Thomas Coburn

Mr. COBURN

Mr. COBURN. Mr. President, I ask unanimous consent that reading of the amendment be dispensed with.

Mr. COBURN

Mr. COBURN. Mr. President, first of all, I am the individual who has a hold on that bill because I think we need to have real property reform, and there is a bill that is coming out of the Homeland Security Committee that is a bipartisan bill authored by Senator Carper, with the cosponsorship of both Senator Collins and Senator Lieberman, that has real property reform. As the Senator knows, McKinney-Vento places a limitation on all Federal properties before they can ever be disposed of. So the real property reform needs to go through at the same time the McKinney-Vento bill goes through so that we reform both of those, so that we still protect the rights of the homeless in this country but at the same time enable the agencies of the Federal Government to dispose of them. We now have 22,000 pieces of property the Federal Government does not want but we can't get rid of. So the reason that is being held up is we are trying to get those to move together and in tandem so that we can fix both problems at the same time. I would say this in response to the Senator. I understand how you have locked arms to move this bill, but what the American people are not going to understand is, if there is $2 billion worth of waste--and there is; the IG of HUD said it, there is no question about it, a billion dollars worth of fraud, a thousand convictions, another $1.2 billion in overpayments to supposed landlords. There is no reason not to fix that right now. It can be fixed with this bill. This bill is going to get passed, it is going to get signed. Move it and fix it. I yield the floor.

Mr. COBURN. I thank the chairman. I understand they desire no further votes on this amendment. I ask to speak on the subject matter of my amendment, knowing that it will not get a vote--which is disturbing on such an issue as the one we have in front of us. We are talking about housing. For years we have spent a tremendous amount of money on homelessness in this country. What this amendment would do, frankly, is help us know what to do on homelessness. It would cause us to take an in-depth look at our current state of homelessness in hopes of providing constructive solutions to that problem. We have spent billions of dollars every year for Federal housing programs, but homelessness rates have remained constant for decades. In other words, it doesn't matter how much money we have spent, we have not seen a decline in homelessness. We ought to be about asking the question: What is wrong? We continue to spend more money. Yet we make no impact on the rate of homelessness. A number of reviews have found Federal housing programs are ineffective and misspend too much money on nonhousing assistance, are not sufficiently allocated or distributed, and are subject to tens of millions of dollars of waste and fraud. The waste and fraud actually has been documented. HUD's ability to effectively carry out its mission is so impaired that these shortcomings should be addressed if we ever hope to eliminate homelessness in our country. In the past year alone the inspector general of the department found nearly $1 billion--let me restate that--one thousand million dollars in waste in HUD alone. That is their own inspector general. There is nothing in this bill that addresses this issue. This amendment was designed for us to look at that. HUD also reported $1.5 billion, of which over 80 percent were overpayments in terms of improper payments. The charge on the Congress is to manage the programs effectively. We have a bill before us, and we have an amendment that will help us do that. To me, it is disconcerting in the fact that we are not going to even take up and look at $2.25 billion worth of waste every year. I have sympathies with the chairman and his ranking member in that they do not want other amendment votes. But this is an amendment we are going to see again. We are going to see it on an appropriations bill the next time we have one with anything to do with housing. Here are the following criminal activities found at the Department of Housing and Urban Development: 2,684 arrests with the fraud, 1,338 indictments, and 1,055 convictions. We are going to pass a housing bill, and we are not going to address these issues? We are not even going to vote on them, even though we have 1,055 convictions and 1,338 indictments on fraud and overpayment and corruption within the Department of Housing and Urban Development? In efforts to remedy the housing problems, Congress has allocated $4 billion to HUD's community development block grants. One of the vehicles HUD uses to combat homelessness is this CDBG program. An OMB analysis determined that the CDBG grants were ineffective in accomplishing what they intended to accomplish. The conclusion stated that major problems, including the lack of a clear purpose and an annual and long-term outcome measure--in other words, there is no metric to see if the money we are spending is doing any good. There is no requirement on us, either through this bill or any other bill, that there be a measurement to say we will spend money to help homelessness but look to see if that is effective. None of that is available. It is not available. Also, it was noted they did not target funds to the areas of greatest need. They went to the areas of greatest political influence, not the areas of greatest homelessness. And the inability to produce transparent information. The whole idea behind this amendment would help HUD and Congress address those very issues. It also will help us know what to do about it, if we actually find them. The average age of the world's democracies is 200 years. That is the average. They are not conquered. They die from within. They die over lose fiscal policy. Those are not my words. That is a paraphrase of the Scottish historian as he looked at the Athenian Empire and wrote about it about the time our country was being founded. I daresay I have great concerns for us as a free country when we will allow $2.25 billion a year to be defrauded out of the Department of Housing and Urban Development, and then we will not allow an amendment that doesn't change it. It just says let's look at it and find out where it is and what we can do about it. We are not going to allow it on a housing bill. It is interesting where we have come. We say we want to help the people who are in the midst of a housing emergency, in the midst of problems with their mortgages, in the midst of those who were either being gamed into a mortgage or stupidly going into a mortgage they couldn't afford, but at the same time we will not do the real work we are asked to do, which is to make sure the programs we do have, that are already authorized, already funded, are run efficiently. It is no wonder confidence in us is lacking. Here is $2.25 billion that we could address in this bill toward a solution--toward finding out how we at least eliminate 70 or 80 percent of that, and we will not even allow an amendment to address that. That is not a reflection on the chairman. I understand what he and the ranking member are trying to do to get this bill through. But this is not an amendment to which anybody should have any opposition. This is an amendment that should be accepted; to say, yes, we need to study this. We need to find it. Yet when we have asked for that it has been denied. My only thought is, either we do not want to look at the fraud and we do not want to look at the overpayments or we think it is just fine. That is what I am left with and that is what the American people are left with. Mr. President, $2.25 billion would do a lot to help a lot of people having trouble with their mortgages today. That $2.25 billion could come back in and, if directed in the proper way, could significantly increase the effort of holding onto the homes of 100,000 people. Yet we are not going to look at it. There is no question we need to do more. Unfortunately, I am not going to be able to vote for this bill because we are going to give tax credit to builders who don't need to have a tax credit. We are going to give $4.5 billion more in CDBG block grant money that HUD already said hasn't been spent wisely to begin with. We already have $1 billion worth of fraud in it. I will not support the bill. I do support the right of the chairman in managing the bill in the way he is managing it at the present time, but I also will say this amendment will be back--as it should--not just for us, and not, as it should, just for the taxpayers but the real taxpayers who are going to pay back this $2.25 billion, which is our kids. I yield the floor.

Mr. COBURN. I ask unanimous consent the pending amendment be set aside and call up amendment No. 4400.

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

Mr. COBURN

Mr. COBURN. Mr. President, 5 years ago, Africa was in crisis and in despair. HIV/AIDS was decimating whole communities. Some countries, such as Botswana, were literally on a path to extinction, with rates of HIV infection among pregnant women in some locations reaching as high as 40 and even 50 percent. In South Africa, while a third of pregnant woman were infected with the virus, the country's political leaders were actually denying that AIDS was caused by HIV infection, an ominous sign that little help was on the way for the over 4 million South Africans--over 10 percent of the population--dying of AIDS. In 2003, if a woman in sub-Saharan Africa was infected with HIV, the familiar story was all too oft-repeated. She would very likely watch her husband die first, and then her youngest children would also become infected either at birth or through breastfeeding, as she languished under her own death sentence. Within a short time, her children would be orphans, left to fend for themselves in the streets and slums of Nairobi, or Soweto, often getting sick with their own HIV infections and dying alone, without food or shelter or medicine. The sheer numbers at the time were staggering. The disease affected well over 20 million people in sub-Saharan Africa by the year 2000, roughly equivalent to the total number of American children under 6 years old. The problem seemed overwhelming, indeed hopeless. What was the world doing to stop the carnage? Were there armies of doctors sweeping in with the miracle drugs that had been saving lives in America and other rich countries for nearly a decade? No. The U.S. was spending under $200 million a year on HIV/AIDS overseas, mostly on report-writing, some condom marketing, and ``capacity-building'' programs that never actually used any of the capacity supposedly built and that had no measurable impact on the devouring epidemic. Treatment was the demand of most global health activists of the day. An indignant group gathered in South Africa in 2002. ``While a necessary component of the response to HIV/AIDS, prevention will never be enough,'' insisted Winston Zulu of the Network of Zambian People Living with HIV/AIDS (NZP+). ``When will the world wake up to the fact that the 16 million Africans that have already died of HIV/AIDS? This is only the beginning if we continue down the prevention-only path. This movement will make treatment, which we all know strengthens prevention efforts, our priority demand.'' Domestic and international chapters of ACT-UP and others were heckling U.S. officials at international health conferences, demanding antiretroviral treatment for people with HIV/AIDS in the developing world, especially in Africa. And then something remarkable happened. On a cold January night in Washington, DC, far from the overcrowded, underequipped clinics of Africa, an American president made a promise--a $15 billion promise to provide treatment to millions of Africans, within 5 years. Anti-retroviral drugs can extend life for many years. And the cost of those drugs has dropped from $12,000 a year to under $300 a year--which places a tremendous possibility within our grasp. Ladies and gentlemen, seldom has history offered a greater opportunity to do so much for so many...tonight I propose the Emergency Plan for AIDS Relief-- a work of mercy beyond all current international efforts to help the people of Africa. This comprehensive plan will prevent 7 million new AIDS infections, treat at least 2 million people with life-extending drugs, and provide humane care for millions of people suffering from AIDS, and for children orphaned by AIDS.--President George W. Bush, State of the Union Address, Jan. 28, 2003. Glimmers of hope ignited around the world that night, as the U.S. policy against providing treatment in a foreign aid program came to an abrupt and inspiring end. The Congress took up the challenge, and passed a bill a few months later that was ground-breaking, a seismic shift in current policy and funding levels. The first and perhaps most dramatic policy shift was the statutory requirement that over half, a full 55 percent of all $15 billion of the program's funding be spent on life-saving medical treatment for people with HIV/AIDS. People said it couldn't be done. The naysayers said that Africans would not be able to adhere to complex drug regimens. They said that there simply wasn't the capacity to absorb all those dollars and build new clinics and expand hospital wings. They said people wouldn't come from miles around to get tested and treated. We wouldn't be able to use mopeds and bicycles to deliver drugs to the rural hinterlands. There weren't enough doctors. There wasn't sufficient logistic ability to store so many drugs. These arguments are being repeated today. They were uninspired and uninformed in 2003 and they still are today. The President's Emergency Plan for AIDS Relief, PEPFAR, has proven them all wrong. Since PEPFAR started, over 1.4 million people who would either be dead or dying today have received life-saving antiretroviral treatment. That's millions of children who didn't become orphans. Millions of parents who get to see their children grow up. Millions of moms whose babies were protected from infection. Countless communities across the plains and prairies, streets and slums of Africa and the Caribbean, where hope has taken a foothold. Where once stigma and despair kept people from even getting tested, people now come out by the thousands on HIV testing days in Kampala and elsewhere. PEPFAR is a comprehensive program, investing heavily in prevention and care as well as treatment. However, the majority of the funds have been spent on treatment. The true nature of PEPFAR, the appeal of the program, the miracle that has raised millions from the dead is the program's commitment to life-saving anti- retroviral treatment. If you ask Africans what PEPFAR is, they'll tell you it's about AIDS treatment. It is the treatment component of PEPFAR that has made it the most successful U.S. humanitarian effort in history because it has literally saved the lives of millions, preserved families and communities, and rescued countless babies from being born with an AIDS death sentence. Five years later, the American people stand at a crossroads. PEPFAR is expiring and the true test of our commitment to life-saving treatment is before us. We have a choice. Will we lose heart? Will we lose our focus? Will we allow a program that was ambitious, inspiring, targeted and tangibly and measurably effective at saving lives become diluted, vague, ill-defined and lose its life-saving impact? Will we allow partisanship and competing priorities and even some good intentions cloud and subvert the long-term success of PEPFAR? Will we turn PEPFAR into just another bloated, unmeasured and unmeasurable foreign aid program with no accountability and no real impact, a program that tries to do too much and accomplishes too little? As funding increases and rhetoric builds, will we, in this moment of testing, betray our historic commitment to Africa and the lives of millions of its inhabitants? It is embarrassing to admit that we find ourselves on a direct path to that shameful outcome. The once loud and indignant voices demanding treatment for Africans have found other priorities, it would seem. Inexplicably and inexcusably, the House and Senate PEPFAR reauthorization bills, negotiated with the approval of the Administration, reverse what was undoubtedly the most important element of PEPFAR the requirement that the majority of funding be spent on HIV/ AIDS treatment. What's more, the bills more than triple PEPFAR funding, but only increase treatment targets by 50 percent. Despite their $50 billion price-tags, the House-passed bill and the Senate committee- reported bill would only add an additional one million people, of the many more millions in need, to the treatment rolls over the next five years. It seems that, after five years focusing on helping people with HIV/AIDS, the focus of the program under these proposed reauthorizations would shift to helping the foreign aid ``industrial complex'' of USAID contractors based in the U.S. and European capitals. The proposed reauthorization bills would prioritize literally every possible development cause except HIV diagnosis and treatment. It is this glaring policy reversal that is the impetus for S. 2749, the ``Save Lives First Act of 2008.'' The bill reinstates the current policy requiring at least 55 percent of funding to go to life-saving medical treatment for people infected with HIV/AIDS. It also allocates a small percentage of funding for the critical diagnostic screening that must be ramped up dramatically if we are to locate and treat every infected person in the countries where PEPFAR operates. Finally, the bill acknowledges that every baby infected with HIV by her mother during birth or breastfeeding is a largely preventable tragedy that should be eliminated. Although we have grave concerns about many other policies in the House and Senate reauthorization bills, including the prevention policy, the expansion of funding to rich countries, the ``mission creep'' that diverts funding from high-priority HIV/AIDS programs to lower-priority development programs, and others, we chose to focus in the Save Lives First Act on the critical problem of the House and Senate bills' betrayal of the President's and the 108th Congress' historic commitment to life-saving HIV/AIDS treatment. There is no question that PEPFAR has been the most successful foreign aid program since the Marshall Plan. The structural reason for its success is that it approaches and addresses AIDS for what it is--a viral epidemic. Though much may have changed in the past four years, this simple fact has not, and will not, change. Regardless of location, demography, mode of transmission, and so forth, the basic method of combating an epidemic, any epidemic, is the same: find the infected, provide them care, and help them prevent transmission to others. There are 33 million people living with HIV, and only they can prevent the transmission of the disease. If we find the people with HIV, we could not only treat them, but yes, prevent new infections as well. That's why treatment and testing are critical to prevention efforts. They are not the whole story--behavior change programs are needed--but diagnosis and treatment are two of the foundations of disease control. What's more, prevention through education is far less costly than treatment. Uganda's success in the 1990s proved that with the proper message and political leadership, behavior change that reduces transmission rates dramatically can be achieved fairly inexpensively. The current PEPFAR program and its original authorizing legislation are appropriately structured on this foundation of diagnosis, treatment and successful prevention. So what are the mechanics of treating people? First, you must diagnose those who are infected. That is why this bill designates specific funding for performing rapid tests, and sets testing target goals. If we test 1 billion people over the next 5 years, we will discover the vast majority of all those living with HIV. However, experience shows that people will not get tested, no matter how much they may want to, without an incentive to know their status. It cannot be disputed that people known to be HIV positive suffer enormous stigma and discrimination throughout the world, and therefore need an incentive strong enough to overcome this. The incentive is treatment. If people know that, should they be found to be HIV positive, there is hope and health in their future, they will have an incentive to get tested. The promise of a longer and healthier life is necessary to overcome the stigma--and, in a self-reinforcing loop, the presence of treatment, and the effect of people literally returning from the dead, goes a long way to reduce HIV stigma. That is one of the reasons why the Save Lives First Act maintains the 55 percent allocation of PEPFAR funding for treatment, and seeks to increase the number of people treated proportionally to the increase in overall funding. The AIDS drug nevirapine, which costs only $4 per treatment, can dramatically reduce the likelihood that a newborn will become infected with HIV. Yet a new U.N. report delivers the news that only a quarter of HIV-positive pregnant women in poorer countries are receiving the medication needed to prevent baby AIDS. Furthermore, the number of AIDS orphans in poorer countries continues to increase, and in sub-Saharan Africa an estimated 12.1 million children in 2007 had lost one or both parents to HIV. By sticking to the fundamental disease control methods of testing and treatment, new infections are prevented. First, we have seen here in the U.S. that people who know their HIV status are less likely to engage in risky behavior--they seek to protect themselves and their partners. The Centers for Disease Control and Prevention reports that the 25 percent of Americans who don't know their HIV status transmit 50-75 percent of new infections. What's more, a recent study has suggested that increased testing in the U.S. reduced infection. Further, people who are receiving treatment have less of the virus in them, and are less infectious. There is increasing evidence documenting this phenomenon. Behavior change programs targeted to the general population, most of whom are uninfected, may help reduce infection rates to a point, but it is hard to think of a more direct preventive measure than rendering an HIV positive person less infectious and less likely to infect others. Therefore, claims that the bill does not address prevention are simply untrue. First, billions and billions of dollars not dedicated to treatment and testing are available for prevention in the House and Senate bills. After spending 55 percent of the $50 billion in the bills on lifesaving treatment, there will still be $27.5 billion left over from which prevention programs could be funded, dramatically more programs than under the current, $15 billion program. Second, and to an important extent, testing and treatment are part of an effective prevention approach. In addition, some have claimed that the Save Lives First Act significantly increases costs, anywhere from $13-$17 billion. These claims miss the point of the Save Lives First Act--which is not to add to costs, but to prioritize how authorized funds are spent. As the attached treatment cost analysis shows, the total dollar amount for all drugs, test kits, and prevention-of-mother-to-child-transmission materials needed to meet the goals in the bill is just over $11 billion (using conservative assumptions about costs that are likely to be lower in reality due to government discounts). A reauthorization bill containing $50 billion plus numerous ``such sums'' authorities, such as the bills under current consideration in the House and Senate, would contain sufficient money to meet these goals as well as procure the infrastructure necessary to deliver these drugs and diagnostic tests. These costs are not added on top of the proposed reauthorization spending levels, as some have claimed. Rather, the Save Lives First Act takes the first 55 percent of all funding in any reauthorization bill-- whatever the ultimate amount of funding turns out to be--$30 billion, $50 billion or more (as is actually likely given the current appropriations frenzy in the Congress)--and directs it to treatment costs. If meeting the heroic targets in our bill--adding 5 million new people to treatment (in addition to the 2 million already in treatment), conducting a billion HIV tests, and saving babies from being infected by their moms--ends up costing more than 55 percent of PEPFAR funding, we challenge any critic to think of a better use of funds. However, as the attached chart demonstrates, there will be plenty of money in a $50 billion bill left for prevention and care after meeting the requirements of the Save Lives First Act. The current alternative to this approach, as embodied by the House and Senate bills containing no money dedicated to testing and treatment--is that millions of people will die for lack of treatment. In addition, the vast majority of people with HIV will remain ignorant of their status, and will continue to unknowingly infect others, continuing the cycle that led to the devastating epidemic we now face. Letting people die, and keeping people ignorant of their status, is not the way to end this epidemic. We recognize this truth here in the U.S., where we spend 11 percent annually on prevention, but 67 percent on treatment out of a total budget of $23.3 billion spent on AIDS domestically. Some have argued that a heroic American commitment to testing and treatment such as the targets in the Save Lives First Act will discourage other donors from supporting diagnosis and treatment. The truth is that other donors have yet to demonstrate substantial commitment to bilateral treatment programs. Most other donors prefer to fund treatment through their contributions to the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria, a multilateral organization affiliated with the United Nations, to which the U.S. is the largest (by far) contributor. That is what the Global Fund is for--to create efficiencies of scale and allow smaller donors to contribute to those more efficient programs rather than reinventing the wheel and starting up their own bilateral programs. When other donors do invest in bilateral efforts, it is almost always on the prevention side--funding needle exchanges for drug users, condom and ``empowerment'' programs for prostitutes, and other prevention efforts in Africa, Asia and eastern Europe, usually based on behavior change programs. This is all the more reason why one donor, the U.S., needs to focus on diagnosis and treatment--the rest of the donor community is not as committed to these programs compared to other approaches. But let's say that other donors want to support treatment--great! We welcome their participation. There is so much to do--between 7 and 8.4 million people still need treatment today. PEPFAR certainly can't treat everyone in a given year, and will have to rely on the efforts of others going forward, if we want to bring hope to everyone affected by this dreadful disease. We are proud of PEPFAR and the millions of miracles it has created already in its first four years of operation. The American people can look at PEPFAR and, unlike what they'll find with most government programs, they can see measurable and tangible results in the faces of the millions saved and cared for with U.S. funding. PEPFAR isn't ``broken,'' and it doesn't require ``fixing'' in its reauthorization-- it's a stunning success. The burden of proof is on those who want to radically change PEPFAR policies, not on those of us who want to preserve them. We look forward to working with the President and House and Senate leaders to ensure that PEPFAR continues its successful, miraculous, life-saving track record. Bertha, a 23-year-old PEPFAR treatment client in Tanzania speaks for millions when she says, ``If it is not these ARVs, I think I was dead long time ago because I use and I am still using these drugs. Now I can do anything. I'm healthy and I'm strong.'' Mr. President, I ask unanimous consent that my endnotes and graph be printed in the Record.

Mr. COBURN

Mr. COBURN. Mr. President, 40 percent of the money in the United Nations is absolutely wasted. They will not report transparency in anything they do. We know on their procurement it is at least 40 percent. We know 25 percent of the last peacekeeping operation was wasted through fraud. We should not send another penny to the United Nations until they become transparent with how they are spending the money they have now. I urge my colleagues to vote in opposition.

Mr. COBURN

Mr. COBURN. Madam President, the only cost in this country that has risen faster than medical care has been college education. There is no shortage of student loan money under Government-guaranteed loans. We sent $77 billion to colleges and universities last year, half of them through earmarks. The more money we send to universities, the higher the tuitions go. That is one of the reasons it is higher than it is today. According to the Secretary, in a study issued this last week, there is no shortage of available student loans among the federally backed Student Loan Guarantee Program. There is a slight shortage in the 10-percent private. This amendment does not address or increase at all the availability that is already there. So we are not doing anything with this amendment other than spending the very money these kids are going to have to pay back. By borrowing now, they will have to pay it back two and threefold.

Mr. COBURN

Mr. COBURN. Mr. President, I yield the floor.

Mr. COBURN. Here is what we know. Medicare fraud, out and out pure Medicare fraud. It is somewhere between $70 billion and $90 billion. I picked the middle, which is $80 billion. We have testimony and studies and lots of data on that that will show us that at least $80 billion worth of Medicare money is being ripped off every year. Let me give some examples. I will go through some. Here is one company that billed Medicare $170 million for HIV drugs. Do you know how much in HIV drugs they did? Less than a million. But they billed $170 million. There was $142 million for nonexistent delivery of supplies and parts and medical equipment--$142 million. How about taking Medicare numbers from seniors and billing Medicare for prosthetic arms on people who already have two arms? That came to $1.4 billion last year. Think about that--$1.4 billion was billed to Medicare for prosthetic arms for people who don't need prosthetic arms. How about 80 percent of the drugs billed across the entire United States for HIV under Medicare went to the State of Florida, which has less than 10 percent of the HIV patients who are eligible for Medicare. How is that possible? How about one wheelchair that got billed to Medicare? It was never sent, but they billed $5 million to Medicare through multiple billings. It is easy to add up to $80 billion. I could go on. How about fake Medicare providers for the elderly, when they steal their number and send multiple bills to multiple locations throughout the country for the same Medicare patient. That is $10 billion in improper payments. The actual improper payments were $37 billion the year before last, and $27 billion last year and of that, $10 billion of it is unrecoverable. We paid too much or we paid the wrong person. That is $10 billion out the door, which is $250 per man, woman, and child in this country in improper payments on Medicare. Medicaid is another one. There was $30 billion worth of fraud. It is higher than that; that is only the Federal Government's portion of it. It is easily documented, but we cannot document it because Medicaid doesn't file improper payments like the law says they are supposed to. Why? It is because we have not had the guts to put any teeth into forcing HHS to have improper payments. Last year, finally we got 6 months of improper payments on only direct payments to doctors. They found $13 billion worth of improper payments. We have a report that says there is probably $15 billion worth of fraud in Medicaid in New York City alone, of which the Federal Government's share would be about $8 billion to $9 billion. How about the fact that we paid, in 10 States, over $30 million for payments for Medicaid services to people who are dead? Yes, we paid that. We have a great system that is working well. How about the fact that 65 percent of all Medicaid rehabilitative services are fraudulent? So of the rehab bills that are filed with Medicaid through CMS, 65 percent are fraudulent. Why do we continue to let that happen? Where is the oversight? Ninety percent of New York Medicaid school-based service claims were illegitimate. Case management. CMS reports that in one State, 72.4 percent of the claims weren't valid in terms of Medicaid case management. Then we have the infamous drug scandals with the drug companies that have been overbilling to the tune of a billion dollars. How about Social Security disability fraud? We have that listed at $2.5 billion. What we know is the following: There is at least $6.5 billion in improper payments in Social Security disability. So we have paid them a much smaller percentage than we have on any other improper payment program throughout the Federal Government and said we will take a small percentage of that, less than 40 percent, which is normally 80 percent, and we will list it at $2.5 billion. It is coming out of Social Security every year--totally wrong--and that $2.5 billion could stay in the SSI program to fund people who were truly disabled. Yet we let $2.5 billion sneak out. Why? That is us. We have not done the oversight. If you add up all of the rest of the improper payments in the Federal Government, you come to $55 billion. That is what is reported. But that doesn't include the 18 agencies of the Federal Government that don't even report improper payments, even though it is the law, which accounts for another $179 billion worth of spending. And if they are anywhere close to the rest of it, there is 5 to 10 percent of improper payments. So there is anywhere from $3 billion to $7 billion more in improper payments. DOD performance awards. Here is what we have done. Over the last 3 years, the DOD paid out $8 billion on average a year to contractors for performance bonuses that didn't meet the performance requirements of their contract. Think about that--$8 billion a year. That is almost twice the total budget of my home State that we are paying for performance bonuses for contractors that don't meet the requirements of the contract, but we pay them anyway. Why do we allow that? Why do we allow that to happen? How about DOD maintenance of unneeded properties? We have testimony and a report that shows they have 22,000 pieces of property they don't want. They are spending about $3 billion maintaining properties they don't want. But we put roadblocks in the way so they cannot get rid of them. Is that Americans' fault or is that something we should have addressed? We didn't do it. Consequently, we are going to throw out $3 billion more this year to maintain properties we should have sold 5 to 10 years ago. We also know that within the Federal Government, outside of the DOD, we have another $18 billion worth of properties we cannot get rid of because we cannot go through the hundreds of hoops we have to be able to get rid of them. That is a one-time savings. That is not even on here. That is a one-time savings we would achieve if we had a real property reform that forced the bureaucracy to do what was best when it came to real property. Going back to the performance bonuses, when GAO looked at it, they found no connection between the payment of performance bonuses at the Pentagon and performance--not just on this $8 billion they said was paid erroneously, but on the rest of it. I think we have an Armed Services Committee in the Senate. We certainly have a DOD Appropriations Committee in the Senate. You would think this might be one thing we wanted to do oversight on. Yet no oversight hearing has happened. Why is that? Why haven't we looked at how we are wasting this money? How about no-bid contracts. This is my favorite. We have seen the problems between Boeing and Northrup-Grumman on a new tanker, a $35 billion new contract--except we know we have needed a new tanker for 12 years. We have had planning on that for 12 years. We are letting a cost-plus contract go through because we don't know what we want. Do we not think whoever won that contract ought to have to take some risk, development risk? Do we think the American taxpayer ought to pay that? We know we lose at least $5 billion a year across the Government in no- bid contracts. That is probably minor. That is a small estimate within the Pentagon. We have not even looked at all the other no-bid contracts throughout FEMA, which we know was tremendously wasteful during Katrina. We know that at least $3 billion of the money we spent during Katrina, from hearings we had on homeland security, was wasted. When the average price we pay to pick up debris from Katrina to the guy actually picking it up is $6 a yard, and we are paying the Corps of Engineers $32 a yard, there is a problem. The taxpayers are getting swindled by 500 percent. Yet we did that to the tune of billions of dollars after Katrina, with no management or oversight. What we know is in homeland security--and especially from Congressmen Waxman and Davis in the House--32 Homeland Security Department contracts, worth a total of $34 billion in no-bid contracts, have experienced significant overcharges, wasteful spending, and mismanagement. Between 2003 and 2005, the no-bid contracts in the Department of Homeland Security increased by 739 percent. There is no management. We are allowing that to happen. When we argue that we cannot let the bureaucrats control it, when we say we have to do earmarks, but we don't do oversight, we are letting the bureaucrats control it. If there is $300 billion worth of waste, fraud, and abuse here, and our earmarks account for $18 billion, what price are we paying by not managing the Federal Government and having oversight? We are not doing it. Emergency spending, another one we won't be critical of ourselves. We put emergency spending in on the floor and add from $20 billion to $40 billion and call it an emergency, and none of it meets the definition of an emergency. We do that so we can go outside of the spending parameters that we have limited ourselves to either through pay-go or the budget. But it looks good at home--or does it? It looks good at home until we start talking about the waste, talking about the fraud, talking about the mismanagement, talking about the denial of our oath we took when we came here to uphold the Constitution. When we allow bureaucracies to waste money, when we don't have oversight of those bureaucracies, then in fact we have abandoned our oath. It is interesting, in emergencies, up until recently, when we had emergency spending, we paid for it. In my home State of Oklahoma we had the Oklahoma City bombing, a tremendous tragedy. It was the first major internal terrorist act we had. All of the money that went toward restoration of that was paid for. We didn't borrow it from our grandchildren. Let me go back again. When we don't pay for things with emergency spending, we charge it to them. When we have a true emergency, which we might say we didn't plan for, that is one thing, but when we know what we are putting into the bill is not an emergency, we are saying they don't matter, we don't care. We care more about looking good and getting some constituent satisfied than thinking about the future of these kids. How about other areas? How about crop insurance? Do you realize that for every dollar we pay out in crop insurance, we spend over $3 in administrative fees and underwriting to insurance companies? How is that a good deal? Regardless of where you are on the farm bill, why would we do that? That is at a rate of five times what the rest of the insurance industry earns. Who has the sweet deal here? Who has the sweet deal? It is not these kids. They don't have a sweet deal, when we are paying three times more than we should to administer a crop insurance program and not requiring farmers to participate. That is the minimum we can save--$4 billion a year--by saying you can earn the same amount of money as everybody else in the casualty insurance business, and no more. No more sweet deals for crop insurance firms. But do we do it? No. I voted wrong on one of the amendments for it. It may have been the amendment of the person sitting in the chair. But we didn't do it. One of my favorites is the United Nations. We sent $5.3 billion last year to the U.N. and we cannot get the State Department to tell us what our total was in 2007. That was 2006. By law, they are supposed to provide that, but they don't comply. The Foreign Relations Committee won't make them comply, and the Appropriations Committee won't do it, because we don't want to know how much we send. But the American people want to know. But the Secretary of State does not want to give it to us. Our committees will not force them to do it. What do we know about that, of the leaked documents that came out looking at how money is spent? What we know is on procurement and peacekeeping that at least 40 percent of the money that is spent is wasted. Think about that. At least 40 percent is influenced through people of influence and does not ever get to what it is supposed to be doing. It never gets into the peacekeeping field. Only 60 percent of the procurement money actually ever gets to where we want peacekeeping, and yet we don't do anything about it. We have asked for transparency at the United Nations. This body voted 99 to 1 to condition last year's money on that transparency. It went to conference, and all of a sudden for some reason that was dropped. I wonder why that happened? We thought the United Nations owed us an explanation to tell us where they spent our $5.3 billion but, in our wisdom, we did not accede to that because it might have upset the U.N. Consequently, about $1 billion a year of what we send to the United Nations is pure waste--pure waste. It goes to fraud. It goes to buy off people. It goes to not accomplishing the goals. If we look at what we are trying to do in Darfur and the new U.N. program over there in terms of sending an interdiction force, what we know is 40 percent of the money has been wasted. It has been scavenged. It has been taken away. It is not going to make a difference in somebody's life. It is interesting, the U.N. peacekeeping budget this year will grow from $5 billion to $7 billion, a 40-percent growth in 1 year. And of the top five contributors to the U.N. budget, which is us, the United Kingdom, France, Japan, and Germany, all of our budgets are going to grow around 6 or 7 percent. But because we do not have any transparency, we do not have any management at the United Nations, we have a spoil system and we do not have the courage in our body to hold them accountable, we are going to throw $1 billion to $2 billion of our kids' money away. Oh, I know, we shouldn't rock the boat at the United Nations. They are the people who care about freedom in the world. It is hard to see. If they care about freedom, transparency would be one of the No. 1 things they would assure themselves. How about another $10-billion worth of savings? We have $64 billion worth of IT contracts going on right now; $27 billion of those are on the high-risk list. In other words, we routinely lose about 20 percent of our investments in ITs. They don't ever accomplish their goals. We spend the money, and we never get anything for it. Where is the management for that program? Where is the accountability for that? It is similar to the tanker program: Give me a cost-plus program, I don't know what I want now, but I know I want something, and I will tell you as we go what I want. And so the bills start adding up. So out of the $64 billion we spent last year, $27 billion of it is questionable we are ever getting anything out of it. Take a conservative estimate of that, which is less than what we know historically the IT oversight from GAO has told us, and we are going to lose $10 billion on programs that were not asked for right, were not managed properly or we just flat did not get what we asked for and parted our ways and threw these kids' money away. Then there is another $17.5 billion we can save from the National Flood Insurance Program. It was created in 1968 by Congress to prevent the need for future emergency spending for large floods. It was designed to be self-supporting, to pay back any debts with proceeds from ratepayers. But what happened was, on the way to the store, the politicians got in between them. So now we have a vast majority of properties that have been grandfathered in that historically have made claims. They were built before the NFIP construction standards, and they receive premium subsidies. In the wake of Katrina, we have a one- time savings of $17.5 billion that we could have had we had that program. But where are we? We now have Gulf Coast States lobbying us that we should increase that program, except the kids I showed the picture of are responsible for that. The other item, and I challenge all my colleagues to start talking with Federal workers about where they can save money. If you ask them, every one of them says, yes, we can save money. As a matter of fact, we can save a lot of money, but nobody is asking. As a matter of fact, the system is, if we haven't spent the money by the 10th month, we are told to spend it, we are told to spend the money because we might not get enough money next year, and if we don't spend it, then it looks like we don't need it and, therefore, our budgets will be declined. In fact, out of the $1.36 trillion we are going to spend this year, we could save 5 percent easily, 5 percent efficiency. If we can save it, if the Federal employees, the thousands with whom I have talked, are right, why aren't we saving? Let's go down through a few more, and then I will finish. We know if we simplify the Tax Code, either change it to a flat tax or straight tax or a value-added tax--whichever one you want, it doesn't matter--what we know is if we did that, we could get significant savings. Let me tell you how. One is we know compliance will be better. But we also know we have a $10 billion budget for employees at the IRS that if, in fact, we could create a simpler, fairer, straighter system--you pick which kind, I don't care, value-added tax, whatever it is--that we would not need nearly that many employees and we would not spend $160 billion a year paying our taxes, which is what we pay other people outside the IRS. We also know the IRS, for every dollar they spend investing in compliance, gets between $3 and $4 back. So somewhere between $50 billion and $100 billion out of the $370 billion that we don't get now, we can save. But we tend to want to use it for a political debate. How about eliminating outdated and wasteful programs. Let me go through some of them. That is $18 billion. Science fiction weapons, $431 million, got nothing for it over the last 10 years, nothing for it, and we spent $431 million and got nothing. The Coast Guard lengthened eight patrol boats through an earmark. It cost $100 million. They are all worthless now. We have to buy eight patrol boats. Somebody had a good idea. How about excessive fuel costs? At minimum, $35 million a year, and what we know now looks like in Iraq another $12 million worth of fraud occurring in the fuel depots inside Baghdad. Another $40 million, $50 million on fuel. How about improper travel payments at the Defense Department, $4 million a year? Security clearances--it costs us half a billion dollars a year to do security clearances because we are doing it in the Dark Ages when, in fact, for almost every other thing around this country we have developed modern systems, computer-aided IT to develop how fast and how often we can clear security items. Yet we spend half a billion, and it takes a year to get somebody cleared. We could cut that in half. We had a wonderful earmark for polyester t-shirts for our marines. The only problem is, if their MRAP or humvee has a fire, it sticks to their skin. But we still spend $3 million on them. How about a ferry to nowhere, 84 million bucks? We rejected the developmental boat proposed from a defense contractor in 2002, and the U.S. Navy was required to accept the project and the bid and deploy it to the seas for field engagement, even though it never proved economically worthwhile. How about a James Bond boat, $4.5 million, three of them? A high-altitude airship. The President knows something about this. The Missile Defense Agency did not request funding for this program. As a matter of fact, they said they canceled the program called the high- altitude airship because of capability limitations. Yet we continue to spend at least $1 million a year every year on that program because somebody wants it. Some constituent, some moneyed interest, somebody who might employ 20 or 30 people wants it. Somebody wants it, so we have to look good. How about the American Embassy in Iraq, $592 million? We know a good 20 percent of it is pure waste. We have seen the fraud. We have seen the reports. We know what is going on there. Have we cut back the amount of money? Have we limited the amount of money on it? No. We offered an amendment and couldn't get it done. How about USAID in Afghanistan, $5.68 billion spent for schools. In the first snow, the roofs collapsed on them. Did we do anything about it? No, we hired the contractor to do more stuff on a cost-plus basis. How about hospital clinics that were supposedly built, except after we paid for them, the Afghanistan Government told us they didn't build them. How do we let that happen? That is us. That isn't the bureaucracy; that is us. We are letting it happen. We are allowing it. We spend $20 billion on Federal AIDS programs and what we know is lots of it gets wasted. We know there is widespread deficiencies within the Centers for Disease Control and Prevention in the HIV prevention program. Those are not my words; that is the HHS inspector general. Two million dollars was embezzled at the San Juan AIDS Institute. NIH is spending $120 million right now on a vaccine program. The starter of that program and the major scientists who started it said it will not work, and they are not contributing, but we continue to spend $120 million on a program everybody in science knows is not going to work, but we are doing it. By the way, we spent $300,000 or $400,000 on HIV Vaccine Awareness Day, and we don't even have a vaccine. It is important we spend it, but we cannot get rid of it because somebody objects. AIDS housing, millions of dollars wasted. Here is my favorite. How about $1 million paid to dead farmers? A billion, I am sorry, a billion dollars paid to dead farmers for their crops. They are dead. We are continuing to pay them, up to 15 years some of them. It is the only program you can continue to collect after you are dead, and yet we have an Agriculture Department that allows that to happen. How about this--this is great--the National Park Service centennial celebration. We are going to spend $100 million in a time when our deficit is $607 billion, our debt $10 trillion, and our unfunded liabilities are $7 trillion, and we are going to spend $100 million to celebrate our national parks? That doesn't pass the smell test. Nobody is sitting around their dinner table tonight saying if we are ever in the kind of shape we are in, we ought to be doing that. How about $100 million for the conventions that we did under emergency funding? We spent $100 million, everybody's money, for each city so we could have the conventions in Denver and Minneapolis. The other interesting thing about the national parks is it doesn't turn 100 until 2016, 8 years from now, but we are going to spend the money. How about a $30 billion subsidy to Amtrak? Amtrak started with a subsidy and was supposed to get better. We continue to not hold them accountable. How about a $244 million subsidy for food on Amtrak? Maybe we want to continue to have Amtrak. Maybe it is worth it to us to have a $1.5 billion subsidy every year on Amtrak. I would agree with that. Maybe that is the right priority. But should we be subsidizing a quarter of a million dollars a year for people's food on Amtrak? But we are. Other items--essential air service to small communities that are within driving distance of another community, we are going to spend $110 million this year. How about the fact that we are going to pay Federal employees $250 million to ride the transit? Nobody else in this country gets paid to ride the transit. Nobody else gets their transit bills paid. But Federal employees, we are going to take a quarter of a billion dollars every year, and we are going to say to some of the best paid, best benefited workers in the country that we are going to give you a quarter of a billion dollars in subsidy so you will ride the transit. Well, economics will tell them to ride the transit. The American taxpayer shouldn't do that. Well, I am wearing thin, I know, my colleagues, and so I will stop and enter into the Record the remaining 50 pages of examples I have of stupidity for which we are responsible. The real important thing to keep in mind, if you have been listening to this, is that we are on an unsustainable course, that, in fact, a child born today is going to inherit something different from what we did. We inherited opportunity. They are going to inherit debt. We inherited a leadership and a heritage that says you sacrifice for the next generation. They are going to inherit a legacy that says you kick the next generation in the teeth. Everything I have outlined today is something we could have controlled, we as Members of the Senate, but we are so busy doing earmarks that we don't do any oversight. Now, what I just outlined to this body is what my staff has discovered in 3 years. Think what would happen if all of us were aggressively oversighting every agency of the Federal Government. Think how efficient it would be. Think how much waste wouldn't be there. Think about what a great deal we would be doing for these kids. America expects us to tighten our belt. They expect us to do what they are having to do right now. They are tired of our wasteful spending, they are tired of our earmarks, and they are tired of our bridges to nowhere. We better listen. There is a rumble, and if we don't listen, it is our own fault that we will continue to decline in esteem in front of the American people. We will have well earned it. So the next time somebody says they want to raise your taxes, ask them how much of that they got rid of before they do it. We don't have a shortage of money. We have a shortage of courage. We have a shortage of character. We have a shortage of intensity to solve the real problems that are facing this country. And until we tackle this, we should not say one thing to anybody in this country about increased taxes. It is morally reprehensible, it violates our oath, and most of all, it does great damage to our country. I ask unanimous consent that the examples that I referred to be printed in the Record.

Mr. COBURN. Mr. President, I am going to spend a little while tonight talking about the budget. I have listened to the budget debate all day, just like I did yesterday. I came in yesterday and listened to the debate. I have heard about tax increases and I have heard about spending and I have heard the things going back and forth. But what I did not hear was anything that had to do with this: This is the oath of a Senator. There are some interesting things. Let me read it first: I do solemnly swear that I will support and defend the Constitution of the United States against all enemies, foreign and domestic; that I will bear true faith and allegiance to the same; that I take this obligation freely, without any mental reservation or purpose of evasion; and that I will well and faithfully discharge the duties of the office on which I am about to enter: So help me God. The interesting thing about that oath is nowhere in that oath does it mention your State. There was, by design, never any intended part by our Founders that we would place parochialism ahead of our duty to this country. Yet where do we find ourselves today? With $9 trillion, almost $10 trillion, at the end of this fiscal year, in direct debt. We have heard all sorts of numbers quoted today. The actual number for the obligated unpaid-for liabilities that our next generations will face is actually $79 trillion. It is interesting where that comes from because that comes from the retirement benefits for our service personnel, the retirement benefits for Federal employees, including people who work in this Chamber, Medicare payments, Medicaid payments, all the various trust funds we have set up through the years, such as the Inland Waterway Trust Fund, the trust funds associated with other distinct obligations in terms of infrastructure in this country. We are stealing all that money every year that is supposed to go to it. As a matter of fact, the budget deficit this year will be, in real accounting standards--not Enron accounting standards--$607 billion, of which about $160 billion of that is going to come from Social Security and about another $30 billion to $35 billion from all these other trust funds. So when you hear a number that comes from Washington, I want us to be very suspect because we are much like the CEO at Enron, Ken Lay. We are not going to send you the real number. It is not because we do not intend to be honest; it is because we have sold out to parochialism. Now, I want us to think about that for a minute. Later on, I am going to show some examples. I am going to go through $350 billion-plus worth of waste that occurs annually in this country. But how is it that we have $350 billion--by the way, it is not going to be disputable. There is going to be an absolute reference to either a GAO study, a CBO score, a congressional hearing or published reports that are out there. So it is not going to be Tom Coburn's estimate. It is going to be a factual basis of what is occurring in our country. But how is it we got to the point where Members of Congress--both of the House and of the Senate--have all of a sudden forgotten what their oath is; that, in fact, their primary means is: How do I send more money home to my State? How is it that we have gotten to where we have $79 trillion in unfunded liabilities? We have $10 trillion in true debt, at the end of this fiscal year. We are going to have a $600 billion deficit--real deficit--this year, which we are going to obligate our children to pay for. I would put forth: We forgot our oath. We forgot what it is about. Our State is not mentioned. When I am parochial for my State, there is no way I can live up to the oath I took when I came into this body. There is no way, if I am parochial for Oklahoma or Ohio, I can possibly make a decision that is in the long-term best interest of the country, when I am thinking about the best interest of my State in the short term. So, consequently, what came about from that? Well, here is what we saw in terms of earmarks, the growth of earmarks and the growth of Government spending. Isn't it interesting, we have heard all the debate today about tax increases, but nobody, except Senator Brownback, talked about cutting spending. Here we have the earmarks in 2006. In 2007, there were another 11,800 earmarks. So it went to 12,000 earmarks. But the spending continues to rise. There is a correlation between earmarks and spending, and it is this: Earmarks are the gateway drug for overspending. Let me explain how it works. If I want something for Oklahoma and I submit a request and the appropriators are kind enough to honor that request and I do not vote for the bill, regardless of whether I agree with the bill, the next time another appropriations bill comes up and I have a request, I will not get it. So all of a sudden my earmark blinds me on a parochial basis for what is best for Oklahoma, but I do not do what is best for the country. So you see this trend going up, and it continues to go up. If you had one for debt, you would see that. If you had one for unfunded liabilities, you would see the same thing. Now, what did our Founders have to say: Congress had not unlimited powers to provide for the general welfare, but were restrained to those specifically enumerated. This is Thomas Jefferson, the founder of the Democratic Party. This is what he said: As it was never meant they should provide for that welfare but by the exercise of the enumerated powers. Earmarks are not enumerated powers. The only power they are is how we find ways to get ourselves reelected. That is the power they are. Here is the founder of the modern Democratic Party who now chastises us with his words about what earmarks are. Yet what do we do? We are going to have a vote. We are going to have a vote on this budget on a moratorium on earmarks. I am very thankful to Senator DeMint for bringing that up. The argument about earmarks is over everywhere except in Washington. If you look at all the polling data throughout the country, in every State, it does not matter if you are Democrat or Republican or Independent, it is over. They have already decided the issue. Eighty- five percent of the people in this country say we should not be doing it. It does not have anything to do with age. It does not have anything to do with party. Do you know what it has to do with? Those people who are getting them and are well heeled and well connected to politicians, they are the ones who do not want the earmark party to be over. That ought to send a warning signal to the rest of Americans that there is something wrong with this process. Here is what is wrong with the process: [T]he principle of spending money to be paid by posterity, under the name of funding, is but swindling futurity on a large scale. This is the same bright man who was very involved in the genesis of our country, talking to us from history about what is important on earmarks. In 1996, there were less than 900 earmarks. How did we go--in 10 short years--from 3,000 to 15,000? What changed? The argument is: We have an obligation not to let the bureaucrats spend the money. Does that mean all the time before this, when they were much lower, we were not doing a good job? Or could it be that all of a sudden the political tool of earmarks became the soup du jour that politicians use to get themselves reelected and collect campaign money by accomplishing those things? So I wish to spend a little time tonight talking about the unsustainable course we are on. International markets now doubt our ability to pay off our debt. Our AAA credit rating is in jeopardy. The dollar is declining. Medicare has hit a trigger for the first time in its history that signals we are dipping into general revenues at a rate that is unsustainable. By the way, Medicare was never intended to be paid for with funds from general revenue. Do we have a moral obligation as Members of Congress to do what every other family does in tough times and tighten our belts? So what I am going to try to do tonight is lay out $388 billion worth of things the Congress could do tomorrow that would save us $388 billion. Now, somebody may dispute the fact that if we totally changed the Tax Code to either a flat tax or a sales tax we might not have a tax gap-- the amount that is owed that is not paid--of $350 billion or $370 billion. We may only have one of $270 billion. I will admit that. So you can take an arrow at that. But the rest of it you cannot take an arrow at. All the rest of it is indisputable. As a matter of fact, we had testimony before the Budget Committee and before the Finance Committee by the IRS that said if, in fact, you funded them properly, they could get between $30 billion and $40 billion of the tax gap back over a period of 5 years. We know for every $1 we give them in terms of enforcement, they get $3 to $4 back. The problem in our country is overspending and wasteful spending. It is not undertaxation. It is a moral question whether we will ask the American people for more money when, in fact, we are terrible slobs with the way we control and manage the money they have today, where we are wasteful. The American people would expect us to get rid of fraud, waste, and abuse before we raise their taxes. Calling for higher taxes is akin to saying you want a performance bonus for us. That is what it is saying. It is absurd to claim the Government is operating at peak efficiency and spending cannot be cut anywhere. But yet we do not see it. It is not just the Democratic budgets. It is the Republican budgets. I will give credit to President Bush. At least he has a park program and at least they have brought forward recommendations of getting rid of programs that absolutely are not functioning, absolutely do not come anywhere close to meeting the goals. Because they have special interests, they are protected by individual Senators. Blocking new spending is not about obstructionism. The real obstruction is wasteful spending and not going after the wasteful spending at a time when we are asking Americans, who are tightening their belts, to give more money to the Government. That is the real obstruction. Looking for new ways to spend money is not our job. Our job is to conduct oversight and eliminate programs that are not working. We are not doing our oversight. As a matter of fact, the CRS did a study on oversight. If we put this sign right up here and we look at oversight hearings, what you will see is: As the earmarks have gone up, oversight has gone down. Do you know why? Because the only thing the Appropriations staff has time to do is to barely get the bill out and then manage all the earmarks. So where is the oversight to see what is working and what is not? It isn't there. The other assumption with this budget is that we have a blank check-- and with Republican budgets, not just the majority's budgets--to spend money however we desire, however we choose. Well, that does not appear in the Constitution. We have totally thrown it away when it comes to spending. We have totally thrown it away under the concept of either the interstate commerce clause or the general welfare clause. We have decided that those do not mean anything, even though the significant Founders of our country believed they did. So let's go back to the oath. Does the oath mean anything? I will ``defend the Constitution'' is what it says. Oh, that means I will twist it to make sure I can do parochial things that make me look good at home. Is that what it means? Can I fully represent and do what is best for our country when I am worried about doing what is best for my State and me? Which one is the more moral position? James Madison, the father of our Constitution, was very clear on this point. He said: With respect to the two words ``general welfare,'' I have always regarded them as qualified by the detail of powers enumerated in the Constitution that are connected with it. To take them in a literal and unlimited sense would be a metamorphosis of the Constitution into a character which there is a host of proofs was not contemplated by its creators. In other words, when you are starting to fudge the deal, that is not what we intended, guys. When you are starting to play games with the Constitution, that is not what we intended. And he spoke it in anticipation so that he would be on record. And we would know what his record was about, what they intended about general welfare. The arguments we hear in defense of earmarks would be ridiculed by our Founders after they got over their nausea. President Reagan criticized the 1987 highway bill because it had 152 earmarks. As a matter of fact, the one before that he vetoed and sent back, and it had even fewer than that. So this isn't an old phenomenon; this is a modern phenomenon. This is something modern that we need to change. It is interesting that so many in this body seem more interested in adhering to the constitutional scholarship of Jack Abramoff rather than James Madison, much to our detriment. Why do you think we have between an 11 and 22 percent confidence rating from the American people about whether we are doing their business in the best interests of the country, rather than our business? Another argument I hear often is that we know better than faceless bureaucrats. Yet if we don't like what an agency is doing, we don't have anyone to blame but ourselves. We have the power of the purse and the power of oversight. The problem is we only use the power of the purse to spend, not to restrict. The last time a rescission bill--and for those who don't know what that is, it is a bill that decreases rather than increases spending--went through Congress was 1995. Overcoming our addiction to earmarks will help us confront the massive waste that is in the Federal budget. We have to do a top-down review of everything in this country if, in fact, we want to hold to the things that are really important, the things that are really worth our sacrifice, which is the next two generations. Now, it is really interesting that the Government Accounting Office says that every family today is responsible for an unfunded liability of almost a half million dollars. If we think about what that means in terms of carrying that interest, paying your regular taxes and then carrying that--the other thing is if you divide the unfunded liability by the 200 million kids who are going to come on between now and the next 75 years, what we are talking about is $400,000 per child; $400,000 per individual child who is born starting today and moving forward that we are going to add. Think about carrying the interest. Think about what will happen to them. Now, let me put up a chart, and we will go through this for a minute. This has $383 billion--actually a more recent chart shows $385 billion--in annual expenditures that are wasted. I would like to spend a minute on that, but let me describe what it is. It is $3,000 for every American household in this country down the drain. It is a full 4-year scholarship for two-thirds of all of the college students in this country. It is enough money to buy a new home for 2 million Americans, based on the average price of a home. It is enough money to get the 2 million Americans who are facing foreclosure out of foreclosure and pay for their entire mortgage. That is what we are wasting in one year. It is enough money to pay for the health care of everybody in this country who is either underinsured or uninsured. All 47 million who are uninsured and the 35 million who are underinsured, we can pay for them, just by getting rid of this waste. It is more than the gross domestic product of 85 percent of every country on Earth. How much we are wasting through fraud and abuse and waste is greater than 85 percent of the gross domestic product of every country on this Earth. It is more than the gross domestic product of 40 States in our Union. It is enough to meet the one campaign's annual goals to end extreme poverty over the next 10 years, over 10 times not enough. More importantly, it is enough to build 1,500 bridges to nowhere over every river in the world, times 10. That is how much money it is. So what are the crises that we face? It is important that we put ourselves in the shoes of the typical American family in this time of tightening. What do they do? They reassess. They look for waste. Their debt is fixed. They try not to get additional debt. They try to spend less money. They try to conserve. They try to turn the thermostat down. They try to only drive when they have to drive. They try to buy cheaper foods. They don't buy the things they would like to buy. They buy and spend money only on bare necessities, if they can. Well, a $607 billion deficit this year, a $10 trillion debt, and a $79 trillion unfunded liability ought to cause us to do the same thing, except we have only heard 1 percent in 2 days of debate talk about eliminating wasteful spending, and that was Senator Sam Brownback from Kansas. In the short term, we will get through this economic slowdown. Hopefully, energy prices will become more affordable for us. But everybody knows in this body, whether we want to admit it or not, we are approaching the day of reckoning that we would not get through. As David Walker, who is the Comptroller General of the United States, a nonpartisan position, said: We are on an unsustainable course. It is absolutely unsustainable. The question is whether our kids are worth us making the hard choices. Economists on the left and the right from groups ranging from the Brookings Institute to the Heritage Foundation recognize the course we are on. We hear all the time that the only problems are the mandatory programs: Medicare, Social Security, and Medicaid. I am going to show tonight that it is not the only problem. It is a lot of the problem, there is no question about it. It is not just the demographics of it and the growth. There are a lot of management problems that we fail to address. Each family's share, which I spoke about a minute ago, of the unfunded liabilities is over $450,000 right now. By 2040--and this is not my number, this is the Government Accounting Office--total Federal spending will have to be cut by 60 percent or we will have to double Federal income tax rates. Now, we heard Senator Hatch talk about how 50 percent of the country now pays 97 percent of the taxes. What happens when we double our tax rates, or another question is, what happens when we don't have any Government programs except Medicare and Medicaid and Social Security? No military, no Department of Education, no NASA, no NIH, no CDC. All of those are gone in a very few short years. More importantly, in 2012, my generation starts heavily hitting Medicare and Social Security, the first baby boomers. What happens if we don't address that? We would be wise to remember the words of Will Durant: A great civilization is not conquered from without until it has destroyed itself from within. For the typical family sitting around the dinner table right now across America, the answer is obvious. It is time for some belt tightening. It is time for us to do the hard work of eliminating the duplication of wasteful programs. From their perspective, if they have to tighten their belt, we should too. It is not our money, it is theirs. Yet in this body we don't believe we have to live by the same set of rules. We have demonstrated that by our behavior. We like to pretend that we don't live in the world of credit ratings and scores. We ignore economic realities and look for ways to spend money on things that aren't necessary--they may be nice but aren't necessary--with little regard to how our decisions are going to affect our ability to pay for things we must pay for. By arguing that Americans aren't taxed enough, Members of Congress are claiming that Government spending can't be cut any more in the budget because the Government is running so efficiently it deserves a raise. I don't think there is hardly anybody out in America's midsection, northeast, northwest, southeast, southwest, south central, who believes that. That is a fairy tale that is believed here, except we don't confront it. Every year we have given Congress a performance bonus that has been adamantly unearned. Americans find this absurd. That is one of the reasons our approval rating is so low. A question we should ask probably is, if our Nation's survival were at stake right now, would we be acting any differently? Would we have this budget, or the Republican budget, from 2006? Would those have been the budgets? No, they wouldn't have been. We would have been thinking long term. We would have been making the hard decisions. We would have said: Our country is worth us irritating some special interest group over some item that is no longer efficient or no longer effective. We wouldn't be worried about weighing the future of our children and our grandchildren against the special interests and monied of this country. We wouldn't worry about it. Well, the fact is, the future is on the line, and if we don't act in the next couple of years, we are going to fall into Will Durant's trap, as we will have rotted inside our own excesses of politics, as we quietly didn't do the things that we could have done to fix the problems that are in front of this country. It is called maintenance. It is like when you don't mow your grass or you don't pick up the trash in front of your yard. What happens is the value goes down, the pride goes down. Well, that is what has happened to us because myself and the vast majority of Americans believe overspending is a greater moral challenge than undertaxation. I want to spend some time now going through what I call 2008, a waste odyssey. This waste odyssey is--I am going to be describing a few areas of Government, and I am going to go through them fairly fast so we can see it, and it will be on my Web site in the next week or so. But I am going to outline at least $385 billion, of which I will guarantee $355 billion of it cannot be legitimately challenged that is not waste; $355 billion annually that is wasted or defrauded from the taxpayers of this country, and we are doing nothing about it. This budget doesn't do anything about it; our appropriations oversight committees don't do anything about it. The committees don't make the amendments to do something about it. We do nothing about it. So we come back to that all-important oath. Mr. President, $385 billion listed, $383 billion on this one chart, $385 billion of which $355 billion nobody will be able to dispute. (Mr. BROWN assumed the Chair.)

Mr. COBURN

Mr. COBURN. Mr. President, how much time does the Senator from Utah have?

Mr. COBURN. According to the agreement we had, that would put us until 7:25 when Senator Brown would be eligible to speak; is that right?

Mr. COBURN. I thank the chair.

Mr. COBURN

Mr. COBURN. Mr. President, I am going to spend a few minutes tonight on some observations. My hope is over the next couple of days to outline something that has never been done on the Senate floor before, and that is to discuss where we as a body fail. We are all the time telling the American people what we do great or how bad the other side is, but rarely do we take a look at ourselves and say: What is going on? What are the problems we face? I had a great weekend this weekend in Oklahoma. Part of Oklahoma got snow, part of it had 65 degrees and Sun and no wind. But I had some experiences I want to share because I think they are pertinent and also poignant to the issue we are discussing. I also note I have been listening to the debate all afternoon, and the debate is nothing but finger-pointing--one budget, the other budget, how bad somebody is, what somebody didn't do, what somebody wants to do. It strikes me that as I reflect on the people whom I saw this weekend and their hopes and dreams, most of this debate does not have anything to do with them. Most of this debate has to do with us, which is exactly the opposite reason of why we were sent here. What we have heard is a partisan debate, partisanship based on parties, not partisanship based on principles, not partisanship based on children, not partisanship based on the future, but who can twang it, who can manipulate it, who can create doubt and undermine someone else's position. I traveled to Oklahoma City. My brother has been in the hospital for 16 days. He had a major operation called Whipple--it takes a long time to get over it--for pancreatic carcinoma. That is what they do the operation for. He has four kids and four grandkids and one on the way. I got to thinking, as he lay there with an NG tube in him and a feeding tube through his jejunum, what would he like for his kids? What would he like for us to be talking about for the future? Down the hall were a whole lot of other people just like him. He is 61 years old. He is not thinking about himself as he lays there in the hospital. He is thinking about what is the future for his grandkids. I visited with one of my longest term friends this weekend. He is not thinking about himself right now. He is thinking about his grandkids. He has one and one on the way, going to be delivered this next weekend. He didn't mention one thing about himself. He mentioned about what the future was for his kids. I think about the ladies whom I saw this morning in my medical office about to have babies. Their hopes and their dreams are about the generation that is to come, about how this miracle birth is going to take place over the next couple of weeks for both these ladies. One is named Natalie and one is named Brooke; one is a first-time mom, the other is a second-time mom. The things they are looking forward to with their children are totally dependent on whether we act as adults in this body. I have just been struck at how far off the mark we are. I think Kent Conrad is a great guy. I looked at what he did last year. He is a pretty fiscally conservative guy. Kent sponsored less than $20 billion worth of new spending over the next 5 years, total sponsorships. Many times in the last 3 or 4 years, we have had debates about how we handle the problems. The differences between us are not that great. What guides us, though, and what is destroying our country, I fear, is the fact that we are putting political parties and the benefits of the political budget ahead of the best interests of our kids. One of the things I hope to do tomorrow is to outline for the American public and this body everything I found in the last 3 years in terms of waste on an annualized basis. I want my colleagues to hear that again. Everything I have found in terms of waste where we do not do it right, where we are wasting taxpayers' dollars every year, and I can conservatively, just on what I found and I can fully document--I want you to understand that, Mr. President; it is not Tom Coburn's opinion, it is the opinion of the GAO, the CBO, oversight committees, and other committees of Congress that are documenting what I am about to share. What I am going to share tomorrow is how we fail because we are talking about a budget today--I told Kent Conrad, I am not out to game his budget. It will spend more money. That is not a whole lot different from what we have been doing. But how dare we spend another penny when I can document, and none of my colleagues can refute, $366 billion a year of waste or fraud, $366 billion a year. Let me explain what that means to the average consumer. If you are at home today and you are in the 25-percent tax bracket in terms of income tax, what that means is that about 9 percent of the money you pay, we blow. So that is one-third, that is 9 out of the 28 percent, one-third of all the money you pay to the Federal Government, not counting your Social Security and Medicare taxes, but of your income taxes, one-third of it, we blow. The interesting thing is that not since 1995 has the Congress done any rescission spending. Let me explain what that is. That is the Congress looks at our budget and says: Are there any areas where we can save money, where we are not doing well, where we can be more efficient, where we can improve things? We haven't had a rescission package since 1995. That is 13 years that we have not had a rescission package. There are lots of reasons for that, none of them good. It does not matter which party is in control. There has not been a rescission package for 13 years. So it is not about parties. It is not about gaming somebody because somebody is a Democrat or somebody is a Republican. Our problems in our Nation today are much more serious than partisanship. They are much greater than the beneficial effects of winning an election based on how you can make somebody else look lousy. One of the important things I hope will come out as we go through this in the next couple of days is whether we really care about what is going to happen. We can look at the stock market--it has weak knees today; look at the price of commodities--it is rising. There is no secret we are in a time of economic weakness. Depression is described as two quarters successively. We are probably there. Nobody knows. Nobody has a crystal ball to know that. But the fact is, it is what we are leaving right now for these two, Brooke and Natalie's children who are going to be born in the next 3 weeks. What do we leave them? We are leaving them a gift, and the gift is debtor's prison. Let me say that again. I don't say that lightly. We are leaving them a gift. According to the Government Accountability Office, if you are born tomorrow, you inherit $400,000 of unfunded liabilities. Does anybody know anybody who is working and struggling and making a middle- class income or even an upper income who is going to be able to afford that amount? Just paying the interest on it is $28,000 a year, and you have to absorb that by the time you get old enough to work. So we are talking about another $6,000 worth of interest before they start paying off any principal. So, in essence, the heritage through our incompetence, our bickering, our partisanship because we have to show somebody up, the heritage is every kid who is born, by the time they get a chance to work, is going to be accumulating about $1 million worth of debt. The question we have to ask ourselves is, What happens to them? What happens to the dream of a Brooke or a Natalie and their children? What is going to happen to them? We are about this far from losing the triple-A credit rating on our country, on our bonds. At the same time, we see that in the last 8 years, the price of gold relative to the dollar is fourfold. What does that tell us? Is there a shortage of gold? No. Is there a fourfold increase in the demand for gold for industrial uses? No. It is a flight to safety because many people in the world do not believe we are going to be able to pay back the $79 trillion of unfunded liabilities we have left. So as we come to a budget for the United States and we pass one-- which we will, probably--we do it absent the light of looking at $360 billion-plus that is wasted every year--$360 billion. People might say: What is that? It is pretty easy. How about Medicare fraud, $80 billion a year. How about Medicare improper payments? We pay people when they do not deserve to be paid--not fraud, just incompetency--$10 billion a year. There is $90 billion in one program. There is nothing in this budget that fixes that situation. There was nothing in the Republican budgets that fixed that. Why not? I know the answer to why not. The answer to why not is because we were too busy making political games, political strokes. We were too busy being partisan. The time for partisanship in our country is past. We may not believe that, but history is going to show it. David Walker, the Comptroller General of the United States, one of the fairest, most openminded men I believe I have ever met in my life, on Wednesday is leaving that position. Why is he doing that? He has a guaranteed job until 2012, a great job, head of an agency that really is stellar in what it does in its performance. Why is he leaving that position? Because he is scared to death for our country because nobody is listening in positions of power. Nobody is paying attention to the unsustainable course on which we find ourselves. We are not. We haven't in the budget. We didn't in our budget. We are not. We don't on the supplementals that come through here to ``fund the war'' because we load up $20 billion to $30 billion more debt right on top of our kids. We hear all these false numbers. Yes, I said false. The budget numbers are games. The President's numbers about the deficit are wrong. The Budget Committee's numbers about the deficit are wrong. They are not realistic. They do not take into account the fact that we are going to steal about $170 billion worth of Social Security money this year--I think $163 billion is the accurate number. We are going to write an IOU, and then we are not going to tell the American public that we increased the debt another $163 billion. We are just going to pass that along to our kids. I have some little things for you to think about as we outline this. There is $2.5 billion a year in Social Security disability fraud. There is another $1 billion in improper payments. Think about this. Just $2.5 billion. Just $2.5 billion. Just 2,500 millions. Just 2,500 millions or 2,500,000 thousands. They are pretty hard numbers to get our hands on. So anyhow, in the next few days, I am going to list out one by one, I am going to go through everything we have seen in the last 3 years that continues daily in this Federal Government that this body won't attack. When we offer amendments in this body, they are either accepted so they can be thrown out in conference when they actually do something, such as the census amendment that was in the Senate. We are now going to be asked for about $2 billion more for the census even though we have been saying all along there was a problem there. We ignored it, the House conferees with the Senate conferees ignored it, and now we are going to spend $2 billion more. What we are going to do is outline thoroughly what just one office, just one Senate office, has found over 3 years, and it is all going to be fully documented, with footnotes, so you can see exactly where it came from. It is going to be indisputable. Now ask yourself, if you are an American out there struggling to pay your gas and things are not looking great for the next 6 months for you, what would you think if all the Senators did that and we really did get rid of all the waste, fraud, and abuse in the Federal Government, or at least a meaningful component of it, and that we really probably could cut $600 billion out of our budget, which would mean we could either--if you wanted a bigger Government, you could do more, or if you wanted to pay fewer taxes, you could pay less? But most importantly, we could live up to the heritage that is ours, which is creating an opportunity for our children and our grandchildren in the future. I am convinced that Americans aren't really asking for higher taxes. What they are asking for is smart spending, hard work by us to make sure what we spend is worth it. What they are asking for is no more earmarks. That is what 85 percent of them are asking for. And they are asking for no more bridges to nowhere and what it symbolizes in terms of excess, in terms of a lack of common sense or a lack of caring. I don't know which it is, but the fact is, we are on a collision course that is going to undermine the future of this country. Will Durant, a historian, said that democracies never fail and are never collapsed from without until they have moral decay that causes the collapse from within. When we are spending the money of our grandchildren today and not doing anything about the waste we have in our budget, the question has to be asked: Are we already there? Have we already risen to the point where the political class, the political elites care so much about their positions--both parties--that they are willing to throw the future of the next two generations of this great country under the bus? The next year is critical for this Nation, as we see what happened today in the stock market, another lower earnings, as we see consumer confidence decline. Wouldn't it be nice if the Senate stood up to the challenge that is facing this country and did so without the first partisan word about parties and said: Let's fix it. Let's fix it. I have had an ongoing study since I have been in Government to ask Federal employees this question, and I have never had a different answer. And the question is this: If you are a Federal employee, no matter where you work, what branch you work in, or what you do, if you had to, tomorrow, for the sake of our future, become 5 percent more efficient--in other words, not spend $1 out of $20--could you do it? Do you realize I have asked that question thousands of times, and I have never been told no. I have never been told no. Well, if that is the case, why aren't we doing it, when we are going to have a $607 billion deficit? We are going to be at $10 trillion of debt at the end of this year. That is real debt. That doesn't talk about unfunded liabilities, which are $79 trillion. So we have $10 trillion worth of debt, $79 trillion under infinity, of unfunded liabilities, and we don't talk about that. How is it that we find ourselves allowing such things as the military to continue to hang on to buildings they do not want to the tune of $2 billion to $3 billion a year just in maintenance costs? How is it that we have $18 billion worth of buildings we don't want but we can't sell because of the roadblocks we have put in the way to be able to sell them? How is it that the Pentagon pays performance bonuses of $8 billion a year to companies that don't meet the requirements of performance bonuses? How is it that we are allowing that to continue to happen? We have known of that for 3 years. Why is it happening? By the way, what is the big stir right now? The big stir is Boeing didn't get the contract and Lockheed--or EADS did. Nobody is asking the right question on that. It doesn't matter who got the contract. It is a cost-plus contract. If we don't know what we want in a refueling tanker now after 8 years of studying it, we are never going to know. So a $35 billion contract is going to become a $45 billion contract, just like all the rest of them. Instead, we ought to be insisting, if you are doing business with the Federal Government and making money, you ought to take some risk. There ought to be no more cost-plus contracts on procurements like that. There ought to be none. Whoever has that contract ought to take part of the risk for the American people because they are having a great benefit in terms of the profits they are going to make. So we have a lot in front of us. What is $350 billion in annual waste? What does that mean? Here is what it means. It means $3,000 for every family. That is what we are wasting. Three thousand dollars for every family in this country we are blowing, that we are throwing away because we care more about partisanship than we do the future. We care more about making the executive branch look bad than we do the future. We care more about our earmarks than we do the future. There is a legitimate role for the Federal Government to have the Senate and the House direct spending. That is not the dispute. But the way you do it best is through oversight, not through earmarking. The way you do it best is to know exactly what is happening rather than earmarking it. The gateway drug to overspending since 1998 has been earmarks because when you earmark, you don't vote against bills. What happens is, the next time you earmark, the committee chairman comes up to you and says: You didn't vote for my bill last time. Sorry, I can't fill a thing. So we have this almost extortion-like process whereas earmarks are granted to you if you vote for a bill. You are not even looking at the total bill, you are looking at the earmarks. Do our children deserve better? Are they worth our sacrifice? Is it really worth it for us to not necessarily get what we want if we can secure the future? I am having trouble knowing whether this body really believes that. We have outlined to appropriations committees, everybody has been sent a report of everything we have found in the last 3 years, and it has been essentially ignored because we are too interested in making sure we beat the path to looking good at home. When you take an oath to be a U.S. Senator--and I don't think this is said often enough--there is nothing in that oath that says anything about your State. I am not here to represent the vital interests of Oklahoma. I was elected by Oklahomans to represent the vital interests of this country. And when I get confused about where my loyalties lie, our country suffers, and that is exactly what is happening to us right now. We have gone from 600 earmarks in 1998 to a high of 14,870, almost 12,000 last year. What is going on? Where is the common sense? People from Vermont to Oklahoma to California to New Mexico to Montana, they know better. So the special interests of the few are being advantaged while we sacrifice those that come after us. Now, that is a firm indictment. But you can't continue to waste $360 billion a year, ignore oversight, not do anything about it, and then puff up and say-- Republican and Democrat--I am going to pass a budget and I am never going to look at any of that. Well, that is exactly what my party has done. That is exactly what the party in charge today is doing. We are ignoring the very real fact that this Government needs hands-on management, it needs aggressive oversight, and it needs this $360 billion worth of waste eliminated in this budget. And if we pass this budget or any other budget--whether my party offered one or not, even the President's budget--if we pass any budget that doesn't take this into account, what we are doing is spitting all over the hopes and dreams of the youngest Americans in our country. We are saying: You don't count. We got ours, you will have to worry about getting yours. We will take, you will have to give. And, oh, by the way, we are sorry there is not going to be enough resources left for you to have a college education or to own a home or for us to defend ourselves or for you to have health care like many of us are going to have as we wander off at 65, knowing that you are going to be working hard through increased payroll taxes just to pay for the promises that we couldn't make efficient and that we overpromised. So, Mr. President, I know I have carried on some tonight, but I think our problems are much more severe than what our behavior would deem. I think the degree of difficulty we find ourselves in today is directly attributable to our lack of courage. We are more interested in not offending somebody than we are securing our kids' and grandkids' future. That is not something I want to be accused of. So I will take the ridicule of this body for being ``Doctor No,'' for saying: We are not going to spend more money on new things, we are not going to have more programs until we can pay for the programs we have. And if it takes one person saying: I am not going to agree to pass bills under unanimous consent, I am not going to agree to not have the opportunity to amend them, then so be it. The $3,000 per family per year is enough to make a difference, a big difference, in their future. I think Brooke's and Natalie's babies are worth it. I do not know about you all. I am ready to give up something. Most of all, I am willing to give up my seat in the Senate for doing what I think is right in the long term for our country. If I do what is politically expedient and win reelection, what good is it if I have not fixed the very real problems that are facing our country? It is time for a gut check in this country. It is time for the American people to look at you, us, and say: Are you really doing for us, or are you really doing for you? My accusation is too often we do for us and not for the generations to come. I will be back to outline in detail where this $360 million--billion; let me make sure everyone understands--$360 billion worth of waste, fraud, and abuse occurs every year in our budget, and we have done nothing. Let me say it again: We have done nothing about it. How dare we talk about raising taxes. How dare we talk about anything except doing the business that should be at hand, which is being good stewards of our children's future. I yield the floor, and I suggest the absence of a quorum.

Mr. COBURN

Mr. COBURN. Mr. President, first of all, I, too, want to express my respect for the Senator from Wisconsin. We have a lot of things on which we agree. This happens to be something on which we adamantly disagree. But I appreciate, as someone who pushes the limits in this body, his desire to have this debate because I think it is important. We just heard the Senator from Michigan talk, and the statement would have been a fairly accurate reflection 2 years ago. But it has nothing to do, and it is not even anywhere close, to what is ongoing in Iraq today. I think the case could have been made 2 years ago that Iraq was in a civil war. Nobody who has visited Iraq in the last 2 months can make that claim. It is not there. Outside of the Green Zone, I met with people whose daughters had been murdered by al-Qaida. I met with people whose father had been murdered. I met with both Sunni and Shia in the same village, in multiple villages, who had reconciled because they reject the terrorism of al-Qaida. There is no question lots of mistakes have been made with the Iraq policy. But the claims under which we try to describe Iraq today in light of how it was 12 months ago are fictitious at best and damaging probably in terms of what the truth is. Do we find ourselves in a very difficult situation? Absolutely. Is this an expensive war? Absolutely. Would we all like to not be where we are? I think almost everybody would agree to that. But probably the more important question for me is, where are we today compared to where we were 12 months ago, and have, in fact, the mistakes of the past been reflected in policies that have changed and bode for a greater future absent additional mistakes? The desire of the Senator from Wisconsin to have us out in a way that limits our exposure is something that I would love to be able to see. But the practical nature of what he wants to accomplish could not be accomplished in less than 18 to 24 months. I mean, it could not happen. You go and talk to the military; it could not happen without us leaving tons of equipment. But the point is, we should not dwell on that. The point is, did we make the necessary changes that can create an outcome that gives us an honorable exit from the situation, and does it leave a genocide behind? I firmly believe, having traveled--my trip prior to this one was 6 months before the surge. I want to tell you the difference is like night and day, everywhere I went. I duplicated places I went before. So with the earnestness that the Senator from Wisconsin drives his position, we ought to reflect on what has been accomplished. I also find it very disingenuous to talk about the cost of this war by the person who sponsored more legislation and greater Government spending than anybody in this body in the 109th Congress, in the first session of this Congress. The fact is, $349 billion worth of new spending was coauthored by the Senator from Michigan last year, $349 billion, the same Senator who voted to fund the bridge to nowhere. I happen to agree we ought to be paying for the war. We ought to be paying for the war, and we could easily pay for the war by eliminating wasteful spending. I would direct you to the Reader's Digest last month where they estimated $1 trillion we are missing in wasteful spending. That is an underestimate. So for us to make a claim of a fiscal nature, by the person who has cosponsored more spending than anybody in this body, and has voted against amendments to decrease wasteful spending, is somewhat less than genuine, I believe. I think the other thing that needs to be said is we had a debate, and we actually funded the surge. It actually happened. We ought to be talking about what happened with that. To me, it is phenomenal, the difference. I will tell you, I am very--we lost a soldier from Ardmore, OK, a 19-year-old soldier killed by an IED. How can it be that we can continue to do this unless we are doing it for the right reasons and the right cause? I believe if we walk away, no matter how we got there, rightly or wrongly, if we walk away, what I see happening, from my experience in Iraq in 1993 after the first gulf war and before this one, as a medical missionary, here is what I see happening: If we do what the Senator from Wisconsin wants us to do, and we effectively carry this out, I see an unstable northern Iraq. I see a war between Iran, Turkey, and Kurdistan. I see a marked civil war between Shia and Sunni, with involvement of the Sunni Triangle, Sunni crescent. I see a total destabilization of the Mideast. But beyond all of that, what I see is tremendous additional tragedy that we will have impacted onto the people of Iraq, and in the deaths of 500,000 to 1 million more people. And the question ought to be: Do we have a moral obligation to fix what we started? The assessment of the Senator from Wisconsin is that we cannot fix it so therefore we ought to come home, we ought to get out, that it was a mistake to begin with; it does not matter what has happened in the past other than we learned from it. The question is, what can we do about the future? I want to tell you, I do not buy everything the Pentagon says. I am pretty critical across their spending, across everything else. I accused them of lying to me on the training of Iraqi troops in 2006. But when you see what has been transformed in the training of troops in Iraq, which is comparable to our training of our own troops over the same period of time, and what they have accomplished both in terms of synergism with both their equipment, their military leaders, and their troops, and they walk out of training as a Sunni and Shia together and you see that and you say we are going to walk away from that, we are not going to finish it, we are going to allow this thing to collapse-- and it will. So then the question is, have we made another mistake in not fulfilling an obligation in something that we started? I do not believe we can do that. If we do that, I think the blood of every Iraqi that is displaced or dies after that is on us--not on the Taliban, not on al- Qaida, not on Shia extremists, not on Sunni extremists but on us. We can win. We will win. We can. There is political progress all across the board, locally and at the regional and at the national government level. I would remind the Members of this body how long it took us to get a functioning government, a functioning government after our independence, one that was based on a constitution, one that was based on the rule of law. It was not smooth sailing. We did not do it in a short period of time. And we did not even get it right when it came to equal rights of individuals. We did not get it right. Yet we are frustrated with that. I see a new day in Iraq. It is not over. It is dangerous, it is still very dangerous. But the progress, the improvement, the reconciliation between Shia and Sunni is unbelievable. In province across province, the Shia, the Sunni awaking, the sons of Iraq phenomenon, the coordination of local governments across ethnic lines is in stark contrast with what was there a year and a half ago. Do we just abandon that? Think about the message it sends if we are not going to create a stable Iraq. What immediately do they do? They immediately start going to their own intrinsic ethnic corner. We divide. We send the Kurds one way, the Shia one way, and the Sunni one way. We create a holocaust. I want to say publicly I have had a lot of misgivings about what our country has done in the Middle East. But I have no misgivings at all at this time about the course we are on. The leadership of General Petraeus, the leadership of Ambassador Crocker, the leadership of the people within Iraq, sheikhs within small communities risking their lives every day to stand up and say: I will join hands with a Sunni, with the Shia. I am going to reject al-Qaida and we are going to get our lives back together--that is happening. That is a dynamic that is forcefully happening because people want peace. This will eliminate that movement. This will create insecurity. This will drive people to their corners. This will drive people to extreme positions. In fact, what we have accomplished in the last 12 months will be denuded and neutered out to the point where we will have created a worse situation rather than a better one. To the soldiers and families who have sacrificed so much in this war, I say thank you from my family. The real problem of the administration, the mistake they made, is we should all be sacrificing for this war, not just our military families. We have refused to do that as Members of the Senate by making sure that we pay for this war, by getting rid of things that are lower priorities, getting rid of things that are duplicative. We didn't do that. We said, we will charge it to our kids. We can't ruffle any feathers and make the hard choices. The Senator from Michigan said: We do things based on value and priorities. That is baloney. We do things based on how we get reelected, with the exception of the Senator from Wisconsin, who is one of the most honorable men in this body. He never thinks about that issue. He thinks about what he thinks is right. But the way we do things around here is what is politically expedient, not what is right. For her to claim that that is how we do things, when we can't even get rid of billions of dollars in duplicative programs, $8 billion worth of buildings that the Pentagon wants to get rid of because it might ruffle some politician's feathers somewhere--we don't do things based on priority or on value. We do it on political expediency. Again, I thank the troops and the families who are sacrificing. I am amazed at the progress that has been made, literally amazed. I believe we ought to honestly look at that before we walk a different direction. We ought to truly reassess where we are. It is a big price. I know it is. We have paid a big price in this endeavor. It is fair to question whether we should continue it. But it is not fair to not look at what has happened over the last 12 months in a realistic and open assessment that says, is there light at the end of the tunnel? I will tell you, there is. Individually, in talking to Shia and Sunni families while over there, outside of the Green Zone, walking among them without protection, seeing the hope in their eyes that finally things are going to get back to where they can take care of their families, move ahead with their goals and their personal lives, the leadership exhibited by our military, not just in leadership roles but all the way down to the private and what they are doing and how they are doing it and how they are carrying it out in Iraq, is something we can all be proud of. I don't think we should jeopardize what they are doing by voting for this bill. It is great for us to question. Sometimes we haven't done that well enough. But to ignore the reality of what is happening today in Iraq and the trend lines and the movement lines and the economic growth lines and the power lines and the oil production lines and the agreement among Shia and Sunni at all of these regional and provincial levels, to ignore that is a grave mistake on our part. It is my hope that we don't carry forward with this idea. It is also my hope that we will truly recognize, not be blinded, not be sold a bill of goods. I am not suggesting that. We should ask the tough questions. But to deny the marked change, the tremendous progress, the tremendous freedom, the tremendous lifting of the burden on the Iraqi people that has happened in the last 12 months and not say that means something and not say that that means we are going absolutely in the right direction--we haven't won this war, but we certainly have them on the run. We certainly have the Iraqi people enamored with us to the point where we are not despised. We are welcome now in the vast majority of Iraq. In 95 percent of Iraq we are welcome because we are a liberator of them from al-Qaida, not from Saddam but from al-Qaida, the one who cut their 8-year-old daughter's head off because she looked at them wrong, the ruthlessness of radical Islam. That is what is at stake right now. We can differ in our approach on how we might battle that, but this is the heat sink right now. Iraq is the heat sink for al- Qaida. It is where they are, where they are coming. We are winning. The Iraqi people are winning, and the Iraqi troops are winning. Let's not destroy that. I yield the floor.

Mr. COBURN

Mr. COBURN. A large portion of them are Medicaid eligible. As a matter of fact, 27 percent of the funds that go into IHS are people from Medicaid. If they are Medicaid eligible, then they are eligible for every one of these programs. A large portion are Medicare eligible. A large portion of money that comes into IHS comes from Medicare, and they are also eligible under that. So the majority of our Native American population already have these services available to them under two other programs. The other question I would ask through the Chair of the chairman is-- there are other clinics and IHS facilities, I believe, and please correct me, that are being run well and that will be able to utilize these services for that smaller portion of Native Americans because they will have the funds because they are meeting basic core medical needs now. My amendment doesn't take that away. It just says if you are in an IHS clinic and over half of them already have these services available through another government program, why would we add that when we are not taking care of the diabetes, the dialysis, and every other thing we have? My question to the chairman is--I would love for him to consider that this is a better way to go rather than blanketly treating everybody the same and that we have to prioritize, and that by having IHS Directors make that priority--in different areas, that is true--in terms of what goes through the tribal government, what we will get is better care.

Mr. COBURN. Madam President, I just want a few more minutes and then I am through. The Senator from North Dakota makes a great point: that there are people who are using reservation-based IHS facilities who are essentially trapped. They are trapped. They don't get the option to go somewhere else. What this bill does--and in many of those instances, the core medical needs are not being met. What this bill does is makes sure the core medical needs are going to be met because we are going to add four new services for those people. So now they are trapped in a system that doesn't deliver the quality, doesn't deliver the service, and doesn't deliver the prevention, we are going to make it worse. We are going to make it worse because we are going to add services that are available to half of the Native American population right now through another Government program, and we are going to dilute the resources for the very people who are trapped on reservations. But the very point is, three-quarters of Native Americans are in an urban area. They are not limited to that. They are not limited at all. They should have had the choice to be able to go wherever they wanted to go today. We turned that down. We had 29 people vote for that--or 28 people vote for that. I know the chairman is going to work with me to try to get there someday. But that is when you give Native Americans their due and meet our commitments. When they have the same choice, the same security, the same health care that you and I have, then we will have met our commitment under our treaties, and not until then would we have met it.

Mr. COBURN. I will yield.

Mr. COBURN. Madam President, I want to make a couple of points because what we have heard is a lot of negative today. I want to say how proud I am of the Cherokees, the Chickasaw, the Choctaw, and the Creek in Oklahoma. I totally disagree with gaming. I think it undermines virtue. I think it is destroying a lot of society. But several of the tribes in my State have invested their dollars--not IHS dollars, their dollars--in health care, and they need to be recognized. Their facilities, most oftentimes, are fantastic, and their care is fantastic. So I don't want us to leave the debate without recognizing some of the vast improvements that where we have failed, the tribes have actually picked it up and supplied it, and that means shame on us because maybe there wouldn't be as much gaming if we were fulfilling the needs. Gaming is not without its societal consequences, regardless of how much we benefit in terms of dollars that come into the Treasury. So I didn't want us to leave this without recognizing that we have lots of great performance in lots of great areas. We also have lots of great providers and doctors and workers in IHS, but we have some who aren't. We also have some who couldn't get a job anywhere else, some whom nobody else would hire. Yet we will hire them because we are so short, both on funds and needs. That ought not to be there either. If somebody is not competent to practice with the public, they shouldn't be competent to practice at IHS and the same at the VA and the same in our prisons and the same in other areas. So it is my hope we will look straight forward. It is hard to run against your own chairman on amendments on a bill, and we intentionally did not put up these amendments at the request of the chairman when we were doing the markup on the Indian health care bill. Again, I will state in finality, and then sit down, these ``improvements'' in many areas will offer some improvement but in many more areas will take away from core medical care that is offered to the very people who aren't getting adequate care today. So it ought to be flexible. It ought to be where the core medical needs are met, we are offering these, and whether or not we shouldn't be offering them because what we are doing is, we are taking that lady who is going to be on dialysis, and we could have prevented it because we are not doing the core medical things and we are looking at the wrong thing. We are taking a gal who has early diabetic neuropathy and we are going to condemn her to a life on dialysis or a kidney transplant, and most of them would not get kidney transplants. They are going to get hooked up to a machine for 8 hours a day because we are--but we are going to feel good about ourselves saying we now have hospice and long-term care, and all of these other things. I think it is a mistake the way we have done that. It is my main opposition to the bill. I think we have an opportunity to rigorously and tremendously change the structure, the delivery of care. We have an opportunity to change the paradigm under which we treat Native Americans, to prevention. We have talked about suicide on all of the reservations. The chairman and many have been concerned about prevention of that. But we ought to be just as concerned about prevention of all of the other diseases and change the paradigm under which IHS works instead of more of the same. So with that, I ask for the yeas and nays. I yield the floor.

Mr. COBURN. Madam President, through the Chair, would the chairman agree a large portion of people who are eligible for Indian health care service today already have these services available to them through another Federal Government program?

Mr. COBURN. That is 30 minutes for me and none for you.

Mr. COBURN. I thank the Chair. This is a real straightforward amendment. It says if you are a tribal member and you have been the victim of rape or sexual assault, the right to have your assailant tested for HIV and AIDS and other sexually transmitted diseases cannot be denied you. We have done this a lot of times. Most of us agree with that. We think it is the right thing to do when somebody is an assailant and we have people at risk, and not putting those Native Americans into a period of a year waiting or taking medicines they should not have to take because they do not know the status of the person who committed an assault on them. So it is very straightforward. I will not spend a lot of time on it. I am not trying to inflame the issue. I think it is something Native Americans ought to have that every other American today has. I yield back and intend to ask for the yeas and nays at the appropriate time.

Mr. COBURN. Madam President, will the Senator from North Dakota yield?

Mr. COBURN. Madam President, I would like to reclaim my time, if I might.