Kent Conrad

Mr. CONRAD

Mr. CONRAD. The Senator is exactly correct. And of course that money we are using to pay interest on this debt can't be used for any other purpose. It can't be used for a tax cut; it can't be used to build a road; it can't be used to build a bridge; it can't be used to build a school; it can't be used to pay a teacher. It is money down a rathole, but it has to be paid.

Mr. CONRAD. The gross interest that we are paying a year would be over $300 billion. If you think about that, that is a stunning amount of money. The gross interest is over $300 billion. Perhaps one of the staff people has the budget book in front of them and can tell us a precise number. While we are waiting for that--the point is very clear. Although you owe $5.6 trillion, which is the gross debt of the United States, interest on the publicly held debt is what gets all of the attention. The press and our colleagues and our President have all focused on the publicly held debt. That is $3.4 trillion as we sit here today--$3.4 trillion. But that is the debt the Federal Government owes people who are outside the government. That is what we owe to bondholders. That is what we owe to kids who have a savings bond. That is what we owe to people who buy Treasury bills. That is what we owe to people who are holding instruments in other countries, who have loaned money to the United States. That is the publicly held debt, $3.4 trillion. But the gross debt includes the debt of the general fund to trust funds, money we have borrowed over time to trust funds to use for other purposes. We have borrowed hundreds of billions of dollars from the Social Security trust fund. We are paying interest on that, too. That is part of the gross debt, and that has to be paid just as certainly as this publicly held debt. It has the same legal position as the publicly held debt and it, of course, is much larger. As I said, that is $5.6 trillion of gross debt that the Nation has today.

Mr. CONRAD. I am happy to yield.

Mr. CONRAD. Generally speaking, we are paying between 5 percent and 6 percent on the debt of the United States.

Mr. CONRAD. Madam President, I would be happy to try to sum up by saying, first of all, the chairman of the Senate Budget Committee told us last week he does not intend to mark up the budget in the Budget Committee. We urge him to reconsider. We urge him to have a public markup in which there is debate, discussion, and votes so that the Budget Committee meets its obligation and responsibility. No. 2, when talking about 1993--because some have said, well, this is what happened in 1993; that we did not have the budget from the President before we wrote a budget resolution on the floor of the Senate--the differences are quite clear. In 1993, the Senate Budget Committee marked up fully a budget. No. 2, we had a good deal more detail from the President in 1993 in terms of functional totals, in terms of what each of the areas should get or what kind of cuts they could expect. We do not have that this time. So now, in 2001, we do not have the Budget Committee doing a markup. At least that is what the chairman so far has said. We hope he will reconsider. We do not have the level of detail we had in 1993. So what is about to happen is really quite remarkable. We are going to have the Senate write a budget resolution without ever seeing the President's budget and without the Budget Committee ever doing its job to write a budget and to mark it up. I thank the Chair and yield the floor.

Mr. CONRAD. That is the people's money, the people's money that we are paying to service the people's debt. Again, I wish to be very clear. I agree with the President absolutely when he says it is the people's money--absolutely that is true. It also happens to be the people's debt. It also happens to be the people's Social Security and the people's national defense and the people's education. The thing that worries me the most--I have been reading David Stockman's book, ``The Triumph Of Politics.'' I hope every Member of this body will read that book before we vote on the budget. It goes back to 1981 when we had a massive tax cut, massive increase in spending for defense, and we put this country in a deficit ditch from which it took us 17 years to get out. We exploded the national debt, quadrupled the national debt. That could happen again. Back in the 1980s we had time to recover. This time there is no time to recover because this time the baby boomers start to retire in 11 years. Back in the 1980s we had 17 years to get well. It took tax increases, it took spending cuts, it took tremendous political will to change the fiscal course of the country, to get us back on track. But, make no mistake, this time there is no time to get well because the baby boomers start to retire in 11 years. If we get it wrong this time, that debt will eat our country alive. I wish every Member could have heard the briefing we got from the Comptroller General of the United States, who warned us, who alerted us to where we are headed with debt. Yes, we have a surplus now. That surplus is temporary, and we are headed for big debt. We can either dig the hole deeper before we start filling it in--which is a very attractive thing to do because that means we all get to vote for a massive tax cut. I am advocating a tax cut, about half as big as the President's. But I think we all should be alert to what we are facing.

Mr. CONRAD. Yes.

Mr. CONRAD. I do not recall the exact percentage that foreign debt holders have. It is interesting; I looked at those numbers last week, but as I am getting older, my mind retains things less well. Although I look young, I am aging rapidly.

Mr. CONRAD. The Japanese and Germans and the Belgians--the Belgians have a lot of this debt.

Mr. CONRAD. Yes.

Mr. CONRAD. That is exactly, in part, what we are saying. This debt is real. It is there. It is growing. We are paying interest on it. One of the things we learned in the 1980s is it really works to reduce deficits and reduce debt. Alan Greenspan alerted us to this and Secretary Rubin alerted us to this, by saying: Look, when you are paying down debt instead of building debt, you take pressure off of interest rates because it means the Federal Government is borrowing less money. When we borrow less money, that means there are fewer people in there competing for the funds to loan. That means interest rates are lower. That means the economy is stronger. That means our competitive position in the world is better. That means we have stronger economic growth. In fact, I remember Secretary Bentsen saying for every 1 percent we are able to reduce interest rates, that lifted the economy by over $100 billion because of the debt burden taken off the economy. That is a bigger assistance to the American economy and American taxpayers than any tax cut we are contemplating around here.

Mr. CONRAD. It is a real tax cut. It is a real cut in costs for Americans. It is a real lift to the economy. It is something that puts us in a much stronger competitive position. It puts us in a much stronger position when the baby boomers start to collect on their Medicare and Social Security because the country is then in a stronger financial position to deal with those liabilities.

Mr. CONRAD. It benefits every taxpayer.

Mr. CONRAD. I am happy to yield.

Mr. CONRAD. The chairman of the committee has not told me that. After I asked him last week to reconsider the decision not to hold up a markup, he told me he would give me a final answer today. I still retain some hope that he will permit a markup in the committee.

Mr. CONRAD. That is correct.

Mr. CONRAD

Mr. CONRAD. Mr. President, I request I be permitted to speak as in morning business.

Mr. CONRAD. Maybe 5 minutes.

Mr. CONRAD. Mr. President, I ask unanimous consent the order for the quorum call be dispensed with.

Mr. CONRAD

Mr. CONRAD. Mr. President, yesterday in my role as ranking member on the Senate Budget Committee, I met with Senator Domenici, the chairman of the Senate Budget Committee. He informed me he intended not to have a markup of the budget in the Budget Committee but to come directly to the floor of the Senate. This was pursuant to a request I had made that we proceed to schedule a markup in the committee. I told him I thought a decision not to have a markup in the Budget Committee would be a mistake. We have never had a circumstance in which we have tried to bring a budget for the United States to the floor of the Senate without the Budget Committee, which has the primary responsibility, meeting first to hammer out an agreement. Senator Domenici, the chairman of the Budget Committee, told me he believes it will be impossible for us to reach an agreement. I don't know how anyone can be certain of that before we have tried. I hope very much that he will--and I asked Senator Domenici yesterday to reconsider to give us a chance to debate and discuss the budget in the Budget Committee and to have votes. That is how we make decisions. I still hold some optimism that after discussion and debate we might find agreement. It might not be on precisely what the President has proposed. Someone recommended yesterday that we try to agree on a 1- year budget. But we have a country that has some serious challenges. Anybody who has been watching the markets knows they continue to decline, and decline precipitously. While it is true that the best immediate response is monetary policy and the Federal Reserve Board lowering interest rates, that has now been done three times, and still the slide continues, and still we see warning signals about the economy. We see Japan in a perilous position. We have had a serious energy shock in this country. We see high levels of individual debt in America. We see very dramatic weakness in the financial markets. I personally believe we have an obligation and a responsibility to try to respond as quickly as possible. I think that means, on the fiscal policy side, we fast-forward the parts of the President's proposed tax cut to try to provide some stimulus to this economy. We can wait, and we can doddle and deliberate, or we can act. I hope very much that we take the opportunity to work in the Budget Committee to try to find common ground, to try to find a basis on which we can agree so we can get a swift response on the fiscal side to provide some confidence to the American people, to provide some confidence that their Government is responding to what is happening in their daily lives. Some have said, well, if you agree on something that is other than precisely what the President has proposed, that will be seen as a defeat for the President. I don't think we need to be in that position. I think we can find perhaps an overall global agreement that would be seen as a win for the country, a win for the President, and a win for the Congress. Nobody is defeated, nobody is hurt, but that collectively we have worked together to do what is best for the country. I really think we can do that, and at the end of the day it might be precisely what the President has proposed. But it may well enjoy his support. The fact is, circumstances have changed. He made a proposal during the campaign. I didn't agree with every part of it, but I respect him for doing it. The question now is, What do we do in light of what we face today? It does not need to be exactly what was proposed more than a year ago. Circumstances have changed. We have a requirement and a responsibility to respond to what is occurring. I am again asking Senator Domenici to reconsider. I am asking colleagues on both sides to urge Senator Domenici to reconsider. The Members on the Budget Committee have been very diligent in their responsibilities. We had an outstanding set of hearings. We ought to debate and discuss a budget resolution for this country before it comes to the floor of the Senate. I think it really invites chaos to come out here with the Budget Committee for the first time ever failing to even meet and failing to even try. What kind of procedure is that? I hope very much that Members of goodwill will get together in this Chamber and try to do what is best for the country and try to go through the kind of process we normally do to reach agreement. This idea that we predict failure before we have tried I think is a mistake. We ought to try debate and we ought to discuss and vote and provide some leadership so that we have a budget resolution out on the floor that has been carefully vetted by the Members who have the primary responsibility--the Senate Budget Committee. I thank the Chair. I yield the floor.

Mr. CONRAD

Mr. CONRAD. Mr. President, today I would like to recognize the achievements of Air Force Captain Glen Christensen. Captain Glen Christensen was named 21st Air Force Company Grade Officer for 2000. In the selection for this award, Glen was in competition with Wing Company Grade Officers from seven other Air Force Bases including Robbus AFB, GA, MacDill AFB, FL, Pope AFB, NC, Charleston AFB, SC, Little Rock AFB, AK, McGuire AFB, NJ, and Dover AFB, DE. Candidates for the awards were evaluated in five categories which include: duty achievement; self improvement; off-duty accomplishments; other leadership accomplishments, and positive representation of the U.S. Air Force. Three weeks prior, Captain Christensen had been selected Company Grade Officer of the Year for the 89th Security Forces Squadron at Andrews Air Force Base, MD, and then for the 89th Support Group, and finally for the 89th Airlift Wing at Andrews. He won the squadron and group competition for the second consecutive year. At the group level, he represented Security Forces and competed with selectees from Mission Support, Services and Civil Engineering squadrons. At the Wing level, Christensen competed with five other group winners from among 454 company grade officers in all groups. In addition to Security Forces, which Glen represented, group winners came from Logistics, Medical, Operations, and Communications groups and from the Wing Commander's staff. While second in command of the third largest Security Forces unit in the Air Force, Captain Christensen organized and directed security at Andrews AFB for the NATO 50th Anniversary Summit, two Joint Services Open House Air Shows, and the recent Presidential Inauguration, in addition to everyday base law enforcement and security for the ``President's base'' and ``Air Force One.'' Glen graduated in 1993 from the United States Air Force Academy with Military Distinction. He is the son of Everett and Sybil Christensen of Madelia, MN. Mr. President, I offer my congratulations to Captain Christensen and his family on this award.

Mr. CONRAD

Mr. CONRAD. Mr. President, today I am introducing the Sustaining Access to Vital Emergency Medical Services Act of 2001. This bill would take important steps to strengthen the emergency medical service system in rural communities and across the Nation. Across America, emergency medical care reduces human suffering and saves lives. According to recent statistics, the average U.S. citizen will require the services of an ambulance at least twice during his or her life. As my colleagues surely know, delays in receiving care can mean the difference between illness and permanent injury, between life and death. In rural communities, which often lack access to local health care services, the need for reliable EMS is particularly critical. Over the next few decades, the need for quality emergency medical care in rural areas is projected to increase as the elderly population in these communities continues to rise. Unfortunately, while the need for effective EMS systems may increase, we have seen the number of individuals able to provide these services decline. Nationwide, the majority of emergency medical personnel are unpaid volunteers. As rural economies continue to suffer, and individuals have less and less time to devote to volunteering, it has become increasingly difficult for rural EMS squads to recruit and retain personnel. In my State of North Dakota, this phenomenon has resulted in a sharp reduction in EMS squad size. In 1980, on average there were 35 members per EMS squad; today, the average squad size has plummeted to 12 individuals per unit. I am concerned that continued reductions in EMS squad size could jeopardize rural residents' access to needed medical services. For this reason, the legislation I am introducing today includes measures to help communities recruit, retain, and train EMS providers. My bill would establish a Rural Emergency Medical Services Training and Equipment Assistance program. This program would authorize $50 million in grant funding for fiscal years 2002-2007, which could be used in rural EMS squads to meet various personnel needs. For example, this funding could help cover the costs of training volunteers in emergency response, injury prevention, and safety awareness; volunteers could also access this funding to help meet the costs of obtaining State emergency medical certification. In addition, EMS squads would be offered the flexibility to use grant funding to acquire new equipment, such as cardiac defibrillators. This is particularly important for rural squads that have difficulty affording state-of-the-art equipment that is needed for stabilizing patients during long travel times between the rural accident site and the nearest medical facility. This grant funding could also be used to provide community education training in CPR, first aid or other emergency medical needs. In addition, this legislation takes steps to help ensure emergency medical providers are fairly reimbursed for ambulance services provided to Medicare, Medicare+Choice, and Medicaid managed care beneficiaries. As you may know, the Balanced Budget Act required that Medicare+Choice and Medicaid managed care plans provide payment for emergency services that a ``prudent layperson'' would determine are medically needed. However, regulations implementing this requirement did not include ambulance services within the definition of ``emergency services.'' Because of this oversight, ambulance providers are sometimes left in the difficult position of providing services to individuals who, by any rational review, appear to need immediate medical attention. However, when it is later determined that the patient's symptoms were the result of heartburn, for example, rather than a serious heart condition, the ambulance provider is denied payment for services. This is simply unfair. While it is certainly important that EMS providers take care not to provide unnecessary services, it is unfair to deny ambulance providers payment when they provide immediate emergency services to individuals who appear tin serious need of medical care. In my State, EMS providers are operating on tight budgets and cannot afford to provide high levels of uncompensated care. To ensure EMS services remain available, particularly in underserved rural areas, we must ensure that EMS providers are appropriately reimbursed for the care they provide to our communities. For this reason, my legislation would revise the ``prudent layperson'' definition to include ambulance services. This change will ensure that ambulance providers who provide care in situations where a responsible observer would deem this care medically necessary receive reimbursement under traditional Medicare, Medicare+Choice, and Medicaid managed care. It is my hope that the Sustaining Access to Vital Emergency Medical Services Act will help ensure EMS providers can continue providing quality medical care to our communities. I am happy to say that this legislation is supported by the National Association of State EMS Directors, the National Rural Health Association, and the American Ambulance Association. I am also pleased that Senators Thomas, Daschle, Johnson, and others are joining me in this effort. I urge my colleagues to support this important piece of legislation.

Mr. CONRAD

Mr. CONRAD. Mr. President, today I am introducing the Sustaining Access to Vital Emergency Medical Services Act of 2001. This bill would take important steps to strengthen the emergency medical service system in rural communities and across the Nation. Across America, emergency medical care reduces human suffering and saves lives. According to recent statistics, the average U.S. citizen will require the services of an ambulance at least twice during his or her life. As my colleagues surely know, delays in receiving care can mean the difference between illness and permanent injury, between life and death. In rural communities, which often lack access to local health care services, the need for reliable EMS is particularly critical. Over the next few decades, the need for quality emergency medical care in rural areas is projected to increase as the elderly population in these communities continues to rise. Unfortunately, while the need for effective EMS systems may increase, we have seen the number of individuals able to provide these services decline. Nationwide, the majority of emergency medical personnel are unpaid volunteers. As rural economies continue to suffer, and individuals have less and less time to devote to volunteering, it has become increasingly difficult for rural EMS squads to recruit and retain personnel. In my State of North Dakota, this phenomenon has resulted in a sharp reduction in EMS squad size. In 1980, on average there were 35 members per EMS squad; today, the average squad size has plummeted to 12 individuals per unit. I am concerned that continued reductions in EMS squad size could jeopardize rural residents' access to needed medical services. For this reason, the legislation I am introducing today includes measures to help communities recruit, retain, and train EMS providers. My bill would establish a Rural Emergency Medical Services Training and Equipment Assistance program. This program would authorize $50 million in grant funding for fiscal years 2002-2007, which could be used in rural EMS squads to meet various personnel needs. For example, this funding could help cover the costs of training volunteers in emergency response, injury prevention, and safety awareness; volunteers could also access this funding to help meet the costs of obtaining State emergency medical certification. In addition, EMS squads would be offered the flexibility to use grant funding to acquire new equipment, such as cardiac defibrillators. This is particularly important for rural squads that have difficulty affording state-of-the-art equipment that is needed for stabilizing patients during long travel times between the rural accident site and the nearest medical facility. This grant funding could also be used to provide community education training in CPR, first aid or other emergency medical needs. In addition, this legislation takes steps to help ensure emergency medical providers are fairly reimbursed for ambulance services provided to Medicare, Medicare+Choice, and Medicaid managed care beneficiaries. As you may know, the Balanced Budget Act required that Medicare+Choice and Medicaid managed care plans provide payment for emergency services that a ``prudent layperson'' would determine are medically needed. However, regulations implementing this requirement did not include ambulance services within the definition of ``emergency services.'' Because of this oversight, ambulance providers are sometimes left in the difficult position of providing services to individuals who, by any rational review, appear to need immediate medical attention. However, when it is later determined that the patient's symptoms were the result of heartburn, for example, rather than a serious heart condition, the ambulance provider is denied payment for services. This is simply unfair. While it is certainly important that EMS providers take care not to provide unnecessary services, it is unfair to deny ambulance providers payment when they provide immediate emergency services to individuals who appear tin serious need of medical care. In my State, EMS providers are operating on tight budgets and cannot afford to provide high levels of uncompensated care. To ensure EMS services remain available, particularly in underserved rural areas, we must ensure that EMS providers are appropriately reimbursed for the care they provide to our communities. For this reason, my legislation would revise the ``prudent layperson'' definition to include ambulance services. This change will ensure that ambulance providers who provide care in situations where a responsible observer would deem this care medically necessary receive reimbursement under traditional Medicare, Medicare+Choice, and Medicaid managed care. It is my hope that the Sustaining Access to Vital Emergency Medical Services Act will help ensure EMS providers can continue providing quality medical care to our communities. I am happy to say that this legislation is supported by the National Association of State EMS Directors, the National Rural Health Association, and the American Ambulance Association. I am also pleased that Senators Thomas, Daschle, Johnson, and others are joining me in this effort. I urge my colleagues to support this important piece of legislation.

Mr. CONRAD

Mr. CONRAD. I move to lay that motion on the table. The motion to lay on the table was agreed to. Amendments Nos. 70, 71, and 73

Mr. CONRAD

Mr. CONRAD. Mr. President, parliamentary inquiry.