Thomas Coburn

Mr. COBURN

Mr. COBURN. Mr. Speaker, I just want to answer a couple of questions about this in terms of HIV in regard to AIDS. This bill does not deny treatment to legal immigrants that have AIDS. What it says is the government does not have a responsibility to pay for that treatment on non-U.S. citizens. I think if we poll the vast majority of the people in this country, I think they would agree with this. The second thing is most Americans in this country pay for their own health care, either through a health plan, insurance payment, or working. They pay for their health care. We have created a class in this country that does not feel that it should pay for its health care on a disease that at this point in time the vast majority of which is a preventible disease. The third point that I would like to make is that this bill does deny AIDS treatment to illegal immigrants, illegal. Yes, it does. Illegal immigrants, those people who are here illegally. So what we are saying with this bill is that if you have a sponsor and you are here legally, that sponsor should cover for your cost of the AIDS treatment.

Mr. COBURN

Mr. COBURN. If I have time, I would be happy to yield.

Mr. COBURN. Mr. Speaker, I have thought a lot about how to best convey what my thoughts are on this subject. I stand here today, not as a member of one party or another, not as somebody who readily admits that they are pro-life. I am. But I stand here today as a doctor. Mr. Speaker, I have spent the last 18 years of my life, including a great deal of the time of the last 2 years while I have been in this Congress, caring for women who deliver babies. I have personally been involved in over 3,000 births that I have attended. I have seen every complication and every anomaly that has been mentioned in this debate on partial-birth abortion. I am not standing here as somebody who is pro-life, I am not standing here as somebody that is a freshman Republican. I stand here today to make known to Members that they can vote against an override for only two reasons on this bill. One is that they are totally misinformed of the true medical facts, or that they are pro-abortion at any stage, for any reason. The facts will bear that out. That is not meant to offend anybody. If somebody feels that way, they should stand up and speak that truth. But this procedure, this procedure is designed to aid and abet the abortionist. There is no truth to the fact that this procedure protects the lives of women. There is no truth to the fact that this procedure preserves fertility. There is no truth to the fact that this procedure in fact is used on complicated, anomalous conceptions. This procedure is used to terminate mid and late second trimester pregnancies at the elective request of women who so desire it. This has nothing to do with women's emotional health. This has to do with termination of oftentimes viable children by a gruesome and heinous procedure. What we should hear from those who are going to vote against overriding this is that they agree, that they agree that this procedure is an adequate and expected procedure that should be used, and that it is all right to terminate the life of a 26-week fetus that otherwise the physicians would be held liable under the courts in every State to not save its life, should it be born spontaneously. So this debate is not about health of women. This debate is about whether or not true facts are going to be discussed in this Chamber on the basis of knowledge and sound science, rather than a political endpoint that sacrifices children in this country. Mr. Speaker, this vote is about untruth tied to emotion. We should be willing in our country if we are going to heal our country, if we are going to repair our country, to stand and speak honestly about what this procedure is. I have the experience. There is no one else in this body that has handled all these complications. This procedure never needs to be done again in this United States.

Mr. COBURN

Mr. COBURN. Mr. Speaker, it has been just 15 years since the first cases of AIDS were recognized. The first thousand cases had been reported to the CDC by February 1983. The cumulative incidence of reported AIDS reached 10,000 in the spring of 1985, only 2 years later. The cumulative number of cases reached a total of 513,486 by the end of 1995. Of these, 319,849 were known to have died. Clearly, this is an epidemic of historic proportion that is continuing to grow. While no cure exists for AIDS, we know enough about the disease to prevent its spread completely. For instance, we now know that AIDS is caused by the human immunodeficiency virus [HIV] and is actually the end stage of HIV infection. We also know that the disease is transmitted through the exchange of body fluids and it attacks the body's immune system, eventually leaving the body unable to fend off disease. What we do not know is the extent of the disease. We have failed to employ the public health procedures which have been successful in curtailing other epidemics in our efforts against HIV. These include confidential HIV reporting and partner notification. We have made an effort to report cases of AIDS on a State and National level but not cases of HIV. We do not make it a priority to notify those who may have been exposed that their lives may be endangered. Put simply, the Federal Government and the public health community have been AWOL in the battle against HIV. Sound medical practices have been abandoned and replaced with political correctness. HIV has been treated as a civil rights' issue instead of the public health crisis that it is. Today, I am happy to introduce the HIV Prevention Act of 1996 in an attempt to return sound medical practices to our Nation's public health policy and curtail the spread of the deadly HIV epidemic. Recent scientific breakthroughs make prompt passage of this bill extremely important. Many of the world's top HIV scientists have suggested that it may be possible to eradicate the virus from the body and completely suppress it by using a combination of new HIV drugs. Some believe that these drugs may transform HIV from a terminal disease into a chronic disease like diabetes or heart disease. However, researchers agree that the success of these drugs depends upon getting treatment early. This bill aims at protecting the uninfected and at helping those who are infected to discover their status as early as possible to maximize the opportunities now available. The following is a section-by-section summary of the proposal. Improved HIV Epidemic Measurement The HIV Prevention Act establishes a confidential national HIV reporting effort. Currently every State reports AIDS cases, which is merely the end stage HIV infection. By confidentially reporting new cases of HIV, those responsible for control of the disease can more accurately determine the current extent of the epidemic as well as future trends, rates of progression, direction of spread, possible changes in transmissibility and other critical factors of disease control. Such information will allow for the development of long-term strategies based on reliable data.

Mr. COBURN

Mr. COBURN. Mr. Chairman, I think this debate goes back down to one of the core issues in our country, whether a physician, no matter what particular oath they took, whether or not they are going to follow that oath, nowhere should a medical procedure get in the way of offering care to any other patient. I think most people will agree with that. If this bill is flawed in any way, that can be corrected. But the intent of this bill and the necessity of this bill demand that we pass this today. There are people who are not receiving the benefit of the skills of providers and health providers who have dedicated their life because of patent infringement attempts. So I would beg my colleagues to look, to support the healing professionals by allowing them to do what they have committed their lives to do, which is to offer care, not limited by someone's greed or someone's selfishness.

Mr. COBURN. Mr. Chairman, we have just heard the gentleman from Kentucky speak of the reductions that would be brought forward. What I would ask those who are listening to this debate today is to consider the following: Wherever we work, whatever we do, could we not, through efficiency and better planning and good insight, reduce the costs of what we are doing or increase the efficiency with which we do it, or save 2 percent of the amount of time that it takes us to do it? Could we not do that? The trouble is, inside Washington we do not believe that that is possible. The real fact is that we can save a whole lot more than 1.9 percent. Outside of Washington, DC, outside of the thought process that goes on here, in everyday America, people are doing that very thing. This is not a cynical attempt to make a point. The fact is, the largess of our Federal bureaucracy is killing our future. The Republican Congress made a commitment to this country. They fumbled the ball. They have now decided to spend $4.1 billion more than what they promised just 9 months ago to spend. This is getting back part of it. It is two pennies. It is two pennies for the future of our children. It is not to say that the appropriation committees do not do a good job, but the fact is, the very people that are going to receive this money can do a better job. They be more efficient. They can accomplish more with less if, in fact, we will just tell them to do it. I would ask our Members to support this amendment, not for us but for the commitment that we have made to the future, for our children and for our grandchildren.

Mr. COBURN

Mr. COBURN. Mr. Chairman, I yield myself such time as I may consume. Mr. Chairman, I take a few moments to clarify the record. The Committee on Commerce has held hearings on this. We have had one hearing in which we had significant testimony where care was denied based on the perverse incentives to the physician, and I think it is just the start of hearings that we are going to have in this regard, and I would like that placed in the Record. Mr. Chairman, I reserve the balance of my time.

Mr. COBURN. Mr. Chairman, I recognize that the chairman has done and his committee have done great work on this. But I want to change the perspective for a minute about what we are talking about. We are talking about two pennies, two pennies out of every dollar we spend in this and every other appropriation bill to try to preserve the pattern of getting a balanced budget, No. 1; No. 2, living up to the commitment that this Congress made a short 8 months ago. Mr. Chairman, I would draw the analogy we are getting ready to see the Olympics. The Americans who trained for the Olympics, if their coaches and if their trainers had said, ``You cannot do any better,'' they are not going to compete well, but the fact is, everywhere in this Federal Government is fat, tons of fat, lots of places to save money, lots of places to become more efficient, lots of places to achieve economies of scale that have not been recognized and not been looked at. The fact is that it takes hard leadership to set that standard for the people who are going to spend this money, and what we would like to do is to say we recognize the tremendous efforts that have been moved in that direction. We just think that we can go further, and we would like for our colleagues to consider the 2 percent, 1.9 percent. Why? Children and grandchildren. Mr. Chairman, this deficit is not going to be $115 billion this year. There is another $65 billion on top of that recognized from the use of Social Security funds to fund the general obligations of this Government. So at the minimum it is $180 billion this year. I ask that my colleagues support this bill.

Mr. COBURN. Mr. Chairman, I yield the balance of my time to the gentleman from Florida [Mr. Weldon].

Mr. COBURN. Mr. Chairman, I yield 1 minute to the gentlewoman from New Jersey [Mrs. Roukema]. (Mrs. ROUKEMA asked and was given permission to revise and extend her remarks.)

Mr. COBURN. Mr. Chairman, I yield myself such time as I may consume. Mr. Chairman, this is about looking at perspective and motivation and what our charge is as physicians as we look at health care in this country, and every physician, every provider, takes an oath to put patients and their well-being first. This amendment simply protects Federal employees the way we have protected Medicaid and Medicare patients by saying there cannot be a perverse incentive to not put the patient first, and it also states that in doing so, the well-being of the patient will be put first. This amendment is supported by over 123 provider groups. It is vastly supported by Members of the House. It is a start back down the road where physicians are asked to do the right thing, to not be placed in the position in a competitive environment where they sacrifice quality care for their own livelihood, and this amendment prohibits that in regard to Federal employees. It is my understanding that we may, in fact, have an acceptance of our amendment by the chairman of this subcommittee. Mr. Chairman, I reserve the balance of my time.

Mr. COBURN

Mr. COBURN. Mr. Chairman, we have heard a lot tonight already. We heard a lot in the debate on the rule about discrimination. We just heard about family values. I do not think it is about any of those things. The real debate is about homosexuality and whether or not we sanction homosexuality in this country. Mr. Chairman, I come from a district in Oklahoma who has very profound beliefs that homosexuality is wrong. I represent that district. They base that belief on what they believe God says about homosexuality. It is what they believe God says about it. What they believe is, is that homosexuality is immoral, that it is based on perversion, that it is based on lust. It is not to say that the individual is any less valuable than anybody that might believe that, but it is discrimination towards the act, not towards the individuals. That should be something that we stand for, that should be something that we stand on. So I support the Defense of Marriage Act for many reasons, but I support it because my district supports it. My district says it is time to say that homosexuality should not be sanctioned on an equal level with heterosexuality, and there are lots of reasons to back that up. If you look at some of the studies that are put forward to say homosexuality is equal to heterosexuality, all you have to do is look at the number of partners on average that we see with homosexuality, and there are studies to say that over 43 percent of all people who profess homosexuality have greater than 500 partners. There are studies that would say that. The point being is I stand here representing my district to say homosexuality, the act of homosexuality, not the individual, is immoral, it is wrong. We should say that and we should not be afraid to stand on the very principles of our beliefs. We can claim our beliefs, we can claim to represent the beliefs of those whom we represent, and we should stand for that. Others have different beliefs, I recognize that, and I would yield to their beliefs. But for me and my district, I am going to yield to the beliefs that we hold. I believe it is discrimination against the act and not the individual. We hear about diversity, but we do not hear about perversity, and I think that we should not be afraid to talk about the very issues that are at the core of this. This is a great debate that we are going to have in our country, and it is not going to end with the debate on this bill. The fact is, no society that has lived through the transition to homosexuality and the perversion which it lives and what it brought forth. It is not to say that the individuals are any less valuable or any less bright, but the fact is it is morally wrong, and I stand on that statement.

Mr. COBURN

Mr. COBURN. Mr. Chairman, I want to thank the people in my district who work for the Social Security Administration who brought this to light, some very brave people who bucked the system, who bucked the union to say that seniors' money, Social Security trust fund money, should not pay for union representation on the job. The fact is, union Members pay $4.3 million a year. Let us let the union use that to pay for people to represent them in the workplace. It is about balancing the budget, it is about being good stewards with our seniors' money. It is about doing the right thing. Please support the amendment. Please do not support the substitute.

Mr. COBURN. Mr. Chairman, I rise in opposition to this amendment. I understand this is a complex issue, but after 17 years of research not one person in this body can stand up and tell me one positive medical outcome that has come from this research. There is none in the scientific literature, there is none projected. We hear: could, might, may. The fact is there is no proof, there is no scientific study at this time of any quantifiable benefit. It was mentioned earlier that some people just oppose the Government. I oppose all people researching this effort. And I would take just a moment for us to look at what happened on AIDS testing of newborn babies and the very group of ethicists that our Government used to say it is fine to test a newborn baby, identify that it has HIV, and then never tell the mother or the child that it is infected. Those are the kind of ethicists that are telling us that it is OK. Mr. Chairman, this is not OK. This is destroying and disrupting various great precious quality of life. I am opposed to it, the Government being involved in it; I am opposed to it, private sector being involved in it. We dare not tread. We have had 17 years to prove that we have no benefit. It is extremely interesting, I agree, Mr. Chairman, but it is also extremely wrong.

Mr. COBURN. Mr. Chairman, I yield myself such time as I may consume. Mr. Chairman, the issue here is not whether or not our appropriations committees have done a good job. We think they have. The issue is that the national debt is rising by $600 million every day. What this amendment is talking about is saving two pennies, two pennies for our children, two pennies for our grandchildren, three days' worth of the rise in the debt. That is all we are talking about saving. If we were going to go into a crisis situation where we were forced economically to make the decisions that are necessary to put our budget in balance, we would all agree that there would be efficiencies that could be gleaned that we are not gleaning at this time. There would be things we could accomplish that we are not. The chairman of the committee said we essentially had a flat budget for Labor-HHS. I would respectfully disagree. Mr. Chairman, the point I would make is that a $2.5 billion increase in this appropriation bill is not seen as a flat budget by most of the people in the United States. What we are asking is that 1.9 percent, two pennies in savings, be accomplished. We can accomplish it through efficiency. It can be accomplished through flexibility and efficiency. The fact that we do not attempt to do that speaks poorly of us as a body. Mr. Chairman, I would say this bill appropriates $65.7 billion in discretionary spending. The spending for the bill, including all the entitlements, is $285 billion. That portion of entitlements this does not affect. It does not change. I agree with the chairman that they have done a good job and that we need to control entitlement spending. The fact is this House, this body, this administration, has not controlled entitlement spending. So what else are we to do to protect our children, to preserve the opportunity for the future? Two percent, 2 pennies in efficiency, our children are worth that, our seniors are worth that, the entire country is worth that. I would ask the body to consider saving two pennies for our children and grandchildren. Mr. Chairman, I yield back the balance of my time.

Mr. COBURN. Mr. Chairman, I yield 1 minute to the gentleman from Indiana [Mr. Hostettler].

Mr. COBURN. Mr. Chairman, I yield 1 minute to the gentleman from Minnesota [Mr. Gutknecht].

Mr. COBURN. Mr. Chairman, I think everybody here wants the same thing for our children. The fact is that we do not know how well this system that we have works. And for the young third child that the gentleman from Pennsylvania [Mr. Greenwood] described, we have a problem, there is no question. We have a problem today with the system that we have. Mr. Chairman, there are some things that we do know about title X. That where less money is spent, there is less pregnancy, there is less sexual activity, there is less sexually transmitted disease, there is less abortion. Where there is more money spent, there is more of each of those. Mr. Chairman, I do not know what causes that. I do not know whether the cart is before the horse or after the horse. I honestly do not know. We do not know. We are all going based on what we think. The one thing I do know as a practicing physician is that if a child comes into my clinic, a parent has to sign this permission slip to get a shot, to get a wound closed if the parent is not there, to get any service from me as a physician. I have to have had the parent's permission to do that, with the exception of giving that child sexual activity protection. Mr. Chairman, the point being we have to work through what the gentleman from Maryland [Mr. Gilchrest] says. If we fail in our responsibility as a parent, should the Government bypass that failure or should we work to reemphasize and replace the responsibility, hard as it may be, on that dysfunctional parent, on that failing family, on that failing parent? What I say, and what I believe, is that we should work hard to move the responsibility back. Where we fail, let us correct where we are failing. Let us work to solve those problems, but let us not disinvolve the parent in this process. Mr. Chairman, we cannot do both. Nobody questions the motivations of my colleagues when they think we should do it the other way. I think that they are just as well-intentioned as I am. I do not want the first child to get pregnant out of wedlock.

Mr. COBURN

Mr. COBURN. Mr. Speaker, I was going to speak this morning on health insurance, but based on the comments of the gentleman from Missouri [Mr. Volkmer], I think what we ought to do is take another look at ourselves. We accomplish nothing, we demean the House, we demean each one of us when we use such words as were used by the gentleman from Missouri. I would just tell my colleagues, as a freshman Member of this House, that we do not do anything positive for our country, for our future generations, or for ourselves by vicious personal attacks. To name someone a dictator is both inappropriate and demeaning to the House. My words would be that we should look at that and say, what are we doing when we do that? We have not put forward anything positive for anybody in terms of our districts, in terms of the American public, by doing so. I would just hope that we would follow an example different than that as we talk in the 1-minutes in the morning.

Mr. COBURN

Mr. COBURN. As my colleagues know, it is interesting. The gentleman from California [Mr. Packard] and his committee have done a good job. This debate is not about whether or not they have done a good job. It is whether or not we can let us not do a better job. We have the greatest respect for what the gentleman from California and his committee have done. But as my colleagues know, it is these 2 pennies. It is can we save 2 pennies? Can we be 2 percent more efficient? Can we do more? I have been in Washington 19 months, and what I have heard is ``can't.'' The fact is that the debt that our children, our children and grandchildren, are going to get to pay back is rising at the rate of $2.785 billion a day, and what we are saying is: 2 percent. Now, if we were at war right now and we got together as a country and said we have an objective, the objective is to defeat the enemy, well, we have an enemy in front of us as a Nation, and that enemy is our deficit and our debt. Two percent, 1.9 percent; 2 pennies out of every dollar to preserve opportunity for our children; it is not too much to ask. The two gentlemen that are speaking in favor of this amendment ran their offices for $100,000 less than the Congressmen before them in spite of the fact this past year, in spite of the fact that we had a reduction in the opportunity for more. So the point, I would say, is we can effectively represent our districts, we can effectively accomplish what we need to accomplish by being 2 percent more efficient. The fact is in this bill spending goes up about 1.9 percent over last year, and what we are asking is to freeze the spending, essentially a 2-percent cut in the bill, pulling things down so that our children and our children's children will not be enslaved by debt. $2.785 billion a day because this Congress will not live within its limits of the money that comes to it. When I leave this place, I want to be able to say that I did everything that I could to ensure opportunity and preserve opportunity for my children and the children that are from my district.

Mr. COBURN. Mr. Chairman, I yield to the gentleman from California.

Mr. COBURN. Mr. Chairman, that would be a great thing.

Mr. COBURN

Mr. COBURN. I yield to the gentlewoman from California.

Mr. COBURN. Mr. Chairman, I think it is important to recognize the difference is, it is not just important, it is the only thing that will solve the AIDS epidemic, is treating HIV prevention. I yield to the gentlewoman from California.

Mr. COBURN. Mr. Chairman, I move to strike the requisite number of words. Mr. Chairman, I was somewhat hesitant to come down and talk on this subject, but I find myself as a physician who has cared for AIDS patients, who knows AIDS patients, that we are, through this amendment, perpetuating a mistake, a very major mistake in this country, and that is that we are focusing again dollars on AIDS, and we are missing the concept of AIDS prevention. The fact is that we are going to spend $171 million on housing for AIDS patients this year. The fact is that this Government is going to spend $7.41 billion in 1996 on AIDS. The reason we have the AIDS epidemic that we do today, the reason we have the increased numbers requiring AIDS housing is because we focused on the wrong thing. That is, HIV prevention. Until we refocus our efforts, until we redirect our dollars to preventing the infection in the first place, we are giving poor solace to those who will come after those that have been so unfortunately infected with this disease that we will see increasing numbers and we will have to have more numbers. Prevention is the key to HIV. Prevention is the compassionate way to spend our Federal dollars so that we do not have another 4,000, 5,00, 50,000, 100,000, 200,00 people yearly coming down with AIDS as a complex and serious life-ending disease. The reason it also is wrong is because today if we identify somebody who has just now become HIV positive, we have the drugs in our armamentarium to prevent them from becoming AIDS patients. We can now identify, if we choose to do so, people who are infected with HIV, and we can start treatments, that now the studies, the multiple drug treatments will tell us, that we will not have AIDS coming about. We continue to perpetuate a wrong strategy as far as the HIV and AIDS epidemic. We need to start talking about HIV prevention; $171 million, that is never going to be enough to care for those people who have AIDS; $271 million is not going to be enough to care for those people who have AIDS. I think we should have more money for those people who have AIDS and need our assistance. But we are perpetuating a decisionmaking process that is not going to help solve this problem. Until we recognize it, and unless we recognize it, then we will do a disservice, not to just those people who presently have AIDS but to those who eventually will have AIDS. So I think it is very important that we look again at what we are spending and how we are spending it, and if we are going to increase funding in terms of the AIDS epidemic, any increase in funding ought to go toward HIV prevention and not additional AIDS housing.