulation for the sake of regulation. Second, H.R. 3580 expands the scope of the Government's current clinical trials website, www.clinicaltrials.gov, and adds clinical trial results. I understand the desire of some members to make clinical trials transparent and the desire of scientists to have as much access as possible to clinical trial data. But I am very concerned that average citizens will not understand all of the complex scientific information being presented to them and instead of talking to their physicians to understand the data about adverse events, primary and secondary outcomes, and baselines, they will instead avoid taking drugs that could make them feel better or save their lives. I hope that the National Institutes of Health and the Food and Drug Administration are very careful while implementing this title of H.R. 3580. If expanded improperly, clinicaltrials.gov will frighten people, not educate and assist them. Third, this legislation changes the FDA process for granting waivers for participation on advisory committees. The FDA has 23 advisory committees that meet to discuss applications pending before the FDA and other issues. Currently, only four of those advisory committees have complete membership. Serving on an advisory committee is not a glamorous job, even though we rely on those committees to guide the FDA's approval and regulatory processes. Understandably, scientists that serve on the committees have more to gain from doing their research and making tenure, than working part-time for the Government. Given all of those issues, instead of creating incentives to work on the committees, this legislation makes it more burdensome and complex. People have expressed concern about biased committee members, but the facts demonstrate that the FDA is quite vigilant about screening individuals to serve on the committees. And the FDA has been working on new regulations to strengthen the screening process even more. I hope that we do not see a slowdown in the drug approval process due to an inability to fill the membership of advisory committees. Senator Brown and I also worked on language that would help bring new antibiotics and generic versions of old antibiotics to market. At the last minute, that language was stripped out of the House bill in order to pay for a half month of pediatric exclusivity. I hope that Representatives Dingell and Barton hold to their promise of moving that antibiotics legislation in the near future. Overall, I am disappointed that necessary FDA reauthorizations became vehicles for legislation that need more work, are overly broad, and will weigh down the FDA at a time when we need to be helping, not hurting, the FDA.

Mr. BURR

Mr. BURR. Mr. President, it gives me great pleasure to stand before my colleagues today to urge them to confirm two great lawyers in North Carolina to be U.S. district court judges. I wish to take a moment to commend my colleagues on the Judiciary Committee for unanimously reporting out Bill Osteen, Jr., and Martin Reidinger before we adjourned for the August recess. I thank Judiciary Chairman Leahy and Ranking Member Specter for their dedication to ensuring that judicial nominees get hearings and votes on the Senate floor. I am grateful for the care and passion with which the Judiciary Committee members approach their responsibility of examining nominees for Federal judgeships. I have often said that there is no area of our daily lives that is not somehow affected by judicial decisions. The decisions made by judges today will have a lasting effect long after we are gone from this institution. It is critical that these Federal judges serve to administer justice according to the strict interpretation of law and the Constitution. We have before us today the opportunity to confirm two individuals who are committed to doing just that. As I mentioned in my remarks before the Judiciary Committee when he had his hearing, this is not the first time that somebody by the name of Bill Osteen has been before the Senate for consideration. Fifteen years ago, Bill Osteen's father was confirmed to be a U.S. district court judge. Bill Osteen, Jr., was nominated by the President to be a Federal judge because he is qualified to serve on the bench, and I am confident he will continue to work towards a strong judicial system in North Carolina. Born and raised in Greensboro, he attended the University of North Carolina in Chapel Hill for both undergraduate and graduate law school. He has a diverse legal background and has litigated many cases spanning all areas of the legal profession. Trying both civil and criminal matters, Bill spent much of his time in the Federal courtroom. After today, I hope he continues to spend his time in the Federal courtroom but now for a different reason in a different seat. While I am impressed by the professional qualifications he will bring to the bench if confirmed, perhaps most importantly, Bill is a good man. Bill is a family man. He is a good dad to his two children Ann- Bennet and Bill. He is a good husband to his wife Elizabeth. I urge my colleagues to support Bill's nomination and to confirm him to serve on North Carolina's Federal bench. Martin Reidinger of Asheville, NC, is also before the Senate today to be confirmed as a U.S. district court judge. Like Bill, Martin graduated from the University of North Carolina for both his undergraduate and law degrees, graduating with honors from the law school. Martin's well-established Federal practice in western North Carolina has existed for a number of years. Throughout his career, he has handled all types of cases, represented a wide range of clients, and has appeared in all levels of State and Federal court. I had the pleasure of meeting Martin's family as well: his wife Patti, and his four children: Heather, Sara, Alex, and Max. Martin's family and friends are proud of him for all of his accomplishments, and Martin has continuously expressed how honored he is to be considered for the Federal bench. These two nominees have tremendous legal experience, an unwavering commitment to their families, and are men with good moral character. On too many occasions, we have let judicial nominations escalate into contentious debates where people's good reputations are tarnished as a result of partisan politics. We have seen it throughout history, and no one party is to blame. Unfortunately, both sides share blame. But it is great to see how this body can come together to work to make a difference in the lives of Americans. As policymakers, our debates certainly affect every American. We hear from thousands of our constituents every week, and when we make decisions, we think about how to best balance the competing policy positions so we are able to make good laws. But every day, judges see how these laws we are responsible for making, apply in real life. They do not have the benefit of changing the law based on who appears before them. We owe it to our constituents to put fair-minded and qualified judges on the bench whom we are confident will apply the laws this body passes in an impartial manner. By confirming Bill Osteen, Jr., and Martin Reidinger to the Federal bench in North Carolina, I believe we are fulfilling that obligation. I urge my colleagues to support both of their nominations. Mr. President, I yield the floor.

Mr. BURR

Mr. BURR. Mr. President, I thank Senator Grassley for, as a key member of the Finance Committee, acknowledging the fact that it is time we treat all Americans the same; that if you give a tax break on one side, you should give a tax break on the other side; that you should treat everybody alike. I think we approach this in a bipartisan way with Senator Wyden and Senator Bennett, and though we disagree about exactly how to implement it, this is tremendous progress. As the chairman described the difficulty we have today and the challenge in front of us, I think all of us say: When are we going to fix it? Today, we are on the floor talking about an expansion for uninsured children. What we are attempting to do is to take care of the whole uninsured population. Through refundable tax credits, which I believe reach all Americans--not some and not just those with incomes that have tax deductibility at the end of a calendar year but all Americans--I think we accomplish that commitment to say we want to go out and make sure every American has coverage. We want to make sure they have the resources to go in the private marketplace and negotiate coverage that reflects their age, their income, their health condition. We want health care to be portable so you are no longer locked to an employer because of health care. We want individuals to have the capacity to take it with them, regardless of where they work. We propose that once we reach tax equity, every individual in this country would receive annually a $2,160 refundable flat tax credit, and every family would receive a $5,400 annual refundable flat tax credit, more than enough money to cover the tax consequences of a benefit that is not treated as wages, and for any extra money that is left over if you are on employer plans, it would be deposited in a health savings account where those additional funds could only be used for health care. For individuals in the market today who don't have coverage, all of a sudden we have provided the money for them to go into the marketplace and to negotiate coverage for themselves or for their families. That check would go directly from the U.S. Treasury to the insurer that is providing that coverage. If there is something left over from their tax credit after they have negotiated for coverage, it would go into their health savings account. We are maximizing the amount of dollars just by treating Americans the same--not by giving one special favors and others being deprived of that but saying we are going to treat all Americans the same. Then, an amazing thing happens: We no longer have a debate on uninsured Americans because every American has the opportunity through that--it is not under the Government plan--to receive that refundable flat tax credit. Some may be at home saying: This really doesn't apply to me. But it does because when you eliminate the uninsured in this country, you eliminate the cost shift each one of us who has health insurance today pays for. I tell my colleagues that the cost of every American's health insurance will come down if, in fact, we solve this problem once and for all. I think the commitment from the ranking member of the Finance Committee is an important first step for us treating the tax side of this in an equitable fashion, and I look forward to working with our other colleagues on exactly what the solution is. I yield the floor.

Mr. BURR

Mr. BURR. Mr. President, I wish to honor the life of George Edward ``Skip'' Prosser, head coach of the Wake Forest University basketball team. As a Demon Deacon alumni myself, I join the entire Wake Forest University community in mourning his untimely passing. I knew Skip personally. Skip was a friend of mine. And before I mention many of his accomplishments as a basketball coach, perhaps Skip's most admirable achievement in life was that he was a good husband and good dad. When I first heard the news of Skip's passing, my first thoughts were not of basketball but of his wife Nancy and his sons, Scott and Mark. My heartfelt thoughts and prayers go out to Skip's family and to the Wake Forest community that adored him. Coach Prosser had countless basketball accomplishments, and as I stand here today, I can only scratch the surface of what he has achieved. When he joined Wake Forest University for the 2001 to 2002 season, after successful coaching at Loyola, Maryland, and Xavier, he added a much needed spark to our basketball program that yielded immediate success. Coach Prosser is the only coach in NCAA history to take three different schools to the NCAA Tournament in his first season at each of those schools. In his first four seasons coaching at Wake Forest, Coach Prosser led the Demon Deacons to the NCAA tournament, and in 2003 he led the team to its first outright regular season ACC title in over 40 years. In the 2004 to 2005 season, Coach Prosser's Demon Deacons rose to No. 1 in the national rankings for the first time in school history. One of his most impressive statistics was his career wins percentage of .666 that is among the highest winning percentages of active coaches. More impressive, however, is the statement Coach Prosser often made about his personal coaching record. It personified the kind of man Skip was. When his record was applauded, he often responded by saying, ``I don't have a career record. The players won those games.'' In addition to the honor and praise Coach Prosser got for his achievements on the court, his work off the court also deserved high marks. Coach Prosser always emphasized that academic success was the first priority for his athletes. In fact, every senior on Coach Prosser's team graduated with a diploma in 4 years. The Wake Forest student body embraced him as one of their own because he took every opportunity to spend time with them--frequently walking through the Wake Forest Quad, talking with students, and game after game filling our home basketball coliseum with Demon Deacon pride. Skip Prosser will be missed. He was an outstanding man who brought a community together through the game he so loved. Again, I send my deepest condolences to Skip's family, his athletes, his fans, and his friends.